Pre-Authorization List for HIP Members | EmblemHealth

Retired 12/31/2019

63276 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic
63277 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar
63278 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral
63280 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical
63281 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic
63282 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar
63283 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral
63285 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical
63286 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic
63287 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar
63290 Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level
63295 Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (List separately in addition to code for primary procedure)
63300 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical
63301 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach
63302 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar approach
63303 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal or retroperitoneal approach
63304 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical
63305 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach
63306 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar approach
63307 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, lumbar or sacral by transperitoneal or retroperitoneal approach
63308 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (List separately in addition to codes for single segment)
63620 Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion
63621 Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure)
63650 Percutaneous implantation of neurostimulator electrode array, epidural
63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
63661 Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63662 Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63663 Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
63685 Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver
63700 Repair of meningocele; less than 5 cm diameter
63702 Repair of meningocele; larger than 5 cm diameter
63704 Repair of myelomeningocele; less than 5 cm diameter
63706 Repair of myelomeningocele; larger than 5 cm diameter
63740 Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy
63741 Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy
64400 Injection, anesthetic agent; trigeminal nerve, any division or branch
64402 Injection, anesthetic agent; facial nerve
64405 Injection, anesthetic agent; greater occipital nerve
64413 Injection, anesthetic agent; cervical plexus
64415 Injection, anesthetic agent; brachial plexus, single
64416 Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement)
64417 Injection, anesthetic agent; axillary nerve
64418 Injection, anesthetic agent; suprascapular nerve
64420 Injection, anesthetic agent; intercostal nerve, single
64421 Injection, anesthetic agent; intercostal nerves, multiple, regional block
64425 Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves
64430 Injection, anesthetic agent; pudendal nerve
64445 Injection, anesthetic agent; sciatic nerve, single
64446 Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter (including catheter placement)
64447 Injection, anesthetic agent; femoral nerve, single
64448 Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement)
64449 Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)
64450 Injection, anesthetic agent; other peripheral nerve or branch
64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g., Morton's neuroma)
64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
64480 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic each additional level (list separately in addition to code for primary procedure)
64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
64484 4 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
64491 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; second level (list separately in addition to code for primary procedure)
64492 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), cervical or thoracic; third and any additional level(s) (list separately in addition to code for primary procedure)
64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; second level (list separately in addition to code for primary procedure)
64495 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or ct), lumbar or sacral; third and any additional level(s) (list separately in addition to code for primary procedure)
64550 Application of surface (transcutaneous) neurostimulator
64553 Percutaneous implantation of neurostimulator electrode array; cranial nerve
64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed
64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming
64568 Incision for implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator
64569 Revision or replacement of cranial nerve (e.g., vagus nerve) neurostimulator electrode array, including connection to existing pulse generator
64570 Removal of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator
64575 Incision for implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)
64580 Incision for implantation of neurostimulator electrode array; neuromuscular
64581 Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)
64585 Revision or removal of peripheral neurostimulator electrode array
64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling
64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver
64600 Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch
64605 Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale
64610 Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring
64611 Chemodenervation of parotid and submandibular salivary glands, bilateral
64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm)
64615 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., for chronic migraine)
64616 Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis)
64617 Chemodenervation of muscle(s); larynx, unilateral, percutaneous (e.g., for spasmodic dysphonia), includes guidance by needle electromyography, when performed
64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
64634 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure
64642 Chemodenervation of one extremity; 1-4 muscle(s)
64643 Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (list separately in addition to code for primary procedure)
64644 Chemodenervation of one extremity; 5 or more muscles
64645 Chemodenervation of one extremity; each additional extremity, 5 or more muscles (list separately in addition to code for primary procedure)
64646 Chemodenervation of trunk muscle(s); 1-5 muscle(s)
64647 Chemodenervation of trunk muscle(s); 6 or more muscle(s)
64650 Chemodenervation of eccrine glands; both axillae
64653 Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, neck), per day
64912 Nerve repair; with nerve allograft, each nerve, first strand (cable)
64913 Nerve repair; with nerve allograft, , each additional strand (List separately in addition to code for primary procedure)
64999 Unlisted procedure, nervous system
65710 Keratoplasty (corneal transplant); anterior lamellar
65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia) Revised
65750 Keratoplasty (corneal transplant); penetrating (in aphakia)
65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia)
65756 Keratoplasty (corneal transplant); endothelial.
65757 Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure).
65760 Keratomileusis
65765 Keratophakia
65767 Epikeratoplasty
65770 Keratoprosthesis
65771 Radial keratotomy
65778 Placement of amniotic membrane on the ocular surface; without sutures
65779 Placement of amniotic membrane on the ocular surface; single layer, sutured
65780 Ocular surface reconstruction; amniotic membrane transplantation, multiple layers
65781 Ocular surface reconstruction; limbal stem cell allograft (e.g., cadaveric or living donor)
65782 Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)
65785 Implantation of intrastromal corneal ring segments
65820 Goniotomy
65855 Trabeculoplasty by laser surgery
66150 Fistulization of sclera for glaucoma; trephination with iridectomy
66155 Fistulization of sclera for glaucoma; thermocauterization with iridectomy
66160 Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy
66170 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae
66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)
66174 Transluminal dilation of aqueous outflow canal; without retention of device or stent
66175 Transluminal dilation of aqueous outflow canal; with retention of device or stent
66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft
66180 Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft
66183 Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft
66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft
66710 Ciliary body destruction; cyclophotocoagulation, transscleral
66720 Ciliary body destruction; cryotherapy
66761 Iridotomy/iridectomy by laser surgery (e.g., for glaucoma) (per session)
67027 Implantation of intravitreal drug delivery system (e.g., ganciclovir implant), includes concomitant removal of vitreous
67028 Intravitreal injection of a pharmacologic agent (separate procedure)
67221 Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy (includes intravenous infusion)
67225 Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment)
67255 Scleral reinforcement (separate procedure); with graft
67299 Unlisted procedure, posterior segment
67311 Strabismus surgery, recession or resection procedure; 1 horizontal muscle
67312 Strabismus surgery, recession or resection procedure; 2 horizontal muscles
67314 Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique)
67316 Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique)
67318 Strabismus surgery, any procedure, superior oblique muscle
67320 Transposition procedure (e.g., for paretic extraocular muscle), any extraocular muscle (specify) (List separately in addition to code for primary procedure)
67331 Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (List separately in addition to code for primary procedure)
67332 Strabismus surgery on patient with scarring of extraocular muscles (e.g., prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (e.g., dysthyroid ophthalmopathy) (List separately in addition to code for primary procedure)
67334 Strabismus surgery by posterior fixation suture technique, with or without muscle recession (List separately in addition to code for primary procedure)
67335 Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery)
67340 Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in addition to code for primary procedure)
67343 Release of extensive scar tissue without detaching extraocular muscle (separate procedure)
67345 Chemodenervation of extraocular muscle
67400 Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy
67405 Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only
67412 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion
67413 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body
67414 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression
67420 Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of lesion
67430 Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of foreign body
67440 Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with drainage
67445 Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of bone for decompression
67450 Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); for exploration, with or without biopsy
67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)
67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material (e.g., banked fascia)
67902 Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia)
67903 Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach
67904 Repair of blepharoptosis; (tarso) levator resection or advancement, external approach
67906 Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)
67908 Repair of blepharoptosis; conjunctive-tarso-Müller's muscle-levator resection (e.g., Fasanella-Servet type)
67909 Reduction of overcorrection of ptosis
67911 Repair of ectropion; extensive (e.g., tarsal strip operations)
67914 Repair of ectropion; extensive (e.g., tarsal strip operations)
67915 Repair of ectropion; extensive (e.g., tarsal strip operations)
67916 Repair of ectropion; extensive (e.g., tarsal strip operations)
67917 Repair of ectropion; extensive (e.g., tarsal strip operations)
67921 Repair of entropion; suture
67922 Repair of entropion; thermocauterization
67923 Repair of entropion; excision tarsal wedge
67924 Repair of entropion; extensive (e.g., tarsal strip or capsulopalpebral fascia repairs operation)
68816 Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation
69090 Ear piercing
69300 Otoplasty, protruding ear, with or without size reduction
69501 Transmastoid antrotomy (simple mastoidectomy)
69502 Mastoidectomy; complete
69511 Mastoidectomy; radical
69601 Revision mastoidectomy; resulting in complete mastoidectomy
69602 Revision mastoidectomy; resulting in modified radical mastoidectomy
69603 Revision mastoidectomy; resulting in radical mastoidectomy
69604 Revision mastoidectomy; resulting in tympanoplasty
69620 Myringoplasty (surgery confined to drumhead and donor area)
69631 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction
69632 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (e.g., postfenestration)
69633 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (e.g., partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])
69635 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction
69636 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction
69637 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (e.g., partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])
69641 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction
69642 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction
69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction
69644 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction
69645 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction
69646 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction
69650 Stapes mobilization
69660 Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material;
69661 Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out
69710 Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone
69711 Removal or repair of electromagnetic bone conduction hearing device in temporal bone
69714 Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
69715 Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy
69717 Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
69718 Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy
69930 Cochlear device implantation, with or without mastoidectomy
70336 Magnetic resonance (e.g., proton) imaging, temporomandibular joint(s)
70450 Computed tomography, head or brain; without contrast material
70460 Computed tomography, head or brain; with contrast material(s)
70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections
70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material
70481 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)
70482 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections
70486 Computed tomography, maxillofacial area; without contrast material
70487 Computed tomography, maxillofacial area; with contrast material(s)
70488 Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections
70490 Computed tomography, soft tissue neck; without contrast material
70491 Computed tomography, soft tissue neck; with contrast material(s)
70492 Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections
70496 Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing
70498 Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing
70540 Magnetic resonance (e.g., proton) imaging, orbit, face, and/or neck; without contrast material(s)
70542 Magnetic resonance (e.g., proton) imaging, orbit, face, and/or neck; with contrast material(s)
70543 Magnetic resonance (e.g., proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences
70544 Magnetic resonance angiography, head; without contrast material(s)
70545 Magnetic resonance angiography, head; with contrast material(s)
70546 Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences
70547 Magnetic resonance angiography, neck; without contrast material(s)
70548 Magnetic resonance angiography, neck; with contrast material(s)
70549 Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences
70551 Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material
70552 Magnetic resonance (e.g., proton) imaging, brain (including brain stem); with contrast material(s)
70553 Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences
70554 Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration
70555 Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing
71250 Computed tomography, thorax; without contrast material
71260 Computed tomography, thorax; with contrast material(s)
71270 Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections
71275 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing
71550 Magnetic resonance (e.g., proton) imaging, chest (e.g., for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)
71551 Magnetic resonance (e.g., proton) imaging, chest (e.g., for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s)
71552 Magnetic resonance (e.g., proton) imaging, chest (e.g., for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences
71555 Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)
72125 Computed tomography, cervical spine; without contrast material
72126 Computed tomography, cervical spine; with contrast material
72127 Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections
72128 Computed tomography, thoracic spine; without contrast material
72129 Computed tomography, thoracic spine; with contrast material
72130 Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections
72131 Computed tomography, lumbar spine; without contrast material
72132 Computed tomography, lumbar spine; with contrast material
72133 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections
72141 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material
72142 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; with contrast material(s)
72146 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, thoracic; without contrast material
72147 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, thoracic; with contrast material(s)
72148 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; without contrast material
72149 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; with contrast material(s)
72156 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical
72157 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic
72158 Magnetic resonance (e.g., proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar
72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)
72191 Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
72192 Computed tomography, pelvis; without contrast material
72193 Computed tomography, pelvis; with contrast material(s)
72194 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections
72195 Magnetic resonance (e.g., proton) imaging, pelvis; without contrast material(s)
72196 Magnetic resonance (e.g., proton) imaging, pelvis; with contrast material(s)
72197 Magnetic resonance (e.g., proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences
72198 Magnetic resonance angiography, pelvis, with or without contrast material(s)
72295 Discography, lumbar, radiological supervision and interpretation
73200 Computed tomography, upper extremity; without contrast material
73201 Computed tomography, upper extremity; with contrast material(s)
73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections
73206 Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing
73218 Magnetic resonance (e.g., proton) imaging, upper extremity, other than joint; without contrast material(s)
73219 Magnetic resonance (e.g., proton) imaging, upper extremity, other than joint; with contrast material(s)
73220 Magnetic resonance (e.g., proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences
73221 Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; without contrast material(s)
73222 Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; with contrast material(s)
73223 Magnetic resonance (e.g., proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences
73225 Magnetic resonance angiography, upper extremity, with or without contrast material(s)
73700 Computed tomography, lower extremity; without contrast material
73701 Computed tomography, lower extremity; with contrast material(s)
73702 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections
73706 Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing
73718 Magnetic resonance (e.g., proton) imaging, lower extremity other than joint; without contrast material(s)
73719 Magnetic resonance (e.g., proton) imaging, lower extremity other than joint; with contrast material(s)
73720 Magnetic resonance (e.g., proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences
73721 Magnetic resonance (e.g., proton) imaging, any joint of lower extremity; without contrast material
73722 Magnetic resonance (e.g., proton) imaging, any joint of lower extremity; with contrast material(s)
73723 Magnetic resonance (e.g., proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences
73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s)
74150 Computed tomography, abdomen; without contrast material
74160 Computed tomography, abdomen; with contrast material(s)
74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections
74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74175 Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74176 Computed tomography, abdomen and pelvis; without contrast material
74177 Computed tomography, abdomen and pelvis; with contrast material(s)
74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
74181 Magnetic resonance (e.g., proton) imaging, abdomen; without contrast material(s)
74182 Magnetic resonance (e.g., proton) imaging, abdomen; with contrast material(s)
74183 Magnetic resonance (e.g., proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences
74185 Magnetic resonance angiography, abdomen, with or without contrast material(s)
74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material
74262 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed.
