Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.3 CMR 40.00 - RATES FOR SERVICES UNDER M.G.L. c. 152, WORKERS' COMPENSATION ACT › Section 40.06 - Fees

Current through Register 1525, July 5, 2024
(1)
Acupuncture
.
Code
Fee
40.06(1) Acupuncture
							 Description
97039
9.53
Unlisted modality (specify type and time if constant
							 attendance)
97124
18.73
Therapeutic procedure, one or more areas, each 15
							 minutes; massage, including effleurage, petrissage and/or tapotement (stroking,
							 compression, percussion)
97139
13.17
Unlisted therapeutic procedure (specify)
97810
27.01
Acupuncture, one or more needles; without electrical
							 stimulation, initial 15 minutes of personal one-on-one contact with the
							 patient
97811
20.33
Acupuncture, one or more needles; without electrical
							 stimulation, each additional 15 minutes of personal one-on-one contact with the
							 patient, with re-insertion of needle(s) (List separately in addition to code
							 for primary procedure)
97813
28.63
Acupuncture, one or more needles; with electrical
							 stimulation, initial 15 minutes of personal one-on-one contact with the
							 patient
97814
22.98
Acupuncture, one or more needles; with electrical
							 stimulation, each additional 15 minutes of personal one-on-one contact with the
							 patient, with re-insertion of needle(s) (List separately in addition to code
							 for primary procedure)
99080
26.09
Special reports such as insurance forms, more than
							 the information conveyed in the usual medical communications or standard
							 reporting form
99201
30.72
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 problem focused history; a problem focused
examination; straightforward medical decision making.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually the presenting problems are self limited or minor.
							 Physicians typically spend ten minutes face-to-face with the patient and/or
							 family
99202
53.39
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: an
							 expanded problem focused history; an expanded problem focused examination;
							 straightforward medical decision making. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually the presenting
							 problems are of low to moderate severity. Physicians typically spend 20 minutes
							 face-to-face with the patient and/or family
99203
79.92
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 detailed history; a detailed examination; medical decision making of low
							 complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually the presenting problems are of
							 moderate severity. Physicians typically spend 30 minutes face-to-face with the
							 patient and/or family
99204
112.90
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: a
							 comprehensive history; a comprehensive examination; medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually the presenting problems are of
							 moderate to high severity. Physicians typically spend 45 minutes face-to-face
							 with the patient and/or family
99211
17.60
Office or other outpatient visit for the evaluation
							 and management of an established patient that may not require the presence of a
							 physician. Usually, the presenting problem(s) are minimal. Typically, five
							 minutes are spent performing or supervising these services
99212
31.79
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: a problem focused history; a problem focused examination;
							 straightforward medical decision making. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend ten minutes
							 face-to-face with the patient and/or family.
99213
49.73
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: an expanded problem focused history; an expanded problem
							 focused examination; medical decision making of low complexity. Counseling
							 and/or coordination of care with other providers 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 complexity.
							 Physicians typically spend 15 minutes face-to-face with the patient and/or
							 family.
99214
74.00
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: a detailed history; a detailed examination; medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend 25
							 minutes face-to-face with the patient and/or family.
(2)
Anesthesia
.
PAYMENT
EQUALS
: (TIME UNITS + BASE UNITS +
				MODIFYING UNITS)
TIMES
$39.00 (Rate per UNIT)
Code
2008 Base Unit
40.06(2) - Anesthesia
							 Description
00100
5
Anesthesia for procedures on salivary glands,
							 including biopsy
00102
6
Anesthesia for procedures involving plastic repair of
							 cleft lip
00103
5
Anesthesia for reconstructive procedures of eyelid
							 (eg, blepharoplasty, ptosis surgery)
00104
4
Anesthesia for electroconvulsive therapy
00120
5
Anesthesia for procedures on external, middle, and
							 inner ear including biopsy; not otherwise specified
00124
4
Anesthesia for procedures on external, middle, and
							 inner ear including biopsy; otoscopy
00126
4
Anesthesia for procedures on external, middle, and
							 inner ear including biopsy; tympanotomy
00140
5
Anesthesia for procedures on eye; not otherwise
							 specified
00142
4
Anesthesia for procedures on eye; lens
							 surgery
00144
6
Anesthesia for procedures on eye; corneal
							 transplant
00145
6
Anesthesia for procedures on eye; vitreoretinal
							 surgery
00147
4
Anesthesia for procedures on eye;
							 iridectomy
00148
4
Anesthesia for procedures on eye;
							 ophthalmoscopy
00160
5
Anesthesia for procedures on nose and accessory
							 sinuses; not otherwise specified
00162
7
Anesthesia for procedures on nose and accessory
							 sinuses; radical surgery
00164
4
Anesthesia for procedures on nose and accessory
							 sinuses; biopsy, soft tissue
00170
5
Anesthesia for intraoral procedures, including
							 biopsy; not otherwise specified
00172
6
Anesthesia for intraoral procedures, including
							 biopsy; repair of cleft palate
00174
6
Anesthesia for intraoral procedures, including
							 biopsy; excision of retropharyngeal tumor
00176
7
Anesthesia for intraoral procedures, including
							 biopsy; radical surgery
00190
5
Anesthesia for procedures on facial bones or skull;
							 not otherwise specified
00192
7
Anesthesia for procedures on facial bones or skull;
							 radical surgery (including prognathism)
00210
11
Anesthesia for intracranial procedures; not otherwise
							 specified
00212
5
Anesthesia for intracranial procedures; subdural
							 taps
00214
9
Anesthesia for intracranial procedures; burr holes,
							 including ventriculography
00215
9
Anesthesia for intracranial procedures; cranioplasty
							 or elevation of depressed skull fracture, extradural (simple or
							 compound)
00216
15
Anesthesia for intracranial procedures; vascular
							 procedures
00218
13
Anesthesia for intracranial procedures; procedures in
							 sitting position
00220
10
Anesthesia for intracranial procedures; cerebrospinal
							 fluid shunting procedures
00222
6
Anesthesia for intracranial procedures;
							 electrocoagulation of intracranial nerve
00300
5
Anesthesia for all procedures on the integumentary
							 system, muscles and nerves of head, neck, and posterior trunk, not otherwise
							 specified
00320
6
Anesthesia for all procedures on esophagus, thyroid,
							 larynx, trachea and lymphatic system of neck; not otherwise specified, age 1
							 year or older
00322
3
Anesthesia for all procedures on esophagus, thyroid,
							 larynx, trachea and lymphatic system of neck; needle biopsy of
							 thyroid
00350
10
Anesthesia for procedures on major vessels of neck;
							 not otherwise specified
00352
5
Anesthesia for procedures on major vessels of neck;
							 simple ligation
00400
3
Anesthesia for procedures on the integumentary system
							 on the extremities, anterior trunk and perineum; not otherwise
							 specified
00402
5
Anesthesia for procedures on the integumentary system
							 on the extremities, anterior trunk and perineum; reconstructive procedures on
							 breast (eg, reduction or augmentation mammoplasty, muscle flaps)
00404
5
Anesthesia for procedures on the integumentary system
							 on the extremities, anterior trunk and perineum; radical or modified radical
							 procedures on breast
00406
13
Anesthesia for procedures on the integumentary system
							 on the extremities, anterior trunk and perineum; radical or modified radical
							 procedures on breast with internal mammary node dissection
00410
4
Anesthesia for procedures on the integumentary system
							 on the extremities, anterior trunk and perineum; electrical conversion of
							 arrhythmias
00450
5
Anesthesia for procedures on clavicle and scapula;
							 not otherwise specified
00452
6
Anesthesia for procedures on clavicle and scapula;
							 radical surgery
00454
3
Anesthesia for procedures on clavicle and scapula;
							 biopsy of clavicle
00470
6
Anesthesia for partial rib resection; not otherwise
							 specified
00472
10
Anesthesia for partial rib resection; thoracoplasty
							 (any type)
00474
13
Anesthesia for partial rib resection; radical
							 procedures (eg, pectus excavatum)
00500
15
Anesthesia for all procedures on
							 esophagus
00520
6
Anesthesia for closed chest procedures; (including
							 bronchoscopy) not otherwise specified
00522
4
Anesthesia for closed chest procedures; needle biopsy
							 of pleura
00524
4
Anesthesia for closed chest procedures;
							 pneumocentesis
00528
8
Anesthesia for closed chest procedures;
							 mediastinoscopy and diagnostic thoracoscopy not utilizing one lung
							 ventilation
00529
11
Anesthesia for closed chest procedures;
							 mediastinoscopy and diagnostic thoracoscopy utilizing one lung
							 ventilation
00530
4
Anesthesia for permanent transvenous pacemaker
							 insertion
00532
4
Anesthesia for access to central venous
							 circulation
00534
7
Anesthesia for transvenous insertion or replacement
							 of pacing cardioverter-defibrillator
00537
7
Anesthesia for cardiac electrophysiologic procedures
							 including radiofrequency ablation
00539
18
Anesthesia for tracheobronchial
							 reconstruction
00540
12
Anesthesia for thoracotomy procedures involving
							 lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy);
							 not otherwise specified
00542
15
Anesthesia for thoracotomy procedures involving
							 lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy);
							 decortication
00541
15
Anesthesia for thoracotomy procedures involving
							 lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy);
							 utilizing one lung ventilation
00546
15
Anesthesia for thoracotomy procedures involving
							 lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy);
							 pulmonary resection with thoracoplasty
00548
17
Anesthesia for thoracotomy procedures involving
							 lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy);
							 intrathoracic procedures on the trachea and bronchi
00550
10
Anesthesia for sternal debridement
00560
15
Anesthesia for procedures on heart, pericardial sac,
							 and great vessels of chest; without pump oxygenator
00562
20
Anesthesia for procedures on heart, pericardial sac,
							 and great vessels of chest; with pump oxygenator
00563
25
Anesthesia for procedures on heart, pericardial sac,
							 and great vessels of chest; with pump oxygenator with hypothermic circulatory
							 arrest
00566
25
Anesthesia for direct coronary artery bypass grafting
							 without pump oxygenator
00580
20
Anesthesia for heart transplant or heart/lung
							 transplant
00600
10
Anesthesia for procedures on cervical spine and cord;
							 not otherwise specified
00604
13
Anesthesia for procedures on cervical spine and cord;
							 procedures with patient in the sitting position
00620
10
Anesthesia for procedures on thoracic spine and cord;
							 not otherwise specified
00622
13
Anesthesia for procedures on thoracic spine and cord;
							 thoracolumbar sympathectomy
00625
13
Anesthesia for procedures on the thoracic spine and
							 cord, via an anterior transthoracic approach; not utilizing one lung
							 ventilation
00626
15
Anesthesia for procedures on the thoracic spine and
							 cord, via an anterior transthoracic approach; utilizing one lung
							 ventilation
00630
8
Anesthesia for procedures in lumbar region; not
							 otherwise specified
00632
7
Anesthesia for procedures in lumbar region; lumbar
							 sympathectomy
00634
10
Anesthesia for procedures in lumbar region;
							 chemonucleolysis
00635
4
Anesthesia for procedures in lumbar region;
							 diagnostic or therapeutic lumbar puncture
00640
3
Anesthesia for manipulation of the spine or for
							 closed procedures on the cervical, thoracic or lumbar spine
00670
13
Anesthesia for extensive spine and spinal cord
							 procedures (eg, spinal instrumentation or vascular procedures)
00700
4
Anesthesia for procedures on upper anterior abdominal
							 wall; not otherwise specified
00702
4
Anesthesia for procedures on upper anterior abdominal
							 wall; percutaneous liver biopsy
00730
5
Anesthesia for procedures on upper posterior
							 abdominal wall
00740
5
Anesthesia for upper gastrointestinal endoscopic
							 procedures, endoscope introduced proximal to duodenum
00750
4
Anesthesia for hernia repairs in upper abdomen; not
							 otherwise specified
00752
6
Anesthesia for hernia repairs in upper abdomen;
							 lumbar and ventral (incisional) hernias and/or wound dehiscence
00754
7
Anesthesia for hernia repairs in upper abdomen;
							 omphalocele
00756
7
Anesthesia for hernia repairs in upper abdomen;
							 transabdominal repair of diaphragmatic hernia
00770
15
Anesthesia for all procedures on major abdominal
							 blood vessels
00790
7
Anesthesia for intraperitoneal procedures in upper
							 abdomen including laparoscopy; not otherwise specified
00792
13
Anesthesia for intraperitoneal procedures in upper
							 abdomen including laparoscopy; partial hepatectomy or management of liver
							 hemorrhage (excluding liver biopsy)
00794
8
Anesthesia for intraperitoneal procedures in upper
							 abdomen including laparoscopy; pancreatectomy, partial or total (eg, Whipple
							 procedure)
00796
30
Anesthesia for intraperitoneal procedures in upper
							 abdomen including laparoscopy; liver transplant (recipient)
00797
11
Anesthesia for intraperitoneal procedures in upper
							 abdomen including laparoscopy; gastric restrictive procedure for morbid
							 obesity
00800
4
Anesthesia for procedures on lower anterior abdominal
							 wall; not otherwise specified
00802
5
Anesthesia for procedures on lower anterior abdominal
							 wall; panniculectomy
00810
5
Anesthesia for lower intestinal endoscopic
							 procedures, endoscope introduced distal to duodenum
00820
5
Anesthesia for procedures on lower posterior
							 abdominal wall
00830
4
Anesthesia for hernia repairs in lower abdomen; not
							 otherwise specified
00832
6
Anesthesia for hernia repairs in lower abdomen;
							 ventral and incisional hernias
00840
6
Anesthesia for intraperitoneal procedures in lower
							 abdomen including laparoscopy; not otherwise specified
00842
4
Anesthesia for intraperitoneal procedures in lower
							 abdomen including laparoscopy; amniocentesis
00844
7
Anesthesia for intraperitoneal procedures in lower
							 abdomen including laparoscopy; abdominoperineal resection
00846
8
Anesthesia for intraperitoneal procedures in lower
							 abdomen including laparoscopy; radical hysterectomy
00848
8
Anesthesia for intraperitoneal procedures in lower
							 abdomen including laparoscopy; pelvic exenteration
00851
6
Anesthesia for intraperitoneal procedures in lower
							 abdomen including laparoscopy; tubal ligation/transection
00860
6
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; not otherwise specified
00862
7
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; renal procedures, including upper one-third
							 of ureter, or donor nephrectomy
00864
8
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; total cystectomy
00865
7
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; radical prostatectomy (suprapubic,
							 retropubic)
00866
10
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; adrenalectomy
00868
10
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; renal transplant (recipient)
00870
5
Anesthesia for extraperitoneal procedures in lower
							 abdomen, including urinary tract; cystolithotomy
00872
7
Anesthesia for lithotripsy, extracorporeal shock
							 wave; with water bath
00873
5
Anesthesia for lithotripsy, extracorporeal shock
							 wave; without water bath
00880
15
Anesthesia for procedures on major lower abdominal
							 vessels; not otherwise specified
00882
10
Anesthesia for procedures on major lower abdominal
							 vessels; inferior vena cava ligation
00902
5
Anesthesia for; anorectal procedure
00904
7
Anesthesia for; radical perineal
							 procedure
00906
4
Anesthesia for; vulvectomy
00908
6
Anesthesia for; perineal prostatectomy
00910
3
Anesthesia for transurethral procedures (including
							 urethrocystoscopy); not otherwise specified
00912
5
Anesthesia for transurethral procedures (including
							 urethrocystoscopy); transurethral resection of bladder tumor(s)
00914
5
Anesthesia for transurethral procedures (including
							 urethrocystoscopy); transurethral resection of prostate
00916
5
Anesthesia for transurethral procedures (including
							 urethrocystoscopy); post-transurethral resection bleeding
00918
5
Anesthesia for transurethral procedures (including
							 urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral
							 calculus
00920
3
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); not otherwise specified
00921
3
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); vasectomy, unilateral or
							 bilateral
00922
6
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); seminal vesicles
00924
4
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); undescended testis, unilateral or
							 bilateral
00926
4
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); radical orchiectomy, inguinal
00928
6
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); radical orchiectomy,
							 abdominal
00930
4
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); orchiopexy, unilateral or
							 bilateral
00932
4
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); complete amputation of penis
00934
6
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); radical amputation of penis with
							 bilateral inguinal lymphadenectomy
00936
8
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); radical amputation of penis with
							 bilateral inguinal and iliac lymphadenectomy
00938
4
Anesthesia for procedures on male genitalia
							 (including open urethral procedures); insertion of penile prosthesis (perineal
							 approach)
00940
3
Anesthesia for vaginal procedures (including biopsy
							 of labia, vagina, cervix or endometrium); not otherwise specified
00942
4
Anesthesia for vaginal procedures (including biopsy
							 of labia, vagina, cervix or endometrium); colpotomy, vaginectomy, colporrhaphy,
							 and open urethral procedures
00944
6
Anesthesia for vaginal procedures (including biopsy
							 of labia, vagina, cervix or endometrium); vaginal hysterectomy
00948
4
Anesthesia for vaginal procedures (including biopsy
							 of labia, vagina, cervix or endometrium); cervical cerclage
00950
5
Anesthesia for vaginal procedures (including biopsy
							 of labia, vagina, cervix or endometrium); culdoscopy
00952
4
Anesthesia for vaginal procedures (including biopsy
							 of labia, vagina, cervix or endometrium); hysteroscopy and/or
							 hysterosalpingography
01112
5
Anesthesia for bone marrow aspiration and/or biopsy,
							 anterior or posterior iliac crest
01120
6
Anesthesia for procedures on bony pelvis
01130
3
Anesthesia for body cast application or
							 revision
01140
15
Anesthesia for interpelviabdominal (hindquarter)
							 amputation
01150
10
Anesthesia for radical procedures for tumor of
							 pelvis, except hindquarter amputation
01160
4
Anesthesia for closed procedures involving symphysis
							 pubis or sacroiliac joint
01170
8
Anesthesia for open procedures involving symphysis
							 pubis or sacroiliac joint
01173
12
Anesthesia for open repair of fracture disruption of
							 pelvis or column fracture involving acetabulum
01180
3
Anesthesia for obturator neurectomy;
							 extrapelvic
01190
4
Anesthesia for obturator neurectomy;
							 intrapelvic
01200
4
Anesthesia for all closed procedures involving hip
							 joint
01202
4
Anesthesia for arthroscopic procedures of hip
							 joint
01210
6
Anesthesia for open procedures involving hip joint;
							 not otherwise specified
01212
10
Anesthesia for open procedures involving hip joint;
							 hip disarticulation
01214
8
Anesthesia for open procedures involving hip joint;
							 total hip arthroplasty
01215
10
Anesthesia for open procedures involving hip joint;
							 revision of total hip arthroplasty
01220
4
Anesthesia for all closed procedures involving upper
							 two-thirds of femur
01230
6
Anesthesia for open procedures involving upper
							 two-thirds of femur; not otherwise specified
01232
5
Anesthesia for open procedures involving upper
							 two-thirds of femur; amputation
01234
8
Anesthesia for open procedures involving upper
							 two-thirds of femur; radical resection
01250
4
Anesthesia for all procedures on nerves, muscles,
							 tendons, fascia, and bursae of upper leg
01260
3
Anesthesia for all procedures involving veins of
							 upper leg, including exploration
01270
8
Anesthesia for procedures involving arteries of upper
							 leg, including bypass graft; not otherwise specified
01272
4
Anesthesia for procedures involving arteries of upper
							 leg, including bypass graft; femoral artery ligation
01274
6
Anesthesia for procedures involving arteries of upper
							 leg, including bypass graft; femoral artery embolectomy
01320
4
Anesthesia for all procedures on nerves, muscles,
							 tendons, fascia, and bursae of knee and/or popliteal area
01340
4
Anesthesia for all closed procedures on lower
							 one-third of femur
01360
5
Anesthesia for all open procedures on lower one-third
							 of femur
01380
3
Anesthesia for all closed procedures on knee
							 joint
01382
3
Anesthesia for diagnostic arthroscopic procedures of
							 knee joint
01390
3
Anesthesia for all closed procedures on upper ends of
							 tibia, fibula, and/or patella
01392
4
Anesthesia for all open procedures on upper ends of
							 tibia, fibula, and/or patella
01400
4
Anesthesia for open or surgical arthroscopic
							 procedures on knee joint; not otherwise specified
01402
7
Anesthesia for open or surgical arthroscopic
							 procedures on knee joint; total knee arthroplasty
01404
5
Anesthesia for open or surgical arthroscopic
							 procedures on knee joint; disarticulation at knee
01420
3
Anesthesia for all cast applications, removal, or
							 repair involving knee joint
01430
3
Anesthesia for procedures on veins of knee and
							 popliteal area; not otherwise specified
01432
6
Anesthesia for procedures on veins of knee and
							 popliteal area; arteriovenous fistula
01440
8
Anesthesia for procedures on arteries of knee and
							 popliteal area; not otherwise specified
01442
8
Anesthesia for procedures on arteries of knee and
							 popliteal area; popliteal thromboendarterectomy, with or without patch
							 graft
01444
8
Anesthesia for procedures on arteries of knee and
							 popliteal area; popliteal excision and graft or repair for occlusion or
							 aneurysm
01462
3
Anesthesia for all closed procedures on lower leg,
							 ankle, and foot
01464
3
Anesthesia for arthroscopic procedures of ankle
							 and/or foot
01470
3
Anesthesia for procedures on nerves, muscles,
							 tendons, and fascia of lower leg, ankle, and foot; not otherwise
							 specified
01472
5
Anesthesia for procedures on nerves, muscles,
							 tendons, and fascia of lower leg, ankle, and foot; repair of ruptured Achilles
							 tendon, with or without graft
01474
5
Anesthesia for procedures on nerves, muscles,
							 tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg,
							 Strayer procedure)
01480
3
Anesthesia for open procedures on bones of lower leg,
							 ankle, and foot; not otherwise specified
01482
4
Anesthesia for open procedures on bones of lower leg,
							 ankle, and foot; radical resection (including below knee
							 amputation)
01484
4
Anesthesia for open procedures on bones of lower leg,
							 ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula
01486
7
Anesthesia for open procedures on bones of lower leg,
							 ankle, and foot; total ankle replacement
01490
3
Anesthesia for lower leg cast application, removal,
							 or repair
01500
8
Anesthesia for procedures on arteries of lower leg,
							 including bypass graft; not otherwise specified
01502
6
Anesthesia for procedures on arteries of lower leg,
							 including bypass graft; embolectomy, direct or with catheter
01520
3
Anesthesia for procedures on veins of lower leg; not
							 otherwise specified
01522
5
Anesthesia for procedures on veins of lower leg;
							 venous thrombectomy, direct or with catheter
01610
5
Anesthesia for all procedures on nerves, muscles,
							 tendons, fascia, and bursae of shoulder and axilla
01620
4
Anesthesia for all closed procedures on humeral head
							 and neck, sternoclavicular joint, acromioclavicular joint, and shoulder
							 joint
01622
4
Anesthesia for diagnostic arthroscopic procedures of
							 shoulder joint
01630
5
Anesthesia for open or surgical arthroscopic
							 procedures on humeral head and neck, sternoclavicular joint, acromioclavicular
							 joint, and shoulder joint; not otherwise specified
01632
6
Anesthesia for open or surgical arthroscopic
							 procedures on humeral head and neck, sternoclavicular joint, acromioclavicular
							 joint, and shoulder joint; radical resection
01634
9
Anesthesia for open or surgical arthroscopic
							 procedures on humeral head and neck, sternoclavicular joint, acromioclavicular
							 joint, and shoulder joint; shoulder disarticulation
01636
15
Anesthesia for open or surgical arthroscopic
							 procedures on humeral head and neck, sternoclavicular joint, acromioclavicular
							 joint, and shoulder joint; interthoracoscapular (forequarter)
							 amputation
01638
10
Anesthesia for open or surgical arthroscopic
							 procedures on humeral head and neck, sternoclavicular joint, acromioclavicular
							 joint, and shoulder joint; total shoulder replacement
01650
6
Anesthesia for procedures on arteries of shoulder and
							 axilla; not otherwise specified
01652
10
Anesthesia for procedures on arteries of shoulder and
							 axilla; axillary-brachial aneurysm
01654
8
Anesthesia for procedures on arteries of shoulder and
							 axilla; bypass graft
01656
10
Anesthesia for procedures on arteries of shoulder and
							 axilla; axillary-femoral bypass graft
01670
4
Anesthesia for all procedures on veins of shoulder
							 and axilla
01680
3
Anesthesia for shoulder cast application, removal or
							 repair; not otherwise specified
01682
4
Anesthesia for shoulder cast application, removal or
							 repair; shoulder spica
01710
3
Anesthesia for procedures on nerves, muscles,
							 tendons, fascia, and bursae of upper arm and elbow; not otherwise
							 specified
01712
5
Anesthesia for procedures on nerves, muscles,
							 tendons, fascia, and bursae of upper arm and elbow; tenotomy, elbow to
							 shoulder, open
01714
5
Anesthesia for procedures on nerves, muscles,
							 tendons, fascia, and bursae of upper arm and elbow; tenoplasty, elbow to
							 shoulder
01716
5
Anesthesia for procedures on nerves, muscles,
							 tendons, fascia, and bursae of upper arm and elbow; tenodesis, rupture of long
							 tendon of biceps
01730
3
Anesthesia for all closed procedures on humerus and
							 elbow
01732
3
Anesthesia for diagnostic arthroscopic procedures of
							 elbow joint
01740
4
Anesthesia for open or surgical arthroscopic
							 procedures of the elbow; not otherwise specified
01742
5
Anesthesia for open or surgical arthroscopic
							 procedures of the elbow; osteotomy of humerus
01744
5
Anesthesia for open or surgical arthroscopic
							 procedures of the elbow; repair of nonunion or malunion of humerus
01756
6
Anesthesia for open or surgical arthroscopic
							 procedures of the elbow; radical procedures
01758
5
Anesthesia for open or surgical arthroscopic
							 procedures of the elbow; excision of cyst or tumor of humerus
01760
7
Anesthesia for open or surgical arthroscopic
							 procedures of the elbow; total elbow replacement
01770
6
Anesthesia for procedures on arteries of upper arm
							 and elbow; not otherwise specified
01772
6
Anesthesia for procedures on arteries of upper arm
							 and elbow; embolectomy
01780
3
Anesthesia for procedures on veins of upper arm and
							 elbow; not otherwise specified
01782
4
Anesthesia for procedures on veins of upper arm and
							 elbow; phleborrhaphy
01810
3
Anesthesia for all procedures on nerves, muscles,
							 tendons, fascia, and bursae of forearm, wrist, and hand
01820
3
Anesthesia for all closed procedures on radius, ulna,
							 wrist, or hand bones
01829
3
Anesthesia for diagnostic arthroscopic procedures on
							 the wrist
01830
3
Anesthesia for open or surgical
							 arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or
							 hand joints; not otherwise specified
01832
6
Anesthesia for open or surgical
							 arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or
							 hand joints; total wrist replacement
01840
6
Anesthesia for procedures on arteries of forearm,
							 wrist, and hand; not otherwise specified
01842
6
Anesthesia for procedures on arteries of forearm,
							 wrist, and hand; embolectomy
01844
6
Anesthesia for vascular shunt, or shunt revision, any
							 type (eg, dialysis)
01850
3
Anesthesia for procedures on veins of forearm, wrist,
							 and hand; not otherwise specified
01852
4
Anesthesia for procedures on veins of forearm, wrist,
							 and hand; phleborrhaphy
01860
3
Anesthesia for forearm, wrist, or hand cast
							 application, removal, or repair
01916
5
Anesthesia for diagnostic
							 arteriography/venography
01920
7
Anesthesia for cardiac catheterization including
							 coronary angiography and ventriculography (not to include Swan-Ganz
							 catheter)
01922
7
Anesthesia for non-invasive imaging or radiation
							 therapy
01924
5
Anesthesia for therapeutic interventional
							 radiological procedures involving the arterial system; not otherwise
							 specified
01925
7
Anesthesia for therapeutic interventional
							 radiological procedures involving the arterial system; carotid or
							 coronary
01926
8
Anesthesia for therapeutic interventional
							 radiological procedures involving the arterial system; intracranial,
							 intracardiac, or aortic
01930
5
Anesthesia for therapeutic interventional
							 radiological procedures involving the venous/lymphatic system (not to include
							 access to the central circulation); not otherwise specified
01931
7
Anesthesia for therapeutic interventional
							 radiological procedures involving the venous/lymphatic system (not to include
							 access to the central circulation); intrahepatic or portal circulation (eg,
							 transvenous intrahepatic portosystemic shunt[s] [TIPS])
01932
6
Anesthesia for therapeutic interventional
							 radiological procedures involving the venous/lymphatic system (not to include
							 access to the central circulation); intrathoracic or jugular
01933
7
Anesthesia for therapeutic interventional
							 radiological procedures involving the venous/lymphatic system (not to include
							 access to the central circulation); intracranial
01935
5
Anesthesia for percutaneous image guided procedures
							 on the spine and spinal cord; diagnostic
01936
5
Anesthesia for percutaneous image guided procedures
							 on the spine and spinal cord; therapeutic
01951
3
Anesthesia for second- and third-degree burn excision
							 or debridement with or without skin grafting, any site, for total body surface
							 area (TBSA) treated during anesthesia and surgery; less than 4% total body
							 surface area
01952
5
Anesthesia for second- and third-degree burn excision
							 or debridement with or without skin grafting, any site, for total body surface
							 area (TBSA) treated during anesthesia and surgery; between 4% and 9% of total
							 body surface area
01953
1
Anesthesia for second- and third-degree burn excision
							 or debridement with or without skin grafting, any site, for total body surface
							 area (TBSA) treated during anesthesia and surgery; each additional 9% total
							 body surface area or part thereof (List separately in addition to code for
							 primary procedure performed)
01958
5
Anesthesia for external cephalic version
							 procedure
01960
5
Anesthesia for vaginal delivery only
01961
7
Anesthesia for cesarean delivery only
01962
8
Anesthesia for urgent hysterectomy following
							 delivery
01963
8
Anesthesia for cesarean hysterectomy without any
							 labor analgesia/anesthesia care
01965
4
Anesthesia for incomplete or missed abortion
							 procedures
01966
4
Anesthesia for induced abortion
							 procedures
01967
5
Neuraxial labor analgesia/anesthesia for planned
							 vaginal delivery (this includes any repeat subarachnoid needle placement and
							 drug injection and/or any necessary replacement of an epidural catheter during
							 labor)
01968
2
Anesthesia for cesarean delivery following neuraxial
							 labor analgesia/anesthesia (List separately in addition to code for primary
							 procedure performed)
01969
5
Anesthesia for cesarean hysterectomy following
							 neuraxial labor analgesia/anesthesia (List separately in addition to code for
							 primary procedure performed)
01990
7
Physiological support for harvesting of organ(s) from
							 brain-dead patient
01991
3
Anesthesia for diagnostic or therapeutic nerve blocks
							 and injections (when block or injection is performed by a different provider);
							 other than the prone position
01992
5
Anesthesia for diagnostic or therapeutic nerve blocks
							 and injections (when block or injection is performed by a different provider);
							 prone position
01996
3
Daily hospital management of epidural or subarachnoid
							 continuous drug administration
01999
0
Unlisted anesthesia procedure(s)
(3)
Chiropractors
.
Code
Fee
40.06(3) - Chiropractic
							 Description
98940
29.79
Chiropractic manipulative treatment (CMT); spinal,
							 one to two regions
98941
38.54
Chiropractic manipulative treatment (CMT); spinal,
							 three to four regions
98942
47.66
Chiropractic manipulative treatment (CMT); spinal,
							 five regions
98943
28.60
Chiropractic manipulative treatment (CMT);
							 extraspinal, one or more regions
99201
30.10
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 problem focused history; A problem focused examination; Straightforward medical
							 decision making. Counseling and/or coordination of care with other providers 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. Physicians typically spend ten minutes face-to-face with the
							 patient and/or family.
99202
51.54
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: An
							 expanded problem focused history; An expanded problem focused examination;
							 Straightforward medical decision making. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend 20
							 minutes face-to-face with the patient and/or family.
99203
76.11
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 detailed history; A detailed examination; Medical decision making of low
							 complexity. Counseling and/or coordination of care with other providers 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. Physicians typically spend 30 minutes face-to-face with the
							 patient and/or family.
99204
112.85
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; Medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers 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. Physicians typically spend 45 minutes
							 face-to-face with the patient and/or family.
9921 1
17.97
Office or other outpatient visit for the evaluation
							 and management of an established patien that may not require the presence of a
							 physician. Usually, the presenting problem(s) are minimal. Typically, five
							 minutes are spent performing or supervising these services.
99212
31.13
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: A problem focused history; A problem focused examination;
							 Straightforward medical decision making. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend ten minutes
							 face-to-face with the patient and/or family.
99213
49.35
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: An expanded problem focused history; An expanded problem
							 focused examination; Medical decision making of low complexity. Counseling and
							 coordination of care with other providers 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. Physicians
							 typically spend 15 minutes face-to-face with the patient and/or
							 family.
99214
73.96
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: A detailed history; A detailed examination; Medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend 25
							 minutes face-to-face with the patient and/or family.
99358
73.29
Prolonged evaluation and management service before
							 and/or after direct (face-to-face) patient care (eg, review of extensive
							 records and tests, communication with other professionals and/or the
							 patient/family); first hour (List separately in addition to code for other
							 physician service(s) and/or inpatient or outpatient Evaluation and Management
							 service)
99359
35.43
Prolonged evaluation and management service before
							 and/or after direct (face-to-face) patient care (eg, review of extensive
							 records and tests, communication with other professionals and/or the
							 patient/family); each additional 30 minutes (List separately in addition to
							 code for prolonged physician service)
99368
24.60
Medical team conference with interdisciplinary team
							 of health care professionals, patient and/or family not present, 30 minutes or
							 more; participation by nonphysician qualified health care
							 professional
80047
30.51
Basic metabolic panel (Calcium, ionized) This panel
							 must include the following: Calcium, ionized (82330) Carbon dioxide (82374)
							 Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium
							 (84295) Urea Nitrogen (BUN) (84520)
80048
11.83
Basic metabolic panel (Calcium, total) This panel
							 must include the following: Calcium (82310) Carbon dioxide (82374) Chloride
							 (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295)
							 Urea nitrogen (BUN) (84520)
80051
9.80
Electrolyte panel This panel must include the
							 following: Carbon dioxide (82374) Chloride (82435) Potassium (84132) Sodium
							 (84295)
80053
14.77
Comprehensive metabolic panel This panel must include
							 the following: Albumin (82040) Bilirubin, total (82247) Calcium (82310) Carbon
							 dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose
							 (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155)
							 Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase,
							 aspartate amino (AST) (SGOT) (84450)
80061
18.72
Lipid panel This panel must include the following:
							 Cholesterol, serum, total (82465)
Lipoprotein, direct measurement, high density
							 cholesterol (HDL cholesterol) (83718)
Triglycerides (84478)
80069
12.13
Renal function panel This panel must include the
							 following: Albumin (82040) Calcium (82310) Carbon dioxide (bicarbonate) (82374)
							 Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic
							 (phosphate) (84100) Potassium (84132) Sodium (84295)
80074
62.84
Acute hepatitis panel This panel must include the
							 following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core
							 antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg)
							 (87340) Hepatitis C antibody (86803)
80076
11.42
Hepatic function panel This panel must include the
							 following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248)
							 Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino
							 (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT)
							 (84450)
80100
16.32
Drug screen, qualitative; multiple drug classes
							 chromatographic method, each procedure
80101
19.24
Drug screen, qualitative; single drug class method
							 (eg, immunoassay, enzyme assay), each drug class
80102
18.51
Drug confirmation, each procedure
80150
21.06
Amikacin
80152
25.01
Amitriptyline
80154
25.84
Benzodiazepines
80156
20.34
Carbamazepine; total
80157
18.52
Carbamazepine; free
80158
25.23
Cyclosporine
80160
24.05
Desipramine
80162
18.55
Digoxin
80164
18.93
Dipropylacetic acid (valproic acid)
80166
21.66
Doxepin
80168
22.83
Ethosuximide
80170
22.90
Gentamicin
80172
22.76
Gold
80173
20.34
Haloperidol
80174
24.05
Imipramine
80176
20.52
Lidocaine
80178
9.24
Lithium
80182
18.93
Nortriptyline
80184
16.01
Phenobarbital
80185
18.52
Phenytoin; total
80186
19.23
Phenytoin; free
80188
23.18
Primidone
80190
23.41
Procainamide;
80192
23.41
Procainamide; with metabolites (eg, n-acetyl
							 procainamide)
80194
20.39
Quinidine
80195
10.18
Sirolimus
80196
9.92
Salicylate
80197
10.18
Tacrolimus
80198
19.77
Theophylline
80200
22.52
Tobramycin
80201
16.66
Topiramate
80202
18.93
Vancomycin
80299
19.13
Quantitation of drug, not elsewhere
							 specified
80400
45.56
ACTH stimulation panel; for adrenal insufficiency
							 This panel must include the following: Cortisol (82533 x 2)
80402
121.46
ACTH stimulation panel; for 21 hydroxylase deficiency
							 This panel must include the following: Cortisol (82533 x 2) 17
							 hydroxyprogesterone (83498 x 2)
80406
106.06
ACTH stimulation panel; for 3
							 beta-hydroxydehydrogenase deficiency This panel must include the following:
							 Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2)
80408
175.34
Aldosterone suppression evaluation panel (eg, saline
							 infusion) This panel must include the following: Aldosterone (82088 x 2) Renin
							 (84244 x 2)
80410
112.23
Calcitonin stimulation panel (eg, calcium,
							 pentagastrin) This panel must include the following: Calcitonin (82308 x
							 3)
80412
460.50
Corticotropic releasing hormone (CRH) stimulation
							 panel This panel must include the following: Cortisol (82533 x 6)
							 Adrenocorticotropic hormone (ACTH) (82024 x 6)
80414
72.16
Chorionic gonadotropin stimulation panel;
							 testosterone response This panel must include the following: Testosterone
							 (84403 x 2 on three pooled blood samples)
80415
78.08
Chorionic gonadotropin stimulation panel; estradiol
							 response This panel must include the following: Estradiol (82670 x 2 on three
							 pooled blood samples)
80416
184.38
Renal vein renin stimulation panel (eg, captopril)
							 This panel must include the following: Renin (84244 x 6)
80417
61.46
Peripheral vein renin stimulation panel (eg,
							 captopril) This panel must include the following: Renin (84244 x 2)
80418
809.76
Combined rapid anterior pituitary evaluation panel
							 This panel must include the following: Adrenocorticotropic hormone (ACTH)
							 (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormone
							 (FSH) (83001 x 4) Prolactin (84146 x 4) Human growth hormone (HGH) (93003x4)
							 Cortisol (82533 x 4) Thyroid stimulating hormone (TSH) (84443 x 4)
80420
100.64
Dexamethasone suppression panel, 48 hour This panel
							 must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x
							 2) Volume measurement for timed collection (81050 x 2)
80422
64.38
Glucagon tolerance panel; for insulinoma This panel
							 must include the following: Glucose (82947 x 3) Insulin (83525 x 3)
80424
70.56
Glucagon tolerance panel; for pheochromocytoma This
							 panel must include the following: Catecholamines, fractionated (82384 x
							 2)
80426
207.40
Gonadotropin releasing hormone stimulation panel This
							 panel must include the following: Follicle stimulating hormone (FSH) (83001 x
							 4) Luteinizing hormone (LH) (83002 x 4)
80428
93.16
Growth hormone stimulation panel (eg, arginine
							 infusion, l-dopa administration) This panel must include the following: Human
							 growth hormone (HGH) (83003 x 4)
80430
109.60
Growth hormone suppression panel (glucose
							 administration) This panel must include the following: Glucose (82947 x 3)
							 Human growth hormone (HGH) (83003 x 4)
80432
188.73
Insulin-induced C-peptide suppression panel This
							 panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose
							 (82947 x 5)
80434
141.30
Insulin tolerance panel; for ACTH insufficiency This
							 panel must include the following: Cortisol (82533 x 5) Glucose (82947 x
							 5)
80435
143.85
Insulin tolerance panel; for growth hormone
							 deficiency This panel must include the following: Glucose (82947 x 5) Human
							 growth hormone (HGH) (83003 x 5)
80436
127.36
Metyrapone panel This panel must include the
							 following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2)
80438
70.41
Thyrotropin releasing hormone (TRH) stimulation
							 panel; one hour This panel must include the following: Thyroid stimulating
							 hormone (TSH) (84443 x 3)
80439
93.88
Thyrotropin releasing hormone (TRH) stimulation
							 panel; two hour This panel must include the following: Thyroid stimulating
							 hormone (TSH) (84443 x 4)
80440
81.24
Thyrotropin releasing hormone (TRH) stimulation
							 panel; for hyperprolactinemia This panel must include the following: Prolactin
							 (84146 x 3)
81000
4.43
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents;
							 non-automated, with microscopy
81001
4.43
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents; automated,
							 with microscopy
81002
3.57
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents;
							 non-automated, without microscopy
81003
3.14
Urinalysis, by dip stick or tablet reagent for
							 bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein,
							 specific gravity, urobilinogen, any number of these constituents; automated,
							 without microscopy
81005
3.03
Urinalysis; qualitative or semiquantitative, except
							 immunoassays
81007
3.59
Urinalysis; bacteriuria screen, except by culture or
							 dipstick
81015
4.24
Urinalysis; microscopic only
81020
5.15
Urinalysis; two or three glass test
81025
8.84
Urine pregnancy test, by visual color comparison
							 methods
81050
4.19
Volume measurement for timed collection,
							 each
82000
17.31
Acetaldehyde, blood
82003
28.28
Acetaminophen
82009
6.31
Acetone or other ketone bodies, serum;
							 qualitative
82010
11.42
Acetone or other ketone bodies, serum;
							 quantitative
82013
15.61
Acetylcholinesterase
82016
19.37
Acylcarnitines; qualitative, each
							 specimen
82017
14.94
Acylcarnitines; quantitative, each
							 specimen
82024
53.97
Adrenocorticotropic hormone (ACTH)
82030
36.05
Adenosine, 5-monophosphate, cyclic (cyclic
							 AMP)
82040
6.92
Albumin; serum
82042
7.23
Albumin; urine or other source, quantitative, each
							 specimen
82043
7.56
Albumin; urine, microalbumin,
							 quantitative
82044
6.39
Albumin; urine, microalbumin, semiquantitative (eg,
							 reagent strip assay)
82045
47.43
Albumin; ischemia modified
82055
15.10
Alcohol (ethanol); any specimen except
							 breath
82075
16.84
Alcohol (ethanol); breath
82085
13.56
Aldolase
82088
56.94
Aldosterone
82101
38.96
Alkaloids, urine, quantitative
82103
18.77
Alpha-1-antitrypsin; total
82104
20.20
Alpha-1-antitrypsin; phenotype
82105
23.44
Alpha-fetoprotein (AFP); serum
82106
23.44
Alpha-fetoprotein (AFP); amniotic fluid
82107
89.99
Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and
							 total AFP (including ratio)
82108
35.60
Aluminum
82120
5.25
Amines, vaginal fluid, qualitative
82127
19.37
Amino acids; single, qualitative, each
							 specimen
82128
19.37
Amino acids; multiple, qualitative, each
							 specimen
82131
23.57
Amino acids; single, quantitative, each
							 specimen
82135
23.00
Aminolevulinic acid, delta (ALA)
82136
14.94
Amino acids, two to five amino acids, quantitative,
							 each specimen
82139
14.94
Amino acids, six or more amino acids, quantitative,
							 each specimen
82140
20.36
Ammonia
82143
9.61
Amniotic fluid scan (spectrophotometric)
82145
21.72
Amphetamine or methamphetamine
82150
9.06
Amylase
82154
40.29
Androstanediol glucuronide
82157
40.90
Androstenedione
82160
34.94
Androsterone
82163
25.16
Angiotensin II
82164
20.39
Angiotensin I - converting enzyme (ACE)
82172
21.65
Apolipoprotein, each
82175
26.51
Arsenic
82180
13.81
Ascorbic acid (Vitamin C), blood
82190
7.61
Atomic absorption spectroscopy, each
							 analyte
82205
16.01
Barbiturates, not elsewhere specified
82232
22.61
Beta-2 microglobulin
82239
23.94
Bile acids; total
82240
37.13
Bile acids; cholylglycine
82247
7.02
Bilirubin; total
82248
7.02
Bilirubin; direct
82252
6.35
Bilirubin; feces, qualitative
82261
14.94
Biotinidase, each specimen
82270
4.54
Blood, occult, by peroxidase activity (eg, guaiac),
							 qualitative; feces, consecutive collected specimens with single determination,
							 for colorectal neoplasm screening (ie, patient was provided three cards or
							 single triple card for consecutive collection)
82271
4.54
Blood, occult, by peroxidase activity (eg, guaiac),
							 qualitative; other sources
82272
4.54
Blood, occult, by peroxidase activity (eg, guaiac),
							 qualitative, feces, one-three simultaneous determinations, performed for other
							 than colorectal neoplasm screening
82274
20.70
Blood, occult, by fecal hemoglobin determination by
							 immunoassay, qualitative, feces, one-three simultaneous
							 determinations
82286
9.62
Bradykinin
82300
32.33
Cadmium
82306
41.36
Calcifediol (25-OH Vitamin D-3)
82307
45.02
Calciferol (Vitamin D)
82308
37.41
Calcitonin
82310
7.20
Calcium; total
82330
19.09
Calcium; ionized
82331
7.23
Calcium; after calcium infusion test
82340
8.43
Calcium; urine quantitative, timed
							 specimen
82355
16.17
Calculus; qualitative analysis
82360
17.99
Calculus; quantitative analysis, chemical
82365
18.01
Calculus; infrared spectroscopy
82370
17.51
Calculus; X-ray diffraction
82373
25.23
Carbohydrate deficient transferrin
82374
6.83
Carbon dioxide (bicarbonate)
82375
17.22
Carbon monoxide (carboxyhemoglobin);
							 quantitative
82376
8.37
Carbon monoxide (carboxyhemoglobin);
							 qualitative
82378
26.51
Carcinoembryonic antigen (CEA)
82379
14.94
Carnitine (total and free), quantitative, each
							 specimen
82380
12.89
Carotene
82382
24.02
Catecholamines; total urine
82383
35.01
Catecholamines; blood
82384
35.28
Catecholamines; fractionated
82387
29.07
Cathepsin-D
82390
15.01
Ceruloplasmin
82397
14.94
Chemiluminescent assay
82415
17.70
Chloramphenicol
82435
6.42
Chloride; blood
82436
7.02
Chloride; urine
82438
6.83
Chloride; other source
82441
8.38
Chlorinated hydrocarbons, screen
82465
6.08
Cholesterol, serum or whole blood, total
82480
11.01
Cholinesterase; serum
82482
10.74
Cholinesterase; RBC
82485
28.85
Chondroitin B sulfate, quantitative
82486
25.23
Chromatography, qualitative; column (eg, gas liquid
							 or HPLC), analyte not elsewhere specified
82487
22.30
Chromatography, qualitative; paper, 1-dimensional,
							 analyte not elsewhere specified
82488
29.85
Chromatography, qualitative; paper, 2-dimensional,
							 analyte not elsewhere specified
82489
25.84
Chromatography, qualitative; thin layer, analyte not
							 elsewhere specified
82491
25.23
Chromatography, quantitative, column (eg, gas liquid
							 or HPLC); single analyte not elsewhere specified, single stationary and mobile
							 phase
82492
25.23
Chromatography, quantitative, column (eg, gas liquid
							 or HPLC); multiple analytes, single stationary and mobile phase
82495
28.34
Chromium
82507
38.85
Citrate
82520
21.17
Cocaine or metabolite
82523
17.81
Collagen cross links, any method
82525
17.34
Copper
82528
31.45
Corticosterone
82530
23.35
Cortisol; free
82533
22.78
Cortisol; total
82540
6.48
Creatine
82541
25.23
Column chromatography/mass spectrometry (eg, GC/MS,
							 or HPLC/MS), analyte not elsewhere specified; qualitative, single stationary
							 and mobile phase
82542
25.23
Column chromatography/mass spectrometry (eg, GC/MS,
							 or HPLC/MS), analyte not elsewhere specified; quantitative, single stationary
							 and mobile phase
82543
25.23
Column chromatography/mass spectrometry (eg, GC/MS,
							 or HPLC/MS), analyte not elsewhere specified; stable isotope dilution, single
							 analyte, quantitative, single stationary and mobile phase
82544
25.23
Column chromatography/mass spectrometry (eg, GC/MS,
							 or HPLC/MS), analyte not elsewhere specified; stable isotope dilution, multiple
							 analytes, quantitative, single stationary and mobile phase
82550
9.10
Creatine kinase (CK), (CPK); total
82552
18.71
Creatine kinase (CK), (CPK); isoenzymes
82553
10.83
Creatine kinase (CK), (CPK); MB fraction
							 only
82554
10.68
Creatine kinase (CK), (CPK); isoforms
82565
7.16
Creatinine; blood
82570
7.23
Creatinine; other source
82575
13.20
Creatinine; clearance
82585
8.11
Cryofibrinogen
82595
9.04
Cryoglobulin, qualitative or semi-quantitative (eg,
							 cryocrit)
82600
27.11
Cyanide
82607
20.91
Cyanocobalamin (Vitamin B-12);
82608
20.01
Cyanocobalamin (Vitamin B-12); unsaturated binding
							 capacity
82610
15.86
Cystatin C
82615
11.41
Cystine and homocystine, urine,
							 qualitative
82626
35.31
Dehydroepiandrosterone (DHEA)
82627
31.07
Dehydroepiandrosterone-sulfate (DHEA-S)
82633
43.28
Desoxycorticosterone, 11-
82634
40.90
Deoxycortisol, 11-
82638
17.11
Dibucaine number
82646
28.85
Dihydrocodeinone
82649
35.91
Dihydromorphinone
82651
36.07
Dihydrotestosterone (DHT)
82652
53.78
Dihydroxyvitamin D, 1,25-
82654
19.34
Dimethadione
82656
16.01
Elastase, pancreatic (EL-1), fecal, qualitative or
							 semi-quantitative
82657
25.23
Enzyme activity in blood cells, cultured cells, or
							 tissue, not elsewhere specified; nonradioactive substrate, each
							 specimen
82658
25.23
Enzyme activity in blood cells, cultured cells, or
							 tissue, not elsewhere specified; radioactive substrate, each
							 specimen
82664
48.00
Electrophoretic technique, not elsewhere
							 specified
82666
29.50
Epiandrosterone
82668
26.26
Erythropoietin
82670
39.04
Estradiol
82671
45.13
Estrogens; fractionated
82672
30.30
Estrogens; total
82677
25.91
Estriol
82679
34.88
Estrone
82690
24.15
Ethchlorvynol
82693
20.82
Ethylene glycol
82696
32.95
Etiocholanolone
82705
7.11
Fat or lipids, feces; qualitative
82710
23.47
Fat or lipids, feces; quantitative
82715
24.05
Fat differential, feces, quantitative
82725
18.60
Fatty acids, nonesterified
82726
25.23
Very long chain fatty acids
82728
19.03
Ferritin
82731
89.99
Fetal fibronectin, cervicovaginal secretions,
							 semi-quantitative
82735
25.91
Fluoride
82742
27.66
Flurazepam
82746
20.54
Folic acid; serum
82747
21.91
Folic acid; RBC
82757
24.24
Fructose, semen
82759
30.01
Galactokinase, RBC
82760
15.64
Galactose
82775
29.43
Galactose-1-phosphate uridyl transferase;
							 quantitative
82776
11.71
Galactose-1-phosphate uridyl transferase;
							 screen
82784
10.39
Gammaglobulin; IgA, IgD, IgG, IgM, each
82785
23.01
Gammaglobulin; IgE
82787
5.15
Gammaglobulin; immunoglobulin subclasses (IgG1, 2, 3,
							 or 4), each
82800
11.83
Gases, blood, pH only
82803
27.04
Gases, blood, any combination of pH, pCO2, pO2, CO2,
							 HCO3 (including calculated O2 saturation);
82805
39.65
Gases, blood, any combination of pH, pCO2, pO2, CO2,
							 HCO3 (including calculated O2 saturation); with O2 saturation, by direct
							 measurement, except pulse oximetry
82810
12.20
Gases, blood, O2 saturation only, by direct
							 measurement, except pulse oximetry
82820
10.76
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin
							 saturation with oxygen)
82926
7.61
Gastric acid, free and total, each
							 specimen
82928
9.15
Gastric acid, free or total, each
							 specimen
82938
24.72
Gastrin after secretin stimulation
82941
24.64
Gastrin
82943
19.97
Glucagon
82945
5.48
Glucose, body fluid, other than blood
82946
21.06
Glucagon tolerance test
82947
5.48
Glucose; quantitative, blood (except reagent
							 strip)
82948
3.57
Glucose; blood, reagent strip
82950
6.64
Glucose; post glucose dose (includes
							 glucose)
82951
17.99
Glucose; tolerance test (GTT), three specimens
							 (includes glucose)
82952
4.02
Glucose; tolerance test, each additional beyond three
							 specimens
82953
21.16
Glucose; tolbutamide tolerance test
82955
12.47
Glucose-6-phosphate dehydrogenase (G6PD);
							 quantitative
82960
8.11
Glucose-6-phosphate dehydrogenase (G6PD);
							 screen
82962
3.27
Glucose, blood by glucose monitoring device(s)
							 cleared by the FDA specifically for home use
82963
30.01
Glucosidase, beta
82965
10.80
Glutamate dehydrogenase
82975
22.13
Glutamine (glutamic acid amide)
82977
10.06
Glutamyltransferase, gamma (GGT)
82978
19.91
Glutathione
82979
9.62
Glutathione reductase, RBC
82980
25.60
Glutethimide
82985
21.06
Glycated protein
83001
25.97
Gonadotropin; follicle stimulating hormone
							 (FSH)
83002
25.88
Gonadotropin; luteinizing hormone (LH)
83003
23.29
Growth hormone, human (HGH)
							 (somatotropin)
83008
23.45
Guanosine monophosphate (GMP), cyclic
83009
94.11
Helicobacter pylori, blood test analysis for urease
							 activity, non-radioactive isotope (eg, C-13)
83010
17.58
Haptoglobin; quantitative
83012
24.02
Haptoglobin; phenotypes
83013
94.11
Helicobacter pylori; breath test analysis for urease
							 activity, non-radioactive isotope (eg, C-13)
83014
10.98
Helicobacter pylori; drug administration
83015
26.31
Heavy metal (eg, arsenic, barium, beryllium, bismuth,
							 antimony, mercury); screen
83018
30.68
Heavy metal (eg, arsenic, barium, beryllium, bismuth,
							 antimony, mercury); quantitative, each
83020
17.99
Hemoglobin fractionation and quantitation;
							 electrophoresis (eg, A2, S, C, and/or F)
83021
25.23
Hemoglobin fractionation and quantitation;
							 chromatography (eg, A2, S, C, and/or F)
83026
3.30
Hemoglobin; by copper sulfate method,
							 non-automated
83030
11.56
Hemoglobin; F (fetal), chemical
83033
8.33
Hemoglobin; F (fetal), qualitative
83036
13.56
Hemoglobin; glycosylated (A1C)
83037
21.06
Hemoglobin; glycosylated (A1C) by device cleared by
							 FDA for home use
83045
6.93
Hemoglobin; methemoglobin, qualitative
83050
10.23
Hemoglobin; methemoglobin, quantitative
83051
10.21
Hemoglobin; plasma
83055
6.87
Hemoglobin; sulfhemoglobin, qualitative
83060
11.56
Hemoglobin; sulfhemoglobin, quantitative
83065
9.62
Hemoglobin; thermolabile
83068
11.83
Hemoglobin; unstable, screen
83069
5.51
Hemoglobin; urine
83070
6.64
Hemosiderin; qualitative
83071
9.61
Hemosiderin; quantitative
83080
14.94
b-Hexosaminidase, each assay
83088
41.26
Histamine
83090
23.57
Homocysteine
83150
27.04
Homovanillic acid (HVA)
83491
24.47
Hydroxycorticosteroids, 17- (17-OHCS)
83497
18.01
Hydroxyindolacetic acid, 5-(HIAA)
83498
37.95
Hydroxyprogesterone, 17-d
83499
35.22
Hydroxyprogesterone, 20-
83500
31.65
Hydroxyproline; free
83505
33.96
Hydroxyproline; total
83516
16.01
Immunoassay for analyte other than infectious agent
							 antibody or infectious agent antigen, qualitative or semiquantitative; multiple
							 step method
83518
10.68
Immunoassay for analyte other than infectious agent
							 antibody or infectious agent antigen, qualitative or semiquantitative; single
							 step method (eg, reagent strip)
83519
18.88
Immunoassay, analyte, quantitative; by
							 radiopharmaceutical technique (eg, RIA)
83520
18.09
Immunoassay, analyte, quantitative; not otherwise
							 specified
83525
15.98
Insulin; total
83527
17.68
Insulin; free
83528
22.22
Intrinsic factor
83540
9.05
Iron
83550
12.21
Iron binding capacity
83570
9.61
Isocitric dehydrogenase (IDH)
83582
19.8
Ketogenic steroids, fractionation
83586
17.89
Ketosteroids, 17- (17-KS); total
83593
36.75
Ketosteroids, 17- (17-KS); fractionation
83605
14.92
Lactate (lactic acid)
83615
8.44
Lactate dehydrogenase (LD), (LDH);
83625
17.88
Lactate dehydrogenase (LD), (LDH); isoenzymes,
							 separation and quantitation
83630
27.42
Lactoferrin, fecal; qualitative
83631
27.42
Lactoferrin, fecal; quantitative
83632
28.24
Lactogen, human placental (HPL) human chorionic
							 somatomammotropin
83633
7.69
Lactose, urine; qualitative
83634
16.10
Lactose, urine; quantitative
83655
16.91
Lead
83661
30.71
Fetal lung maturity assessment; lecithin
							 sphingomyelin (L/S) ratio
83662
26.43
Fetal lung maturity assessment; foam stability
							 test
83663
26.43
Fetal lung maturity assessment; fluorescence
							 polarization
83664
26.43
Fetal lung maturity assessment; lamellar body
							 density
83670
11.77
Leucine aminopeptidase (LAP)
83690
9.62
Lipase
83695
18.09
Lipoprotein (a)
83698
47.43
Lipoprotein-associated phospholipase A2
							 (Lp-PLA2)
83700
15.73
Lipoprotein, blood; electrophoretic separation and
							 quantitation
83701
34.68
Lipoprotein, blood; high resolution fractionation and
							 quantitation of lipoproteins including lipoprotein subclasses when performed
							 (eg, electrophoresis, ultracentrifugation)
83704
44.08
Lipoprotein, blood; quantitation of lipoprotein
							 particle numbers and lipoprotein particle subclasses (eg, by nuclear magnetic
							 resonance spectroscopy)
83718
11.44
Lipoprotein, direct measurement; high density
							 cholesterol (HDL cholesterol)
83719
16.26
Lipoprotein, direct measurement; VLDL
							 cholesterol
83721
12.81
Lipoprotein, direct measurement; LDL
							 cholesterol
83727
24.02
Luteinizing releasing factor (LRH)
83735
9.36
Magnesium
83775
9.75
Malate dehydrogenase
83785
34.36
Manganese
83788
25.23
Mass spectrometry and tandem mass spectrometry (MS,
							 MS/MS), analyte not elsewhere specified; qualitative, each specimen
83789
25.23
Mass spectrometry and tandem mass spectrometry (MS,
							 MS/MS), analyte not elsewhere specified; quantitative, each
							 specimen
83805
24.63
Meprobamate
83825
22.72
Mercury, quantitative
83835
23.67
Metanephrines
83840
22.81
Methadone
83857
10.97
Methemalbumin
83858
20.71
Methsuximide
83864
27.82
Mucopolysaccharides, acid; quantitative
83866
13.76
Mucopolysaccharides, acid; screen
83872
8.19
Mucin, synovial fluid (Ropes test)
83873
24.04
Myelin basic protein, cerebrospinal fluid
83874
18.04
Myoglobin
83880
47.43
Natriuretic peptide
83883
15.86
Nephelometry, each analyte not elsewhere
							 specified
83885
34.23
Nickel
83887
33.09
Nicotine
83890
5.60
Molecular diagnostics; molecular isolation or
							 extraction
83891
5.60
Molecular diagnostics; isolation or extraction of
							 highly purified nucleic acid
83892
5.60
Molecular diagnostics; enzymatic
							 digestion
83893
5.60
Molecular diagnostics; dot/slot blot
							 production
83894
5.60
Molecular diagnostics; separation by gel
							 electrophoresis (eg, agarose, polyacrylamide)
83896
5.60
Molecular diagnostics; nucleic acid probe,
							 each
83897
5.60
Molecular diagnostics; nucleic acid transfer (eg,
							 Southern, Northern)
83898
6.10
Molecular diagnostics; amplification, target, each
							 nucleic acid sequence
83900
12.20
Molecular diagnostics; amplification, target,
							 multiplex, first two nucleic acid sequences
83901
6.10
Molecular diagnostics; amplification, target,
							 multiplex, each additional nucleic acid sequence beyond two (List separately in
							 addition to code for primary procedure)
83902
5.75
Molecular diagnostics; reverse
							 transcription
83903
6.10
Molecular diagnostics; mutation scanning, by physical
							 properties (eg, single strand conformational polymorphisms (SSCP),
							 heteroduplex, denaturing gradient gel electrophoresis (DGGE), RNA'ase A),
							 single segment, each
83904
6.10
Molecular diagnostics; mutation identification by
							 sequencing, single segment, each segment
83905
6.10
Molecular diagnostics; mutation identification by
							 allele specific transcription, single segment, each segment
83906
6.10
Molecular diagnostics; mutation identification by
							 allele specific translation, single segment, each segment
83907
18.66
Molecular diagnostics; lysis of cells prior to
							 nucleic acid extraction (eg, stool specimens, paraffin embedded
							 tissue)
83908
6.10
Molecular diagnostics; amplification, signal, each
							 nucleic acid sequence
83909
6.10
Molecular diagnostics; separation and identification
							 by high resolution technique (eg, capillary electrophoresis)
83912
5.60
Molecular diagnostics; interpretation and
							 report
83913
18.66
Molecular diagnostics; RNA stabilization
83914
6.10
Mutation identification by enzymatic ligation or
							 primer extension, single segment, each segment (eg, oligonucleotide ligation
							 assay (OLA), single base chain extension (SBCE), or allele-specific primer
							 extension (ASPE))
83915
15.58
Nucleotidase 5'-
83916
28.09
Oligoclonal immune (oligoclonal bands)
83918
23.00
Organic acids; total, quantitative, each
							 specimen
83919
23.00
Organic acids; qualitative, each specimen
83921
23.00
Organic acid, single, quantitative
83925
27.19
Opiates (eg, morphine, meperidine)
83930
9.24
Osmolality; blood
83935
9.52
Osmolality; urine
83937
41.71
Osteocalcin (bone g1a protein)
83945
17.99
Oxalate
83950
89.99
Oncoprotein, HER-2/neu
83970
57.67
Parathormone (parathyroid hormone)
83986
5.00
pH, body fluid, except blood
83992
20.54
Phencyclidine (PCP)
83993
27.42
Calprotectin, fecal
84022
21.76
Phenothiazine
84030
7.69
Phenylalanine (PKU), blood
84035
5.11
Phenylketones, qualitative
84060
10.32
Phosphatase, acid; total
84061
10.39
Phosphatase, acid; forensic examination
84066
13.50
Phosphatase, acid; prostatic
84075
7.23
Phosphatase, alkaline;
84078
10.20
Phosphatase, alkaline; heat stable (total not
							 included)
84080
20.66
Phosphatase, alkaline; isoenzymes
84081
23.09
Phosphatidylglycerol
84085
9.42
Phosphogluconate, 6-, dehydrogenase, RBC
84087
14.42
Phosphohexose isomerase
84100
6.63
Phosphorus inorganic (phosphate);
84105
7.23
Phosphorus inorganic (phosphate); urine
84106
5.99
Porphobilinogen, urine; qualitative
84110
11.80
Porphobilinogen, urine; quantitative
84119
10.60
Porphyrins, urine; qualitative
84120
20.55
Porphyrins, urine; quantitation and
							 fractionation
84126
35.59
Porphyrins, feces; quantitative
84127
10.60
Porphyrins, feces; qualitative
84132
6.42
Potassium; serum
84133
6.01
Potassium; urine
84134
20.38
Prealbumin
84135
26.73
Pregnanediol
84138
26.46
Pregnanetriol
84140
28.89
Pregnenolone
84143
30.25
17-hydroxypregnenolone
84144
29.15
Progesterone
84146
27.08
Prolactin
84150
34.88
Prostaglandin, each
84152
25.70
Prostate specific antigen (PSA); complexed (direct
							 measurement)
84153
25.70
Prostate specific antigen (PSA); total
84154
25.70
Prostate specific antigen (PSA); free
84155
5.12
Protein, total, except by refractometry;
							 serum
84156
5.12
Protein, total, except by refractometry;
							 urine
84157
5.12
Protein, total, except by refractometry; other source
							 (eg, synovial fluid, cerebrospinal fluid)
84160
7.23
Protein, total, by refractometry, any
							 source
84163
21.03
Pregnancy-associated plasma protein-A
							 (PAPP-A)
84165
15.01
Protein; electrophoretic fractionation and
							 quantitation, serum
84166
24.92
Protein; electrophoretic fractionation and
							 quantitation, other fluids with concentration (eg, urine, CSF)
84181
23.80
Protein; Western Blot, with interpretation and
							 report, blood or other body fluid
84182
25.15
Protein; Western Blot, with interpretation and
							 report, blood or other body fluid, immunological probe for band identification,
							 each
84202
20.05
Protoporphyrin, RBC; quantitative
84203
12.03
Protoporphyrin, RBC; screen
84206
24.89
Proinsulin
84207
37.96
Pyridoxal phosphate (Vitamin B-6)
84210
15.17
Pyruvate
84220
13.18
Pyruvate kinase
84228
16.26
Quinine
84233
89.99
Receptor assay; estrogen
84234
90.64
