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 |