74263 Computed tomographic (CT) colonography, screening, including image postprocessing
74328 Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation
74712 Magnetic resonance (e.g., proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation
74713 Magnetic resonance (e.g., proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (List separately in addition to code for primary procedure)
75557 Cardiac magnetic resonance imaging for morphology and function without contrast material;
75559 Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging
75561 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;
75563 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging
75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium
75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)
75573 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed)
75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)
75635 Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing
75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation
75956 Endovascular repair of descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation
75957 Endovascular repair of descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation
75958 Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological supervision and interpretation
75959 Placement of distal extension prosthesis(s) (delayed) after endovascular repair of descending thoracic aorta, as needed, to level of celiac origin, radiological supervision and interpretation
76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation
76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation
76380 Computed tomography, limited or localized follow-up study
76390 Magnetic resonance spectroscopy
76499 Unlisted diagnostic radiographic procedure
76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation
76802 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation
76810 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)
76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
76812 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)
76813 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation
76814 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure)
76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal
76818 Fetal biophysical profile; with non-stress testing
76819 Fetal biophysical profile; without non-stress testing
76820 Doppler velocimetry, fetal; umbilical artery
76821 Doppler velocimetry, fetal; middle cerebral artery
76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording;
76826 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; follow-up or repeat study
76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete
76828 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study
76873 Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)
76940 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
76948 Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation
76965 Ultrasonic guidance for interstitial radioelement application
76975 Gastrointestinal endoscopic ultrasound, supervision and interpretation
76998 Ultrasonic guidance, intraoperative
77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)(List separately in addition to code for primary procedure) (Revised 01/01/2017)
77011 Computed tomography guidance for stereotactic localization
77012 Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation
77013 Computed tomography guidance for, and monitoring of, parenchymal tissue ablation
77014 Computed tomography guidance for placement of radiation therapy fields
77021 Magnetic resonance guidance for needle placement (e.g., for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
77022 Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation
77058 Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral
77059 Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral
77061 Digital breast tomosynthesis; unilateral
77062 Digital breast tomosynthesis; bilateral
77078 Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (e.g., hips, pelvis, spine)
77084 Magnetic resonance (e.g., proton) imaging, bone marrow blood supply
77261 Therapeutic radiology treatment planning; simple
77262 Therapeutic radiology treatment planning; intermediate
77263 Therapeutic radiology treatment planning; complex
77280 Therapeutic radiology simulation-aided field setting; simple
77285 Therapeutic radiology simulation-aided field setting; intermediate
77290 Therapeutic radiology simulation-aided field setting; complex
77293 Respiratory motion management simulation (List separately in addition to code for primary procedure)
77295 3-dimensional radiotherapy plan, including dose-volume histograms
77299 Unlisted procedure, therapeutic radiology clinical treatment planning
77300 Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician
77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
77305 Teletherapy, isodose plan (whether hand or computer calculated); simple (1 or 2 parallel opposed unmodified ports directed to a single area of interest)
77306 Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)
77307 Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
77316 Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)
77317 Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)
77318 Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)
77321 Special teletherapy port plan, particles, hemibody, total body
77331 Special dosimetry (e.g., TLD, microdosimetry) (specify), only when prescribed by the treating physician
77332 Treatment devices, design and construction; simple (simple block, simple bolus)
77333 Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus)
77334 Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)
77336 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy
77338 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan
77370 Special medical radiation physics consultation
77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based
77372 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based
77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple
77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex
77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed
77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services
77401 Radiation treatment delivery, superficial and/or ortho voltage, per day
77402 Radiation treatment delivery, =>1 MeV; simple
77407 Radiation treatment delivery, =>1 MeV; intermediate
77412 Radiation treatment delivery, => 1 MeV; complex
77417 Therapeutic radiology port image(s)
77422 High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking
77423 High energy neutron radiation treatment delivery; 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)
77424 Intraoperative radiation treatment delivery, x-ray, single treatment session
77425 Intraoperative radiation treatment delivery, electrons, single treatment session
77427 Radiation treatment management, 5 treatments
77431 Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only
77432 Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of one session)
77435 Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions
77469 Intraoperative radiation treatment management
77470 Special treatment procedure (e.g., total body irradiation, hemibody radiation, per oral or endocavitary irradiation)
77499 Unlisted procedure, therapeutic radiology treatment management
77520 Proton treatment delivery; simple, without compensation
77522 Proton treatment delivery; simple, with compensation
77523 Proton treatment delivery; intermediate
77525 Proton treatment delivery; complex
77600 Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)
77605 Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)
77610 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators
77615 Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators
77620 Hyperthermia generated by intracavitary probe(s)
77750 Infusion or instillation of radioelement solution (includes 3-month follow-up care)
77761 Intracavitary radiation source application; simple
77762 Intracavitary radiation source application; intermediate
77763 Intracavitary radiation source application; complex
77767 Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel
77768 Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions
77770 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel
77771 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels
77772 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels
77778 Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed
77789 Surface application of low dose rate radionuclide source
77790 Supervision, handling, loading of radiation source
77799 Unlisted procedure, clinical brachytherapy
78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)
78013 Thyroid imaging (including vascular flow, when performed);
78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)
78015 Thyroid carcinoma metastases imaging; limited area (e.g., neck and chest only)
78016 Thyroid carcinoma metastases imaging; with additional studies (e.g., urinary recovery)
78018 Thyroid carcinoma metastases imaging; whole body
78020 Thyroid carcinoma metastases uptake (List separately in addition to code for primary procedure)
78070 Parathyroid planar imaging (including subtraction, when performed);
78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT)
78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization
78075 Adrenal imaging, cortex and/or medulla
78102 Bone marrow imaging; limited area
78103 Bone marrow imaging; multiple areas
78104 Bone marrow imaging; whole body
78185 Spleen imaging only, with or without vascular flow
78195 Lymphatics and lymph nodes imaging
78201 Liver imaging; static only
78202 Liver imaging; with vascular flow
78205 Liver imaging (SPECT);
78206 Liver imaging (SPECT); with vascular flow
78215 Liver and spleen imaging; static only
78216 Liver and spleen imaging; with vascular flow
78226 Hepatobiliary system imaging, including gallbladder when present;
78227 Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed
78230 Salivary gland imaging;
78231 Salivary gland imaging; with serial images
78232 Salivary gland function study
78258 Esophageal motility
78261 Gastric mucosa imaging
78262 Gastroesophageal reflux study
78264 Gastric emptying imaging study (e.g., solid, liquid, or both);
78265 Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than 8 hours), requiring use of portable or implantable pump
78266 Gastric emptying imaging study (e.g., solid, liquid, or both); with small bowel and colon transit, multiple days
78278 Acute gastrointestinal blood loss imaging
78282 Gastrointestinal protein loss
78290 Intestine imaging (e.g., ectopic gastric mucosa, Meckel's localization, volvulus)
78291 Peritoneal-venous shunt patency test (e.g., for LeVeen, Denver shunt)
78300 Bone and/or joint imaging; limited area
78305 Bone and/or joint imaging; multiple areas
78306 Bone and/or joint imaging; whole body
78315 Bone and/or joint imaging; 3 phase study
78320 Bone and/or joint imaging; tomographic (SPECT)
78414 Determination of central c-v hemodynamics (non-imaging) (e.g., ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations
78428 Cardiac shunt detection
78445 Non-cardiac vascular flow imaging (ie, angiography, venography)
78451 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection
78453 Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
78454 Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection
78456 Acute venous thrombosis imaging, peptide
78457 Venous thrombosis imaging, venogram; unilateral
78458 Venous thrombosis imaging, venogram; bilateral
78459 Myocardial imaging, positron emission tomography (PET), metabolic evaluation
78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative
78468 Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique
78469 Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification
78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing
78473 Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification
78481 Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification
78483 Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification
78491 Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress
78492 Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest and/or stress
78494 Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing
78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure)
78579 Pulmonary ventilation imaging (e.g., aerosol or gas)
78580 Pulmonary perfusion imaging (e.g., particulate)
78582 Pulmonary ventilation (e.g., aerosol or gas) and perfusion imaging
78597 Quantitative differential pulmonary perfusion, including imaging when performed
78598 Quantitative differential pulmonary perfusion and ventilation (e.g., aerosol or gas), including imaging when performed
78600 Brain imaging, less than 4 static views;
78601 Brain imaging, less than 4 static views; with vascular flow
78605 Brain imaging, minimum 4 static views;
78606 Brain imaging, minimum 4 static views; with vascular flow
78607 Brain imaging, tomographic (SPECT)
78608 Brain imaging, positron emission tomography (PET); metabolic evaluation
78609 Brain imaging, positron emission tomography (PET); perfusion evaluation
78610 Brain imaging, vascular flow only
78630 Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography
78635 Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography
78645 Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation
78647 Cerebrospinal fluid flow, imaging (not including introduction of material); tomographic (SPECT)
78650 Cerebrospinal fluid leakage detection and localization
78660 Radiopharmaceutical dacryocystography
78700 Kidney imaging morphology;
78701 Kidney imaging morphology; with vascular flow
78707 Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention
78708 Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (e.g., angiotensin converting enzyme inhibitor and/or diuretic)
78709 Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (e.g., angiotensin converting enzyme inhibitor and/or diuretic)
78710 Kidney imaging morphology; tomographic (SPECT)
78725 Kidney function study, non-imaging radioisotopic study
78730 Urinary bladder residual study (List separately in addition to code for primary procedure)
78740 Ureteral reflux study (radiopharmaceutical voiding cystogram)
78761 Testicular imaging with vascular flow
78800 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); limited area
78801 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); multiple areas
78802 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, single day imaging
78803 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographic (SPECT)
78804 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, requiring 2 or more days imaging
78805 Radiopharmaceutical localization of inflammatory process; limited area
78806 Radiopharmaceutical localization of inflammatory process; whole body
78807 Radiopharmaceutical localization of inflammatory process; tomographic (SPECT)
78811 Positron emission tomography (PET) imaging; limited area (e.g., chest, head/neck)
78812 Positron emission tomography (PET) imaging; skull base to mid-thigh
78813 Positron emission tomography (PET) imaging; whole body
78814 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (e.g., chest, head/neck)
78815 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh
78816 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body
79101 Radiopharmaceutical therapy, by intravenous administration
79445 5 Radiopharmaceutical therapy, by intra-arterial particulate administration
81105 Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-1a/b (L33P)
81106 Human Platelet Antigen 2 genotyping (HPA-2), GP1BA (glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (e.g., neonatal alloimmune thrombocytopenia [NAIT],  post- transfusion purpura), gene analysis, common variant, HPA-2a/b (T145M)
81107 Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex], antigen CD41 [GPIIb]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-3a/b (I843S)
81108 Human Platelet Antigen 4 genotyping (HPA-4), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-4a/b (R14)
81109 Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (e.g., HPA-5a/b (K505E)
81110 Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa])(e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-6a/b (R489Q)
81111 Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex, antigen CD41] [GPIIb]) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-9a/b (V837M)
81112 Human Platelet Antigen 15 genotyping (HPA-15), CD109 (CD109 molecule) (e.g., neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-15a/b (S682Y)
81120 IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (e.g., glioma), common variants (e.g., R132H, R132C)
81121 IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (e.g., glioma), common variants (e.g., R140W, R172M)
81162 BRCA1, BRCA2 (breast cancer 1 and 2) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis
81170 ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (e.g., acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain (New code effective 01/01/2016)
81200 ASPA (aspartoacylase) (e.g., Canavan disease) gene analysis, common variants (e.g., E285A, Y231X)
81201 APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence
81202 APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants
81203 APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants
81205 BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (e.g., maple syrup urine disease) gene analysis, common variants (e.g., R183P, G278S, E422X)
81206 BCR/ABL1 (t(9;22)) (e.g., chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative
81207 BCR/ABL1 (t(9;22)) (e.g., chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative
81208 BCR/ABL1 (t(9;22)) (e.g., chronic myelogenous leukemia) translocation analysis; other breakpoint, qualitative or quantitative
81209 BLM (Bloom syndrome, RecQ helicase-like) (e.g., Bloom syndrome) gene analysis, 2281del6ins7 variant
81210 BRAF (B-Raf proto-oncogene, serine/threonine kinase) (e.g., colon cancer, melanoma), gene analysis, V600 variant(s)
81211 BRCA1, BRCA2 (breast cancer 1 and 2) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510 bp, exon 8-9 del 7.1kb)
81212 BRCA1, BRCA2 (breast cancer 1 and 2) (e.g., hereditary breast and ovarian cancer) gene analysis; 185 delAG, 5385insC, 6174delT variants
81213 BRCA1, BRCA2 (breast cancer 1 and 2) (e.g., hereditary breast and ovarian cancer) gene analysis; uncommon duplication/deletion variants
81214 BRCA1 (breast cancer 1) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510 bp, exon 8-9 del 7.1kb)
81215 BRCA1 (breast cancer 1) (e.g., hereditary breast and ovarian cancer) gene analysis; known familial variant
81216 BRCA2 (breast cancer 2) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81217 BRCA2 (breast cancer 2) (e.g., hereditary breast and ovarian cancer) gene analysis; known familial variant
81218 Oophorectomy, partial or total, unilateral or bilateral;
81219 CALR (calreticulin) (e.g., myeloproliferative disorders), gene analysis, common variants in exon 9
81220 CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; common variants (e.g., ACMG/ACOG guidelines)
81221 CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; known familial variants
81222 CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; duplication/deletion variants
81223 CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; full gene sequence
81224 CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; intron 8 poly-T analysis (e.g., male infertility)
81228 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (e.g., bacterial artificial chromosome [BAC] or oligo-based comparative genomic hybridization [CGH] microarray analysis)
81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities
81235 EGFR (epidermal growth factor receptor) (e.g., non-small cell lung cancer) gene analysis, common variants (e.g., exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q)
81238 F9 (coagulation factor IX) (e.g., hemophilia B), full gene sequence
81241 F5 (coagulation factor V) (e.g., hereditary hypercoagulability) gene analysis, Leiden variant
81242 FANCC (Fanconi anemia, complementation group C) (e.g., Fanconi anemia, type C) gene analysis, common variant (e.g., IVS4+4A>T)
81243 FMR1 (fragile X mental retardation 1) (e.g., fragile X mental retardation) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles
81244 FMR1 (Fragile X mental retardation 1) (e.g., fragile X mental retardation) gene analysis; characterization of alleles (e.g., expanded size and methylation status)
81245 FLT3 (fms-related tyrosine kinase 3) (e.g., acute myeloid leukemia), gene analysis; internal tandem duplication (ITD) variants (ie, exons 14, 15)
81246 FLT3 (fms-related tyrosine kinase 3) (e.g., acute myeloid leukemia), gene analysis; tyrosine kinase domain (TKD) variants (e.g., D835, I836)
81247 G6PD (glucose-6-phosphate dehydrogenase) (e.g., hemolytic anemia, jaundice), gene analysis; common variant(s) (e.g., A, A-)
81248 G6PD (glucose-6-phosphate dehydrogenase) (e.g., hemolytic anemia, jaundice), gene analysis; known familial variant(s)
81249 G6PD (glucose-6-phosphate dehydrogenase) (e.g., hemolytic anemia, jaundice), gene analysis; full gene sequence
81250 G6PC (glucose-6-phosphatase, catalytic subunit) (e.g., Glycogen storage disease, type 1a, von Gierke disease) gene analysis, common variants (e.g., R83C, Q347X)
81251 GBA (glucosidase, beta, acid) (e.g., Gaucher disease) gene analysis, common variants (e.g., N370S, 84GG, L444P, IVS2+1G>A)
81255 HEXA (hexosaminidase A [alpha polypeptide]) (e.g., Tay-Sachs disease) gene analysis, common variants (e.g., 1278insTATC, 1421+1G>C, G269S)
81256 HFE (hemochromatosis) (e.g., hereditary hemochromatosis) gene analysis, common variants (e.g., C282Y, H63D)
81257 HBA1/HBA2 (alpha globin 1 and alpha globin 2) (e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis, for common deletions or variant (e.g., Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, and Constant Spring)
81258 HBA1/HBA2 (alpha globin 1 and alpha globin 2)(e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant
81259 HBA1/HBA2 (alpha globin 1 and alpha globin 2)(e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence
81260 HBA1/HBA2 (alpha globin 1 and alpha globin 2)(e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence
81262 IGH@ (Immunoglobulin heavy chain locus) (e.g., leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); direct probe methodology (e.g., Southern blot)
81269 HBA1/HBA2 (alpha globin 1 and alpha globin 2)(e.g., alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; duplication/deletion variants
81270 JAK2 (Janus kinase 2) (e.g., myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant
81272 KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (e.g., gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (e.g., exons 8, 11, 13, 17, 18)
81273 KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (e.g., mastocytosis), gene analysis, D816 variant(s)
81275 KRAS (Kirsten rat sarcoma viral oncogene homolog) (e.g., carcinoma) gene analysis; variants in exon 2 (e.g., codons 12 and 13)
81276 KRAS (Kirsten rat sarcoma viral oncogene homolog) (e.g., carcinoma) gene analysis; additional variant(s) (e.g., codon 61, codon 146)
81287 MGMT (O-6-methylguanine-DNA methyltransferase) (e.g., glioblastoma multiforme), methylation analysis
81288 MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis
81290 MCOLN1 (mucolipin 1) (e.g., Mucolipidosis, type IV) gene analysis, common variants (e.g., IVS3-2A>G, del6.4kb)