Receptor assay; progesterone
84235
73.12
Receptor assay; endocrine, other than estrogen or
							 progesterone (specify hormone)
84238
51.09
Receptor assay; non-endocrine (specify
							 receptor)
84244
30.73
Renin
84252
28.28
Riboflavin (Vitamin B-2)
84255
35.67
Selenium
84260
43.28
Serotonin
84270
30.36
Sex hormone binding globulin (SHBG)
84275
18.77
Sialic acid
84285
32.90
Silica
84295
6.72
Sodium; serum
84300
6.79
Sodium; urine
84302
6.79
Sodium; other source
84305
23.62
Somatomedin
84307
23.62
Somatostatin
84311
9.03
Spectrophotometry, analyte not elsewhere
							 specified
84315
3.50
Specific gravity (except urine)
84375
27.39
Sugars, chromatographic, TLC or paper
							 chromatography
84376
7.69
Sugars (mono-, di-, and oligosaccharides); single
							 qualitative, each specimen
84377
7.69
Sugars (mono-, di-, and oligosaccharides); multiple
							 qualitative, each specimen
84378
16.10
Sugars (mono-, di-, and oligosaccharides); single
							 quantitative, each specimen
84379
16.10
Sugars (mono-, di-, and oligosaccharides); multiple
							 quantitative, each specimen
84392
6.64
Sulfate, urine
84402
35.57
Testosterone; free
84403
36.08
Testosterone; total
84425
29.67
Thiamine (Vitamin B-1)
84430
16.26
Thiocyanate
84432
22.44
Thyroglobulin
84436
9.61
Thyroxine; total
84437
9.04
Thyroxine; requiring elution (eg,
							 neonatal)
84439
12.60
Thyroxine; free
84442
20.66
Thyroxine binding globulin (TBG)
84443
23.47
Thyroid stimulating hormone (TSH)
84445
71.05
Thyroid stimulating immune globulins
							 (TSI)
84446
19.81
Tocopherol alpha (Vitamin E)
84449
24.57
Transcortin (cortisol binding globulin)
84450
7.22
Transferase; aspartate amino (AST) (SGOT)
84460
7.40
Transferase; alanine amino (ALT) (SGPT)
84466
17.84
Transferrin
84478
8.04
Triglycerides
84479
9.04
Thyroid hormone (T3 or T4) uptake or thyroid hormone
							 binding ratio (THBR)
84480
19.81
Triiodothyronine T3; total (TT-3)
84481
23.67
Triiodothyronine T3; free
84482
21.27
Triiodothyronine T3; reverse
84484
13.75
Troponin, quantitative
84485
10.49
Trypsin; duodenal fluid
84488
9.61
Trypsin; feces, qualitative
84490
10.63
Trypsin; feces, quantitative, 24-hour
							 collection
84510
14.53
Tyrosine
84512
10.31
Troponin, qualitative
84520
5.51
Urea nitrogen; quantitative
84525
5.25
Urea nitrogen; semiquantitative (eg, reagent strip
							 test)
84540
6.64
Urea nitrogen, urine
84545
9.23
Urea nitrogen, clearance
84550
6.31
Uric acid; blood
84560
6.64
Uric acid; other source
84577
17.43
Urobilinogen, feces, quantitative
84578
4.54
Urobilinogen, urine; qualitative
84580
8.92
Urobilinogen, urine; quantitative, timed
							 specimen
84583
7.02
Urobilinogen, urine; semiquantitative
84585
21.66
Vanillylmandelic acid (VMA), urine
84586
26.68
Vasoactive intestinal peptide (VIP)
84588
47.43
Vasopressin (antidiuretic hormone, ADH)
84590
16.20
Vitamin A
84591
16.20
Vitamin, not otherwise specified
84597
19.15
Vitamin K
84600
22.45
Volatiles (eg, acetic anhydride, carbon
							 tetrachloride, dichloroethane, dichloromethane, diethylether, isopropyl
							 alcohol, methanol)
84620
16.55
Xylose absorption test, blood and/or
							 urine
84630
15.91
Zinc
84681
29.07
C-peptide
84702
21.03
Gonadotropin, chorionic (hCG);
							 quantitative
84703
10.49
Gonadotropin, chorionic (hCG);
							 qualitative
84704
21.03
Gonadotropin, chorionic (hCG); free beta
							 chain
84830
14.02
Ovulation tests, by visual color comparison methods
							 for human luteinizing hormone
85002
6.29
Bleeding time
85004
9.04
Blood count; automated differential WBC
							 count
85007
4.81
Blood count; blood smear, microscopic examination
							 with manual differential WBC count
85008
4.81
Blood count; blood smear, microscopic examination
							 without manual differential WBC count
85009
5.19
Blood count; manual differential WBC count, buffy
							 coat
85013
3.31
Blood count; spun microhematocrit
85014
3.31
Blood count; hematocrit (Hct)
85018
3.31
Blood count; hemoglobin (Hgb)
85025
10.86
Blood count; complete (CBC), automated (Hgb, Hct,
							 RBC, WBC and platelet count) and automated differential WBC count
85027
9.04
Blood count; complete (CBC), automated (Hgb, Hct,
							 RBC, WBC and platelet count)
85032
6.01
Blood count; manual cell count (erythrocyte,
							 leukocyte, or platelet) each
85041
4.05
Blood count; red blood cell (RBC),
							 automated
85044
6.01
Blood count; reticulocyte, manual
85045
5.59
Blood count; reticulocyte, automated
85046
7.80
Blood count; reticulocytes, automated, including one
							 or more cellular parameters (eg, reticulocyte hemoglobin content (CHr),
							 immature reticulocyte fraction (IRF), reticulocyte volume (MRV), RNA content),
							 direct measurement
85048
3.55
Blood count; leukocyte (WBC), automated
85049
6.25
Blood count; platelet, automated
85055
15.37
Reticulated platelet assay
85130
10.68
Chromogenic substrate assay
85170
5.05
Clot retraction
85175
5.41
Clot lysis time, whole blood dilution
85210
18.14
Clotting; factor II, prothrombin,
							 specific
85220
24.66
Clotting; factor V (AcG or proaccelerin), labile
							 factor
85230
25.02
Clotting; factor VII (proconvertin, stable
							 factor)
85240
25.02
Clotting; factor VIII (AHG), one stage
85244
28.53
Clotting; factor VIII related antigen
85245
32.06
Clotting; factor VIII, VW factor, ristocetin
							 cofactor
85246
32.06
Clotting; factor VIII, VW factor antigen
85247
32.06
Clotting; factor VIII, von Willebrand factor,
							 multimetric analysis
85250
26.60
Clotting; factor IX (PTC or Christmas)
85260
25.02
Clotting; factor X (Stuart-Prower)
85270
25.02
Clotting; factor XI (PTA)
85280
27.04
Clotting; factor XII (Hageman)
85290
22.83
Clotting; factor XIII (fibrin
							 stabilizing)
85291
12.42
Clotting; factor XIII (fibrin stabilizing), screen
							 solubility
85292
26.46
Clotting; prekallikrein assay (Fletcher factor
							 assay)
85293
26.46
Clotting; high molecular weight kininogen assay
							 (Fitzgerald factor assay)
85300
16.55
Clotting inhibitors or anticoagulants; antithrombin
							 III, activity
85301
15.11
Clotting inhibitors or anticoagulants; antithrombin
							 III, antigen assay
85302
16.80
Clotting inhibitors or anticoagulants; protein C,
							 antigen
85303
17.81
Clotting inhibitors or anticoagulants; protein C,
							 activity
85305
16.20
Clotting inhibitors or anticoagulants; protein S,
							 total
85306
19.97
Clotting inhibitors or anticoagulants; protein S,
							 free
85307
19.97
Activated Protein C (APC) resistance
							 assay
85335
17.99
Factor inhibitor test
85337
14.56
Thrombomodulin
85345
6.01
Coagulation time; Lee and White
85347
5.95
Coagulation time; activated
85348
5.20
Coagulation time; other methods
85360
11.74
Euglobulin lysis
85362
9.62
Fibrin(ogen) degradation (split) products (FDP)
							 (FSP); agglutination slide, semiquantitative
85366
10.54
Fibrin(ogen) degradation (split) products (FDP)
							 (FSP); paracoagulation
85370
9.60
Fibrin(ogen) degradation (split) products (FDP)
							 (FSP); quantitative
85378
9.97
Fibrin degradation products, D-dimer; qualitative or
							 semiquantitative
85379
14.22
Fibrin degradation products, D-dimer;
							 quantitative
85380
14.22
Fibrin degradation products, D-dimer; ultrasensitive
							 (eg, for evaluation for venous thromboembolism), qualitative or
							 semiquantitative
85384
11.87
Fibrinogen; activity
85385
11.87
Fibrinogen; antigen
85390
7.22
Fibrinolysins or coagulopathy screen, interpretation
							 and report
85400
12.36
Fibrinolytic factors and inhibitors;
							 plasmin
85410
10.77
Fibrinolytic factors and inhibitors; alpha-2
							 antiplasmin
85415
24.02
Fibrinolytic factors and inhibitors; plasminogen
							 activator
85420
9.13
Fibrinolytic factors and inhibitors; plasminogen,
							 except antigenic assay
85421
14.23
Fibrinolytic factors and inhibitors; plasminogen,
							 antigenic assay
85441
5.88
Heinz bodies; direct
85445
9.52
Heinz bodies; induced, acetyl
							 phenylhydrazine
85460
8.11
Hemoglobin or RBCs, fetal, for fetomaternal
							 hemorrhage; differential lysis (Kleihauer-Betke)
85461
9.26
Hemoglobin or RBCs, fetal, for fetomaternal
							 hemorrhage; rosette
85475
12.40
Hemolysin, acid
85520
18.29
Heparin assay
85525
16.55
Heparin neutralization
85530
19.81
Heparin-protamine tolerance test
85536
9.04
Iron stain, peripheral blood
85540
12.02
Leukocyte alkaline phosphatase with count
85547
8.92
Mechanical fragility, RBC
85549
26.21
Muramidase
85555
9.34
Osmotic fragility, RBC; unincubated
85557
11.36
Osmotic fragility, RBC; incubated
85576
30.01
Platelet, aggregation (in vitro), each
							 agent
85576
30.01
Platelet, aggregation (in vitro), each
							 agent
85597
6.53
Platelet neutralization
85610
5.49
Prothrombin time;
85611
5.51
Prothrombin time; substitution, plasma fractions,
							 each
85612
8.38
Russell viper venom time (includes venom);
							 undiluted
85613
8.38
Russell viper venom time (includes venom);
							 diluted
85635
13.76
Reptilase test
85651
4.96
Sedimentation rate, erythrocyte;
							 non-automated
85652
3.77
Sedimentation rate, erythrocyte;
							 automated
85660
7.71
Sickling of RBC, reduction
85670
8.07
Thrombin time; plasma
85675
9.58
Thrombin time; titer
85705
9.77
Thromboplastin inhibition, tissue
85730
8.38
Thromboplastin time, partial (PTT); plasma or whole
							 blood
85732
9.04
Thromboplastin time, partial (PTT); substitution,
							 plasma fractions, each
85810
16.32
Viscosity
86000
9.75
Agglutinins, febrile (eg, Brucella, Francisella,
							 Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each
							 antigen
86001
7.30
Allergen specific IgG quantitative or
							 semiquantitative, each allergen
86003
7.30
Allergen specific IgE; quantitative or
							 semiquantitative, each allergen
86005
11.14
Allergen specific IgE; qualitative, multiallergen
							 screen (dipstick, paddle, or disk)
86021
21.03
Antibody identification; leukocyte
							 antibodies
86022
25.66
Antibody identification; platelet
							 antibodies
86023
17.40
Antibody identification; platelet associated
							 immunoglobulin assay
86038
16.89
Antinuclear antibodies (ANA);
86039
15.60
Antinuclear antibodies (ANA); titer
86060
10.20
Antistreptolysin 0; titer
86063
8.07
Antistreptolysin 0; screen
86140
7.23
C-reactive protein;
86141
18.09
C-reactive protein; high sensitivity
							 (hsCRP)
86146
19.21
Beta 2 Glycoprotein I antibody, each
86147
19.21
Cardiolipin (phospholipid) antibody, each Ig
							 class
86148
19.21
Anti-phosphatidylserine (phospholipid)
							 antibody
86155
22.33
Chemotaxis assay, specify method
86156
8.91
Cold agglutinin; screen
86157
11.27
Cold agglutinin; titer
86160
16.78
Complement; antigen, each component
86161
16.78
Complement; functional activity, each
							 component
86162
28.39
Complement; total hemolytic (CH50)
86171
12.16
Complement fixation tests, each antigen
86185
12.50
Counterimmunoelectrophoresis, each
							 antigen
86200
18.09
Cyclic citrullinated peptide (CCP),
							 antibody
86215
18.51
Deoxyribonuclease, antibody
86225
19.20
Deoxyribonucleic acid (DNA) antibody; native or
							 double stranded
86226
16.92
Deoxyribonucleic acid (DNA) antibody; single
							 stranded
86235
25.06
Extractable nuclear antigen, antibody to, any method
							 (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody
86243
28.68
Fc receptor
86255
12.16
Fluorescent noninfectious agent antibody; screen,
							 each antibody
86256
16.84
Fluorescent noninfectious agent antibody; titer, each
							 antibody
86277
21.99
Growth hormone, human (HGH), antibody
86280
11.44
Hemagglutination inhibition test (HAI)
86294
27.41
Immunoassay for tumor antigen, qualitative or
							 semiquantitative (eg, bladder tumor antigen)
86300
29.07
Immunoassay for tumor antigen, quantitative; CA 15-3
							 (27.29)
86301
29.07
Immunoassay for tumor antigen, quantitative; CA
							 19-9
86304
29.07
Immunoassay for tumor antigen, quantitative; CA
							 125
86308
7.23
Heterophile antibodies; screening
86309
9.04
Heterophile antibodies; titer
86310
10.30
Heterophile antibodies; titers after absorption with
							 beef cells and guinea pig kidney
86316
29.07
Immunoassay for tumor antigen, other antigen,
							 quantitative (eg, CA 50, 72-4, 549), each
86317
20.95
Immunoassay for infectious agent antibody,
							 quantitative, not otherwise specified
86318
18.09
Immunoassay for infectious agent antibody,
							 qualitative or semiquantitative, single step method (eg, reagent
							 strip)
86320
31.32
Immunoelectrophoresis; serum
86325
31.24
Immunoelectrophoresis; other fluids (eg, urine,
							 cerebrospinal fluid) with concentration
86327
31.70
Immunoelectrophoresis; crossed (2-dimensional
							 assay)
86329
19.62
Immunodiffusion; not elsewhere specified
86331
16.75
Immunodiffusion; gel diffusion, qualitative
							 (Ouchterlony), each antigen or antibody
86332
34.05
Immune complex assay
86334
31.21
Immunofixation electrophoresis; serum
86335
41.00
Immunofixation electrophoresis; other fluids with
							 concentration (eg, urine, CSF)
86336
21.77
Inhibin A
86337
29.92
Insulin antibodies
86340
21.06
Intrinsic factor antibodies
86341
27.65
Islet cell antibody
86343
17.41
Leukocyte histamine release test (LHR)
86344
11.16
Leukocyte phagocytosis
86353
68.49
Lymphocyte transformation, mitogen (phytomitogen) or
							 antigen induced blastogenesis
86355
16.01
B cells, total count
86356
15.37
Mononuclear cell antigen, quantitative (eg, flow
							 cytometry), not otherwise specified, each antigen
86357
16.01
Natural killer (NK) cells, total count
86359
16.01
T cells; total count
86360
19.21
T cells; absolute CD4 and CD8 count, including
							 ratio
86361
15.37
T cells; absolute CD4 count
86367
16.01
Stem cells (ie, CD34), total count
86376
20.33
Microsomal antibodies (eg, thyroid or liver-kidney),
							 each
86378
27.51
Migration inhibitory factor test (MIF)
86382
23.62
Neutralization test, viral
86384
15.91
Nitroblue tetrazolium dye test (NTD)
86403
14.24
Particle agglutination; screen, each
							 antibody
86406
14.87
Particle agglutination; titer, each
							 antibody
86430
7.93
Rheumatoid factor; qualitative
86431
7.93
Rheumatoid factor; quantitative
86480
86.59
Tuberculosis test, cell mediated immunity measurement
							 of gamma interferon antigen response
86590
15.41
Streptokinase, antibody
86592
5.96
Syphilis test; qualitative (eg, VDRL, RPR,
							 ART)
86593
6.16
Syphilis test; quantitative
86602
13.64
Antibody; actinomyces
86603
14.58
Antibody; adenovirus
86606
20.59
Antibody; Aspergillus
86609
13.64
Antibody; bacterium, not elsewhere
							 specified
86611
13.64
Antibody; Bartonella
86612
18.03
Antibody; Blastomyces
86615
18.43
Antibody; Bordetella
86617
21.64
Antibody; Borrelia burgdorferi (Lyme disease)
							 confirmatory test (eg, Western Blot or immunoblot)
86618
19.97
Antibody; Borrelia burgdorferi (Lyme
							 disease)
86619
18.69
Antibody; Borrelia (relapsing fever)
86622
12.14
Antibody; Brucella
86625
13.64
Antibody; Campylobacter
86628
16.78
Antibody; Candida
86631
16.52
Antibody; Chlamydia
86632
17.74
Antibody; Chlamydia, IgM
86635
16.03
Antibody; Coccidioides
86638
16.94
Antibody; Coxiella burnetii (Q fever)
86641
12.14
Antibody; Cryptococcus
86644
20.11
Antibody; cytomegalovirus (CMV)
86645
19.97
Antibody; cytomegalovirus (CMV), IgM
86648
13.64
Antibody; Diphtheria
86651
18.43
Antibody; encephalitis, California (La
							 Crosse)
86652
18.43
Antibody; encephalitis, Eastern equine
86653
18.43
Antibody; encephalitis, St. Louis
86654
18.43
Antibody; encephalitis, Western equine
86658
14.58
Antibody; enterovirus (eg, coxsackie, echo,
							 polio)
86663
18.33
Antibody; Epstein-Barr (EB) virus, early antigen
							 (EA)
86664
19.97
Antibody; Epstein-Barr (EB) virus, nuclear antigen
							 (EBNA)
86665
19.97
Antibody; Epstein-Barr (EB) virus, viral capsid
							 (VCA)
86666
13.64
Antibody; Ehrlichia
86668
12.14
Antibody; Francisella tularensis
86671
13.64
Antibody; fungus, not elsewhere specified
86674
19.97
Antibody; Giardia lamblia
86677
20.28
Antibody; Helicobacter pylori
86682
13.64
Antibody; helminth, not elsewhere
							 specified
86684
13.64
Antibody; Haemophilus influenza
86687
11.72
Antibody; HTLV-I
86688
13.94
Antibody; HTLV-II
86689
27.05
Antibody; HTLV or HIV antibody, confirmatory test
							 (eg, Western Blot)
86692
23.62
Antibody; hepatitis, delta agent
86694
20.11
Antibody; herpes simplex, non-specific type
							 test
86695
18.43
Antibody; herpes simplex, type 1
86696
27.05
Antibody; herpes simplex, type 2
86698
17.46
Antibody; histoplasma
86701
12.41
Antibody; HIV-1
86702
14.75
Antibody; HIV-2
86703
14.75
Antibody; HIV-1 and HIV-2, single assay
86704
16.84
Hepatitis B core antibody (HBcAb); total
86705
16.44
Hepatitis B core antibody (HBcAb); IgM
							 antibody
86706
14.61
Hepatitis B surface antibody (HBsAb)
86707
16.16
Hepatitis Be antibody (HBeAb)
86708
16.24
Hepatitis A antibody (HAAb); total
86709
15.73
Hepatitis A antibody (HAAb); IgM antibody
86710
14.58
Antibody; influenza virus
86713
21.39
Antibody; Legionella
86717
13.00
Antibody; Leishmania
86720
12.14
Antibody; Leptospira
86723
13.00
Antibody; Listeria monocytogenes
86727
14.58
Antibody; lymphocytic choriomeningitis
86729
16.69
Antibody; lymphogranuloma venereum
86732
13.00
Antibody; mucormycosis
86735
18.23
Antibody; mumps
86738
14.58
Antibody; mycoplasma
86741
13.00
Antibody; Neisseria meningitides
86744
13.00
Antibody; Nocardia
86747
13.00
Antibody; parvovirus
86750
13.00
Antibody; Plasmodium (malaria)
86753
13.00
Antibody; protozoa, not elsewhere
							 specified
86756
18.01
Antibody; respiratory syncytial virus
86757
27.05
Antibody; Rickettsia
86759
18.43
Antibody; rotavirus
86762
20.11
Antibody; rubella
86765
18.00
Antibody; rubeola
86768
13.00
Antibody; Salmonella
86771
13.00
Antibody; Shigella
86774
13.00
Antibody; tetanus
86777
20.11
Antibody; Toxoplasma
86778
20.12
Antibody; Toxoplasma, IgM
86781
18.50
Antibody; Treponema pallidum, confirmatory test (eg,
							 FTA-abs)
86784
17.55
Antibody; Trichinella
86787
18.00
Antibody; varicella-zoster
86788
19.97
Antibody; West Nile virus, IgM
86789
20.11
Antibody; West Nile virus
86790
13.00
Antibody; virus, not elsewhere specified
86793
13.00
Antibody; Yersinia
86800
20.70
Thyroglobulin antibody
86803
16.24
Hepatitis C antibody;
86804
21.64
Hepatitis C antibody; confirmatory test (eg,
							 immunoblot)
86805
73.05
Lymphocytotoxicity assay, visual crossmatch; with
							 titration
86806
66.49
Lymphocytotoxicity assay, visual crossmatch; without
							 titration
86807
55.29
Serum screening for cytotoxic percent reactive
							 antibody (PRA); standard method
86808
41.47
Serum screening for cytotoxic percent reactive
							 antibody (PRA); quick method
86812
36.06
HLA typing; A, B, or C (eg, A10, B7, B27), single
							 antigen
86813
81.02
HLA typing; A, B, or C, multiple antigens
86816
38.92
HLA typing; DR/DQ, single antigen
86817
89.95
HLA typing; DR/DQ, multiple antigens
86821
78.88
HLA typing; lymphocyte culture, mixed
							 (MLC)
86822
51.07
HLA typing; lymphocyte culture, primed
							 (PLC)
86880
7.50
Antihuman globulin test (Coombs test); direct, each
							 antiserum
86885
7.99
Antihuman globulin test (Coombs test); indirect,
							 qualitative, each reagent red cell
86886
7.23
Antihuman globulin test (Coombs test); indirect, each
							 antibody titer
86900
4.17
Blood typing; ABO
86901
4.17
Blood typing; Rh (D)
86903
13.19
Blood typing; antigen screening for compatible blood
							 unit using reagent serum, per unit screened
86904
13.28
Blood typing; antigen screening for compatible unit
							 using patient serum, per unit screened
86905
5.34
Blood typing; RBC antigens, other than ABO or Rh (D),
							 each
86906
10.83
Blood typing; Rh phenotyping, complete
86940
11.46
Hemolysins and agglutinins; auto, screen,
							 each
86941
16.92
Hemolysins and agglutinins; incubated
87001
6.88
Animal inoculation, small animal; with
							 observation
87003
23.52
Animal inoculation, small animal; with observation
							 and dissection
87015
9.33
Concentration (any type), for infectious
							 agents
87040
14.42
Culture, bacterial; blood, aerobic, with isolation
							 and presumptive identification of isolates (includes anaerobic culture, if
							 appropriate)
87045
13.18
Culture, bacterial; stool, aerobic, with isolation
							 and preliminary examination (eg, KIA, LIA), Salmonella and Shigella
							 species
87046
13.18
Culture, bacterial; stool, aerobic, additional
							 pathogens, isolation and presumptive identification of isolates, each
							 plate
87070
12.03
Culture, bacterial; any other source except urine,
							 blood or stool, aerobic, with isolation and presumptive identification of
							 isolates
87071
13.18
Culture, bacterial; quantitative, aerobic with
							 isolation and presumptive identification of isolates, any source except urine,
							 blood or stool
87073
13.18
Culture, bacterial; quantitative, anaerobic with
							 isolation and presumptive identification of isolates, any source except urine,
							 blood or stool
87075
13.22
Culture, bacterial; any source, except blood,
							 anaerobic with isolation and presumptive identification of isolates
87076
7.30
Culture, bacterial; anaerobic isolate, additional
							 methods required for definitive identification, each isolate
87077
7.30
Culture, bacterial; aerobic isolate, additional
							 methods required for definitive identification, each isolate
87081
9.26
Culture, presumptive, pathogenic organisms, screening
							 only;
87084
9.75
Culture, presumptive, pathogenic organisms, screening
							 only; with colony estimation from density chart
87086
11.28
Culture, bacterial; quantitative colony count,
							 urine
87088
11.31
Culture, bacterial; with isolation and presumptive
							 identification of each isolate, urine
87101
10.77
Culture, fungi (mold or yeast) isolation, with
							 presumptive identification of isolates; skin, hair, or nail
87102
11.74
Culture, fungi (mold or yeast) isolation, with
							 presumptive identification of isolates; other source (except blood)
87103
12.60
Culture, fungi (mold or yeast) isolation, with
							 presumptive identification of isolates; blood
87106
14.42
Culture, fungi, definitive identification, each
							 organism; yeast
87107
14.42
Culture, fungi, definitive identification, each
							 organism; mold
87109
21.50
Culture, mycoplasma, any source
87110
27.37
Culture, chlamydia, any source
87116
15.10
Culture, tubercle or other acid-fast bacilli (eg, TB,
							 AFB, mycobacteria) any source, with isolation and presumptive identification of
							 isolates
87118
15.29
Culture, mycobacterial, definitive identification,
							 each isolate
87140
7.79
Culture, typing; immunofluorescent method, each
							 antiserum
87143
17.51
Culture, typing; gas liquid chromatography (GLC) or
							 high pressure liquid chromatography (HPLC) method
87147
7.23
Culture, typing; immunologic method, other than
							 immunofluoresence (eg, agglutination grouping), per antiserum
87149
28.02
Culture, typing; identification by nucleic acid
							 probe
87152
7.31
Culture, typing; identification by pulse field gel
							 typing
87158
7.31
Culture, typing; other methods
87164
8.11
Dark field examination, any source (eg, penile,
							 vaginal, oral, skin); includes specimen collection
87166
8.11
Dark field examination, any source (eg, penile,
							 vaginal, oral, skin); without collection
87168
5.96
Macroscopic examination; arthropod
87169
5.96
Macroscopic examination; parasite
87172
5.96
Pinworm exam (eg, cellophane tape prep)
87176
8.22
Homogenization, tissue, for culture
87177
12.43
Ova and parasites, direct smears, concentration and
							 identification
87181
6.64
Susceptibility studies, antimicrobial agent; agar
							 dilution method, per agent (eg, antibiotic gradient strip)
87184
9.63
Susceptibility studies, antimicrobial agent; disk
							 method, per plate (12 or fewer agents)
87185
6.64
Susceptibility studies, antimicrobial agent; enzyme
							 detection (eg, beta lactamase), per enzyme
87186
12.08
Susceptibility studies, antimicrobial agent;
							 microdilution or agar dilution (minimum inhibitory concentration (MIC) or
							 breakpoint), each multi-antimicrobial, per plate
87187
14.48
Susceptibility studies, antimicrobial agent;
							 microdilution or agar dilution, minimum lethal concentration (MLC), each plate
							 (List separately in addition to code for primary procedure)
87188
9.27
Susceptibility studies, antimicrobial agent;
							 macrobroth dilution method, each agent
87190
6.88
Susceptibility studies, antimicrobial agent;
							 mycobacteria, proportion method, each agent
87197
20.99
Serum bactericidal titer (Schlicter test)
87205
5.96
Smear, primary source with interpretation; Gram or
							 Giemsa stain for bacteria, fungi, or cell types
87206
7.50
Smear, primary source with interpretation;
							 fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or
							 cell types
87207
8.37
Smear, primary source with interpretation; special
							 stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia,
							 trypanosomes, herpes viruses)
87209
25.11
Smear, primary source with interpretation; complex
							 special stain (eg, trichrome, iron hemotoxylin) for ova and
							 parasites
87210
5.96
Smear, primary source with interpretation; wet mount
							 for infectious agents (eg, saline, India ink, KOH preps)
87220
5.96
Tissue examination by KOH slide of samples from skin,
							 hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)
87230
27.30
Toxin or antitoxin assay, tissue culture (eg,
							 Clostridium difficile toxin)
87250
27.32
Virus isolation; inoculation of embryonated eggs, or
							 small animal, includes observation and dissection
87252
36.42
Virus isolation; tissue culture inoculation,
							 observation, and presumptive identification by cytopathic effect
87253
28.22
Virus isolation; tissue culture, additional studies
							 or definitive identification (eg, hemabsorption, neutralization,
							 immunofluoresence stain), each isolate
87254
27.32
Virus isolation; centrifuge enhanced (shell vial)
							 technique, includes identification with immunofluorescence stain, each
							 virus
87255
47.31
Virus isolation; including identification by
							 non-immunologic method, other than by cytopathic effect (eg, virus specific
							 enzymatic activity)
87260
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; adenovirus
87265
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Bordetella pertussis/parapertussis
87267
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Enterovirus, direct fluorescent antibody
							 (DFA)
87269
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; giardia
87270
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Chlamydia trachomatis
87271
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody
							 (DFA)
87272
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; cryptosporidium
87273
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Herpes simplex virus type 2
87274
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Herpes simplex virus type 1
87275
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; influenza B virus
87276
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; influenza A virus
87277
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Legionella micdadei
87278
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Legionella pneumophila
87279
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Parainfluenza virus, each type
87280
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; respiratory syncytial virus
87281
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Pneumocystis carinii
87283
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Rubeola
87285
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Treponema pallidum
87290
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; Varicella zoster virus
87299
16.01
Infectious agent antigen detection by
							 immunofluorescent technique; not otherwise specified, each organism
87300
16.01
Infectious agent antigen detection by
							 immunofluorescent technique, polyvalent for multiple organisms, each polyvalent
							 antiserum
87301
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 adenovirus enteric types 40/41
87305
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Aspergillus
87320
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Chlamydia trachomatis
87324
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Clostridium difficile toxin(s)
87327
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Cryptococcus neoformans
87328
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 cryptosporidium
87329
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 giardia
87332
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 cytomegalovirus
87335
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Escherichia coli 0157
87336
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Entamoeba histolytica dispar group
87337
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Entamoeba histolytica group
87338
16.04
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Helicobacter pylori, stool
87339
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Helicobacter pylori
87340
14.43
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 hepatitis B surface antigen (HBsAg)
87341
14.43
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 hepatitis B surface antigen (HBsAg) neutralization
87350
16.10
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 hepatitis Be antigen (HBeAg)
87380
15.54
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 hepatitis, delta agent
87385
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Histoplasma capsulatum
87390
24.65
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 HIV-1
87391
24.65
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 HIV-2
87400
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Influenza, A or B, each
87420
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 respiratory syncytial virus
87425
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 rotavirus
87427
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Shiga-like toxin
87430
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique, qualitative or semiquantitative, multiple-step method;
							 Streptococcus, group A
87449
16.01
Infectious agent antigen detection by enzyme
							 immunoassay technique qualitative or semiquantitative; multiple step method,
							 not otherwise specified, each organism
87450
10.68
Infectious agent antigen detection by enzyme
							 immunoassay technique qualitative or semiquantitative; single step method, not
							 otherwise specified, each organism
87451
10.68
Infectious agent antigen detection by enzyme
							 immunoassay technique qualitative or semiquantitative; multiple step method,
							 polyvalent for multiple organisms, each polyvalent antiserum
87470
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Bartonella henselae and Bartonella quintana, direct probe
							 technique
87471
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Bartonella henselae and Bartonella quintana, amplified probe
							 technique
87472
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Bartonella henselae and Bartonella quintana, quantification
87475
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Borrelia burgdorferi, direct probe technique
87476
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Borrelia burgdorferi, amplified probe technique
87477
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Borrelia burgdorferi, quantification
87480
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Candida species, direct probe technique
87481
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Candida species, amplified probe technique
87482
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); Candida species, quantification
87485
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia pneumoniae, direct probe technique
87486
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia pneumoniae, amplified probe technique
87487
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia pneumoniae, quantification
87490
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia trachomatis, direct probe technique
87491
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia trachomatis, amplified probe technique
87492
22.93
Infectious agent detection by nucleic acid (DNA or
							 RNA); Chlamydia trachomatis, quantification
87495
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); cytomegalovirus, direct probe technique
87496
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); cytomegalovirus, amplified probe technique
87497
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); cytomegalovirus, quantification
87498
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); enterovirus, amplified probe technique
87500
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified
							 probe technique
87510
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Gardnerella vaginalis, direct probe technique
87511
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Gardnerella vaginalis, amplified probe technique
87512
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); Gardnerella vaginalis, quantification
87515
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis B virus, direct probe technique
87516
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis B virus, amplified probe technique
87517
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis B virus, quantification
87520
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis C, direct probe technique
87521
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis C, amplified probe technique
87522
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis C, quantification
87525
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis G, direct probe technique
87526
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis G, amplified probe technique
87527
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); hepatitis G, quantification
87528
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes simplex virus, direct probe technique
87529
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes simplex virus, amplified probe technique
87530
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes simplex virus, quantification
87531
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes virus-6, direct probe technique
87532
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes virus-6, amplified probe technique
87533
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); Herpes virus-6, quantification
87534
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-1, direct probe technique
87535
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-1, amplified probe technique
87536
78.52
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-1, quantification
87537
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-2, direct probe technique
87538
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-2, amplified probe technique
87539
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); HIV-2, quantification
87540
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Legionella pneumophila, direct probe technique
87541
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Legionella pneumophila, amplified probe technique
87542
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); Legionella pneumophila, quantification
87550
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria species, direct probe technique
87551
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria species, amplified probe technique
87552
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria species, quantification
87555
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria tuberculosis, direct probe technique
87556
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria tuberculosis, amplified probe technique
87557
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria tuberculosis, quantification
87560
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria avium-intracellulare, direct probe technique
87561
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria avium-intracellulare, amplified probe technique
87562
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycobacteria avium-intracellulare, quantification
87580
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma pneumoniae, direct probe technique
87581
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma pneumoniae, amplified probe technique
87582
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); Mycoplasma pneumoniae, quantification
87590
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Neisseria gonorrhoeae, direct probe technique
87591
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Neisseria gonorrhoeae, amplified probe technique
87592
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA); Neisseria gonorrhoeae, quantification
87620
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); papillomavirus, human, direct probe technique
87621
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); papillomavirus, human, amplified probe technique
87622
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); papillomavirus, human, quantification
87640
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Staphylococcus aureus, amplified probe technique
87641
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Staphylococcus aureus, methicillin resistant, amplified probe
							 technique
87650
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group A, direct probe technique
87651
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group A, amplified probe technique
87652
58.33
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group A, quantification
87653
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA); Streptococcus, group B, amplified probe technique
87660
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA); Trichomonas vaginalis, direct probe technique
87797
28.02
Infectious agent detection by nucleic acid (DNA or
							 RNA), not otherwise specified; direct probe technique, each
							 organism
87798
36.39
Infectious agent detection by nucleic acid (DNA or
							 RNA), not otherwise specified; amplified probe technique, each
							 organism
87799
59.85
Infectious agent detection by nucleic acid (DNA or
							 RNA), not otherwise specified; quantification, each organism
87800
56.03
Infectious agent detection by nucleic acid (DNA or
							 RNA), multiple organisms; direct probe(s) technique
87801
72.78
Infectious agent detection by nucleic acid (DNA or
							 RNA), multiple organisms; amplified probe(s) technique
87802
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; Streptococcus, group B
87803
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; Clostridium difficile toxin A
87804
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; Influenza
87804
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; Influenza
87807
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; respiratory syncytial virus
87808
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; Trichomonas vaginalis
87809
16.01
Infectious agent antigen detection by immunoassay
							 with direct optical observation; adenovirus
87810
16.01
Infectious agent detection by immunoassay with direct
							 optical observation; Chlamydia trachomatis
87850
16.01
Infectious agent detection by immunoassay with direct
							 optical observation; Neisseria gonorrhoeae
87880
16.01
Infectious agent detection by immunoassay with direct
							 optical observation; Streptococcus, group A
87899
16.01
Infectious agent detection by immunoassay with direct
							 optical observation; not otherwise specified
87900
182.11
Infectious agent drug susceptibility phenotype
							 prediction using regularly updated genotypic bioinformatics
87901
114.95
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); HIV 1, reverse transcriptase and protease
87902
114.95
Infectious agent genotype analysis by nucleic acid
							 (DNA or RNA); Hepatitis C virus
87903
682.72
Infectious agent phenotype analysis by nucleic acid
							 (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through
							 ten drugs tested
87904
36.42
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)
88130
21.02
Sex chromatin identification; Barr bodies
88140
11.17
Sex chromatin identification; peripheral blood smear,
							 polymorphonuclear drumsticks
88142
28.31
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 manual screening under physician supervision
88143
28.31
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 with manual screening and rescreening under physician supervision
88147
15.90
Cytopathology smears, cervical or vaginal; screening
							 by automated system under physician supervision
88148
21.23
Cytopathology smears, cervical or vaginal; screening
							 by automated system with manual rescreening under physician
							 supervision
88150
14.76
Cytopathology, slides, cervical or vaginal; manual
							 screening under physician supervision
88152
14.76
Cytopathology, slides, cervical or vaginal; with
							 manual screening and computer-assisted rescreening under physician
							 supervision
88153
14.76
Cytopathology, slides, cervical or vaginal; with
							 manual screening and rescreening under physician supervision
88154
14.76
Cytopathology, slides, cervical or vaginal; with
							 manual screening and computer-assisted rescreening using cell selection and
							 review under physician supervision
88155
8.37
Cytopathology, slides, cervical or vaginal,
							 definitive hormonal evaluation (eg, maturation index, karyopyknotic index,
							 estrogenic index) (List separately in addition to code(s) for other technical
							 and interpretation services)
88164
14.76
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); manual screening under physician supervision
88165
14.76
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); with manual screening and rescreening under physician
							 supervision
88166
14.76
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); with manual screening and computer-assisted rescreening under
							 physician supervision
88167
14.76
Cytopathology, slides, cervical or vaginal (the
							 Bethesda System); with manual screening and computer-assisted rescreening using
							 cell selection and review under physician supervision
88174
29.85
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 screening by automated system, under physician supervision
88175
37.01
Cytopathology, cervical or vaginal (any reporting
							 system), collected in preservative fluid, automated thin layer preparation;
							 with screening by automated system and manual rescreening or review, under
							 physician supervision
88230
48.38
Tissue culture for non-neoplastic disorders;
							 lymphocyte
88233
122.81
Tissue culture for non-neoplastic disorders; skin or
							 other solid tissue biopsy
88235
122.81
Tissue culture for non-neoplastic disorders; amniotic
							 fluid or chorionic villus cells
88237
55.83
Tissue culture for neoplastic disorders; bone marrow,
							 blood cells
88239
206.12
Tissue culture for neoplastic disorders; solid
							 tumor
88240
14.11
Cryopreservation, freezing and storage of cells, each
							 cell line
88241
14.11
Thawing and expansion of frozen cells, each
							 aliquot
88245
207.98
Chromosome analysis for breakage syndromes; baseline
							 Sister Chromatid Exchange (SCE), 20-25 cells
88248
241.96
Chromosome analysis for breakage syndromes; baseline
							 breakage, score 50-100 cells, count 20 cells, two karyotypes (eg, for ataxia
							 telangiectasia, Fanconi anemia, fragile X)
88249
241.96
Chromosome analysis for breakage syndromes; score 100
							 cells, clastogen stress (eg, diepoxybutane, mitomycin C, ionizing radiation, UV
							 radiation)
88261
246.93
Chromosome analysis; count five cells, one karyotype,
							 with banding
88262
174.14
Chromosome analysis; count 15-20 cells, two
							 karyotypes, with banding
88263
204.68
Chromosome analysis; count 45 cells for mosaicism,
							 two karyotypes, with banding
88264
174.14
Chromosome analysis; analyze 20-25 cells
88267
251.17
Chromosome analysis, amniotic fluid or chorionic
							 villus, count 15 cells, one karyotype, with banding
88269
232.38
Chromosome analysis, in situ for amniotic fluid
							 cells, count cells from six-12 colonies, one karyotype, with
							 banding
88271
29.93
Molecular cytogenetics; DNA probe, each (eg,
							 FISH)
88272
37.41
Molecular cytogenetics; chromosomal in situ
							 hybridization, analyze three-five cells (eg, for derivatives and
							 markers)
88273
44.89
Molecular cytogenetics; chromosomal in situ
							 hybridization, analyze ten-30 cells (eg, for microdeletions)
88274
48.63
Molecular cytogenetics; interphase in situ
							 hybridization, analyze 25-99 cells
88275
56.11
Molecular cytogenetics; interphase in situ
							 hybridization, analyze 100-300 cells
88280
35.07
Chromosome analysis; additional karyotypes, each
							 study
88283
95.84
Chromosome analysis; additional specialized banding
							 technique (eg, NOR, C-banding)
88285
26.54
Chromosome analysis; additional cells counted, each
							 study
88289
48.11
Chromosome analysis; additional high resolution
							 study
88371
31.05
Protein analysis of tissue by Western Blot, with
							 interpretation and report;
88372
31.79
Protein analysis of tissue by Western Blot, with
							 interpretation and report; immunological probe for band identification,
							 each
88400
7.02
Bilirubin, total, transcutaneous
89050
6.61
Cell count, miscellaneous body fluids (eg,
							 cerebrospinal fluid, joint fluid), except blood;
89051
7.70
Cell count, miscellaneous body fluids (eg,
							 cerebrospinal fluid, joint fluid), except blood; with differential
							 count
89055
5.96
Leukocyte assessment, fecal, qualitative or
							 semiquantitative
89060
9.99
Crystal identification by light microscopy with or
							 without polarizing lens analysis, tissue or any body fluid (except
							 urine)
89125
6.03
Fat stain, feces, urine, or respiratory
							 secretions
89160
5.15
Meat fibers, feces
89190
6.64
Nasal smear for eosinophils
89225
4.67
Starch granules, feces
89235
7.69
Water load test
89300
9.77
Semen analysis; presence and/or motility of sperm
							 including Huhner test (post coital)
89310
12.03
Semen analysis; motility and count (not including
							 Huhner test)
89320
16.84
Semen analysis; volume, count, motility, and
							 differential
89321
16.84
Semen analysis; sperm presence and motility of sperm,
							 if performed
89322
21.65
Semen analysis; volume, count, motility, and
							 differential using strict morphologic criteria (eg, Kruger)
89325
14.91
Sperm antibodies
89329
29.30
Sperm evaluation; hamster penetration
							 test
89330
13.83
Sperm evaluation; cervical mucus penetration test,
							 with or without spinnbarkeit test
89331
27.37
Sperm evaluation, for retrograde ejaculation, urine
							 (sperm concentration, motility, and morphology, as indicated)
(5)
Dental Services
.
Code
Fee
40.06(5) - Dental Service
							 Description
D0120
30.40
Periodic oral evaluation - established
							 patient
D0140
60.00
Limited oral evaluation - problem focused
D0150
60.00
Comprehensive oral evaluation - new or established
							 patient
D0160
80.00
Detailed and extensive oral evaluation - problem
							 focused, by report
D0170
53.60
Re-evaluation - limited, problem focused (established
							 patient; not postoperative visit)
D0180
79.20
Comprehensive periodontal evaluation - new or
							 established patient
D0210
100.00
Intraoral - complete series (including
							 bitewings)
D0220
20.00
Intraoral - periapical, first film
D0230
16.00
Intraoral - periapical, each additional
							 film
D0240
30.40
Intraoral - occlusal film
D0250
32.00
Extraoral - first film
D0260
28.00
Extraoral - each additional film
D0270
20.00
Bitewing - single film
D0272
32.00
Bitewings - two films
D0273
40.00
Bitewings - three films
D0274
48.00
Bitewings - four films
D0277
72.80
Vertical bitewings - seven to eight films
D0290
66.40
Posterior-anterior or lateral skull and facial bone
							 survey film
D0310
132.00
Sialography
D0321
104.00
Other temporomandibular joint films, by
							 report
D0322
220.00
Tomographic survey
D0330
88.00
Panoramic film
D0340
92.00
Cephalometric film
D0350
36.00
Oral/facial photographic images
D0460
40.00
Pulp vitality tests
D0470
76.80
Diagnostic casts
D0472
112.00
Accession of tissue, gross examination, preparation,
							 and transmission of written report
D0473
264.00
Accession of tissue, gross and microscopic
							 examination, preparation and transmission of written report
D0474
12.00
Accession of tissue, gross and microscopic
							 examination, including assessment of surgical margins for presence of disease,
							 preparation and transmission of written report
D0480
12.00
Accession of exfoliative cytologic smears,
							 microscopic examination, preparation and transmission of written
							 report
D1110
69.60
Prophylaxis - adult
D1204
26.40
Topical application of fluoride (prophylaxis not
							 included) - adult
D1206
28.80
Topical fluoride varnish; therapeutic application for
							 moderate to high caries risk patients
D1351
41.60
Sealant - per tooth
D1510
280.00
Space maintainer - fixed-unilateral
D1515
424.00
Space maintainer - fixed-bilateral
D1520
128.00
Space maintainer - removable-unilateral
D1525
180.00
Space maintainer - removable-bilateral
D1550
80.00
Recementation of space maintainer
D1555
44.00
Removal of fixed space maintainer
D2140
88.00
Amalgam-one surface, primary or permanent
D2150
110.40
Amalgam-two surfaces, primary or
							 permanent
D2160
132.00
Amalgam-three surfaces, primary or
							 permanent
D2161
156.00
Amalgam-four or more surfaces, primary or
							 permanent
D2330
104.00
Resin - one surface, anterior
D2331
129.60
Resin - two surfaces, anterior
D2332
157.60
Resin - three surfaces, anterior
D2335
200.00
Resin - four or more surfaces or involving incisal
							 angle (anterior)
D2390
176.80
Resin-based composite crown, anterior
D2391
116.00
Resin-based composite - one surface,
							 posterior
D2392
151.20
Resin-based composite - two surfaces,
							 posterior
D2393
184.00
Resin-based composite - three surfaces,
							 posterior
D2394
216.00
Resin-based composite - four or more surfaces,
							 posterior
D2510
240.00
Inlay - metallic -one surface
D2520
680.00
Inlay - metallic - two surfaces
D2530
756.00
Inlay - metallic - three or more surfaces
D2542
720.00
Onlay - metallic - two surfaces
D2543
772.00
Onlay - metallic - three surfaces
D2544
880.00
Onlay - metallic - four or more surfaces
D2610
288.00
Inlay - porcelain/ceramic - one surface
D2620
389.60
Inlay - porcelain/ceramic - two surfaces
D2630
632.00
Inlay - porcelain/ceramic - three or more
							 surfaces
D2642
748.00
Onlay - porcelain/ceramic - two surfaces
D2643
796.00
Onlay - porcelain/ceramic - three
							 surfaces
D2644
912.00
Onlay - porcelain/ceramic - four or more
							 surfaces
D2662
1,016.00
Onlay - resin-based composite - two
							 surfaces
D2663
960.00
Onlay - resin-based composite - three
							 surfaces
D2664
1,016.00
Onlay - resin-based composite - four or more
							 surfaces
D2710
240.00
Crown - resin-based composite (indirect)
D2712
300.00
Crown - 3/4 resin-based composite
							 (indirect)
D2720
1,120.00
Crown - resin with high noble metal
D2721
640.00
Crown - resin with predominantly base
							 metal
D2740
960.00
Crown - porcelain/ceramic substrate
D2750
880.00
Crown - porcelain fused to high noble
							 metal
D2751
796.00
Crown - porcelain fused to predominantly base
							 metal
D2752
800.00
Crown - porcelain fused to noble metal
D2780
920.00
Crown - 3/4 cast high noble metal
D2782
1,100.00
Crown - 3/4 cast noble metal
D2783
1,005.60
Crown - 3/4 porcelain/ceramic
D2790
918.40
Crown - full cast high noble metal
D2791
744.00
Crown - full cast predominantly base
							 metal
D2792
856.00
Crown - full cast noble metal
D2794
1,120.00
Crown - titanium
D2799
200.00
Provisional crown
D2910
75.20
Recement inlay, onlay or partial coverage
							 restoration
D2915
72.00
Recement cast or prefabricated post and
							 core
D2920
76.00
Recement crown
D2930
208.00
Prefabricated stainless steel crown - primary
							 tooth
D2931
240.00
Prefabricated stainless steel crown - permanent
							 tooth
D2932
200.00
Prefabricated resin crown
D2934
232.00
Stainless steel crown - primary
D2940
80.00
Sedative filling
D2950
227.20
Core buildup, including any pins
D2951
36.00
Pin retention - per tooth, in addition to
							 restoration
D2952
316.00
Post and core in addition to crown, indirectly
							 fabricated
D2954
256.00
Prefabricated post and core in addition to
							 crown
D2970
224.80
Temporary crown (fractured tooth)
D2971
224.80
Additional procedures to construct new crown under
							 existing partial denture framework
D2980
150.40
Crown repair, by report
D3110
48.00
Pulp cap - direct (excluding final
							 restoration)
D3120
56.00
Pulp cap - indirect (excluding final
							 restoration)
D3220
132.00
Therapeutic pulpotomy (excluding final restoration) -
							 removal of pulp coronal to the dentinocemental junction and application of
							 medicament
D3221
145.60
Pulpal debridement, primary and permanent
							 teeth
D3310
560.00
Anterior (excluding final restoration)
D3320
660.00 Bicuspid (excluding final
							 restoration)
D3330
840.00
Molar (excluding final restoration)
D3332
260.00
Incomplete endodontic therapy; inoperable,
							 unrestorable or fractured tooth
D3333
312.00
Internal root repair of perforation
							 defects
D3346
640.00
Retreatment of previous root canal therapy -
							 anterior
D3347
760.00
Retreatment of previous root canal therapy -
							 bicuspid
D3348
921.60
Retreatment of previous root canal therapy -
							 molar
D3351
156.00
Apexification/recalcification - initial visit (apical
							 closure/calcific repair of perforations, root resorption,
etc.
)
D3352
169.60
Apexification/recalcification - interim medication
							 replacement (apical closure/calcific repair of perforations, root resorption,
etc.
)
D3410
639.20
Apicoectomy/periradicular surgery -
							 anterior
D3421
560.00
Apicoectomy/periradicular surgery - bicuspid (first
							 root)
D3425
656.00
Apicoectomy/periradicular surgery - molar (first
							 root)
D3430
120.00
Retrograde filling - per root
D3450
420.00
Root amputation - per root
D3920
313.60
Hemisection (including any root removal), not
							 including root canal therapy
D4210
304.00
Gingivectomy or gingivoplasty - Four or more
							 contiguous teeth or bounded teeth spaces per quadrant
D4211
140.00
Gingivectomy or gingivoplasty - one to three
							 contiguous teeth or bounded teeth spaces per quadrant
D4240
560.00
Gingival flap procedure, including root planing -
							 four or more contiguous teeth or bounded teeth spaces per quadrant
D4241
240.00
Gingival flap procedure, including root planing - one
							 to three contiguous teeth or bounded teeth spaces per quadrant
D4249
625.60
Clinical crown lengthening - hard tissue
D4260
880.00
Osseous surgery (including flap entry and closure) -
							 four or more contiguous teeth or bounded teeth spaces per quadrant
D4261
760.00
Osseous surgery (including flap entry and closure) -
							 one to three contiguous teeth or bounded teeth spaces per quadrant
D4263
269.60
Bone replacement graft - first site in
							 quadrant
D4264
180.00
Bone replacement graft - each additional site in
							 quadrant
D4265
236.00
Biologic materials to aid in soft and osseous tissue
							 regeneration
D4266
360.00
Guided tissue regeneration - resorbable barrier, per
							 site
D4270
743.20
Pedicle soft tissue graft procedure
D4271
718.40
Free soft tissue graft procedure (including donor
							 site surgery)
D4273
928.00
Subepithelial connective tissue graft procedures, per
							 tooth
D4274
460.00
Distal or proximal wedge procedure (when not
							 performed in conjunction with surgical procedures in the same anatomical
							 area)
D4275
780.00
Soft tissue allograft
D4341
180.00
Periodontal scaling and root planing - four or more
							 teeth per quadrant
D4342
124.00
Periodontal scaling and root planing - one to three
							 teeth, per quadrant
D4355
116.00
Full mouth debridement to enable comprehensive
							 evaluation and diagnosis
D4381
29.60
Localized delivery of antimicrobial agents via a
							 controlled release vehicle into diseased crevicular tissue, per tooth, by
							 report
D4910
96.00
Periodontal maintenance
D4920
88.00
Unscheduled dressing change (by someone other than
							 treating dentist)
D5110
960.00
Complete denture - maxillary
D5120
960.00
Complete denture - mandibular
D5130
1,040.00
Immediate denture - maxillary
D5140
1,040.00
Immediate denture - mandibular
D5211
760.00
Maxillary partial denture - resin base (including any
							 conventional clasps, rests and teeth)
D5212
780.00
Mandibular partial denture - resin base (including
							 any conventional clasps, rests and teeth)
D5213
1,040.00
Maxillary partial denture - cast metal framework with
							 resin denture bases (including any conventional clasps, rests and
							 teeth)
D5214
1,040.00
Mandibular partial denture - cast metal framework
							 with resin denture bases (including any conventional clasps, rests and
							 teeth)
D5225
1,000.00
Maxillary partial denture - flexible base (including
							 any clasps, rests and teeth)
D5226
960.00
Mandibular partial denture - flexible base (including
							 any clasps, rests and teeth)
D5281
520.00
Removable unilateral partial denture - one piece cast
							 metal (including clasps and teeth)
D5410
60.00
Adjust complete denture - maxillary
D5411
36.00
Adjust complete denture - mandibular
D5421
68.00
Adjust partial denture - maxillary
D5422
60.00
Adjust partial denture - mandibular
D5510
132.00
Repair broken complete denture base
D5520
116.00
Replace missing or broken teeth - complete denture
							 (each tooth)
D5610
124.00
Repair resin denture base
D5620
168.00
Repair cast framework
D5630
140.00
Repair or replace broken clasp
D5640
112.00
Replace broken teeth - per tooth
D5650
128.00
Add tooth to existing partial denture
D5660
132.80
Add clasp to existing partial denture
D5670
340.00
Replace all teeth and acrylic on cast metal framework
							 (maxillary)
D5671
480.00
Replace all teeth and acrylic on cast metal framework
							 (mandibular)
D5710
280.00
Rebase complete maxillary denture
D5711
378.40
Rebase complete mandibular denture
D5720
320.00
Rebase maxillary partial denture
D5721
316.00
Rebase mandibular partial denture
D5730
240.00
Reline complete maxillary denture
							 (chairside)
D5731
211.20
Reline lower complete mandibular denture
							 (chairside)
D5740
180.00
Reline maxillary partial denture
							 (chairside)
D5741
200.00
Reline mandibular partial denture
							 (chairside)
D5750
285.60
Reline complete maxillary denture
							 (laboratory)
D5751
300.00
Reline complete mandibular denture
							 (laboratory)
D5760
285.60
Reline maxillary partial denture
							 (laboratory)
D5761
267.20
Reline mandibular partial denture
							 (laboratory)
D5820
380.00
Interim partial denture (maxillary)
D5821
428.00
Interim partial denture (mandibular)
D5850
110.40
Tissue conditioning, maxillary
D5851
134.40
Tissue conditioning, mandibular
D5862
360.00
Precision attachment, by report
D6010
1,560.00
Surgical placement of implant body: endosteal
							 implant
D6040
1,200.00
Surgical placement: eposteal implant
D6050
360.00
Surgical placement: transosteal implant
D6055
1,040.00
Dental implant supported connecting bar
D6056
420.00
Prefabricated abutment - includes
							 placement
D6057
560.00
Custom abutment - includes placement
D6058
1,000.00
Abutment supported porcelain/ceramic
							 crown
D6059
1,036.00
Abutment supported porcelain fused to metal crown
							 (high noble metal)
D6060
960.00
Abutment supported porcelain fused to metal crown
							 (predominantly base metal)
D6061
920.00
Abutment supported porcelain fused to metal crown
							 (noble metal)
D6062
1,050.40
Abutment supported cast metal crown (high noble
							 metal)
D6063
360.00
Abutment supported cast metal crown (predominantly
							 base metal)
D6064
820.00
Abutment supported cast metal crown (noble
							 metal)
D6065
1,040.00
Implant supported porcelain/ceramic crown
D6066
1,120.00
Implant supported porcelain fused to metal crown
							 (titanium, titanium alloy, high noble metal)
D6067
1,480.00
Implant supported metal crown (titanium, titanium
							 alloy, high noble metal)
D6068
480.00
Abutment supported retainer for porcelain/ceramic
							 FPD
D6069
960.00
Abutment supported retainer for porcelain fused to
							 metal FPD (high noble metal)
D6071
528.80
Abutment supported retainer for porcelain fused to
							 metal FPD (noble metal)
D6072
1,360.00
Abutment supported retainer for cast metal FPD (high
							 noble metal)
D6077
1,120.00
Implant supported retainer for cast metal FPD
							 (titanium, titanium alloy, or high noble metal)
D6092
88.00
Recement implant/abutment supported crown
D6093
60.00
Recement implant/abutment supported fixed partial
							 denture
D6205
240.00
Pontic - indirect resin based composite
D6210
880.00
Pontic - cast high noble metal
D6211
520.00
Pontic - cast predominantly base metal
D6212
704.00
Pontic - cast noble metal
D6240
872.00
Pontic - porcelain fused to high noble
							 metal
D6241
760.00
Pontic - porcelain fused to predominantly base
							 metal
D6242
798.40
Pontic - porcelain fused to noble metal
D6250
904.00
Pontic - resin with high noble metal
D6251
616.00
Pontic - resin with predominantly base
							 metal
D6252
480.00
Pontic - resin with noble metal
D6253
240.00
Provisional pontic
D6545
320.00
Retainer - cast metal for resin bonded fixed
							 prosthesis
D6602
676.00
Inlay - cast high noble metal, two
							 surfaces
D6606
600.00
Inlay - cast noble metal, two surfaces
D6610
720.00
Onlay - cast high noble metal, two
							 surfaces
D6611
860.00
Onlay - cast high noble metal, three or more
							 surfaces
D6615
920.00
Onlay - cast noble metal, three or more
							 surfaces
D6710
276.00
Crown - indirect resin based composite
D6720
764.00
Crown - resin with high noble metal
D6721
604.00
Crown - resin with predominantly base
							 metal
D6722
640.00
Crown - resin with noble metal
D6750
877.60
Crown - porcelain fused to high noble
							 metal
D6751
756.80
Crown - porcelain fused to predominantly base
							 metal
D6752
800.00
Crown - porcelain fused to noble metal
D6780
800.00
Crown - 3/4 cast high noble metal
D6782
840.00
Crown - 3/4 noble metal
D6790
864.00
Crown - full cast high noble metal
D6791
560.00
Crown - full cast predominantly base
							 metal
D6792
680.00
Crown - full cast noble metal
D6793
240.00
Provisional retainer crown
D6930
100.00
Recement bridge
D6950
360.00
Precision attachment
D6970
200.00
Post and core in addition to fixed partial denture
							 retainer, indirectly fabricated
D6972
280.00
Prefabricated post and core in addition to bridge
							 retainer
D6973
216.00
Core build up for retainer, including any
							 pins
D6980
168.80
Bridge repair, by report
D7111
80.00
Extraction, coronal remnants - deciduous
							 tooth
D7140
112.00
Extraction, erupted tooth or exposed root (elevation
							 and/or forceps removal)
D7210
200.00
Surgical removal of erupted tooth requiring elevation
							 of mucoperiosteal flap and removal of bone and/or section of tooth
D7220
247.20
Removal of impacted tooth - soft tissue
D7230
320.00
Removal of impacted tooth - partially
							 bony
D7240
400.00
Removal of impacted tooth - completely
							 bony
D7241
476.00
Removal of impacted tooth - completely bony, with
							 unusual surgical complications
D7250
214.40
Surgical removal of residual tooth roots (cutting
							 procedure)
D7261
460.00
Primary closure of a sinus perforation
D7280
320.00
Surgical access of an unerupted tooth
D7283
120.00
Placement of device to facilitate eruption of
							 impacted tooth
D7285
312.00
Biopsy of oral tissue - hard (bone,
							 tooth)
D7286
277.60
Biopsy of oral tissue - soft
D7287
72.00
Exfoliative cytological sample collection
D7288
104.00
Brush biopsy - transepithelial sample
							 collection
D7291
171.20
Transseptal fiberotomy/supra crestal fiberotomy, by
							 report
D7310
200.00
Alveoloplasty in conjunction with extractions-four or
							 more teeth or tooth spaces, per quadrant
D7311
224.00
Alveoloplasty in conjunction with extractions - one
							 to three teeth or tooth spaces, per quadrant
D7320
200.00
Alveoloplasty not in conjunction with
							 extractions-four or more teeth or tooth spaces, per quadrant
D7321
160.80
Alveoloplasty not in conjunction with extractions -
							 one to three teeth or tooth spaces, per quadrant
D7340
357.60
Vestibuloplasty - ridge extension (second
							 epithelialization)
D7350
1,760.00
Vestibuloplasty - ridge extension (including soft
							 tissue grafts, muscle reattachments, revision of soft tissue attachment and
							 management of hytrophied and hyperplastic tissue
D7410
200.00
Excision of benign lesion up to 1.25 cm
D7411
400.80
Excision of benign lesion greater than 1.25
							 cm
D7465
56.00
Destruction of lesion(s) by physical or chemical
							 method, by report
D7471
236.00
Removal of lateral exostosis (maxilla or
							 mandible)
D7473
400.00
Removal of torus mandibularis
D7510
148.00
Incision and drainage of abscess - intraoral soft
							 tissue
D7511
236.00
Incision and drainage of abscess - intraoral soft
							 tissue - complicated (includes drainage of multiple fascial spaces)
D7520
80.00
Incision and drainage of abscess - extraoral soft
							 tissue
D7530
60.00
Removal of foreign body from mucosa, skin, or
							 subcutaneous alveolar tissue
D7550
244.00
Partial ostectomy/sequestrectomy for removal of
							 nonvital bone
D7670
80.00
Alveolus-closed reduction, may include stabilization
							 of teeth
D7740
796.00
Mandible-closed reduction
D7820
192.00
Closed reduction of dislocation
D7830
960.00
Manipulation under anesthesia
D7880
356.00
Occlusal orthotic appliance
D7881
380.00
TMD therapy
D7911
12.00
Complicated suture - up to 5 cm
D7960
380.00
Frenulectomy (frenectomy or frenotomy) - separate
							 procedure
D7963
557.60
Frenuloplasty
D8010
243.20
Limited orthodontic treatment of the primary
							 dentition
D8020
353.60
Limited orthodontic treatment of the transitional
							 dentition
D8030
200.00
Limited orthodontic treatment of the adolescent
							 dentition
D8040
333.60
Limited orthodontic treatment of the adult
							 dentition
D8050
333.60
Interceptive orthodontic treatment of the primary
							 dentition
D8060
373.60
Interceptive orthodontic treatment of the
							 transitional dentition
D8070
316.80
Comprehensive orthodontic treatment of the
							 transitional dentition
D8080
323.20
Comprehensive orthodontic treatment of the adolescent
							 dentition
D8090
323.20
Comprehensive orthodontic treatment of the adult
							 dentition
D8210
280.00
Removable appliance therapy
D8220
360.00
Fixed appliance therapy
D8660
244.00
Preorthodontic treatment visit
D8670
300.00
Periodic orthodontic treatment visit (as part of
							 contract)
D8680
308.00
Orthodontic retention (removal of appliances,
							 construction and placement of retainer(s))
D8690
200.00
Orthodontic treatment (alternative billing to a
							 contract fee)
D8691
76.00
Repair of orthodontic appliance
D8692
200.00
Replacement of lost or broken retainer
D9110
75.20
Palliative (emergency) treatment of dental pain -
							 minor procedure
D9120
120.00
Fixed partial denture sectioning
D9220
248.00
Deep sedation/general anesthesia - first 30
							 minutes
D9221
132.00
Deep sedation/general anesthesia - each additional 15
							 minutes
D9230
52.00
Analgesia, anxiolysis, inhalation of nitrous
							 oxide
D9241
240.00
Intravenous conscious sedation/analgesia - first 30
							 minutes
D9242
116.00
Intravenous conscious sedation/analgesia - each
							 additional 15 minutes
D9310
64.00
Consultation-diagnostic service provided by dentist
							 or physician other than requesting dentist or physician
D9910
27.20
Application of desensitizing medicament
D9940
333.60
Occlusal guards, by report
D9942
100.00
Repair and/or reline of occlusal guard
D9952
220.00
Occlusal adjustment - complete
(6)
Durable Medical Equipment, Prosthetics/Orthotics, and
			 Supplies
.
