Addendum M.-Proposed HCPCS Codes for Assignment to Composite APCs for CY 2013

CPT codes and descriptions only are copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

HCPCS Code Short Descriptor CI SI Single Code APC Assignment 90801 Psy dx interview Q3 0323 90802 Intac psy dx interview Q3 0323 90804 Psytx office 20-30 min Q3 0322 90805 Psytx off 20-30 min w/e&m Q3 0322 90806 Psytx off 45-50 min Q3 0323 90807 Psytx off 45-50 min w/e&m Q3 0323 90808 Psytx office 75-80 min Q3 0323 90809 Psytx off 75-80 w/e&m Q3 0323 90810 Intac psytx off 20-30 min Q3 0322 90811 Intac psytx 20-30 w/e&m Q3 0322 90812 Intac psytx off 45-50 min Q3 0323 90813 Intac psytx 45-50 min w/e&m Q3 0323 90814 Intac psytx off 75-80 min Q3 0323 90815 Intac psytx 75-80 w/e&m Q3 0323 90845 Psychoanalysis Q3 0323 90846 Family psytx w/o patient Q3 0324 90847 Family psytx w/patient Q3 0324 90849 Multiple family group psytx Q3 0325 90853Group psychotherapy Q3 0325 90857 Intac group psytx Q3 0325 90862 Medication management Q3 0605 90865 Narcosynthesis Q3 0323 90880 Hypnotherapy Q3 0323 90899 Psychiatric service/therapy Q3 0322 96101 Psycho testing by psych/phys Q3 0382 96102 Psycho testing by technician Q3 0373 96103 Psycho testing admin by comp Q3 0373 96111 Developmental test extend Q3 0373 96116 Neurobehavioral status exam Q3 0382 96118 Neuropsych tst by psych/phys Q3 0382 96119 Neuropsych testing by tec Q3 0382 96120 Neuropsych tst admin w/comp CH Q3 0373 96150Assess hlth/behave init Q3 0432 96151 Assess hlth/behave subseq Q3 0432 96152 Intervene hlth/behave indiv Q3 0432 96153 Intervene hlth/behave group CH Q3 0031 96154 Interv hlth/behav fam w/pt Q3 0432 G0451 Devlopment test interpt&rep Q3 0432 M0064Visit for drug monitoring CH Q3 0606 33225 L ventric pacing lead add-on Q3 0655 33249 Nsert pace-defib w/lead Q3 0108 36600Withdrawal of arterial blood Q3 003543752 Nasal/orogastric w/stent Q3 0272

71010Chest x-ray Q3 0260 71015 Chest x-ray Q3 0260 71020Chest x-ray Q3 0260 92953Temporary external pacing Q3 0094 94002Vent mgmt inpat init day Q3 0079 94003Vent mgmt inpat subq day Q3 0079 94660 Pos airway pressure cpap Q3 0078 94662 Neg press ventilation cnp Q3 0079 94762 Measure blood oxygen level Q3 0097 93619 Electrophysiology evaluation Q3 0085 93620 Electrophysiology evaluation Q3 0085 93650Ablate heart dysrhythm focus Q3 0085 93651 Ablate heart dysrhythm focus Q3 0086 93652Ablate heart dysrhythm focus Q3 0086 55875Transperi needle place pros Q3 0163 77778Apply interstit radiat compl Q3 0651 99205Office/outpatient visit new Q3 0608 99215Office/outpatient visit est Q3 0607 G0379Direct refer hospital observ Q3 0604 99284 Emergency dept visit Q3 0615 99285 Emergency dept visit Q3 0616 99291 Critical care first hour Q3 0617 G0384Lev 5 hosp type B ED visit Q3 0630 76604 Us exam chest Q3 0265 76700 Us exam abdom complete Q3 0266 76705 Echo exam of abdomen Q3 0266 76770 Us exam abdo back wall comp Q3 0266 76775 Us exam abdo back wall lim Q3 0266 76776 Us exam k transpl w/doppler Q3 0266 76831 Echo exam uterus Q3 0267 76856 Us exam pelvic complete Q3 0266 76857 Us exam pelvic limited Q3 0265 76870 Us exam scrotum Q3 0266 74176Ct abd & pelvis Q3 0331 70450Ct head/brain w/o dye Q3 0332 70480Ct orbit/ear/fossa w/o dye Q3 0332 70486Ct maxillofacial w/o dye Q3 0332 70490Ct soft tissue neck w/o dye Q3 0332 71250Ct thorax w/o dye Q3 0332 72125 Ct neck spine w/o dye Q3 0332 72128 Ct chest spine w/o dye Q3 0332 72131 Ct lumbar spine w/o dye Q3 0332 72192 Ct pelvis w/o dye Q3 0332 73200Ct upper extremity w/o dye Q3 0332 73700Ct lower extremity w/o dye Q3 0332 74150Ct abdomen w/o dye Q3 0332 74261 Ct colonography dx Q3 0332 70460Ct head/brain w/dye Q3 0283 70470Ct head/brain w/o & w/dye Q3 033370481 Ct orbit/ear/fossa w/dye Q3 0283