81292 MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81293 MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81294 MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81295 MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81296 MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81297 MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81298 MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81299 MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81300 MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81301 Microsatellite instability analysis (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (e.g., BAT25, BAT26), includes comparison of neoplastic and normal tissue, if performed
81311 NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (e.g., colorectal carcinoma), gene analysis, variants in exon 2 (e.g., codons 12 and 13) and exon 3 (e.g., codon 61)
81314 PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (e.g., gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (e.g., exons 12, 18)
81317 PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis
81318 PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants
81319 PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants
81321 PTEN (phosphatase and tensin homolog) (e.g., Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; full sequence analysis
81322 PTEN (phosphatase and tensin homolog) (e.g., Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; known familial variant
81323 PTEN (phosphatase and tensin homolog) (e.g., Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant
81324 PMP22 (peripheral myelin protein 22) (e.g., Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis
81325 PMP22 (peripheral myelin protein 22) (e.g., Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis
81326 PMP22 (peripheral myelin protein 22) (e.g., Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant
81330 SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (e.g., Niemann-Pick disease, Type A) gene analysis, common variants (e.g., R496L, L302P, fsP330)
81335 TPMT(thiopurine S-methyltransferase) (e.g., drug metabolism),  gene analysis, common variants (e.g., *2, *3)
81346 TYMS (thymidylate synthetase) (e.g., 5-fluorouracil/5-FU drug metabolism), gene analysis, common variant(s) (e.g., tandem repeat variant)
81350 UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (e.g., irinotecan metabolism), gene analysis, common variants (e.g., *28, *36, *37)
81355 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (e.g., warfarin metabolism), gene analysis, common variant(s) (e.g., -1639G>A, c.173+1000C>T)
81381 HLA Class I typing, high resolution (ie, alleles or allele groups); one allele or allele group (e.g., B*57:01P), each
81400 Molecular pathology procedure, Level 1(e.g., identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis)
81401 Molecular pathology procedure, Level 2 (e.g., 2-10 SNPs, 1 methylated variant, or 1 somatic variant [typically using nonsequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat)
81402 Molecular pathology procedure, Level 3 (e.g., >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant analysis], immunoglobulin and T-cell receptor gene rearrangements, duplication/deletion variants of 1 exon, loss of heterozygosity [LOH], uniparental disomy [UPD])
81403 Molecular pathology procedure, Level 4 (e.g., analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons)
81404 Molecular pathology procedure, Level 5 (e.g., analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)
81405 Molecular pathology procedure, Level 6 (e.g., analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis)
81406 Molecular pathology procedure, Level 7 (e.g., analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons, cytogenomic array analysis for neoplasia)
81407 Molecular pathology procedure, Level 8 (e.g., analysis of 26-50 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of >50 exons, sequence analysis of multiple genes on one platform)
81408 Molecular pathology procedure, Level 9 (e.g., analysis of >50 exons in a single gene by DNA sequence analysis)
81412 Ashkenazi Jewish associated disorders (e.g., Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, AND SMPD1
81420 Fetal chromosomal aneuploidy (e.g., trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21
81435 Hereditary colon cancer disorders (e.g., Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include sequencing of at least 10 genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11
81436 Hereditary colon cancer disorders (e.g., Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11
81479 Unlisted molecular pathology procedure [when specified as gene analysis of V600K variant]
81490 Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score
81493 Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score
81507 Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy
81519 Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score
81520 Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin- embedded tissue, algorithm reported as a recurrence risk score
81521 Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin- embedded tissue, algorithm reported as index related to risk of distant metastasis
81525 Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score
81538 Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival
81541 Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin- embedded tissue, algorithm reported as a disease- specific mortality risk score
81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (e.g., benign or suspicious)
81551 Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy
81595 Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score
81599 Unlisted multianalyte assay with algorithmic analysis
82542 Column chromatography, includes mass spectrometry, if performed (e.g., HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen
82657 Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen
82731 Fetal fibronectin, cervicovaginal secretions, semi-quantitative
84999 Unlisted chemistry procedure
85415 Fibrinolytic factors and inhibitors; plasminogen activator
86790 Antibody; virus, not elsewhere specified
86849 Unlisted immunology procedure
87483 Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (e.g., Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets
87623 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (e.g., 6, 11, 42, 43, 44)
87900 Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics
87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions
87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus
87903 Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested
87904 Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure)
87906 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (e.g., integrase, fusion)
88230 Tissue culture for non-neoplastic disorders; lymphocyte
88272 Molecular cytogenetics; chromosomal in situ hybridization, analyze 3-5 cells (e.g., for derivatives and markers)
88273 Molecular cytogenetics; chromosomal in situ hybridization, analyze 10-30 cells (e.g., for microdeletions)
88274 Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells
88291 Cytogenetics and molecular cytogenetics, interpretation and report
88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure)
88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure
88356 Morphometric analysis; nerve
88360 Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual
88361 Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology
88363 Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (e.g., KRAS mutational analysis) [when specified in relation to BRAF testing]
88368 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure
89250 Culture of oocyte(s)/embryo(s), less than 4 days;
89251 Culture of oocyte(s)/embryo(s), less than 4 days; with co-culture of oocyte(s)/embryos
89253 Assisted embryo hatching, microtechniques (any method)
89254 Oocyte identification from follicular fluid
89255 Preparation of embryo for transfer (any method)
89257 Sperm identification from aspiration (other than seminal fluid)
89258 Cryopreservation; embryo(s)
89260 Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen analysis
89261 Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis
89264 Sperm identification from testis tissue, fresh or cryopreserved
89268 Insemination of oocytes
89272 Extended culture of oocyte(s)/embryo(s), 4-7 days
89280 Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes
89281 Assisted oocyte fertilization, microtechnique; greater than 10 oocytes
89290 Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to 5 embryos
89291 Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); greater than 5 embryos
89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
89310 Semen analysis; motility and count (not including Huhner test)
89320 Semen analysis; volume, count, motility, and differential
89321 Semen analysis; sperm presence and motility of sperm, if performed
90867 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management
90868 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session
90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management
91035 Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation
91110 Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus through ileum, with physician interpretation and report
91111 Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus with physician interpretation and report
91200 Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report
92025 Computerized corneal topography, unilateral or bilateral, with interpretation and report
92275 Electroretinography with interpretation and report
92287 Anterior segment imaging with interpretation and report; with fluorescein angiography
92499 Unlisted ophthalmological service or procedure
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering) (New code 1-1-2014)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); (New code 1-1-2014)
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) (New code 1-1-2014)
92524 Behavioral and qualitative analysis of voice and resonance (New code 1-1-2014)
92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis
92587 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report
92588 Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report
92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
92601 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming
92602 Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming
92603 Diagnostic analysis of cochlear implant, age 7 years or older; with programming
92604 Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming
92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
92929 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)
92933 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
92934 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)
92937 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
92938 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure)
92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
92943 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel
92944 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)
92971 CardiAssist-method of circulatory assist; external
92974 Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure)
92997 Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel
92998 Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)
93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report
93025 Microvolt T-wave alternans for assessment of ventricular arrhythmias
93224 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional
93225 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)
93226 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report
93227 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional
93228 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional
93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional
93260 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system
93261 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system
93268 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified health care professional
93270 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)
93271 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis
93272 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional
93282 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system
93283 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system
93289 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements
93292 nterrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system
93295 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
93303 Transthoracic echocardiography for congenital cardiac anomalies; complete
93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study
93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
93307 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography
93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
93350 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report;
93351 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional
93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;
93455 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography
93456 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
93457 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization
93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
93459 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
93461 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
93580 Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant
93581 Percutaneous transcatheter closure of a congenital ventricular septal defect with implant
93583 Percutaneous transcatheter septal reduction therapy (e.g., alcohol septal ablation) including temporary pacemaker insertion when performed
93590 Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve
93592 Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (List separately in addition to code for primary procedure)
93600 Bundle of His recording
93602 Intra-atrial recording
93603 Right ventricular recording
93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure)
93610 Intra-atrial pacing
93612 Intraventricular pacing
93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)
93618 Induction of arrhythmia by electrical pacing
93619 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia
93620 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording
93621 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)
93622 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure)
93623 Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)
93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia
93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement
93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation
93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure)
93668 Peripheral arterial disease (PAD) rehabilitation, per session
93745 Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events
93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
93798 Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)
93799 Unlisted cardiovascular service or procedure
93886 Transcranial Doppler study of the intracranial arteries; complete study
93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
94014 Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health care professional
94015 Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)
94016 Patient-initiated spirometric recording per 30-day period of time; review and interpretation only by a physician or other qualified health care professional
94660 Continuous positive airway pressure ventilation (CPAP), initiation and management
94669 Mechanical chest wall oscillation to facilitate lung function, per session
94726 Plethysmography for determination of lung volumes and, when performed, airway resistance
94728 Airway resistance by impulse oscillometry
94750 Pulmonary compliance study (e.g., plethysmography, volume and pressure measurements)
94760 Noninvasive ear or pulse oximetry for oxygen saturation; single determination
94761 Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise)
94762 Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)
95249 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook- up, calibration of monitor, patient training, and printout of recording
95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording
95251 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report
95782 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
95783 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
95801 Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
95803 Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
95805 Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
95806 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoracoabdominal movement)
95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
95808 Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist
95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist
95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report
95907 Nerve conduction studies; 1-2 studies
95908 Nerve conduction studies; 3-4 studies
95909 Nerve conduction studies; 5-6 studies
95910 Nerve conduction studies; 7-8 studies
95911 Nerve conduction studies; 9-10 studies
95912 Nerve conduction studies; 11-12 studies
95913 Nerve conduction studies; 13 or more studies
95925 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs
95926 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs
95927 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head
95930 Visual evoked potential (VEP) testing central nervous system, checkerboard or flash
95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
95941 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure)
95961 Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health care professional
95962 Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician or other qualified health care professional (List separately in addition to code for primary procedure)
95965 Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization)
95966 Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (e.g., sensory, motor, language, or visual cortex localization)
95967 Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, each additional modality (e.g., sensory, motor, language, or visual cortex localization) (List separately in addition to code for primary procedure)
95970 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming
95971 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming
95972 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, first hour
95974 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour
95975 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)
95978 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour
95979 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; each additional 30 minutes after first hour (List separately in addition to code for primary procedure)
95980 Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; intraoperative, with programming
95990 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed
95991 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional Revised code
95999 Unlisted neurological or neuromuscular diagnostic procedure
96000 Comprehensive computer-based motion analysis by video-taping and 3D kinematics;
96001 Comprehensive computer-based motion analysis by video-taping and 3D kinematics; with dynamic plantar pressure measurements during walking
96002 Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles
96003 Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
96105 Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour
96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report
96118 Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
96119 Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face
96120 Neuropsychological testing (e.g., Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report
96125 Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
96368 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure)
96369 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)
96370 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
96371 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure)
96377 Application of on-body injector (includes cannula insertion) for timed subcutaneous injection
96379 Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion
96523 Irrigation of implanted venous access device for drug delivery systems
96567 Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (e.g., lip) by activation of photosensitive drug(s), each phototherapy exposure session
96573 Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day
96574 Debridement of premalignant hyperkeratotic lesion(s) (ie, targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day
96902 Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality
96910 Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B
96912 Photochemotherapy; psoralens and ultraviolet A (PUVA)
96913 Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least four to eight hours of care under direct supervision of the physician (includes application of medication and dressings)
96920 Laser treatment for inflammatory skin disease (psoriasis); total area less than 250 sq cm
96921 Laser treatment for inflammatory skin disease (psoriasis); 250 sq cm to 500 sq cm
96922 Laser treatment for inflammatory skin disease (psoriasis); over 500 sq cm
96999 Unlisted special dermatological service or procedure
97010 Application of a modality to 1 or more areas; hot or cold packs
97012 Application of a modality to 1 or more areas; traction, mechanical
97014 Application of a modality to 1 or more areas; electrical stimulation (unattended)
97016 Application of a modality to one or more areas; vasopneumatic devices
97018 Application of a modality to 1 or more areas; paraffin bath
97022 Application of a modality to 1 or more areas; whirlpool
97024 Application of a modality to 1 or more areas; diathermy (e.g., microwave)
97026 Application of a modality to 1 or more areas; infrared
97028 Application of a modality to 1 or more areas; ultraviolet
97032 Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes
97033 Application of a modality to 1 or more areas; iontophoresis, each 15 minutes
97034 Application of a modality to 1 or more areas; contrast baths, each 15 minutes
97035 Application of a modality to 1 or more areas; ultrasound, each 15 minutes
97036 Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes
97039 Unlisted modality (specify type and time if constant attendance)
97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
97113 Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises
97116 Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)
97124 Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)
97127 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact
97139 Unlisted therapeutic procedure (specify)
97140 Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
97150 Therapeutic procedure(s), group (2 or more individuals)
97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
97164 Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family.
97165 Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
97166 Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
97167 Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
97168 Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family.