Code
Fee Nu
Fee Ue
Fee RR
114.3 CMR 40.06(6) - DMEPOS
							 Description
A4216
0.45
Sterile water, saline and/or dextrose, diluent/flush,
							 10 ml
A4217
2.66
Sterile water/saline, 500 ml
A4221
22.64
Supplies for maintenance of drug infusion catheter,
							 per week (list drug separately)
A4222
46.73
Infusion supplies for external drug infusion pump,
							 per cassette or bag (list drugs separately)
A4233
0.80
Replacement battery, alkaline (other than J cell),
							 for use with medically necessary home blood glucose monitor owned by patient,
							 each
A4234
3.63
Replacement battery, alkaline, J cell, for use with
							 medically necessary home blood glucose monitor owned by patient,
							 each
A4235
2.34
Replacement battery, lithium, for use with medically
							 necessary home blood glucose monitor owned by patient, each
A4236
1.68
Replacement battery, silver oxide, for use with
							 medically necessary home blood glucose monitor owned by patient,
							 each
A4253
36.94
Blood glucose test or reagent strips for home blood
							 glucose monitor, per 50 strips
A4255
3.91
Platforms for home blood glucose monitor, 50 per
							 box
A4256
11.44
Normal, low, and high calibrator
							 solution/chips
A4257
12.75
Replacement lens shield cartridge for use with laser
							 skin piercing device, each
A4258
18.05
Spring-powered device for lancet, each
A4259
10.83
Lancets, per box of 100
A4265
3.39
Paraffin, per pound
A4280
5.45
Adhesive skin support attachment for use with
							 external breast prosthesis, each
A4310
7.72
Insertion tray without drainage bag and without
							 catheter (accessories only)
A4311
13.97
Insertion tray without drainage bag with indwelling
							 catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone
							 elastomer or hydrophilic,
etc.
)
A4312
15.33
Insertion tray without drainage bag with indwelling
							 catheter, Foley type, two-way, all silicone
A4313
15.74
Insertion tray without drainage bag with indwelling
							 catheter, Foley type, three-way, for continuous irrigation
A4314
21.50
Insertion tray with drainage bag with indwelling
							 catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone
							 elastomer or hydrophilic,
etc.
)
A4315
22.43
Insertion tray with drainage bag with indwelling
							 catheter, Foley type, two-way, all silicone
A4316
28.40
Insertion tray with drainage bag with indwelling
							 catheter, Foley type, three-way, for continuous irrigation
A4320
5.33
Irrigation tray with bulb or piston syringe, any
							 purpose
A4321
I.C
Therapeutic agent for urinary catheter
							 irrigation
A4322
3.04
Irrigation syringe, bulb or piston, each
A4326
10.37
Male external catheter with integral collection
							 chamber, any type, each
A4327
42.27
Female external urinary collection device; meatal
							 cup, each
A4328
8.88
Female external urinary collection device; pouch,
							 each
A4330
7.15
Perianal fecal collection pouch with adhesive,
							 each
A4331
3.18
Extension drainage tubing, any type, any length, with
							 connector/adaptor, for use with urinary leg bag or urostomy pouch,
							 each
A4332
0.12
Lubricant, individual sterile packet,
							 each
A4333
2.20
Urinary catheter anchoring device, adhesive skin
							 attachment, each
A4334
4.93
Urinary catheter anchoring device, leg strap,
							 each
A4338
12.26
Indwelling catheter; Foley type, two-way latex with
							 coating (Teflon, silicone, silicone elastomer, or hydrophilic,
etc.
), each
A4340
31.75
Indwelling catheter; specialty type, (eg, Coude,
							 mushroom, wing,
etc.
), each
A4344
15.20
Indwelling catheter, Foley type, two-way, all
							 silicone, each
A4346
19.59
Indwelling catheter; Foley type, three-way for
							 continuous irrigation, each
A4349
2.02
Male external catheter, with or without adhesive,
							 disposable, each
A4351
1.81
Intermittent urinary catheter; straight tip, with or
							 without coating (Teflon, silicone, silicone elastomer, or hydrophilic,
etc.
), each
A4352
6.42
Intermittent urinary catheter; Coude (curved) tip,
							 with or without coating (Teflon, silicone, silicone elastomeric, or
							 hydrophilic,
etc.
), each
A4353
6.99
Intermittent urinary catheter, with insertion
							 supplies
A4354
11.80
Insertion tray with drainage bag but without
							 catheter
A4355
7.57
Irrigation tubing set for continuous bladder
							 irrigation through a three-way indwelling Foley catheter, each
A4356
38.79
External urethral clamp or compression device (not to
							 be used for catheter clamp), each
A4357
8.25
Bedside drainage bag, day or night, with or without
							 anti-reflux device, with or without tube, each
A4358
6.63
Urinary drainage bag, leg or abdomen, vinyl, with or
							 without tube, with straps, each
A4361
17.83
Ostomy faceplate, each
A4362
2.94
Skin barrier; solid, 4 x 4 or equivalent;
							 each
A4363
2.36
Ostomy clamp, any type, replacement only,
							 each
A4364
2.89
Adhesive, liquid, or equal, any type, per
							 oz.
A4365
11.32
Adhesive remover wipes, any type, per 50
A4366
1.30
Ostomy vent, any type, each
A4367
6.62
Ostomy belt, each
A4368
0.26
Ostomy filter, any type, each
A4369
2.42
Ostomy skin barrier, liquid (spray, brush,
etc.
), per oz.
A4371
3.65
Ostomy skin barrier, powder, per oz.
A4372
4.18
Ostomy skin barrier, solid 4 x 4 or equivalent,
							 standard wear, with built-in convexity, each
A4373
6.28
Ostomy skin barrier, with flange (solid, flexible or
							 accordion), with built-in convexity, any size, each
A4375
17.18
Ostomy pouch, drainable, with faceplate attached,
							 plastic, each
A4376
47.58
Ostomy pouch, drainable, with faceplate attached,
							 rubber, each
A4377
4.29
Ostomy pouch, drainable, for use on faceplate,
							 plastic, each
A4378
30.75
Ostomy pouch, drainable, for use on faceplate,
							 rubber, each
A4379
15.02
Ostomy pouch, urinary, with faceplate attached,
							 plastic, each
A4380
37.33
Ostomy pouch, urinary, with faceplate attached,
							 rubber, each
A4381
4.61
Ostomy pouch, urinary, for use on faceplate, plastic,
							 each
A4382
24.62
Ostomy pouch, urinary, for use on faceplate, heavy
							 plastic, each
A4383
28.19
Ostomy pouch, urinary, for use on faceplate, rubber,
							 each
A4384
9.62
Ostomy faceplate equivalent, silicone ring,
							 each
A4385
5.10
Ostomy skin barrier, solid 4 x 4 or equivalent,
							 extended wear, without built-in convexity, each
A4387
I.C
Ostomy pouch, closed, with barrier attached, with
							 built-in convexity (one piece), each
A4388
4.36
Ostomy pouch, drainable, with extended wear barrier
							 attached, (one piece), each
A4389
6.22
Ostomy pouch, drainable, with barrier attached, with
							 built-in convexity (one piece), each
A4390
9.61
Ostomy pouch, drainable, with extended wear barrier
							 attached, with built-in convexity (one piece), each
A4391
7.07
Ostomy pouch, urinary, with extended wear barrier
							 attached (one piece), each
A4392
8.18
Ostomy pouch, urinary, with standard wear barrier
							 attached, with built-in convexity (one piece), each
A4393
9.04
Ostomy pouch, urinary, with extended wear barrier
							 attached, with built-in convexity (one piece), each
A4394
2.58
Ostomy deodorant, with or without lubricant, for use
							 in ostomy pouch, per fluid ounce
A4395
0.05
Ostomy deodorant for use in ostomy pouch, solid, per
							 tablet
A4396
40.48
Ostomy belt with peristomal hernia
							 support
A4397
4.07
Irrigation supply; sleeve, each
A4398
13.56
Ostomy irrigation supply; bag, each
A4399
12.26
Ostomy irrigation supply; cone/catheter, including
							 brush
A4400
48.87
Ostomy irrigation set
A4402
1.36
Lubricant, per oz.
A4404
1.69
Ostomy ring, each
A4405
3.40
Ostomy skin barrier, nonpectin-based, paste, per
							 oz.
A4406
5.74
Ostomy skin barrier, pectin-based, paste, per
							 oz.
A4407
8.76
Ostomy skin barrier, with flange (solid, flexible, or
							 accordion), extended wear, with built-in convexity, 4 x 4 in. or smaller,
							 each
A4408
9.87
Ostomy skin barrier, with flange (solid, flexible or
							 accordion), extended wear, with built-in convexity, larger than 4 x 4 in.,
							 each
A4409
6.22
Ostomy skin barrier, with flange (solid, flexible or
							 accordion), extended wear, without built-in convexity, 4 x 4 in. or smaller,
							 each
A4410
9.04
Ostomy skin barrier, with flange (solid, flexible or
							 accordion), extended wear, without built-in convexity, larger than 4 x 4 in.,
							 each
A4411
5.10
Ostomy skin barrier, solid 4 x 4 or equivalent,
							 extended wear, with built-in convexity, each
A4412
2.70
Ostomy pouch, drainable, high output, for use on a
							 barrier with flange (two piece system), without filter, each
A4413
5.50
Ostomy pouch, drainable, high output, for use on a
							 barrier with flange (two piece system), with filter, each
A4414
4.93
Ostomy skin barrier, with flange (solid, flexible or
							 accordion), without built-in convexity, 4 x 4 in. or smaller, each
A4415
6.00
Ostomy skin barrier, with flange (solid, flexible or
							 accordion), without built-in convexity, larger than 4 x 4 in., each
A4416
A4417
2.75
3.72
Ostomy pouch, closed, with barrier attached, with
							 filter (one piece), each Ostomy pouch, closed, with barrier attached, with
							 built-in convexity, with filter (one piece), each
A4418
1.81
Ostomy pouch, closed; without barrier attached, with
							 filter (one piece), each
A4419
1.74
Ostomy pouch, closed; for use on barrier with
nonlocking flange, with filter (two piece),
							 each
A4420
I.C
Ostomy pouch, closed; for use on barrier with
							 locking
flange (two piece), each
A4422
0.12
Ostomy absorbent material (sheet/pad/crystal
							 packet)
for use in ostomy pouch to thicken liquid
							 stomal
output, each
A4423
1.86
Ostomy pouch, closed; for use on barrier with
							 locking
A4424
4.75
flange, with filter (two piece), each Ostomy pouch,
							 drainable, with barrier attached, with
A4425
3.58
filter (one piece), each Ostomy pouch, drainable; for
							 use on barrier with
A4426
2.73
nonlocking flange, with filter (two piece system),
							 each Ostomy pouch, drainable; for use on barrier with
A4427
2.78
locking flange (two piece system), each Ostomy pouch,
							 drainable; for use on barrier with
A4428
6.51
locking flange, with filter (two piece system), each
							 Ostomy pouch, urinary, with extended wear barrier
attached, with faucet-type tap with valve (one
							 piece), each
A4429
8.25
Ostomy pouch, urinary, with barrier attached, with
							 built-in convexity, with faucet-type tap with valve
A4430
8.52
(one piece), each Ostomy pouch, urinary, with
							 extended wear barrier
attached, with built-in convexity, with faucet-type
							 tap with valve (one piece), each
A4431
6.22
Ostomy pouch, urinary; with barrier attached, with
							 faucet-type tap with valve (one piece), each
A4432
3.59
Ostomy pouch, urinary; for use on barrier with
							 nonlocking flange, with faucet-type tap with valve
A4433
3.34
(two piece), each Ostomy pouch, urinary; for use on
							 barrier with
A4434
3.76
locking flange (two piece), each Ostomy pouch,
							 urinary; for use on barrier with
locking flange, with faucet-type tap with valve (two
							 piece), each
A4455
1.43
Adhesive remover or solvent (for tape, cement or
							 other adhesive), per oz.
A4461
A4463
3.29
13.31
Surgical dressing holder, nonreusable, each Surgical
							 dressing holder, reusable, each
A4481
A4483
0.37 I.C
Tracheostoma filter, any type, any size, each
							 Moisture exchanger, disposable, for use with invasive
A4556
10.32
mechanical ventilation Electrodes (eg, apnea
							 monitor), per pair
A4557
A4558
21.10
4.63
Lead wires (eg, apnea monitor), per pair Conductive
							 gel or paste, for use with electrical device
A4559
0.10
(eg, TENS, NMES), per oz.
Coupling gel or paste, for use with ultrasound
							 device,
A4561
19.95
per oz.
Pessary, rubber, any type
A4562
49.68
Pessary, nonrubber, any type
A4595
28.81
Electrical stimulator supplies, two lead, per month,
							 (eg, TENS, NMES)
A4604
66.81
Tubing with integrated heating element for use with
							 positive airway pressure device
A4605
16.40
Tracheal suction catheter, closed system,
							 each
A4608
58.15
Transtracheal oxygen catheter, each
A4611
196.45
147.34
20.37
Battery, heavy duty; replacement for patient-owned
							 ventilator
A4612
79.93
60.95
8.14
Battery cables; replacement for patient-owned
							 ventilator
A4613
122.58
88.65
12.27
Battery charger; replacement for patient-owned
							 ventilator
A4614
23.78
Peak expiratory flow rate meter, hand
							 held
A4615
0.83
Cannula, nasal
A4616
0.08
Tubing (oxygen), per foot
A4617
3.59
Mouthpiece
A4618
8.89
6.67
1.02
Breathing circuits
A4619
1.21
Face tent
A4620
0.69
Variable concentration mask
A4623
6.55
Tracheostomy, inner cannula
A4624
2.24
Tracheal suction catheter, any type other than closed
							 system, each
A4625
5.89
Tracheostomy care kit for new
							 tracheostomy
A4626
3.19
Tracheostomy cleaning brush, each
A4628
3.74
Oropharyngeal suction catheter, each
A4629
4.63
Tracheostomy care kit for established
							 tracheostomy
A4630
6.25
Replacement batteries, medically necessary,
transcutaneous electrical stimulator, owned by
							 patient
A4633
41.04
Replacement bulb/lamp for ultraviolet light therapy
							 system, each
A4635
5.12
3.39
0.69
Underarm pad, crutch, replacement, each
A4636
4.21
3.07
0.43
Replacement, handgrip, cane, crutch, or walker,
							 each
A4637
2.13
1.61
0.30
Replacement, tip, cane, crutch, walker,
							 each
A4638
I.C
I.C
I.C
Replacement battery for patient-owned ear pulse
							 generator, each
A4639
287.21
Replacement pad for infrared heating pad system,
							 each
A4640
63.32
44.86
6.45
Replacement pad for use with medically necessary
							 alternating pressure pad owned by patient
A5051
2.07
Ostomy pouch, closed; with barrier attached (one
							 piece), each
A5052
1.49
Ostomy pouch, closed; without barrier attached (one
							 piece), each
A5053
1.49
Ostomy pouch, closed; for use on faceplate,
							 each
A5054
1.79
Ostomy pouch, closed; for use on barrier with flange
							 (two piece), each
A5055
1.44
Stoma cap
A5061
3.52
Ostomy pouch, drainable; with barrier attached, (one
							 piece), each
A5062
2.22
Ostomy pouch, drainable; without barrier attached
							 (one piece), each
A5063
2.70
Ostomy pouch, drainable; for use on barrier with
							 flange (two piece system), each
A5071
6.01
Ostomy pouch, urinary; with barrier attached (one
							 piece), each
A5072
3.52
Ostomy pouch, urinary; without barrier attached (one
							 piece), each
A5073
3.18
Ostomy pouch, urinary; for use on barrier with flange
							 (two piece), each
A5081
3.30
Continent device; plug for continent
							 stoma
A5082
11.89
Continent device; catheter for continent
							 stoma
A5083
I.C.
Continent device, stoma absorptive cover for
							 continent stoma
A5093
1.95
Ostomy accessory; convex insert
A5102
22.42
Bedside drainage bottle, with or without tubing,
							 rigid or expandable, each
A5105
34.65
Urinary suspensory with leg bag, with or without
							 tube, each
A5112
29.93
Urinary leg bag; latex
A5113
4.47
Leg strap; latex, replacement only, per
							 set
A5114
A5121
7.60
7.39
Leg strap; foam or fabric, replacement only, per set
							 Skin barrier; solid, 6 x 6 or equivalent, each
A5122
10.92
Skin barrier; solid, 8 x 8 or equivalent,
							 each
A5126
1.32
Adhesive or nonadhesive; disk or foam pad
A5131
15.86
Appliance cleaner, incontinence and ostomy
							 appliances, per 16 oz.
A5200
11.30
Percutaneous catheter/tube anchoring device, adhesive
							 skin attachment
A5500
63.58
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
190.71
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
28.28
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
28.28
For diabetics only, modification (including fitting)
							 of off-the-shelf depth-inlay shoe or custom molded shoe with wedge(s), per
							 shoe
A5505
28.28
For diabetics only, modification (including fitting)
							 of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar,
							 per shoe
A5506
28.28
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
28.28
For diabetics only, not otherwise specified
							 modification (including fitting) of off-the-shelf depth-inlay shoe or custom
							 molded shoe, per shoe
A5512
25.94
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
A5513
38.71
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
A6010
30.96
Collagen based wound filler, dry form, per gram of
							 collagen
A6011
2.28
Collagen based wound filler, gel/paste, per gram of
							 collagen
A6021
21.02
Collagen dressing, pad size 16 sq. in. or less,
							 each
A6022
21.02
Collagen dressing, pad size more than 16 sq. in. but
							 less than or equal to 48 sq. in., each
A6023
190.30
Collagen dressing, pad size more than 48 square
							 inches, each
A6024
6.19
Collagen dressing wound filler, per 6 in.
A6154
14.38
Wound pouch, each
A6196
7.35
Alginate or other fiber gelling dressing, wound
							 cover, pad size 16 sq. in. or less, each dressing
A6197
16.44
Alginate or other fiber gelling dressing, wound
							 cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each
							 dressing
A6199
5.29
Alginate or other fiber gelling dressing, wound
							 filler, per 6 in.
A6203
3.35
Composite dressing, pad size 16 sq. in. or less, with
							 any size adhesive border, each dressing
A6204
6.23
Composite dressing, pad size more than 16 sq. in. but
							 less than or equal to 48 sq. in., with any size adhesive border, each
							 dressing
A6207
7.34
Contact layer, more than 16 sq. in. but less than or
							 equal to 48 sq. in., each dressing
A6209
7.48
Foam dressing, wound cover, pad size 16 sq. in. or
							 less, without adhesive border, each dressing
A6210
19.92
Foam dressing, wound cover, pad size more than 16 sq.
							 in. but less than or equal to 48 sq. in., without adhesive border, each
							 dressing
A6211
29.37
Foam dressing, wound cover, pad size more then 48 sq.
							 in., without adhesive border, each dressing
A6212
9.70
Foam dressing, wound cover, pad size 16 sq. in. or
							 less, with any size adhesive border, each dressing
A6214
10.29
Foam dressing, wound cover, pad size more than 48 sq.
							 in., with any size adhesive border, each dressing
A6216
0.05
Gauze, nonimpregnated, nonsterile, pad size 16 sq.
							 in. or less, without adhesive border, each dressing
A6217
I.C.
Gauze, nonimpregnated, nonsterile, pad size more than
							 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each
							 dressing
A6219
0.95
Gauze, nonimpregnated, pad size 16 sq. in. or less,
							 with any size adhesive border, each dressing
A6220
2.58
Gauze, nonimpregnated, pad size more than 16 sq. in.
							 but less than or equal to 48 sq. in., with any size adhesive border, each
							 dressing
A6222
2.13
Gauze, impregnated with other than water, normal
							 saline, or hydrogel, pad size 16 sq. in. or less, without adhesive border, each
							 dressing
A6223
2.42
Gauze, impregnated with other than water, normal
							 saline, or hydrogel, pad size more than 16 sq. in. but less than or equal to 48
							 sq. in., without adhesive border, each dressing
A6224
3.61
Gauze, impregnated with other than water, normal
							 saline, or hydrogel, pad size more than 48 sq. in., without adhesive border,
							 each dressing
A6229
3.61
Gauze, impregnated, water or normal saline, pad size
							 more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive
							 border, each dressing
A6231
4.66
Gauze, impregnated, hydrogel, for direct wound
							 contact, pad size 16 sq. in. or less, each dressing
A6232
6.88
Gauze, impregnated, hydrogel, for direct wound
							 contact, pad size greater than 16 sq. in., but less than or equal to 48 sq.
							 in., each dressing
A6233
19.19
Gauze, impregnated, hydrogel for direct wound
							 contact, pad size more than 48 sq. in., each dressing
A6234
6.54
Hydrocolloid dressing, wound cover, pad size 16 sq.
							 in. or less, without adhesive border, each dressing
A6235
16.82
Hydrocolloid dressing, wound cover, pad size more
							 than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border,
							 each dressing
A6236
27.25
Hydrocolloid dressing, wound cover, pad size more
							 than 48 sq. in., without adhesive border, each dressing
A6237
7.91
Hydrocolloid dressing, wound cover, pad size 16 sq.
							 in. or less, with any size adhesive border, each dressing
A6238
22.79
Hydrocolloid dressing, wound cover, pad size more
							 than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive
							 border, each dressing
A6240
12.24
Hydrocolloid dressing, wound filler, paste, per fl.
							 oz.
A6241
2.57
Hydrocolloid dressing, wound filler, dry form, per
							 gm
A6242
6.07
Hydrogel dressing, wound cover, pad size 16 sq. in.
							 or less, without adhesive border, each dressing
A6243
12.31
Hydrogel dressing, wound cover, pad size more than 16
							 sq. in. but less than or equal to 48 sq. in., without adhesive border, each
							 dressing
A6244
39.28
Hydrogel dressing, wound cover, pad size more than 48
							 sq. in., without adhesive border, each dressing
A6245
7.27
Hydrogel dressing, wound cover, pad size 16 sq. in.
							 or less, with any size adhesive border, each dressing
A6246
9.92
Hydrogel dressing, wound cover, pad size more than 16
							 sq. in. but less than or equal to 48 sq. in., with any size adhesive border,
							 each dressing
A6247
23.78
Hydrogel dressing, wound cover, pad size more than 48
							 sq. in., with any size adhesive border, each dressing
A6248
16.24
Hydrogel dressing, wound filler, gel, per fl.
							 oz.
A6251
1.99
Specialty absorptive dressing, wound cover, pad size
							 16 sq. in. or less, without adhesive border, each dressing
A6252
3.25
Specialty absorptive dressing, wound cover, pad size
							 more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive
							 border, each dressing
A6253
6.34
Specialty absorptive dressing, wound cover, pad size
							 more than 48 sq. in., without adhesive border, each dressing
A6254
1.21
Specialty absorptive dressing, wound cover, pad size
							 16 sq. in. or less, with any size adhesive border, each dressing
A6255
3.03
Specialty absorptive dressing, wound cover, pad size
							 more than 16 sq. in. but less than or equal to 48 sq. in., with any size
							 adhesive border, each dressing
A6257
1.53
Transparent film, 16 sq. in. or less, each
							 dressing
A6258
4.30
Transparent film, more than 16 sq. in. but less than
							 or equal to 48 sq. in., each dressing
A6259
10.94
Transparent film, more than 48 sq. in., each
							 dressing
A6266
1.92
Gauze, impregnated, other than water, normal saline,
							 or zinc paste, any width, per linear yd.
A6402
0.12
Gauze, nonimpregnated, sterile, pad size 16 sq. in.
							 or less, without adhesive border, each dressing
A6403
0.43
Gauze, nonimpregnated, sterile, pad size more than 16
							 sq. in. but less than or equal to 48 sq. in., without adhesive border, each
							 dressing
A6407
1.88
Packing strips, nonimpregnated, up to two in. in
							 width, per linear yd.
A6410
0.39
Eye pad, sterile, each
A6411
I.C.
Eye pad, non-sterile, each
A6441
0.67
Padding bandage, nonelastic, nonwoven/nonknitted,
							 width greater than or equal to three in. and less than five in., per
							 yd.
A6442
0.17
Conforming bandage, nonelastic, knitted/woven,
							 nonsterile, width less than three in., per yd.
A6443
0.29
Conforming bandage, nonelastic, knitted/woven,
							 nonsterile, width greater than or equal to three in. and less than five in.,
							 per yd.
A6444
0.56
Conforming bandage, nonelastic, knitted/woven,
							 nonsterile, width greater than or equal to five in., per yd.
A6445
0.32
Conforming bandage, nonelastic, knitted/woven,
							 sterile, width less than three in., per yd.
A6446
0.41
Conforming bandage, nonelastic, knitted/woven,
							 sterile, width greater than or equal to three in. and less than five in., per
							 yd.
A6447
0.67
Conforming bandage, nonelastic, knitted/woven,
							 sterile, width greater than or equal to five in., per yd.
A6448
1.16
Light compression bandage, elastic, knitted/woven,
							 width less than three in., per yd.
A6449
1.75
Light compression bandage, elastic, knitted/woven,
							 width greater than or equal to three in. and less than five in., per
							 yd.
A6450
I.C.
Light compression bandage, elastic, knitted/woven,
							 width greater than or equal to five inches, per yard
A6451
I.C.
Moderate compression bandage, elastic,
knitted/woven, load resistance of 1.25 to 1.34 foot
							 pounds at 50% maximum stretch, width greater than or equal to three in. and
							 less than five in., per yd.
A6452
5.91
High compression bandage, elastic, knitted/woven,
							 load resistance greater than or equal to 1.35 foot pounds at 50% maximum
							 stretch, width greater than or equal to three in. and less than five in., per
							 yd.
A6453
0.61
Self-adherent bandage, elastic, nonknitted/nonwoven,
							 width less than three in., per yd.
A6454
0.77
Self-adherent bandage, elastic, nonknitted/nonwoven,
							 width greater than or equal to three in. and less than five in., per
							 yard
A6455
1.39
Self-adherent bandage, elastic, nonknitted/nonwoven,
							 width greater than or equal to five in., per yd.
A6456
1.28
Zinc paste impregnated bandage, nonelastic,
							 knitted/woven, width greater than or equal to 3 in. and less than 5 in., per
							 yd.
A6457
1.14
Tubular dressing with or without elastic, any width,
							 per linear yard
A6501
AI +20%
Compression burn garment, bodysuit (head to foot),
							 custom fabricated
A6502
AI +20%
Compression burn garment, chin strap, custom
							 fabricated
A6503
AI +20%
Compression burn garment, facial hood, custom
							 fabricated
A6504
AI +20%
Compression burn garment, glove to wrist, custom
							 fabricated
A6505
AI +20%
Compression burn garment, glove to elbow, custom
							 fabricated
A6506
AI +20%
Compression burn garment, glove to axilla, custom
							 fabricated
A6507
AI +20%
Compression burn garment, foot to knee length, custom
							 fabricated
A6508
AI +20%
Compression burn garment, foot to thigh length,
							 custom fabricated
A6509
AI +20%
Compression burn garment, upper trunk to waist
							 including arm openings (vest), custom fabricated
A6510
AI +20%
Compression burn garment, trunk, including arms down
							 to leg openings (leotard), custom fabricated
A6511
AI +20%
Compression burn garment, lower trunk including leg
							 openings (panty), custom fabricated
A6513
AI +20%
Compression burn mask, face and/or neck, plastic or
							 equal, custom fabricated
A6531
43.27
Gradient compression stocking, below knee, 30-40 mm
							 Hg, each
A6532
60.96
Gradient compression stocking, below knee, 40-50 mm
							 Hg, each
A6550
27.42
Wound care set, for negative pressure wound therapy
							 electrical pump, includes all supplies and accessories
A7000
8.75
Canister, disposable, used with suction pump,
							 each
A7001
31.30
Canister, nondisposable, used with suction pump,
							 each
A7002
3.63
Tubing, used with suction pump, each
A7003
2.74
Administration set, with small volume nonfiltered
							 pneumatic nebulizer, disposable
A7004
1.55
Small volume nonfiltered pneumatic nebulizer,
							 disposable
A7005
29.20
Administration set, with small volume nonfiltered
							 pneumatic nebulizer, nondisposable
A7006
8.54
Administration set, with small volume filtered
							 pneumatic nebulizer
A7007
4.18
Large volume nebulizer, disposable, unfilled, used
							 with aerosol compressor
A7008
11.00
Large volume nebulizer, disposable, prefilled, used
							 with aerosol compressor
A7009
39.79
Reservoir bottle, nondisposable, used with large
							 volume ultrasonic nebulizer
A7010
23.59
Corrugated tubing, disposable, used with large volume
							 nebulizer, 100 ft.
A7012
3.76
Water collection device, used with large volume
							 nebulizer
A7013
0.78
Filter, disposable, used with aerosol
							 compressor
A7014
4.24
Filter, nondisposable, used with aerosol compressor
							 or
ultrasonic generator
A7015
1.72
Aerosol mask, used with DME nebulizer
A7016
6.85
Dome and mouthpiece, used with small
							 volume
ultrasonic nebulizer
A7017
134.04
100.52
13.40
Nebulizer, durable, glass or autoclavable
							 plastic,
bottle type, not used with oxygen
A7018
0.38
Water, distilled, used with large volume
							 nebulizer,
1000 ml
A7025
434.94
High frequency chest wall oscillation system
							 vest,
replacement for use with patient owned
							 equipment,
each
A7026
28.75
High frequency chest wall oscillation system
							 hose,
replacement for use with patient owned
							 equipment,
each
A7027
179.35
Combination oral/nasal mask, used with
							 continuous
positive airway pressure device, each
A7028
49.54
Oral cushion for combination oral/nasal
							 mask,
replacement only, each
A7029
20.24
Nasal pillows for combination oral/nasal
							 mask,
replacement only, pair
A7030
188.64
Full face mask used with positive airway
							 pressure
device, each
A7031
69.77
Face mask interface, replacement for full face
							 mask,
each
A7032
40.53
Cushion for use on nasal mask interface,
							 replacement
only, each
A7033
28.41
Pillow for use on nasal cannula type
							 interface,
replacement only, pair
A7034
117.64
Nasal interface (mask or cannula type) used
							 with
positive airway pressure device, with or without
							 head
strap
A7035
37.16
Headgear used with positive airway pressure
							 device
A7036
18.20
Chinstrap used with positive airway pressure
							 device
A7037
41.02
Tubing used with positive airway pressure
							 device
A7038
4.58
Filter, disposable, used with positive airway
							 pressure
device
A7039
15.33
Filter, nondisposable, used with positive
							 airway
pressure device
A7040
39.48
One way chest drain valve
A7041
74.19
Water seal drainage container and tubing for use
							 with
implanted chest tube
A7042
177.41
Implanted pleural catheter, each
A7043
28.11
Vacuum drainage bottle and tubing for use
							 with
implanted catheter
A7044
120.91
Oral interface used with positive airway
							 pressure
device, each
A7045
19.47
14.60
1.95
Exhalation port with or without swivel used
							 with
accessories for positive airway devices,
							 replacement
only
A7046
19.51
Water chamber for humidifier, used with
							 positive
airway pressure device, replacement, each
A7501
105.03
Tracheostoma valve, including diaphragm,
							 each
A7502
49.91
Replacement diaphragm/faceplate for
							 tracheostoma
valve, each
A7503
11.33
Filter holder or filter cap, reusable, for use in a
							 tracheostoma heat and moisture exchange system, each
A7504
0.67
Filter for use in a tracheostoma heat and moisture
							 exchange system, each
A7505
4.68
Housing, reusable without adhesive, for use in a heat
							 and moisture exchange system and/or with a tracheostoma valve, each
A7506
0.33
Adhesive disc for use in a heat and moisture exchange
							 system and/or with tracheostoma valve, any type each
A7507
2.49
Filter holder and integrated filter without adhesive,
							 for use in a tracheostoma heat and moisture exchange system, each
A7508
2.87
Housing and integrated adhesive, for use in a
							 tracheostoma heat and moisture exchange system and/or with a tracheostoma
							 valve, each
A7509
1.41
Filter holder and integrated filter housing, and
							 adhesive, for use as a tracheostoma heat and moisture exchange system,
							 each
A7520
47.48
Tracheostomy/laryngectomy tube, noncuffed,
							 polyvinylchloride (PVC), silicone or equal, each
A7521
47.05
Tracheostomy/laryngectomy tube, cuffed,
							 polyvinylchloride (PVC), silicone or equal, each
A7522
45.16
Tracheostomy/laryngectomy tube, stainless steel or
							 equal (sterilizable and reusable), each
A7524
77.40
Tracheostoma stent/stud/button, each
A7525
2.07
Tracheostomy mask, each
A7526
3.37
Tracheostomy tube collar/holder, each
A7527
3.58
Tracheostomy/laryngectomy tube plug/stop,
							 each
A8000
153.35
115.03
15.33
Helmet, protective, soft, prefabricated, includes all
							 components and accessories
A8001
153.35
115.03
15.33
Helmet, protective, hard, prefabricated, includes all
							 components and accessories
A8002
AI +70%
Helmet, protective, soft, custom fabricated, includes
							 all components and accessories
A8003
AI +70%
Helmet, protective, hard, custom fabricated, includes
							 all components and accessories
A8004
I.C.
I.C.
I.C.
Soft interface for helmet, replacement
							 only
E0100
20.29
15.20
5.31
Cane, includes canes of all materials, adjustable or
							 fixed, with tip
E0105
48.46
36.35
7.53
Cane, quad or three-prong, includes canes of all
							 materials, adjustable or fixed, with tips
E0110
77.59
58.18
15.99
Crutches, forearm, includes crutches of various
							 materials, adjustable or fixed, pair, complete with tips and
							 handgrips
E0111
53.26
41.10
8.43
Crutch, forearm, includes crutches of various
							 materials, adjustable or fixed, each, with tip and handgrip
E0112
31.45
24.00
8.44
Crutches, underarm, wood, adjustable or fixed, pair,
							 with pads, tips and handgrips
E0113
21.13
15.86
5.15
Crutch, underarm, wood, adjustable or fixed, each,
							 with pad, tip and handgrip
E0114
40.11
30.32
7.28
Crutches, underarm, other than wood, adjustable or
							 fixed, pair, with pads, tips and handgrips
E0116
27.74
20.88
4.59
Crutch, underarm, other than wood, adjustable or
							 fixed, with pad, tip, handgrip, with or without shock absorber,
							 each
E0117
192.71
144.55
19.26
Crutch, underarm, articulating, spring assisted,
							 each
E0130
64.70
48.52
14.30
Walker, rigid (pickup), adjustable or fixed
							 height
E0135
83.84
64.32
14.67
Walker, folding (pickup), adjustable or fixed
							 height
E0140
360.71
270.54
36.08
Walker, with trunk support, adjustable or fixed
							 height, any type
E0141
114.09
85.57
19.01
Walker, rigid, wheeled, adjustable or fixed
							 height
E0143
120.23
89.98
18.35
Walker, folding, wheeled, adjustable or fixed
							 height
E0144
318.45
203.01
27.08
Walker, enclosed, four sided framed, rigid or
							 folding, wheeled with posterior seat
E0147
574.81
431.13
57.48
Walker, heavy duty, multiple braking system, variable
							 wheel resistance
E0148
127.05
95.28
12.72
Walker, heavy duty, without wheels, rigid or folding,
							 any type, each
E0149
223.20
167.39
22.32
Walker, heavy duty, wheeled, rigid or folding, any
							 type
E0153
58.97
44.23
6.66
Platform attachment, forearm crutch, each
E0154
65.40
49.06
7.28
Platform attachment, walker, each
E0155
31.56
24.05
3.85
Wheel attachment, rigid pick-up walker, per
							 pair
E0156
26.43
19.85
3.38
Seat attachment, walker
E0157
81.92
61.45
8.99
Crutch attachment, walker, each
E0158
32.18
24.12
3.55
Leg extensions for walker, per set of
							 four
E0159
17.81
13.38
1.80
Brake attachment for wheeled walker, replacement,
							 each
E0160
33.06
24.77
3.96
Sitz type bath or equipment, portable, used with or
							 without commode
E0161
22.30
16.69
3.57
Sitz type bath or equipment, portable, used with or
							 without commode, with faucet attachment(s)
E0162
145.70
113.00
15.29
Sitz bath chair
E0163
102.25
76.67
20.77
Commode chair, mobile or stationary, with fixed
							 arms
E0165
15.79
Commode chair, mobile or stationary, with
							 detachable
arms
E0167
12.00
9.04
1.07
Pail or pan for use with commode chair, replacement
							 only
E0168
150.92
113.18
15.17
Commode chair, extra wide and/or heavy duty,
							 stationary or mobile, with or without arms, any type, each
E0170
160.72
Commode chair with integrated seat lift mechanism,
							 electric, any type
E0171
28.92
Commode chair with integrated seat lift mechanism,
							 non-electric, any type
E0175
64.98
48.74
6.51
Foot rest, for use with commode chair,
							 each
E0181
26.06
Powered pressure reducing mattress overlay/pad,
							 alternating, with pump, includes heavy duty
E0182
22.25
Pump for alternating pressure pad, for replacement
							 only
E0184
194.70
149.32
23.78
Dry pressure mattress
E0185
319.86
245.48
44.94
Gel or gel-like pressure pad for mattress, standard
							 mattress length and width
E0186
17.26
Air pressure mattress
E0187
19.73
Water pressure mattress
E0188
22.47
16.87
2.64
Synthetic sheepskin pad
E0189
51.96
38.98
5.31
Lambswool sheepskin pad, any size
E0191
9.99
7.46
1.02
Heel or elbow protector, each
E0193
903.46
Powered air flotation bed (low air loss
							 therapy)
E0194
3,254.34
Air fluidized bed
E0196
27.62
Gel pressure mattress
E0197
188.34
165.44
25.98
Air pressure pad for mattress, standard mattress
							 length and width
E0198
188.34
142.92
19.51
Water pressure pad for mattress, standard mattress
							 length and width
E0199
28.30
21.21
2.82
Dry pressure pad for mattress, standard mattress
							 length and width
E0200
67.39
50.57
9.15
Heat lamp, without stand (table model), includes
							 bulb, or infrared element
E0202
60.28
Phototherapy (bilirubin) light with
							 photometer
E0205
164.95
123.71
18.14
Heat lamp, with stand, includes bulb, or infrared
							 element
E0210
32.64
24.48
2.66
Electric heat pad, standard
E0215
60.21
45.17
6.30
Electric heat pad, moist
E0217
496.47
372.32
55.28
Water circulating heat pad with pump
E0220
7.20
5.38
0.76
Hot water bottle
E0225
330.35
247.76
32.56
Hydrocollator unit, includes pads
E0230
7.21
5.39
0.81
Ice cap or collar
E0235
15.76
Paraffin bath unit, portable (see medical supply code
							 A4265 for paraffin)
E0236
44.25
Pump for water circulating pad
E0238
22.98
16.90
2.61
Nonelectric heat pad, moist
E0239
449.83
337.39
44.99
Hydrocollator unit, portable
E0249
99.60
74.70
10.95
Pad for water circulating heat unit
E0250
97.76
Hospital bed, fixed height, with any type side rails,
							 with mattress
E0251
74.08
Hospital bed, fixed height, with any type side rails,
							 without mattress
E0255
117.48
Hospital bed, variable height, hi-lo, with any type
							 side rails, with mattress
E0256
83.35
Hospital bed, variable height, hi-lo, with any type
							 side rails, without mattress
E0260
140.46
Hospital bed, semi-electric (head and foot
							 adjustment), with any type side rails, with mattress
E0261
136.94
Hospital bed, semi-electric (head and foot
							 adjustment), with any type side rails, without mattress
E0265
199.88
Hospital bed, total electric (head, foot, and height
							 adjustments), with any type side rails, with mattress
E0266
177.59
Hospital bed, total electric (head, foot, and height
							 adjustments), with any type side rails, without
mattress
E0271
222.04
173.46
23.06
Mattress, innerspring
E0272
202.37
151.05
21.13
Mattress, foam rubber
E0275
14.57
10.94
1.46
Bed pan, standard, metal or plastic
E0276
11.31
8.94
1.51
Bed pan, fracture, metal or plastic
E0277
703.47
Powered pressure-reducing air mattress
E0280
36.58
27.42
3.65
Bed cradle, any type
E0290
74.74
Hospital bed, fixed height, without side rails, with
							 mattress
E0291
54.30
Hospital bed, fixed height, without side rails,
							 without mattress
E0292
84.04
Hospital bed, variable height, hi-lo, without side
							 rails, with mattress
E0293
71.51
Hospital bed, variable height, hi-lo, without side
							 rails, without mattress
E0294
130.65
Hospital bed, semi-electric (head and foot
							 adjustment), without side rails, with mattress
E0295
127.35
Hospital bed, semi-electric (head and foot
							 adjustment), without side rails, without mattress
E0296
164.20
Hospital bed, total electric (head, foot, and height
							 adjustments), without side rails, with mattress
E0297
140.67
Hospital bed, total electric (head, foot, and height
							 adjustments), without side rails, without mattress
E0300
2,838.62
2,128.96
283.86
Pediatric crib, hospital grade, fully
							 enclosed
E0301
270.72
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
715.44
Hospital bed, extra heavy duty, extra wide, with
							 weight capacity greater than 600 pounds, with any type side rails, without
							 mattress
E0303
303.98
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
770.67
Hospital bed, extra heavy duty, extra wide, with
							 weight capacity greater than 600 pounds, with any type side rails, with
							 mattress
E0305
17.79
Bedside rails, half-length
E0310
185.02
138.77
22.76
Bedside rails, full-length
E0316
211.28
Safety enclosure frame/canopy for use with hospital
							 bed, any type
E0325
10.11
6.69
1.51
Urinal; male, jug-type, any material
E0326
10.50
7.87
1.19
Urinal; female, jug-type, any material
E0371
444.48
Nonpowered advanced pressure reducing overlay for
							 mattress, standard mattress length and width
E0372
539.34
Powered air overlay for mattress, standard mattress
							 length and width
E0373
614.47
Nonpowered advanced pressure reducing
							 mattress
E0424
199.28
Stationary compressed gaseous oxygen system, rental;
							 includes container, contents, regulator, flowmeter, humidifier, nebulizer,
							 cannula or mask, and tubing
E0431
31.79
Portable gaseous oxygen system, rental; includes
							 portable container, regulator, flowmeter, humidifier, cannula or mask, and
							 tubing
E0434
31.79
Portable liquid oxygen system, rental; includes
							 portable container, supply reservoir, humidifier, flowmeter, refill adaptor,
							 contents gauge, cannula or mask, and tubing
E0439
199.28
Stationary liquid oxygen system, rental; includes
							 container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or
							 mask, & tubing
E0441
77.45
Oxygen contents, gaseous (for use with owned gaseous
							 stationary systems or when both a stationary and portable gaseous system are
							 owned), one month's supply = 1 unit
E0442
77.45
Oxygen contents, liquid (for use with owned liquid
							 stationary systems or when both a stationary and portable liquid system are
							 owned), one month's supply = 1 unit
E0443
77.45
Portable oxygen contents, gaseous (for use only with
							 portable gaseous systems when no stationary gas or liquid system is used), one
							 month's supply = 1 unit
E0444
77.45
Portable oxygen contents, liquid (for use only with
							 portable liquid systems when no stationary gas or liquid system is used), one
							 month's supply = 1 unit
E0450
954.52
Volume control ventilator, without pressure support
							 mode, may include pressure control mode, used with invasive interface (eg,
							 tracheostomy tube)
E0457
614.51
460.85
61.45
Chest shell (cuirass)
E0459
50.89
Chest wrap
E0460
623.53
Negative pressure ventilator; portable or
							 stationary
E0462
247.69
Rocking bed, with or without side rails
E0463
1,406.38
Pressure support ventilator with volume control mode,
							 may include pressure control mode, used with invasive interface (eg,
							 tracheostomy tube)
E0464
1,406.38
Pressure support ventilator with volume control mode,
							 may include pressure control mode, used with noninvasive interface (eg,
							 mask)
E0470
231.77
Respiratory assist device, bi-level pressure
							 capability, without backup rate feature, used with noninvasive interface, eg,
							 nasal or facial mask (intermittent assist device with continuous positive
							 airway pressure device)
E0471
642.17
Respiratory assist device, bi-level pressure
							 capability, with back-up rate feature, used with noninvasive interface, eg,
							 nasal or facial mask (intermittent assist device with continuous positive
							 airway pressure device)
E0472
642.17
Respiratory assist device, bi-level pressure
							 capability, with backup rate feature, used with invasive interface, eg,
							 tracheostomy tube (intermittent assist device with continuous positive airway
							 pressure device)
E0480
43.94
Percussor, electric or pneumatic, home
							 model
E0482
430.02
Cough stimulating device, alternating positive and
							 negative airway pressure
E0483
1,063.13
High frequency chest wall oscillation air-pulse
							 generator system, (includes hoses and vest), each
E0484
36.92
27.70
3.69
Oscillatory positive expiratory pressure
							 device,
nonelectric, any type, each
E0485
AI + 50%
Oral device/appliance used to reduce upper airway
							 collapsibility, adjustable or non-adjustable, prefabricated, includes fitting
							 and adjustment
E0486
AI + 70%
Oral device/appliance used to reduce upper airway
							 collapsibility, adjustable or non-adjustable, custom fabricated, includes
							 fitting and adjustment
E0486
AI + 70%
Oral device/appliance used to reduce upper airway
							 collapsibility, adjustable or non-adjustable, custom fabricated, includes
							 fitting and adjustment
E0486
AI + 70%
Oral device/appliance used to reduce upper airway
							 collapsibility, adjustable or non-adjustable, custom fabricated, includes
							 fitting and adjustment
E0500
109.77
IPPB machine, all types, with built-in nebulization;
							 manual or automatic valves; internal or external power source
E0550
42.61
Humidifier, durable for extensive supplemental
							 humidification during IPPB treatments or oxygen delivery
E0560
171.52
128.64
20.10
Humidifier, durable for supplemental humidification
							 during IPPB treatment or oxygen delivery
E0561
107.00
80.24
10.69
Humidifier, nonheated, used with positive airway
							 pressure device
E0562
301.22
225.91
30.11
Humidifier, heated, used with positive airway
							 pressure device
E0565
61.01
Compressor, air power source for equipment which is
							 not self-contained or cylinder driven
E0570
16.11
Nebulizer, with compressor
E0571
29.97
Aerosol compressor, battery powered, for use with
							 small volume nebulizer
E0572
38.09
Aerosol compressor, adjustable pressure, light duty
							 for intermittent use
E0574
40.26
Ultrasonic/electronic aerosol generator with small
							 volume nebulizer
E0575
102.78
Nebulizer, ultrasonic, large volume
E0580
134.04
100.52
13.40
Nebulizer, durable, glass or autoclavable plastic,
							 bottle type, for use with regulator or flowmeter
E0585
29.81
Nebulizer, with compressor and heater
E0600
45.79
Respiratory suction pump, home model, portable or
							 stationary, electric
E0601
96.99
Continuous airway pressure (CPAP) device
E0602
29.52
22.14
2.96
Breast pump, manual, any type
E0605
26.43
19.85
2.66
Vaporizer, room type
E0606
22.94
Postural drainage board
E0607
66.82
50.10
6.68
Home blood glucose monitor
E0610
202.18
151.66
21.33
Pacemaker monitor, self-contained, (checks battery
							 depletion, includes audible and visible check systems)
E0615
478.82
359.12
58.50
Pacemaker monitor, self-contained, checks battery
							 depletion and other pacemaker components, includes digital/visible check
							 systems
E0617
304.05
External defibrillator with integrated
							 electrocardiogram analysis
E0617
337.57
External defibrillator with integrated
							 electrocardiogram analysis
E0618
280.35
Apnea monitor, without recording feature
E0619
I.C.
Apnea monitor, with recording feature
E0620
874.39
655.79
87.43
Skin piercing device for collection of capillary
							 blood, laser, each
E0621
95.99
72.36
9.25
Sling or seat, patient lift, canvas or
							 nylon
E0627
337.32
253.00
33.74
Seat lift mechanism incorporated into a combination
							 lift-chair mechanism
E0628
337.32
253.00
33.74
Separate seat lift mechanism for use with patient
							 owned furniture - electric
E0629
330.71
248.01
33.08
Separate seat lift mechanism for use with patient
							 owned furniture - nonelectric
E0630
101.89
Patient lift, hydraulic or mechanical, includes any
							 seat, sling, strap(s), or pad(s)
E0635
122.36
Patient lift, electric, with seat or
							 sling
E0636
1,054.56
Multipositional patient support system, with
							 integrated lift, patient accessible controls
E0650
720.22
540.16
88.87
Pneumatic compressor, nonsegmental home
							 model
E0651
780.66
585.50
92.49
Pneumatic compressor, segmental home model without
							 calibrated gradient pressure
E0652
5,301.45
3,972.53
445.36
Pneumatic compressor, segmental home model with
							 calibrated gradient pressure
E0655
101.75
76.30
10.78
Nonsegmental pneumatic appliance for use with
							 pneumatic compressor, half arm
E0660
158.24
118.68
14.14
Nonsegmental pneumatic appliance for use with
							 pneumatic compressor, full leg
E0665
136.99
102.88
13.22
Nonsegmental pneumatic appliance for use with
							 pneumatic compressor, full arm
E0666
138.08
103.59
14.23
Nonsegmental pneumatic appliance for use with
							 pneumatic compressor, half leg
E0667
275.20
206.41
36.56
Segmental pneumatic appliance for use with pneumatic
							 compressor, full leg
E0668
441.88
331.42
43.61
Segmental pneumatic appliance for use with pneumatic
							 compressor, full arm
E0669
174.06
130.56
17.41
Segmental pneumatic appliance for use with pneumatic
							 compressor, half leg
E0671
415.35
311.50
41.54
Segmental gradient pressure pneumatic appliance, full
							 leg
E0672
322.73
242.06
32.28
Segmental gradient pressure pneumatic appliance, full
							 arm
E0673
268.17
201.15
26.82
Segmental gradient pressure pneumatic appliance, half
							 leg
E0675
384.55
Pneumatic compression device, high pressure, rapid
							 inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral
							 system)
E0691
898.59
673.94
89.86
Ultraviolet light therapy system panel, includes
							 bulbs/lamps, timer, and eye protection; treatment area 2 sq. ft. or
							 less
E0692
1,128.37
846.29
112.83
Ultraviolet light therapy system panel, includes
							 bulbs/lamps, timer, and eye protection, 4 ft. panel
E0693
1,390.98
1,043.24
139.10
Ultraviolet light therapy system panel, includes
							 bulbs/lamps, timer, and eye protection, 6 ft. panel
E0694
4,427.34
3,320.53
442.73
Ultraviolet multidirectional light therapy system in
							 6 ft. cabinet, includes bulbs/lamps, timer, and eye protection
E0705
54.89
40.36
5.61
Transfer device, any type, each
E0720
367.58
Transcutaneous electrical nerve stimulation (TENS)
							 device, two lead, localized stimulation
E0730
370.56
Transcutaneous electrical nerve stimulation (TENS)
							 device, four or more leads, for multiple nerve stimulation
E0731
303.19
Form-fitting conductive garment for delivery of TENS
							 or NMES (with conductive fibers separated from the patient's skin by layers of
							 fabric)
E0740
522.87
392.18
52.29
Incontinence treatment system, pelvic floor
							 stimulator, monitor, sensor, and/or trainer
E0744
91.57
Neuromuscular stimulator for scoliosis
E0745
89.51
Neuromuscular stimulator, electronic shock
							 unit
E0747
3,328.66
2,473.13
330.78
Osteogenesis stimulator, electrical, noninvasive,
							 other than spinal applications
E0748
3,890.70
2,918.04
389.07
Osteogenesis stimulator, electrical, noninvasive,
							 spinal applications
E0749
284.37
Osteogenesis stimulator, electrical, surgically
							 implanted
E0760
3,233.10
2,424.83
323.32
Osteogenesis stimulator, low intensity
							 ultrasound,
noninvasive
E0762
934.63
700.95
93.47
Transcutaneous electrical joint stimulation device
							 system, includes all accessories
E0764
11,066.82
8,300.12
1,106.67
Functional neuromuscular stimulator, transcutaneous
							 stimulation of muscles of ambulation with computer control, used for walking by
							 spinal cord injured, entire system, after completion of training
							 program
E0765
84.13
63.12
8.43
FDA approved nerve stimulator, with replaceable
							 batteries, for treatment of nausea and vomiting
E0776
143.16
105.33
18.65
IV pole
E0779
16.73
Ambulatory infusion pump, mechanical, reusable, for
							 infusion eight hours or greater
E0780
10.37
Ambulatory infusion pump, mechanical, reusable, for
							 infusion less than eight hours
E0781
225.14
Ambulatory infusion pump, single or multiple
							 channels, electric or battery operated, with administrative equipment, worn by
							 patient
E0782
3,649.40
2,737.06
364.96
Infusion pump, implantable, non-programmable
							 (includes all components, eg, pump, catheter, connectors,
etc.
)
E0783
8,186.91
6,140.19
818.70
Infusion pump system, implantable, programmable
							 (includes all components, eg, pump, catheter, connectors,
etc.
)
E0784
417.57
External ambulatory infusion pump,
							 insulin
E0785
472.50
Implantable intraspinal (epidural/intrathecal)
							 catheter used with implantable infusion pump, replacement
E0786
7,697.60
5,773.22
769.76
Implantable programmable infusion pump,
replacement (excludes implantable intraspinal
							 catheter)
E0791
316.20
Parenteral infusion pump, stationary, single, or
							 multi-channel
E0840
73.28
54.93
14.53
Traction frame, attached to headboard, cervical
							 traction
E0849
515.31
386.46
51.53
Traction equipment, cervical, free-standing
							 stand/frame, pneumatic, applying traction force to other than
							 mandible
E0850
105.06
78.80
12.27
Traction stand, freestanding, cervical
							 traction
E0855
502.63
376.96
50.26
Cervical traction equipment not requiring additional
							 stand or frame
E0856
I.C.
I.C.
I.C.