70482 Ct orbit/ear/fossa w/o&w/dye Q3 0333 70487Ct maxillofacial w/dye Q3 0283 70488 Ct maxillofacial w/o & w/dye Q3 0333 70491 Ct soft tissue neck w/dye Q3 0283 70492 Ct sft tsue nck w/o & w/dye Q3 0333 70496Ct angiography head Q3 0662 70498 Ct angiography neck Q3 0662 71260Ct thorax w/dye Q3 0283 71270Ct thorax w/o & w/dye Q3 0333 71275 Ct angiography chest Q3 0662 72126Ct neck spine w/dye Q3 0283 72127Ct neck spine w/o & w/dye Q3 0333 72129 Ct chest spine w/dye Q3 0283 72130Ct chest spine w/o & w/dye Q3 0333 72132 Ct lumbar spine w/dye Q3 0283 72133Ct lumbar spine w/o & w/dye Q3 0333 72191 Ct angiograph pelv w/o&w/dye Q3 0662 72193Ct pelvis w/dye Q3 0283 72194Ct pelvis w/o & w/dye Q3 0333 73201 Ct upper extremity w/dye Q3 0283 73202 Ct uppr extremity w/o&w/dye Q3 0333 73206Ct angio upr extrm w/o&w/dye Q3 0662 73701 Ct lower extremity w/dye Q3 0283 73702 Ct lwr extremity w/o&w/dye Q3 0333 73706Ct angio lwr extr w/o&w/dye Q3 0662 74160Ct abdomen w/dye Q3 0283 74170Ct abdomen w/o & w/dye Q3 0333 74175 Ct angio abdom w/o & w/dye Q3 0662 74177Ct abd & pelv w/contrast Q3 0334 74178 Ct abd & pelv 1/> regns Q3 0334 74262 Ct colonography dx w/dye Q3 0283 75635 Ct angio abdominal arteries Q3 0662 70336 Magnetic image jaw joint Q3 0336 70540 Mri orbit/face/neck w/o dye Q3 0336 70544 Mr angiography head w/o dye Q3 0336 70547 Mr angiography neck w/o dye Q3 0336 70551 Mri brain w/o dye Q3 0336 70554 Fmri brain by tech Q3 0336 71550 Mri chest w/o dye Q3 0336 72141 Mri neck spine w/o dye Q3 0336 72146 Mri chest spine w/o dye Q3 0336 72148 Mri lumbar spine w/o dye Q3 0336 72195 Mri pelvis w/o dye Q3 0336 73218 Mri upper extremity w/o dye Q3 0336 73221 Mri joint upr extrem w/o dye Q3 0336 73718 Mri lower extremity w/o dye Q3 0336 73721 Mri jnt of lwr extre w/o dye Q3 0336 74181 Mri abdomen w/o dye Q3 0336 75557Cardiac mri for morph Q3 033675559 Cardiac mri w/stress img Q3 0336