97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes
97535 Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes
97542 Wheelchair management (e.g., assessment, fitting, training), each 15 minutes
97545 Work hardening/conditioning; initial 2 hours
97546 Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure)
97605 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters
97606 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
97607 Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters
97608 Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
97750 Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes
97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes
97763 Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes
99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session
99184 Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling
99199 Unlisted special service, procedure or report
99341 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99342 Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99344 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99345 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
99347 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99348 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99350 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99500 Home visit for prenatal monitoring and assessment to include fetal heart rate, non-stress test, uterine monitoring, and gestational diabetes monitoring
99601 Home infusion/specialty drug administration, per visit (up to 2 hours);
99602 Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour (List separately in addition to code for primary procedure)
A0021 Ambulance service, outside state per mile, transport (Medicaid only)
A0130 Nonemergency transportation: wheelchair van
A0140 Nonemergency transportation and air travel (private or commercial) intra- or interstate
A0426 Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)
A0428 Ambulance service, basic life support, nonemergency transport, (BLS)
A0430 Ambulance service, conventional air services, transport, one way (fixed wing)
A0431 Ambulance service, conventional air services, transport, one way (rotary wing)
A0434 Specialty care transport (SCT)
A0435 Fixed wing air mileage, per statute mile
A0436 Rotary wing air mileage, per statute mile
A0999 Unlisted ambulance service
A4221 Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
A4224 Supplies for maintenance of insulin infusion catheter, per week
A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
A4290 Sacral nerve stimulation test lead, each
A4335 Incontinence supply; miscellaneous
A4575 Conductive gel or paste, for use with electrical device (e.g., TENS, NMES), per oz
A4604 Authorization required on or after 12/1/18: Tubing with integrated heating element for use with positive airway pressure device
A4606 Oxygen probe for use with oximeter device, replacement
A4649 Surgical supply; miscellaneous
A4650 Implantable radiation dosimeter, each
A5500 For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
A5501 For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe
A5504 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with wedge(s), per shoe
A5505 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, per shoe
A5506 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with off-set heel(s), per shoe
A5507 For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe, per shoe
A5508 For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom molded shoe, per shoe
A5510 For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe
A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each
A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher, includes arch filler and other shaping material, custom fabricated, each
A6261 Wound filler, gel/paste, per fluid ounce, not otherwise specified
A6262 Wound filler, dry form, per gram, not otherwise specified
A6549 Gradient compression stocking/sleeve, not otherwise specified
A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories
A7025 High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each
A7026 High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each
A7027 Combination oral/nasal mask, used with continuous positive airway pressure device, each
A7028 Oral cushion for combination oral/nasal mask, replacement only, each
A7029 Nasal pillows for combination oral/nasal mask, replacement only, pair
A7030 Full face mask used with positive airway pressure device, each
A7031 Face mask interface, replacement for full face mask, each
A7032 Authorization required on or after 12/1/18: Cushion for use on nasal mask interface, replacement only, each
A7033 Pillow for use on nasal cannula type interface, replacement only, pair
A7034 Authorization required on or after 12/1/18: Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap
A7035 Authorization required on or after 12/1/18: Headgear used with positive airway pressure device
A7036 Authorization required on or after 12/1/18: Chinstrap used with positive airway pressure device
A7037 Authorization required on or after 12/1/18: Tubing used with positive airway pressure device
A7038 Authorization required on or after 12/1/18: Filter, disposable, used with positive airway pressure device
A7039 Authorization required on or after 12/1/18: Filter, non disposable, used with positive airway pressure device
A7044 Oral interface used with positive airway pressure device, each
A7045 Exhalation port with or without swivel used with accessories for positive airway devices, replacement only
A7046 Authorization required on or after 12/1/18: Water chamber for humidifier, used with positive airway pressure device, replacement, each
A9282 Wig, any type, each
A9586 Florbetapir F18, diagnostic, per study dose, up to 10 millicuries
A9606 Radium RA-223 dichloride, therapeutic, per microcurie
A9900 Miscellaneous dme supply, accessory, and/or service component of another hcpcs code
A9999 Miscellaneous dme supply or accessory, not otherwise specified
C1715 Brachytherapy needle
C1716 Brachytherapy source, nonstranded, gold-198, per source
C1717 Brachytherapy source, nonstranded, high dose rate iridium-192, per source
C1719 Brachytherapy source, nonstranded, nonhigh dose rate iridium-192, per source
C1721 Cardioverter-defibrillator, dual chamber (implantable)
C1722 Cardioverter-defibrillator, single chamber (implantable)
C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)
C1728 Catheter, brachytherapy seed administration
C1767 Generator, neurostimulator (implantable), nonrechargeable
C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)
C1778 Lead, neurostimulator (implantable)
C1779 Lead, pacemaker, transvenous VDD single pass
C1785 Pacemaker, dual chamber, rate-responsive (implantable)
C1786 Pacemaker, single chamber, rate-responsive (implantable)
C1789 Prosthesis, breast (implantable)
C1816 Receiver and/or transmitter, neurostimulator (implantable)
C1820 Generator, neurostimulator (implantable), with rechargeable battery and charging system
C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)
C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable)
C1885 Catheter, transluminal angioplasty, laser
C1889 Implantable/insertable device for device intensive procedure, not otherwise classified
C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)
C1896 Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)
C1898 Lead, pacemaker, other than transvenous VDD single pass
C1899 Lead, pacemaker/cardioverter-defibrillator combination (implantable)
C1900 Lead, left ventricular coronary venous system
C2619 Pacemaker, dual chamber, nonrate-responsive (implantable)
C2620 Pacemaker, single chamber, nonrate-responsive (implantable)
C2621 Pacemaker, other than single or dual chamber (implantable)
C2634 Brachytherapy source, nonstranded, high activity, iodine-125, greater than 1.01 mCi (NIST), per source
C2635 Brachytherapy source, nonstranded, high activity, palladium-103, greater than 2.2 mCi (NIST), per source
C2636 Brachytherapy linear source, nonstranded, palladium-103, per 1 mm
C2637 Brachytherapy source, nonstranded, ytterbium-169, per source
C2638 Brachytherapy source, stranded, iodine-125, per source
C2639 Brachytherapy source, nonstranded, iodine-125, per source
C2640 Brachytherapy source, stranded, palladium-103, per source
C2641 Brachytherapy source, nonstranded, palladium-103, per source
C2642 Brachytherapy source, stranded, cesium-131, per source
C2643 Brachytherapy source, nonstranded, cesium-131, per source
C2698 Brachytherapy source, stranded, not otherwise specified, per source
C2699 Brachytherapy source, nonstranded, not otherwise specified, per source
C8900 Magnetic resonance angiography with contrast, abdomen
C8901 Magnetic resonance angiography without contrast, abdomen
C8902 Magnetic resonance angiography without contrast followed by with contrast, abdomen
C8903 Magnetic resonance imaging with contrast, breast; unilateral
C8904 Magnetic resonance imaging without contrast, breast; unilateral
C8905 Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral
C8906 Magnetic resonance imaging with contrast, breast; bilateral
C8907 Magnetic resonance imaging without contrast, breast; bilateral
C8908 Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral
C8909 Magnetic resonance angiography with contrast, chest (excluding myocardium)
C8910 Magnetic resonance angiography without contrast, chest (excluding myocardium)
C8911 Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)
C8912 Magnetic resonance angiography with contrast, lower extremity
C8913 Magnetic resonance angiography without contrast, lower extremity
C8914 Magnetic resonance angiography without contrast followed by with contrast, lower extremity
C8918 Magnetic resonance angiography with contrast, pelvis
C8919 Magnetic resonance angiography without contrast, pelvis
C8920 Magnetic resonance angiography without contrast followed by with contrast, pelvis
C8921 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete
C8922 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study
C8923 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color doppler echocardiography
C8924 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording when performed, follow-up or limited study
C8928 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report
C8929 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography
C8930 Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision
C8931 Magnetic resonance angiography with contrast, spinal canal and contents
C8932 Magnetic resonance angiography without contrast, spinal canal and contents
C8933 Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents
C8934 Magnetic resonance angiography with contrast, upper extremity
C8935 Magnetic resonance angiography without contrast, upper extremity
C8936 Magnetic resonance angiography without contrast followed by with contrast, upper extremity
C9030 Injection, copanlisib, 1 mg
C9031 Lutetium Lu 177, dotatate, therapeutic, 1 mCi
C9032 Injection, voretigene neparvovec-rzyl, 1 billion vector genome
C9033 Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
C9034 Injection, dexamethasone 9%, intraocular, 1 mcg
C9140 Injection, factor VIII (antihemophilic factor, recombinant) (Afstyla), 1 IU
C9399 Unclassified drugs or biologicals
C9462 Injection, delafloxacin, 1 mg
C9463 Injection, aprepitant, 1 mg
C9464 Injection, rolapitant, 0.5 mg
C9465 Hyaluronan or derivative, Durolane, for intra-articular injection, per dose
C9466 Injection, benralizumab, 1 mg
C9467 Injection, rituximab and hyaluronidase, 10 mg
C9468 Injection, Factor IX (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 IU
C9600 Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
C9601 Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
C9602 Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
C9603 Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
C9604 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
C9605 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)
C9606 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
C9607 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel
C9608 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)
C9725 Placement of endorectal intracavitary applicator for high intensity brachytherapy
C9726 Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure
C9728 Placement of interstitial device(s) for radiation therapy/surgery guidance (e.g., fiducial markers, dosimeter), for other than the following sites (any approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or multiple
C9739 Cystourethroscpy, with insertion of transprostatic implant; 1 to 3
C9740 Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants
E0157 Crutch attachment, walker, each
E0159 Brake attachment for wheeled walker, replacement, each
E0160 Sitz type bath or equipment, portable, used with or without commode
E0170 Commode chair with integrated seat lift mechanism, electric, any type
E0171 Commode chair with integrated seat lift mechanism, non-electric, any type
E0172 Seat lift mechanism placed over or on top of toilet, any type
E0175 Foot rest, for use with commode chair, each
E0181 Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty
E0182 Pump for alternating pressure pad, for replacement only
E0184 Dry pressure mattress
E0185 Gel or gel-like pressure pad for mattress, standard mattress length and width
E0186 Air pressure mattress
E0187 Water pressure mattress
E0189 Lambswool sheepskin pad, any size
E0190 Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories
E0193 Powered air flotation bed (low air loss therapy)
E0194 Air fluidized bed
E0196 Gel pressure mattress
E0197 Air pressure pad for mattress, standard mattress length and width
E0198 Water pressure pad for mattress, standard mattress length and width
E0200 Heat lamp, without stand (table model), includes bulb, or infrared element
E0203 Therapeutic lightbox, minimum 10,000 lux, table top model
E0205 Heat lamp, with stand, includes bulb, or infrared element
E0210 Electric heat pad, standard
E0217 Water circulating heat pad with pump
E0218 Water circulating cold pad with pump
E0221 Infrared heating pad system
E0225 Hydrocollator unit, includes pads
E0235 Paraffin bath unit, portable (see medical supply code a4265 for paraffin)
E0236 Pump for water circulating pad
E0239 Hydrocollator unit, portable
E0246 Transfer tub rail attachment
E0247 Transfer bench for tub or toilet with or without commode opening
E0248 Transfer bench, heavy duty, for tub or toilet with or without commode opening
E0250 Hospital bed, fixed height, with any type side rails, with mattress
E0251 Hospital bed, fixed height, with any type side rails, without mattress
E0255 Hospital bed, variable height, hi-lo, with any type side rails, with mattress
E0256 Hospital bed, variable height, hi-lo, with any type side rails, without mattress
E0260 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
E0261 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress
E0265 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress
E0266 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress
E0270 Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress
E0271 Mattress, innerspring
E0272 Mattress, foam rubber
E0273 Bed board
E0274 Over-bed table
E0277 Powered pressure-reducing air mattress
E0280 Bed cradle, any type
E0290 Hospital bed, fixed height, without side rails, with mattress
E0291 Hospital bed, fixed height, without side rails, without mattress
E0292 Hospital bed, variable height, hi-lo, without side rails, with mattress
E0293 Hospital bed, variable height, hi-lo, without side rails, without mattress
E0294 Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress
E0295 Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress
E0296 Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress
E0297 Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress
E0300 Pediatric crib, hospital grade, fully enclosed, with or without top enclosure
E0301 Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress
E0302 Hospital bed, extra heavy-duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress
E0303 Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress
E0304 Hospital bed, extra heavy-duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress
E0305 Bed side rails, half length
E0310 Bed side rails, full length
E0315 Bed accessory: board, table, or support device, any type
E0316 Safety enclosure frame/canopy for use with hospital bed, any type
E0328 Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress
E0329 Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress
E0350 Control unit for electronic bowel irrigation/evacuation system
E0352 Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system
E0371 Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width
E0372 Powered air overlay for mattress, standard mattress length and width
E0373 Nonpowered advanced pressure reducing mattress
E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0425 Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0430 Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing
E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing
E0433 Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge
E0434 Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing
E0435 Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor
E0439 Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing
E0440 Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0441 Stationary oxygen contents, gaseous, 1 month's supply = 1 unit
E0442 Stationary oxygen contents, liquid, 1 month's supply = 1 unit
E0443 Portable oxygen contents, gaseous, 1 month's supply = 1 unit
E0444 Portable oxygen contents, liquid, 1 month's supply = 1 unit
E0445 Oximeter device for measuring blood oxygen levels noninvasively
E0446 Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories
E0455 Oxygen tent, excluding croup or pediatric tents
E0457 Chest shell (cuirass)
E0459 Chest wrap
E0462 Rocking bed with or without side rails
E0465 Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)
E0466 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)
E0470 Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)
E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0472 Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)
E0480 Percussor, electric or pneumatic, home model
E0481 Intrapulmonary percussive ventilation system and related accessories
E0482 Cough stimulating device, alternating positive and negative airway pressure
E0483 High frequency chest wall oscillation air-pulse generator system, (includes hoses and vest), each
E0484 Oscillatory positive expiratory pressure device, non-electric, any type, each
E0485 Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, prefabricated, includes fitting and adjustment
E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment
E0487 Spirometer, electronic, includes all accessories
E0550 Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery
E0555 Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter
E0561 Humidifier, non heated, used with positive airway pressure device
E0562 Humidifier, heated, used with positive airway pressure device
E0570 Nebulizer, with compressor
E0572 Aerosol compressor, adjustable pressure, light duty for intermittent use
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer
E0575 Nebulizer, ultrasonic, large volume
E0580 Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter
E0585 Nebulizer, with compressor and heater
E0601 Continuous positive airway pressure (CPAP) device
E0605 Vaporizer, room type
E0610 Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)
E0615 Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems
E0617 External defibrillator with integrated electrocardiogram analysis
E0618 Apnea monitor, without recording feature
E0619 Apnea monitor, with recording feature
E0620 Skin piercing device for collection of capillary blood, laser, each
E0625 Patient lift, bathroom or toilet, not otherwise classified
E0627 Seat lift mechanism, electric, any type
E0629 Seat lift mechanism, non-electric, any type
E0630 Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)
E0635 Patient lift, electric, with seat or sling
E0636 Multipositional patient support system, with integrated lift, patient accessible controls
E0637 Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels
E0638 Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels
E0639 Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories
E0640 Patient lift, fixed system, includes all components/accessories
E0641 Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels
E0642 Standing frame/table system, mobile (dynamic stander), any size including pediatric
E0650 Pneumatic compressor, nonsegmental home model
E0651 Pneumatic compressor, segmental home model without calibrated gradient pressure
E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure
E0655 Nonsegmental pneumatic appliance for use with pneumatic compressor, half arm
E0656 Segmental pneumatic appliance for use with pneumatic compressor, trunk
E0657 Segmental pneumatic appliance for use with pneumatic compressor, chest
E0660 Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg
E0665 Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm
E0666 Nonsegmental pneumatic appliance for use with pneumatic compressor, half leg
E0667 Segmental pneumatic appliance for use with pneumatic compressor, full leg
E0668 Segmental pneumatic appliance for use with pneumatic compressor, full arm
E0669 Segmental pneumatic appliance for use with pneumatic compressor, half leg
E0670 Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk
E0671 Segmental gradient pressure pneumatic appliance, full leg
E0672 Segmental gradient pressure pneumatic appliance, full arm
E0673 Segmental gradient pressure pneumatic appliance, half leg
E0675 Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)
E0676 Intermittent limb compression device (includes all accessories), not otherwise specified
E0691 Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 sq ft or less
E0692 Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 ft panel
E0693 Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 ft panel
E0700 Safety equipment, device or accessory, any type
E0710 Restraints, any type (body, chest, wrist or ankle)
E0720 Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation
E0730 Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation
E0740 Non-implanted pelvic floor electrical stimulator, complete system
E0744 Neuromuscular stimulator for scoliosis
E0745 Neuromuscular stimulator, electronic shock unit
E0746 Electromyography (emg), biofeedback device
E0747 Osteogenesis stimulator, electrical, noninvasive, other than spinal applications
E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications
E0749 Osteogenesis stimulator, electrical, surgically implanted
E0755 Electronic salivary reflex stimulator (intra-oral/non-invasive)
E0760 Osteogenesis stimulator, low intensity ultrasound, noninvasive
E0761 Nonthermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device
E0762 Transcutaneous electrical joint stimulation device system, includes all accessories
E0764 Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program
E0765 FDA approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting
E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type
E0769 Electrical stimulation or electromagnetic wound treatment device, not otherwise classified
E0770 Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified
E0776 Iv pole
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
E0780 Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours
E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
E0784 External ambulatory infusion pump, insulin
E0786 Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
E0791 Parenteral infusion pump, stationary, single or multi-channel
E0830 Ambulatory traction device, all types, each