Cervical traction device, cervical collar with
							 inflatable air bladder
E0860
38.53
29.51
6.51
Traction equipment, overdoor, cervical
E0870
116.31
87.62
13.40
Traction frame, attached to footboard, extremity
							 traction (eg, Buck's)
E0880
125.54
95.02
19.71
Traction stand, freestanding, extremity traction (eg,
							 Buck's)
E0890
120.41
96.99
32.83
Traction frame, attached to footboard, pelvic
							 traction
E0900
128.12
96.12
27.62
Traction stand, freestanding, pelvic traction (eg,
							 Buck's)
E0910
20.00
Trapeze bars, also known as Patient Helper, attached
							 to bed, with grab bar
E0911
49.85
Trapeze bar, heavy duty, for patient weight capacity
							 greater than 250 pounds, attached to bed, with grab bar
E0912
114.47
Trapeze bar, heavy duty, for patient weight capacity
							 greater than 250 pounds, free standing, complete with grab bar
E0920
46.14
Fracture frame, attached to bed, includes
							 weights
E0930
45.69
Fracture frame, freestanding, includes
							 weights
E0935
22.73
Continuous passive motion exercise device for use on
							 knee only
E0940
34.77
Trapeze bar, freestanding, complete with grab
							 bar
E0941
36.90
Gravity assisted traction device, any
							 type
E0942
19.85
14.88
1.99
Cervical head harness/halter
E0944
45.88
34.40
3.97
Pelvic belt/harness/boot
E0945
44.32
34.31
3.77
Extremity belt/harness
E0946
59.16
Fracture frame, dual with cross bars, attached to bed
							 (eg, Balken, Four Poster)
E0947
606.46
454.84
62.89
Fracture frame, attachments for complex pelvic
							 traction
E0948
586.59
413.70
58.64
Fracture frame, attachments for complex cervical
							 traction
E0950
88.36
66.27
8.85
Wheelchair accessory, tray, each
E0951
17.08
12.80
1.96
Heel loop/holder, any type, with or without ankle
							 strap, each
E0952
16.89
12.66
1.96
Toe loop/holder, any type, each
E0955
202.18
151.63
20.23
Wheelchair accessory, headrest, cushioned, any type,
							 including fixed mounting hardware, each
E0956
98.58
73.93
9.87
Wheelchair accessory, lateral trunk or hip support,
							 any type, including fixed mounting hardware, each
E0957
137.93
103.45
13.79
Wheelchair accessory, medial thigh support, any type,
							 including fixed mounting hardware, each
E0958
37.09
Manual wheelchair accessory, one-arm drive
							 attachment, each
E0959
44.21
33.46
3.91
Manual wheelchair accessory, adapter for amputee,
							 each
E0960
90.98
68.24
9.10
Wheelchair accessory, shoulder harness/straps or
							 chest strap, including any type mounting hardware
E0961
29.74
12.63
2.64
Manual wheelchair accessory, wheel lock brake
							 extension (handle), each
E0966
71.37
53.52
6.62
Manual wheelchair accessory, headrest extension,
							 each
E0967
65.69
49.25
6.57
Manual wheelchair accessory, hand rim with
							 projections, any type, each
E0968
16.94
Commode seat, wheelchair
E0969
156.63
117.48
13.22
Narrowing device, wheelchair
E0971
43.39
32.56
4.34
Manual wheelchair accessory, anti-tipping device,
							 each
E0973
114.97
86.23
9.31
Wheelchair accessory, adjustable height, detachable
							 armrest, complete assembly, each
E0974
74.07
55.54
7.06
Manual wheelchair accessory, anti-rollback device,
							 each
E0978
42.70
31.66
4.28
Wheelchair accessory, positioning belt/safety
							 belt/pelvic strap, each
E0980
33.06
24.66
3.30
Safety vest, wheelchair
E0981
47.15
35.70
4.08
Wheelchair accessory, seat upholstery, replacement
							 only, each
E0982
51.53
38.64
4.38
Wheelchair accessory, back upholstery, replacement
							 only, each
E0983
249.93
Manual wheelchair accessory, power add-on to convert
							 manual wheelchair to motorized wheelchair, joystick control
E0984
1,760.94
1,320.70
176.09
Manual wheelchair accessory, power add-on to convert
							 manual wheelchair to motorized wheelchair, tiller control
E0985
202.85
152.12
20.30
Wheelchair accessory, seat lift mechanism
E0986
4,864.24
3,648.20
486.43
Manual wheelchair accessory, push activated power
							 assist, each
E0990
117.43
91.75
13.22
Wheelchair accessory, elevating leg rest, complete
							 assembly, each
E0992
95.15
71.37
7.92
Manual wheelchair accessory, solid seat
							 insert
E0994
17.63
13.23
1.78
Armrest, each
E0995
25.84
19.36
2.66
Wheelchair accessory, calf rest/pad, each
E1002
4,053.21
3,039.90
405.32
Wheelchair accessory, power seating system, tilt
							 only
E1003
4,391.30
3,293.48
439.14
Wheelchair accessory, power seating system, recline
							 only, without shear reduction
E1004
4,869.05
3,651.77
486.90
Wheelchair accessory, power seating system, recline
							 only, with mechanical shear reduction
E1005
5,270.36
3,952.78
527.03
Wheelchair accessory, power seatng System, recline
							 only, with power shear reduction
E1006
6,455.70
4,841.78
645.55
Wheelchair accessory, power seating system,
							 combination tilt and recline, without shear reduction
E1007
8,741.27
6,555.94
874.13
Wheelchair accessory, power seating system,
							 combination tilt and recline, with mechanical shear reduction
E1008
8,742.05
6,556.55
874.20
Wheelchair accessory, power seating system,
							 combination tilt and recline, with power shear reduction
E1009
AI + 35%
I.C.
I.C.
Wheelchair accessory, addition to power seating
							 system, mechanically linked leg elevation system, including pushrod and leg
							 rest, each
E1010
1,143.79
857.86
114.38
Wheelchair accessory, addition to power seating
							 system, power leg elevation system, including leg rest, pair
E1011
I.C.
I.C.
I.C.
Modification to pediatric size wheelchair, width
							 adjustment package (not to be dispensed with initial chair)
E1014
365.14
273.85
36.52
Reclining back, addition to pediatric size
							 wheelchair
E1015
114.70
86.02
11.46
Shock absorber for manual wheelchair,
							 each
E1016
131.31
98.48
13.14
Shock absorber for power wheelchair, each
E1017
AI + 35%
I.C.
I.C.
Heavy duty shock absorber for heavy duty or extra
							 heavy duty manual wheelchair, each
E1018
AI + 35%
I.C.
I.C.
Heavy duty shock absorber for heavy duty or extra
							 heavy duty power wheelchair, each
E1020
243.41
182.55
24.32
Residual limb support system for
							 wheelchair
E1028
206.54
154.89
20.65
Wheelchair accessory, manual swingaway, retractable
							 or removable mounting hardware for joystick, other control interface or
							 positioning accessory
E1029
369.54
277.15
36.95
Wheelchair accessory, ventilator tray,
							 fixed
E1030
1,165.27
873.96
116.53
Wheelchair accessory, ventilator tray,
							 gimbaled
E1031
49.09
Rollabout chair, any and all types with castors five
							 in. or greater
E1035
613.20
Multi-positional patient transfer system, with
							 integrated seat, operated by care giver
E1037
108.49
Transport chair, pediatric size
E1038
18.03
Transport chair, adult size, patient weight capacity
							 up to and including 300 pounds
E1039
34.20
Transport chair, adult size, heavy duty, patient
							 weight capacity greater than 300 pounds
E1050
86.56
Fully reclining wheelchair; fixed full-length arms,
							 swing-away, detachable, elevating legrests
E1060
126.07
Fully reclining wheelchair; detachable arms, desk, or
							 full-length, swing-away, detachable, elevating leg rests
E1070
109.53
Fully reclining wheelchair; detachable arms, desk or
							 full-length, swing-away, detachable footrests
E1083
72.72
Hemi-wheelchair; fixed full-length arms, swing-away,
							 detachable, elevating legrests
E1084
96.57
Hemi-wheelchair; detachable arms, desk, or
							 full-length, swing-away, detachable, elevating leg rests
E1087
126.51
High-strength lightweight wheelchair; fixed
							 full-length arms, swing-away, detachable, elevating legrests
E1088
150.77
High strength lightweight wheelchair, detachable arms
							 desk or full length, swing away detachable elevating leg rests
E1092
109.23
Wide heavy duty wheel chair, detachable arms (desk or
							 full length), swing away detachable elevating leg rests
E1093
93.94
Wide, heavy-duty wheelchair; detachable arms, desk or
							 full-length arms, swing-away, detachable footrests
E1100
103.81
Semi-reclining wheelchair, fixed full-length arms,
							 swing away detachable elevating leg rests
E1110
101.66
Semi-reclining wheelchair; detachable arms, desk or
							 full-length, elevating legrest
E1150
81.58
Wheelchair, detachable arms, desk or full-length
							 swing away detachable elevating leg rests
E1160
62.50
Wheelchair, fixed full-length arms, swing away
							 detachable elevating leg rests
E1161
2,366.09
1,774.57
236.61
Manual adult size wheelchair, includes tilt in
							 space
E1170
89.31
Amputee wheelchair, fixed full-length arms, swing
							 away detachable elevating leg rests
E1171
80.15
Amputee wheelchair, fixed full-length arms, without
							 footrests or leg rest
E1172
97.95
Amputee wheelchair, detachable arms (desk or
							 full-length) without footrests or leg rest
E1180
101.34
Amputee wheelchair, detachable arms (desk or
							 full-length) swing away detachable foot rests
E1190
107.92
Amputee wheelchair, detachable arms (desk or
							 full-length) swing away detachable elevating leg rests
E1195
125.63
Heavy duty wheelchair, fixed full-length arms, swing
							 away detachable elevating leg rests
E1200
87.01
Amputee wheelchair, fixed full-length arms, swing
							 away detachable footrest
E1221
47.51
Wheelchair with fixed arm, footrests
E1222
67.79
Wheelchair with fixed arm, elevating leg
							 rests
E1223
74.02
Wheelchair with detachable arms,
							 footrests
E1224
81.15
Wheelchair with detachable arms, elevating leg
							 rests
E1225
38.42
Wheelchair accessory, manual semi-reclining back,
							 (recline greater than 15 degrees, but less than 80 degrees), each
E1226
463.80
347.82
47.74
Wheelchair accessory, manual fully reclining back,
							 (recline greater than 80 degrees), each
E1227
E1228
235.88
176.93
23.59
28.02
Special height arms for wheelchair Special back
							 height for wheelchair
E1230
2,261.79
1,788.81
222.45
Power operated vehicle (three- or four-wheel
							 nonhighway), specify brand name and model number
E1240
103.02
Lightweight wheelchair, detachable arms, (desk or
							 full length) swing away detachable, elevating leg rest
E1270
78.94
Lightweight wheelchair, fixed full length arms, swing
							 away detachable elevating leg rests
E1280
131.26
Heavy duty wheelchair, detachable arms (desk or full
							 length) elevating leg rests
E1295
121.47
Heavy duty wheelchair, fixed full length arms,
							 elevating leg rest
E1296
491.67
368.75
49.94
Special wheelchair seat height from floor
E1297
88.92
66.68
9.88
Special wheelchair seat depth, by
							 upholstery
E1298
360.10
270.07
36.85
Special wheelchair seat depth and/or width, by
							 construction
E1310
1,825.29
1,368.97
156.12
Whirlpool, nonportable (built-in type)
E1353
32.87
Regulator
E1355
24.75
Stand/rack
E1372
163.03
120.68
23.69
Immersion external heater for nebulizer
E1390
199.28
Oxygen concentrator, single delivery port, capable of
							 delivering 85% or greater oxygen concentration at the prescribed flow
							 rate
E1391
199.28
Oxygen concentrator, dual delivery port, capable of
							 delivering 85% or greater oxygen concentration at the prescribed flow rate,
							 each
E1392
51.63
Portable oxygen concentrator, rental
E1405
229.09
Oxygen and water vapor enriching system with heated
							 delivery
E1406
215.39
Oxygen and water vapor enriching system without
							 heated delivery
E1700
312.39
234.31
31.23
Jaw motion rehabilitation system
E1701
10.37
Replacement cushions for jaw motion rehabilitation
							 system, package of six
E1702
22.57
Replacement measuring scales for jaw motion
							 rehabilitation system, package of 200
E1800
104.13
Dynamic adjustable elbow extension/flexion device,
							 includes soft interface material
E1801
129.00
Static progressive stretch elbow device, extension
							 and/or flexion, with or without range of motion adjustment, includes all
							 components and accessories
E1802
326.80
Dynamic adjustable forearm pronation/supination
							 device, includes soft interface material
E1805
126.34
Dynamic adjustable wrist extension/flexion device,
							 includes soft interface material
E1806
105.91
Static progressive stretch wrist device, flexion
							 and/or extension, with or without range of motion adjustment, includes all
							 components and accessories
E1810
105.89
Dynamic adjustable knee extension/flexion device,
							 includes soft interface material
E1811
134.12
Static progressive stretch knee device, extension
							 and/or flexion, with or without range of motion adjustment, includes all
							 components and accessories
E1812
85.99
Dynamic knee, extension/flexion device with active
							 resistance control
E1815
126.34
Dynamic adjustable ankle extension/flexion device,
							 includes soft interface material
E1816
136.24
Static progressive stretch ankle device, flexion
							 and/or extension, with or without range of motion adjustment, includes all
							 components and accessories
E1818
139.09
Static progressive stretch forearm
							 pronation/supination device, with or without range of motion adjustment,
							 includes all components and accessories
E1820
81.74
61.31
8.17
Replacement soft interface material, dynamic
							 adjustable extension/flexion device
E1821
105.25
78.95
10.51
Replacement soft interface material/cuffs for
							 bi-directional static progressive stretch device
E1825
126.34
Dynamic adjustable finger extension/flexion device,
							 includes soft interface material
E1830
126.34
Dynamic adjustable toe extension/flexion device,
							 includes soft interface material
E1840
382.71
Dynamic adjustable shoulder flexion/abduction/
							 rotation device, includes soft interface material
E1841
453.00
Static progressive stretch shoulder device, with or
							 without range of motion adjustment, includes all components and
							 accessories
E2000
51.83
Gastric suction pump, home model, portable or
							 stationary, electric
E2100
643.19
482.40
64.32
Blood glucose monitor with integrated voice
							 synthesizer
E2101
188.56
141.42
18.86
Blood glucose monitor with integrated lancing/blood
							 sample
E2120
283.52
Pulse generator system for tympanic treatment of
							 inner ear endolymphatic fluid
E2201
373.10
279.83
37.31
Manual wheelchair accessory, nonstandard seat frame,
							 width greater than or equal to 20 inches and less than 24 inches
E2202
473.98
355.50
47.40
Manual wheelchair accessory, nonstandard seat frame
							 width, 24-27 in.
E2203
479.05
359.28
47.89
Manual wheelchair accessory, nonstandard seat frame
							 depth, 20 to less than 22 inches
E2204
813.40
610.05
81.35
Manual wheelchair accessory, nonstandard seat frame
							 depth, 22 to 25 inches
E2205
32.67
24.52
3.25
Manual wheelchair accessory, handrim without
							 projections (includes ergonomic or contoured), any type, replacement only,
							 each
E2206
40.68
30.50
4.06
Manual wheelchair accessory, wheel Lock assembly,
							 complete, each
E2207
43.35
32.51
4.34
Wheelchair accessory, crutch and cane holder,
							 each
E2208
118.78
89.09
11.87
Wheelchair accessory, cylinder tank carrier,
							 each
E2209
107.16
80.38
10.74
Accessory, arm trough, with or without hand support,
							 each
E2210
6.55
4.92
0.56
Wheelchair accessory, bearings, any type, replacement
							 only, each
E2211
40.91
29.30
3.96
Manual wheelchair accessory, pneumatic propulsion
							 tire, any size, each
E2212
5.88
4.42
0.61
Manual wheelchair accessory, tube for pneumatic
							 propulsion tire, any size, each
E2213
30.41
22.79
3.05
Manual wheelchair accessory, insert for pneumatic
							 propulsion tire (removable), any type, any size, each
E2214
36.00
26.99
3.96
Manual wheelchair accessory, pneumatic caster tire,
							 any size, each
E2215
9.60
7.18
0.95
Manual wheelchair accessory, tube for pneumatic
							 caster tire, any size, each
E2216
AI + 30%
I.C.
I.C.
Manual wheelchair accessory, foam filled propulsion
							 tire, any size, each
E2217
AI + 30%
I.C.
I.C.
Manual wheelchair accessory, foam filled caster tire,
							 any size, each
E2218
AI + 30%
I.C.
I.C.
Manual wheelchair accessory, foam propulsion tire,
							 any size, each
E2219
40.31
30.24
4.01
Manual wheelchair accessory, foam caster tire, any
							 size, each
E2220
28.52
21.81
2.75
Manual wheelchair accessory, solid (rubber/plastic)
							 propulsion tire, any size, each
E2221
25.55
19.18
2.58
Manual wheelchair accessory, solid (rubber/plastic)
							 caster tire (removable), any size, each
E2222
21.06
15.81
2.09
Manual wheelchair accessory, solid (rubber/plastic)
							 caster tire with integrated wheel, any size, each
E2223
5.61
4.21
0.56
Manual wheelchair accessory, valve, any type,
							 replacement only, each
E2224
98.06
73.55
10.29
Manual wheelchair accessory, propulsion wheel
							 excludes tire, any size, each
E2225
17.40
13.04
1.74
Manual wheelchair accessory, caster wheel excludes
							 tire, any size, replacement only, each
E2226
37.94
28.46
3.79
Manual wheelchair accessory, caster fork, any size,
							 replacement only, each
E2227
AI + 35%
I.C.
I.C.
Manual wheelchair accessory, gear reduction drive
							 wheel, each
E2228
AI + 35%
I.C.
I.C.
Manual wheelchair accessory, wheel braking system and
							 lock, complete, each
E2310
1,170.24
877.68
117.02
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
2,369.20
1,776.90
236.93
Power wheelchair accessory, electronic connection
							 between wheelchair controller and two or more power seating system motors,
							 including all related electronics, indicator feature, mechanical function
							 selection switch, and fixed mounting hardware
E2312
2,473.18
1,454.36
193.92
Power wheelchair accessory, hand or chin control
							 interface, mini-proportional remote joystick, proportional, including fixed
							 mounting hardware
E2312
1,939.18
1,854.88
193.92
Power wheelchair accessory, hand or chin control
							 interface, mini-proportional remote joystick, proportional, including fixed
							 mounting hardware
E2313
307.93
230.95
30.81
Power wheelchair accessory, harness for upgrade to
							 expandable controller, including all fasteners, connectors and mounting
							 hardware, each
E2321
2,231.00
1,673.25
223.10
Power wheelchair accessory, hand control interface,
							 remote joystick, nonproportional, including all related electronics, mechanical
							 stop switch, and fixed mounting hardware
E2322
1,410.36
1,771.94
236.26
Power wheelchair accessory, hand control interface,
							 multiple mechanical switches, nonproportional, including all related
							 electronics, mechanical stop switch, and fixed mounting hardware
E2323
69.16
51.87
6.92
Power wheelchair accessory, specialty joystick handle
							 for hand control interface, prefabricated
E2323
69.16
51.87
6.92
Power wheelchair accessory, specialty joystick handle
							 for hand control interface, prefabricated
E2323
69.16
51.87
6.92
Power wheelchair accessory, specialty joystick handle
							 for hand control interface, prefabricated
E2324
43.82
32.87
4.37
Power wheelchair accessory, chin cup for chin control
							 interface
E2324
43.82
32.87
4.37
Power wheelchair accessory, chin cup for chin control
							 interface
E2324
43.82
32.87
4.37
Power wheelchair accessory, chin cup for chin control
							 interface
E2325
1,346.83
1,010.13
134.70
Power wheelchair accessory, sip and puff interface,
							 nonproportional, including all related electronics, mechanical stop switch, and
							 manual swingaway mounting hardware
E2325
1,346.83
1,010.13
134.70
Power wheelchair accessory, sip and puff interface,
							 nonproportional, including all related electronics, mechanical stop switch, and
							 manual swingaway mounting hardware
E2325
1,346.83
1,010.13
134.70
Power wheelchair accessory, sip and puff interface,
							 nonproportional, including all related electronics, mechanical stop switch, and
							 manual swingaway mounting hardware
E2326
347.14
260.34
34.73
Power wheelchair accessory, breath tube kit for sip
							 and puff interface
E2326
347.14
260.34
34.73
Power wheelchair accessory, breath tube kit for sip
							 and puff interface
E2326
347.14
260.34
34.73
Power wheelchair accessory, breath tube kit for sip
							 and puff interface
E2327
3,420.77
2,565.57
342.08
Power wheelchair accessory, head control interface,
							 mechanical, proportional, including all related electronics, mechanical
							 direction change switch, and fixed mounting hardware
E2328
4,955.32
3,716.50
495.52
Power wheelchair accessory, head control or extremity
							 control interface, electronic, proportional, including all related electronics
							 and fixed mounting hardware
E2329
1,766.13
1,324.60
176.61
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
3,422.09
2,566.58
342.20
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
E2340
358.36
268.79
35.85
Power wheelchair accessory, nonstandard seat frame
							 width, 20-23 in.
E2341
537.58
403.19
53.76
Power wheelchair accessory, nonstandard seat frame
							 width, 24-27 in.
E2342
447.98
335.99
44.80
Power wheelchair accessory, nonstandard seat frame
							 depth, 20 or 21 in.
E2343
716.78
537.58
71.67
Power wheelchair accessory, nonstandard seat frame
							 depth, 22-25 in.
E2351
698.63
523.96
69.88
Power wheelchair accessory, electronic interface to
							 operate speech generating device using power wheelchair control
							 interface
E2360
112.34
84.26
11.29
Power wheelchair accessory, 22 NF nonsealed lead acid
							 battery, each
E2361
139.47
104.62
13.95
Power wheelchair accessory, 22 NF sealed lead acid
							 battery, each, (
e.g.
, gel cell, absorbed glassmat)
E2362
91.98
68.98
9.20
Power wheelchair accessory, group 24 nonsealed lead
							 acid battery, each
E2363
186.00
139.50
18.61
Power wheelchair accessory, group 24 sealed lead acid
							 battery, each (
e.g.
, gel cell, absorbed glassmat)
E2364
112.34
84.26
11.29
Power wheelchair accessory, U-1 nonsealed lead acid
							 battery, each
E2365
112.17
84.15
11.22
Power wheelchair accessory, U-1 sealed lead acid
							 battery, each (
e.g.
, gel cell, absorbed glassmat)
E2366
263.62
197.72
26.43
Power wheelchair accessory, battery charger, single
							 mode, for use with only one battery type, sealed or non-sealed,
							 each
E2367
419.08
314.31
41.91
Power wheelchair accessory, battery charger, dual
							 mode, for use with either battery type, sealed or nonsealed, each
E2368
516.57
387.44
51.67
Power wheelchair component, motor, replacement
							 only
E2369
449.94
337.45
45.00
Power wheelchair component, gear box, replacement
							 only
E2370
802.84
602.12
80.29
Power wheelchair component, motor and gear box
							 combination, replacement only
E2371
150.74
113.06
15.08
Power wheelchair accessory, group 27 sealed lead acid
							 battery, (
e.g.
, gel cell, absorbed glassmat), each
E2372
AI + 35%
I.C.
I.C.
Power wheelchair accessory, group 27 nonsealed lead
							 acid battery, each
E2373
1,209.93
907.47
121.00
Power wheelchair accessory, hand or chin control
							 interface, compact remote joystick, proportional, including fixed mounting
							 hardware
E2374
534.02
400.53
53.40
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
856.56
642.40
85.65
Power wheelchair accessory, nonexpandable controller,
							 including all related electronics and mounting hardware, replacement
							 only
E2376
1,342.27
1,006.72
134.23
Power wheelchair accessory, expandable controller,
							 including all related electronics and mounting hardware, replacement
							 only
E2377
485.71
364.30
48.56
Power wheelchair accessory, expandable controller,
							 including all related electronics and mounting hardware, upgrade provided at
							 initial issue
E2381
76.18
57.14
7.63
Power wheelchair accessory, pneumatic drive wheel
							 tire, any size, replacement only, each
E2382
20.77
15.57
2.07
Power wheelchair accessory, tube for pneumatic drive
							 wheel tire, any size, replacement only, each
E2383
151.88
113.91
15.19
Power wheelchair accessory, insert for pneumatic
							 drive wheel tire (removable), any type, any size, replacement only,
							 each
E2384
80.91
60.68
8.11
Power wheelchair accessory, pneumatic caster tire,
							 any size, replacement only, each
E2385
49.50
37.11
4.96
Power wheelchair accessory, tube for pneumatic caster
							 tire, any size, replacement only, each
E2386
150.51
112.87
15.05
Power wheelchair accessory, foam filled drive wheel
							 tire, any size, replacement only, each
E2387
67.49
50.65
6.75
Power wheelchair accessory, foam filled caster tire,
							 any size, replacement only, each
E2388
50.39
37.80
5.04
Power wheelchair accessory, foam drive wheel tire,
							 any size, replacement only, each
E2389
27.36
20.51
2.74
Power wheelchair accessory, foam caster tire, any
							 size, replacement only, each
E2390
42.79
32.07
4.28
Power wheelchair accessory, solid (rubber/plastic)
							 drive wheel tire, any size, replacement only, each
E2391
20.50
15.38
2.05
Power wheelchair accessory, solid (rubber/plastic)
							 caster tire (removable), any size, replacement only, each
E2392
53.88
40.41
5.40
Power wheelchair accessory, solid (rubber/plastic)
							 caster tire with integrated wheel, any size, replacement only, each
E2393
AI + 35%
I.C
I.C
Power wheelchair accessory, valve for pneumatic tire
							 tube, any type, replacement only, each
E2394
76.75
57.57
7.69
Power wheelchair accessory, drive wheel excludes
							 tire, any size, replacement only, each
E2395
54.55
40.93
5.46
Power wheelchair accessory, caster wheel excludes
							 tire, any size, replacement only, each
E2396
64.07
48.07
7.13
Power wheelchair accessory, caster fork, any size,
							 replacement only, each
E2397
E2402
AI + 35%
I.C
I.C
1,716.46
Power wheelchair accessory, lithium-based battery,
							 each Negative pressure wound therapy electrical pump, stationary or
							 portable
E2500
391.06
293.29
39.11
Speech generating device, digitized speech, using
							 pre-recorded messages, less than or equal to eight minutes recording
							 time
E2502
1,195.80
896.86
119.59
Speech generating device, digitized speech, using
							 prerecorded messages, greater than eight minutes but less than or equal to 20
							 minutes recording time
E2504
1,577.42
1,183.05
157.76
Speech generating device, digitized speech, using
							 prerecorded messages, greater than 20 minutes but less than or equal to 40
							 minutes recording time
E2506
2,312.96
1,734.69
231.29
Speech generating device, digitized speech, using
							 prerecorded messages, greater than 40 minutes recording time
E2508
3,576.61
2,682.47
357.67
Speech generating device, synthesized speech,
							 requiring message formulation by spelling and access by physical contact with
							 the device
E2510
6,768.25
5,076.18
676.82
Speech generating device, synthesized speech,
							 permitting multiple methods of message formulation and multiple methods of
							 device access
E2511
AI + 30%
I.C
I.C
Speech generating software program, for personal
							 computer or personal digital assistant
E2512
AI + 30%
I.C
I.C
Accessory for speech generating device, mounting
							 system
E2601
61.16
45.87
6.13
General use wheelchair seat cushion, width less than
							 22 in., any depth
E2602
119.40
89.55
11.94
General use wheelchair seat cushion, width 22 in. or
							 greater, any depth
E2603
151.59
113.69
15.17
Skin protection wheelchair seat cushion, width less
							 than 22 in., any depth
E2604
188.41
141.33
18.83
Skin protection wheelchair seat cushion, width 22 in.
							 or greater, any depth
E2605
269.17
201.91
26.93
Positioning wheelchair seat cushion, width less than
							 22 in., any depth
E2606
419.93
314.94
42.01
Positioning wheelchair seat cushion, width 22 in. or
							 greater, any depth
E2607
289.85
217.39
28.99
Skin protection and positioning wheelchair seat
							 cushion, width less than 22 in., any depth
E2608
348.09
261.07
34.80
Skin protection and positioning wheelchair seat
							 cushion, width 22 in. or greater, any depth
E2611
312.35
234.29
31.23
General use wheelchair back cushion, width less than
							 22 in., any height, including any type mounting hardware
E2612
422.54
316.89
42.25
General use wheelchair back cushion, width 22 in. or
							 greater, any height, including any type mounting hardware
E2613
393.04
294.78
39.31
Positioning wheelchair back cushion, posterior, width
							 less than 22 in., any height, including any type mounting hardware
E2614
543.93
407.97
54.40
Positioning wheelchair back cushion, posterior, width
							 22 in. or greater, any height, including any type mounting hardware
E2615
452.32
339.23
45.24
Positioning wheelchair back cushion,
							 posterior-lateral, width less than 22 in., any height, including any type
							 mounting hardware
E2616
608.58
456.45
60.86
Positioning wheelchair back cushion,
							 posterior-lateral, width 22 in. or greater, any height, including any type
							 mounting hardware
E2619
51.32
38.51
5.13
Replacement cover for wheelchair seat cushion or back
							 cushion, each
E2620
547.70
410.79
54.77
Positioning wheelchair back cushion, planar back with
							 lateral supports, width less than 22 in., any height, including any type
							 mounting hardware
E2621
574.76
431.08
57.47
Positioning wheelchair back cushion, planar back with
							 lateral supports, width 22 in. or greater, any height, including any type
							 mounting hardware
L0112
1,178.03
Cranial cervical orthosis, congenital torticollis
							 type, with or without soft interface material, adjustable range of motion
							 joint, custom fabricated
L0120
21.39
Cervical, flexible, nonadjustable (foam
							 collar)
L0130
137.29
Cervical, flexible, thermoplastic collar, molded to
							 patient
L0140
66.73
Cervical, semi-rigid, adjustable (plastic
							 collar)
L0150
99.40
Cervical, semi-rigid, adjustable molded chin cup
							 (plastic collar with mandibular/occipital piece)
L0160
168.38
Cervical, semi-rigid, wire frame occipital/mandibular
							 support
L0170
663.10
Cervical, collar, molded to patient model
L0172
102.37
Cervical, collar, semi-rigid thermoplastic foam, two
							 piece
L0174
295.33
Cervical, collar, semi-rigid, thermoplastic foam, two
							 piece with thoracic extension
L0180
398.35
Cervical, multiple post collar, occipital/mandibular
							 supports, adjustable
L0190
482.75
Cervical, multiple post collar, occipital/mandibular
							 supports, adjustable cervical bars (SOMI, Guilford, Taylor types)
L0200
452.73
Cervical, multiple post collar, occipital/mandibular
							 supports, adjustable cervical bars, and thoracic extension
L0210
39.84
Thoracic, rib belt
L0220
107.26
Thoracic, rib belt, custom fabricated
L0430
1,135.00
Spinal orthosis, anterior-posterior-lateral control,
							 with interface material, custom fitted (DeWall Posture Protector
							 only)
L0450
186.85
TLSO, flexible, provides trunk support, upper
							 thoracic region, produces intracavitary pressure to reduce load on the
							 intervertebral disks with rigid stays or panel(s), includes shoulder straps and
							 closures, prefabricated, includes fitting and adjustment
L0452
AI + 70%.
TLSO, flexible, provides trunk support, upper
							 thoracic region, produces intracavitary pressure to reduce load on the
							 intervertebral disks with rigid stays or panel(s), includes shoulder straps and
							 closures, custom fabricated
L0454
291.91
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
L0456
837.12
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
L0458
750.63
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
844.88
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, includes fitting and adjustment
L0462
1,050.90
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
1,251.08
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 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
L0466
347.54
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, includes fitting and shaping the frame, prefabricated,
							 includes fitting and adjustment
L0468
449.08
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
							 intravertebral disks, includes fitting and shaping the frame, prefabricated,
							 includes fitting and adjustment
L0470
637.80
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 the sagittal,
							 coronal, and transverse planes, produces intracavitary pressure to reduce load
							 on intravertebral disks, includes fitting and shaping the frame, prefabricated,
							 includes fitting and adjustment
L0472
388.61
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 the sagittal, coronal, and transverse planes, includes fitting and shaping
							 the frame, prefabricated, includes fitting and adjustment
L0480
1,342.86
TLSO, triplanar control, one 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 the sagittal, coronal, and
							 transverse planes, includes a carved plaster or CAD-CAM model, custom
							 fabricated
L0482
1,401.23
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 the sagittal, coronal, and transverse
							 planes, includes a carved plaster or CAD-CAM model, custom
							 fabricated
L0484
1,910.59
TLSO, triplanar control, two 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
2,027.03
TLSO, triplanar control, two 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
844.88
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
238.10
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
646.42
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
425.36
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
L0621
87.11
Sacroiliac orthosis, flexible, provides pelvic-sacral
							 support, reduces motion about the sacroiliac joint, includes straps, closures,
							 may include pendulous abdomen design, prefabricated, includes fitting and
							 adjustment
L0622
277.74
Sacroiliac orthosis, flexible, provides pelvic-sacral
							 support, reduces motion about the sacroiliac joint, includes straps, closures,
							 may include pendulous abdomen design, custom fabricated
L0623
AI + 50%.
Sacroiliac orthosis, provides pelvic-sacral support,
							 with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion
							 about the sacroiliac joint, includes straps, closures, may include pendulous
							 abdomen design, prefabricated, includes fitting and adjustment
L0624
AI + 70%
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
46.35
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,
							 includes fitting and adjustment
L0626
65.60
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
L0627
345.97
Lumbar orthosis, sagittal control, with rigid
							 anterior and posterior panels, posterior extends from L-1 to below L-5
							 vertebra, produces intracavitarypressure to reduce load on the intervertebral
							 discs, includes straps, closures, may include padding, shoulder straps,
							 pendulous abdomen design, prefabricated, includes fitting and
							 adjustment
L0628
70.61
Lumbar-sacral orthosis, flexible, provides
							 lumbosacral 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, includes fitting and adjustment
L0629
AI + 70%
Lumbar-sacral orthosis, flexible, provides
							 lumbosacral 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
136.31
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, includes fitting and
							 adjustment
L0631
864.05
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, includes fitting and
							 adjustment
L0632
AI + 70%.
LSO, sagittal control, with rigid anterior and
							 posterio 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
241.35
LSO, 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, includes fitting and adjustment
L0634
AI + 70%.
LSO, 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
L0635
788.67
LSO, 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
1,270.32
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
985.53
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,
							 prefabricated, includes fitting and adjustment
L0638
1,110.09
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
985.53
LSO, 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, includes fitting and adjustment
L0640
880.72
LSO, 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
L0700
1,811.11
CTLSO, anterior-posterior-lateral control, molded to
							 patient model (Minerva type)
L0710
1,954.07
CTLSO, anterior-posterior-lateral control, molded to
							 patient model, with interface material (Minerva type)
L0810
2,726.96
Halo procedure, cervical halo incorporated into
							 jacket
L0820
2,322.30
Halo procedure, cervical halo incorporated into
							 plaster body jacket
L0830
3,020.24
Halo procedure, cervical halo incorporated into
							 Milwaukee type orthosis
L0859
1,043.56
Addition to halo procedure, magnetic resonance image
							 compatible systems, rings and pins, any material
L0861
181.41
Addition to halo procedure, replacement
							 liner/interface material
L0970
92.15
TLSO, corset front
L0972
82.98
LSO, corset front
L0974
181.90
TLSO, full corset
L0976
137.81
LSO, full corset
L0978
166.92
Axillary crutch extension
L0980
18.77
Peroneal straps, pair
L0982
17.50
Stocking supporter grips, set of four
L0984
55.14
Protective body sock, each
L1000
2,065.61
CTLSO (Milwaukee), inclusive of furnishing initial
							 orthosis, including model
L1005
2,693.89
Tension based scoliosis orthosis and accessory pads,
							 includes fitting and adjustment
L1010
59.72
Addition to CTLSO or scoliosis orthosis, axilla
							 sling
L1020
69.69
Addition to CTLSO or scoliosis orthosis, kyphosis
							 pad
L1025
107.97
Addition to CTLSO or scoliosis orthosis, kyphosis
							 pad, floating
L1030
51.29
Addition to CTLSO or scoliosis orthosis, lumbar
							 bolster pad
L1040
62.90
Addition to CTLSO or scoliosis orthosis, lumbar or
							 lumbar rib pad
L1050
67.13
Addition to CTLSO or scoliosis orthosis, sternal
							 pad
L1060
80.17
Addition to CTLSO or scoliosis orthosis, thoracic
							 pad
L1070
72.55
Addition to CTLSO or scoliosis orthosis, trapezius
							 sling
L1080
47.50
Addition to CTLSO or scoliosis orthosis,
							 outrigger
L1085
124.11
Addition to CTLSO or scoliosis orthosis, outrigger,
							 bilateral with vertical extensions
L1090
73.91
Addition to CTLSO or scoliosis orthosis, lumbar
							 sling
L1100
155.95
Addition to CTLSO or scoliosis orthosis, ring flange,
							 plastic or leather
L1110
243.03
Addition to CTLSO or scoliosis orthosis, ring flange,
							 plastic or leather, molded to patient model
L1120
32.02
Addition to CTLSO, scoliosis orthosis, cover for
							 upright, each
L1200
1,499.67
TLSO, inclusive of furnishing initial orthosis
							 only
L1210
210.98
Addition to TLSO, (low profile), lateral thoracic
							 extension
L1220
178.63
Addition to TLSO, (low profile), anterior thoracic
							 extension
L1230
515.39
Addition to TLSO, (low profile), Milwaukee type
							 superstructure
L1240
68.06
Addition to TLSO, (low profile), lumbar derotation
							 pad
L1250
68.02
Addition to TLSO, (low profile), anterior ASIS
							 pad
L1260
68.06
Addition to TLSO, (low profile), anterior thoracic
							 derotation pad
L1270
68.06
Addition to TLSO, (low profile), abdominal
							 pad
L1280
92.74
Addition to TLSO, (low profile), rib gusset
							 (elastic), each
L1290
68.06
Addition to TLSO, (low profile), lateral trochanteric
							 pad
L1300
1,432.76
Other scoliosis procedure, body jacket molded to
							 patient model
L1310
1,542.02
Other scoliosis procedure, postoperative body
							 jacket
L1500
2,015.56
THKAO, mobility frame (Newington, Parapodium
							 types)
L1510
1,191.06
THKAO, standing frame, with or without tray and
							 accessories
L1520
1,998.13
THKAO, swivel walker
L1600
124.86
HO, abduction control of hip joints, flexible, Frejka
							 type with cover, prefabricated, includes fitting and adjustment
L1610
38.26
HO, abduction control of hip joints, flexible,
							 (Frejka cover only), prefabricated, includes fitting and adjustment
L1620
127.09
HO, abduction control of hip joints, flexible,
							 (Pavlik harness), prefabricated, includes fitting and adjustment
L1630
182.18
HO, abduction control of hip joints, semi-flexible
							 (Von Rosen type), custom fabricated
L1640
496.08
HO, abduction control of hip joints, static, pelvic
							 band or spreader bar, thigh cuffs, custom fabricated
L1650
246.94
HO, abduction control of hip joints, static,
							 adjustable (Ilfled type), prefabricated, includes fitting and
							 adjustment
L1652
300.03
Hip orthosis, bilateral thigh cuffs with adjustable
							 abductor spreader bar, adult size, prefabricated, includes fitting and
							 adjustment, any type
L1660
169.65
HO, abduction control of hip joints, static, plastic,
							 prefabricated, includes fitting and adjustment
L1680
982.44
HO, abduction control of hip joints, dynamic, pelvic
							 control, adjustable hip motion control, thigh cuffs (Rancho hip action type),
							 custom fabricated
L1685
1,278.81
HO, abduction control of hip joint, postoperative hip
							 abduction type, custom fabricated
L1686
810.92
HO, abduction control of hip joint, postoperative hip
							 abduction type, prefabricated, includes fitting and adjustments
L1690
1,627.58
Combination, bilateral, lumbo-sacral, hip, femur
							 orthosis providing adduction and internal rotation control, prefabricated,
							 includes fitting and adjustment
L1700
1,564.68
Legg Perthes orthosis, (Toronto type), custom
							 fabricated
L1710
1,921.90
Legg Perthes orthosis, (Newington type), custom
							 fabricated
L1720
1,086.86
Legg Perthes orthosis, trilateral, (Tachdijan type),
							 custom fabricated
L1730
1,142.67
Legg Perthes orthosis, (Scottish Rite type), custom
							 fabricated
L1755
1,702.14
Legg Perthes orthosis, (Patten bottom type), custom
							 fabricated
L1800
53.64
KO, elastic with stays, prefabricated, includes
							 fitting and adjustment
L1810
83.35
KO, elastic with joints, prefabricated, includes
							 fitting and adjustment
L1815
104.15
KO, elastic or other elastic type material with
							 condylar pad(s), prefabricated, includes fitting and adjustment
L1820
122.74
Knee orthosis, elastic with condylar pads and joints,
							 with or without patellar control, prefabricated, includes fitting and
							 adjustment
L1825
57.52
KO, elastic knee cap, prefabricated, includes fitting
							 and adjustment
L1830
70.54
KO, immobilizer, canvas longitudinal, prefabricated,
							 includes fitting and adjustment
L1831
247.71
Knee orthosis, locking knee joint(s), positional
							 orthosis, prefabricated, includes fitting and adjustment
L1832
640.07
Knee orthosis, adjustable knee joints (unicentric or
							 polycentric), positional orthosis, rigid support, prefabricated, includes
							 fitting and adjustment
L1834
834.56
KO, without knee joint, rigid, custom
							 fabricated
L1836
112.30
Knee orthosis, rigid, without joint(s), includes soft
							 interface material, prefabricated, includes fitting and adjustment
L1840
786.51
KO, derotation, medial-lateral, anterior cruciate
							 ligament, custom fabricated
L1843
755.20
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, includes fitting and adjustment
L1844
1,377.12
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,
							 custom fabricated
L1845
702.24
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, includes fitting and adjustment
L1846
1,045.16
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,
							 custom fabricated
L1847
484.10
KO, double upright with adjustable joint, with
							 inflatable air support chamber(s), prefabricated, includes fitting and
							 adjustment
L1850
285.45
KO, Swedish type, prefabricated, includes fitting and
							 adjustment
L1860
914.78
KO, modification of supracondylar prosthetic socket,
							 custom fabricated (SK)
L1900
256.10
AFO, spring wire, dorsiflexion assist calf band,
							 custom fabricated
L1901
14.90
Ankle orthosis, elastic, prefabricated, includes
							 fitting and adjustment (
e.g.
, neoprene, Lycra)
L1902
74.14
AFO, ankle gauntlet, prefabricated, includes fitting
							 and adjustment
L1904
505.56
AFO, molded ankle gauntlet, custom
							 fabricated
L1906
108.58
AFO, multiligamentus ankle support, prefabricated,
							 includes fitting and adjustment
L1907
473.60
AFO, supramalleolar with straps, with or without
							 interface/pads, custom fabricated
L1910
255.64
AFO, posterior, single bar, clasp attachment to shoe
							 counter, prefabricated, includes fitting and adjustment
L1920
374.64
AFO, single upright with static or adjustable stop
							 (Phelps or Perlstein type), custom fabricated
L1930
220.14
AFO, plastic or other material, prefabricated,
							 includes fitting and adjustment
L1932
751.08
AFO, rigid anterior tibial section, total carbon
							 fiber or equal material, prefabricated, includes fitting and
							 adjustment
L1940
531.69
AFO, plastic or other material,
							 custom-fabricated
L1945
995.21
AFO, molded to patient model, plastic, rigid anterior
							 tibial section (floor reaction), custom fabricated
L1950
768.97
AFO, spiral, (Institute of Rehabilitative Medicine
							 type), plastic, custom fabricated
L1951
706.87
AFO, spiral, (Institute of Rehabilitative Medicine
							 type), plastic or other material, prefabricated, includes fitting and
							 adjustment
L1960
595.91
AFO, posterior solid ankle, plastic, custom
							 fabricated
L1970
765.00
AFO, plastic, with ankle joint, custom
							 fabricated
L1971
394.51
AFO, plastic or other material with ankle joint,
							 prefabricated, includes fitting and adjustment
L1980
382.79
AFO, single upright free plantar dorsiflexion, solid
							 stirrup, calf band/cuff (single bar BK orthosis), custom fabricated
L1990
455.40
AFO, double upright free plantar dorsiflexion, solid
							 stirrup, calf band/cuff (double bar BK orthosis), custom fabricated
L2000
928.46
KAFO, single upright, free knee, free ankle, solid
							 stirrup, thigh and calf bands/cuffs (single bar AK orthosis), custom
							 fabricated
L2005
3,448.94
Knee ankle foot orthosis, any material, single or
							 double upright, stance control, automatic lock and swing phase release,
							 mechanical activation, includes ankle joint, any type, custom
							 fabricated
L2010
843.90
KAFO, single upright, free ankle, solid stirrup,
							 thigh and calf bands/cuffs (single bar AK orthosis), without knee joint, custom
							 fabricated
L2020
1,197.45
KAFO, double upright, free knee, free ankle, solid
							 stirrup, thigh and calf bands/cuffs (double bar AK orthosis), custom
							 fabricated
L2030
971.19
KAFO, double upright, free ankle, solid stirrup,
							 thigh and calf bands/cuffs, (double bar AK orthosis), without knee joint,
							 custom fabricated
L2034
1,684.16
Knee ankle foot orthosis, full plastic, single
							 upright, with or without free motion knee, medial lateral rotation control,
							 with or without free motion ankle, custom fabricated
L2035
148.30
Knee ankle foot orthosis, full plastic, static
							 (pediatric size), without free motion ankle, prefabricated, includes fitting
							 and adjustment
L2036
1,994.65
Knee ankle foot orthosis, full plastic, double
							 upright, with or without free motion knee, with or without free motion ankle,
							 custom fabricated
L2037
1,790.67
Knee ankle foot orthosis, full plastic, single
							 upright, with or without free motion knee, with or without free motion ankle,
							 custom fabricated
L2038
1,537.10
Knee ankle foot orthosis, full plastic, with or
							 without free motion knee, multi-axis ankle, custom fabricated
L2040
183.03
HKAFO, torsion control, bilateral rotation straps,
							 pelvic band/belt, custom fabricated
L2050
512.14
HKAFO, torsion control, bilateral torsion cables, hip
							 joint, pelvic band/belt, custom fabricated
L2060
521.33
HKAFO, torsion control, bilateral torsion cables,
							 ball bearing hip joint, pelvic band/ belt, custom fabricated
L2070
125.86
HKAFO, torsion control, unilateral rotation straps,
							 pelvic band/belt, custom fabricated
L2080
386.69
HKAFO, torsion control, unilateral torsion cable, hip
							 joint, pelvic band/belt, custom fabricated
L2090
371.63
HKAFO, torsion control, unilateral torsion cable,
							 ball bearing hip joint, pelvic band/belt, custom fabricated
L2106
730.97
AFO, fracture orthosis, tibial fracture cast
							 orthosis, thermoplastic type casting material, custom fabricated
L2108
1,110.45
AFO, fracture orthosis, tibial fracture cast
							 orthosis, custom fabricated
L2112
455.80
AFO, fracture orthosis, tibial fracture orthosis,
							 soft, prefabricated, includes fitting and adjustment
L2114
550.54
AFO, fracture orthosis, tibial fracture orthosis,
							 semi-rigid, prefabricated, includes fitting and adjustment
L2116
707.02
AFO, fracture orthosis, tibial fracture orthosis,
							 rigid, prefabricated, includes fitting and adjustment
L2126
1,157.86
KAFO, fracture orthosis, femoral fracture cast
							 orthosis, thermoplastic type casting material, custom fabricated
L2128
1,843.50
KAFO, fracture orthosis, femoral fracture cast
							 orthosis, custom fabricated
L2132
681.12
Knee ankle foot orthosis (KAFO), fracture orthosis,
							 femoral fracture cast orthosis, soft, prefabricated, includes fitting and
							 adjustment
L2134
958.80
Knee ankle foot orthosis (KAFO), fracture orthosis,
							 femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and
							 adjustment
L2136
1,071.71
KAFO, fracture orthosis, femoral fracture cast
							 orthosis, rigid, prefabricated, includes fitting and adjustment
L2180
111.39
Addition to lower extremity fracture orthosis,
							 plastic shoe insert with ankle joints
L2182
98.49
Addition to lower extremity fracture orthosis, drop
							 lock knee joint
L2184
103.39
Addition to lower extremity fracture orthosis,
							 limited motion knee joint
L2186
124.80
Addition to lower extremity fracture orthosis,
							 adjustable motion knee joint, Lerman type
L2188
302.99
Addition to lower extremity fracture orthosis,
							 quadrilateral brim
L2190
93.89
Addition to lower extremity fracture orthosis, waist
							 belt
L2192
347.28
Addition to lower extremity fracture orthosis, hip
							 joint, pelvic band, thigh flange, and pelvic belt
L2200
38.34
Addition to lower extremity, limited ankle motion,
							 each joint
L2210
54.20
Addition to lower extremity, dorsiflexion assist
							 (plantar flexion resist), each joint
L2220
66.03
Addition to lower extremity, dorsiflexion and plantar
							 flexion assist/resist, each joint
L2230
61.87
Addition to lower extremity, split flat caliper
							 stirrups and plate attachment
L2232
83.76
Addition to lower extremity orthosis, rocker bottom
							 for total contact ankle foot orthosis, for custom fabricated orthosis
							 only
L2240
82.97
Addition to lower extremity, round caliper and plate
							 attachment
L2250
286.51
Addition to lower extremity, foot plate, molded to
							 patient model, stirrup attachment
L2260
161.64
Addition to lower extremity, reinforced solid stirrup
							 (Scott-Craig type)
L2265
126.61
Addition to lower extremity, long tongue
							 stirrup
L2270
50.63
Addition to lower extremity, varus/valgus correction
							 (T) strap, padded/lined or malleolus pad
L2275
106.16
Addition to lower extremity, varus/valgus correction,
							 plastic modification, padded/lined
L2280
402.85
Addition to lower extremity, molded inner
							 boot
L2300
217.09
Addition to lower extremity, abduction bar (bilateral
							 hip involvement), jointed, adjustable
L2310
99.19
Addition to lower extremity, abduction bar,
							 straight
L2320
203.36
Addition to lower extremity, non-molded lacer, for
							 custom fabricated orthosis only
L2330
354.30
Addition to lower extremity, lacer molded to patient
							 model, for custom fabricated orthosis only
L2335
242.04
Addition to lower extremity, anterior swing
							 band
L2340
360.37
Addition to lower extremity, pretibial shell, molded
							 to patient model
L2350
718.47
Addition to lower extremity, prosthetic type, (BK)
							 socket, molded to patient model, (used for PTB, AFO orthoses)
L2360
41.72
Addition to lower extremity, extended steel
							 shank
L2370
206.99
Addition to lower extremity, Patten
							 bottom
L2375
97.58
Addition to lower extremity, torsion control, ankle
							 joint and half solid stirrup
L2380
99.27
Addition to lower extremity, torsion control,
							 straight knee joint, each joint
L2385
137.66
Addition to lower extremity, straight knee joint,
							 heavy duty, each joint
L2387
177.92
Addition to lower extremity, polycentric knee joint,
							 for custom fabricated knee ankle foot orthosis, each joint
L2390
117.68
Addition to lower extremity, offset knee joint, each
							 joint
L2395
168.21
Addition to lower extremity, offset knee joint, heavy
							 duty, each joint
L2397
99.42
Addition to lower extremity orthosis, suspension
							 sleeve
L2405
73.38
Addition to knee joint, drop lock, each
L2415
102.22
Addition to knee lock with integrated release
							 mechanism (bail, cable, or equal), any material, each joint
L2425
120.65
Addition to knee joint, disc or dial lock for
							 adjustable knee flexion, each joint
L2430
120.65
Addition to knee joint, ratchet lock for active and
							 progressive knee extension, each joint
L2492
95.65
Addition to knee joint, lift loop for drop lock
							 ring
L2500
339.17
Addition to lower extremity, thigh/weight bearing,
							 gluteal/ischial weight bearing, ring
L2510
652.26
Addition to lower extremity, thigh/weight bearing,
							 quadri-lateral brim, molded to patient model
L2520
480.46
Addition to lower extremity, thigh/weight bearing,
							 quadri-lateral brim, custom fitted
L2525
1,310.53
Addition to lower extremity, thigh/weight bearing,
							 ischial containment/narrow M-L brim molded to patient model
L2526
712.20
Addition to lower extremity, thigh/weight bearing,
							 ischial containment/narrow M-L brim, custom fitted
L2530
214.87
Addition to lower extremity, thigh/weight bearing,
							 lacer, nonmolded
L2540
454.53
Addition to lower extremity, thigh/weight bearing,
							 lacer, molded to patient model
L2550
231.58
Addition to lower extremity, thigh/weight bearing,
							 high roll cuff
L2570
384.06
Addition to lower extremity, pelvic control, hip
							 joint, Clevis type, two position joint, each
L2580
417.55
Addition to lower extremity, pelvic control, pelvic
							 sling
L2600
165.60
Addition to lower extremity, pelvic control, hip
							 joint, Clevis type, or thrust bearing, free, each
L2610
195.82
Addition to lower extremity, pelvic control, hip
							 joint, Clevis or thrust bearing, lock, each
L2620
287.46
Addition to lower extremity, pelvic control, hip
							 joint, heavy-duty, each
L2622
329.52
Addition to lower extremity, pelvic control, hip
							 joint, adjustable flexion, each
L2624
267.01
Addition to lower extremity, pelvic control, hip
							 joint, adjustable flexion, extension, abduction control, each
L2627
1,843.03
Addition to lower extremity, pelvic control, plastic,
							 molded to patient model, reciprocating hip joint and cables
L2628
1,575.36
Addition to lower extremity, pelvic control, metal
							 frame, reciprocating hip joint and cables
L2630
247.55
Addition to lower extremity, pelvic control, band and
							 belt, unilateral
L2640
354.83
Addition to lower extremity, pelvic control, band and
							 belt, bilateral
L2650
97.02
Addition to lower extremity, pelvic and thoracic
							 control, gluteal pad, each
L2660
200.12
Addition to lower extremity, thoracic control,
							 thoracic band
L2670
137.54
Addition to lower extremity, thoracic control,
							 paraspinal uprights
L2680
126.18
Addition to lower extremity, thoracic control,
							 lateral support uprights
L2750
89.86
Addition to lower extremity orthosis, plating chrome
							 or nickel, per bar
L2755
109.94
Addition to lower extremity orthosis, high strength,
							 lightweight material, all hybrid lamination/prepreg composite, per segment, for
							 custom fabricated orthosis only
L2760
48.99
Addition to lower extremity orthosis, extension, per
							 extension, per bar (for lineal adjustment for growth)
L2768
109.66
Orthotic side bar disconnect device, per
							 bar
L2770
49.79
Addition to lower extremity orthosis, any material,
							 per bar or joint
L2780
72.76
Addition to lower extremity orthosis, noncorrosive
							 finish, per bar
L2785
27.64
Addition to lower extremity orthosis, drop lock
							 retainer, each
L2795
91.35
Addition to lower extremity orthosis, knee control,
							 full kneecap
L2800
114.67
Addition to lower extremity orthosis, knee control,
							 knee cap, medial or lateral pull, for use with custom fabricated orthosis
							 only
L2810
83.97
Addition to lower extremity orthosis, knee control,
							 condylar pad
L2820
92.97
Addition to lower extremity orthosis, soft interface
							 for molded plastic, below knee section
L2830
101.01
Addition to lower extremity orthosis, soft interface
							 for molded plastic, above knee section
L2840
35.36
Addition to lower extremity orthosis, tibial length
							 sock, fracture or equal, each
L2850
63.93
Addition to lower extremity orthosis, femoral length
							 sock, fracture or equal, each
L2999
A.I. + 50%
Unlisted procedure for lower extremity
							 orthosis
L3000
264.39
Foot insert, removable, molded to patient model, UCB
							 type, Berkeley shell, each
L3001
111.32
Foot insert, removable, molded to patient model,
							 Spenco, each
L3002
135.93
Foot insert, removable, molded to patient model,
							 Plastazote or equal, each
L3003
146.67
Foot insert, removable, molded to patient model,
							 silicone gel, each
L3010
146.67
Foot insert, removable, molded to patient model,
							 longitudinal arch support, each
L3020
167.00
Foot insert, removable, molded to patient model,
							 longitudinal/metatarsal support, each
L3030
64.24
Foot insert, removable, formed to patient foot,
							 each
L3031
130.00
Foot, insert/plate, removable, addition to lower
							 extremity orthosis, high strength, lightweight material, all hybrid
							 lamination/prepreg composite, each
L3040
39.60
Foot, arch support, removable, premolded,
longitudinal, each
L3050
39.60
Foot, arch support, removable, premolded, metatarsal,
							 each
L3060
62.09
Foot, arch support, removable, premolded,
longitudinal/metatarsal, each
L3070
26.73
Foot, arch support, nonremovable, attached to shoe,
							 longitudinal, each
L3080
26.73
Foot, arch support, nonremovable, attached to shoe,
							 metatarsal, each
L3090
34.27
Foot, arch support, nonremovable, attached to shoe,
							 longitudinal/metatarsal, each
L3100
36.39
Hallus-valgus night dynamic splint
L3140
74.94
Foot, abduction rotation bar, including
							 shoes
L3150
68.51
Foot, abduction rotation bar, without
							 shoes
L3160
AI + 50%
Foot, adjustable shoe style positioning
							 device
L3170
42.84
Foot, plastic, silicone, or equal, heel stabilizer,
							 each
L3203
58.03
Orthopedic shoe, oxford wit supinator or pronator,
							 junior
L3207
AI + 50%
Orthopedic shoe, hightop with supinator or pronator,
							 junior
L3211
70.56
Surgical boot, each, junior
L3214
AI + 50%
Benesch boot, pair, junior
L3215
89.99
Orthopedic footwear, ladies shoes, oxford,
							 "each"
L3216
115.06
Orthopedic footwear, ladies shoes, depth inlay
							 "each"
L3217
AI + 50%
Orthopedic footwear, ladies shoes, hightop, depth
							 inlay "each"
L3219
137.00
Orthopedic footwear, mens shoes, oxford,
							 "each"
L3221
139.94
Orthopedic footwear, mens shoes, depth inlay
							 "each"
L3222
175.00
Orthopedic footwear, mens shoes, hightop, depth inlay
							 "each"
L3224
60.09
Orthopedic footwear, woman's shoe, oxford, used as an
							 integral part of a brace (orthosis)
L3225
72.73
Orthopedic footwear, man's shoe, oxford, used as an
							 integral part of a brace (orthosis)
L3230
303.97
Orthopedic footwear, custom shoes, depth inlay
							 "each"
L3250
399.89
Orthopedic footwear, custom molded shoe, removable
							 inner mold, prosthetic shoe, each
L3251
Foot, shoe molded to patient model, silicone shoe,
							 each
L3252
300.08
Foot, shoe molded to patient model, plastazote (or
							 similar), custom fabricated, each
L3253
80.02
Foot, molded shoe, plastazote (or similar) custom
							 fitted, each
L3254
28.00
Non-standard size or width
L3255
AI + 70%
Non-standard size or length
L3257
54.99
Orthopedic footware, additional charge for split
							 size
L3260
30.00
Ambulatory surgical boot, each
L3265
24.99
Plastazote sandal, each
L3300
43.88
Lift, elevation, heel, tapered to metatarsals, per
							 inch
L3310
68.51
Lift, elevation, heel and sole, neoprene, per
							 inch
L3330
476.34
Lift, elevation, metal extension (skate)
L3332
62.09
Lift, elevation, inside shoe, tapered, up to one-half
							 in.
L3334
32.11
Lift, elevation, heel, per in.
L3340
71.73
Heel wedge, SACH
L3350
19.28
Heel wedge
L3360
29.97
Sole wedge, outside sole
L3370
41.72
Sole wedge, between sole
L3380
41.72
Clubfoot wedge
L3390
41.72
Outflare wedge
L3400
34.27
Metatarsal bar wedge, rocker
L3410
78.13
Metatarsal bar wedge, between sole
L3420
46.03
Full sole and heel wedge, between sole
L3430
134.88
Heel, counter, plastic reinforced
L3440
64.24
Heel, counter, leather reinforced
L3450
88.85
Heel, SACH cushion type
L3455
34.27
Heel, new leather, standard
L3460
28.89
Heel, new rubber, standard
L3465
49.25
Heel, Thomas with wedge
L3470
52.45
Heel, Thomas extended to ball
L3480
52.45
Heel, pad and depression for spur
L3485
28.50
Heel, pad-removeable for spur
L3500
24.62
Orthopedic shoe addition, insole, leather
L3510
24.62
Orthopedic shoe addition, insole, rubber
L3520
26.73
Orthopedic shoe addition, insole, felt covered with
							 leather
L3530
26.73
Orthopedic shoe addition, sole, half
L3540
42.84
Orthopedic shoe addition, sole, full
L3550
7.48
Orthopedic shoe addition, toe tap,
							 standard
L3560
19.28
Orthopedic shoe addition, toe tap,
							 horseshoe
L3570
71.73
Orthopedic shoe addition, special extension to instep
							 (leather with eyelets)
L3580
54.59
Orthopedic shoe addition, convert instep to Velcro
							 closure
L3590
44.95
Orthopedic shoe addition, convert firm shoe counter
							 to soft counter
L3595
35.32
Orthopedic shoe addition, March bar
L3600
64.24
Transfer of an orthosis from one shoe to another,
							 caliper plate, existing
L3610
84.55
Transfer of an orthosis from one shoe to another,
							 caliper plate, new
L3620
64.24
Transfer of an orthosis from one shoe to another,
							 solid stirrup, existing
L3630
84.55
Transfer of an orthosis from one shoe to another,
							 solid stirrup, new
L3640
36.39
Transfer of an orthosis from one shoe to another,
							 Dennis Browne splint (Riveton), both shoes
L3649
AI + 70%
Orthopedic shoe modification, addition or transfer
							 not otherwise specified
L3650
58.00
SO, figure of eight design abduction restrainer,
							 prefabricated, includes fitting and adjustment
L3651
50.44
SO, single shoulder, elastic, prefabricated, includes
							 fitting and adjustment (
e.g.
, neoprene, Lycra)
L3652
152.00
SO, double shoulder, elastic, prefabricated, includes
							 fitting and adjustment (
e.g.
, neoprene, Lycra)
L3660
108.13
SO, figure of eight design abduction restrainer,
							 canvas and webbing, prefabricated, includes fitting and adjustment
L3670
89.22
SO, acromio/clavicular (canvas and webbing type),
							 prefabricated, includes fitting and adjustment
L3671
690.23
Shoulder orthosis (SO), shoulder cap design, without
							 joints, may include soft interface, straps, custom fabricated, includes fitting
							 and adjustment
L3672
858.34
SO, abduction positioning (airplane design), thoracic
							 component and support bar, without joints, may inlcude soft interface, straps,
							 custom fabricated, includes fitting and adjustment
L3673
935.49
Shoulder orthosis (SO), abduction positioning
							 (airplane design), thoracic component and support bar, includes nontorsion
							 joint/turnbuckle, may include soft interface, straps, custom fabricated,
							 includes fitting and adjustment
L3675
134.42
SO, vest type abduction restrainer, canvas webbing
							 type, or equal, prefabricated, includes fitting and adjustment
L3700
55.08
EO, elastic with stays, prefabricated, includes
							 fitting and adjustment
L3701
15.60
Elbow orthosis (EO), elastic, prefabricated, includes
							 fitting and adjustment (
e.g.