C8901 MRA w/o cont, abd Q3 0336 C8904MRI w/o cont, breast, uni Q3 0336 C8907MRI w/o cont, breast, bi Q3 0336 C8910MRA w/o cont, chest Q3 0336 C8913MRA w/o cont, lwr ext Q3 0336 C8919MRA w/o cont, pelvis Q3 0336 C8932MRA, w/o dye, spinal canal Q3 0336 C8935MRA, w/o dye, upper extr Q3 0336 70542 Mri orbit/face/neck w/dye Q3 0284 70543 Mri orbt/fac/nck w/o & w/dye Q3 0337 70545 Mr angiography head w/dye Q3 0284 70546 Mr angiograph head w/o&w/dye Q3 0337 70548 Mr angiography neck w/dye Q3 0284 70549 Mr angiograph neck w/o&w/dye Q3 0337 70552 Mri brain w/dye Q3 0284 70553 Mri brain w/o & w/dye Q3 0337 71551 Mri chest w/dye Q3 0284 71552 Mri chest w/o & w/dye Q3 0337 72142 Mri neck spine w/dye Q3 0284 72147 Mri chest spine w/dye Q3 0284 72149 Mri lumbar spine w/dye Q3 0284 72156 Mri neck spine w/o & w/dye Q3 0337 72157 Mri chest spine w/o & w/dye Q3 0337 72158 Mri lumbar spine w/o & w/dye Q3 0337 72196 Mri pelvis w/dye Q3 0284 72197 Mri pelvis w/o & w/dye Q3 0337 73219 Mri upper extremity w/dye Q3 0284 73220 Mri uppr extremity w/o&w/dye Q3 0337 73222 Mri joint upr extrem w/dye Q3 0284 73223 Mri joint upr extr w/o&w/dye Q3 0337 73719 Mri lower extremity w/dye Q3 0284 73720 Mri lwr extremity w/o&w/dye Q3 0337 73722 Mri joint of lwr extr w/dye Q3 0284 73723 Mri joint lwr extr w/o&w/dye Q3 0337 74182 Mri abdomen w/dye Q3 0284 74183 Mri abdomen w/o & w/dye Q3 0337 75561 Cardiac mri for morph w/dye Q3 0337 75563Card mri w/stress img & dye Q3 0337 C8900MRA w/cont, abd Q3 0284 C8902MRA w/o fol w/cont, abd Q3 0337 C8903MRI w/cont, breast, uni Q3 0284 C8905MRI w/o fol w/cont, brst, un Q3 0337 C8906MRI w/cont, breast, bi Q3 0284 C8908MRI w/o fol w/cont, breast, Q3 0337 C8909MRA w/cont, chest Q3 0284 C8911 MRA w/o fol w/cont, chest Q3 0337 C8912MRA w/cont, lwr ext Q3 0284 C8914MRA w/o fol w/cont, lwr ext Q3 0337 C8918MRA w/cont, pelvis Q3 0284C8920MRA w/o fol w/cont, pelvis Q3 0337

C8931 MRA, w/dye, spinal canal Q3 0284 C8933MRA, w/o&w/dye, spinal canal Q3 0337 C8934MRA, w/dye, upper extremity Q3 0284 C8936MRA, w/o&w/dye, upper extr Q3 0337Addendum M.-Proposed HCPCS Codes for Assignment to Composite APCs for CY 2013

Composite APC Assignment 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0034 0108 0108 0617, 0618, or 80030617, 0618, or 8003

0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 0617, 0618, or 8003 8000 8000 8000 8000 8000 8001 8001 8002 8002 8002 8003 8003 8003 8003 8004 8004 8004 8004 8004 8004 8004 8004 8004 8004 8005 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8005 or 8006 8006 80068006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8006 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 80088007 or 8008

8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8007 or 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 8008 80088008 8008 8008 8008 8008