E0840 Traction frame, attached to headboard, cervical traction
E0849 Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible
E0850 Traction stand, freestanding, cervical traction
E0920 Fracture frame, attached to bed, includes weights
E0930 Fracture frame, free standing, includes weights
E0935 Continuous passive motion exercise device for use on knee only
E0936 Continuous passive motion exercise device for use other than knee
E0940 Trapeze bar, free standing, complete with grab bar
E0941 Gravity assisted traction device, any type
E0946 Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)
E0947 Fracture frame, attachments for complex pelvic traction
E0948 Fracture frame, attachments for complex cervical traction
E0951 Heel loop/holder, any type, with or without ankle strap, each
E0952 Toe loop/holder, any type, each
E0955 Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each
E0956 Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each
E0957 Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each
E0959 Manual wheelchair accessory, adapter for amputee, each
E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware
E0961 Manual wheelchair accessory, wheel lock brake extension (handle), each
E0967 Manual wheelchair accessory, hand rim with projections, any type, replacement only, each
E0969 Narrowing device, wheelchair
E0973 Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each
E0974 Manual wheelchair accessory, anti-rollback device, each
E0980 Safety vest, wheelchair
E0981 Wheelchair accessory, seat upholstery, replacement only, each
E0982 Wheelchair accessory, back upholstery, replacement only, each
E0983 Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control
E0984 Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control
E0985 Wheelchair accessory, seat lift mechanism
E0986 Manual wheelchair accessory, push-rim activated power assist system
E0988 Manual wheelchair accessory, lever-activated, wheel drive, pair
E0992 Manual wheelchair accessory, solid seat insert
E0994 Arm rest, each
E0995 Wheelchair accessory, calf rest/pad, replacement only, each
E1002 Wheelchair accessory, power seating system, tilt only
E1003 Wheelchair accessory, power seating system, recline only, without shear reduction
E1004 Wheelchair accessory, power seating system, recline only, with mechanical shear reduction
E1005 Wheelchair accessory, power seating system, recline only, with power shear reduction
E1006 Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction
E1007 Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction
E1008 Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction
E1009 Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each
E1010 Wheelchair accessory, addition to power seating system, power leg elevation system, including legrest, pair
E1011 Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)
E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each
E1014 Reclining back, addition to pediatric size wheelchair
E1015 Shock absorber for manual wheelchair, each
E1016 Shock absorber for power wheelchair, each
E1017 Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each
E1018 Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each
E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory
E1029 Wheelchair accessory, ventilator tray, fixed
E1030 Wheelchair accessory, ventilator tray, gimbaled
E1036 Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs
E1050 Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests
E1060 Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests
E1070 Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest
E1161 Manual adult size wheelchair, includes tilt in space
E1220 Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification
E1225 Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each
E1226 Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each
E1229 Wheelchair, pediatric size, not otherwise specified
E1230 Power operated vehicle (3- or 4-wheel nonhighway), specify brand name and model number
E1231 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system
E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system
E1233 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system
E1234 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system
E1235 Wheelchair, pediatric size, rigid, adjustable, with seating system
E1236 Wheelchair, pediatric size, folding, adjustable, with seating system
E1237 Wheelchair, pediatric size, rigid, adjustable, without seating system
E1238 Wheelchair, pediatric size, folding, adjustable, without seating system
E1239 Power wheelchair, pediatric size, not otherwise specified
E1240 Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest
E1250 Lightweight wheelchair, fixed full length arms, swing away detachable footrest
E1260 Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest
E1270 Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests
E1280 Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests
E1285 Heavy duty wheelchair, fixed full length arms, swing away detachable footrest
E1290 Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest
E1295 Heavy-duty wheelchair, fixed full-length arms, elevating legrest
E1296 Special wheelchair seat height from floor
E1297 Special wheelchair seat depth, by upholstery
E1298 Special wheelchair seat depth and/or width, by construction
E1352 Oxygen accessory, flow regulator capable of positive inspiratory pressure
E1355 Stand/rack
E1356 Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each
E1357 Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each
E1358 Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each
E1372 Immersion external heater for nebulizer
E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate
E1391 Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each
E1392 Portable oxygen concentrator, rental
E1399 Durable medical equipment, miscellaneous
E1405 Oxygen and water vapor enriching system with heated delivery
E1406 Oxygen and water vapor enriching system without heated delivery
E1800 Dynamic adjustable elbow extension/flexion device, includes soft interface material
E1801 Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
E1802 Dynamic adjustable forearm pronation/supination device, includes soft interface material
E1805 Dynamic adjustable wrist extension/flexion device, includes soft interface material
E1806 Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories
E1825 Dynamic adjustable finger extension/flexion device, includes soft interface material
E1840 Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material
E1841 Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories
E2000 Gastric suction pump, home model, portable or stationary, electric
E2100 Blood glucose monitor with integrated voice synthesizer
E2101 Blood glucose monitor with integrated lancing/blood sample
E2201 Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches
E2202 Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches
E2203 Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches
E2204 Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches
E2205 Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each
E2206 Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each
E2207 Wheelchair accessory, crutch and cane holder, each
E2208 Wheelchair accessory, cylinder tank carrier, each
E2209 Accessory, arm trough, with or without hand support, each
E2210 Wheelchair accessory, bearings, any type, replacement only, each
E2211 Manual wheelchair accessory, pneumatic propulsion tire, any size, each
E2212 Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each
E2213 Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each
E2214 Manual wheelchair accessory, pneumatic caster tire, any size, each
E2215 Manual wheelchair accessory, tube for pneumatic caster tire, any size, each
E2216 Manual wheelchair accessory, foam filled propulsion tire, any size, each
E2217 Manual wheelchair accessory, foam filled caster tire, any size, each
E2218 Manual wheelchair accessory, foam propulsion tire, any size, each
E2219 Manual wheelchair accessory, foam caster tire, any size, each
E2220 Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each
E2221 Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each
E2222 Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each
E2224 Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each
E2225 Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each
E2226 Manual wheelchair accessory, caster fork, any size, replacement only, each
E2227 Manual wheelchair accessory, gear reduction drive wheel, each
E2228 Manual wheelchair accessory, wheel braking system and lock, complete, each
E2230 Manual wheelchair accessory, manual standing system
E2231 Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware
E2291 Back, planar, for pediatric size wheelchair including fixed attaching hardware
E2292 Seat, planar, for pediatric size wheelchair including fixed attaching hardware
E2293 Back, contoured, for pediatric size wheelchair including fixed attaching hardware
E2294 Seat, contoured, for pediatric size wheelchair including fixed attaching hardware
E2295 Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features
E2300 Wheelchair accessory, power seat elevation system, any type
E2301 Wheelchair accessory, power standing system, any type
E2310 Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware
E2311 Power wheelchair accessory, electronic connection between wheelchair controller and 2 or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware
E2312 Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware
E2313 Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each
E2321 Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware
E2322 Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware
E2323 Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated
E2324 Power wheelchair accessory, chin cup for chin control interface
E2325 Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware
E2326 Power wheelchair accessory, breath tube kit for sip and puff interface
E2327 Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware
E2328 Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware
E2329 Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware
E2330 Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware
E2331 Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware
E2351 Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface
E2358 Power wheelchair accessory, group 34 non-sealed lead acid battery, each
E2359 Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
E2360 Power wheelchair accessory, 22nf non-sealed lead acid battery, each
E2361 Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)
E2362 Power wheelchair accessory, group 24 non-sealed lead acid battery, each
E2363 Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
E2364 Power wheelchair accessory, u-1 non-sealed lead acid battery, each
E2365 Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
E2366 Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each
E2367 Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each
E2368 Power wheelchair component, drive wheel motor, replacement only
E2369 Power wheelchair component, drive wheel gear box, replacement only
E2370 Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only
E2371 Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each
E2372 Power wheelchair accessory, group 27 non-sealed lead acid battery, each
E2373 Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware
E2374 Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only
E2375 Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only
E2376 Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only
E2377 Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue
E2378 Power wheelchair component, actuator, replacement only
E2381 Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each
E2382 Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each
E2383 Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each
E2384 Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each
E2385 Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each
E2386 Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each
E2387 Power wheelchair accessory, foam filled caster tire, any size, replacement only, each
E2388 Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each
E2389 Power wheelchair accessory, foam caster tire, any size, replacement only, each
E2390 Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each
E2391 Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each
E2392 Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each
E2394 Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each
E2395 Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each
E2396 Power wheelchair accessory, caster fork, any size, replacement only, each
E2397 Power wheelchair accessory, lithium-based battery, each
E2402 Negative pressure wound therapy electrical pump, stationary or portable 
E2500 Speech generating device, digitized speech, using prerecorded messages, less than or equal to 8 minutes recording time
E2502 Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time
E2504 Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time
E2506 Speech generating device, digitized speech, using prerecorded messages, greater than 40 minutes recording time
E2508 Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device
E2510 Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access
E2511 Speech generating software program, for personal computer or personal digital assistant
E2512 Accessory for speech generating device, mounting system
E2599 Accessory for speech generating device, not otherwise classified
E2609 Custom fabricated wheelchair seat cushion, any size
E2610 Wheelchair seat cushion, powered
E2611 General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware
E2612 General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware
E2613 Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware
E2614 Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware
E2615 Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware
E2616 Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware
E2617 Custom fabricated wheelchair back cushion, any size, including any type mounting hardware
E2619 Replacement cover for wheelchair seat cushion or back cushion, each
E2620 Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware
E2621 Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware
E2622 Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth
E2623 Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth
E2624 Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth
E2625 Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth
E2626 Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable
E2627 Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type
E2628 Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining
E2629 Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)
E2630 Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support
E2631 Wheelchair accessory, addition to mobile arm support, elevating proximal arm
E2632 Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control
E2633 Wheelchair accessory, addition to mobile arm support, supinator
E8000 Gait trainer, pediatric size, posterior support, includes all accessories and components
E8001 Gait trainer, pediatric size, upright support, includes all accessories and components
E8002 Gait trainer, pediatric size, anterior support, includes all accessories and components
G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
G0129 Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more)
G0130 Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
G0155 Services of clinical social worker in home health or hospice settings, each 15 minutes
G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes
G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
G0161 Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes
G0166 External counterpulsation, per treatment session
G0206 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
G0219 PET imaging whole body; melanoma for noncovered indications
G0235 PET imaging, any site, not otherwise specified
G0248 Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient's ability to perform testing and report results
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0250 Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests
G0252 PET imaging, full and partial-ring PET scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)
G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
G0276 Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD) or placebo-control, performed in an approved coverage with evidence development (CED) clinical trial
G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)
G0281 Electrical stimulation, (unattended), to one or more areas, for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care
G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee
G0295 Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses
G0297 Low dose CT scan (LDCT) for lung cancer screening
G0302 Preoperative pulmonary surgery services for preparation for LVRS, complete course of services, to include a minimum of 16 days of services
G0303 Preoperative pulmonary surgery services for preparation for LVRS, 10 to 15 days of services
G0304 Preoperative pulmonary surgery services for preparation for LVRS, 1 to 9 days of services
G0305 Postdischarge pulmonary surgery services after LVRS, minimum of 6 days of services
G0329 Electromagnetic therapy, to one or more areas for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care
G0339 Electromagnetic therapy, to one or more areas for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care
G0340 Image guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
G0341 Percutaneous islet cell transplant, includes portal vein catheterization and infusion
G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
G0422 Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session
G0423 Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session
G0452 Molecular pathology procedure; physician interpretation and report
G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment
G0472 Hepatitis C antibody screening for individual at high risk and other covered indication(s)
G0493 Skilled services of a registered nurse (RN) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
G0494 Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
G0495 Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
G0496 Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
G0505 Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
G6001 Ultrasonic guidance for placement of radiation therapy fields
G6002 Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
G6003 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev
G6004 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev
G6005 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev
G6006 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater
G6007 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev
G6008 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev
G6009 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev
G6010 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater
G6011 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev
G6012 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev
G6013 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev
G6014 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater
G6015 Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session
G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session
G6017 Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
G9143 Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
J0129 Injection, abatacept, 10 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
J0178 Injection, aflibercept, 1 mg
J0180 Injection, agalsidase beta, 1 mg
J0202 Injection, alemtuzumab, 1 mg
J0221 Injection, alglucosidase alfa, (Lumizyme), 10 mg
J0256 Injection, alpha 1-proteinase inhibitor (human), not otherwise specified, 10 mg
J0257 Injection, alpha 1 proteinase inhibitor (human), (GLASSIA), 10 mg
J0475 Injection, baclofen, 10 mg
J0476 Injection, baclofen, 50 mcg for intrathecal trial
J0490 Injection, belimumab, 10 mg
J0585 Injection, onabotulinumtoxinA, 1 unit
J0586 Injection, abobotulinumtoxinA, 5 units
J0587 Injection, rimabotulinumtoxinB, 100 units
J0588 Injection, incobotulinumtoxinA, 1 unit
J0597 Injection, C-1 esterase inhibitor (human), Berinert, 10 units
J0598 Injection, C-1 esterase inhibitor (human), Cinryze, 10 units
J0641 Injection, levoleucovorin calcium, 0.5 mg
J0717 Injection, certolizumab pegol, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
J0735 Injection, clonidine hydrochloride, 1 mg
J0775 Injection, collagenase, clostridium histolyticum, 0.01 mg
J0800 Injection, corticotropin, up to 40 units
J0881 Injection, darbepoetin alfa, 1 mcg (non-ESRD use)
J0885 Injection, epoetin alfa, (for non-ESRD use), 1000 units
J0897 Injection, denosumab, 1 mg
J1170 Injection, hydromorphone, up to 4 mg
J1300 Injection, eculizumab, 10 mg
J1428 Injection, eteplirsen, 10 mg
J1442 Injection, filgrastim (G-CSF), excludes biosimilars, 1 microgram
J1458 Injection, galsulfase, 1 mg 
J1459 Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg
J1555 Injection, immune globulin (cuvitru), 100 mg
J1556 Injection, immune globulin (Bivigam), 500 mg
J1557 Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mg
J1559 Injection, immune globulin (Hizentra), 100 mg
J1561 Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg
J1566 Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
J1568 Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg
J1569 Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg
J1572 Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg
J1575 Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin
J1602 Injection, golimumab, 1 mg, for intravenous use
J1726 Injection, hydroxyprogesterone caproate, (makena), 10 mg
J1729 Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
J1743 Injection, idursulfase, 1 mg
J1745 Injection, infliximab, excludes biosimilar, 10 mg
J1786 Injection, imiglucerase, 10 units
J1833 Injection, isavuconazonium, 1 mg
J1931 Injection, laronidase, 0.1 mg
J2182 Injection, mepolizumab, 1 mg
J2278 Injection, ziconotide, 1 microgram
J2323 Injection, natalizumab, 1 mg
J2326 Injection, nusinersen, 0.1 mg
J2350 Injection, ocrelizumab, 1 mg
J2353 Injection, octreotide, depot form for intramuscular injection, 1 mg
J2469 Injection, palonosetron HCl, 25 mcg
J2505 Injection, pegfilgrastim, 6 mg
J2778 Injection, ranibizumab, 0.1 mg 
J2796 Injection, romiplostim, 10 mcg
J2820 Injection, sargramostim (GM-CSF), 50 mcg
J2940 Injection, somatrem, 1 mg
J2941 Injection, somatropin, 1 mg
J3010 Injection, fentanyl citrate, 0.1 mg
J3060 Injection, taliglucerase alfa, 10 units
J3262 Injection, tocilizumab, 1 mg
J3357 Ustekinumab, for subcutaneous injection, 1 mg
J3358 Ustekinumab, for intravenous injection, 1 mg
J3380 Injection, vedolizumab, 1 mg
J3385 Injection, velaglucerase alfa, 100 units
J3396 Injection, verteporfin, 0.1 mg
J3489 Injection, zoledronic acid, 1 mg
J3490 Injection, zoledronic acid, 1 mg
J3590 Unclassified biologics
J7175 Injection, factor x, (human), 1 i.u. (New Code: 01/01/2017)
J7179 Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco (New Code: 01/01/2017)
J7180 Injection, factor XIII (antihemophilic factor, human), 1 IU
J7181 Injection, factor XIII A-subunit, (recombinant), per IU
J7182 Injection, factor VIII, (antihemophilic factor, recombinant), (NovoEight), per IU
J7183 Injection, von Willebrand factor complex (human), Wilate, 1 IU vWF:RCo
J7185 Injection, factor VIII (antihemophilic factor, recombinant) (XYNTHA), per IU
J7186 Injection, antihemophilic factor VIII/von Willebrand factor complex (human), per factor VIII i.u.