, neoprene, Lycra)
L3702
221.18
Elbow orthosis (EO), without joints, may include soft
							 interface, straps, custom fabricated, includes fitting and
							 adjustment
L3710
122.49
EO, elastic with metal joints, prefabricated,
							 includes fitting and adjustment
L3720
516.08
Elbow orthosis (EO), double upright with forearm/arm
							 cuffs, free motion, custom fabricated
L3730
948.36
EO, double upright with forearm/arm cuffs,
							 extension/flexion assist, custom fabricated
L3740
1,124.36
Elbow orthosis (EO), double upright with forearm/arm
							 cuffs, adjustable position Lock with active control, custom
							 fabricated
L3760
383.07
Elbow orthosis (EO), with adjustable position locking
							 joint(s), prefabricated, includes fitting and adjustments, any type
L3762
82.37
Elbow orthosis (EO), rigid, without joints, includes
							 soft interface material, prefabricated, includes fitting and
							 adjustment
L3763
557.35
Elbow wrist hand orthosis (EWHO), rigid, without
							 joints, may include soft interface, straps, custom fabricated, includes fitting
							 and adjustment
L3764
728.30
Elbow wrist hand orthosis (EWHO), includes one or
							 more nontorsion joints, elastic bands, turnbuckles, may include soft interface,
							 straps, custom fabricated, includes fitting and adjustment
L3765
982.19
Elbow wrist hand finger orthosis (EWHFO), rigid,
							 without joints, may include soft interface, straps, custom fabricated, includes
							 fitting and adjustment
L3766
1,040.07
Elbow wrist hand finger orthosis (EWHFO), includes
							 one or more nontorsion joints, elastic bands, turnbuckles, may include soft
							 interface, straps, custom fabricated, includes fitting and
							 adjustment
L3806
347.95
WHFO, includes one or more nontorsion joint(s),
							 turnbuckles, elastic bands/springs, may include soft interface material,
							 straps, custom fabricated, includes fitting and adjustment
L3807
191.54
Wrist hand finger orthosis (WHFO), without joint(s),
							 prefabricated, includes fitting and adjustments, any type
L3808
323.61
Wrist hand finger orthosis (WHFO), rigid without
							 joints, may include soft interface material; straps, custom fabricated,
							 includes fitting and adjustment
L3900
1,026.53
WHFO, dynamic flexor hinge, reciprocal wrist
							 extension/flexion, finger flexion/extension, wrist or finger driven, custom
							 fabricated
L3901
1,267.98
WHFO, dynamic flexor hinge, reciprocal wrist
							 extension/flexion, finger flexion/extension, cable driven, custom
							 fabricated
L3904
2,431.38
WHFO, external powered, electric, custom
							 fabricated
L3905
759.66
Wrist hand finger orthosis (WHFO), includes one or
							 more nontorsion joints, elastic bands, turnbuckles, may include soft interface,
							 straps, custom fabricated, includes fitting and adjustment
L3906
370.14
Wrist hand orthosis (WHO), without joints, may
							 include soft interface, straps, custom fabricated, includes fitting and
							 adjustment
L3908
63.03
WHO, wrist extension control cock-up, nonmolded,
							 prefabricated, includes fitting and adjustment
L3909
10.80
WO, elastic, prefabricated, includes fitting and
							 adjustment (
e.g.
, neoprene, Lycra)
L3911
18.97
Wrist hand finger orthosis (WHFO), elastic,
							 prefabricated, includes fitting and adjustment (
e.g.
,
							 neoprene, Lycra)
L3912
74.83
HFO, flexion glove with elastic finger control,
							 prefabricated, includes fitting and adjustment
L3913
207.47
Hand finger orthosis (HFO), without joints, may
							 include soft interface, straps, custom fabricated, includes fitting and
							 adjustment
L3915
407.17
Wrist hand orthosis (WHO), includes one or more
							 nontorsion joint(s), elastic bands, turnbuckles, may include soft interface,
							 straps, prefabricated, includes fitting and adjustment
L3917
80.92
Hand orthosis (HO), metacarpal fracture orthosis,
							 prefabricated, includes fitting and adjustment
L3919
207.47
Hand orthosis (HO), without joints, may include soft
							 interface, straps, custom fabricated, includes fitting and
							 adjustment
L3921
246.06
Hand finger orthosis (HFO), includes one or more
							 nontorsion joints, elastic bands, turnbuckles, may include soft interface,
							 straps, custom fabricated, includes fitting and adjustment
L3923
91.52
Hand finger orthosis (HFO), without joints, may
							 include soft interface, straps, prefabricated, includes fitting and
							 adjustment
L3925
41.16
FO, proximal interphalangeal (PIP)/distal
							 interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include
							 soft interface material, prefabricated, includes fitting and
							 adjustment
L3927
AI + 50%
FO, proximal interphalangeal (PIP)/distal
							 interphalangeal (DIP), without joint/spring, extension/flexion
							 (
e.g.
, static or ring type), may include soft interface
							 material, prefabricated, includes fitting and adjustment
L3929
61.68
HFO, includes one or more nontorsion joint(s),
							 turnbuckles, elastic bands/springs, may include soft interface material,
							 straps, prefabricated, includes fitting and adjustment
L3931
162.84
WHFO, includes one or more nontorsion joint(s),
							 turnbuckles, elastic bands/springs, may include soft interface material,
							 straps, prefabricated, includes fitting and adjustment
L3933
163.44
Finger orthosis (FO), without joints, may include
							 soft interface, custom fabricated, includes fitting and adjustment
L3935
169.22
Finger orthosis, nontorsion joint, may include soft
							 interface, custom fabricated, includes fitting and adjustment
L3956
I.C.
Addition of joint to upper extremity orthosis, any
							 material; per joint
L3960
688.97
SEWHO, abduction positioning, airplane design,
							 prefabricated, includes fitting and adjustment
L3961
1,286.96
Shoulder elbow wrist hand orthosis (SEWHO), shoulder
							 cap design, without joints, may include soft interface, straps, custom
							 fabricated, includes fitting and adjustment
L3962
754.83
SEWHO, abduction positioning, Erb's palsy design,
							 prefabricated, includes fitting and adjustment
L3964
621.11
465.80
62.10
SEO, mobile arm support attached to wheelchair,
							 balanced, adjustable, prefabricated, includes fitting and
							 adjustment
L3964
621.11
465.80
62.10
SEO, mobile arm support attached to wheelchair,
							 balanced, adjustable, prefabricated, includes fitting and
							 adjustment
L3964
621.11
465.80
62.10
SEO, mobile arm support attached to wheelchair,
							 balanced, adjustable, prefabricated, includes fitting and
							 adjustment
L3965
991.11
743.33
99.13
SEO, mobile arm support attached to wheelchair,
							 balanced, adjustable Rancho type, prefabricated, includes fitting and
							 adjustment
L3965
991.11
743.33
99.13
SEO, mobile arm support attached to wheelchair,
							 balanced, adjustable Rancho type, prefabricated, includes fitting and
							 adjustment
L3965
991.11
743.33
99.13
SEO, mobile arm support attached to wheelchair,
							 balanced, adjustable Rancho type, prefabricated, includes fitting and
							 adjustment
L3966
746.64
559.98
74.67
SEO, mobile arm support attached to wheelchair,
							 balanced, reclining, prefabricated, includes fitting and adjustment
L3966
746.64
559.98
74.67
SEO, mobile arm support attached to wheelchair,
							 balanced, reclining, prefabricated, includes fitting and adjustment
L3966
746.64
559.98
74.67
SEO, mobile arm support attached to wheelchair,
							 balanced, reclining, prefabricated, includes fitting and adjustment
L3967
1,519.48
Shoulder elbow wrist hand orthosis (SEWHO), abduction
							 positioning (airplane design), thoracic component and support bar, without
							 joints, may include soft interface, straps, custom fabricated, includes fitting
							 and adjustment
L3968
858.96
644.22
85.89
SEO, mobile arm support attached to wheelchair,
							 balanced, friction arm support (friction dampening to proximal and distal
							 joints), prefabricated, includes fitting and adjustment
L3968
858.96
644.22
85.89
SEO, mobile arm support attached to wheelchair,
							 balanced, friction arm support (friction dampening to proximal and distal
							 joints), prefabricated, includes fitting and adjustment
L3968
858.96
644.22
85.89
SEO, mobile arm support attached to wheelchair,
							 balanced, friction arm support (friction dampening to proximal and distal
							 joints), prefabricated, includes fitting and adjustment
L3969
660.74
495.54
66.08
SEO, mobile arm support, monosuspension arm and hand
							 support, overhead elbow forearm hand sling support, yoke type arm suspension
							 support, prefabricated, includes fitting and adjustment
L3969
660.74
495.54
66.08
SEO, mobile arm support, monosuspension arm and hand
							 support, overhead elbow forearm hand sling support, yoke type arm suspension
							 support, prefabricated, includes fitting and adjustment
L3969
660.74
495.54
66.08
SEO, mobile arm support, monosuspension arm and hand
							 support, overhead elbow forearm hand sling support, yoke type arm suspension
							 support, prefabricated, includes fitting and adjustment
L3970
224.66
168.50
22.47
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, elevating proximal arm
L3970
224.66
168.50
22.47
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, elevating proximal arm
L3970
224.66
168.50
22.47
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, elevating proximal arm
L3971
1,442.33
Shoulder elbow wrist hand orthosis (SEWHO), shoulder
							 cap design, includes one or more nontorsion joints, elastic bands, turnbuckles,
							 may include soft interface, straps, custom fabricated, includes fitting and
							 adjustment
L3972
168.07
126.05
16.81
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, offset or lateral rocker arm with elastic balance control
L3972
168.07
126.05
16.81
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, offset or lateral rocker arm with elastic balance control
L3972
168.07
126.05
16.81
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, offset or lateral rocker arm with elastic balance control
L3973
1,519.48
Shoulder elbow wrist hand orthosis (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
L3974
142.55
106.91
14.27
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, supinator
L3974
142.55
106.91
14.27
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, supinator
L3974
142.55
106.91
14.27
Shoulder elbow orthosis (SEO), addition to mobile arm
							 support, supinator
L3975
1,286.96
Shoulder elbow wrist hand finger orthosis (SEWHO),
							 shoulder cap design, without joints, may include soft interface, straps, custom
							 fabricated, includes fitting and adjustment
L3976
1,286.96
Shoulder elbow wrist hand finger orthosis (SEWHO),
							 abduction positioning (airplane design), thoracic component and support bar,
							 without joints, may include soft interface, straps, custom fabricated, includes
							 fitting and adjustment
L3977
1,442.33
Shoulder elbow wrist hand finger orthosis (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
1,519.48
Shoulder elbow wrist hand finger orthosis (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, incl
L3980
325.24
Upper extremity fracture orthosis, humeral,
prefabricated, includes fitting and
							 adjustment
L3982
342.79
Upper extremity fracture orthosis, radius/ulnar,
							 prefabricated, includes fitting and adjustment
L3984
341.01
Upper extremity fracture orthosis, wrist,
							 prefabricated, includes fitting and adjustment
L3995
34.40
Addition to upper extremity orthosis, sock, fracture
							 or equal, each
L4000
1,232.35
Replace girdle for spinal orthosis (CTLSO or
							 SO)
L4002
AI + 70%
Replacement strap, any orthosis, includes all
							 components, any length, any type
L4010
541.14
Replace trilateral socket brim
L4020
701.52
Replace quadrilateral socket brim, molded to patient
							 model
L4030
407.10
Replace quadrilateral socket brim, custom
							 fitted
L4040
360.36
Replace molded thigh lacer, for custom fabricated
							 orthosis only
L4045
352.66
Replace non-molded thigh lacer, for custom fabricated
							 orthosis only
L4050
405.45
Replace molded calf lacer, for custom fabricated
							 orthosis only
L4055
287.40
Replace non-molded calf lacer, for custom fabricated
							 orthosis only
L4060
268.36
Replace high roll cuff
L4070
254.04
Replace proximal and distal upright for
							 KAFO
L4080
108.74
Replace metal bands KAFO, proximal thigh
L4090
84.70
Replace metal bands KAFO-AFO, calf or distal
							 thigh
L4100
95.17
Replace leather cuff KAFO, proximal thigh
L4110
81.81
Replace leather cuff KAFO-AFO, calf or distal
							 thigh
L4130
400.04
Replace pretibial shell
L4350
83.72
Ankle control orthosis, stirrup style, rigid,
							 includes any type interface (
e.g.
, pneumatic, gel),
							 prefabricated, includes fitting and adjustment
L4360
297.68
Walking boot, pneumatic, with or without joints, with
							 or without interface material, prefabricated, includes fitting and
							 adjustment
L4370
202.97
Pneumatic full leg splint, prefabricated, includes
							 fitting and adjustment
L4380
115.48
Pneumatic knee splint, prefabricated, includes
							 fitting and adjustment
L4386
133.45
Walking boot, non-pneumatic, with or without joints,
							 with or without interface material, prefabricated, includes fitting and
							 adjustment
L4392
20.68
Replacement, soft interface material, static
							 AFO
L4394
15.10
Replace soft interface material, foot drop
							 splint
L4396
147.55
Static ankle foot orthosis, including soft interface
							 material, adjustable for fit, for positioning, pressure reduction, may be used
							 for minimal ambulation, prefabricated, includes fitting and
							 adjustment
L4398
67.93
Foot drop splint, recumbent positioning device,
							 prefabricated, includes fitting and adjustment
L5000
434.04
Partial foot, shoe insert with longitudinal arch, toe
							 filler
L5010
1,052.05
Partial foot, molded socket, ankle height, with toe
							 filler
L5020
1,789.88
Partial foot, molded socket, tibial tubercle height,
							 with toe filler
L5050
2,340.34
Ankle, Symes, molded socket, SACH foot
L5060
2,372.67
Ankle, Symes, metal frame, molded leather socket,
							 articulated ankle/foot
L5100
2,399.82
Below knee, molded socket, shin, SACH
							 foot
L5105
3,655.13
Below knee, plastic socket, joints and thigh lacer,
							 SACH foot
L5150
3,085.81
Knee disarticulation (or through knee), molded
							 socket, external knee joints, shin, SACH foot
L5160
3,618.72
Knee disarticulation (or through knee), molded
							 socket, bent knee configuration, external knee joints, shin, SACH
							 foot
L5200
3,598.61
Above knee, molded socket, single axis constant
							 friction knee, shin, SACH foot
L5210
2,265.99
Above knee, short prosthesis, no knee joint
							 (stubbies), with foot blocks, no ankle joints, each
L5220
2,432.04
Above knee, short prosthesis, no knee joint
							 (stubbies), with articulated ankle/foot, dynamically aligned, each
L5230
3,428.72
Above knee, for proximal femoral focal deficiency,
							 constant friction knee, shin, SACH foot
L5250
4,786.21
Hip disarticulation, Canadian type; molded socket,
							 hip joint, single axis constant friction knee, shin, SACH foot
L5270
5,138.59
Hip disarticulation, tilt table type; molded socket,
							 locking hip joint, single axis constant friction knee, shin, SACH
							 foot
L5280
5,147.34
Hemipelvectomy, Canadian type; molded socket, hip
							 joint, single axis constant friction knee, shin, SACH foot
L5301
2,107.24
Below knee, molded socket, shin, SACH foot,
							 endoskeletal system
L5311
2,833.53
Knee disarticulation (or through knee), molded
							 socket, external knee joints, shin, SACH foot, endoskeletal system
L5321
2,972.75
Above knee, molded socket, open end, SACH foot,
							 endoskeletal system, single axis knee
L5331
4,429.79
Hip disarticulation, Canadian type, molded socket,
							 endoskeletal system, hip joint, single axis knee, SACH foot
L5341
4,341.54
Hemipelvectomy, Canadian type, molded socket,
							 endoskeletal system, hip joint, single axis knee, SACH foot
L5400
1,033.89
Immediate postsurgical or early fitting, application
							 of initial rigid dressing, including fitting, alignment, suspension, and one
							 cast change, below knee
L5410
394.79
Immediate postsurgical or early fitting, application
							 of initial rigid dressing, including fitting, alignment and suspension, below
							 knee, each additional cast change and realignment
L5420
1,305.75
Immediate postsurgical or early fitting, application
							 of initial rigid dressing, including fitting, alignment and suspension and one
							 cast change AK or knee disarticulation
L5430
452.26
Immediate postsurgical or early fitting, application
							 of initial rigid dressing, including fitting, alignment and suspension, AK or
							 knee disarticulation, each additional cast change and realignment
L5450
349.98
Immediate postsurgical or early fitting, application
							 of nonweight bearing rigid dressing, below knee
L5460
514.57
Immediate postsurgical or early fitting, application
							 of nonweight bearing rigid dressing, above knee
L5500
1,256.53
Initial, below knee PTB type socket, nonalignable
							 system, pylon, no cover, SACH foot, plaster socket, direct formed
L5505
1,758.90
Initial, above knee - knee disarticulation, ischial
							 level socket, nonalignable system, pylon, no cover, SACH foot plaster socket,
							 direct formed
L5510
1,566.55
Preparatory, below knee PTB type socket,
nonalignable system, pylon, no cover, SACH foot,
							 plaster socket, molded to model
L5520
1,640.70
Preparatory, below knee PTB type socket,
nonalignable system, pylon, no cover, SACH foot,
							 thermoplastic or equal, direct formed
L5530
1,787.90
Preparatory, below knee PTB type socket,
nonalignable system, pylon, no cover, SACH foot,
							 thermoplastic or equal, molded to model
L5535
1,865.14
Preparatory, below knee PTB type socket,
nonalignable system, pylon, no cover, SACH foot,
							 prefabricated, adjustable open end socket
L5540
1,773.42
Preparatory, below knee PTB type socket,
nonalignable system, pylon, no cover, SACH foot,
							 laminated socket, molded to model
L5560
1,689.04
Preparatory, above knee - knee disarticulation,
							 ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster
							 socket, molded to model
L5570
2,037.01
Preparatory, above knee - knee disarticulation,
							 ischial level socket, nonalignable system, pylon, no cover, SACH foot,
							 thermoplastic or equal, direct formed
L5580
2,112.61
Preparatory, above knee - knee disarticulation,
							 ischial level socket, nonalignable system, pylon, no cover, SACH foot,
							 thermoplastic or equal, molded to model
L5585
2,364.77
Preparatory, above knee - knee disarticulation,
							 ischial level socket, nonalignable system, pylon, no cover, SACH foot,
							 prefabricated adjustable open end socket
L5590
2,382.30
Preparatory, above knee - knee disarticulation,
							 ischial level socket, nonalignable system, pylon, no cover, SACH foot,
							 laminated socket, molded to model
L5595
4,248.26
Preparatory, hip disarticulation - hemipelvectomy,
							 pylon, no cover, SACH foot, thermoplastic or equal, molded to patient
							 model
L5600
5,023.42
Preparatory, hip disarticulation - hemipelvectomy,
							 pylon, no cover, SACH foot, laminated socket, molded to patient
							 model
L5610
2,125.16
Addition to lower extremity, endoskeletal system,
							 above knee, hydracadence system
L5611
1,845.41
Addition to lower extremity, endoskeletal system,
							 above knee - knee disarticulation, 4-bar linkage, with friction swing phase
							 control
L5613
2,806.98
Addition to lower extremity, endoskeletal system,
							 above knee - knee disarticulation, 4-bar linkage, with hydraulic swing phase
							 control
L5614
1,423.05
Addition to lower extremity, endoskeletal system,
							 above knee - knee disarticulation, 4-bar linkage, with pneumatic swing phase
							 control
L5616
1,317.12
Addition to lower extremity, endoskeletal system,
							 above knee, universal multiplex system, friction swing phase
							 control
L5617
495.65
Addition to lower extremity, quick change
							 self-aligning unit, above or below knee, each
L5618
322.12
Addition to lower extremity, test socket,
							 Symes
L5620
318.43
Addition to lower extremity, test socket, below
							 knee
L5622
388.19
Addition to lower extremity, test socket, knee
							 disarticulation
L5624
416.41
Addition to lower extremity, test socket, above
							 knee
L5626
495.90
Addition to lower extremity, test socket, hip
							 disarticulation
L5628
469.85
Addition to lower extremity, test socket,
hemipelvectomy
L5629
364.00
Addition to lower extremity, below knee, acrylic
							 socket
L5630
439.02
Addition to lower extremity, Symes type, expandable
							 wall socket
L5631
503.26
Addition to lower extremity, above knee or knee
							 disarticulation, acrylic socket
L5632
217.40
Addition to lower extremity, Symes type, PTB brim
							 design socket
L5634
339.98
Addition to lower extremity, Symes type, posterior
							 opening (Canadian) socket
L5636
291.85
Addition to lower extremity, Symes type, medial
							 opening socket
L5637
285.72
Addition to lower extremity, below knee, total
							 contact
L5638
418.06
Addition to lower extremity, below knee, leather
							 socket
L5639
1,284.18
Addition to lower extremity, below knee, wood
							 socket
L5640
549.30
Addition to lower extremity, knee disarticulation,
							 leather socket
L5642
532.23
Addition to lower extremity, above knee, leather
							 socket
L5643
1,782.72
Addition to lower extremity, hip disarticulation,
							 flexible inner socket, external frame
L5644
665.79
Addition to lower extremity, above knee, wood
							 socket
L5645
763.36
Addition to lower extremity, below knee, flexible
							 inner socket, external frame
L5646
627.57
Addition to lower extremity, below knee, air, fluid,
							 gel or equal, cushion socket
L5647
911.10
Addition to lower extremity, below knee, suction
							 socket
L5648
565.57
Addition to lower extremity, above knee, air, fluid,
							 gel or equal, cushion socket
L5649
1,635.55
Addition to lower extremity, ischial
							 containment/narrow M-L socket
L5650
419.37
Addition to lower extremity, total contact, above
							 knee or knee disarticulation socket
L5651
1,375.51
Addition to lower extremity, above knee, flexible
							 inner socket, external frame
L5652
462.76
Addition to lower extremity, suction suspension,
							 above knee or knee disarticulation socket
L5653
523.53
Addition to lower extremity, knee disarticulation,
							 expandable wall socket
L5654
379.85
Addition to lower extremity, socket insert, Symes
							 (Kemblo, Pelite, Aliplast, Plastazote or equal)
L5655
271.16
Addition to lower extremity, socket insert, below
							 knee (Kemblo, Pelite, Aliplast, Plastazote or equal)
L5656
321.75
Addition to lower extremity, socket insert, knee
							 disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal)
L5658
363.21
Addition to lower extremity, socket insert, above
							 knee (Kemblo, Pelite, Aliplast, Plastazote or equal)
L5661
697.01
Addition to lower extremity, socket insert,
							 multidurometer, Symes
L5665
586.46
Addition to lower extremity, socket insert,
multidurometer, below knee
L5666
73.41
Addition to lower extremity, below knee, cuff
							 suspension
L5668
106.43
Addition to lower extremity, below knee, molded
							 distal cushion
L5670
247.58
Addition to lower extremity, below knee, molded
							 supracondylar suspension (PTS or similar)
L5671
427.29
Addition to lower extremity, below knee/above knee
							 suspension locking mechanism (shuttle, lanyard or equal), excludes socket
							 insert
L5672
301.18
Addition to lower extremity, below knee, removable
							 medial brim suspension
L5673
677.72
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
407.76
Addition to lower extremity, below knee, knee joints,
							 single axis, pair
L5677
564.74
Addition to lower extremity, below knee, knee joints,
							 polycentric, pair
L5678
34.11
Addition to lower extremity, below knee joint covers,
							 pair
L5679
564.73
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
296.84
Addition to lower extremity, below knee, thigh lacer,
							 nonmolded
L5681
1,109.28
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
716.31
Addition to lower extremity, below knee, thigh lacer,
							 gluteal/ischial, molded
L5683
1,109.28
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
51.79
Addition to lower extremity, below knee, fork
							 strap
L5685
108.01
Addition to lower extremity prosthesis, below knee,
							 suspension/sealing sleeve, with or without valve, any material,
							 each
L5686
51.73
Addition to lower extremity, below knee, back check
							 (extension control)
L5688
61.00
Addition to lower extremity, below knee, waist belt,
							 webbing
L5690
112.08
Addition to lower extremity, below knee, waist belt,
							 padded and lined
L5692
135.02
Addition to lower extremity, above knee, pelvic
							 control belt, light
L5694
207.79
Addition to lower extremity, above knee, pelvic
							 control belt, padded and lined
L5695
157.73
Addition to lower extremity, above knee, pelvic
							 control, sleeve suspension, neoprene or equal, each
L5696
203.68
Addition to lower extremity, above knee or knee
							 disarticulation, pelvic joint
L5697
91.95
Addition to lower extremity, above knee or knee
							 disarticulation, pelvic band
L5698
103.21
Addition to lower extremity, above knee or knee
							 disarticulation, Silesian bandage
L5699
207.21
All lower extremity prostheses, shoulder
							 harness
L5700
2,503.15
Replacement, socket, below knee, molded to patient
							 model
L5701
3,105.38
Replacement, socket, above knee/knee disarticulation,
							 including attachment plate, molded to patient model
L5702
3,913.86
Replacement, socket, hip disarticulation, including
							 hip joint, molded to patient model
L5703
2,030.95
Ankle, Symes, molded to patient model, socket without
							 solid ankle cushion heel (SACH) foot, replacement only
L5704
510.40
Custom shaped protective cover, below
							 knee
L5705
935.70
Custom shaped protective cover, above
							 knee
L5706
912.68
Custom shaped protective cover, knee
							 disarticulation
L5707
1,226.17
Custom shaped protective cover, hip
							 disarticulation
L5710
348.86
Addition, exoskeletal knee-shin system, single axis,
							 manual lock
L5711
585.21
Addition, exoskeletal knee-shin system, single axis,
							 manual lock, ultra-light material
L5712
464.98
Addition, exoskeletal knee-shin system, single axis,
							 friction swing and stance phase control (safety knee)
L5714
418.64
Addition, exoskeletal knee-shin system, single axis,
							 variable friction swing phase control
L5716
752.15
Addition, exoskeletal knee-shin system, polycentric,
							 mechanical stance phase lock
L5718
903.46
Addition, exoskeletal knee-shin system, polycentric,
							 friction swing and stance phase control
L5722
847.65
Addition, exoskeletal knee-shin system, single axis,
							 pneumatic swing, friction stance phase control
L5724
1,559.20
Addition, exoskeletal knee-shin system, single axis,
							 fluid swing phase control
L5726
1,936.91
Addition, exoskeletal knee-shin system, single axis,
							 external joints, fluid swing phase control
L5728
2,725.43
Addition, exoskeletal knee-shin system, single axis,
							 fluid swing and stance phase control
L5780
1,048.19
Addition, exoskeletal knee-shin system, single axis,
							 pneumatic/hydra pneumatic swing phase control
L5781
3,374.24
Addition to lower limb prosthesis, vacuum pump,
							 residual limb volume management and moisture evacuation system
L5782
3,557.22
Addition to lower limb prosthesis, vacuum pump,
							 residual limb volume management and moisture evacuation system, heavy
							 duty
L5785
595.08
Addition, exoskeletal system, below knee, ultra-light
							 material (titanium, carbon fiber or equal)
L5790
823.56
Addition, exoskeletal system, above knee, ultra-light
							 material (titanium, carbon fiber or equal)
L5795
1,229.79
Addition, exoskeletal system, hip disarticulation,
							 ultra-light material (titanium, carbon fiber or equal)
L5810
557.65
Addition, endoskeletal knee-shin system, single axis,
							 manual lock
L5811
835.34
Addition, endoskeletal knee-shin system, single axis,
							 manual lock, ultra-light material
L5812
631.92
Addition, endoskeletal knee-shin system, single axis,
							 friction swing and stance phase control (safety knee)
L5814
3,131.94
Addition, endoskeletal knee-shin system, polycentric,
							 hydraulic swing phase control, mechanical stance phase lock
L5816
787.77
Addition, endoskeletal knee-shin system, polycentric,
							 mechanical stance phase lock
L5818
1,099.94
Addition, endoskeletal knee-shin system, polycentric,
							 friction swing and stance phase control
L5822
1,950.47
Addition, endoskeletal knee-shin system, single axis,
							 pneumatic swing, friction stance phase control
L5824
1,530.65
Addition, endoskeletal knee-shin system, single axis,
							 fluid swing phase control
L5826
2,678.39
Addition, endoskeletal knee-shin system, single axis,
							 hydraulic swing phase control, with miniature high activity frame
L5828
3,234.48
Addition, endoskeletal knee-shin system, single axis,
							 fluid swing and stance phase control
L5830
2,173.40
Addition, endoskeletal knee-shin system, single axis,
							 pneumatic/swing phase control
L5840
3,182.45
Addition, endoskeletal knee-shin system, 4-bar
							 linkage or multiaxial, pneumatic swing phase control
L5845
1,511.53
Addition, endoskeletal knee-shin system, stance
							 flexion feature, adjustable
L5848
906.84
Addition to endoskeletal knee-shin system, fluid
							 stance extension, dampening feature, with or without adjustability
L5850
109.89
Addition, endoskeletal system, above knee or hip
							 disarticulation, knee extension assist
L5855
265.30
Addition, endoskeletal system, hip disarticulation,
							 mechanical hip extension assist
L5856
20,475.22
Addition to lower extremity prosthesis, endoskeletal
							 knee-shin system, microprocessor control feature, swing and stance phase,
							 includes electronic sensor(s), any type
L5857
7,414.22
Addition to lower extremity prosthesis, endoskeletal
							 knee-shin system, microprocessor control feature, swing phase only, includes
							 electronic sensor(s), any type
L5858
15,673.19
Addition to lower extremity prosthesis, endoskeletal
							 knee shin system, microprocessor control feature, stance phase only, includes
							 electronic sensor(s), any type
L5910
414.83
Addition, endoskeletal system, below knee, alignable
							 system
L5920
607.73
Addition, endoskeletal system, above knee or hip
							 disarticulation, alignable system
L5925
288.64
Addition, endoskeletal system, above knee, knee
							 disarticulation or hip disarticulation, manual lock
L5930
2,981.78
Addition, endoskeletal system, high activity knee
							 control frame
L5940
430.90
Addition, endoskeletal system, below knee,
							 ultra-light material (titanium, carbon fiber or equal)
L5950
839.16
Addition, endoskeletal system, above knee,
							 ultra-light material (titanium, carbon fiber or equal)
L5960
923.06
Addition, endoskeletal system, hip disarticulation,
							 ultra-light material (titanium, carbon fiber or equal)
L5962
504.94
Addition, endoskeletal system, below knee, flexible
							 protective outer surface covering system
L5964
914.80
Addition, endoskeletal system, above knee, flexible
							 protective outer surface covering system
L5966
1,178.41
Addition, endoskeletal system, hip disarticulation,
							 flexible protective outer surface covering system
L5968
3,064.55
Addition to lower limb prosthesis, multiaxial ankle
							 with swing phase active dorsiflexion feature
L5970
232.62
All lower extremity prostheses, foot, external keel,
							 SACH foot
L5971
232.62
All lower extremity prosthesis, solid ankle cushion
							 heel (SACH) foot, replacement only
L5972
352.92
All lower extremity prostheses, flexible keel foot
							 (SAFE, STEN, Bock Dynamic or equal)
L5974
260.97
All lower extremity prostheses, foot, single axis
							 ankle/foot
L5975
390.95
All lower extremity prosthesis, combination single
							 axis ankle and flexible keel foot
L5976
590.25
All lower extremity prostheses, energy storing foot
							 (Seattle Carbon Copy II or equal)
L5978
319.08
All lower extremity prostheses, foot, multiaxial
							 ankle/foot
L5979
2,034.66
All lower extremity prostheses, multiaxial ankle,
							 dynamic response foot, one piece system
L5980
3,739.01
All lower extremity prostheses, flex-foot
							 system
L5981
2,784.58
All lower extremity prostheses, flex-walk system or
							 equal
L5982
659.38
All exoskeletal lower extremity prostheses, axial
							 rotation unit
L5984
594.67
All endoskeletal lower extremity prosthesis, axial
							 rotation unit, with or without adjustability
L5985
250.14
All endoskeletal lower extremity prostheses, dynamic
							 prosthetic pylon
L5986
557.24
All lower extremity prostheses, multiaxial rotation
							 unit (MCP or equal)
L5987
6,066.57
All lower extremity prosthesis, shank foot system
							 with vertical loading pylon
L5988
1,684.70
Addition to lower limb prosthesis, vertical shock
							 reducing pylon feature
L5990
1,529.95
Addition to lower extremity prosthesis, user
							 adjustable heel height
L5993
AI + 70%
Addition to lower extremity prosthesis, heavy duty
							 feature, foot only, (for patient weight greater than 300 lbs)
L5994
AI + 70%
Addition to lower extremity prosthesis, heavy duty
							 feature, knee only, (for patient weight greater than 300 lbs)
L5995
AI + 70%
Addition to lower extremity prosthesis, heavy duty
							 feature, other than foot or knee, (for patient weight greater than 300
							 lbs)
L6000
1,141.39
Partial hand, Robin-Aids, thumb remaining (or
							 equal)
L6010
1,270.18
Partial hand, Robin-Aids, little and/or ring finger
							 remaining (or equal)
L6020
1,184.25
Partial hand, Robin-Aids, no finger remaining (or
							 equal)
L6025
6,748.54
Transcarpal/metacarpal or partial hand
							 disarticulation prosthesis, external power, self-suspended, inner socket with
							 removable forearm section, electrodes and cables, two batteries, charger,
							 myoelectric control of terminal device
L6050
1,807.84
Wrist disarticulation, molded socket, flexible elbow
							 hinges, triceps pad
L6055
2,854.00
Wrist disarticulation, molded socket with expandable
							 interface, flexible elbow hinges, triceps pad
L6100
1,819.17
Below elbow, molded socket, flexible elbow hinge,
							 triceps pad
L6110
1,816.09
Below elbow, molded socket (Muenster or Northwestern
							 suspension types)
L6120
2,295.01
Below elbow, molded double wall split socket, step-up
							 hinges, half cuff
L6130
2,494.19
Below elbow, molded double wall split socket, stump
							 activated locking hinge, half cuff
L6200
2,855.32
Elbow disarticulation, molded socket, outside locking
							 hinge, forearm
L6205
3,958.13
Elbow disarticulation, molded socket with expandable
							 interface, outside locking hinges, forearm
L6250
2,366.60
Above elbow, molded double wall socket, internal
							 locking elbow, forearm
L6300
4,264.68
Shoulder disarticulation, molded socket, shoulder
							 bulkhead, humeral section, internal locking elbow, forearm
L6310
2,606.83
Shoulder disarticulation, passive restoration
							 (complete prosthesis)
L6320
1,474.80
Shoulder disarticulation, passive restoration
							 (shoulder cap only)
L6350
3,364.78
Interscapular thoracic, molded socket, shoulder
							 bulkhead, humeral section, internal locking elbow, forearm
L6360
2,736.19
Interscapular thoracic, passive restoration (complete
							 prosthesis)
L6370
1,799.79
Interscapular thoracic, passive restoration (shoulder
							 cap only)
L6380
1,007.86
Immediate postsurgical or early fitting, application
							 of initial rigid dressing, including fitting alignment and suspension of
							 components, and one cast change, wrist disarticulation or below
							 elbow
L6382
1,313.50
Immediate postsurgical or early fitting, application
							 of initial rigid dressing including fitting alignment and suspension of
							 components, and one cast change, elbow disarticulation or above
							 elbow
L6384
1,637.85
Immediate postsurgical or early fitting, application
							 of initial rigid dressing including fitting alignment and suspension of
							 components, and one cast change, shoulder disarticulation or interscapular
							 thoracic
L6386
388.51
Immediate postsurgical or early fitting, each
							 additional cast change and realignment
L6388
503.54
Immediate postsurgical or early fitting, application
							 of rigid dressing only
L6400
1,993.31
Below elbow, molded socket, endoskeletal system,
							 including soft prosthetic tissue shaping
L6450
3,468.52
Elbow disarticulation, molded socket, endoskeletal
							 system, including soft prosthetic tissue shaping
L6500
2,989.76
Above elbow, molded socket, endoskeletal system,
							 including soft prosthetic tissue shaping
L6550
3,515.90
Shoulder disarticulation, molded socket, endoskeletal
							 system, including soft prosthetic tissue shaping
L6570
4,775.34
Interscapular thoracic, molded socket, endoskeletal
							 system, including soft prosthetic tissue shaping
L6580
1,393.42
Preparatory, wrist disarticulation or below elbow,
							 single wall plastic socket, friction wrist, flexible elbow hinges, figure of
							 eight harness, humeral cuff, Bowden cable control, USMC or equal pylon, no
							 cover, molded to patient model
L6582
1,233.06
Preparatory, wrist disarticulation or below elbow,
							 single wall socket, friction wrist, flexible elbow hinges, figure of eight
							 harness, humeral cuff, Bowden cable control, USMC or equal pylon, no cover,
							 direct formed
L6584
2,039.35
Preparatory, elbow disarticulation or above elbow,
							 single wall plastic socket, friction wrist, locking elbow, figure of eight
							 harness, fair lead cable control, USMC or equal pylon, no cover, molded to
							 patient model
L6586
1,782.69
Preparatory, elbow disarticulation or above elbow,
							 single wall socket, friction wrist, locking elbow, figure of eight harness,
							 fair lead cable control, USMC or equal pylon, no cover, direct
							 formed
L6588
2,998.33
Preparatory, shoulder disarticulation or
							 interscapular thoracic, single wall plastic socket, shoulder joint, locking
							 elbow, friction wrist, chest strap, fair lead cable control, USMC or equal
							 pylon, no cover, molded to patient model
L6590
2,647.08
Preparatory, shoulder disarticulation or
							 interscapular thoracic, single wall socket, shoulder joint, locking elbow,
							 friction wrist, chest strap, fair lead cable control, USMC or equal pylon, no
							 cover, direct formed
L6600
161.14
Upper extremity additions, polycentric hinge,
							 pair
L6605
159.10
Upper extremity additions, single pivot hinge,
							 pair
L6610
143.02
Upper extremity additions, flexible metal hinge,
							 pair
L6611
347.22
Addition to upper extremity prosthesis, external
							 powered, additional switch, any type
L6615
149.23
Upper extremity addition, disconnect locking wrist
							 unit
L6616
61.66
Upper extremity addition, additional disconnect
							 insert for locking wrist unit, each
L6620
276.73
Upper extremity addition, flexion/extension wrist
							 unit, with or without friction
L6621
1,928.92
Upper extremity prosthesis addition,
							 flexion/extension wrist with or without friction, for use with external powered
							 terminal device
L6623
605.94
Upper extremity addition, spring assisted rotational
							 wrist unit with latch release
L6624
3,176.01
Upper extremity addition, flexion/extension and
							 rotation wrist unit
L6625
609.18
Upper extremity addition, rotation wrist unit with
							 cable lock
L6628
488.66
Upper extremity addition, quick disconnect hook
							 adapter, Otto Bock or equal
L6629
129.79
Upper extremity addition, quick disconnect lamination
							 collar with coupling piece, Otto Bock or equal
L6630
246.85
Upper extremity addition, stainless steel, any
							 wrist
L6632
60.00
Upper extremity addition, latex suspension sleeve,
							 each
L6635
154.79
Upper extremity addition, lift assist for
							 elbow
L6637
420.57
Upper extremity addition, nudge control elbow
							 lock
L6638
2,108.91
Upper extremity addition to prosthesis, electric
							 locking feature, only for use with manually powered elbow
L6639
1,286.19
Upper extremity addition, heavy duty feature, any
							 elbow
L6640
240.63
Upper extremity additions, shoulder abduction joint,
							 pair
L6641
163.33
Upper extremity addition, excursion amplifier, pulley
							 type
L6642
228.47
Upper extremity addition, excursion amplifier, lever
							 type
L6645
274.23
Upper extremity addition, shoulder flexion-abduction
							 joint, each
L6646
2,659.81
Upper extremity addition, shoulder joint,
multipositional locking, flexion, adjustable
							 abduction friction control, for use with body powered or external powered
							 system
L6647
437.88
Upper extremity addition, shoulder lock mechanism,
							 body powered actuator
L6648
2,743.22
Upper extremity addition, shoulder lock mechanism,
							 external powered actuator
L6650
317.09
Upper extremity addition, shoulder universal joint,
							 each
L6655
70.61
Upper extremity addition, standard control cable,
							 extra
L6660
100.03
Upper extremity addition, heavy duty control
							 cable
L6665
48.10
Upper extremity addition, Teflon, or equal, cable
							 lining
L6670
43.99
Upper extremity addition, hook to hand, cable
							 adapter
L6672
144.85
Upper extremity addition, harness, chest or shoulder,
							 saddle type
L6675
137.55
Upper extremity addition, harness,
							 (
e.g.
figure of eight type), single cable design
L6676
108.97
Upper extremity addition, harness,
							 (
e.g.
figure of eight type), dual cable design
L6677
250.16
Upper extremity addition, harness, triple control,
							 simultaneous operation of terminal device and elbow
L6680
202.80
Upper extremity addition, test socket, wrist
							 disarticulation or below elbow
L6682
246.79
Upper extremity addition, test socket, elbow
							 disarticulation or above elbow
L6684
369.09
Upper extremity addition, test socket, shoulder
							 disarticulation or interscapular thoracic
L6686
676.20
Upper extremity addition, suction socket
L6687
495.50
Upper extremity addition, frame type socket, below
							 elbow or wrist disarticulation
L6688
480.92
Upper extremity addition, frame type socket, above
							 elbow or elbow disarticulation
L6689
591.48
Upper extremity addition, frame type socket, shoulder
							 disarticulation
L6690
620.28
Upper extremity addition, frame type socket,
							 interscapular-thoracic
L6691
395.37
Upper extremity addition, removable insert,
							 each
L6692
534.94
Upper extremity addition, silicone gel insert or
							 equal, each
L6693
2,394.18
Upper extremity addition, locking elbow, forearm
							 counterbalance
L6694
677.72
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
564.73
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
1,109.28
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
1,109.28
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
427.29
Addition to upper extremity prosthesis, below
							 elbow/above elbow, lock mechanism, excludes socket insert
L6703
332.40
Terminal device, passive hand/mitt, any material, any
							 size
L6704
503.08
Terminal device, sport/recreational/work attachment,
							 any material, any size
L6706
343.57
Terminal device, hook, mechanical, voluntary opening,
							 any material, any size, lined or unlined
L6707
1,237.49
Terminal device, hook, mechanical, voluntary closing,
							 any material, any size, lined or unlined
L6708
744.38
Terminal device, hand, mechanical, voluntary opening,
							 any material, any size
L6709
1,040.75
Terminal device, hand, mechanical, voluntary closing,
							 any material, any size
L6805
310.65
Addition to terminal device, modifier wrist
							 unit
L6810
160.41
Addition to terminal device, precision pinch
							 device
L6881
3,447.69
Automatic grasp feature, addition to upper limb
							 electric prosthetic terminal device
L6882
2,615.22
Microprocessor control feature, addition to upper
							 limb prosthetic terminal device
L6883
1,363.19
Replacement socket, below elbow/wrist
							 disarticulation, molded to patient model, for use with or without external
							 power
L6884
1,934.38
Replacement socket, above elbow/elbow
							 disarticulation, molded to patient model, for use with or without external
							 power
L6885
2,736.19
Replacement socket, shoulder disarticulation/
interscapular thoracic, molded to patient model, for
							 use with or without external power
L6890
161.57
Addition to upper extremity prosthesis, glove for
							 terminal device, any material, prefabricated, includes fitting and
							 adjustment
L6895
639.57
Addition to upper extremity prosthesis, glove for
							 terminal device, any material, custom fabricated
L6900
1,297.54
Hand restoration (casts, shading and measurements
							 included), partial hand, with glove, thumb or one finger remaining
L6905
1,261.25
Hand restoration (casts, shading and measurements
							 included), partial hand, with glove, multiple fingers remaining
L6910
1,228.71
Hand restoration (casts, shading and measurements
							 included), partial hand, with glove, no fingers remaining
L6915
577.34
Hand restoration (shading and measurements included),
							 replacement glove for above
L6920
6,551.88
Wrist disarticulation, external power, self-suspended
							 inner socket, removable forearm shell, Otto Bock or equal switch, cables, two
							 batteries and one charger, switch control of terminal device
L6925
7,617.30
Wrist disarticulation, external power, self-suspended
							 inner socket, removable forearm shell, Otto Bock or equal electrodes, cables,
							 two batteries and one charger, myoelectronic control of terminal
							 device
L6930
6,388.01
Below elbow, external power, self-suspended inner
							 socket, removable forearm shell, Otto Bock or equal switch, cables, two
							 batteries and one charger, switch control of terminal device
L6935
7,437.03
Below elbow, external power, self-suspended inner
							 socket, removable forearm shell, Otto Bock or equal electrodes, cables, two
							 batteries and one charger, myoelectronic control of terminal device
L6940
8,153.41
Elbow disarticulation, external power, molded inner
							 socket, removable humeral shell, outside locking hinges, forearm, Otto Bock or
							 equal switch, cables, two batteries and one charger, switch control of terminal
							 device
L6945
9,280.46
Elbow disarticulation, external power, molded inner
							 socket, removable humeral shell, outside locking hinges, forearm, Otto Bock or
							 equal electrodes, cables, two batteries and one charger, myoelectronic control
							 of terminal device
L6950
8,572.50
Above elbow, external power, molded inner socket,
							 removable humeral shell, internal locking elbow, forearm, Otto Bock or equal
							 switch, cables, two batteries and one charger, switch control of terminal
							 device
L6955
10,378.59
Above elbow, external power, molded inner socket,
							 removable humeral shell, internal locking elbow, forearm, Otto Bock or equal
							 electrodes, cables, two batteries and one charger, myoelectronic control of
							 terminal device
L6960
11,439.98
Shoulder disarticulation, external power, molded
							 inner socket, removable shoulder shell, shoulder bulkhead, humeral section,
							 mechanical elbow, forearm, Otto Bock or equal switch, cables, two batteries and
							 one charger, switch control of terminal device
L6965
13,422.59
Shoulder disarticulation, external power, molded
							 inner socket, removable shoulder shell, shoulder bulkhead, humeral section,
							 mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries
							 and one charger, myoelectronic control of terminal device
L6970
14,367.62
Interscapular-thoracic, external power, molded inner
							 socket, removable shoulder shell, shoulder bulkhead, humeral section,
							 mechanical elbow, forearm, Otto Bock or equal switch, cables, two batteries and
							 one charger, switch control of terminal device
L6975
16,193.97
Interscapular-thoracic, external power, molded inner
							 socket, removable shoulder shell, shoulder bulkhead, humeral section,
							 mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries
							 and one charger, myoelectronic control of terminal device
L7007
3,114.32
Electric hand, switch or myoelectric controlled,
							 adult
L7008
5,262.22
Electric hand, switch or myoelectric, controlled,
							 pediatric
L7009
3,264.81
Electric hook, switch or myoelectric controlled,
							 adult
L7040
2,495.91
Prehensile actuator, switch controlled
L7045
1,388.49
Electric hook, switch or myoelectric controlled,
							 pediatric
L7170
5,085.91
Electronic elbow, Hosmer or equal, switch
							 controlled
L7180
32,334.77
Electronic elbow, microprocessor sequential control
							 of elbow and terminal device
L7181
33,790.06
Electronic elbow, microprocessor simultaneous control
							 of elbow and terminal device
L7185
5,297.57
Electronic elbow, adolescent, Variety Village or
							 equal, switch controlled
L7186
8,360.17
Electronic elbow, child, Variety Village or equal,
							 switch controlled
L7190
7,099.57
Electronic elbow, adolescent, Variety Village or
							 equal, myoelectronically controlled
L7191
8,801.11
Electronic elbow, child, Variety Village or equal,
							 myoelectronically controlled
L7260
2,245.57
Electronic wrist rotator, Otto Bock or
							 equal
L7261
4,056.39
Electronic wrist rotator, for Utah arm
L7266
850.51
Servo control, Steeper or equal
L7272
1,891.14
Analogue control, UNB or equal
L7274
6,108.88
Proportional control, six-12 volt, Liberty, Utah or
							 equal
L7360
231.27
Six volt battery, each
L7362
239.02
Battery charger, six volt, each
L7364
432.51
Twelve volt battery, each
L7366
588.81
Battery charger, twelve volt, each
L7367
328.32
Lithium ion battery, replacement
L7368
425.62
Lithium ion battery charger
L7400
258.47
Addition to upper extremity prosthesis, below
							 elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or
							 equal)
L7401
289.35
Addition to upper extremity prosthesis, above elbow
							 disarticulation, ultralight material (titanium, carbon fiber or
							 equal)
L7402
312.48
Addition to upper extremity prosthesis, shoulder
							 disarticulation/interscapular thoracic, ultralight material (titanium, carbon
							 fiber or equal)
L7403
310.56
Addition to upper extremity prosthesis, below
							 elbow/wrist disarticulation, acrylic material
L7404
468.72
Addition to upper extremity prosthesis, above elbow
							 disarticulation, acrylic material
L7405
613.03
Addition to upper extremity prosthesis, shoulder
							 disarticulation/interscapular thoracic, acrylic material
L7621
I.C.
Terminal device, hook or hand, heavy duty,
							 mechanical, voluntary opening, any material, any size, lined or
							 unlined
L7622
I.C.
Terminal device, hook or hand, heavy duty,
							 mechanical, voluntary closing, any material, any size, lined or
							 unlined
L7900
462.85
Male vacuum erection system
L8000
31.94
Breast prosthesis, mastectomy bra
L8001
105.77
Breast prosthesis, mastectomy bra, with integrated
							 breast prosthesis form, unilateral
L8002
139.12
Breast prosthesis, mastectomy bra, with integrated
							 breast prosthesis form, bilateral
L8015
50.55
External breast prosthesis garment, with mastectomy
							 form, post-mastectomy
L8020
172.33
Breast prosthesis, mastectomy form
L8030
361.35
Breast prosthesis, silicone or equal
L8035
3,089.60
Custom breast prosthesis, post mastectomy, molded to
							 patient model
L8040
2,256.97
Nasal prosthesis, provided by a
							 nonphysician
L8040
2,256.97
Nasal prosthesis, provided by a
							 nonphysician
L8040
2,256.97
Nasal prosthesis, provided by a
							 nonphysician
L8041
2,720.52
Midfacial prosthesis, provided by a
							 nonphysician
L8041
2,720.52
Midfacial prosthesis, provided by a
							 nonphysician
L8041
2,720.52
Midfacial prosthesis, provided by a
							 nonphysician
L8042
3,056.77
Orbital prosthesis, provided by a
							 nonphysician
L8042
3,056.77
Orbital prosthesis, provided by a
							 nonphysician
L8042
3,056.77
Orbital prosthesis, provided by a
							 nonphysician
L8043
3,423.59
Upper facial prosthesis, provided by a
							 nonphysician
L8043
3,423.59
Upper facial prosthesis, provided by a
							 nonphysician
L8043
3,423.59
Upper facial prosthesis, provided by a
							 nonphysician
L8044
3,790.39
Hemi-facial prosthesis, provided by a
							 nonphysician
L8044
3,790.39
Hemi-facial prosthesis, provided by a
							 nonphysician
L8044
3,790.39
Hemi-facial prosthesis, provided by a
							 nonphysician
L8045
2,382.92
Auricular prosthesis, provided by a
							 nonphysician
L8045
2,382.92
Auricular prosthesis, provided by a
							 nonphysician
L8045
2,382.92
Auricular prosthesis, provided by a
							 nonphysician
L8046
2,445.42
Partial facial prosthesis, provided by a
							 nonphysician
L8046
2,445.42
Partial facial prosthesis, provided by a
							 nonphysician
L8046
2,445.42
Partial facial prosthesis, provided by a
							 nonphysician
L8047
1,253.28
Nasal septal prosthesis, provided by a
							 nonphysician
L8047
1,253.28
Nasal septal prosthesis, provided by a
							 nonphysician
L8047
1,253.28
Nasal septal prosthesis, provided by a
							 nonphysician
L8300
72.46
Truss, single with standard pad
L8310
114.41
Truss, double with standard pads
L8320
60.83
Truss, addition to standard pad, water
							 pad
L8330
56.55
Truss, addition to standard pad, scrotal
							 pad
L8400
15.39
Prosthetic sheath, below knee, each
L8410
23.73
Prosthetic sheath, above knee, each
L8415
24.55
Prosthetic sheath, upper limb, each
L8417
63.32
Prosthetic sheath/sock, including a gel cushion
							 layer, below knee or above knee, each
L8420
17.87
Prosthetic sock, multiple ply, below knee,
							 each
L8430
20.90
Prosthetic sock, multiple ply, above knee,
							 each
L8435
23.31
Prosthetic sock, multiple ply, upper limb,
							 each
L8440
40.40
Prosthetic shrinker, below knee, each
L8460
65.87
Prosthetic shrinker, above knee, each
L8465
44.03
Prosthetic shrinker, upper limb, each
L8470
5.74
Prosthetic sock, single ply, fitting, below knee,
							 each
L8480
10.02
Prosthetic sock, single ply, fitting, above knee,
							 each
L8485
10.04
Prosthetic sock, single ply, fitting, upper limb,
							 each
L8500
638.30
Artificial larynx, any type
L8501
138.36
Tracheostomy speaking valve
L8507
35.33
Tracheo-esophageal voice prosthesis, patient
							 inserted, any type, each
L8509
92.10
Tracheo-esophageal voice prosthesis, inserted by a
							 licensed health care provider, any type
L8510
213.09
Voice amplifier
L8511
61.33
Insert for indwelling tracheoesophageal prosthesis,
							 with or without valve, replacement only, each
L8512
1.82
Gelatin capsules or equivalent, for use with
							 tracheoesophageal voice prosthesis, replacement only, per ten
L8513
4.38
Cleaning device used with tracheoesophageal voice
							 prosthesis, pipet, brush, or equal, replacement only, each
L8514
79.52
Tracheoesophageal puncture dilator, replacement only,
							 each
L8515
53.23
Gelatin capsule, application device for use with
							 tracheoesophageal voice prosthesis, each
L8600
541.09
Implantable breast prosthesis, silicone or
							 equal
L8603
376.16
Injectable bulking agent, collagen implant, urinary
							 tract, 2.5 ml syringe, includes shipping and necessary supplies
L8606
184.87
Injectable bulking agent, synthetic implant, urinary
							 tract, 1 ml syringe, includes shipping and necessary supplies
L8609
5,494.58
Artificial cornea
L8610
502.81
Ocular implant
L8612
616.35
Aqueous shunt
L8613
268.38
Ossicula implant
L8614
16,447.22
Cochlear device, includes all internal and external
							 components
L8615
380.34
Headset/headpiece for use with cochlear implant
							 device, replacement
L8616
88.59
Microphone for use with cochlear implant device,
							 replacement
L8617
77.37
Transmitting coil for use with cochlear implant
							 device, replacement
L8618
22.11
Transmitter cable for use with cochlear implant
							 device, replacement
L8619
7,060.69
Cochlear implant external speech processor,
							 replacement
L8621
0.52
Zinc air battery for use with cochlear implant
							 device, replacement, each
L8622
0.28
Alkaline battery for use with cochlear implant
							 device, any size, replacement, each
L8623
54.55
Lithium ion battery for use with cochlear implant
							 device speech processor, other than ear level, replacement, each
L8624
136.00
Lithium ion battery for use with cochlear implant
							 device speech processor, ear level, replacement, each
L8630
385.88
Metacarpophalangeal joint implant
L8631
1,881.80
Metacarpal phalangeal joint replacement, two or more
							 pieces, metal (
e.g.
, stainless steel or cobalt chrome),
							 ceramic-like material (
e.g.
, pyrocarbon), for surgical
							 implantation (all sizes, includes entire system)
L8641
400.93
Metatarsal joint implant
L8642
243.90
Hallux implant
L8658
349.58
Interphalangeal joint spacer, silicone or equal,
							 each
L8659
1,627.34
Interphalangeal finger joint replacement, two or more
							 pieces, metal (
e.g.
, stainless steel or cobalt chrome),
							 ceramic-like material (
e.g.
, pyrocarbon) for surgical
							 implantation, any size
L8670
478.18
Vascular graft material, synthetic,
							 implant
L8680
387.36
Implantable neurostimulator electrode,
							 each
L8681
926.72
Patient programmer (external) for use with
							 implantable programmable neurostimulator pulse generator
L8682
5,027.57
Implantable neurostimulator radiofrequency
							 receiver
L8683
4,425.41
Radiofrequency transmitter (external) for use with
							 implantable neurostimulator radiofrequency receiver
L8684
584.96
Radiofrequency transmitter (external) for use with
							 implantable sacral root neurostimulator receiver for bowel and bladder
							 management, replacement
L8685
11,027.88
Implantable neurostimulator pulse generator, single
							 array, rechargeable, includes extension
L8686
7,036.64
Implantable neurostimulator pulse generator, single
							 array, non-rechargeable, includes extension
L8687
14,351.67
Implantable neurostimulator pulse generator, dual
							 array, rechargeable, includes extension
L8688
9,157.52
Implantable neurostimulator pulse generator, dual
							 array, non-rechargeable, includes extension
L8689
1,454.68
External recharging system for battery (internal) for
							 use with implantable neurostimulator
L8690
4,011.80
Auditory osseointegrated device, includes all
							 internal and external components
L8691
2,248.74
Auditory osseointegrated device, external sound
							 processor, replacement
L8695
14.04
External recharging system for battery (external) for
							 use with implantable neurostimulator
L7614
I.C.
Terminal device, hand, mechanical, voluntary closing,
							 any material, any size, pediatric
L7621
I.C.
Terminal device, hook or hand, heavy duty,
							 mechanical, voluntary opening, any material, any size, lined or
							 unlined
L7622
I.C.
Terminal device, hook or hand, heavy duty,
							 mechanical, voluntary closing, any material, any size, lined or
							 unlined
L7900
462.85
Male vacuum erection system
L8000
31.94
Breast prosthesis, mastectomy bra
L8001
105.77
Breast prosthesis, mastectomy bra, with integrated
							 breast prosthesis form, unilateral
L8002
139.12
Breast prosthesis, mastectomy bra, with integrated
							 breast prosthesis form, bilateral
L8015
50.55
External breast prosthesis garment, with mastectomy
							 form, post-mastectomy
L8020
172.33
Breast prosthesis, mastectomy form
L8030
361.35
Breast prosthesis, silicone or equal
L8035
3,089.60
Custom breast prosthesis, post mastectomy, molded to
							 patient model
L8040
2,256.97
Nasal prosthesis, provided by a
							 nonphysician
L8041
2,720.52
Midfacial prosthesis, provided by a
							 nonphysician
L8042
3,056.77
Orbital prosthesis, provided by a
							 nonphysician
L8043
3,423.59
Upper facial prosthesis, provided by a
							 nonphysician
L8044
3,790.39
Hemi-facial prosthesis, provided by a
							 nonphysician
L8045
2,382.92
Auricular prosthesis, provided by a
							 nonphysician
L8046
2,445.42
Partial facial prosthesis, provided by a
							 nonphysician
L8047
1,253.28
Nasal septal prosthesis, provided by a
							 nonphysician
L8300
72.46
Truss, single with standard pad
L8310
114.41
Truss, double with standard pads
L8320
60.83
Truss, addition to standard pad, water
							 pad
L8330
56.55
Truss, addition to standard pad, scrotal
							 pad
L8400
15.39
Prosthetic sheath, below knee, each
L8410
23.73
Prosthetic sheath, above knee, each
L8415
24.55
Prosthetic sheath, upper limb, each
L8417
63.32
Prosthetic sheath/sock, including a gel cushion
							 layer, below knee or above knee, each
L8420
17.87
Prosthetic sock, multiple ply, below knee,
							 each
L8430
20.90
Prosthetic sock, multiple ply, above knee,
							 each
L8435
23.31
Prosthetic sock, multiple ply, upper limb,
							 each
L8440
40.40
Prosthetic shrinker, below knee, each
L8460
65.87
Prosthetic shrinker, above knee, each
L8465
44.03
Prosthetic shrinker, upper limb, each
L8470
5.74
Prosthetic sock, single ply, fitting, below knee,
							 each
L8480
10.02
Prosthetic sock, single ply, fitting, above knee,
							 each
L8485
10.04
Prosthetic sock, single ply, fitting, upper limb,
							 each
L8500
638.30
Artificial larynx, any type
L8501
138.36
Tracheostomy speaking valve
L8507
35.33
Tracheo-esophageal voice prosthesis, patient
							 inserted, any type, each
L8509
92.10
Tracheo-esophageal voice prosthesis, inserted by a
							 licensed health care provider, any type
L8510
213.09
Voice amplifier
L8511
61.33
Insert for indwelling tracheoesophageal prosthesis,
							 with or without valve, replacement only, each
L8512
1.82
Gelatin capsules or equivalent, for use with
							 tracheoesophageal voice prosthesis, replacement only, per ten
L8513
4.38
Cleaning device used with tracheoesophageal voice
							 prosthesis, pipet, brush, or equal, replacement only, each
L8514
79.52
Tracheoesophageal puncture dilator, replacement only,
							 each
L8515
53.23
Gelatin capsule, application device for use with
							 tracheoesophageal voice prosthesis, each
L8600
541.09
Implantable breast prosthesis, silicone or
							 equal
L8603
376.16
Injectable bulking agent, collagen implant, urinary
							 tract, 2.5 ml syringe, includes shipping and necessary supplies
L8606
184.87
Injectable bulking agent, synthetic implant, urinary
							 tract, 1 ml syringe, includes shipping and necessary supplies
L8609
5,494.58
Artificial cornea
L8610
502.81
Ocular implant
L8612
616.35
Aqueous shunt
L8613
268.38
Ossicula implant
L8614
16,447.22
Cochlear device, includes all internal and external
							 components
L8615
380.34
Headset/headpiece for use with cochlear implant
							 device, replacement
L8616
88.59
Microphone for use with cochlear implant device,
							 replacement
L8617
77.37
Transmitting coil for use with cochlear implant
							 device, replacement
L8618
22.11
Transmitter cable for use with cochlear implant
							 device, replacement
L8619
7,060.69
Cochlear implant external speech processor,
							 replacement
L8621
0.52
Zinc air battery for use with cochlear implant
							 device, replacement, each
L8622
0.28
Alkaline battery for use with cochlear implant
							 device, any size, replacement, each
L8623
54.55
Lithium ion battery for use with cochlear implant
							 device speech processor, other than ear level, replacement, each
L8624
136.00
Lithium ion battery for use with cochlear implant
							 device speech processor, ear level, replacement, each
L8630
385.88
Metacarpophalangeal joint implant
L8631
1,881.80
Metacarpal phalangeal joint replacement, two or more
							 pieces, metal (
e.g.
, stainless steel or cobalt chrome),
							 ceramic-like material (
e.g.
, pyrocarbon), for surgical
							 implantation (all sizes, includes entire system)
L8641
400.93
Metatarsal joint implant
L8642
243.90
Hallux implant
L8658
349.58
Interphalangeal joint spacer, silicone or equal,
							 each
L8659
1,627.34
Interphalangeal finger joint replacement, two or more
							 pieces, metal (
e.g.
, stainless steel or cobalt chrome),
							 ceramic-like material (
e.g.
, pyrocarbon) for surgical
							 implantation, any size
L8670
478.18
Vascular graft material, synthetic,
							 implant
L8680
387.36
Implantable neurostimulator electrode,
							 each
L8681
926.72
Patient programmer (external) for use with
							 implantable programmable neurostimulator pulse generator
L8682
5,027.57
Implantable neurostimulator radiofrequency
							 receiver
L8683
4,425.41
Radiofrequency transmitter (external) for use with
							 implantable neurostimulator radiofrequency receiver
L8684
584.96
Radiofrequency transmitter (external) for use with
							 implantable sacral root neurostimulator receiver for bowel and bladder
							 management, replacement
L8685
11,027.88
Implantable neurostimulator pulse generator, single
							 array, rechargeable, includes extension
L8686
7,036.64
Implantable neurostimulator pulse generator, single
							 array, non-rechargeable, includes extension
L8687
14,351.67
Implantable neurostimulator pulse generator, dual
							 array, rechargeable, includes extension
L8688
9,157.52
Implantable neurostimulator pulse generator, dual
							 array, non-rechargeable, includes extension
L8689
1,454.68
External recharging system for battery (internal) for
							 use with implantable neurostimulator
L8690
4,011.80
Auditory osseointegrated device, includes all
							 internal and external components
L8691
2,248.74
Auditory osseointegrated device, external sound
							 processor, replacement
L8695
14.04
External recharging system for battery (external) for
							 use with implantable neurostimulator
(7)
Freestanding Diagnostic Facilities/Radiology
.
Code
Global
PC
TC
40.06(7) - Radiologic Service
							 Description
70010
222.25
60.54
161.71
Myelography, posterior fossa, radiological
							 supervision and interpretation
70015
152.67
61.90
90.77
Cisternography, positive contrast, radiological
							 supervision and interpretation
70030
31.56
8.87
22.69
Radiologic examination, eye, for detection of foreign
							 body
70100
35.12
9.21
25.91
Radiologic examination, mandible; partial, less than
							 four views
70110
44.56
12.52
32.04
Radiologic examination, mandible; complete, minimum
							 of four views
70120
39.40
9.21
30.20
Radiologic examination, mastoids; less than three
							 views per side
70130
60.66
17.27
43.38
Radiologic examination, mastoids; complete, minimum
							 of three views per side
70134
53.75
17.27
36.48
Radiologic examination, internal auditory meati,
							 complete
70140
36.52
9.55
26.97
Radiologic examination, facial bones; less than three
							 views
70150
49.80
12.86
36.94
Radiologic examination, facial bones; complete,
							 minimum of three views
70160
36.16
8.87
27.30
Radiologic examination, nasal bones, complete,
							 minimum of three views
70170
I.C.
15.15
I.C.
Dacryocystography, nasolacrimal duct, radiological
							 supervision and interpretation
70190
41.35
10.69
30.66
Radiologic examination; optic foramina
70200
51.40
14.00
37.40
Radiologic examination; orbits, complete, minimum of
							 four views
70210
35.84
8.41
27.44
Radiologic examination, sinuses, paranasal, less than
							 three views
70220
47.16
12.52
34.64
Radiologic examination, sinuses, paranasal, complete,
							 minimum of three views
70240
32.24
9.55
22.69
Radiologic examination, sella turcica
70250
41.45
11.72
29.74
Radiologic examination, skull; less than four
							 views
70260
57.27
17.27
40.00
Radiologic examination, skull; complete, minimum of
							 four views
70300
16.74
5.56
11.19
Radiologic examination, teeth; single
							 view
70310
36.28
8.52
27.76
Radiologic examination, teeth; partial examination,
							 less than full mouth
70320
53.96
11.49
42.46
Radiologic examination, teeth; complete, full
							 mouth
70328
34.20
9.21
24.99
Radiologic examination, temporomandibular joint, open
							 and closed mouth; unilateral
70330
54.18
12.18
42.00
Radiologic examination, temporomandibular joint, open
							 and closed mouth; bilateral
70332
109.17
27.32
81.84
Temporomandibular joint arthrography, radiological
							 supervision and interpretation
70336
619.89
75.64
544.25
Magnetic resonance (eg, proton) imaging,
							 temporomandibular joint(s)
70350
24.65
8.87
15.79
Cephalogram, orthodontic
70355
29.96
10.35
19.61
Orthopantogram
70360
30.64
8.87
21.77
Radiologic examination; neck, soft tissue
70370
83.75
15.83
67.92
Radiologic examination; pharynx or larynx, including
							 fluoroscopy and/or magnification technique
70371
122.31
42.31
80.00
Complex dynamic pharyngeal and speech evaluation by
							 cine or video recording
70373
99.93
21.61
78.32
Laryngography, contrast, radiological supervision and
							 interpretation
70380
43.21
8.87
34.34
Radiologic examination, salivary gland for
							 calculus
70390
114.91
19.56
95.35
Sialography, radiological supervision and
							 interpretation
70450
266.01
43.57
222.45
Computed tomography, head or brain; without contrast
							 material
70460
338.13
58.03
280.10
Computed tomography, head or brain; with contrast
							 material(s)
70470
411.13
64.95
346.18
Computed tomography, head or brain; without contrast
							 material, followed by contrast material(s) and further sections
70480
366.45
65.29
301.15
Computed tomography, orbit, sella, or posterior fossa
							 or outer, middle, or inner ear; without contrast material
70481
428.43
70.55
357.89
Computed tomography, orbit, sella, or posterior fossa
							 or outer, middle, or inner ear; with contrast material(s)
70482
498.74
73.86
424.88
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
321.32
57.91
263.41
Computed tomography, maxillofacial area; without
							 contrast material
70487
387.96
66.90
321.06
Computed tomography, maxillofacial area; with
							 contrast material(s)
70488
474.24
72.38
401.87
Computed tomography, maxillofacial area; without
							 contrast material, followed by contrast material(s) and further
							 sections
70490
320.88
65.75
255.13
Computed tomography, soft tissue neck; without
							 contrast material
70491
383.79
70.55
313.24
Computed tomography, soft tissue neck; with contrast
							 material(s)
70492
466.98
73.86
393.12
Computed tomography, soft tissue neck; without
							 contrast material followed by contrast material(s) and further
							 sections
70496
730.37
89.77
640.61
Computed tomographic angiography, head, with contrast
							 material(s), including noncontrast images, if performed, and image
							 postprocessing
70498
733.59
90.23
643.37
Computed tomographic angiography, neck, with contrast
							 material(s), including noncontrast images, if performed, and image
							 postprocessing
70540
653.81
68.60
585.20
Magnetic resonance (eg, proton) imaging, orbit, face,
							 and/or neck; without contrast material(s)
70542
745.35
82.73
662.62
Magnetic resonance (eg, proton) imaging, orbit, face,
							 and/or neck; with contrast material(s)
70543
1,122.49
109.55
1,012.94
Magnetic resonance (eg, proton) imaging, orbit, face,
							 and/or neck; without contrast material(s), followed by contrast material(s) and
							 further sequences
70544
692.12
61.34
630.78
Magnetic resonance angiography, head; without
							 contrast material(s)
70545
689.36
61.34
628.02
Magnetic resonance angiography, head; with contrast
							 material(s)
70546
1,164.58
91.93
1,072.65
Magnetic resonance angiography, head; without
							 contrast material(s), followed by contrast material(s) and further
							 sequences
70547
690.28
60.88
629.40
Magnetic resonance angiography, neck; without
							 contrast material(s)
70548
710.53
61.34
649.19
Magnetic resonance angiography, neck; with contrast
							 material(s)
70549
1,164.58
91.93
1,072.65
Magnetic resonance angiography, neck; without
							 contrast material(s), followed by contrast material(s) and further
							 sequences
70551
671.90
75.64
596.26
Magnetic resonance (eg, proton) imaging, brain
							 (including brain stem); without contrast material
70552
766.29
91.25
675.04
Magnetic resonance (eg, proton) imaging, brain
							 (including brain stem); with contrast material(s)
70553
1,129.94
120.40
1,009.54
Magnetic resonance (eg, proton) imaging, brain
							 (including brain stem); without contrast material, followed by contrast
							 material(s) and further sequences
70554
809.37
106.80
702.57
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
I.C.
131.45
I.C.
Magnetic resonance imaging, brain, functional MRI;
							 requiring physician or psychologist administration of entire neurofunctional
							 testing
70557
I.C.
151.12
I.C.
Magnetic resonance (eg, proton) imaging, brain
							 (including brain stem and skull base), during open intracranial procedure (eg,
							 to assess for residual tumor or residual vascular malformation); without
							 contrast material
70558
I.C.
166.11
I.C.
Magnetic resonance (eg, proton) imaging, brain
							 (including brain stem and skull base), during open intracranial procedure (eg,
							 to assess for residual tumor or residual vascular malformation); with contrast
							 material(s)
70559
I.C.
167.63
I.C.
Magnetic resonance (eg, proton) imaging, brain
							 (including brain stem and skull base), during open intracranial procedure (eg,
							 to assess for residual tumor or residual vascular malformation); without
							 contrast material(s), followed by contrast material(s) and further
							 sequences
71010
29.14
9.21
19.93
Radiologic examination, chest; single view,
							 frontal
71015
34.77
10.69
24.07
Radiologic examination, chest; stereo,
							 frontal
71020
38.01
11.03
26.97
Radiologic examination, chest, two views, frontal and
							 lateral;
71021
46.46
13.66
32.80
Radiologic examination, chest, two views, frontal and
							 lateral; with apical lordotic procedure
71022
51.97
15.49
36.48
Radiologic examination, chest, two views, frontal and
							 lateral; with oblique projections
71023
71.39
19.72
51.67
Radiologic examination, chest, two views, frontal and
							 lateral; with fluoroscopy
71030
53.81
15.49
38.32
Radiologic examination, chest, complete, minimum of
							 four views;
71034
103.86
24.59
79.26
Radiologic examination, chest, complete, minimum of
							 four views; with fluoroscopy
71035
38.34
9.21
29.14
Radiologic examination, chest, special views (eg,
							 lateral decubitus, Bucky studies)
71040
108.25
28.99
79.26
Bronchography, unilateral, radiological supervision
							 and interpretation
71060
158.02
37.67
120.35
Bronchography, bilateral, radiological supervision
							 and interpretation
71090
I.C.
30.08
I.C.
Insertion pacemaker, fluoroscopy and radiography,
							 radiological supervision and interpretation
71100
38.01
11.03
26.97
Radiologic examination, ribs, unilateral; two
							 views
71101
45.70
13.66
32.04
Radiologic examination, ribs, unilateral; including
							 posteroanterior chest, minimum of three views
71110
48.76
13.66
35.10
Radiologic examination, ribs, bilateral; three
							 views
71111
60.43
15.83
44.60
Radiologic examination, ribs, bilateral; including
							 posteroanterior chest, minimum of four views
71120
39.63
10.35
29.28
Radiologic examination; sternum, minimum of
							 two
views
71130
43.99
11.03
32.96
Radiologic examination; sternoclavicular joint or
							 joints, minimum of three views
71250
343.60
59.06
284.54
Computed tomography, thorax; without contrast
							 material
71260
411.18
63.17
348.02
Computed tomography, thorax; with contrast
							 material(s)
71270
508.26
70.55
437.71
Computed tomography, thorax; without contrast
							 material, followed by contrast material(s) and further sections
71275
650.23
98.63
551.60
Computed tomographic angiography, chest
							 (noncoronary), with contrast material(s), including noncontrast images, if
							 performed, and image postprocessing
71550
710.91
74.20
636.71
Magnetic resonance (eg, proton) imaging, chest (eg,
							 for evaluation of hilar and mediastinal lymphadenopathy); without contrast
							 material(s)
71551
812.12
88.16
723.96
Magnetic resonance (eg, proton) imaging, chest (eg,
							 for evaluation of hilar and mediastinal lymphadenopathy); with contrast
							 material(s)
71552
1,209.82
115.60
1,094.22
Magnetic resonance (eg, proton) imaging, chest (eg,
							 for evaluation of hilar and mediastinal lymphadenopathy); without contrast
							 material(s), followed by contrast material(s) and further sequences
71555
706.02
93.19
612.83
Magnetic resonance angiography, chest (excluding
							 myocardium), with or without contrast material(s)
72010
77.60
22.41
55.19
Radiologic examination, spine, entire, survey study,
							 anteroposterior and lateral
72020
27.65
7.72
19.93
Radiologic examination, spine, single view, specify
							 level
72040
42.15
11.03
31.12
Radiologic examination, spine, cervical; two or three
							 views
72050
60.09
15.49
44.60
Radiologic examination, spine, cervical; minimum of
							 four views
72052
75.45
18.41
57.03
Radiologic examination, spine, cervical; complete,
							 including oblique and flexion and/or extension studies
72069
38.79
11.49
27.30
Radiologic examination, spine, thoracolumbar,
							 standing (scoliosis)
72070
40.31
11.03
29.28
Radiologic examination, spine; thoracic, two
							 views
72072
45.21
11.03
34.18
Radiologic examination, spine; thoracic, three
							 views
72074
53.80
11.03
42.76
Radiologic examination, spine; thoracic, minimum of
							 four views
72080
41.69
11.03
30.66
Radiologic examination, spine; thoracolumbar, two
							 views
72090
52.02
14.46
37.56
Radiologic examination, spine; scoliosis study,
							 including supine and erect studies
72100
44.45
11.03
33.42
Radiologic examination, spine, lumbosacral; two or
							 three views
72110
61.93
15.49
46.45
Radiologic examination, spine, lumbosacral; minimum
							 of four views
72114
80.51
18.41
62.10
Radiologic examination, spine, lumbosacral; complete,
							 including bending views
72120
56.10
11.03
45.06
Radiologic examination, spine, lumbosacral, bending
							 views only, minimum of four views
72125
344.06
59.06
285.00
Computed tomography, cervical spine; without contrast
							 material
72126
410.04
62.02
348.02
Computed tomography, cervical spine; with contrast
							 material
72127
503.58
64.95
438.63
Computed tomography, cervical spine; without contrast
							 material, followed by contrast material(s) and further sections
72128
343.60
59.06
284.54
Computed tomography, thoracic spine; without contrast
							 material
72129
410.50
62.49
348.02
Computed tomography, thoracic spine; with contrast
							 material
72130
502.20
64.95
437.25
Computed tomography, thoracic spine; without contrast
							 material, followed by contrast material(s) and further sections
72131
343.14
59.06
284.08
Computed tomography, lumbar spine; without contrast
							 material
72132
409.58
62.02
347.56
Computed tomography, lumbar spine; with contrast
							 material
72133
503.12
64.95
438.17
Computed tomography, lumbar spine; without contrast
							 material, followed by contrast material(s) and further sections
72141
631.35
81.58
549.77
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, cervical; without contrast material
72142
772.75
98.17
674.58
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, cervical; with contrast material(s)
72146
661.85
81.58
580.27
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, thoracic; without contrast material
72147
725.80
98.17
627.63
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, thoracic; with contrast material(s)
72148
655.45
75.64
579.81
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, lumbar; without contrast material
72149
764.91
91.25
673.66
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, lumbar; with contrast material(s)
72156
1,132.34
131.09
1,001.25
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, without contrast material, followed by contrast material(s) and
							 further sequences; cervical
72157
1,095.98
131.09
964.89
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, without contrast material, followed by contrast material(s) and
							 further sequences; thoracic
72158
1,121.19
120.40
1,000.79
Magnetic resonance (eg, proton) imaging, spinal canal
							 and contents, without contrast material, followed by contrast material(s) and
							 further sequences; lumbar
72159
718.83
89.77
629.06
Magnetic resonance angiography, spinal canal and
							 contents, with or without contrast material(s)
72170
31.56
8.87
22.69
Radiologic examination, pelvis; one or two
							 views
72190
45.03
10.69
34.34
Radiologic examination, pelvis; complete, minimum of
							 three views
72191
627.76
93.19
534.57
Computed tomographic angiography, pelvis, with
							 contrast material(s), including noncontrast images, if performed, and image
							 postprocessing
72192
331.08
55.75
275.33
Computed tomography, pelvis; without contrast
							 material
72193
392.04
59.52
332.53
Computed tomography, pelvis; with contrast
							 material(s)
72194
493.77
62.02
431.75
Computed tomography, pelvis; without contrast
							 material, followed by contrast material(s) and further sections
72195
666.26
74.20
592.06
Magnetic resonance (eg, proton) imaging, pelvis;
							 without contrast material(s)
72196
757.35
88.62
668.73
Magnetic resonance (eg, proton) imaging, pelvis; with
							 contrast material(s)
72197
1,134.16
115.14
1,019.02
Magnetic resonance (eg, proton) imaging, pelvis;
							 without contrast material(s), followed by contrast material(s) and further
							 sequences
72198
700.16
91.93
608.23
Magnetic resonance angiography, pelvis, with or
							 without contrast material(s)
72200
33.86
8.87
24.99
Radiologic examination, sacroiliac joints; less than
							 three views
72202
40.67
9.55
31.12
Radiologic examination, sacroiliac joints; three
							 or
more views
72220
35.38
8.87
26.51
Radiologic examination, sacrum and coccyx, minimum of
							 two views
72240
214.67
46.08
168.59
Myelography, cervical, radiological supervision and
							 interpretation
72255
196.74
45.16
151.58
Myelography, thoracic, radiological supervision and
							 interpretation
72265
194.01
41.97
152.04
Myelography, lumbosacral, radiological supervision
							 and interpretation
72270
299.67
67.92
231.75
Myelography, two or more regions (eg,
							 lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical),
							 radiological supervision and interpretation
72275
126.72
36.35
90.37
Epidurography, radiological supervision and
							 interpretation
72285
288.88
56.89
231.98
Discography, cervical or thoracic, radiological
							 supervision and interpretation
72291
I.C.
69.36
I.C.
Radiological supervision and interpretation,
							 percutaneous vertebroplasty or vertebral augmentation including cavity
							 creation, per vertebral body; under fluoroscopic guidance
72292
I.C.
71.77
I.C.
Radiological supervision and interpretation,
							 percutaneous vertebroplasty or vertebral augmentation including cavity
							 creation, per vertebral body; under CT guidance
72295
263.06
42.10
220.96
Discography, lumbar, radiological supervision and
							 interpretation
73000
32.14
8.06
24.07
Radiologic examination; clavicle,
							 complete
73010
33.40
8.87
24.53
Radiologic examination; scapula, complete
73020
28.11
7.72
20.39
Radiologic examination, shoulder; one
							 view
73030
35.26
9.21
26.05
Radiologic examination, shoulder; complete, minimum
							 of two views
73040
127.12
27.78
99.34
Radiologic examination, shoulder, arthrography,
							 radiological supervision and interpretation
73050
41.93
10.35
31.58
Radiologic examination; acromioclavicular joints,
							 bilateral, with or without weighted distraction
73060
34.92
8.87
26.05
Radiologic examination; humerus, minimum of two
							 views
73070
31.80
7.72
24.07
Radiologic examination, elbow; two views
73080
39.06
8.87
30.20
Radiologic examination, elbow; complete, minimum of
							 three views
73085
117.91
27.78
90.13
Radiologic examination, elbow, arthrography,
							 radiological supervision and interpretation
73090
32.14
8.06
24.07
Radiologic examination; forearm, two
							 views
73092
32.14
8.06
24.07
Radiologic examination; upper extremity, infant,
							 minimum of two views
73100
32.60
8.06
24.53
Radiologic examination, wrist; two views
73110
38.00
8.87
29.14
Radiologic examination, wrist; complete, minimum of
							 three views
73115
115.93
27.32
88.61
Radiologic examination, wrist, arthrography,
							 radiological supervision and interpretation
73120
31.68
8.06
23.61
Radiologic examination, hand; two views
73130
35.70
8.87
26.84
Radiologic examination, hand; minimum of three
							 views
73140
31.57
6.58
24.99
Radiologic examination, finger(s), minimum of
							 two
views
73200
315.93
55.75
260.19
Computed tomography, upper extremity; without
							 contrast material
73201
377.20
59.06
318.14
Computed tomography, upper extremity; with contrast
							 material(s)
73202
477.84
62.02
415.82
Computed tomography, upper extremity; without
							 contrast material, followed by contrast material(s) and further
							 sections
73206
593.24
93.19
500.05
Computed tomographic angiography, upper extremity,
							 with contrast material(s), including noncontrast images, if performed, and
							 image postprocessing
73218
664.85
68.60
596.25
Magnetic resonance (eg, proton) imaging, upper
							 extremity, other than joint; without contrast material(s)
73219
748.11
82.73
665.39
Magnetic resonance (eg, proton) imaging, upper
							 extremity, other than joint; with contrast material(s)
73220
1,129.39
110.01
1,019.39
Magnetic resonance (eg, proton) imaging, upper
							 extremity, other than joint; without contrast material(s), followed by contrast
							 material(s) and further sequences
73221
639.54
68.60
570.93
Magnetic resonance (eg, proton) imaging, any joint of
							 upper extremity; without contrast material(s)
73222
722.80
82.73
640.07
Magnetic resonance (eg, proton) imaging, any joint of
							 upper extremity; with contrast material(s)
73223
1,095.33
109.55
985.79
Magnetic resonance (eg, proton) imaging, any joint of
							 upper extremity; without contrast material(s), followed by contrast material(s)
							 and further sequences
73225
685.48
86.46
599.02
Magnetic resonance angiography, upper extremity, with
							 or without contrast material(s)
73500
30.18
8.87
21.31
Radiologic examination, hip, unilateral; one
							 view
73510
41.35
10.69
30.66
Radiologic examination, hip, unilateral; complete,
							 minimum of two views
73520
45.82
13.32
32.50
Radiologic examination, hips, bilateral, minimum of
							 two views of each hip, including anteroposterior view of pelvis
73525
117.75
27.62
90.13
Radiologic examination, hip, arthrography,
							 radiological supervision and interpretation
73530
I.C.
14.80
I.C.
Radiologic examination, hip, during operative
							 procedure
73540
41.47
10.35
31.12
Radiologic examination, pelvis and hips, infant or
							 child, minimum of two views
73542
102.89
27.95
74.94
Radiological examination, sacroiliac joint
							 arthrography, radiological supervision and interpretation
73550
34.46
8.87
25.59
Radiologic examination, femur, two views
73560
33.40
8.87
24.53
Radiologic examination, knee; one or two
							 views
73562
38.94
9.21
29.74
Radiologic examination, knee; three views
73564
44.45
11.03
33.42
Radiologic examination, knee; complete, four or
							 more
views
73565
34.32
8.87
25.45
Radiologic examination, knee; both knees, standing,
							 anteroposterior
73580
146.89
27.62
119.27
Radiologic examination, knee, arthrography,
							 radiological supervision and interpretation
73590
32.48
8.87
23.61
Radiologic examination; tibia and fibula, two
							 views
73592
32.14
8.06
24.07
Radiologic examination; lower extremity, infant,
							 minimum of two views
73600
31.68
8.06
23.61
Radiologic examination, ankle; two views
73610
35.70
8.87
26.84
Radiologic examination, ankle; complete, minimum of
							 three views
73615
121.43
27.62
93.81
Radiologic examination, ankle, arthrography,
							 radiological supervision and interpretation
73620
31.22
8.06
23.15
Radiologic examination, foot; two views
73630
35.70
8.87
26.84
Radiologic examination, foot; complete, minimum of
							 three views
73650
30.76
8.06
22.69
Radiologic examination; calcaneus, minimum of
							 two
views
73660
30.65
6.58
24.07
Radiologic examination; toe(s), minimum of two
							 views
73700
315.93
55.75
260.19
Computed tomography, lower extremity; without
							 contrast material
73701
379.04
59.52
319.52
Computed tomography, lower extremity; with contrast
							 material(s)
73702
481.98
62.49
419.50
Computed tomography, lower extremity; without
							 contrast material, followed by contrast material(s) and further
							 sections
73706
629.92
98.11
531.81
Computed tomographic angiography, lower extremity,
							 with contrast material(s), including noncontrast images, if performed, and
							 image postprocessing
73718
656.11
68.60
587.50
Magnetic resonance (eg, proton) imaging, lower
							 extremity other than joint; without contrast material(s)
73719
748.11
82.73
665.39
Magnetic resonance (eg, proton) imaging, lower
							 extremity other than joint; with contrast material(s)
73720
1,127.55
109.55
1,018.01
Magnetic resonance (eg, proton) imaging, lower
							 extremity other than joint; without contrast material(s), followed by contrast
							 material(s) and further sequences
73721
646.90
68.60
578.30
Magnetic resonance (eg, proton) imaging, any joint of
							 lower extremity; without contrast material
73722
726.94
82.73
644.21
Magnetic resonance (eg, proton) imaging, any joint of
							 lower extremity; with contrast material(s)
73723
1,095.33
110.01
985.33
Magnetic resonance (eg, proton) imaging, any joint of
							 lower extremity; without contrast material(s), followed by contrast material(s)
							 and further sequences
73725
702.22
93.08
609.15
Magnetic resonance angiography, lower extremity, with
							 or without contrast material(s)
74000
30.98
9.21
21.77
Radiologic examination, abdomen; single
							 anteroposterior view
74010
42.49
11.83
30.66
Radiologic examination, abdomen; anteroposterior and
							 additional oblique and cone views
74020
45.70
13.66
32.04
Radiologic examination, abdomen; complete, including
							 decubitus and/or erect views
74022
54.61
16.29
38.32
Radiologic examination, abdomen; complete acute
							 abdomen series, including supine, erect, and/or decubitus views, single view
							 chest
74150
330.51
61.00
269.51
Computed tomography, abdomen; without contrast
							 material
74160
426.48
65.41
361.06
Computed tomography, abdomen; with contrast
							 material(s)
74170
549.01
71.69
477.31
Computed tomography, abdomen; without contrast
							 material, followed by contrast material(s) and further sections
74175
652.47
97.19
555.28
Computed tomographic angiography, abdomen, with
							 contrast material(s), including noncontrast images, if performed, and image
							 postprocessing
74181
620.70
74.66
546.03
Magnetic resonance (eg, proton) imaging, abdomen;
							 without contrast material(s)
74182
801.54
88.62
712.91
Magnetic resonance (eg, proton) imaging, abdomen;
							 with contrast material(s)
74183
1,134.63
115.14
1,019.48
Magnetic resonance (eg, proton) imaging, abdomen;
							 without contrast material(s), followed by with contrast material(s) and further
							 sequences
74185
700.16
91.93
608.23
Magnetic resonance angiography, abdomen, with or
							 without contrast material(s)
74190
I.C.
24.35
I.C.
Peritoneogram (eg, after injection of air or
							 contrast), radiological supervision and interpretation
74210
85.57
18.41
67.16
Radiologic examination; pharynx and/or cervical
							 esophagus
74220
95.43
23.67
71.76
Radiologic examination; esophagus
74230
99.96
26.98
72.98
Swallowing function, with cineradiography/
							 videoradiography
74235
I.C.
61.92
I.C.
Removal of foreign body(s), esophageal, with use of
							 balloon catheter, radiological supervision and interpretation
74240
118.91
35.50
83.41
Radiologic examination, gastrointestinal tract,
							 upper; with or without delayed films, without KUB
74241
125.36
35.04
90.31
Radiologic examination, gastrointestinal tract,
							 upper; with or without delayed films, with KUB
74245
188.98
46.54
142.44
Radiologic examination, gastrointestinal tract,
							 upper; with small intestine, includes multiple serial films
74246
135.16
35.50
99.66
Radiological examination, gastrointestinal tract,
							 upper, air contrast, with specific high density barium, effervescent agent,
							 with or without glucagon; with or without delayed films, without
							 KUB
74247
146.05
35.50
110.54
Radiological examination, gastrointestinal tract,
							 upper, air contrast, with specific high density barium, effervescent agent,
							 with or without glucagon; with or without delayed films, with KUB
74249
202.63
46.54
156.09
Radiological examination, gastrointestinal tract,
							 upper, air contrast, with specific high density barium, effervescent agent,
							 with or without glucagon; with small intestine follow-through
74250
109.42
24.01
85.41
Radiologic examination, small intestine, includes
							 multiple serial films;
74251
292.60
35.50
257.09
Radiologic examination, small intestine, includes
							 multiple serial films; via enteroclysis tube
74260
249.29
25.50
223.79
Duodenography, hypotonic
74270
154.79
35.50
119.29
Radiologic examination, colon; barium enema, with or
							 without KUB
74280
211.50
50.19
161.31
Radiologic examination, colon; air contrast with
							 specific high density barium, with or without glucagon
74283
230.06
102.51
127.55
Therapeutic enema, contrast or air, for reduction of
							 intussusception or other intraluminal obstruction (eg, meconium
							 ileus)
74290
68.42
16.29
52.13
Cholecystography, oral contrast;
74291
54.68
10.35
44.33
Cholecystography, oral contrast; additional or repeat
							 examination or multiple day examination
74300
I.C.
18.41
I.C.
Cholangiography and/or pancreatography;
							 intraoperative, radiological supervision and interpretation
74301
I.C.
10.69
I.C.
Cholangiography and/or pancreatography; additional
							 set intraoperative, radiological supervision and interpretation (List
							 separately in addition to code for primary procedure)
74305
I.C.
21.84
I.C.
Cholangiography and/or pancreatography; through
							 existing catheter, radiological supervision and interpretation
74320
149.79
27.78
122.01
Cholangiography, percutaneous, transhepatic,
							 radiological supervision and interpretation
74327
142.25
35.85
106.40
Postoperative biliary duct calculus removal,
							 percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique),
							 radiological supervision and interpretation
74328
I.C.
36.31
I.C.
Endoscopic catheterization of the biliary ductal
							 system, radiological supervision and interpretation
74329
I.C.
36.31
I.C.
Endoscopic catheterization of the pancreatic ductal
							 system, radiological supervision and interpretation
74330
I.C.
46.20
I.C.
Combined endoscopic catheterization of the biliary
							 and pancreatic ductal systems, radiological supervision and
							 interpretation
74340
I.C.
27.78
I.C.
Introduction of long gastrointestinal tube (eg,
							 Miller-Abbott), including multiple fluoroscopies and films, radiological
							 supervision and interpretation
74355
I.C.
38.82
I.C.
Percutaneous placement of enteroclysis tube,
							 radiological supervision and interpretation
74360
I.C.
28.70
I.C.
Intraluminal dilation of strictures and/or
							 obstructions (eg, esophagus), radiological supervision and
							 interpretation
74363
I.C.
45.05
I.C.
Percutaneous transhepatic dilation of biliary duct
							 stricture with or without placement of stent, radiological supervision and
							 interpretation
74400
122.81
25.15
97.65
Urography (pyelography), intravenous, with or without
							 KUB, with or without tomography
74410
131.09
25.15
105.94
Urography, infusion, drip technique and/or bolus
							 technique;
74415
148.88
25.15
123.73
Urography, infusion, drip technique and/or bolus
							 technique; with nephrotomography
74420
I.C.
18.87
I.C.
Urography, retrograde, with or without
							 KUB
74425
I.C.
18.87
I.C.
Urography, antegrade (pyelostogram,
							 nephrostogram,
loopogram), radiological supervision and
							 interpretation
74430
85.13
16.59
68.54
Cystography, minimum of thee views, radiological
							 supervision and interpretation
74440
92.70
19.56
73.14
Vasography, vesiculography, or epididymography,
							 radiological supervision and interpretation
74445
I.C.
59.89
I.C.
Corpora cavernosography, radiological supervision and
							 interpretation
74450
I.C.
17.39
I.C.
Urethrocystography, retrograde, radiological
							 supervision and interpretation
74455
104.16
17.39
86.77
Urethrocystography, voiding, radiological supervision
							 and interpretation
74470
I.C.
27.32
I.C.
Radiologic examination, renal cyst study,
							 translumbar, contrast visualization, radiological supervision and
							 interpretation
74475
172.46
27.78
144.68
Introduction of intracatheter or catheter into renal
							 pelvis for drainage and/or injection, percutaneous, radiological supervision
							 and interpretation
74480
172.46
27.78
144.68
Introduction of ureteral catheter or stent into
							 ureter through renal pelvis for drainage and/or injection, percutaneous,
							 radiological supervision and interpretation
74485
153.31
28.08
125.23
Dilation of nephrostomy, ureters, or urethra,
							 radiological supervision and interpretation
74710
55.43
17.27
38.16
Pelvimetry, with or without placental
							 localization
74740
89.32
19.56
69.76
Hysterosalpingography, radiological supervision and
							 interpretation
74742
I.C.
30.93
I.C.
Transcervical catheterization of fallopian tube,
							 radiological supervision and interpretation
74775
I.C.
31.73
I.C.
Perineogram (eg, vaginogram, for sex determination or
							 extent of anomalies)
75557
628.05
126.50
501.55
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material;
75558
691.13
119.69
571.45
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material; with flow/velocity
							 quantification
75559
924.24
162.18
762.07
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material; with stress imaging
75560
907.52
137.49
770.03
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material; with flow/velocity quantification and
							 stress
75561
856.37
139.94
716.44
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material(s), followed by contrast material(s) and
							 further sequences;
75562
900.41
131.33
769.09
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material(s), followed by contrast material(s) and
							 further sequences; with flow/velocity quantification
75563
1,065.49
169.25
896.25
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material(s), followed by contrast material(s) and
							 further sequences; with stress imaging
75564
1,058.78
153.72
905.07
Cardiac magnetic resonance imaging for morphology and
							 function without contrast material(s), followed by contrast material(s) and
							 further sequences; with flow/velocity quantification and stress
75600
479.60
27.46
452.15
Aortography, thoracic, without serialography,
							 radiological supervision and interpretation
75605
441.02
60.67
380.34
Aortography, thoracic, by serialography, radiological
							 supervision and interpretation
75625
436.25
59.13
377.12
Aortography, abdominal, by serialography,
							 radiological supervision and interpretation
75630
488.30
94.79
393.51
Aortography, abdominal plus bilateral iliofemoral
							 lower extremity, catheter, by serialography, radiological supervision and
							 interpretation
75635
779.07
124.36
654.70
Computed tomographic angiography, abdominal aorta and
							 bilateral iliofemoral lower extremity runoff, with contrast material(s),
							 including noncontrast images, if performed, and image
							 postprocessing
75650
454.95
77.37
377.58
Angiography, cervicocerebral, catheter, including
							 vessel origin, radiological supervision and interpretation
75658
453.41
68.00
385.41
Angiography, brachial, retrograde, radiological
							 supervision and interpretation
75660
455.87
68.16
387.71
Angiography, external carotid, unilateral, selective,
							 radiological supervision and interpretation
75662
497.28
88.39
408.88
Angiography, external carotid, bilateral, selective,
							 radiological supervision and interpretation
75665
461.83
68.60
393.23
Angiography, carotid, cerebral, unilateral,
							 radiological supervision and interpretation
75671
498.50
85.93
412.56
Angiography, carotid, cerebral, bilateral,
							 radiological supervision and interpretation
75676
455.71
68.00
387.71
Angiography, carotid, cervical, unilateral,
							 radiological supervision and interpretation
75680
486.99
86.39
400.60
Angiography, carotid, cervical, bilateral,
							 radiological supervision and interpretation
75685
455.87
68.16
387.71
Angiography, vertebral, cervical, and/or
							 intracranial, radiological supervision and interpretation
75705
500.56
113.31
387.25
Angiography, spinal, selective, radiological
							 supervision and interpretation
75710
450.82
59.89
390.93
Angiography, extremity, unilateral, radiological
							 supervision and interpretation
75716
479.64
68.00
411.64
Angiography, extremity, bilateral, radiological
							 supervision and interpretation
75722
447.92
60.67
387.25
Angiography, renal, unilateral, selective (including
							 flush aortogram), radiological supervision and interpretation
75724
493.01
82.29
410.72
Angiography, renal, bilateral, selective (including
							 flush aortogram), radiological supervision and interpretation
75726
445.16
58.37
386.79
Angiography, visceral, selective or supraselective
							 (with or without flush aortogram), radiological supervision and
							 interpretation
75731
453.29
60.97
392.31
Angiography, adrenal, unilateral, selective,
							 radiological supervision and interpretation
75733
492.23
71.84
420.39
Angiography, adrenal, bilateral, selective,
							 radiological supervision and interpretation
75736
448.68
59.59
389.09
Angiography, pelvic, selective or supraselective,
							 radiological supervision and interpretation
75741
439.30
67.70
371.60
Angiography, pulmonary, unilateral, selective,
							 radiological supervision and interpretation
75743
463.05
85.47
377.58
Angiography, pulmonary, bilateral, selective,
							 radiological supervision and interpretation
75746
440.10
58.37
381.72
Angiography, pulmonary, by nonselective catheter or
							 venous injection, radiological supervision and interpretation
75756
460.05
63.60
396.45
Angiography, internal mammary, radiological
							 supervision and interpretation
75774
383.11
18.87
364.23
Angiography, selective, each additional vessel
							 studied after basic examination, radiological supervision and interpretation
							 (List separately in addition to code for primary procedure)
75790
184.83
93.14
91.69
Angiography, arteriovenous shunt (eg, dialysis
							 patient), radiological supervision and interpretation
75801
I.C.
41.56
I.C.
Lymphangiography, extremity only, unilateral,
							 radiological supervision and interpretation
75803
I.C.
59.40
I.C.
Lymphangiography, extremity only, bilateral,
							 radiological supervision and interpretation
75805
I.C.
41.58
I.C.
Lymphangiography, pelvic/abdominal, unilateral,
							 radiological supervision and interpretation
75807
I.C.
59.40
I.C.
Lymphangiography, pelvic/abdominal, bilateral,
							 radiological supervision and interpretation
75809
89.03
23.55
65.48
Shuntogram for investigation of previously placed
							 indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt,
							 indwelling infusion pump), radiological supervision and
							 interpretation
75810
I.C.
57.91
I.C.
Splenoportography, radiological supervision and
							 interpretation
75820
122.80
36.77
86.03
Venography, extremity, unilateral, radiological
							 supervision and interpretation
75822
155.16
54.26
100.90
Venography, extremity, bilateral, radiological
							 supervision and interpretation
75825
426.89
58.51
368.38
Venography, caval, inferior, with serialography,
							 radiological supervision and interpretation
75827
426.75
57.45
369.30
Venography, caval, superior, with serialography,
							 radiological supervision and interpretation
75831
428.89
57.75
371.14
Venography, renal, unilateral, selective,
							 radiological supervision and interpretation
75833
459.23
76.59
382.65
Venography, renal, bilateral, selective, radiological
							 supervision and interpretation
75840
427.81
58.05
369.76
Venography, adrenal, unilateral, selective,
							 radiological supervision and interpretation
75842
460.01
76.45
383.57
Venography, adrenal, bilateral, selective,
							 radiological supervision and interpretation
75860
437.04
60.37
376.66
Venography, venous sinus (eg, petrosal and inferior
							 sagittal) or jugular, catheter, radiological supervision and
							 interpretation
75870
435.03
58.83
376.20
Venography, superior sagittal sinus, radiological
							 supervision and interpretation
75872
454.76
61.99
392.77
Venography, epidural, radiological supervision and
							 interpretation
75880
127.86
36.31
91.55
Venography, orbital, radiological supervision and
							 interpretation
75885
444.66
73.52
371.14
Percutaneous transhepatic portography with
							 hemodynamic evaluation, radiological supervision and interpretation
75887
450.18
74.90
375.28
Percutaneous transhepatic portography without
							 hemodynamic evaluation, radiological supervision and interpretation
75889
429.51
58.37
371.14
Hepatic venography, wedged or free, with hemodynamic
							 evaluation, radiological supervision and interpretation
75891
429.05
58.37
370.68
Hepatic venography, wedged or free, without
							 hemodynamic evaluation, radiological supervision and interpretation
75893
398.92
27.78
371.14
Venous sampling through catheter, with or without
							 angiography (eg, for parathyroid hormone, renin), radiological supervision and
							 interpretation
75894
I.C.
67.38
I.C.
Transcatheter therapy, embolization, any method,
							 radiological supervision and interpretation
75896
I.C.
68.32
I.C.
Transcatheter therapy, infusion, any method (eg,
							 thrombolysis other than coronary), radiological supervision and
							 interpretation
75898
I.C.
85.59
I.C.
Angiography through existing catheter for follow-up
							 study for transcatheter therapy, embolization or infusion
75900
I.C.
24.99
I.C.
Exchange of a previously placed intravascular
							 catheter during thrombolytic therapy with contrast monitoring, radiological
							 supervision and interpretation
75901
171.55
25.15
146.39
Mechanical removal of pericatheter obstructive
							 material (eg, fibrin sheath) from central venous device via separate venous
							 access, radiologic supervision and interpretation
75902
109.22
19.90
89.32
Mechanical removal of intraluminal (intracatheter)
							 obstructive material from central venous device through device lumen,
							 radiologic supervision and interpretation
75940
I.C.
27.92
I.C.
Percutaneous placement of IVC filter, radiological
							 supervision and interpretation
75945
I.C.
21.30
I.C.
Intravascular ultrasound (non-coronary vessel),
							 radiological supervision and interpretation; initial vessel
75946
I.C.
21.14
I.C.
Intravascular ultrasound (non-coronary vessel),
							 radiological supervision and interpretation; each additional non-coronary
							 vessel (List separately in addition to code for primary procedure)
75952
I.C.
230.17
I.C.
Endovascular repair of infrarenal abdominal aortic
							 aneurysm or dissection, radiological supervision and interpretation
75953
I.C.
69.66
I.C.
Placement of proximal or distal extension prosthesis
							 for endovascular repair of infrarenal aortic or iliac artery aneurysm,
							 pseudoaneurysm, or dissection, radiological supervision and
							 interpretation
75954
I.C.
113.54
I.C.
Endovascular repair of iliac artery aneurysm,
							 pseudoaneurysm, arteriovenous malformation, or trauma, radiological supervision
							 and interpretation
75956
I.C.
365.09
I.C.
Endovascular repair of descending thoracic aorta (eg,
							 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
I.C.
313.22
I.C.
Endovascular repair of descending thoracic aorta (eg,
							 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
I.C.
208.10
I.C.
Placement of proximal extension prosthesis for
							 endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm,
							 dissection, penetrating ulcer, intramural hematoma, or traumatic disruption),
							 radiological supervision and interpretation
75959
I.C.
182.16
I.C.
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
75960
464.53
43.30
421.22
Transcatheter introduction of intravascular stent(s)
							 (except coronary, carotid, and vertebral vessel), percutaneous and/or open,
							 radiological supervision and interpretation, each vessel
75961
548.22
216.44
331.78
Transcatheter retrieval, percutaneous, of
							 intravascular foreign body (eg, fractured venous or arterial catheter),
							 radiological supervision and interpretation
75962
491.61
28.08
463.53
Transluminal balloon angioplasty, peripheral artery,
							 radiological supervision and interpretation
75964
276.01
18.71
257.30
Transluminal balloon angioplasty, each additional
							 peripheral artery, radiological supervision and interpretation (List separately
							 in addition to code for primary procedure)
75966
540.43
70.00
470.43
Transluminal balloon angioplasty, renal or other
							 visceral artery, radiological supervision and interpretation
75968
277.09
19.33
257.76
Transluminal balloon angioplasty, each additional
							 visceral artery, radiological supervision and interpretation (List separately
							 in addition to code for primary procedure)
75970
I.C.
42.89
I.C.
Transcatheter biopsy, radiological supervision and
							 interpretation
75978
485.79
27.32
458.46
Transluminal balloon angioplasty, venous (eg,
							 subclavian stenosis), radiological supervision and interpretation
75980
I.C.
73.98
I.C.
Percutaneous transhepatic biliary drainage with
							 contrast monitoring, radiological supervision and interpretation
75982
I.C.
73.98
I.C.
Percutaneous placement of drainage catheter for
							 combined internal and external biliary drainage or of a drainage stent for
							 internal biliary drainage in patients with an inoperable mechanical biliary
							 obstruction, radiological supervision and interpretation
75984
131.88
36.53
95.35
Change of percutaneous tube or drainage catheter with
							 contrast monitoring (eg, genitourinary system, abscess), radiological
							 supervision and interpretation
75989
180.71
61.00
119.71
Radiological guidance (ie, fluoroscopy, ultrasound,
							 or computed tomography), for percutaneous drainage (eg, abscess, specimen
							 collection), with placement of catheter, radiological supervision and
							 interpretation
75992
I.C.
29.00
I.C.
Transluminal atherectomy, peripheral artery,
							 radiological supervision and interpretation
75993
I.C.
18.87
I.C.
Transluminal atherectomy, each additional peripheral
							 artery, radiological supervision and interpretation (List separately in
							 addition to code for primary procedure)
75994
I.C.
69.84
I.C.
Transluminal atherectomy, renal, radiological
							 supervision and interpretation
75995
I.C.
67.86
I.C.
Transluminal atherectomy, visceral, radiological
							 supervision and interpretation
75996
I.C.
18.41
I.C.
Transluminal atherectomy, each additional visceral
							 artery, radiological supervision and interpretation (List separately in
							 addition to code for primary procedure)
76000
103.02
8.41
94.61
Fluoroscopy (separate procedure), up to one hour
							 physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)
76001
I.C.
34.96
I.C.
Fluoroscopy, physician time more than one hour,
							 assisting a nonradiologic physician (eg, nephrostolithotomy, ERCP,
							 bronchoscopy, transbronchial biopsy)
76010
32.82
9.21
23.61
Radiologic examination from nose to rectum for
							 foreign body, single view, child
76080
74.23
27.78
46.45
Radiologic examination, abscess, fistula or sinus
							 tract study, radiological supervision and interpretation
76098
24.31
8.06
16.25
Radiological examination, surgical
							 specimen
76100
137.87
29.91
107.96
Radiologic examination, single plane body section
							 (eg, tomography), other than with urography
76101
186.04
29.45
156.59
Radiologic examination, complex motion (ie,
							 hypercycloidal) body section (eg, mastoid polytomography), other than with
							 urography; unilateral
76102
244.01
28.99
215.03
Radiologic examination, complex motion (ie,
							 hypercycloidal) body section (eg, mastoid polytomography), other than with
							 urography; bilateral
76120
85.80
19.56
66.24
Cineradiography/videoradiography, except where
							 specifically included
76125
I.C.
14.58
I.C.
Cineradiography/videoradiography to complement
							 routine examination (List separately in addition to code for primary
							 procedure)
76140
I.C.
I.C.
I.C.
Consultation on X-ray examination made elsewhere,
							 written report
76150
25.91
I.C.
I.C.
Xeroradiography
76350
I.C.
I.C.
I.C.
Subtraction in conjunction with contrast
							 studies
76376
122.60
10.65
111.94
3D rendering with interpretation and reporting of
							 computed tomography, magnetic resonance imaging, ultrasound, or other
							 tomographic modality; not requiring image postprocessing on an independent
							 workstation
76377
155.57
41.80
113.78
3D rendering with interpretation and reporting of
							 computed tomography, magnetic resonance imaging, ultrasound, or other
							 tomographic modality; requiring image postprocessing on an independent
							 workstation
76380
236.59
49.85
186.75
Computed tomography, limited or localized follow-up
							 study
76390
549.04
68.31
480.73
Magnetic resonance spectroscopy
76496
I.C.
I.C.
I.C.
Unlisted fluoroscopic procedure (eg, diagnostic,
							 interventional)
76497
I.C.
I.C.
I.C.
Unlisted computed tomography procedure (eg,
							 diagnostic, interventional)
76498
I.C.
I.C.
I.C.
Unlisted magnetic resonance procedure (eg,
							 diagnostic, interventional)
76499
I.C.
I.C.
I.C.
Unlisted diagnostic radiographic
							 procedure
76506
127.43
33.43
93.99
Echoencephalography, real time with image
							 documentation (gray scale) (for determination of ventricular size, delineation
							 of cerebral contents, and detection of fluid masses or other intracranial
							 abnormalities), including A-mode encephalography as secondary component where
							 indicated
76510
173.29
81.90
91.39
Ophthalmic ultrasound, diagnostic; B-scan and
							 quantitative A-scan performed during the same patient encounter
76511
122.09
49.56
72.52
Ophthalmic ultrasound, diagnostic; quantitative
							 A-scan only
76512
113.48
49.72
63.75
Ophthalmic ultrasound, diagnostic; B-scan (with or
							 without superimposed non-quantitative A-scan)
76513
103.00
35.10
67.90
Ophthalmic ultrasound, diagnostic; anterior segment
							 ultrasound, immersion (water bath) B-scan or high resolution
							 biomicroscopy
76514
13.31
9.33
3.98
Ophthalmic ultrasound, diagnostic; corneal
							 pachymetry, unilateral or bilateral (determination of corneal
							 thickness)
76516
81.13
28.40
52.73
Ophthalmic biometry by ultrasound echography,
							 A-scan;
76519
86.20
28.86
57.33
Ophthalmic biometry by ultrasound echography, A-scan;
							 with intraocular lens power calculation
76529
80.45
30.19
50.27
Ophthalmic ultrasonic foreign body
							 localization
76536
120.62
28.00
92.61
Ultrasound, soft tissues of head and neck (eg,
							 thyroid, parathyroid, parotid), real time with image documentation
76604
97.88
28.12
69.76
Ultrasound, chest (includes mediastinum), real time
							 with image documentation
76645
97.70
27.32
70.38
Ultrasound, breast(s) (unilateral or bilateral), real
							 time with image documentation
76700
153.21
41.28
111.92
Ultrasound, abdominal, real time with image
							 documentation; complete
76705
114.58
30.25
84.33
Ultrasound, abdominal, real time with image
							 documentation; limited (eg, single organ, quadrant, follow-up)
76770
147.75
37.67
110.08
Ultrasound, retroperitoneal (eg, renal, aorta,
							 nodes), real time with image documentation; complete
76775
115.62
29.91
85.71
Ultrasound, retroperitoneal (eg, renal, aorta,
							 nodes), real time with image documentation; limited
76776
160.40
38.82
121.59
Ultrasound, transplanted kidney, real time and duplex
							 Doppler with image documentation
76800
135.92
54.35
81.57
Ultrasound, spinal canal and contents
76801
151.37
49.73
101.64
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
86.53
42.43
44.10
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
164.71
49.73
114.99
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
111.22
49.39
61.83
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
248.00
96.11
151.89
Ultrasound, pregnant uterus, real time with image
							 documentation, fetal and maternal evaluation plus detailed fetal anatomic
							 examination, transabdominal approach; single or first gestation
76812
206.18
89.87
116.31
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
147.71
60.20
87.51
Ultrasound, pregnant uterus, real time with image
							 documentation, first trimester fetal nuchal translucency measurement,
							 transabdominal or transvaginal approach; single or first gestation
76814
92.43
48.65
43.78
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
104.66
32.76
71.90
Ultrasound, pregnant uterus, real time with image
							 documentation, limited (eg, fetal heart beat, placental location, fetal
							 position and/or qualitative amniotic fluid volume), one or more
							 fetuses
76816
119.47
43.11
76.36
Ultrasound, pregnant uterus, real time with image
							 documentation, follow-up (eg, 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
115.30
37.55
77.74
Ultrasound, pregnant uterus, real time with image
							 documentation, transvaginal
76818
137.47
53.46
84.01
Fetal biophysical profile; with non-stress
							 testing
76819
111.20
39.16
72.04
Fetal biophysical profile; without non-stress
							 testing
76820
75.88
25.80
50.09
Doppler velocimetry, fetal; umbilical
							 artery
76821
114.93
35.85
79.08
Doppler velocimetry, fetal; middle cerebral
							 artery
76825
222.13
84.43
137.70
Echocardiography, fetal, cardiovascular system, real
							 time with image documentation (2D), with or without M-mode
							 recording;
76826
117.27
41.67
75.60
Echocardiography, fetal, cardiovascular system, real
							 time with image documentation (2D), with or without M-mode recording; follow-up
							 or repeat study
76827
93.04
29.15
63.89
Doppler echocardiography, fetal, pulsed wave and/or
							 continuous wave with spectral display; complete
76828
67.52
28.76
38.76
Doppler echocardiography, fetal, pulsed wave and/or
							 continuous wave with spectral display; follow-up or repeat study
76830
131.48
35.04
96.43
Ultrasound, transvaginal
76831
132.04
36.07
95.97
Saline infusion sonohysterography (SIS), including
							 color flow Doppler, when performed
76856
131.94
35.04
96.89
Ultrasound, pelvic (nonobstetric), real time with
							 image documentation; complete
76857
114.79
19.56
95.24
Ultrasound, pelvic (nonobstetric), real time with
							 image documentation; limited or follow-up (eg, for follicles)
76870
130.69
32.88
97.82
Ultrasound, scrotum and contents
76872
157.55
35.80
121.75
Ultrasound, transrectal;
76873
198.50
79.55
118.95
Ultrasound, transrectal; prostate volume study for
							 brachytherapy treatment planning (separate procedure)
76880
133.91
29.79
104.12
Ultrasound, extremity, nonvascular, real time with
							 image documentation
76885
144.23
37.21
107.02
Ultrasound, infant hips, real time with imaging
							 documentation; dynamic (requiring physician manipulation)
76886
114.22
31.73
82.49
Ultrasound, infant hips, real time with imaging
							 documentation; limited, static (not requiring physician
							 manipulation)
76930
114.85
36.82
78.02
Ultrasonic guidance for pericardiocentesis, imaging
							 supervision and interpretation
76932
I.C.
37.28
I.C.
Ultrasonic guidance for endomyocardial biopsy,
							 imaging supervision and interpretation
76936
383.52
103.60
279.92
Ultrasound guided compression repair of arterial
							 pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound
							 evaluation, compression of lesion and imaging)
76937
39.46
15.74
23.71
Ultrasound guidance for vascular access requiring
							 ultrasound evaluation of potential access sites, documentation of selected
							 vessel patency, concurrent realtime ultrasound visualization of vascular needle
							 entry, with permanent recording and reporting (List separately in addition to
							 code for primary procedure)
76940
I.C.
107.50
I.C.
Ultrasound guidance for, and monitoring of,
							 parenchymal tissue ablation
76941
I.C.
67.64
I.C.
Ultrasonic guidance for intrauterine fetal
							 transfusion or cordocentesis, imaging supervision and
							 interpretation
76942
206.74
34.36
172.38
Ultrasonic guidance for needle placement (eg, biopsy
							 aspiration, injection, localization device), imaging supervision and
							 interpretation
76945
I.C.
33.44
I.C.
Ultrasonic guidance for chorionic villus sampling,
							 imaging supervision and interpretation
76946
64.90
19.10
45.80
Ultrasonic guidance for amniocentesis, imaging
							 supervision and interpretation
76948
64.44
18.64
45.80
Ultrasonic guidance for aspiration of ova, imaging
							 supervision and interpretation
76950
84.94
29.45
55.49
Ultrasonic guidance for placement of radiation
							 therapy fields
76965
222.54
69.32
153.22
Ultrasonic guidance for interstitial radioelement
							 application
76970
88.78
19.78
69.00
Ultrasound study follow-up (specify)
76975
I.C.
42.20
I.C.
Gastrointestinal endoscopic ultrasound, supervision
							 and interpretation
76977
25.60
2.93
22.67
Ultrasound bone density measurement and
							 interpretation, peripheral site(s), any method
76998
I.C.
62.36
I.C.
Ultrasonic guidance, intraoperative
76999
I.C.
I.C.
I.C.
Unlisted ultrasound procedure (eg, diagnostic,
							 interventional)
77001
112.01
19.26
92.75
Fluoroscopic guidance for central venous access
							 device placement, replacement (catheter only or complete), or removal (includes
							 fluoroscopic guidance for vascular access and catheter manipulation, any
							 necessary contrast injections through access site or catheter with related
							 venographyradiologic supervision and interpretation, and radiographic
							 documentation of final catheter position) (List separately in addition to code
							 for primary procedure)
77002
83.27
26.40
56.87
Fluoroscopic guidance for needle placement (eg,
							 biopsy, aspiration, injection, localization device)
77003
74.57
28.29
46.29
Fluoroscopic guidance and localization of needle or
							 catheter tip for spine or paraspinous diagnostic or therapeutic injection
							 procedures (epidural, transforaminal epidural, subarachnoid, paravertebral
							 facet joint, paravertebral facet joint nerve, or sacroiliac joint), including
							 neurolytic agent destruction
77011
721.43
61.22
660.21
Computed tomography guidance for stereotactic
							 localization
77012
306.39
59.52
246.87
Computed tomography guidance for needle placement
							 (eg, biopsy, aspiration, injection, localization device), radiological
							 supervision and interpretation
77013
I.C.
204.22
I.C.
Computed tomography guidance for, and monitoring of,
							 parenchymal tissue ablation
77014
212.69
43.11
169.58
Computed tomography guidance for placement of
							 radiation therapy fields
77021
563.36
77.39
485.97
Magnetic resonance guidance for needle placement (eg,
							 for biopsy, needle aspiration, injection, or placement of localization device)
							 radiological supervision and interpretation
77022
I.C.
218.70
I.C.
Magnetic resonance guidance for, and monitoring of,
							 parenchymal tissue ablation
77031
288.09
81.38
206.71
Stereotactic localization guidance for breast biopsy
							 or needle placement (eg, for wire localization or for injection), each lesion,
							 radiological supervision and interpretation
77032
75.67
28.46
47.21
Mammographic guidance for needle placement, breast
							 (eg, for wire localization or for injection), each lesion, radiological
							 supervision and interpretation
77051
17.38
3.27
14.11
Computer-aided detection (computer algorithm analysis
							 of digital image data for lesion detection) with further physician review for
							 interpretation, with or without digitization of film radiographic images;
							 diagnostic mammography (List separately in addition to code for primary
							 procedure)
77052
17.38
3.27
14.11
Computer-aided detection (computer algorithm analysis
							 of digital image data for lesion detection) with further physician review for
							 interpretation, with or without digitization of film radiographic images;
							 screening mammography (List separately in addition to code for primary
							 procedure)
77053
108.68
18.41
90.27
Mammary ductogram or galactogram, single duct,
							 radiological supervision and interpretation
77054
147.78
22.87
124.91
Mammary ductogram or galactogram, multiple ducts,
							 radiological supervision and interpretation
77055
93.80
35.85
57.95
Mammography; unilateral
77056
118.61
44.25
74.36
Mammography; bilateral
77057
94.10
35.85
58.25
Screening mammography, bilateral (2-view film study
							 of each breast)
77058
1,001.75
83.07
918.68
Magnetic resonance imaging, breast, without and/or
							 with contrast material(s); unilateral
77059
1,154.49
83.07
1,071.42
Magnetic resonance imaging, breast, without and/or
							 with contrast material(s); bilateral
77071
37.89
I.C.
I.C.
Manual application of stress performed by physician
							 for joint radiography, including contralateral joint if indicated
77072
26.72
9.55
17.17
Bone age studies
77073
46.92
14.12
32.80
Bone length studies (orthoroentgenogram,
							 scanogram)
77074
77.60
23.33
54.27
Radiologic examination, osseous survey; limited (eg,
							 for metastases)
77075
111.65
27.78
83.87
Radiologic examination, osseous survey; complete
							 (axial and appendicular skeleton)
77076
97.64
35.39
62.26
Radiologic examination, osseous survey,
							 infant
77077
55.79
15.79
40.00
Joint survey, single view, two or more joints
							 (specify)
77078
192.22
12.52
179.70
Computed tomography, bone mineral density study, one
							 or more sites; axial skeleton (eg, hips, pelvis, spine)
77079
97.68
11.03
86.65
Computed tomography, bone mineral density study, one
							 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist,
							 heel)
77080
111.18
10.81
100.37
Dual-energy X-ray absorptiometry (DXA), bone density
							 study, one or more sites; axial skeleton (eg, hips, pelvis, spine)
77081
39.23
11.03
28.20
Dual-energy X-ray absorptiometry (DXA), bone density
							 study, one or more sites; appendicular skeleton (peripheral) (eg, radius,
							 wrist, heel)
77082
37.98
8.41
29.58
Dual-energy X-ray absorptiometry (DXA), bone density
							 study, one or more sites; vertebral fracture assessment
77083
35.78
9.89
25.89
Radiographic absorptiometry (eg, photodensitometry,
							 radiogrammetry), one or more sites
77084
656.67
80.66
576.01
Magnetic resonance (eg, proton) imaging, bone marrow
							 blood supply
77261
72.11
I.C.
I.C.
Therapeutic radiology treatment planning;
							 simple
77262
108.48
I.C.
I.C.
Therapeutic radiology treatment planning;
							 intermediate
77263
161.26
I.C.
I.C.
Therapeutic radiology treatment planning;
							 complex
77280
217.83
35.69
182.14
Therapeutic radiology simulation-aided field setting;
							 simple
77285
367.16
53.00
314.16
Therapeutic radiology simulation-aided field setting;
							 intermediate
77290
536.56
78.68
457.88
Therapeutic radiology simulation-aided field setting;
							 complex
77295
1,055.25
230.71
824.54
Therapeutic radiology simulation-aided field setting;
							 3-dimensional
77299
I.C.
I.C.
I.C.
Unlisted procedure, therapeutic radiology clinical
							 treatment planning
77300
86.76
31.27
55.49
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
2,353.93
404.01
1,949.93
Intensity modulated radiotherapy plan, including
							 dose-volume histograms for target and critical structure partial tolerance
							 specifications
77305
97.44
35.69
61.75
Teletherapy, isodose plan (whether hand or computer
							 calculated); simple (one or two parallel opposed unmodified ports directed to a
							 single area of interest)
77310
131.46
53.00
78.46
Teletherapy, isodose plan (whether hand or computer
							 calculated); intermediate (three or more treatment ports directed to a single
							 area of interest)
77315
180.45
78.68
101.78
Teletherapy, isodose plan (whether hand or computer
							 calculated); complex (mantle or inverted Y, tangential ports, the use of
							 wedges, compensators, complex blocking, rotational beam, or special beam
							 considerations)
77321
175.09
48.20
126.89
Special teletherapy port plan, particles, hemibody,
							 total body
77326
166.95
47.06
119.89
Brachytherapy isodose plan; simple (calculation made
							 from single plane, one to four sources/ribbon application, remote afterloading
							 brachytherapy, one to eight sources)
77327
239.53
70.27
169.26
Brachytherapy isodose plan; intermediate (multiplane
							 dosage calculations, application involving five to ten sources/ribbons, remote
							 afterloading brachytherapy, nine to 12 sources)
77328
332.54
105.96
226.59
Brachytherapy isodose plan; complex (multiplane
							 isodose plan, volume implant calculations, over ten sources/ribbons used,
							 special spatial reconstruction, remote afterloading brachytherapy, over 12
							 sources)
77331
67.87
43.79
24.07
Special dosimetry (eg, TLD, microdosimetry)
							 (specify), only when prescribed by the treating physician
77332
91.86
27.16
64.70
Treatment devices, design and construction; simple
							 (simple block, simple bolus)
77333
94.85
42.31
52.55
Treatment devices, design and construction;
intermediate (multiple blocks, stents, bite blocks,
							 special bolus)
77373
1,967.92
Stereotactic body radiation therapy, treatment
							 delivery, per fraction to one or more lesions, including image guidance, entire
							 course not to exceed five fractions
77399
I.C.