J7187 Injection, von Willebrand factor complex (Humate-P), per IU VWF:RCO
J7188 Injection, factor VIII (antihemophilic factor, recombinant), per IU
J7189 Factor VIIa (antihemophilic factor, recombinant), per 1 mcg
J7190 Factor VIII (antihemophilic factor, human) per IU
J7192 Factor VIII (antihemophilic factor, recombinant) per IU, not otherwise specified
J7193 Factor IX (antihemophilic factor, purified, nonrecombinant) per IU
J7194 Factor IX complex, per IU
J7195 Injection, factor IX (antihemophilic factor, recombinant) per IU, not otherwise specified
J7198 Antiinhibitor, per IU
J7199 Hemophilia clotting factor, not otherwise classified
J7200 Injection, factor IX, (antihemophilic factor, recombinant), Rixubis, per IU
J7201 Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. (Revised Code: 01/01/2017)
J7202 Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. (New Code: 01/01/2017)
J7205 Injection, factor VIII Fc fusion protein (recombinant), per IU
J7207 Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. (New Code: 01/01/2017)
J7209 Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. (New Code: 01/01/2017)
J7210 Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.
J7211 Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
J7308 Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form (354 mg)
J7320 Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg
J7321 Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular injection, per dose
J7322 Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg
J7323 Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose
J7324 Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose
J7325 Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg
J7326 Hyaluronan or derivative, Gel-One, for intra-articular injection, per dose
J7327 Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose
J7328 Hyaluronan or derivative, Gel-Syn, for intra-articular injection, 0.1 mg
J7330 Autologous cultured chondrocytes, implant
J9023 Injection, avelumab, 10 mg
J9035 Injection, bevacizumab, 10 mg " to "Injection, bevacizumab, (Avastin) 10 mg (Cancer indications only; ophthalmologic injections do not require PA.  Submit under J3490 with NDC
J9043 Injection, cabazitaxel, 1 mg
J9055 Injection, cetuximab, 10 mg
J9179 Injection, eribulin mesylate, 0.1 mg
J9219 Leuprolide acetate implant, 65 mg
J9225 Histrelin implant (Vantas), 50 mg
J9228 Injection, ipilimumab, 1 mg
J9264 Injection, paclitaxel protein-bound particles, 1 mg
J9271 Injection, pembrolizumab, 1 mg
J9299 Injection, nivolumab, 1 mg
J9303 Injection, panitumumab, 10 mg
J9305 Injection, pemetrexed, 10 mg
J9306 Injection, pertuzumab, 1 mg
J9310 Injection, rituximab, 100 mg
J9354 Injection, ado-trastuzumab emtansine, 1 mg
J9355 Injection, trastuzumab, 10 mg
K0001 Standard wheelchair
K0002 Standard hemi (low seat) wheelchair
K0003 Lightweight wheelchair
K0004 High strength, lightweight wheelchair
K0005 Ultralightweight wheelchair
K0006 Heavy duty wheelchair
K0007 Extra heavy duty wheelchair
K0008 Custom manual wheelchair/base
K0009 Other manual wheelchair/base
K0010 Standard - weight frame motorized/power wheelchair
K0011 Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
K0012 Lightweight portable motorized/power wheelchair
K0013 Custom motorized/power wheelchair base
K0014 Other motorized/power wheelchair base
K0015 Detachable, non-adjustable height armrest, replacement only, each
K0017 Detachable, adjustable height armrest, base, replacement only, each
K0018 Detachable, adjustable height armrest, upper portion, replacement only, each
K0019 Arm pad, replacement only, each
K0020 Fixed, adjustable height armrest, pair
K0037 High mount flip-up footrest, replacement only, each
K0038 Leg strap, each
K0039 Leg strap, h style, each
K0040 Adjustable angle footplate, each
K0041 Large size footplate, each
K0042 Standard size footplate, replacement only, each
K0043 Footrest, lower extension tube, replacement only, each
K0044 Footrest, upper hanger bracket, replacement only, each
K0045 Footrest, complete assembly, replacement only, each
K0046 Elevating legrest, lower extension tube, replacement only, each
K0047 Elevating legrest, upper hanger bracket, replacement only, each
K0050 Ratchet assembly, replacement only
K0051 Cam release assembly, footrest or legrest, replacement only, each
K0052 Swingaway, detachable footrests, replacement only, each
K0053 Elevating footrests, articulating (telescoping), each
K0056 Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair
K0065 Spoke protectors, each
K0069 Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each
K0070 Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each
K0071 Front caster assembly, complete, with pneumatic tire, replacement only, each
K0072 Front caster assembly, complete, with semi-pneumatic tire, replacement only, each
K0073 Caster pin lock, each
K0077 Front caster assembly, complete, with solid tire, replacement only, each
K0098 Drive belt for power wheelchair, replacement only
K0105 Iv hanger, each
K0108 Wheelchair component or accessory, not otherwise specified
K0195 Elevating leg rests, pair (for use with capped rental wheelchair base)
K0455 Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)
K0601 Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each
K0602 Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each
K0603 Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each
K0604 Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each
K0605 Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each
K0606 Automatic external defibrillator, with integrated electrocardiogram analysis, garment type
K0607 Replacement battery for automated external defibrillator, garment type only, each
K0608 Replacement garment for use with automated external defibrillator, each
K0609 Replacement electrodes for use with automated external defibrillator, garment type only, each
K0672 Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each
K0730 Controlled dose inhalation drug delivery system
K0733 Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
K0738 Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing
K0743 Repair or non routine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
K0744 Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 sq in or less Effective date
K0745 Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 sq in but less than or equal to 48 sq in.
K0746 Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 sq in Effective
K0800 Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds
K0801 Power operated vehicle, group 1 heavy-duty, patient weight capacity 301 to 450 pounds
K0802 Power operated vehicle, group 1 very heavy-duty, patient weight capacity 451 to 600 pounds
K0806 Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds
K0807 Power operated vehicle, group 2 heavy-duty, patient weight capacity 301 to 450 pounds
K0808 Power operated vehicle, group 2 very heavy-duty, patient weight capacity 451 to 600 pounds
K0812 Power operated vehicle, not otherwise classified
K0813 Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0814 Power wheelchair, group 1 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds
K0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0816 Power wheelchair, group 1 standard, captain's chair, patient weight capacity up to and including 300 pounds
K0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0821 Power wheelchair, group 2 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds
K0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0823 Power wheelchair, group 2 standard, captain's chair, patient weight capacity up to and including 300 pounds
K0824 Power wheelchair, group 2 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0825 Power wheelchair, group 2 heavy-duty, captain's chair, patient weight capacity 301 to 450 pounds
K0826 Power wheelchair, group 2 very heavy-duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0827 Power wheelchair, group 2 very heavy-duty, captain's chair, patient weight capacity 451 to 600 pounds
K0828 Power wheelchair, group 2 extra heavy-duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0829 Power wheelchair, group 2 extra heavy-duty, captain's chair, patient weight 601 pounds or more
K0830 Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0831 Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds
K0835 Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0836 Power wheelchair, group 2 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds
K0837 Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0838 Power wheelchair, group 2 heavy-duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds
K0839 Power wheelchair, group 2 very heavy-duty, single power option sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0840 Power wheelchair, group 2 extra heavy-duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0841 Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0842 Power wheelchair, group 2 standard, multiple power option, captain's chair, patient weight capacity up to and including 300 pounds
K0843 Power wheelchair, group 2 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0848 Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0849 Power wheelchair, group 3 standard, captain's chair, patient weight capacity up to and including 300 pounds
K0850 Power wheelchair, group 3 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0851 Power wheelchair, group 3 heavy-duty, captain's chair, patient weight capacity 301 to 450 pounds
K0852 Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0853 Power wheelchair, group 3 very heavy-duty, captain's chair, patient weight capacity 451 to 600 pounds
K0854 Power wheelchair, group 3 extra heavy-duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0855 Power wheelchair, group 3 extra heavy-duty, captain's chair, patient weight capacity 601 pounds or more
K0856 Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0857 Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds
K0858 Power wheelchair, group 3 heavy-duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds
K0859 Power wheelchair, group 3 heavy-duty, single power option, captain's chair, patient weight capacity 301 to 450 pounds
K0860 Power wheelchair, group 3 very heavy-duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0861 Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0862 Power wheelchair, group 3 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0863 Power wheelchair, group 3 very heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0864 Power wheelchair, group 3 extra heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0868 Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0869 Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds
K0870 Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0871 Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0877 Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0878 Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0879 Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0880 Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds
K0884 Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0885 Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds
K0886 Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0890 Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
K0891 Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds
K0898 Power wheelchair, not otherwise classified
K0899 Power mobility device, not coded by dme pdac or does not meet criteria
K0900 Customized durable medical equipment, other than wheelchair
L0112 Cranial cervical orthotic, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated
L0113 Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment
L0454 Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0455 Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf
L0457 Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf
L0458 Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0460 Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0462 Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0464 Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0466 Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0467 Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
L0468 Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0469 Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
L0470 Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
L0472 Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
L0480 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 1 piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated
L0482 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 1 piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated
L0484 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 2 piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated
L0486 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 2 piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated
L0488 Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment
L0490 Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment
L0491 Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0492 Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
L0624 Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
L0625 Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf
L0626 Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0627 Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0628 Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0629 Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated
L0630 Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0631 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0632 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
L0633 Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0634 Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated
L0635 Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment
L0636 Lumbar-sacral orthotic (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated
L0637 Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0638 Lumbar-sacral orthotic (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated
L0639 Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L0640 Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated
L0641 Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0642 Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0643 Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0648 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0649 Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0650 Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
L0651 Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf
L0700 Cervical-thoracic-lumbar-sacral orthotic (CTLSO), anterior-posterior-lateral control, molded to patient model, (Minerva type)
L0710 Cervical-thoracic-lumbar-sacral orthotic (CTLSO), anterior-posterior-lateral-control, molded to patient model, with interface material, (Minerva type)
L0820 Halo procedure, cervical halo incorporated into plaster body jacket
L0830 Halo procedure, cervical halo incorporated into Milwaukee type orthotic
L0980 Peroneal straps, prefabricated, off-the-shelf, pair
L0982 Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)
L1000 Cervical-thoracic-lumbar-sacral orthotic (CTLSO) (Milwaukee), inclusive of furnishing initial orthotic, including model
L1200 Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only
L1300 Other scoliosis procedure, body jacket molded to patient model
L1310 Other scoliosis procedure, postoperative body jacket
L1499 Spinal orthosis, not otherwise specified
L1690 Combination, bilateral, lumbo-sacral, hip, femur orthotic providing adduction and internal rotation control, prefabricated, includes fitting and adjustment
L1700 Legg Perthes orthotic, (Toronto type), custom fabricated
L1710 Legg Perthes orthotic, (Newington type), custom fabricated
L1720 Legg Perthes orthotic, trilateral, (Tachdijan type), custom fabricated
L1755 Legg Perthes orthotic, (Patten bottom type), custom fabricated
L1812 Knee orthosis, elastic with joints, prefabricated, off-the-shelf
L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
L1830 Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf
L1831 Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment
L1832 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1833 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
L1834 Knee orthosis, without knee joint, rigid, custom fabricated
L1836 Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf
L1840 Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated
L1843 Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1844 Knee orthotic (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
L1845 Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1846 Knee orthotic, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated
L1847 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L1848 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf
L1850 Knee orthosis, swedish type, prefabricated, off-the-shelf
L1851 Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
L1852 Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
L1860 Knee orthotic (KO), modification of supracondylar prosthetic socket, custom fabricated (SK)
L1900 Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated
L1902 Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
L1904 Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
L1906 Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf
L1907 Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated
L1910 Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment
L1920 Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated
L1930 Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment
L1932 Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment
L1940 Ankle foot orthosis, plastic or other material, custom fabricated
L1945 Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated
L1950 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated
L1951 Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L1970 Ankle foot orthosis, plastic with ankle joint, custom fabricated
L1971 Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment
L1980 Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated
L1990 Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated
L2000 Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated
L2005 Knee-ankle-foot orthotic (KAFO), any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated
L2010 Knee-ankle-foot orthotic (KAFO), single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'AK' orthotic), without knee joint, custom fabricated
L2020 Knee-ankle-foot orthotic (KAFO), double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'AK' orthotic), custom fabricated
L2030 Knee-ankle-foot orthotic (KAFO), double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'AK' orthotic), without knee joint, custom fabricated
L2034 Knee-ankle-foot orthotic (KAFO), full plastic, single upright, with or without free motion knee, medial-lateral rotation control, with or without free motion ankle, custom fabricated
L2035 Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment
L2036 Knee-ankle-foot orthotic (KAFO), full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated
L2037 Knee-ankle-foot orthotic (KAFO), full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated
L2038 Knee-ankle-foot orthotic (KAFO), full plastic, with or without free motion knee, multi-axis ankle, custom fabricated
L2106 Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated
L2108 Ankle-foot orthotic (AFO), fracture orthotic, tibial fracture cast orthotic, custom fabricated
L2112 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment
L2114 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
L2116 Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment
L2126 Knee-ankle-foot orthotic (KAFO), fracture orthotic, femoral fracture cast orthotic, thermoplastic type casting material, custom fabricated
L2128 Knee-ankle-foot orthotic (KAFO), fracture orthotic, femoral fracture cast orthotic, custom fabricated
L2132 Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment
L2134 Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment
L2136 Knee-ankle-foot orthotic (KAFO), fracture orthotic, femoral fracture cast orthotic, rigid, prefabricated, includes fitting and adjustment