Unlisted procedure, medical radiation physics,
							 dosimetry and treatment devices, and special services
77401
54.85
Radiation treatment delivery, superficial and/or
							 ortho voltage
77402
144.14
Radiation treatment delivery, single treatment area,
							 single port or parallel opposed ports, simple blocks or no blocks; up to 5
							 MeV
77403
130.80
Radiation treatment delivery, single treatment area,
							 single port or parallel opposed ports, simple blocks or no blocks; 6-10
							 MeV
77404
140.92
Radiation treatment delivery, single treatment area,
							 single port or parallel opposed ports, simple blocks or no blocks; 11-19
							 MeV
77406
141.84
Radiation treatment delivery, single treatment area,
							 single port or parallel opposed ports, simple blocks or no blocks; 20 MeV or
							 greater
77407
184.95
Radiation treatment delivery, two separate treatment
							 areas, three or more ports on a single treatment area, use of multiple blocks;
							 up to 5 MeV
77408
171.14
Radiation treatment delivery, two separate treatment
							 areas, three or more ports on a single treatment area, use of multiple blocks;
							 6-10 MeV
77409
184.49
Radiation treatment delivery, two separate treatment
							 areas, three or more ports on a single treatment area, use of multiple blocks;
							 11-19 MeV
77411
184.03
Radiation treatment delivery, two separate treatment
							 areas, three or more ports on a single treatment area, use of multiple blocks;
							 20 MeV or greater
77412
213.78
Radiation treatment delivery, three or more separate
							 treatment areas, custom blocking, tangential ports, wedges, rotational beam,
							 compensators, electron beam; up to 5 MeV
77413
215.63
Radiation treatment delivery, three or more separate
							 treatment areas, custom blocking, tangential ports, wedges, rotational beam,
							 compensators, electron beam; 6-10 MeV
77414
235.42
Radiation treatment delivery, three or more separate
							 treatment areas, custom blocking, tangential ports, wedges, rotational beam,
							 compensators, electron beam; 11-19 MeV
77416
235.42
Radiation treatment delivery, three or more separate
							 treatment areas, custom blocking, tangential ports, wedges, rotational beam,
							 compensators, electron beam; 20 MeV or greater
77417
23.29
Therapeutic radiology port film(s)
77418
721.94
Intensity modulated treatment delivery, single or
							 multiple fields/arcs, via narrow spatially and temporally modulated beams,
							 binary, dynamic MLC, per treatment session
77421
151.78
19.90
131.88
Stereoscopic X-ray guidance for localization of
							 target volume for the delivery of radiation therapy
77422
166.38
High energy neutron radiation treatment delivery;
							 single treatment area using a single port or parallel-opposed ports with no
							 blocks or simple blocking
77423
227.59
High energy neutron radiation treatment delivery; one
							 or more isocenter(s) with coplanar or non-coplanar geometry with blocking
							 and/or wedge, and/or compensator(s)
77427
187.58
Radiation treatment management, five
							 treatments
77431
98.10
Radiation therapy management with complete course of
							 therapy consisting of one or two fractions only
77432
409.28
Stereotactic radiation treatment management of
							 cranial lesion(s) (complete course of treatment consisting of one
							 session)
77435
683.04
Stereotactic body radiation therapy, treatment
							 management, per treatment course, to one or more lesions, including image
							 guidance, entire course not to exceed five fractions
77470
409.01
105.96
303.06
Special treatment procedure (eg, total body
							 irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone
							 irradiation)
77499
I.C.
I.C.
I.C.
Unlisted procedure, therapeutic radiology treatment
							 management
77520
I.C.
Proton treatment delivery; simple, without
							 compensation
77522
I.C.
Proton treatment delivery; simple, with
							 compensation
77523
I.C.
Proton treatment delivery; intermediate
77525
I.C.
Proton treatment delivery; complex
77600
378.05
78.68
299.38
Hyperthermia, externally generated; superficial (ie,
							 heating to a depth of 4 cm or less)
77605
616.68
103.77
512.90
Hyperthermia, externally generated; deep (ie, heating
							 to depths greater than 4 cm)
77610
555.26
75.45
479.81
Hyperthermia generated by interstitial probe(s); five
							 or fewer interstitial applicators
77615
786.40
104.57
681.83
Hyperthermia generated by interstitial probe(s); more
							 than five interstitial applicators
77620
388.09
80.43
307.66
Hyperthermia generated by intracavitary
							 probe(s)
77750
349.94
249.81
100.14
Infusion or instillation of radioelement solution
							 (includes three months follow-up care)
77761
369.08
189.97
179.10
Intracavitary radiation source application;
							 simple
77762
511.05
289.95
221.11
Intracavitary radiation source application;
							 intermediate
77763
718.00
434.48
283.52
Intracavitary radiation source application;
							 complex
77776
420.48
232.93
187.55
Interstitial radiation source application;
							 simple
77777
608.18
378.35
229.83
Interstitial radiation source application;
							 intermediate
77778
869.35
567.59
301.75
Interstitial radiation source application;
							 complex
77781
656.36
64.88
591.48
Remote afterloading high intensity brachytherapy; one
							 - four source positions or catheters
77782
876.75
107.15
769.60
Remote afterloading high intensity brachytherapy;
							 five - eight source positions or catheters
77783
1,201.32
169.35
1,031.96
Remote afterloading high intensity brachytherapy;
							 nine-12 source positions or catheters
77784
1,777.12
264.62
1,512.50
Remote afterloading high intensity brachytherapy;
							 over 12 source positions or catheters
77789
106.68
58.21
48.47
Surface application of radiation source
77790
90.88
53.00
37.88
Supervision, handling, loading of radiation
							 source
77799
I.C.
I.C.
I.C.
Unlisted procedure, clinical
							 brachytherapy
78000
74.87
9.55
65.32
Thyroid uptake; single determination
78001
96.43
13.32
83.11
Thyroid uptake; multiple determinations
78003
82.41
16.63
65.78
Thyroid uptake; stimulation, suppression or discharge
							 (not including initial uptake studies)
78006
222.83
24.69
198.14
Thyroid imaging, with uptake; single
							 determination
78007
155.35
25.50
129.85
Thyroid imaging, with uptake; multiple
							 determinations
78010
158.52
19.90
138.62
Thyroid imaging; only
78011
183.26
22.87
160.39
Thyroid imaging; with vascular flow
78015
215.77
34.36
181.40
Thyroid carcinoma metastases imaging; limited area
							 (eg, neck and chest only)
78016
317.37
41.78
275.58
Thyroid carcinoma metastases imaging; with additional
							 studies (eg, urinary recovery)
78018
353.63
44.37
309.26
Thyroid carcinoma metastases imaging; whole
							 body
78020
101.69
30.75
70.94
Thyroid carcinoma metastases uptake (List separately
							 in addition to code for primary procedure)
78070
217.53
42.08
175.44
Parathyroid imaging
78075
433.00
37.67
395.33
Adrenal imaging, cortex and/or medulla
78099
I.C.
I.C.
I.C.
Unlisted endocrine procedure, diagnostic nuclear
							 medicine
78102
170.73
28.12
142.60
Bone marrow imaging; limited area
78103
235.97
38.47
197.49
Bone marrow imaging; multiple areas
78104
278.30
41.10
237.20
Bone marrow imaging; whole body
78110
81.31
10.01
71.30
Plasma volume, radiopharmaceutical volume-dilution
							 technique (separate procedure); single sampling
78111
122.48
11.49
110.98
Plasma volume, radiopharmaceutical volume-dilution
							 technique (separate procedure); multiple samplings
78120
101.67
11.83
89.83
Red cell volume determination (separate procedure);
							 single sampling
78121
136.02
16.29
119.73
Red cell volume determination (separate procedure);
							 multiple samplings
78122
184.72
23.33
161.39
Whole blood volume determination, including separate
							 measurement of plasma volume and red cell volume (radiopharmaceutical
							 volume-dilution technique)
78130
176.90
31.39
145.50
Red cell survival study;
78135
347.38
32.88
314.50
Red cell survival study; differential organ/tissue
							 kinetics (eg, splenic and/or hepatic sequestration)
78140
190.96
31.39
159.57
Labeled red cell sequestration, differential
							 organ/tissue (eg, splenic and/or hepatic)
78185
195.36
20.70
174.66
Spleen imaging only, with or without vascular
							 flow
78190
381.85
54.34
327.51
Kinetics, study of platelet survival, with or without
							 differential organ/tissue localization
78191
287.35
31.39
255.96
Platelet survival study
78195
352.23
61.64
290.59
Lymphatics and lymph nodes imaging
78199
I.C.
I.C.
I.C.
Unlisted hematopoietic, reticuloendothelial and
							 lymphatic procedure, diagnostic nuclear medicine
78201
183.38
22.07
161.31
Liver imaging; static only
78202
215.53
25.84
189.69
Liver imaging; with vascular flow
78205
297.25
36.19
261.07
Liver imaging (SPECT);
78206
378.80
49.17
329.64
Liver imaging (SPECT); with vascular flow
78215
204.26
25.15
179.10
Liver and spleen imaging; static only
78216
175.51
28.81
146.70
Liver and spleen imaging; with vascular
							 flow
78220
183.20
24.69
158.51
Liver function study with hepatobiliary agents, with
							 serial images
78223
322.33
43.23
279.10
Hepatobiliary ductal system imaging, including
							 gallbladder, with or without pharmacologic intervention, with or without
							 quantitative measurement of gallbladder function
78230
169.45
22.87
146.58
Salivary gland imaging;
78231
164.76
26.18
138.58
Salivary gland imaging; with serial
							 images
78232
171.17
24.01
147.16
Salivary gland function study
78258
229.66
38.13
191.53
Esophageal motility
78261
269.02
35.50
233.51
Gastric mucosa imaging
78262
270.98
34.24
236.74
Gastroesophageal reflux study
78264
300.17
39.96
260.21
Gastric emptying study
78267
I.C.
Urea breath test, C-14 (isotopic); acquisition for
							 analysis
78268
I.C.
Urea breath test, C-14 (isotopic);
							 analysis
78270
92.06
10.35
81.71
Vitamin B-12 absorption study (eg, Schilling test);
							 without intrinsic factor
78271
92.98
9.89
83.09
Vitamin B-12 absorption study (eg, Schilling test);
							 with intrinsic factor
78272
116.52
13.20
103.32
Vitamin B-12 absorption studies combined, with and
							 without intrinsic factor
78278
360.55
50.65
309.90
Acute gastrointestinal blood loss imaging
78282
I.C.
19.56
I.C.
Gastrointestinal protein loss
78290
300.94
35.16
265.78
Intestine imaging (eg, ectopic gastric mucosa,
							 Meckel's localization, volvulus)
78291
255.13
45.05
210.08
Peritoneal-venous shunt patency test (eg, for LeVeen,
							 Denver shunt)
78299
I.C.
I.C.
I.C.
Unlisted gastrointestinal procedure, diagnostic
							 nuclea medicine
78300
185.52
31.73
153.79
Bone and/or joint imaging; limited area
78305
252.03
42.43
209.60
Bone and/or joint imaging; multiple areas
78306
282.03
44.37
237.66
Bone and/or joint imaging; whole body
78315
359.27
52.13
307.14
Bone and/or joint imaging; three phase
							 study
78320
313.88
53.28
260.61
Bone and/or joint imaging; tomographic
							 (SPECT)
78350
40.15
10.57
29.58
Bone density (bone mineral content) study, one or
							 more sites; single photon absorptiometry
78351
14.69
Bone density (bone mineral content) study, one or
							 more sites; dual photon absorptiometry, one or more sites
78399
I.C.
I.C.
I.C.
Unlisted musculoskeletal procedure, diagnostic
							 nuclear medicine
78414
I.C.
23.79
I.C.
Determination of central c-v hemodynamics
							 (non-imaging) (eg, ejection fraction with probe technique) with or without
							 pharmacologic intervention or exercise, single or multiple
							 determinations
78428
210.94
42.26
168.68
Cardiac shunt detection
78445
170.68
25.15
145.52
Non-cardiac vascular flow imaging (ie, angiography,
							 venography)
78456
346.44
51.91
294.53
Acute venous thrombosis imaging, peptide
78457
205.83
38.70
167.14
Venous thrombosis imaging, venogram;
							 unilateral
78458
242.13
46.20
195.93
Venous thrombosis imaging, venogram;
							 bilateral
78459
I.C.
79.87
I.C.
Myocardial imaging, positron emission tomography
							 (PET), metabolic evaluation
78460
202.46
44.37
158.09
Myocardial perfusion imaging; (planar) single study,
							 at rest or stress (exercise and/or pharmacologic), with or without
							 quantification
78461
263.18
63.75
199.43
Myocardial perfusion imaging; multiple studies
							 (planar), at rest and/or stress (exercise and/or pharmacologic), and
							 redistribution and/or rest injection, with or without
							 quantification
78464
356.05
58.67
297.39
Myocardial perfusion imaging; tomographic (SPECT),
							 single study (including attenuation correction when performed), at rest or
							 stress (exercise and/or pharmacologic), with or without
							 quantification
78465
616.75
79.42
537.32
Myocardial perfusion imaging; tomographic (SPECT),
							 multiple studies (including attenuation correction when performed), at rest
							 and/or stress (exercise and/or pharmacologic) and redistribution and/or rest
							 injection, with or without quantification
78466
199.88
36.43
163.45
Myocardial imaging, infarct avid, planar; qualitative
							 or quantitative
78468
259.45
43.40
216.04
Myocardial imaging, infarct avid, planar; with
							 ejection fraction by first pass technique
78469
313.19
49.80
263.39
Myocardial imaging, infarct avid, planar; tomographic
							 SPECT with or without quantification
78472
317.06
51.69
265.37
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
445.23
78.69
366.55
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
78478
80.51
28.72
51.79
Myocardial perfusion study with wall motion,
							 qualitative or quantitative study (List separately in addition to code for
							 primary procedure)
78480
70.91
19.13
51.79
Myocardial perfusion study with ejection fraction
							 (List separately in addition to code for primary procedure)
78481
288.08
54.15
233.93
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
415.63
82.07
333.57
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
I.C.
81.09
I.C.
Myocardial imaging, positron emission tomography
							 (PET), perfusion; single study at rest or stress
78492
I.C.
103.69
I.C.
Myocardial imaging, positron emission tomography
							 (PET), perfusion; multiple studies at rest and/or stress
78494
366.87
64.22
302.65
Cardiac blood pool imaging, gated equilibrium, SPECT,
							 at rest, wall motion study plus ejection fraction, with or without quantitative
							 processing
78496
213.54
26.88
186.66
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)
78499
I.C.
I.C.
I.C.
Unlisted cardiovascular procedure, diagnostic nuclea
							 medicine
78580
234.54
38.13
196.41
Pulmonary perfusion imaging, particulate
78584
191.07
50.65
140.42
Pulmonary perfusion imaging, particulate, with
							 ventilation; single breath
78585
384.63
55.75
328.89
Pulmonary perfusion imaging, particulate, with
							 ventilation; rebreathing and washout, with or without single breath
78586
176.79
20.24
156.55
Pulmonary ventilation imaging, aerosol; single
							 projection
78587
215.30
25.15
190.15
Pulmonary ventilation imaging, aerosol; multiple
							 projections (eg, anterior, posterior, lateral views)
78588
325.34
55.75
269.60
Pulmonary perfusion imaging, particulate, with
							 ventilation imaging, aerosol, one or multiple projections
78591
183.23
20.70
162.53
Pulmonary ventilation imaging, gaseous, single
							 breath, single projection
78593
216.50
24.69
191.81
Pulmonary ventilation imaging, gaseous, with
							 rebreathing and washout with or without single breath; single
							 projection
78594
266.92
26.98
239.94
Pulmonary ventilation imaging, gaseous, with
							 rebreathing and washout with or without single breath; multiple projections
							 (eg, anterior, posterior, lateral views)
78596
428.32
63.73
364.59
Pulmonary quantitative differential function
							 (ventilation/perfusion) study
78599
I.C.
I.C.
I.C.
Unlisted respiratory procedure, diagnostic nuclear
							 medicine
78600
190.58
22.53
168.06
Brain imaging, less than four static
							 views;
78601
229.15
25.84
203.32
Brain imaging, less than four static views; with
							 vascular flow
78605
218.33
27.44
190.89
Brain imaging, minimum four static views;
78606
319.48
32.42
287.07
Brain imaging, minimum four static views; with
							 vascular flow
78607
413.47
62.83
350.64
Brain imaging, tomographic (SPECT)
78608
I.C.
76.03
I.C.
Brain imaging, positron emission tomography (PET)
							 metabolic evaluation
78609
75.57
75.57
I.C.
Brain imaging, positron emission tomography (PET);
							 perfusion evaluation
78610
208.70
16.53
192.17
Brain imaging, vascular flow only
78630
352.57
34.70
317.86
Cerebrospinal fluid flow, imaging (not including
							 introduction of material); cisternography
78635
292.13
31.55
260.57
Cerebrospinal fluid flow, imaging (not including
							 introduction of material); ventriculography
78645
303.93
28.81
275.12
Cerebrospinal fluid flow, imaging (not including
							 introduction of material); shunt evaluation
78647
380.91
45.74
335.17
Cerebrospinal fluid flow, imaging (not including
							 introduction of material); tomographic (SPECT)
78650
337.77
31.39
306.38
Cerebrospinal fluid leakage detection and
							 localization
78660
173.26
26.98
146.28
Radiopharmaceutical dacryocystography
78699
I.C.
I.C.
I.C.
Unlisted nervous system procedure, diagnostic nuclea
							 medicine
78700
195.67
23.33
172.34
Kidney imaging morphology;
78701
232.61
25.15
207.46
Kidney imaging morphology; with vascular
							 flow
78707
277.46
49.17
228.29
Kidney imaging morphology; with vascular flow and
							 function, single study without pharmacological intervention
78708
242.10
62.14
179.96
Kidney imaging morphology; with vascular flow and
							 function, single study, with pharmacological intervention (eg, angiotensin
							 converting enzyme inhibitor and/or diuretic)
78709
374.89
72.03
302.86
Kidney imaging morphology; with vascular flow and
							 function, multiple studies, with and without pharmacological intervention (eg,
							 angiotensin converting enzyme inhibitor and/or diuretic)
78710
295.55
33.56
261.99
Kidney imaging morphology; tomographic
							 (SPECT)
78725
115.37
19.56
95.81
Kidneyfunction study, non-imaging radioisotopic
							 study
78730
90.05
9.86
80.19
Urinary bladder residual study (List separately in
							 addition to code for primary procedure)
78740
207.15
29.11
178.04
Ureteral reflux study (radiopharmaceutical voiding
							 cystogram)
78761
225.40
36.19
189.21
Testicular imaging with vascular flow
78799
I.C.
I.C.
I.C.
Unlisted genitourinary procedure, diagnostic nuclear
							 medicine
78800
212.78
33.86
178.92
Radiopharmaceutical localization of tumor or
							 distribution of radiopharmaceutical agent(s); limited
area
78801
277.63
40.90
236.74
Radiopharmaceutical localization of tumor or
							 distribution of radiopharmaceutical agent(s); multiple
areas
78802
360.83
43.91
316.92
Radiopharmaceutical localization of tumor or
							 distribution of radiopharmaceutical agent(s); whole body, single day
							 imaging
78803
405.46
56.21
349.26
Radiopharmaceutical localization of tumor or
							 distribution of radiopharmaceutical agent(s); tomographic (SPECT)
78804
651.53
54.76
596.77
Radiopharmaceutical localization of tumor or
							 distribution of radiopharmaceutical agent(s); whole body, requiring two or more
							 days imaging
78805
212.57
37.33
175.24
Radiopharmaceutical localization of inflammatory
							 process; limited area
78806
388.11
43.91
344.20
Radiopharmaceutical localization of inflammatory
							 process; whole body
78807
404.70
55.91
348.80
Radiopharmaceutical localization of inflammatory
							 process; tomographic (SPECT)
78811
I.C.
80.27
I.C.
Positron emission tomography (PET) imaging; limited
							 area (eg, chest, head/neck)
78812
I.C.
99.57
I.C.
Positron emission tomography (PET) imaging; skull
							 base to mid-thigh
78813
I.C.
103.34
I.C.
Positron emission tomography (PET) imaging; whole
							 body
78814
I.C.
112.93
I.C.
Positron emission tomography (PET) with concurrently
							 acquired computed tomography (CT) for attenuation correction and anatomical
							 localization imaging; limited area (eg, chest, head/neck)
78815
I.C.
125.27
I.C.
Positron emission tomography (PET) with concurrently
							 acquired computed tomography (CT) for attenuation correction and anatomical
							 localization imaging; skull base to mid-thigh
78816
I.C.
128.24
I.C.
Positron emission tomography (PET) with concurrently
							 acquired computed tomography (CT) for attenuation correction and anatomical
							 localization imaging; whole body
78890
43.39
2.93
40.46
Generation of automated data: interactive process
							 involving nuclear physician and/or allied health professional personnel; simple
							 manipulations and interpretation, not to exceed 30 minutes
78891
89.08
5.09
83.99
Generation of automated data: interactive process
							 involving nuclear physician and/or allied health professional personnel;
							 complex manipulations and interpretation, exceeding 30 minutes
78999
I.C.
I.C.
I.C.
Unlisted miscellaneous procedure, diagnostic nuclear
							 medicine
79005
184.96
91.01
93.95
Radiopharmaceutical therapy, by oral
							 administration
79101
199.17
101.54
97.63
Radiopharmaceutical therapy, by intravenous
							 administration
79200
202.34
101.48
100.86
Radiopharmaceutical therapy, by intracavitary
							 administration
79300
I.C.
83.84
I.C.
Radiopharmaceutical therapy, by interstitial
							 radioactive colloid administration
79403
269.97
117.56
152.41
Radiopharmaceutical therapy, radiolabeled monoclonal
							 antibody by intravenous infusion
79440
193.75
102.56
91.19
Radiopharmaceutical therapy, by intra-articular
							 administration
79445
I.C.
123.74
I.C.
Radiopharmaceutical therapy, by intra-arterial
							 particulate administration
79999
I.C.
I.C.
I.C.
Radiopharmaceutical therapy, unlisted
							 procedure
(8)
Freestanding Ambulatory Surgical Services / Surgery
.
Code
ASC
Rate
Incl
GL Fee
PC
Fee
TC
Fee
40.06(8) - Surgical Services
							 Description
10021
49.59
146.24
Fine needle aspiration; without imaging
							 guidance
10022
193.36
153.93
Fine needle aspiration; with imaging
							 guidance
10040
35.44
95.98
Acne surgery (eg, marsupialization, opening or
							 removal of multiple milia, comedones, cysts, pustules)
10060
49.64
106.83
Incision and drainage of abscess (eg, carbuncle,
							 suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or
							 paronychia); simple or single
10061
62.85
180.17
Incision and drainage of abscess (eg, carbuncle,
							 suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or
							 paronychia); complicated or multiple
10080
62.85
176.95
Incision and drainage of pilonidal cyst;
							 simple
10081
138.64
265.51
Incision and drainage of pilonidal cyst;
							 complicated
10120
62.85
140.41
Incision and removal of foreign body, subcutaneous
							 tissues; simple
10121
719.48
263.98
Incision and removal of foreign body, subcutaneous
							 tissues; complicated
10140
73.92
151.59
Incision and drainage of hematoma, seroma or fluid
							 collection
10160
63.25
125.02
Puncture aspiration of abscess, hematoma, bulla, or
							 cyst
10180
818.67
231.60
Incision and drainage, complex, postoperative wound
							 infection
11000
23.90
52.50
Debridement of extensive eczematous or infected skin;
							 up to 10% of body surface
11001
8.46
22.03
Debridement of extensive eczematous or infected skin;
							 each additional 10% of the body surface (List separately in addition to code
							 for primary procedure)
11004
552.23
Debridement of skin, subcutaneous tissue, muscle and
							 fascia for necrotizing soft tissue infection; external genitalia and
							 perineum
11005
729.92
Debridement of skin, subcutaneous tissue, muscle and
							 fascia for necrotizing soft tissue infection; abdominal wall, with or without
							 fascial closure
11006
688.17
Debridement of skin, subcutaneous tissue, muscle and
							 fascia for necrotizing soft tissue infection; external genitalia, perineum and
							 abdominal wall, with or without fascial closure
11008
265.41
Removal of prosthetic material or mesh, abdominal
							 wall for infection (eg, for chronic or recurrent mesh infection or necrotizing
							 soft tissue infection) (List separately in addition to code for primary
							 procedure)
11010
192.34
477.68
Debridement including removal of foreign material
							 associated with open fracture(s) and/or dislocation(s); skin and subcutaneous
							 tissues
11011
192.34
540.66
Debridement including removal of foreign material
							 associated with open fracture(s) and/or dislocation(s); skin, subcutaneous
							 tissue, muscle fascia, and muscle
11012
192.34
755.39
Debridement including removal of foreign material
							 associated with open fracture(s) and/or dislocation(s); skin, subcutaneous
							 tissue, muscle fascia, muscle, and bone
11040
22.06
46.49
Debridement; skin, partial thickness
11041
25.38
55.24
Debridement; skin, full thickness
11042
118.89
75.40
Debridement; skin, and subcutaneous
							 tissue
11043
118.89
271.72
Debridement; skin, subcutaneous tissue, and
							 muscle
11044
307.53
367.25
Debridement; skin, subcutaneous tissue, muscle, and
							 bone
11055
25.01
47.48
Paring or cutting of benign hyperkeratotic lesion
							 (eg, corn or callus); single lesion
11056
27.95
57.91
Paring or cutting of benign hyperkeratotic lesion
							 (eg, corn or callus); two to four lesions
11057
31.63
69.55
Paring or cutting of benign hyperkeratotic lesion
							 (eg, corn or callus); more than four lesions
11100
35.44
100.36
Biopsy of skin, subcutaneous tissue and/or mucous
							 membrane (including simple closure), unless otherwise listed; single
							 lesion
11101
13.61
31.63
Biopsy of skin, subcutaneous tissue and/or mucous
							 membrane (including simple closure), unless otherwise listed; each
							 separate/additional lesion (List separately in addition to code for primary
							 procedure)
11200
35.44
80.18
Removal of skin tags, multiple fibrocutaneous tags,
							 any area; up to and including 15 lesions
11201
5.88
17.87
Removal of skin tags, multiple fibrocutaneous tags,
							 any area; each additional ten lesions (List separately in addition to code for
							 primary procedure)
11300
35.44
68.48
Shaving of epidermal or dermal lesion, single lesion,
							 trunk, arms or legs; lesion diameter 0.5 cm or less
11301
35.44
90.52
Shaving of epidermal or dermal lesion, single lesion,
							 trunk, arms or legs; lesion diameter 0.6 to 1.0 cm
11302
35.44
107.77
Shaving of epidermal or dermal lesion, single lesion,
							 trunk, arms or legs; lesion diameter 1.1 to 2.0 cm
11303
66.19
127.75
Shaving of epidermal or dermal lesion, single lesion,
							 trunk, arms or legs; lesion diameter over 2.0 cm
11305
35.31
69.16
Shaving of epidermal or dermal lesion, single lesion,
							 scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
11306
35.44
93.90
Shaving of epidermal or dermal lesion, single lesion,
							 scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm
11307
35.44
109.60
Shaving of epidermal or dermal lesion, single lesion,
							 scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm
11308
35.44
124.76
Shaving of epidermal or dermal lesion, single lesion,
							 scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm
11310
35.44
83.66
Shaving of epidermal or dermal lesion, single lesion,
							 face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or
							 less
11311
35.44
103.17
Shaving of epidermal or dermal lesion, single lesion,
							 face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0
							 cm
11312
35.44
119.64
Shaving of epidermal or dermal lesion, single lesion,
							 face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0
							 cm
11313
35.44
150.37
Shaving of epidermal or dermal lesion, single lesion,
							 face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0
							 cm
11400
71.34
120.80
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5
							 cm or less
11401
77.95
143.26
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6
							 to 1.0 cm
11402
84.95
158.70
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1
							 to 2.0 cm
11403
90.83
181.04
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1
							 to 3.0 cm
11404
719.48
205.27
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1
							 to 4.0 cm
11406
719.48
279.96
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over
							 4.0 cm
11420
65.82
119.69
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;
							 excised diameter 0.5 cm or less
11421
78.70
151.56
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;
							 excised diameter 0.6 to 1.0 cm
11422
86.05
169.30
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;
							 excised diameter 1.1 to 2.0 cm
11423
96.35
196.36
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;
							 excised diameter 2.1 to 3.0 cm
11424
719.48
224.17
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;
							 excised diameter 3.1 to 4.0 cm
11426
943.36
314.07
Excision, benign lesion including margins, except
							 skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia;
							 excised diameter over 4.0 cm
11440
77.22
133.88
Excision, other benign lesion including margins,
							 except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips,
							 mucous membrane; excised diameter 0.5 cm or less
11441
86.42
163.74
Excision, other benign lesion including margins,
							 except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips,
							 mucous membrane; excised diameter 0.6 to 1.0 cm
11442
95.25
183.42
Excision, other benign lesion including margins,
							 except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips,
							 mucous membrane; excised diameter 1.1 to 2.0 cm
11443
106.64
218.95
Excision, other benign lesion including margins,
							 except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips,
							 mucous membrane; excised diameter 2.1 to 3.0 cm
11444
388.12
273.38
Excision, other benign lesion including margins,
							 except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips,
							 mucous membrane; excised diameter 3.1 to 4.0 cm
11446
943.36
362.40
Excision, other benign lesion including margins,
							 except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips,
							 mucous membrane; excised diameter over 4.0 cm
11450
943.36
351.22
Excision of skin and subcutaneous tissue for
							 hidradenitis, axillary; with simple or intermediate repair
11451
943.36
463.13
Excision of skin and subcutaneous tissue for
							 hidradenitis, axillary; with complex repair
11462
943.36
349.56
Excision of skin and subcutaneous tissue for
							 hidradenitis, inguinal; with simple or intermediate repair
11463
943.36
472.18
Excision of skin and subcutaneous tissue for
							 hidradenitis, inguinal; with complex repair
11470
943.36
379.52
Excision of skin and subcutaneous tissue for
							 hidradenitis, perianal, perineal, or umbilical; with simple or intermediate
							 repair
11471
943.36
485.86
Excision of skin and subcutaneous tissue for
							 hidradenitis, perianal, perineal, or umbilical; with complex repair
11600
98.92
180.76
Excision, malignant lesion including margins, trunk,
							 arms, or legs; excised diameter 0.5 cm or less
11601
112.89
213.87
Excision, malignant lesion including margins, trunk,
							 arms, or legs; excised diameter 0.6 to 1.0 cm
11602
122.46
233.13
Excision, malignant lesion including margins, trunk,
							 arms, or legs; excised diameter 1.1 to 2.0 cm
11603
130.91
263.23
Excision, malignant lesion including margins, trunk,
							 arms, or legs; excised diameter 2.1 to 3.0 cm
11604
388.12
290.19
Excision, malignant lesion including margins, trunk,
							 arms, or legs; excised diameter 3.1 to 4.0 cm
11606
719.48
400.50
Excision, malignant lesion including margins, trunk,
							 arms, or legs; excised diameter over 4.0 cm
11620
100.03
182.18
Excision, malignant lesion including margins, scalp,
							 neck, hands, feet, genitalia; excised diameter 0.5 cm or less
11621
114.00
215.59
Excision, malignant lesion including margins, scalp,
							 neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
11622
126.13
242.65
Excision, malignant lesion including margins, scalp,
							 neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
11623
136.79
282.16
Excision, malignant lesion including margins, scalp,
							 neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
11624
719.48
318.24
Excision, malignant lesion including margins, scalp,
							 neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm
11626
943.36
390.12
Excision, malignant lesion including margins, scalp,
							 neck, hands, feet, genitalia; excised diameter over 4.0 cm
11640
104.80
190.25
Excision, malignant lesion including margins, face,
							 ears, eyelids, nose, lips; excised diameter 0.5 cm or less
11641
122.46
230.45
Excision, malignant lesion including margins, face,
							 ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm
11642
136.79
264.67
Excision, malignant lesion including margins, face,
							 ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm
11643
148.57
308.81
Excision, malignant lesion including margins, face,
							 ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm
11644
719.48
382.18
Excision, malignant lesion including margins, face,
							 ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm
11646
943.36
498.66
Excision, malignant lesion including margins, face,
							 ears, eyelids, nose, lips; excised diameter over 4.0 cm
11719
11.40
20.67
Trimming of nondystrophic nails, any
							 number
11720
14.71
30.54
Debridement of nail(s) by any method(s); one to
							 five
11721
18.02
43.09
Debridement of nail(s) by any method(s); six or
							 more
11730
35.44
96.07
Avulsion of nail plate, partial or complete, simple;
							 single
11732
18.02
44.11
Avulsion of nail plate, partial or complete, simple;
							 each additional nail plate (List separately in addition to code for primary
							 procedure)
11740
13.24
44.67
Evacuation of subungual hematoma
11750
94.13
206.37
Excision of nail and nail matrix, partial or complete
							 (eg, ingrown or deformed nail), for permanent removal;
11752
129.44
291.79
Excision of nail and nail matrix, partial or
							 complete
(eg, ingrown or deformed nail), for permanent
							 removal; with amputation of tuft of distal phalanx
11755
65.82
131.77
Biopsy of nail unit (eg, plate, bed, matrix,
							 hyponychium, proximal and lateral nail folds) (separate procedure)
11760
94.07
199.47
Repair of nail bed
11762
120.98
261.58
Reconstruction of nail bed with graft
11765
65.22
129.28
Wedge excision of skin of nail fold (eg, for ingrown
							 toenail)
11770
943.36
259.41
Excision of pilonidal cyst or sinus;
							 simple
11771
943.36
508.97
Excision of pilonidal cyst or sinus;
							 extensive
11772
943.36
631.17
Excision of pilonidal cyst or sinus;
							 complicated
11900
28.68
54.26
Injection, intralesional; up to and including seven
							 lesions
11901
30.53
66.42
Injection, intralesional; more than seven
							 lesions
11920
94.07
201.17
Tattooing, intradermal introduction of insoluble
							 opaque pigments to correct color defects of skin, including micropigmentation;
							 6.0 sq cm or less
11921
94.07
226.94
Tattooing, intradermal introduction of insoluble
							 opaque pigments to correct color defects of skin, including micropigmentation;
							 6.1 to 20.0 sq cm
11922
37.88
66.24
Tattooing, intradermal introduction of insoluble
							 opaque pigments to correct color defects of skin, including micropigmentation;
							 each additional 20.0 sq cm (List separately in addition to code for primary
							 procedure)
11950
37.14
76.97
Subcutaneous injection of filling material (eg,
							 collagen); 1 cc or less
11951
43.76
99.16
Subcutaneous injection of filling material (eg,
							 collagen); 1.1 to 5.0 cc
11952
57.17
142.59
Subcutaneous injection of filling material (eg,
							 collagen); 5.1 to 10.0 cc
11954
57.17
168.24
Subcutaneous injection of filling material (eg,
							 collagen); over 10.0 cc
11960
903.02
898.02
Insertion of tissue expander(s) for other than
							 breast, including subsequent expansion
119701,920.92
582.91
Replacement of tissue expander with permanent
							 prosthesis
11971
943.36
499.38
Removal of tissue expander(s) without insertion of
							 prosthesis
11980
28.19
104.14
Subcutaneous hormone pellet implantation
							 (implantation of estradiol and/or testosterone pellets beneath the
							 skin)
11981
28.19
136.98
Insertion, non-biodegradable drug delivery
							 implant
11982
28.19
157.01
Removal, non-biodegradable drug delivery
							 implant
11983
28.19
232.80
Removal with reinsertion, non-biodegradable drug
							 delivery implant
12001
57.17
148.83
Simple repair of superficial wounds of scalp, neck,
							 axillae, external genitalia, trunk and/or extremities (including hands and
							 feet); 2.5 cm or less
12002
57.17
157.66
Simple repair of superficial wounds of scalp, neck,
							 axillae, external genitalia, trunk and/or extremities
(including hands and feet); 2.6 cm to 7.5
							 cm
12004
57.17
184.72
Simple repair of superficial wounds of scalp,
							 neck,
axillae, external genitalia, trunk and/or extremities
							 (including hands and feet); 7.6 cm to 12.5 cm
12005
57.17
229.32
Simple repair of superficial wounds of scalp, neck,
							 axillae, external genitalia, trunk and/or extremities (including hands and
							 feet); 12.6 cm to 20.0 cm
12006
57.17
284.81
Simple repair of superficial wounds of scalp, neck,
							 axillae, external genitalia, trunk and/or extremities (including hands and
							 feet); 20.1 cm to 30.0 cm
12007
57.17
319.74
Simple repair of superficial wounds of scalp, neck,
							 axillae, external genitalia, trunk and/or extremities (including hands and
							 feet); over 30.0 cm
12011
57.17
158.55
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
12013
57.17
173.90
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm
12014
57.17
203.42
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm
12015
57.17
254.54
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm
12016
57.17
300.27
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm
12017
57.17
253.95
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm
12018
57.17
304.54
Simple repair of superficial wounds of face, ears,
							 eyelids, nose, lips and/or mucous membranes; over 30.0 cm
12020
202.27
272.20
Treatment of superficial wound dehiscence; simple
							 closure
12021
202.27
155.39
Treatment of superficial wound dehiscence; with
							 packing
12031
94.07
221.41
Layer closure of wounds of scalp, axillae, trunk
							 and/o extremities (excluding hands and feet); 2.5 cm or less
12032
94.07
298.32
Layer closure of wounds of scalp, axillae, trunk
							 and/o extremities (excluding hands and feet); 2.6 cm to 7.5 cm
12034
94.07
287.38
Layer closure of wounds of scalp, axillae, trunk
							 and/o extremities (excluding hands and feet); 7.6 cm to 12.5 cm
12035
94.07
370.79
Layer closure of wounds of scalp, axillae, trunk
							 and/o extremities (excluding hands and feet); 12.6 cm to 20.0 cm
12036
94.07
407.34
Layer closure of wounds of scalp, axillae, trunk
							 and/o extremities (excluding hands and feet); 20.1 cm to 30.0 cm
12037
94.07
457.58
Layer closure of wounds of scalp, axillae, trunk
							 and/o extremities (excluding hands and feet); over 30.0 cm
12041
94.07
235.05
Layer closure of wounds of neck, hands, feet and/or
							 external genitalia; 2.5 cm or less
12042
94.07
277.92
Layer closure of wounds of neck, hands, feet and/or
							 external genitalia; 2.6 cm to 7.5 cm
12044
94.07
314.37
Layer closure of wounds of neck, hands, feet and/or
							 external genitalia; 7.6 cm to 12.5 cm
12045
94.07
373.96
Layer closure of wounds of neck, hands, feet and/or
							 external genitalia; 12.6 cm to 20.0 cm
12046
94.07
441.49
Layer closure of wounds of neck, hands, feet and/or
							 external genitalia; 20.1 cm to 30.0 cm
12047
94.07
471.99
Layer closure of wounds of neck, hands, feet and/or
							 external genitalia; over 30.0 cm
12051
94.07
260.86
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; 2.5 cm or less
12052
94.07
286.99
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; 2.6 cm to 5.0 cm
12053
94.07
312.95
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; 5.1 cm to 7.5 cm
12054
94.07
334.60
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; 7.6 cm to 12.5 cm
12055
94.07
406.73
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; 12.6 cm to 20.0 cm
12056
94.07
503.48
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; 20.1 cm to 30.0 cm
12057
94.07
540.52
Layer closure of wounds of face, ears, eyelids, nose,
							 lips and/or mucous membranes; over 30.0 cm
13100
202.27
310.16
Repair, complex, trunk; 1.1 cm to 2.5 cm
13101
202.27
385.92
Repair, complex, trunk; 2.6 cm to 7.5 cm
13102
202.27
104.23
Repair, complex, trunk; each additional 5 cm or less
							 (List separately in addition to code for primary procedure)
13120
94.07
321.83
Repair, complex, scalp, arms, and/or legs; 1.1 cm to
							 2.5 cm
13121
202.27
422.40
Repair, complex, scalp, arms, and/or legs; 2.6 cm to
							 7.5 cm
13122
94.07
119.94
Repair, complex, scalp, arms, and/or legs; each
							 additional 5 cm or less (List separately in addition to code for primary
							 procedure)
13131
202.27
353.41
Repair, complex, forehead, cheeks, chin, mouth, neck
							 axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm
13132
202.27
548.43
Repair, complex, forehead, cheeks, chin, mouth, neck
							 axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm
13133
202.27
161.64
Repair, complex, forehead, cheeks, chin, mouth, neck
							 axillae, genitalia, hands and/or feet; each additional 5 cm or less (List
							 separately in addition to code for primary procedure)
13150
202.27
361.55
Repair, complex, eyelids, nose, ears and/or lips; 1.0
							 cm or less
13151
202.27
399.08
Repair, complex, eyelids, nose, ears and/or lips; 1.1
							 cm to 2.5 cm
13152
202.27
540.99
Repair, complex, eyelids, nose, ears and/or lips; 2.6
							 cm to 7.5 cm
13153
94.07
180.05
Repair, complex, eyelids, nose, ears and/or lips;
							 each additional 5 cm or less (List separately in addition to code for primary
							 procedure)
13160
903.02
776.75
Secondary closure of surgical wound or dehiscence,
							 extensive or complicated
14000
672.37
637.52
Adjacent tissue transfer or rearrangement, trunk;
							 defect 10 sq cm or less
14001
672.37
822.76
Adjacent tissue transfer or rearrangement, trunk;
							 defect 10.1 sq cm to 30.0 sq cm
14020
672.37
709.70
Adjacent tissue transfer or rearrangement, scalp, arm
							 and/or legs; defect 10 sq cm or less
14021
672.37
922.90
Adjacent tissue transfer or rearrangement, scalp, arm
							 and/or legs; defect 10.1 sq cm to 30.0 sq cm
14040
672.37
744.02
Adjacent tissue transfer or rearrangement, forehead,
							 cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq
							 cm or less
14041
672.37
1,010.95
Adjacent tissue transfer or rearrangement, forehead,
							 cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1
							 sq cm to 30.0 sq cm
14060
672.37
755.36
Adjacent tissue transfer or rearrangement, eyelids,
							 nose, ears and/or lips; defect 10 sq cm or less
14061
672.37
1,098.01
Adjacent tissue transfer or rearrangement, eyelids,
							 nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm
14300
903.02
1,055.04
Adjacent tissue transfer or rearrangement, more than
							 30 sq cm, unusual or complicated, any area
14350
903.02
732.71
Filleted finger or toe flap, including preparation of
							 recipient site
15040
94.07
271.10
Harvest of skin for tissue cultured skin autograft,
							 100 sq cm or less
15050
202.27
535.06
Pinch graft, single or multiple, to cover small
							 ulcer, tip of digit, or other minimal open area (except on face), up to defect
							 size 2 cm diameter
15150
202.27
708.42
Tissue cultured epidermal autograft, trunk, arms,
							 legs first 25 sq cm or less
15151
202.27
126.85
Tissue cultured epidermal autograft, trunk, arms,
							 legs additional 1 sq cm to 75 sq cm (List separately in addition to code for
							 primary procedure)
15155
202.27
730.87
Tissue cultured epidermal autograft, face, scalp,
							 eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple
							 digits; first 25 sq cm or less
15156
202.27
166.82
Tissue cultured epidermal autograft, face, scalp,
							 eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple
							 digits; additional 1 sq cm to 75 sq cm (List separately in addition to code for
							 primary procedure)
15200
672.37
780.27
Full thickness graft, free, including direct closure
							 of donor site, trunk; 20 sq cm or less
15201
672.37
156.17
Full thickness graft, free, including direct closure
							 of donor site, trunk; each additional 20 sq cm (List separately in addition to
							 code for primary procedure)
15220
672.37
749.07
Full thickness graft, free, including direct closure
							 of donor site, scalp, arms, and/or legs; 20 sq cm or less
15221
202.27
144.85
Full thickness graft, free, including direct closure
							 of donor site, scalp, arms, and/or legs; each additional 20 sq cm (List
							 separately in addition to code for primary procedure)
15240
672.37
885.96
Full thickness graft, free, including direct closure
							 of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands,
							 and/or feet; 20 sq cm or less
15241
202.27
185.01
Full thickness graft, free, including direct closure
							 of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands,
							 and/or feet; each additional 20 sq cm (List separately in addition to code for
							 primary procedure)
15260
672.37
944.42
Full thickness graft, free, including direct closure
							 of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less
15261
672.37
213.15
Full thickness graft, free, including direct closure
							 of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm (List
							 separately in addition to code for primary procedure)
15340
94.07
317.42
Tissue cultured allogeneic skin substitute; first 25
							 sq cm or less
15341
94.07
47.41
Tissue cultured allogeneic skin substitute; each
							 additional 25 sq cm
15570
903.02
874.10
Formation of direct or tubed pedicle, with or without
							 transfer; trunk
15572
903.02
819.06
Formation of direct or tubed pedicle, with or without
							 transfer; scalp, arms, or legs
15574
903.02
883.97
Formation of direct or tubed pedicle, with or without
							 transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or
							 feet
15576
903.02
788.95
Formation of direct or tubed pedicle, with or without
							 transfer; eyelids, nose, ears, lips, or intraoral
15600
903.02
372.01
Delay of flap or sectioning of flap (division and
							 inset) at trunk
15610
903.02
330.61
Delay of flap or sectioning of flap (division and
							 inset) at scalp, arms, or legs
15620
903.02
462.27
Delay of flap or sectioning of flap (division and
							 inset) at forehead, cheeks, chin, neck, axillae, genitalia, hands, or
							 feet
15630
903.02
470.02
Delay of flap or sectioning of flap (division and
							 inset) at eyelids, nose, ears, or lips
15650
903.02
502.88
Transfer, intermediate, of any pedicle flap (eg,
							 abdomen to wrist, Walking tube), any location
15731
903.02
1,068.20
Forehead flap with preservation of vascular pedicle
							 (eg, axial pattern flap, paramedian forehead flap)
15732
903.02
1,485.59
Muscle, myocutaneous, or fasciocutaneous flap; head
							 and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator
							 scapulae)
15734
903.02
1,526.76
Muscle, myocutaneous, or fasciocutaneous flap;
							 trun
15736
903.02
1,379.60
Muscle, myocutaneous, or fasciocutaneous flap; uppe
							 extremity
15738
903.02
1,456.65
Muscle, myocutaneous, or fasciocutaneous flap; lowe
							 extremity
15740
672.37
959.81
Flap; island pedicle
15750
903.02
889.16
Flap; neurovascular pedicle
15756
2,293.67
Free muscle or myocutaneous flap with microvascula
							 anastomosis
15757
2,287.08
Free skin flap with microvascular
							 anastomosis
15758
2,281.38
Free fascial flap with microvascular
							 anastomosis
15760
903.02
826.85
Graft; composite (eg, full thickness of external ear
							 or nasal ala), including primary closure, donor area
15770
903.02
636.09
Graft; derma-fat-fascia
15775
903.02
314.31
Punch graft for hair transplant; one to 15 punch
							 grafts
15776
903.02
445.60
Punch graft for hair transplant; more than 15 punch
							 grafts
15780
903.02
834.10
Dermabrasion; total face (eg, for acne scarring, fine
							 wrinkling, rhytids, general keratosis)
15781
903.02
536.85
Dermabrasion; segmental, face
15782
903.02
586.66
Dermabrasion; regional, other than face
15783
903.02
496.84
Dermabrasion; superficial, any site (eg, tattoo
							 removal
15786
903.02
240.37
Abrasion; single lesion (eg, keratosis,
							 scar)
15787
903.02
56.65
Abrasion; each additional four lesions or less (List
							 separately in addition to code for primary procedure)
15788
903.02
447.02
Chemical peel, facial; epidermal
15789
903.02
576.84
Chemical peel, facial; dermal
15792
903.02
437.47
Chemical peel, nonfacial; epidermal
15793
903.02
467.52
Chemical peel, nonfacial; dermal
15819
903.02
704.85
Cervicoplasty
15820
903.02
527.39
Blepharoplasty, lower eyelid;
15821
903.02
561.24
Blepharoplasty, lower eyelid; with extensive herniate
							 fat pad
15822
903.02
419.61
Blepharoplasty, upper eyelid;
15823
903.02
642.96
Blepharoplasty, upper eyelid; with excessive skin
							 weighting down lid
15824
903.02
I.C.
Rhytidectomy; forehead
15825
903.02
I.C.
Rhytidectomy; neck with platysmal tightening
							 (platysmal flap, P-flap)
15826
903.02
I.C.
Rhytidectomy; glabellar frown lines
15828
903.02
I.C.
Rhytidectomy; cheek, chin, and neck
15829
903.02
I.C.
Rhytidectomy; superficial musculoaponeurotic system
							 (SMAS) flap
15830
903.02
1,116.84
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); abdomen, infraumbilical panniculectomy
15832
903.02
864.16
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); thigh
15833
903.02
805.92
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); leg
15834
57.17
821.96
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); hip
15835
57.17
839.07
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); buttock
15836
418.12
709.05
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); arm
15837
192.34
752.05
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); forearm or hand
15838
192.34
558.04
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); submental fat pad
15839
118.89
816.99
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy); other area
15840
35.44
978.48
Graft for facial nerve paralysis; free fascia graft
							 (including obtaining fascia)
15841
35.31
1,610.39
Graft for facial nerve paralysis; free muscle graft
							 (including obtaining graft)
15842
35.44
2,545.49
Graft for facial nerve paralysis; free muscle flap by
							 microsurgical technique
15845
65.22
910.54
Graft for facial nerve paralysis; regional muscle
							 transfer
15847
65.22
I.C.
Excision, excessive skin and subcutaneous tissue
							 (includes lipectomy), abdomen (eg, abdominoplasty)
15850
35.44
91.65
(includes umbilical transposition and fascial
							 plication) (List separately in addition to code for primary procedure)
Removal of sutures under anesthesia (other
							 than
15851
94.07
100.66
local), same surgeon Removal of sutures under
							 anesthesia (other than
15852
903.02
45.41
local), other surgeon Dressing change (for other than
							 burns) under
15860
903.02
107.35
anesthesia (other than local)
Intravenous injection of agent (eg, fluorescein) to
							 test
15876
903.02
I.C.
vascular flow in flap or graft Suction assisted
							 lipectomy; head and neck
15877
903.02
I.C.
Suction assisted lipectomy; trunk
15878
903.02
I.C.
Suction assisted lipectomy; upper
							 extremity
15879
903.02
I.C.
Suction assisted lipectomy; lower
							 extremity
15920
903.02
560.29
Excision, coccygeal pressure ulcer, with
15922
903.02
722.79
coccygectomy; with primary suture Excision, coccygeal
							 pressure ulcer, with
15931
903.02
636.67
coccygectomy; with flap closure Excision, sacral
							 pressure ulcer, with primary suture;
15933
943.36
790.51
Excision, sacral pressure ulcer, with primary
							 suture;
15934
943.36
878.65
with ostectomy Excision, sacral pressure ulcer, with
							 skin flap closure
15935
943.36
1,043.67
Excision, sacral pressure ulcer, with skin flap
							 closure
15936
943.36
858.22
with ostectomy Excision, sacral pressure ulcer, in
							 preparation for
15937
943.36
1,005.94
muscle or myocutaneous flap or skin graft
							 closure;
Excision, sacral pressure ulcer, in preparation
							 for
15940
719.48
660.16
muscle or myocutaneous flap or skin graft closure;
							 with ostectomy Excision, ischial pressure ulcer, with primary
							 suture;
15941
719.48
879.16
Excision, ischial pressure ulcer, with primary
							 suture;
15944
719.48
853.65
with ostectomy (ischiectomy)
Excision, ischial pressure ulcer, with skin flap
							 closure
15945
719.48
943.61
Excision, ischial pressure ulcer, with skin
							 flap
15946
903.02
1,553.86
closure; with ostectomy Excision, ischial pressure
							 ulcer, with ostectomy, in
15950
903.02
550.26
preparation for muscle or myocutaneous flap or skin
							 graft closure Excision, trochanteric pressure ulcer, with primary
15951
903.02
784.05
suture;
Excision, trochanteric pressure ulcer, with
							 primary
15952
903.02
812.73
suture; with ostectomy Excision, trochanteric
							 pressure ulcer, with skin flap
15953
943.36
907.89
closure;
Excision, trochanteric pressure ulcer, with skin
							 flap
15956
118.89
1,100.62
closure; with ostectomy Excision, trochanteric
							 pressure ulcer, in preparation
15958
55.16
1,127.15
for muscle or myocutaneous flap or skin graft
							 closure; Excision, trochanteric pressure ulcer, in preparation
15999
I.C.
for muscle or myocutaneous flap or skin graft
							 closure;
with ostectomy Unlisted procedure, excision pressure
							 ulcer
16000
28.19
69.15
Initial treatment, first degree burn, when no more
							 tha local treatment is required
16020
903.02
84.95
Dressings and/or debridement of partial-thickness
							 burns, initial or subsequent; small (less than 5% total body surface
							 area)
16025
903.02
145.73
Dressings and/or debridement of partial-thickness
							 burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5%
							 to 10% total body surface area)
16030
903.02
176.25
Dressings and/or debridement of partial-thickness
							 burns, initial or subsequent; large (eg, more than one extremity, or greater
							 than 10% total body surface area)
16035
903.02
205.92
Escharotomy; initial incision
16036
81.60
Escharotomy; each additional incision (List separatel
							 in addition to code for primary procedure)
17000
35.44
76.84
Destruction (eg, laser surgery, electrosurgery,
							 cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg,
							 actinic keratoses); first lesion
17003
4.05
7.75
Destruction (eg, laser surgery, electrosurgery,
							 cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg,
							 actinic keratoses); second through 14 lesions, each (List separately in
							 addition to code for first lesion)
17004
87.15
174.52
Destruction (eg, laser surgery, electrosurgery,
							 cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg,
							 actinic keratoses), 15 or more lesions
17106
118.89
382.26
Destruction of cutaneous vascular proliferative
							 lesion (eg, laser technique); less than 10 sq cm
17107
118.89
659.00
Destruction of cutaneous vascular proliferative
							 lesion (eg, laser technique); 10.0 to 50.0 sq cm
17108
118.89
885.03
Destruction of cutaneous vascular proliferative
							 lesion (eg, laser technique); over 50.0 sq cm
17110
35.44
102.62
Destruction (eg, laser surgery, electrosurgery,
							 cryosurgery, chemosurgery, surgical curettement), of benign lesions other than
							 skin tags or cutaneous vascular proliferative lesions; up to 14
							 lesions
17111
65.22
123.81
Destruction (eg, laser surgery, electrosurgery,
							 cryosurgery, chemosurgery, surgical curettement), of benign lesions other than
							 skin tags or cutaneous vascular proliferative lesions; 15 or more
							 lesions
17250
46.71
77.33
Chemical cauterization of granulation tissue (proud
							 flesh, sinus or fistula)
17260
49.27
94.63
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms
							 or legs; lesion diameter 0.5 cm or less
17261
65.22
136.49
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms
							 or legs; lesion diameter 0.6 to 1.0 cm
17262
65.22
165.05
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms
							 or legs; lesion diameter 1.1 to 2.0 cm
17263
65.22
181.73
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms
							 or legs; lesion diameter 2.1 to 3.0 cm
17264
65.22
195.90
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms
							 or legs; lesion diameter 3.1 to 4.0 cm
17266
110.31
221.36
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms
							 or legs; lesion diameter over 4.0 cm
17270
65.22
142.53
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck,
							 hands, feet, genitalia; lesion diameter 0.5 cm or less
17271
65.22
155.54
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck,
							 hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm
17272
65.22
177.82
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck,
							 hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm
17273
99.65
197.81
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck,
							 hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm
17274
113.26
234.34
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck,
							 hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm
17276
118.89
272.15
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck,
							 hands, feet, genitalia; lesion diameter over 4.0 cm
17280
65.22
133.73
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears,
							 eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or
							 less
17281
85.32
168.29
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears,
							 eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm
17282
97.08
194.71
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears,
							 eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm
17283
112.16
234.50
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears,
							 eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm
17284
118.89
272.98
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears,
							 eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm
17286
118.89
345.71
Destruction, malignant lesion (eg, laser surgery,
							 electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears,
							 eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm
17311
162.31
711.84
Mohs micrographic technique, including removal of all
							 gross tumor, surgical excision of tissue specimens, mapping, color coding of
							 specimens, microscopic examination of specimens by the surgeon, and
							 histopathologic preparation including routine stain(s) (eg, hematoxylin and
							 eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location
							 with surgery directly involving muscle, cartilage, bone, tendon, major nerves,
							 or vessels; first stage, up to five tissue blocks
17312
162.31
433.70
Mohs micrographic technique, including removal of all
							 gross tumor, surgical excision of tissue specimens, mapping, color coding of
							 specimens, microscopic examination of specimens by the surgeon, and
							 histopathologic preparation including routine stain(s) (eg, hematoxylin and
							 eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location
							 with surgery directly involving muscle, cartilage, bone, tendon, major nerves,
							 or vessels; each additional stage after the first stage, up to five tissue
							 blocks (List separately in addition to code for primary procedure)
17313
162.31
651.19
Mohs micrographic technique, including removal of all
							 gross tumor, surgical excision of tissue specimens, mapping, color coding of
							 specimens, microscopic examination of specimens by the surgeon, and
							 histopathologic preparation including routine stain(s) (eg, hematoxylin and
							 eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to five
							 tissue blocks
17314
162.31
401.27
Mohs micrographic technique, including removal of all
							 gross tumor, surgical excision of tissue specimens, mapping, color coding of
							 specimens, microscopic examination of specimens by the surgeon, and
							 histopathologic preparation including routine stain(s) (eg, hematoxylin and
							 eosin, toluidine blue), of the trunk, arms, or legs; each additional stage
							 after the first stage, up to five tissue blocks (List separately in addition to
							 code for primary procedure)
17315
41.92
83.08
Mohs micrographic technique, including removal
							 of
all gross tumor, surgical excision of tissue
							 specimens, mapping, color coding of specimens, microscopic examination of
							 specimens by the surgeon, and histopathologic preparation including routine
							 stain(s) (eg, hematoxylin and eosin, toluidine blue), each additional block
							 after the first five tissue blocks, any stage (List separately in addition to
							 code for primary procedure)
17340
13.23
44.02
Cryotherapy (CO2 slush, liquid N2) for
							 acne
17360
35.44
126.91
Chemical exfoliation for acne (eg, acne paste,
							 acid)
17380
35.44
I.C.
Electrolysis epilation, each 30 minutes
17999
I.C.
Unlisted procedure, skin, mucous membrane and
							 subcutaneous tissue
19000
71.70
120.83
Puncture aspiration of cyst of breast;
19001
71.70
27.05
Puncture aspiration of cyst of breast; each
							 additional cyst (List separately in addition to code for primary
							 procedure)
19020
71.70
439.45
Mastotomy with exploration or drainage of abscess,
							 deep
19030
182.43
Injection procedure only for mammary ductogram or
							 galactogram
19100
193.36
143.90
Biopsy of breast; percutaneous, needle core, not
							 using imaging guidance (separate procedure)
19101
922.44
325.31
Biopsy of breast; open, incisional
19102
317.95
240.49
Biopsy of breast; percutaneous, needle core, using
							 imaging guidance
19103
606.71
632.08
Biopsy of breast; percutaneous, automated vacuum
							 assisted or rotating biopsy device, using imaging guidance
19105
1,417.2
2
2,27
5.75
Ablation, cryosurgical, of fibroadenoma, including
							 ultrasound guidance, each fibroadenoma
19110
922.44
438.55
Nipple exploration, with or without excision of a
							 solitary lactiferous duct or a papilloma lactiferous duct
19112
922.44
424.47
Excision of lactiferous duct fistula
19120
922.44
442.67
Excision of cyst, fibroadenoma, or other benign or
							 malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion
							 (except 19300), open, male or female, one or more lesions
19125
922.44
486.95
Excision of breast lesion identified by preoperative
							 placement of radiological marker, open; single lesion
19126
922.44
151.47
Excision of breast lesion identified by preoperative
							 placement of radiological marker, open; each additional lesion separately
							 identified by a preoperative radiological marker (List separately in addition
							 to code for primary procedure)
19260
1,155.26
Excision of chest wall tumor including
							 ribs
19271
1,603.08
Excision of chest wall tumor involving ribs, with
							 plastic reconstruction; without mediastinal lymphadenectomy
19272
1,763.56
Excision of chest wall tumor involving ribs, with
							 plastic reconstruction; with mediastinal lymphadenectomy
19290
177.56
Preoperative placement of needle localization wire,
							 breast;
19291
76.56
Preoperative placement of needle localization wire,
							 breast; each additional lesion (List separately in addition to code for primary
							 procedure)
19295
114.91
Image guided placement, metallic localization clip,
							 percutaneous, during breast biopsy (List separately in addition to code for
							 primary procedure)
19296
2,528.34
5,002.21
Placement of radiotherapy afterloading balloon
							 catheter into the breast for interstitial radioelement application following
							 partial mastectomy, includes imaging guidance; on date separate from partial
							 mastectomy
19297
2,528.34
88.68
Placement of radiotherapy afterloading balloon
							 catheter into the breast for interstitial radioelement application following
							 partial mastectomy, includes imaging guidance; concurrent with partial
							 mastectomy (List separately in addition to code for primary
							 procedure)
19298
2,528.34
1,695.25
Placement of radiotherapy afterloading brachytherapy
							 catheters (multiple tube and button type) into the breast for interstitial
							 radioelement application following (at the time of or subsequent to) partial
							 mastectomy, includes imaging guidance
19300
2,528.34
548.04
Mastectomy for gynecomastia
19301
2,528.34
550.14
Mastectomy, partial (eg, lumpectomy, tylectomy,
							 quadrantectomy, segmentectomy);
19302
2,528.34
815.08
Mastectomy, partial (eg, lumpectomy, tylectomy,
							 quadrantectomy, segmentectomy); with axillary lymphadenectomy
19303
2,528.34
847.02
Mastectomy, simple, complete
19304
2,528.34
521.07
Mastectomy, subcutaneous
19305
1,016.20
Mastectomy, radical, including pectoral muscles,
							 axillary lymph nodes
19306
1,062.12
Mastectomy, radical, including pectoral muscles,
							 axillary and internal mammary lymph nodes (Urban type operation)
19307
1,067.49
Mastectomy, modified radical, including axillary
							 lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis
							 major muscle
19316
1,417.22
756.83
Mastopexy
19318
1,779.44
1,116.18
Reduction mammaplasty
19324
1,779.44
467.64
Mammaplasty, augmentation; without prosthetic
							 implant
19325
2,528.34
628.57
Mammaplasty, augmentation; with prosthetic
							 implan
19328
1,417.22
474.69
Removal of intact mammary implant
19330
1,417.22
600.40
Removal of mammary implant material
19340
1,779.44
383.80
Immediate insertion of breast prosthesis following
							 mastopexy, mastectomy or in reconstruction
19342
2,528.34
889.56
Delayed insertion of breast prosthesis following
							 mastopexy, mastectomy or in reconstruction
19350
922.44
895.56
Nipple/areola reconstruction
19357
2,528.34
1,504.35
Breast reconstruction, immediate or delayed, with
							 tissue expander, including subsequent expansion
19361
1,551.85
Breast reconstruction with latissimus dorsi flap,
							 without prosthetic implant
19364
2,687.37
Breast reconstruction with free flap
19366
1,417.22
1,333.13
Breast reconstruction with other
							 technique
19367
1,763.11
Breast reconstruction with transverse rectus
							 abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor
							 site;
19368
2,164.21
Breast reconstruction with transverse rectus
							 abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor
							 site; with microvascular anastomosis (supercharging)
19369
1,993.81
Breast reconstruction with transverse rectus
							 abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor
							 site
19370
1,417.22
660.91
Open periprosthetic capsulotomy, breast
19371
1,417.22
761.51
Periprosthetic capsulectomy, breast
19380
1,779.44
744.34
Revision of reconstructed breast
19396
1,417.22
212.42
Preparation of moulage for custom breast
							 implant
19499
I.C.