L2192 Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt
L2350 Addition to lower extremity, prosthetic type, (BK) socket, molded to patient model, (used for PTB, AFO orthoses)
L2525 Addition to lower extremity, thigh/weight bearing, ischial containment/narrow M-L brim molded to patient model
L2627 Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
L2628 Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
L2750 Addition to lower extremity orthosis, plating chrome or nickel, per bar
L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
L2760 Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)
L2768 Orthotic side bar disconnect device, per bar
L2780 Addition to lower extremity orthosis, non-corrosive finish, per bar
L2999 Lower extremity orthoses, not otherwise specified
L3000 Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
L3001 Foot, insert, removable, molded to patient model, spenco, each
L3002 Foot, insert, removable, molded to patient model, plastazote or equal, each
L3003 Foot, insert, removable, molded to patient model, silicone gel, each
L3010 Foot, insert, removable, molded to patient model, longitudinal arch support, each
L3020 Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each
L3030 Foot, insert, removable, formed to patient foot, each
L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each
L3040 Foot, arch support, removable, premolded, longitudinal, each
L3050 Foot, arch support, removable, premolded, metatarsal, each
L3060 Foot, arch support, removable, premolded, longitudinal/ metatarsal, each
L3070 Foot, arch support, non-removable attached to shoe, longitudinal, each
L3080 Foot, arch support, non-removable attached to shoe, metatarsal, each
L3090 Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each
L3100 Hallus-valgus night dynamic splint, prefabricated, off-the-shelf
L3201 Orthopedic shoe, oxford with supinator or pronator, infant
L3203 Orthopedic shoe, oxford with supinator or pronator, junior
L3204 Orthopedic shoe, hightop with supinator or pronator, infant
L3206 Orthopedic shoe, hightop with supinator or pronator, child
L3207 Orthopedic shoe, hightop with supinator or pronator, junior
L3215 Orthopedic footwear, ladies shoe, oxford, each
L3216 Orthopedic footwear, ladies shoe, depth inlay, each
L3217 Orthopedic footwear, ladies shoe, hightop, depth inlay, each
L3219 Orthopedic footwear, mens shoe, oxford, each
L3221 Orthopedic footwear, mens shoe, depth inlay, each
L3222 Orthopedic footwear, mens shoe, hightop, depth inlay, each
L3224 Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthotic)
L3225 Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthotic)
L3230 Orthopedic footwear, custom shoe, depth inlay, each
L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each
L3251 Foot, shoe molded to patient model, silicone shoe, each
L3252 Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each
L3253 Foot, molded shoe plastazote (or similar) custom fitted, each
L3254 Non-standard size or width
L3255 Non-standard size or length
L3257 Orthopedic footwear, additional charge for split size
L3330 Lift, elevation, metal extension (skate)
L3674 Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3678 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf
L3702 Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3720 Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated
L3730 Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated
L3740 Elbow orthotic (EO), double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated
L3763 Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3764 Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3765 Elbow-wrist-hand-finger orthotic (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3766 Elbow-wrist-hand-finger orthotic (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type
L3900 Wrist-hand-finger orthotic (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated
L3901 Wrist-hand-finger orthotic (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated
L3912 Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf
L3916 Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf
L3918 Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf
L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf
L3930 Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf
L3971 Shoulder-elbow-wrist-hand orthotic (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3973 Shoulder-elbow-wrist-hand orthotic (SEWHO), abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3975 Shoulder-elbow-wrist-hand-finger orthotic (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3976 Shoulder-elbow-wrist-hand-finger orthotic (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3977 Shoulder-elbow-wrist-hand-finger orthotic (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3978 Shoulder-elbow-wrist-hand-finger orthotic (SEWHO), abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
L3981 Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments
L3999 Upper limb orthosis, not otherwise specified
L4002 Replacement strap, any orthosis, includes all components, any length, any type
L4010 Replace trilateral socket brim
L4020 Replace quadrilateral socket brim, molded to patient model
L4030 Replace quadrilateral socket brim, custom fitted
L4040 Replace molded thigh lacer, for custom fabricated orthosis only
L4361 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf
L4387 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf
L4396 Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
L4397 Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf
L4631 Ankle-foot orthotic, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated
L5010 Partial foot, molded socket, ankle height, with toe filler
L5020 Partial foot, molded socket, tibial tubercle height, with toe filler
L5050 Ankle, Symes, molded socket, SACH foot
L5060 Ankle, Symes, metal frame, molded leather socket, articulated ankle/foot
L5100 Below knee, molded socket, shin, SACH foot
L5105 Below knee, plastic socket, joints and thigh lacer, SACH foot
L5150 Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot
L5160 Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, SACH foot
L5200 Above knee, molded socket, single axis constant friction knee, shin, SACH foot
L5210 Above knee, short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each
L5220 Above knee, short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each
L5230 Above knee, for proximal femoral focal deficiency, constant friction knee, shin, SACH foot
L5250 Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot
L5270 Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, SACH foot
L5280 Hemipelvectomy, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot
L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system
L5312 Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system
L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee
L5331 Hip disarticulation, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, SACH foot
L5341 Hemipelvectomy, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, SACH foot
L5400 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee
L5410 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment
L5420 Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation
L5430 Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment
L5450 Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee
L5460 Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee
L5500 Initial, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed
L5505 Initial, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed
L5510 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model
L5520 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed
L5530 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model
L5535 Preparatory, below knee PTB type socket, nonalignable system, no cover, SACH foot, prefabricated, adjustable open end socket
L5540 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model
L5560 Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model
L5570 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed
L5580 Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model
L5585 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, prefabricated adjustable open end socket
L5590 Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model
L5595 Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model
L5600 Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, laminated socket, molded to patient model
L5610 Addition to lower extremity, endoskeletal system, above knee, hydracadence system
L5611 Addition to lower extremity, endoskeletal system, above knee, knee disarticulation, 4-bar linkage, with friction swing phase control
L5613 Addition to lower extremity, endoskeletal system, above knee, knee disarticulation, 4-bar linkage, with hydraulic swing phase control
L5614 Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control
L5616 Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control
L5617 Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each
L5618 Addition to lower extremity, test socket, symes
L5620 Addition to lower extremity, test socket, below knee
L5622 Addition to lower extremity, test socket, knee disarticulation
L5624 Addition to lower extremity, test socket, above knee
L5626 Addition to lower extremity, test socket, hip disarticulation
L5628 Addition to lower extremity, test socket, hemipelvectomy
L5629 Addition to lower extremity, below knee, acrylic socket
L5630 Addition to lower extremity, symes type, expandable wall socket
L5631 Addition to lower extremity, above knee or knee disarticulation, acrylic socket
L5632 Addition to lower extremity, symes type, 'ptb' brim design socket
L5634 Addition to lower extremity, symes type, posterior opening (canadian) socket
L5636 Addition to lower extremity, symes type, medial opening socket
L5637 Addition to lower extremity, below knee, total contact
L5638 Addition to lower extremity, below knee, leather socket
L5639 Addition to lower extremity, below knee, wood socket
L5640 Addition to lower extremity, knee disarticulation, leather socket
L5642 Addition to lower extremity, above knee, leather socket
L5643 Addition to lower extremity, hip disarticulation, flexible inner socket, external frame
L5644 Addition to lower extremity, above knee, wood socket
L5645 Addition to lower extremity, below knee, flexible inner socket, external frame
L5646 Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket
L5647 Addition to lower extremity, below knee suction socket
L5648 Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket
L5649 Addition to lower extremity, ischial containment/narrow M-L socket
L5650 Additions to lower extremity, total contact, above knee or knee disarticulation socket
L5651 Addition to lower extremity, above knee, flexible inner socket, external frame
L5652 Addition to lower extremity, suction suspension, above knee or knee disarticulation socket
L5653 Addition to lower extremity, knee disarticulation, expandable wall socket
L5654 Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)
L5655 Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)
L5656 Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)
L5658 Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)
L5661 Addition to lower extremity, socket insert, multi-durometer symes
L5665 Addition to lower extremity, socket insert, multi-durometer, below knee
L5666 Addition to lower extremity, below knee, cuff suspension
L5668 Addition  to lower extremity, below knee, molded distal cushion
L5670 Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)
L5671 Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert
L5672 Addition to lower extremity, below knee, removable medial brim suspension
L5673 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism
L5676 Additions to lower extremity, below knee, knee joints, single axis, pair
L5677 Additions to lower extremity, below knee, knee joints, polycentric, pair
L5678 Additions to lower extremity, below knee, joint covers, pair
L5679 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
L5680 Addition to lower extremity, below knee, thigh lacer, nonmolded
L5681 Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679)
L5682 Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded
L5683 Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679)
L5684 Addition to lower extremity, below knee, fork strap
L5685 Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each
L5686 Addition to lower extremity, below knee, back check (extension control)
L5688 Addition to lower extremity, below knee, waist belt, webbing
L5690 Addition to lower extremity, below knee, waist belt, padded and lined
L5692 Addition to lower extremity, above knee, pelvic control belt, light
L5694 Addition to lower extremity, above knee, pelvic control belt, padded and lined
L5695 Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each
L5696 Addition to lower extremity, above knee or knee disarticulation, pelvic joint
L5697 Addition to lower extremity, above knee or knee disarticulation, pelvic band
L5698 Addition to lower extremity, above knee or knee disarticulation, silesian bandage
L5699 All lower extremity prostheses, shoulder harness
L5700 Replacement, socket, below knee, molded to patient model
L5701 Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model
L5702 Replacement, socket, hip disarticulation, including hip joint, molded to patient model
L5703 Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only
L5704 Custom shaped protective cover, below knee
L5705 Custom shaped protective cover, above knee
L5706 Custom shaped protective cover, knee disarticulation
L5707 Custom shaped protective cover, hip disarticulation
L5710 Addition, exoskeletal knee-shin system, single axis, manual lock
L5711 Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material
L5712 Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
L5714 Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control
L5716 Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5718 Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control
L5722 Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
L5724 Addition, exoskeletal knee-shin system, single axis, fluid swing phase control
L5726 Addition, exoskeletal knee-shin system, single axis, external joints, fluid swing phase control
L5728 Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5780 Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control
L5781 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
L5782 Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty
L5785 Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5790 Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5795 Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
L5810 Addition, endoskeletal knee-shin system, single axis, manual lock
L5811 Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material
L5812 Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)
L5814 Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock
L5816 Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock
L5818 Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control
L5822 Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control
L5824 Addition, endoskeletal knee-shin system, single axis, fluid swing phase control
L5826 Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame
L5828 Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5830 Addition, endoskeletal knee-shin system, single axis, pneumatic/swing phase control
L5840 Addition, endoskeletal knee-shin system, 4-bar linkage or multiaxial, pneumatic swing phase control
L5845 Addition, endoskeletal knee-shin system, stance flexion feature, adjustable
L5848 Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
L5850 Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist
L5855 Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist
L5856 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5857 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type
L5858 Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
L5859 Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)
L5910 Addition, endoskeletal system, below knee, alignable system
L5920 Addition, endoskeletal system, above knee or hip disarticulation, alignable system
L5925 Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock
L5930 Addition, endoskeletal system, high activity knee control frame
L5940 Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)
L5950 Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
L5960 Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)
L5961 Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
L5962 Addition, endoskeletal system, below knee, flexible protective outer surface covering system
L5964 Addition, endoskeletal system, above knee, flexible protective outer surface covering system
L5966 Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system
L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
L5969 Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
L5970 All lower extremity prostheses, foot, external keel, sach foot
L5971 All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only
L5972 All lower extremity prostheses, foot, flexible keel
L5973 Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source
L5974 All lower extremity prostheses, foot, single axis ankle/foot
L5975 All lower extremity prosthesis, combination single axis ankle and flexible keel foot
L5976 All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)
L5978 All lower extremity prostheses, foot, multiaxial ankle/foot
L5979 All lower extremity prostheses, multiaxial ankle, dynamic response foot, one piece system
L5980 All lower extremity prostheses, flex-foot system
L5981 All lower extremity prostheses, flex-walk system or equal
L5982 All exoskeletal lower extremity prostheses, axial rotation unit
L5984 All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability
L5985 All endoskeletal lower extremity prostheses, dynamic prosthetic pylon
L5986 All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)
L5987 All lower extremity prostheses, shank foot system with vertical loading pylon
L5988 Addition to lower limb prosthesis, vertical shock reducing pylon feature
L5990 Addition to lower extremity prosthesis, user adjustable heel height
L5999 Lower extremity prosthesis, not otherwise specified
L6611 Addition to upper extremity prosthesis, external powered, additional switch, any type
L6621 Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device
L6629 Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal
L6632 Upper extremity addition, latex suspension sleeve, each
L6677 Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow
L6680 Upper extremity addition, test socket, wrist disarticulation or below elbow
L6682 Upper extremity addition, test socket, elbow disarticulation or above elbow
L6686 Upper extremity addition, suction socket
L6687 Upper extremity addition, frame type socket, below elbow or wrist disarticulation
L6688 Upper extremity addition, frame type socket, above elbow or elbow disarticulation
L6694 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism
L6695 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
L6696 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695)
L6697 Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695)
L6698 Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert
L6880 Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
L6881 Automatic grasp feature, addition to upper limb electric prosthetic terminal device
L6882 Microprocessor control feature, addition to upper limb prosthetic terminal device
L6883 Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power
L6884 Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power
L6890 Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment
L6925 Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal electrodes, cables, 2 batteries and one charger, myoelectronic control of terminal device
L6935 Below elbow, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal electrodes, cables, 2 batteries and one charger, myoelectronic control of terminal device
L6945 Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, Otto Bock or equal electrodes, cables, 2 batteries and one charger, myoelectronic control of terminal device
L6955 Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, Otto Bock or equal electrodes, cables, 2 batteries and one charger, myoelectronic control of terminal device
L7007 Electric hand, switch or myoelectric controlled, adult
L7008 Electric hand, switch or myoelectric, controlled, pediatric
L7009 Electric hook, switch or myoelectric controlled, adult
L7040 Prehensile actuator, switch controlled
L7045 Electric hook, switch or myoelectric controlled, pediatric
L7170 Electronic elbow, Hosmer or equal, switch controlled
L7180 Electronic elbow, microprocessor sequential control of elbow and terminal device
L7181 Electronic elbow, microprocessor simultaneous control of elbow and terminal device
L7185 Electronic elbow, adolescent, Variety Village or equal, switch controlled
L7186 Electronic elbow, child, Variety Village or equal, switch controlled
L7190 Electronic elbow, adolescent, Variety Village or equal, myoelectronically controlled
L7191 Electronic elbow, child, Variety Village or equal, myoelectronically controlled
L7259 Electronic wrist rotator, any type
L7360 Six volt battery, each
L7364 Twelve volt battery, each
L7366 Battery charger, twelve volt, each
L7367 Lithium ion battery, rechargeable, replacement
L7368 Lithium ion battery charger, replacement only
L7400 Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)
L7401 Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)
L7403 Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material
L7404 Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
L7499 Upper extremity prosthesis, not otherwise specified
L7510 Repair of prosthetic device, repair or replace minor parts
L7520 Repair prosthetic device, labor component, per 15 minutes
L7600 Prosthetic donning sleeve, any material, each
L7900 Male vacuum erection system
L7902 Tension ring, for vacuum erection device, any type, replacement only, each
L8002 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
L8035 Custom breast prosthesis, post mastectomy, molded to patient model
L8040 Nasal prosthesis, provided by a nonphysician
L8041 Midfacial prosthesis, provided by a nonphysician
L8042 Orbital prosthesis, provided by a nonphysician
L8043 Upper facial prosthesis, provided by a nonphysician
L8044 Hemi-facial prosthesis, provided by a nonphysician
L8045 Auricular prosthesis, provided by a nonphysician
L8046 Partial facial prosthesis, provided by a nonphysician
L8047 Nasal septal prosthesis, provided by a non-physician
L8048 Unspecified maxillofacial prosthesis, by report, provided by a non-physician
L8049 Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician
L8400 Prosthetic sheath, below knee, each
L8410 Prosthetic sheath, above knee, each
L8417 Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each
L8430 Prosthetic sock, multiple ply, above knee, each
L8465 Prosthetic shrinker, upper limb, each
L8480 Prosthetic sock, single ply, fitting, above knee, each
L8603 Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies
L8604 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies
L8606 Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies
L8614 Cochlear device, includes all internal and external components
L8618 Transmitter cable for use with cochlear implant device, replacement
L8619 Cochlear implant, external speech processor and controller, integrated system, replacement
L8621 Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each
L8624 Lithium ion battery for use with cochlear implant device speech processor, ear level, replacement, each
L8625 External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each
L8627 Cochlear implant, external speech processor, component, replacement
L8628 Cochlear implant, external controller component, replacement
L8679 Implantable neurostimulator, pulse generator, any type
L8680 Implantable neurostimulator electrode, each. Revised Code
L8681 Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
L8682 Implantable neurostimulator radiofrequency receiver
L8683 Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver
L8684 Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement
L8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension
L8686 Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension
L8687 Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension
L8688 Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension
L8689 External recharging system for battery (internal) for use with implantable neurostimulator, replacement only
L8690 Auditory osseointegrated device, includes all internal and external components
L8691 Auditory osseointegrated device, external sound processor, replacement
L8692 Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment
L8694 Auditory osseointegrated device, transducer/actuator, replacement only, each
L9900 Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code
Q0477 Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0478 Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type
Q0479 Power module for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0480 Driver for use with pneumatic ventricular assist device, replacement only
Q0481 Microprocessor control unit for use with electric ventricular assist device, replacement only
Q0482 Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only
Q0483 Monitor/display module for use with electric ventricular assist device, replacement only
Q0484 Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0485 Monitor control cable for use with electric ventricular assist device, replacement only
Q0486 Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only
Q0487 Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only
Q0488 Power pack base for use with electric ventricular assist device, replacement only
Q0489 Power pack base for use with electric/pneumatic ventricular assist device, replacement only
Q0490 Emergency power source for use with electric ventricular assist device, replacement only
Q0491 Emergency power source for use with electric/pneumatic ventricular assist device, replacement only
Q0492 Emergency power supply cable for use with electric ventricular assist device, replacement only
Q0493 Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only
Q0494 Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0495 Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0496 Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0497 Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0498 Holster for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0499 Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only
Q0500 Filters for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0501 Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0502 Mobility cart for pneumatic ventricular assist device, replacement only
Q0503 Battery for pneumatic ventricular assist device, replacement only, each
Q0504 Power adapter for pneumatic ventricular assist device, replacement only, vehicle type
Q0506 Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0515 Injection, sermorelin acetate, 1 mcg
Q2040 Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
Q2041 Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, including leukapheresis and dose preparation procedures, per infusion
Q2043 Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion
Q3001 Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion
Q4100 Skin substitute, not otherwise specified
Q4101 Apligraf, per sq cm
Q4102 Oasis wound matrix, per sq cm
Q4103 Oasis burn matrix, per sq cm
Q4104 Integra bilayer matrix wound dressing (BMWD), per sq cm
Q4105 Integra dermal regeneration template (DRT) or Integra Omnigraft dermal regeneration matrix, per sq cm
Q4106 Dermagraft, per sq cm
Q4107 GRAFTJACKET, per sq cm
Q4108 Integra matrix, per sq cm
Q4110 PriMatrix, per sq cm
Q4111 GammaGraft, per sq cm
Q4112 Cymetra, injectable, 1 cc
Q4115 AlloSkin, per sq cm
Q4116 AlloDerm, per sq cm
Q4117 HYALOMATRIX, per sq cm
Q4118 MatriStem micromatrix, 1 mg
Q4121 TheraSkin, per sq cm
Q4122 DermACELL, per sq cm
Q4123 AlloSkin RT, per sq cm
Q4124 OASIS ultra tri-layer wound matrix, per sq cm
Q4126 MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm
Q4127 Talymed, per sq cm
Q4128 FlexHD, AllopatchHD, or Matrix HD, per sq cm
Q4130 Strattice TM, per sq cm
Q4131 EpiFix or Epicord, per sq cm
Q4132 Grafix Core, per sq cm
Q4133 Grafix Prime, per sq cm
Q4134 HMatrix, per sq cm
Q4135 Mediskin, per sq cm
Q4136 E-Z Derm, per sq cm
Q4137 AmnioExcel or BioDExCel, per sq cm
Q4140 BioDFence, per sq cm
Q4141 AlloSkin AC, per sq cm
Q4146 Tensix, per sq cm
Q4147 Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm
Q4148 Neox 1k, per sq cm
Q4151 AmnioBand or Guardian, per sq cm
Q4152 DermaPure, per sq cm
Q4153 Dermavest and Plurivest, per sq cm
Q4154 Biovance, per sq cm
Q4156 Neox 100, per sq cm
Q4157 Revitalon, per sq cm
Q4158 Marigen, per sq cm
Q4159 Affinity, per sq cm
Q4160 Nushield, per sq cm
Q4161 Bio-ConneKt wound matrix, per sq cm
Q4163 AmnioPro, BioSkin, BioRenew, WoundEx, Amniogen-45, Amniogen-200, per sq cm
Q4164 Helicoll, per sq cm
Q4165 Keramatrix, per sq cm
Q4166 Cytal, per sq cm
Q4169 Artacent wound, per sq cm
Q4172 PuraPly or PuraPly AM, per sq cm
Q4173 PalinGen or PalinGen XPlus, per sq cm
Q4175 Miroderm, per sq cm
Q4182 Transcyte, per square centimeter
Q5105 Injection, epoetin alfa, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units
Q5106 Injection, epoetin alfa, biosimilar, (Retacrit) (for non-ESRD use), 1000 units
Q5108 Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg
Q5510 Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
Q9950 Injection, sulfur hexafluoride lipid microspheres, per ml
Q9993 Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
Q9995 Injection, emicizumab-kxwh, 0.5 mg
S0265 Genetic counseling, under physician supervision, each 15 minutes
S0515 Scleral lens, liquid bandage device, per lens
S0596 Phakic intraocular lens for correction of refractive error
S0800 Laser in situ keratomileusis (LASIK)
S0810 Photorefractive keratectomy (PRK)
S0812 Phototherapeutic keratectomy (PTK)
S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)
S2053 Transplantation of small intestine and liver allografts
S2054 Transplantation of multivisceral organs
S2060 Lobar lung transplantation
S2065 Simultaneous pancreas kidney transplantation
S2066 Breast reconstruction with gluteal artery perforator (GAP) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral
S2067 Breast reconstruction of a single breast with "stacked" deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral
S2068 Breast reconstruction with deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SIEA) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral
S2080 Laser-assisted uvulopalatoplasty (LAUP)
S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline
S2095 Transcatheter occlusion or embolization for tumor destruction, percutaneous, any method, using yttrium-90 microspheres
S2112 Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells)
S2118 Metal-on-metal total hip resurfacing, including acetabular and femoral components
S2142 Cord blood-derived stem-cell transplantation, allogeneic
S2150 Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre and post transplant care in the global definition
S2202 Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre and post transplant care in the global definition
S2342 Nasal endoscopy for post-operative debridement following functional endoscopic sinus surgery, nasal and/or sinus cavity(s), unilateral or bilateral
S2350 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace
S2351 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, each additional interspace (list separately in addition to code for primary procedure)
S2900 Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)
S3845 Genetic testing for alpha-thalassemia
S3846 Genetic testing for hemoglobin E beta-thalassemia
S3849 Genetic testing for Niemann-Pick disease
S3850 Genetic testing for sickle cell anemia
S3852 DNA analysis for APOE epsilon 4 allele for susceptibility to Alzheimer's disease
S3854 Gene expression profiling panel for use in the management of breast cancer treatment (Eff.07/01/2016)
S3861 Genetic testing, sodium channel, voltage-gated, type V, alpha subunit (SCN5A) and variants for suspected Brugada Syndrome
S3865 Genetic testing, sodium channel, voltage-gated, type V, alpha subunit (SCN5A) and variants for suspected Brugada Syndrome
S3866 Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy (HCM) in an individual with a known HCM mutation in the family
S3870 Comparative genomic hybridization (CGH) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability
S5102 Day care services, adult; per diem
S5105 Day care services, center-based; services not included in program fee, per diem
S5120 Chore services; per 15 minutes
S5121 Chore services; per diem
S5130 Homemaker service, NOS; per 15 minutes
S5131 Homemaker service, NOS; per diem
S5150 Unskilled respite care, not hospice; per 15 minutes
S5160 Emergency response system; installation and testing
S5161 Emergency response system; service fee, per month (excludes installation and testing)
S5165 Home modifications; per service
S5170 Home delivered meals, including preparation; per meal
S8030 Home delivered meals, including preparation; per meal
S8035 Magnetic source imaging
S8037 Magnetic resonance cholangiopancreatography (MRCP)
S8042 Magnetic resonance imaging (MRI), low-field
S8080 Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical
S8085 Fluorine-18 fluorodeoxyglucose (F-18 FDG) imaging using dual-head coincidence detection system (nondedicated PET scan)
S8092 Electron beam computed tomography (also known as ultrafast CT, cine CT)
S8950 Complex lymphedema therapy, each 15 minutes
S9001 Home uterine monitor with or without associated nursing services
S9055 Procuren or other growth factor preparation to promote wound healing
S9123 Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codes 99500-99602 can be used)
S9124 Nursing care, in the home; by licensed practical nurse, per hour
S9127 Social work visit, in the home, per diem
S9128 Speech therapy, in the home, per diem
S9129 Occupational therapy, in the home, per diem
S9131 Physical therapy; in the home, per diem
S9140 Diabetic management program, follow-up visit to non-MD provider
S9145 Insulin pump initiation, instruction in initial use of pump (pump not included)
S9152 Speech therapy, re-evaluation
S9208 Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)
S9211 Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9212 Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)
S9213 Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately); per diem (do not use this code with any home infusion per diem code)
S9214 Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9329 Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with S9330 or S9331)
S9330 Home infusion therapy, continuous (24 hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9331 Home infusion therapy, intermittent (less than 24 hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9336 Home infusion therapy, continuous anticoagulant infusion therapy (e.g., Heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9346 Home infusion therapy, alpha-1-proteinase inhibitor (e.g., Prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9349 Home infusion therapy, tocolytic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9351 Home infusion therapy, continuous or intermittent antiemetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately), per diem
S9353 Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9355 Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9359 Home infusion therapy, antitumor necrosis factor intravenous therapy; (e.g., Infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9373 Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use with hydration therapy codes S9374-S9377 using daily volume scales)
S9374 Home infusion therapy, hydration therapy; 1 liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9375 Home infusion therapy, hydration therapy; more than 1 liter but no more than 2 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9376 Home infusion therapy, hydration therapy; more than 2 liters but no more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9377 Home infusion therapy, hydration therapy; more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), per diem
S9379 Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9472 Cardiac rehabilitation program, nonphysician provider, per diem
S9542 Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9558 Home injectable therapy; growth hormone, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9560 Home injectable therapy; hormonal therapy (e.g., leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9810 Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code)
S9960 Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)
S9961 Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)
T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
T1020 Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs
T1030 Nursing care, in the home, by registered nurse, per diem
T1031 Nursing care, in the home, by licensed practical nurse, per diem
T2002 Nonemergency transportation; per diem
T2003 Nonemergency transportation; encounter/trip
T2004 Nonemergency transport; commercial carrier, multipass
T2005 Nonemergency transportation; stretcher van
T2101 Human breast milk processing, storage and distribution only
V2790 Amniotic membrane for surgical reconstruction, per procedure
V5008 Hearing Screening
V5010 Assessment for Hearing Aid
V5011 Fitting/orientation/checking of hearing aid
V5020 Conformity evaluation
V5030 Hearing aid, monaural, body worn, air conduction
V5040 Hearing aid, monaural, body worn, bone conduction
V5050 Hearing aid, monaural, in the ear
V5060 Hearing aid, monaural, behind the ear
V5070 Glasses, air conduction
V5080 Glasses, bone conduction
V5090 Dispensing fee, unspecified hearing aid
V5095 Semi-implantable middle ear hearing prosthesis
V5100 Hearing aid, bilateral, body worn
V5110 Dispensing fee, bilateral
V5120 Binaural, body
V5130 Binaural, in the ear
V5140 Binaural, in the ear
V5150 Binaural, glasses
V5160 Dispensing fee, binaural
V5190 Hearing aid, CROS, glasses
V5200 Dispensing fee, CROS
V5230 Hearing aid, BICROS, glasses
V5240 Dispensing fee, BICROS
V5242 Hearing aid, analog, monaural, CIC (completely in the ear)
V5243 Hearing aid, analog, monaural, ITC (in the canal)
V5244 Hearing aid, digitally programmable analog, monaural
V5245 Hearing aid, digitally programmable analog, monaural, ITE
V5246 Hearing aid, digitally programmable analog, monaural, ITE (in the ear)
V5247 Hearing aid, digitally programmable analog, monaural, BTE (behind the ear)
V5248 Hearing aid, analog, binaural, CIC
V5249 Hearing aid, analog, binaural, ITC
V5250 Hearing aid, digitally programmable analog, binaural, CIC
V5251 Hearing aid, digitally programmable analog, binaural, ITC
V5252 Hearing aid, digitally programmable, binaural, ITE
V5253 Hearing aid, digitally programmable, binaural, BTEV5256
V5255 Hearing aid, digital, monaural, ITC
V5258 Hearing aid, digital, binaural, CIC
V5259 Hearing aid, digital, binaural, ITC
V5260 Hearing aid, digital, binaural, ITE
V5261 Hearing aid, digital, binaural, BTE
V5267 Hearing aid or assistive listening
V5268 Assistive listening device, telephone amplifier, any type
V5269 Assistive listening device, alerting, any type
V5270 Assistive listening device, television amplifier, any type
V5271 Assistive listening device, television caption decoder
V5272 Assistive listening device, TDD
V5273 Assistive listening device, for use with cochlear implant
V5275 Ear impression, each
V5281 Assistive listening device, personal FM/DM system, monaural (1 receiver, transmitter, microphone), any type
V5282 Assistive listening device, personal FM/DM system, binaural (2 receivers, transmitter, microphone), any type
V5283 Assistive listening device, personal FM/DM neck, loop induction receiver
V5284 Assistive listening device, personal FM/DM, ear level receiver
V5285 Assistive listening device, personal FM/DM, direct audio input receiver
V5286 Assistive listening device, personal blue tooth FM/DM receiver
V5287 Assistive listening device, personal FM/DM receiver, not otherwise specifiedV5288
V5289 Assistive listening device, personal FM/DM adapter/boot coupling device for receiver, any type
V5290 Assistive listening device, transmitter microphone, any type
V5298 Hearing aid, not otherwise classified
V5299 Hearing service, miscellaneous