Unlisted procedure, breast
20000
62.85
206.68
Incision of soft tissue abscess (eg, secondary to
							 osteomyelitis); superficial
20005
950.47
299.78
Incision of soft tissue abscess (eg, secondary to
							 osteomyelitis); deep or complicated
20100
574.00
Exploration of penetrating wound (separate
							 procedure); neck
20101
411.27
Exploration of penetrating wound (separate
							 procedure); chest
20102
481.42
Exploration of penetrating wound (separate
							 procedure); abdomen/flank/back
20103
430.53
581.21
Exploration of penetrating wound (separate
							 procedure); extremity
20150
1,920.92
897.48
Excision of epiphyseal bar, with or without
							 autogenous soft tissue graft obtained through same fascial incision
20200
719.48
197.59
Biopsy, muscle; superficial
20205
719.48
267.80
Biopsy, muscle; deep
20206
317.95
305.62
Biopsy, muscle, percutaneous needle
20220
388.12
212.84
Biopsy, bone, trocar, or needle; superficial (eg,
							 ilium sternum, spinous process, ribs)
20225
388.12
909.54
Biopsy, bone, trocar, or needle; deep (eg, vertebral
							 body, femur)
20240
943.36
229.56
Biopsy, bone, open; superficial (eg, ilium, sternum,
							 spinous process, ribs, trochanter of femur)
20245
943.36
622.24
Biopsy, bone, open; deep (eg, humerus, ischium,
							 femur
20250
950.47
371.07
Biopsy, vertebral body, open; thoracic
20251
950.47
412.86
Biopsy, vertebral body, open; lumbar or
							 cervical
20500
66.19
129.13
Injection of sinus tract; therapeutic (separate
							 procedure
20501
148.66
Injection of sinus tract; diagnostic
							 (sinogram)
20520
101.50
197.18
Removal of foreign body in muscle or tendon sheath;
							 simple
20525
943.36
509.34
Removal of foreign body in muscle or tendon sheath;
							 deep or complicated
20526
32.73
76.96
Injection, therapeutic (eg, local anesthetic,
							 corticosteroid), carpal tunnel
20550
24.64
59.14
Injection(s); single tendon sheath, or ligament,
							 aponeurosis (eg, plantar "fascia")
20551
24.28
58.38
Injection(s); single tendon
							 origin/insertion
20552
23.90
53.95
Injection(s); single or multiple trigger point(s),
							 one o two muscle(s)
20553
26.84
60.41
Injection(s); single or multiple trigger point(s),
							 three or more muscle(s)
20555
1,304.45
318.09
Placement of needles or catheters into muscle and/or
							 soft tissue for subsequent interstitial radioelement application (at the time
							 of or subsequent to the procedure)
20600
24.28
55.31
Arthrocentesis, aspiration and/or injection; small
							 join or bursa (eg, fingers, toes)
20605
27.58
60.14
Arthrocentesis, aspiration and/or injection;
							 intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist,
							 elbow or ankle, olecranon bursa)
20610
37.14
76.76
Arthrocentesis, aspiration and/or injection; major
							 join or bursa (eg, shoulder, hip, knee joint, subacromial bursa)
20612
25.74
59.12
Aspiration and/or injection of ganglion cyst(s) any
							 location
20615
114.36
227.67
Aspiration and injection for treatment of bone
							 cyst
20650
950.47
197.04
Insertion of wire or pin with application of skeletal
							 traction, including removal (separate procedure)
20660
259.20
Application of cranial tongs, caliper, or
							 stereotactic frame, including removal (separate procedure)
20661
461.90
Application of halo, including removal;
							 cranial
20662
950.47
468.49
Application of halo, including removal;
							 pelvic
20663
950.47
442.84
Application of halo, including removal;
							 femoral
20664
731.10
Application of halo, including removal, cranial, 6 or
							 more pins placed, for thin skull osteology (eg, pediatric patients,
							 hydrocephalus, osteogenesis imperfecta), requiring general
							 anesthesia
20665
28.19
132.12
Removal of tongs or halo applied by another
							 physicia
20670
719.48
486.42
Removal of implant; superficial (eg, buried wire, pin
							 or rod) (separate procedure)
20680
943.36
608.09
Removal of implant; deep (eg, buried wire, pin,
							 screw, metal band, nail, rod or plate)
20690
1,304.45
483.79
Application of a uniplane (pins or wires in one
							 plane), unilateral, external fixation system
20692
1,304.45
890.29
Application of a multiplane (pins or wires in more
							 than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli
							 type)
20693
950.47
461.97
Adjustment or revision of external fixation system
							 requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or
							 bar(s))
20694
950.47
451.44
Removal, under anesthesia, of external fixation
							 system
20802
2,345.84
Replantation, arm (includes surgical neck of humerus
							 through elbow joint), complete amputation
20805
3,095.55
Replantation, forearm (includes radius and ulna to
							 radial carpal joint), complete amputation
20808
4,019.75
Replantation, hand (includes hand through
							 metacarpophalangeal joints), complete amputation
20816
2,466.39
Replantation, digit, excluding thumb (includes
							 metacarpophalangeal joint to insertion of flexor sublimis tendon), complete
							 amputation
20822
1,175.77
2,170.99
Replantation, digit, excluding thumb (includes distal
							 tip to sublimis tendon insertion), complete amputation
20824
2,436.87
Replantation, thumb (includes carpometacarpal joint
							 to MP joint), complete amputation
20827
2,219.31
Replantation, thumb (includes distal tip to MP
							 joint), complete amputation
20838
2,322.57
Replantation, foot, complete amputation
20900
1,304.45
631.61
Bone graft, any donor area; minor or small (eg, dowel
							 or button)
20902
1,304.45
607.39
Bone graft, any donor area; major or
							 large
20910
903.02
430.61
Cartilage graft; costochondral
20912
903.02
487.05
Cartilage graft; nasal septum
20920
672.37
401.84
Fascia lata graft; by stripper
20922
672.37
602.03
Fascia lata graft; by incision and area exposure,
							 complex or sheet
20924
1,304.45
506.11
Tendon graft, from a distance (eg, palmaris, toe
							 extensor, plantaris)
20926
202.27
433.34
Tissue grafts, other (eg, paratenon, fat,
							 dermis)
20930
I.C.
Allograft for spine surgery only; morselized (List
							 separately in addition to code for primary procedure)
20931
111.51
Allograft for spine surgery only; structural (List
							 separately in addition to code for primary procedure)
20936
I.C.
Autograft for spine surgery only (includes harvesting
							 the graft); local (eg, ribs, spinous process, or laminar fragments) obtained
							 from same incision (List separately in addition to code for primary
							 procedure)
20937
169.44
Autograft for spine surgery only (includes harvesting
							 the graft); morselized (through separate skin or fascial incision) (List
							 separately in addition to code for primary procedure)
20938
184.43
Autograft for spine surgery only (includes harvesting
							 the graft); structural, bicortical or tricortical (through separate skin or
							 fascial incision) (List separately in addition to code for primary
							 procedure)
20950
62.85
304.01
Monitoring of interstitial fluid pressure (includes
							 insertion of device, eg, wick catheter technique, needle manometer technique)
							 in detection of muscle compartment syndrome
20955
2,499.21
Bone graft with microvascular anastomosis;
							 fibula
20956
2,646.13
Bone graft with microvascular anastomosis; iliac
							 cres
20957
2,459.01
Bone graft with microvascular anastomosis;
							 metatarsa
20962
2,637.14
Bone graft with microvascular anastomosis; other than
							 fibula, iliac crest, or metatarsal
20969
2,783.23
Free osteocutaneous flap with microvascular
							 anastomosis; other than iliac crest, metatarsal, or great
toe
20970
2,775.62
Free osteocutaneous flap with microvascular
							 anastomosis; iliac crest
20972
1,978.29
2,485.71
Free osteocutaneous flap with microvascular
							 anastomosis; metatarsal
20973
1,978.29
2,675.05
Free osteocutaneous flap with microvascular
							 anastomosis; great toe with web space
20974
62.67
Electrical stimulation to aid bone healing;
							 noninvasiv (nonoperative)
20975
176.78
Electrical stimulation to aid bone healing; invasive
							 (operative)
20979
26.11
56.55
Low intensity ultrasound stimulation to aid bone
							 healing, noninvasive (nonoperative)
20982
1,920.92
4,634.67
Ablation, bone tumor(s) (eg, osteoid osteoma,
							 metastasis) radiofrequency, percutaneous, including computed tomographic
							 guidance
20985
145.31
Computer-assisted surgical navigational procedure fo
							 musculoskeletal procedures; image-less (List separately in addition to code for
							 primary procedure)
20986
I.C.
Computer-assisted surgical navigational procedure for
							 musculoskeletal procedures; with image guidance based on intraoperatively
							 obtained images (eg, fluoroscopy, ultrasound) (List separately in addition to
							 code for primary procedure)
20987
I.C.
Computer-assisted surgical navigational procedure for
							 musculoskeletal procedures; with image guidance based on preoperative images
							 (List separately in addition to code for primary procedure)
20999
I.C.
Unlisted procedure, musculoskeletal system,
							 general
21010
1,071.47
713.36
Arthrotomy, temporomandibular joint
21015
729.71
426.33
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of face or scalp
21025
1,782.06
988.28
Excision of bone (eg, for osteomyelitis or bone
							 abscess); mandible
21026
1,782.06
591.47
Excision of bone (eg, for osteomyelitis or bone
							 abscess); facial bone(s)
21029
1,782.06
746.08
Removal by contouring of benign tumor of facial bone
							 (eg, fibrous dysplasia)
21030
248.59
491.22
Excision of benign tumor or cyst of maxilla or zygoma
							 by enucleation and curettage
21031
203.73
380.69
Excision of torus mandibularis
21032
209.24
388.44
Excision of maxillary torus palatinus
21034
1,782.06
1,325.45
Excision of malignant tumor of maxilla or
							 zygoma
21040
1,071.47
493.06
Excision of benign tumor or cyst of mandible, by
							 enucleation and/or curettage
21044
1,782.06
866.40
Excision of malignant tumor of mandible;
21045
1,197.58
Excision of malignant tumor of mandible; radical
							 resection
21046
1,782.06
1,071.26
Excision of benign tumor or cyst of mandible;
							 requiring intra-oral osteotomy (eg, locally aggressive or destructive
							 lesion(s))
21047
1,782.06
1,285.42
Excision of benign tumor or cyst of mandible;
							 requiring extra-oral osteotomy and partial mandibulectomy (eg, locally
							 aggressive or destructive lesion(s))
21048
1,782.06
1,088.86
Excision of benign tumor or cyst of maxilla;
							 requiring intra-oral osteotomy (eg, locally aggressive or destructive
							 lesion(s))
21049
1,235.80
Excision of benign tumor or cyst of maxilla;
							 requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive
							 or destructive lesion(s))
21050
1,782.06
844.50
Condylectomy, temporomandibular joint (separate
							 procedure)
21060
1,782.06
777.49
Meniscectomy, partial or complete, temporomandibular
							 joint (separate procedure)
21070
1,782.06
636.21
Coronoidectomy (separate procedure)
21073
202.26
379.74
Manipulation of temporomandibular joint(s) (TMJ),
							 therapeutic, requiring an anesthesia service (ie, general or monitored
							 anesthesia care)
21076
374.35
986.49
Impression and custom preparation; surgical obturato
							 prosthesis
21077
914.19
2,432.95
Impression and custom preparation; orbital
							 prosthesis
21079
651.62
1,672.99
Impression and custom preparation; interim obturator
							 prosthesis
21080
746.87
1,903.78
Impression and custom preparation; definitive
							 obturator prosthesis
21081
685.82
1,735.73
Impression and custom preparation; mandibular
							 resection prosthesis
21082
629.19
1,593.53
Impression and custom preparation; palatal
							 augmentation prosthesis
21083
618.90
1,520.60
Impression and custom preparation; palatal lift
							 prosthesis
21084
721.86
1,737.63
Impression and custom preparation; speech aid
							 prosthesis
21085
279.48
695.29
Impression and custom preparation; oral surgical
							 splint
21086
673.32
1,805.14
Impression and custom preparation; auricular
							 prosthesis
21087
667.44
1,789.22
Impression and custom preparation; nasal
							 prosthesis
21088
1,782.06
I.C.
Impression and custom preparation; facial
							 prosthesis
21089
I.C.
Unlisted maxillofacial prosthetic
							 procedure
21100
1,782.06
773.46
Application of halo type appliance for maxillofacial
							 fixation, includes removal (separate procedure)
21110
332.81
740.19
Application of interdental fixation device for
							 conditions other than fracture or dislocation, includes removal
21116
186.87
Injection procedure for temporomandibular joint
							 arthrography
21120
1,071.47
654.16
Genioplasty; augmentation (autograft, allograft,
							 prosthetic material)
21121
1,071.47
758.91
Genioplasty; sliding osteotomy, single
							 piece
21122
1,071.47
718.44
Genioplasty; sliding osteotomies, two or more
							 osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical
							 chin)
21123
1,071.47
835.62
Genioplasty; sliding, augmentation with
							 interpositional bone grafts (includes obtaining autografts)
21125
1,071.47
3,132.9
9
Augmentation, mandibular body or angle; prosthetic
							 material
21127
1,782.06
3,406.0
5
Augmentation, mandibular body or angle; with bone
							 graft, onlay or interpositional (includes obtaining autograft)
21137
1,071.47
734.45
Reduction forehead; contouring only
21138
1,782.06
885.70
Reduction forehead; contouring and application of
							 prosthetic material or bone graft (includes obtaining autograft)
21139
1,782.06
959.74
Reduction forehead; contouring and setback of
							 anterior frontal sinus wall
21141
1,316.00
Reconstruction midface, LeFort I; single piece,
							 segment movement in any direction (eg, for Long Face Syndrome), without bone
							 graft
21142
1,281.30
Reconstruction midface, LeFort I; two pieces, segment
							 movement in any direction, without bone graft
21143
1,359.35
Reconstruction midface, LeFort I; three or more
							 pieces, segment movement in any direction, without bone graft
21145
1,511.19
Reconstruction midface, LeFort I; single piece,
							 segment movement in any direction, requiring bone grafts (includes obtaining
							 autografts)
21146
1,495.10
Reconstruction midface, LeFort I; two pieces, segment
							 movement in any direction, requiring bone grafts (includes obtaining
							 autografts) (eg, ungrafted unilateral alveolar cleft)
21147
1,623.65
Reconstruction midface, LeFort I; three or more
							 pieces, segment movement in any direction, requiring bone grafts (includes
							 obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple
							 osteotomies)
21150
1,782.06
1,732.52
Reconstruction midface, LeFort II; anterior intrusion
							 (eg, Treacher-Collins Syndrome)
21151
1,849.76
Reconstruction midface, LeFort II; any direction,
							 requiring bone grafts (includes obtaining autografts)
21154
2,079.28
Reconstruction midface, LeFort III (extracranial), an
							 type, requiring bone grafts (includes obtaining autografts); without LeFort
							 I
21155
2,362.39
Reconstruction midface, LeFort III (extracranial), an
							 type, requiring bone grafts (includes obtaining autografts); with LeFort
							 I
21159
2,728.67
Reconstruction midface, LeFort III (extra and
							 intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts
							 (includes obtaining autografts); without LeFort I
21160
2,894.85
Reconstruction midface, LeFort III (extra and
							 intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts
							 (includes obtaining autografts); with LeFort I
21172
1,697.99
Reconstruction superior-lateral orbital rim and lower
							 forehead, advancement or alteration, with or without grafts (includes obtaining
							 autografts)
21175
2,007.74
Reconstruction, bifrontal, superior-lateral orbital
							 rim and lower forehead, advancement or alteration (eg, plagiocephaly,
							 trigonocephaly, brachycephaly), with or without grafts (includes obtaining
							 autografts)
21179
1,437.11
Reconstruction, entire or majority of forehead and/or
							 supraorbital rims; with grafts (allograft or prosthetic material)
21180
1,627.03
Reconstruction, entire or majority of forehead and/or
							 supraorbital rims; with autograft (includes obtaining grafts)
21181
1,071.47
716.24
Reconstruction by contouring of benign tumor of
							 cranial bones (eg, fibrous dysplasia), extracranial
21182
1,983.86
Reconstruction of orbital walls, rims, forehead,
							 nasoethmoid complex following intra-and extracranial excision of benign tumor
							 of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes
							 obtaining grafts); total area of bone grafting less than 40 sq cm
21183
2,270.70
Reconstruction of orbital walls, rims, forehead,
							 nasoethmoid complex following intra- and extracranial excision of benign tumor
							 of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes
							 obtaining grafts); total area of bone grafting greater than 40 sq cm but less
							 than 80 sq cm
21184
2,350.49
Reconstruction of orbital walls, rims, forehead,
							 nasoethmoid complex following intra- and extracranial excision of benign tumor
							 of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes
							 obtaining grafts); total area of bone grafting greater than 80 sq
							 cm
21188
21193
1,630.13
1,221.27
Reconstruction midface, osteotomies (other than
							 LeFort type) and bone grafts (includes obtaining autografts)
Reconstruction of mandibular rami, horizontal,
							 vertical, C, or L osteotomy; without bone graft
21194
1,392.36
Reconstruction of mandibular rami, horizontal,
							 vertical, C, or L osteotomy; with bone graft (includes obtaining
							 graft)
21195
21196
1,335.87
1,446.59
Reconstruction of mandibular rami and/or body,
							 sagittal split; without internal rigid fixation Reconstruction of mandibular
							 rami and/or body, sagittal split; with internal rigid fixation
21198
1,782.06
1,137.84
Osteotomy, mandible, segmental;
21199
1,782.06
993.46
Osteotomy, mandible, segmental; with genioglossus
							 advancement
21206
1,782.06
1,106.06
Osteotomy, maxilla, segmental (eg, Wassmund or
							 Schuchard)
21208
1,782.06
1,691.11
Osteoplasty, facial bones; augmentation (autograft,
							 allograft, or prosthetic implant)
21209
1,782.06
815.11
Osteoplasty, facial bones; reduction
21210
1,782.06
2,001.90
Graft, bone; nasal, maxillary or malar areas
							 (includes obtaining graft)
21215
1,782.06
3,400.25
Graft, bone; mandible (includes obtaining
							 graft)
21230
1,782.06
762.88
Graft; rib cartilage, autogenous, to face, chin, nose
							 or ear (includes obtaining graft)
21235
1,071.47
727.23
Graft; ear cartilage, autogenous, to nose or ear
							 (includes obtaining graft)
21240
1,782.06
1,100.68
Arthroplasty, temporomandibular joint, with or
							 without autograft (includes obtaining graft)
21242
1,782.06
1,015.29
Arthroplasty, temporomandibular joint, with
							 allograf
21243
1,782.06
1,645.42
Arthroplasty, temporomandibular joint, with
							 prosthetic joint replacement
21244
1,782.06
1,036.87
Reconstruction of mandible, extraoral, with
							 transosteal bone plate (eg, mandibular staple bone plate)
21245
1,782.06
1,134.10
Reconstruction of mandible or maxilla, subperiosteal
							 implant; partial
21246
1,782.06
856.09
Reconstruction of mandible or maxilla, subperiosteal
							 implant; complete
21247
1,598.07
Reconstruction of mandibular condyle with bone and
							 cartilage autografts (includes obtaining grafts) (eg, for hemifacial
							 microsomia)
21248
1,782.06
1,044.44
Reconstruction of mandible or maxilla, endosteal
							 implant (eg, blade, cylinder); partial
21249
1,782.06
1,456.17
Reconstruction of mandible or maxilla,
							 endosteal
implant (eg, blade, cylinder); complete
21255
1,386.02
Reconstruction of zygomatic arch and glenoid fossa
							 with bone and cartilage (includes obtaining autografts)
21256
1,132.24
Reconstruction of orbit with osteotomies
							 (extracranial) and with bone grafts (includes obtaining autografts) (eg,
							 micro-ophthalmia)
21260
1,782.06
1,227.16
Periorbital osteotomies for orbital hypertelorism,
							 with bone grafts; extracranial approach
21261
2,153.72
Periorbital osteotomies for orbital hypertelorism,
							 wit bone grafts; combined intra- and extracranial approach
21263
1,890.40
Periorbital osteotomies for orbital hypertelorism,
							 wit bone grafts; with forehead advancement
21267
21268
1,782.06
1,791.81
1,574.31
Orbital repositioning, periorbital osteotomies,
							 unilateral, with bone grafts; extracranial approach Orbital repositioning,
							 periorbital osteotomies, unilateral, with bone grafts; combined intra- and
							 extracranial approach
21270
1,782.06
905.95
Malar augmentation, prosthetic material
21275
1,782.06
789.01
Secondary revision of orbitocraniofacial
							 reconstruction
21280
1,782.06
515.36
Medial canthopexy (separate procedure)
21282
729.71
346.96
Lateral canthopexy
21295
332.81
176.48
Reduction of masseter muscle and bone (eg, for
							 treatment of benign masseteric hypertrophy); extraoral approach
21296
21299
1,071.47
I.C.
407.61
Reduction of masseter muscle and bone (eg, for
							 treatment of benign masseteric hypertrophy); intraoral approach Unlisted
							 craniofacial and maxillofacial procedure
21310
111.73
119.80
Closed treatment of nasal bone fracture without
							 manipulation
21315
111.73
271.18
Closed treatment of nasal bone fracture; without
							 stabilization
21320
729.71
258.08
Closed treatment of nasal bone fracture; with
							 stabilization
21325
1,071.47
507.27
Open treatment of nasal fracture;
							 uncomplicated
21330
1,071.47
609.78
Open treatment of nasal fracture; complicated, with
							 internal and/or external skeletal fixation
21335
1,071.47
742.95
Open treatment of nasal fracture; with concomitant
							 open treatment of fractured septum
21336
1,169.01
661.16
Open treatment of nasal septal fracture, with or
							 without stabilization
21337
729.71
402.31
Closed treatment of nasal septal fracture, with or
							 without stabilization
21338
1,071.47
806.80
Open treatment of nasoethmoid fracture; without
							 external fixation
21339
1,071.47
861.59
Open treatment of nasoethmoid fracture; with externa
							 fixation
21340
1,782.06
781.71
Percutaneous treatment of nasoethmoid complex
							 fracture, with splint, wire or headcap fixation, including repair of canthal
							 ligaments and/or the nasolacrimal apparatus
21343
1,176.66
Open treatment of depressed frontal sinus
							 fracture
21344
1,483.19
Open treatment of complicated (eg, comminuted or
							 involving posterior wall) frontal sinus fracture, via coronal or multiple
							 approaches
21345
1,071.47
798.53
Closed treatment of nasomaxillary complex fracture
							 (LeFort II type), with interdental wire fixation or fixation of denture or
							 splint
21346
951.99
Open treatment of nasomaxillary complex fracture
							 (LeFort II type); with wiring and/or local fixation
21347
1,143.57
Open treatment of nasomaxillary complex fracture
							 (LeFort II type); requiring multiple open approaches
21348
1,176.43
Open treatment of nasomaxillary complex fracture
							 (LeFort II type); with bone grafting (includes obtaining graft)
21355
1,782.06
437.08
Percutaneous treatment of fracture of malar area,
							 including zygomatic arch and malar tripod, with manipulation
21356
1,071.47
498.76
Open treatment of depressed zygomatic arch fracture
							 (eg, Gillies approach)
21360
1,071.47
523.19
Open treatment of depressed malar fracture, including
							 zygomatic arch and malar tripod
21365
1,073.90
Open treatment of complicated (eg, comminuted or
							 involving cranial nerve foramina) fracture(s) of malar area, including
							 zygomatic arch and malar tripod; with internal fixation and multiple surgical
							 approaches
21366
1,207.16
Open treatment of complicated (eg, comminuted or
							 involving cranial nerve foramina) fracture(s) of malar area, including
							 zygomatic arch and malar tripod; with bone grafting (includes obtaining
							 graft)
21385
21386
706.95
653.09
Open treatment of orbital floor blowout fracture;
							 transantral approach (Caldwell-Luc type operation) Open treatment of orbital
							 floor blowout fracture; periorbital approach
21387
751.69
Open treatment of orbital floor blowout fracture;
							 combined approach
21390
21395
1,782.06
942.32
746.01
Open treatment of orbital floor blowout fracture;
							 periorbital approach, with alloplastic or other implant Open treatment of
							 orbital floor blowout fracture; periorbital approach with bone graft (includes
							 obtaining graft)
21400
332.81
176.10
Closed treatment of fracture of orbit, except
							 blowout; without manipulation
21401
729.71
479.41
Closed treatment of fracture of orbit, except
							 blowout; with manipulation
21406
1,782.06
533.37
Open treatment of fracture of orbit, except blowout;
							 without implant
21407
1,782.06
626.51
Open treatment of fracture of orbit, except blowout;
							 with implant
21408
851.81
Open treatment of fracture of orbit, except blowout;
							 with bone grafting (includes obtaining graft)
21421
1,071.47
721.62
Closed treatment of palatal or maxillary fracture
							 (LeFort I type), with interdental wire fixation or fixation of denture or
							 splint
21422
671.96
Open treatment of palatal or maxillary fracture
							 (LeFort I type);
21423
789.00
Open treatment of palatal or maxillary fracture
							 (LeFort I type); complicated (comminuted or involving cranial nerve foramina),
							 multiple approaches
21431
754.28
Closed treatment of craniofacial separation (LeFort
							 II type) using interdental wire fixation of denture or splint
21432
665.82
Open treatment of craniofacial separation (LeFort III
							 type); with wiring and/or internal fixation
21433
1,633.07
Open treatment of craniofacial separation (LeFort III
							 type); complicated (eg, comminuted or involving cranial nerve foramina),
							 multiple surgical approaches
21435
1,290.93
Open treatment of craniofacial separation (LeFort III
							 type); complicated, utilizing internal and/or external fixation techniques (eg,
							 head cap, halo device, and/or intermaxillary fixation)
21436
1,839.74
Open treatment of craniofacial separation (LeFort III
							 type); complicated, multiple surgical approaches, internal fixation, with bone
							 grafting (includes obtaining graft)
21440
315.52
518.76
Closed treatment of mandibular or maxillary alveolar
							 ridge fracture (separate procedure)
21445
1,071.47
736.83
Open treatment of mandibular or maxillary alveolar
							 ridge fracture (separate procedure)
21450
111.73
543.05
Closed treatment of mandibular fracture; without
							 manipulation
21451
332.81
719.44
Closed treatment of mandibular fracture; with
							 manipulation
21452
729.71
663.47
Percutaneous treatment of mandibular fracture, with
							 external fixation
21453
1,782.06
828.94
Closed treatment of mandibular fracture with
							 interdental fixation
21454
1,071.47
545.55
Open treatment of mandibular fracture with external
							 fixation
21461
1,782.06
1,862.58
Open treatment of mandibular fracture; without
							 interdental fixation
21462
1,782.06
2,031.50
Open treatment of mandibular fracture; with
							 interdental fixation
21465
1,782.06
897.60
Open treatment of mandibular condylar
							 fracture
21470
1,158.59
Open treatment of complicated mandibular fracture b
							 multiple surgical approaches including internal fixation, interdental fixation,
							 and/or wiring of dentures or splints
21480
111.73
98.57
Closed treatment of temporomandibular dislocation;
							 initial or subsequent
21485
729.71
639.31
Closed treatment of temporomandibular dislocation;
							 complicated (eg, recurrent requiring intermaxillary fixation or splinting),
							 initial or subsequent
21490
1,782.06
903.12
Open treatment of temporomandibular
							 dislocation
21495
729.71
672.39
Open treatment of hyoid fracture
21497
729.71
642.86
Interdental wiring, for condition other than
							 fracture
21499
I.C.
Unlisted musculoskeletal procedure, head
21501
818.67
443.75
Incision and drainage, deep abscess or hematoma, sof
							 tissues of neck or thorax;
21502
950.47
517.50
Incision and drainage, deep abscess or hematoma, sof
							 tissues of neck or thorax; with partial rib ostectomy
21510
472.07
Incision, deep, with opening of bone cortex (eg, for
							 osteomyelitis or bone abscess), thorax
21550
388.12
258.55
Biopsy, soft tissue of neck or thorax
21555
943.36
427.07
Excision tumor, soft tissue of neck or thorax;
							 subcutaneous
21556
943.36
401.35
Excision tumor, soft tissue of neck or thorax; deep,
							 subfascial, intramuscular
21557
943.36
563.97
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of neck or thorax
21600
1,304.45
542.72
Excision of rib, partial
21610
1,304.45
1,039.61
Costotransversectomy (separate procedure)
21615
668.43
Excision first and/or cervical rib;
21616
818.83
Excision first and/or cervical rib; with
							 sympathectom
21620
521.01
Ostectomy of sternum, partial
21627
548.67
Sternal debridement
21630
1,237.61
Radical resection of sternum;
21632
1,218.57
Radical resection of sternum; with mediastinal
							 lymphadenectomy
21685
332.81
971.45
Hyoid myotomy and suspension
21700
950.47
425.75
Division of scalenus anticus; without resection of
							 cervical rib
21705
607.25
Division of scalenus anticus; with resection of
							 cervical rib
21720
950.47
374.01
Division of sternocleidomastoid for torticollis, open
							 operation; without cast application
21725
62.85
522.63
Division of sternocleidomastoid for torticollis, open
							 operation; with cast application
21740
1,052.32
Reconstructive repair of pectus excavatum or
							 carinatum; open
21742
I.C.
Reconstructive repair of pectus excavatum or
							 carinatum; minimally invasive approach (Nuss procedure), without
							 thoracoscopy
21743
I.C.
Reconstructive repair of pectus excavatum or
							 carinatum; minimally invasive approach (Nuss procedure), with
							 thoracoscopy
21750
699.66
Closure of median sternotomy separation with or
							 without debridement (separate procedure)
21800
79.02
98.30
Closed treatment of rib fracture, uncomplicated,
							 each
21805
1,169.01
256.12
Open treatment of rib fracture without fixation,
							 each
21810
502.41
Treatment of rib fracture requiring external fixation
							 (flail chest)
21820
79.02
133.75
Closed treatment of sternum fracture
21825
565.57
Open treatment of sternum fracture with or without
							 skeletal fixation
21899
I.C.
Unlisted procedure, neck or thorax
21920
141.94
252.88
Biopsy, soft tissue of back or flank;
							 superficial
21925
943.36
415.10
Biopsy, soft tissue of back or flank;
							 deep
21930
943.36
463.19
Excision, tumor, soft tissue of back or
							 flank
21935
943.36
1,117.98
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of back or flank
22010
878.10
Incision and drainage, open, of deep abscess
							 (subfascial), posterior spine; cervical, thoracic, or
							 cervicothoracic
22015
872.36
Incision and drainage, open, of deep abscess
							 (subfascial), posterior spine; lumbar, sacral, or lumbosacral
22100
795.13
Partial excision of posterior vertebral component
							 (eg, spinous process, lamina or facet) for intrinsic bony lesion, single
							 vertebral segment; cervical
22101
794.19
Partial excision of posterior vertebral component
							 (eg, spinous process, lamina or facet) for intrinsic bony lesion, single
							 vertebral segment; thoracic
22102
2,090.17
796.97
Partial excision of posterior vertebral component
							 (eg, spinous process, lamina or facet) for intrinsic bony lesion, single
							 vertebral segment; lumbar
22103
2,090.17
141.41
Partial excision of posterior vertebral component
							 (eg, spinous process, lamina or facet) for intrinsic bony lesion, single
							 vertebral segment; each additional segment (List separately in addition to code
							 for primary procedure)
22110
975.36
Partial excision of vertebral body, for intrinsic
							 bony lesion, without decompression of spinal cord or nerve root(s), single
							 vertebral segment; cervical
22112
971.02
Partial excision of vertebral body, for intrinsic
							 bony lesion, without decompression of spinal cord or nerve root(s), single
							 vertebral segment; thoracic
22114
973.39
Partial excision of vertebral body, for intrinsic
							 bony lesion, without decompression of spinal cord or nerve root(s), single
							 vertebral segment; lumbar
22116
141.61
Partial excision of vertebral body, for intrinsic
							 bony lesion, without decompression of spinal cord or nerve root(s), single
							 vertebral segment; each additional vertebral segment (List separately in
							 addition to code for primary procedure)
22206
2,266.12
Osteotomy of spine, posterior or posterolateral
							 approach, three columns, one vertebral segment (eg, pedicle/vertebral body
							 subtraction); thoracic
22207
2,238.72
Osteotomy of spine, posterior or posterolateral
							 approach, three columns, one vertebral segment (eg, pedicle/vertebral body
							 subtraction); lumbar
22208
563.55
Osteotomy of spine, posterior or posterolateral
							 approach, three columns, one vertebral segment (eg, pedicle/vertebral body
							 subtraction); each additional vertebral segment (List separately in addition to
							 code for primary procedure)
22210
1,711.64
Osteotomy of spine, posterior or posterolateral
							 approach, one vertebral segment; cervical
22212
1,417.71
Osteotomy of spine, posterior or posterolateral
							 approach, one vertebral segment; thoracic
22214
1,433.30
Osteotomy of spine, posterior or posterolateral
							 approach, one vertebral segment; lumbar
22216
370.21
Osteotomy of spine, posterior or posterolateral
							 approach, one vertebral segment; each additional vertebral segment (List
							 separately in addition to primary procedure)
22220
1,548.36
Osteotomy of spine, including discectomy, anterior
							 approach, single vertebral segment; cervical
22222
1,400.73
Osteotomy of spine, including discectomy, anterior
							 approach, single vertebral segment; thoracic
22224
1,530.02
Osteotomy of spine, including discectomy, anterior
							 approach, single vertebral segment; lumbar
22226
368.37
Osteotomy of spine, including discectomy, anterior
							 approach, single vertebral segment; each additional vertebral segment (List
							 separately in addition to code for primary procedure)
22305
79.02
185.35
Closed treatment of vertebral process
							 fracture(s)
22310
79.02
274.46
Closed treatment of vertebral body fracture(s),
							 without manipulation, requiring and including casting or bracing
22315
79.02
844.73
Closed treatment of vertebral fracture(s) and/or
							 dislocation(s) requiring casting or bracing, with and including casting and/or
							 bracing, with or without anesthesia, by manipulation or traction
22318
1,542.01
Open treatment and/or reduction of odontoid
							 fracture(s) and or dislocation(s) (including os odontoideum), anterior
							 approach, including placement of internal fixation; without
							 grafting
22319
1,688.58
Open treatment and/or reduction of odontoid
							 fracture(s) and or dislocation(s) (including os odontoideum), anterior
							 approach, including placement of internal fixation; with grafting
22325
1,344.05
Open treatment and/or reduction of vertebral
							 fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra
							 or dislocated segment; lumbar
22326
1,406.87
Open treatment and/or reduction of vertebral
							 fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra
							 or dislocated segment; cervical
22327
1,389.12
Open treatment and/or reduction of vertebral
							 fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra
							 or dislocated segment; thoracic
22328
277.75
Open treatment and/or reduction of vertebral
							 fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra
							 or dislocated segment; each additional fractured vertebra or dislocated segment
							 (List separately in addition to code for primary procedure)
22505
659.86
121.59
Manipulation of spine requiring anesthesia, any
							 region
22520
1,304.45
2,793.55
Percutaneous vertebroplasty, one vertebral body,
							 unilateral or bilateral injection; thoracic
22521
1,304.45
2,666.47
Percutaneous vertebroplasty, one vertebral body,
							 unilateral or bilateral injection; lumbar
22522
1,304.45
244.58
Percutaneous vertebroplasty, one vertebral body,
							 unilateral or bilateral injection; each additional thoracic or lumbar vertebral
							 body (List separately in addition to code for primary procedure)
22523
3,549.34
609.50
Percutaneous vertebral augmentation, including cavity
							 creation (fracture reduction and bone biopsy included
22524
3,549.34
583.96
when performed) using mechanical device, one
							 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic
							 Percutaneous vertebral augmentation, including cavity
22525
3,549.34
268.33
creation (fracture reduction and bone biopsy included
							 when performed) using mechanical device, one vertebral body, unilateral or
							 bilateral cannulation (eg, kyphoplasty); lumbar Percutaneous vertebral
							 augmentation, including cavity
22526
1,304.45
2,392.91
creation (fracture reduction and bone biopsy included
							 when performed) using mechanical device, one vertebral body, unilateral or
							 bilateral cannulation (eg, kyphoplasty); each additional thoracic or lumbar
							 vertebral body (List separately in addition to code for primary
							 procedure)
Percutaneous intradiscal electrothermal
							 annuloplasty,
22527
1,304.45
1,980.38
unilateral or bilateral including fluoroscopic
							 guidance;
single level Percutaneous intradiscal electrothermal
							 annuloplasty,
unilateral or bilateral including fluoroscopic
							 guidance; one or more additional levels (List separately in addition to code
							 for primary procedure)
22532
1,670.29
Arthrodesis, lateral extracavitary technique,
							 including minimal discectomy to prepare interspace (other than for
							 decompression); thoracic
22533
1,560.50
Arthrodesis, lateral extracavitary technique,
							 including minimal discectomy to prepare interspace (other than for
							 decompression); lumbar
22534
364.42
Arthrodesis, lateral extracavitary technique,
							 including minimal discectomy to prepare interspace (other than for
							 decompression); thoracic or lumbar, each additional vertebral segment (List
							 separately in addition to code for primary procedure)
22548
1,793.15
Arthrodesis, anterior transoral or extraoral
							 technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid
							 process
22554
1,261.88
Arthrodesis, anterior interbody technique, including
							 minimal discectomy to prepare interspace (other than for decompression);
							 cervical below C2
22556
1,604.39
Arthrodesis, anterior interbody technique, including
							 minimal discectomy to prepare interspace (other than for decompression);
							 thoracic
22558
1,460.65
Arthrodesis, anterior interbody technique, including
							 minimal discectomy to prepare interspace (other than for decompression);
							 lumbar
22585
I
1,259.20
Arthrodesis, anterior interbody technique, including
							 minimal discectomy to prepare interspace (other than for decompression); each
							 additional interspace (List separately in addition to code for primary
							 procedure)
22590
1,487.74
Arthrodesis, posterior technique, craniocervical
							 (occiput-C2)
22595
1,416.93
Arthrodesis, posterior technique, atlas-axis
							 (C1-C2)
22600
1,214.58
Arthrodesis, posterior or posterolateral technique,
							 single level; cervical below C2 segment
22610
1,200.81
Arthrodesis, posterior or posterolateral technique,
							 single level; thoracic (with or without lateral transverse
							 technique)
22612
I
3,883.08
Arthrodesis, posterior or posterolateral technique,
							 single level; lumbar (with or without lateral transverse technique)
22614
394.39
Arthrodesis, posterior or posterolateral technique,
							 single level; each additional vertebral segment (List separately in addition to
							 code for primary procedure)
22630
1,491.22
Arthrodesis, posterior interbody technique, including
							 laminectomy and/or discectomy to prepare interspace (other than for
							 decompression), single interspace; lumbar
22632
320.24
Arthrodesis, posterior interbody technique, including
							 laminectomy and/or discectomy to prepare interspace (other than for
							 decompression), single interspace; each additional interspace (List separately
							 in addition to code for primary procedure)
22800
1,322.62
Arthrodesis, posterior, for spinal deformity, with or
							 without cast; up to six vertebral segments
22802
2,093.75
Arthrodesis, posterior, for spinal deformity, with or
							 without cast; seven to 12 vertebral segments
22804
2,423.25
Arthrodesis, posterior, for spinal deformity, with or
							 without cast; 13 or more vertebral segments
22808
1,779.39
Arthrodesis, anterior, for spinal deformity, with or
							 without cast; two to three vertebral segments
22810
1,988.96
Arthrodesis, anterior, for spinal deformity, with or
							 without cast; four to seven vertebral segments
22812
2,181.84
Arthrodesis, anterior, for spinal deformity, with or
							 without cast; eight or more vertebral segments
22818
2,177.95
Kyphectomy, circumferential exposure of spine and
							 resection of vertebral segment(s) (including body and posterior elements);
							 single or two segments
22819
2,463.80
Kyphectomy, circumferential exposure of spine and
							 resection of vertebral segment(s) (including body and posterior elements);
							 three or more segments
22830
794.63
Exploration of spinal fusion
22840
I
2,245.41
Posterior non-segmental instrumentation (eg,
							 Harrington rod technique, pedicle fixation across one interspace, atlantoaxial
							 transarticular screw fixation, sublaminar wiring at C1, facet screw fixation)
							 (List separately in addition to code for primary procedure)
22841
I.C.
Internal spinal fixation by wiring of spinous
							 processe (List separately in addition to code for primary
							 procedure)
22842
I
2,856.09
Posterior segmental instrumentation (eg, pedicle
							 fixation, dual rods with multiple hooks and sublaminar wires); three to six
							 vertebral segments (List separately in addition to code for primary
							 procedure)
22843
815.26
Posterior segmental instrumentation (eg, pedicle
							 fixation, dual rods with multiple hooks and sublaminar wires); seven to 12
							 vertebral segments (List separately in addition to code for primary
							 procedure)
22844
1,005.14
Posterior segmental instrumentation (eg, pedicle
							 fixation, dual rods with multiple hooks and sublaminar wires); 13 or more
							 vertebral segments (List separately in addition to code for primary
							 procedure)
22845
I
1,844.78
Anterior instrumentation; two to three vertebral
							 segments (List separately in addition to code for
primary procedure)
22846
765.25
Anterior instrumentation; four to seven vertebral
							 segments (List separately in addition to code for
primary procedure)
22847
841.65
Anterior instrumentation; eight or more vertebral
							 segments (List separately in addition to code for primary
							 procedure)
22848
366.03
Pelvic fixation (attachment of caudal end of
							 instrumentation to pelvic bony structures) other than sacrum (List separately
							 in addition to code for primary procedure)
22849
1,272.36
Reinsertion of spinal fixation device
22850
702.39
Removal of posterior nonsegmental instrumentation
							 (eg, Harrington rod)
22851
I
1,827.17
Application of intervertebral biomechanical device(s)
							 (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to
							 vertebral defect or interspace (List separately in addition to code for primary
							 procedure)
22852
672.86
Removal of posterior segmental
							 instrumentation
22855
1,077.99
Removal of anterior instrumentation
22857
1,708.32
Total disc arthroplasty (artificial disc), anterior
							 approach, including discectomy to prepare interspace (other than for
							 decompression), lumbar, single interspace
22862
2,008.52
Revision including replacement of total disc
							 arthroplasty (artificial disc) anterior approach, lumbar, single
							 interspace
22865
1,956.97
Removal of total disc arthroplasty (artificial disc),
							 anterior approach, lumbar, single interspace
22899
I.C.
Unlisted procedure, spine
22900
943.36
387.99
Excision, abdominal wall tumor, subfascial (eg,
							 desmoid)
22999
I.C.
Unlisted procedure, abdomen, musculoskeletal
							 system
23000
23020
719.48
1,920.92
548.50
684.76
Removal of subdeltoid calcareous deposits, open
							 Capsular contracture release (eg, Sever type procedure)
23030
818.67
449.37
Incision and drainage, shoulder area; deep abscess or
							 hematoma
23031
818.67
438.97
Incision and drainage, shoulder area; infected
							 bursa
23035
950.47
691.48
Incision, bone cortex (eg, osteomyelitis or bone
							 abscess), shoulder area
23040
1,304.45
713.22
Arthrotomy, glenohumeral joint, including
							 exploration, drainage, or removal of foreign body
23044
1,304.45
567.81
Arthrotomy, acromioclavicular, sternoclavicular
							 joint, including exploration, drainage, or removal of foreign body
23065
100.03
209.04
Biopsy, soft tissue of shoulder area;
							 superficial
23066
943.36
517.96
Biopsy, soft tissue of shoulder area;
							 deep
23075
719.48
261.86
Excision, soft tissue tumor, shoulder area;
							 subcutaneous
23076
943.36
549.56
Excision, soft tissue tumor, shoulder area; deep,
							 subfascial, or intramuscular
23077
943.36
1,144.05
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of shoulder area
23100
950.47
484.44
Arthrotomy, glenohumeral joint, including
							 biopsy
23101
1,304.45
448.38
Arthrotomy, acromioclavicular joint or
							 sternoclavicular joint, including biopsy and/or excision of torn
							 cartilage
23105
1,304.45
632.25
Arthrotomy; glenohumeral joint, with synovectomy,
							 with or without biopsy
23106
1,304.45
476.86
Arthrotomy; sternoclavicular joint, with synovectomy,
							 with or without biopsy
23107
1,304.45
657.79
Arthrotomy, glenohumeral joint, with joint
							 exploration, with or without removal of loose or foreign body
23120
1,304.45
558.51
Claviculectomy; partial
23125
1,304.45
694.88
Claviculectomy; total
23130
1,920.92
603.72
Acromioplasty or acromionectomy, partial, with or
							 without coracoacromial ligament release
23140
950.47
505.08
Excision or curettage of bone cyst or benign tumor of
							 clavicle or scapula;
23145
1,304.45
682.33
Excision or curettage of bone cyst or benign tumor of
							 clavicle or scapula; with autograft (includes obtaining graft)
23146
1,304.45
612.35
Excision or curettage of bone cyst or benign tumor of
							 clavicle or scapula; with allograft
23150
1,304.45
643.01
Excision or curettage of bone cyst or benign tumor of
							 proximal humerus;
23155
1,304.45
778.83
Excision or curettage of bone cyst or benign tumor of
							 proximal humerus; with autograft (includes obtaining graft)
23156
1,304.45
666.74
Excision or curettage of bone cyst or benign tumor of
							 proximal humerus; with allograft
23170
1,304.45
529.60
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), clavicle
23172
1,304.45
547.67
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), scapula
23174
1,304.45
745.11
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), humeral head to surgical neck
23180
1,304.45
701.11
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis), clavicle
23182
1,304.45
675.01
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis), scapula
23184
1,304.45
755.84
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis), proximal humerus
23190
1,304.45
550.57
Ostectomy of scapula, partial (eg, superior medial
							 angle)
23195
1,304.45
738.27
Resection, humeral head
23200
855.97
Radical resection for tumor; clavicle
23210
897.27
Radical resection for tumor; scapula
23220
1,058.90
Radical resection of bone tumor, proximal
							 humerus;
23221
1,234.43
Radical resection of bone tumor, proximal humerus;
							 with autograft (includes obtaining graft)
23222
1,657.63
Radical resection of bone tumor, proximal humerus;
							 with prosthetic replacement
23330
388.12
233.06
Removal of foreign body, shoulder;
							 subcutaneous
23331
943.36
585.38
Removal of foreign body, shoulder; deep (eg, Neer
							 hemiarthroplasty removal)
23332
876.56
Removal of foreign body, shoulder; complicated (eg,
							 total shoulder)
23350
178.63
Injection procedure for shoulder arthrography or
							 enhanced CT/MRI shoulder arthrography
23395
1,920.92
1,266.78
Muscle transfer, any type, shoulder or upper arm;
							 single
23397
3,549.34
1,131.50
Muscle transfer, any type, shoulder or upper arm;
							 multiple
23400
1,304.45
966.25
Scapulopexy (eg, Sprengels deformity or for
							 paralysis)
23405
1,304.45
626.79
Tenotomy, shoulder area; single tendon
23406
1,304.45
779.71
Tenotomy, shoulder area; multiple tendons
							 through
same incision
23410
1,920.92
892.11
Repair of ruptured musculotendinous cuff (eg, rotator
							 cuff) open; acute
23412
1,920.92
I
2,271.64
Repair of ruptured musculotendinous cuff (eg, rotato
							 cuff) open; chronic
23415
1,920.92
732.20
Coracoacromial ligament release, with or without
							 acromioplasty
23420
1,920.92
I
2,118.74
Reconstruction of complete shoulder (rotator) cuff
							 avulsion, chronic (includes acromioplasty)
23430
1,920.92
737.74
Tenodesis of long tendon of biceps
23440
1,920.92
760.51
Resection or transplantation of long tendon of
							 biceps
23450
3,549.34
948.68
Capsulorrhaphy, anterior; Putti-Platt procedure or
							 Magnuson type operation
23455
3,549.34
1,008.99
Capsulorrhaphy, anterior; with labral repair (eg,
							 Bankart procedure)
23460
3,549.34
1,092.71
Capsulorrhaphy, anterior, any type; with bone
							 block
23462
1,920.92
1,067.17
Capsulorrhaphy, anterior, any type; with coracoid
							 process transfer
23465
3,549.34
1,110.71
Capsulorrhaphy, glenohumeral joint, posterior, with
							 or without bone block
23466
1,920.92
1,097.00
Capsulorrhaphy, glenohumeral joint, any type
							 multi-directional instability
23470
1,210.72
Arthroplasty, glenohumeral joint;
							 hemiarthroplasty
23472
1,488.46
Arthroplasty, glenohumeral joint; total shoulder
							 (glenoid and proximal humeral replacement (eg, total shoulder))
23480
1,920.92
818.43
Osteotomy, clavicle, with or without internal
							 fixation
23485
3,549.34
957.53
Osteotomy, clavicle, with or without internal
							 fixation with bone graft for nonunion or malunion (includes obtaining graft
							 and/or necessary fixation)
23490
1,920.92
810.94
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate; clavicle
23491
3,549.34
1,013.09
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate; proximal humerus
23500
79.02
208.75
Closed treatment of clavicular fracture; without
							 manipulation
23505
79.02
339.76
Closed treatment of clavicular fracture; with
							 manipulation
23515
2,646.58
675.82
Open treatment of clavicular fracture, includes
							 internal fixation, when performed
23520
79.02
214.99
Closed treatment of sternoclavicular dislocation;
							 without manipulation
23525
79.02
339.32
Closed treatment of sternoclavicular dislocation;
							 with manipulation
23530
1,837.10
546.28
Open treatment of sternoclavicular dislocation, acute
							 or chronic;
23532
1,169.01
616.42
Open treatment of sternoclavicular dislocation, acute
							 or chronic; with fascial graft (includes obtaining graft)
23540
79.02
214.04
Closed treatment of acromioclavicular dislocation;
							 without manipulation
23545
79.02
306.58
Closed treatment of acromioclavicular dislocation;
							 with manipulation
23550
1,837.10
567.19
Open treatment of acromioclavicular dislocation,
							 acute or chronic;
23552
1,837.10
653.34
Open treatment of acromioclavicular dislocation,
							 acute or chronic; with fascial graft (includes obtaining graft)
23570
79.02
222.12
Closed treatment of scapular fracture; without
							 manipulation
23575
79.02
376.53
Closed treatment of scapular fracture; with
							 manipulation, with or without skeletal traction (with or without shoulder joint
							 involvement)
23585
2,646.58
898.46
Open treatment of scapular fracture (body, glenoid or
							 acromion) with or without internal fixation
23600
79.02
315.20
Closed treatment of proximal humeral (surgical or
							 anatomical neck) fracture; without manipulation
23605
79.02
459.43
Closed treatment of proximal humeral (surgical or
							 anatomical neck) fracture; with manipulation, with or without skeletal
							 traction
23615
2,646.58
851.31
Open treatment of proximal humeral (surgical or
							 anatomical neck) fracture, includes internal fixation, when performed, includes
							 repair of tuberosity(s), when performed;
23616
2,646.58
1,298.12
Open treatment of proximal humeral (surgical or
							 anatomical neck) fracture, includes internal fixation, when performed, includes
							 repair of tuberosity(s), when performed; with proximal humeral prosthetic
							 replacement
23620
79.02
257.54
Closed treatment of greater humeral tuberosity
							 fracture; without manipulation
23625
79.02
372.19
Closed treatment of greater humeral tuberosity
							 fracture; with manipulation
23630
2,646.58
715.01
Open treatment of greater humeral tuberosity
							 fracture, includes internal fixation, when performed
23650
79.02
288.92
Closed treatment of shoulder dislocation, with
							 manipulation; without anesthesia
23655
659.86
370.58
Closed treatment of shoulder dislocation, with
							 manipulation; requiring anesthesia
23660
1,837.10
574.46
Open treatment of acute shoulder
							 dislocation
23665
79.02
410.57
Closed treatment of shoulder dislocation, with
							 fracture of greater humeral tuberosity, with manipulation
23670
2,646.58
794.27
Open treatment of shoulder dislocation, with fracture
							 of greater humeral tuberosity, includes internal fixation, when
							 performed
23675
79.02
537.83
Closed treatment of shoulder dislocation, with
							 surgical or anatomical neck fracture, with manipulation
23680
1,837.10
872.32
Open treatment of shoulder dislocation, with surgical
							 or anatomical neck fracture, includes internal fixation, when
							 performed
23700
659.86
193.81
Manipulation under anesthesia, shoulder joint,
							 including application of fixation apparatus (dislocation excluded)
23800
3,549.34
1,012.60
Arthrodesis, glenohumeral joint;
23802
1,920.92
1,194.11
Arthrodesis, glenohumeral joint; with autogenous
							 graft (includes obtaining graft)
23900
1,307.47
Interthoracoscapular amputation
							 (forequarter)
23920
1,062.30
Disarticulation of shoulder;
23921
672.37
443.68
Disarticulation of shoulder; secondary closure or
							 scar
revision
23929
I.C.
Unlisted procedure, shoulder
23930
818.67
374.01
Incision and drainage, upper arm or elbow area; deep
							 abscess or hematoma
23931
818.67
306.78
Incision and drainage, upper arm or elbow area;
							 bursa
23935
950.47
499.17
Incision, deep, with opening of bone cortex (eg, for
							 osteomyelitis or bone abscess), humerus or elbow
24000
1,304.45
467.42
Arthrotomy, elbow, including exploration, drainage,
							 or removal of foreign body
24006
1,304.45
703.90
Arthrotomy of the elbow, with capsular excision for
							 capsular release (separate procedure)
24065
135.32
246.18
Biopsy, soft tissue of upper arm or elbow area;
							 superficial
24066
719.48
599.87
Biopsy, soft tissue of upper arm or elbow area; deep
							 (subfascial or intramuscular)
24075
719.48
486.62
Excision, tumor, soft tissue of upper arm or elbow
							 area; subcutaneous
24076
943.36
462.88
Excision, tumor, soft tissue of upper arm or elbow
							 area; deep (subfascial or intramuscular)
24077
943.36
795.87
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of upper arm or elbow area
24100
950.47
393.89
Arthrotomy, elbow; with synovial biopsy
							 only
24101
1,304.45
494.91
Arthrotomy, elbow; with joint exploration, with or
							 without biopsy, with or without removal of loose or foreign body
24102
1,304.45
609.95
Arthrotomy, elbow; with synovectomy
24105
950.47
337.37
Excision, olecranon bursa
24110
950.47
576.61
Excision or curettage of bone cyst or benign tumor,
							 humerus;
24115
1,304.45
657.37
Excision or curettage of bone cyst or benign tumor,
							 humerus; with autograft (includes obtaining graft)
24116
1,304.45
860.94
Excision or curettage of bone cyst or benign tumor,
							 humerus; with allograft
24120
950.47
517.53
Excision or curettage of bone cyst or benign tumor of
							 head or neck of radius or olecranon process;
24125
1,304.45
585.45
Excision or curettage of bone cyst or benign tumor of
							 head or neck of radius or olecranon process; with autograft (includes obtaining
							 graft)
24126
1,304.45
625.09
Excision or curettage of bone cyst or benign tumor of
							 head or neck of radius or olecranon process; with allograft
24130
1,304.45
503.45
Excision, radial head
24134
1,304.45
756.71
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), shaft or distal humerus
24136
1,304.45
623.59
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), radial head or neck
24138
1,304.45
653.22
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), olecranon process
24140
1,304.45
728.09
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis), humerus
24145
1,304.45
615.66
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis), radial head or neck
24147
1,304.45
643.98
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis), olecranon
process
24149
1,304.45
1,129.51
Radical resection of capsule, soft tissue, and
							 heterotopic bone, elbow, with contracture release (separate
							 procedure)
24150
963.36
Radical resection for tumor, shaft or distal
							 humerus;
24151
1,115.31
Radical resection for tumor, shaft or distal humerus;
							 with autograft (includes obtaining graft)
24152
1,920.92
713.88
Radical resection for tumor, radial head or
							 neck;
24153
3,549.34
662.95
Radical resection for tumor, radial head or neck;
							 with autograft (includes obtaining graft)
24155
1,920.92
830.63
Resection of elbow joint (arthrectomy)
24160
1,304.45
601.10
Implant removal; elbow joint
24164
1,304.45
493.13
Implant removal; radial head
24200
112.89
208.54
Removal of foreign body, upper arm or elbow area;
							 subcutaneous
24201
719.48
584.49
Removal of foreign body, upper arm or elbow area;
							 deep (subfascial or intramuscular)
24220
192.11
Injection procedure for elbow
							 arthrography
24300
659.86
401.67
Manipulation, elbow, under anesthesia
24301
1,304.45
745.74
Muscle or tendon transfer, any type, upper arm or
							 elbow, single (excluding 24320-24331)
24305
1,304.45
575.80
Tendon lengthening, upper arm or elbow, each
							 tendon
24310
950.47
472.16
Tenotomy, open, elbow to shoulder, each
							 tendon
24320
1,920.92
753.94
Tenoplasty, with muscle transfer, with or without
							 free graft, elbow to shoulder, single (Seddon-Brookes type
							 procedure)
24330
3,549.34
712.29
Flexor-plasty, elbow (eg, Steindler type
							 advancement);
24331
1,920.92
783.06
Flexor-plasty, elbow (eg, Steindler type
							 advancement); with extensor advancement
24332
950.47
594.44
Tenolysis, triceps
24340
1,920.92
610.35
Tenodesis of biceps tendon at elbow (separate
							 procedure)
24341
1,920.92
711.58
Repair, tendon or muscle, upper arm or elbow, each
							 tendon or muscle, primary or secondary (excludes rotator cuff)
24342
1,920.92
781.01
Reinsertion of ruptured biceps or triceps tendon,
							 distal, with or without tendon graft
24343
1,304.45
698.24
Repair lateral collateral ligament, elbow, with local
							 tissue
24344
3,549.34
1,076.50
Reconstruction lateral collateral ligament, elbow,
							 with tendon graft (includes harvesting of graft)
24345
1,304.45
694.40
Repair medial collateral ligament, elbow, with local
							 tissue
24346
1,920.92
1,073.30
Reconstruction medial collateral ligament, elbow,
							 with tendon graft (includes harvesting of graft)
24357
1,304.45
444.76
Tenotomy, elbow, lateral or medial (eg,
							 epicondylitis, tennis elbow, golfer's elbow); percutaneous
24358
1,304.45
519.11
Tenotomy, elbow, lateral or medial (eg,
							 epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or
							 bone, open
24359
1,304.45
630.15
Tenotomy, elbow, lateral or medial (eg,
							 epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or
							 bone, open with tendon repair or reattachment
24360
1,604.48
888.16
Arthroplasty, elbow; with membrane (eg,
							 fascial)
24361
5,461.16
997.96
Arthroplasty, elbow; with distal humeral prosthetic
							 replacement
24362
2,274.08
959.69
Arthroplasty, elbow; with implant and fascia lata
							 ligament reconstruction
24363
5,461.16
1,453.78
Arthroplasty, elbow; with distal humerus and proximal
							 ulnar prosthetic replacement (eg, total elbow)
24365
1,604.48
636.15
Arthroplasty, radial head;
24366
5,461.16
680.36
Arthroplasty, radial head; with implant
24400
1,304.45
816.42
Osteotomy, humerus, with or without internal
							 fixation
24410
1,304.45
1,038.27
Multiple osteotomies with realignment on
							 intramedullary rod, humeral shaft (Sofield type procedure)
24420
1,920.92
967.66
Osteoplasty, humerus (eg, shortening or lengthening)
							 (excluding 64876)
24430
3,549.34
1,017.89
Repair of nonunion or malunion, humerus; without
							 graft (eg, compression technique)
24435
3,549.34
1,048.00
Repair of nonunion or malunion, humerus; with iliac
							 or other autograft (includes obtaining graft)
24470
1,920.92
653.09
Hemiepiphyseal arrest (eg, cubitus varus or valgus,
							 distal humerus)
24495
1,304.45
667.65
Decompression fasciotomy, forearm, with brachial
							 artery exploration
24498
3,549.34
867.09
Prophylactic treatment (nailing, pinning, plating or
							 wiring), with or without methylmethacrylate, humeral shaft
24500
79.02
341.35
Closed treatment of humeral shaft fracture; without
							 manipulation
24505
79.02
492.22
Closed treatment of humeral shaft fracture; with
							 manipulation, with or without skeletal traction
24515
2,646.58
870.91
Open treatment of humeral shaft fracture with
							 plate/screws, with or without cerclage
24516
2,646.58
858.67
Treatment of humeral shaft fracture, with insertion
							 of intramedullary implant, with or without cerclage and/or locking
							 screws
24530
79.02
367.74
Closed treatment of supracondylar or transcondylar
							 humeral fracture, with or without intercondylar extension; without
							 manipulation
24535
79.02
610.39
Closed treatment of supracondylar or transcondylar
							 humeral fracture, with or without intercondylar extension; with manipulation,
							 with or without skin or skeletal traction
24538
1,169.01
743.88
Percutaneous skeletal fixation of supracondylar or
							 transcondylar humeral fracture, with or without intercondylar
							 extension
24545
2,646.58
883.63
Open treatment of humeral supracondylar or
							 transcondylar fracture, includes internal fixation, when performed; without
							 intercondylar extension
24546
2,646.58
1,055.47
Open treatment of humeral supracondylar or
							 transcondylar fracture, includes internal fixation, when performed; with
							 intercondylar extension
24560
79.02
309.10
Closed treatment of humeral epicondylar fracture,
							 medial or lateral; without manipulation
24565
79.02
509.50
Closed treatment of humeral epicondylar fracture,
							 medial or lateral; with manipulation
24566
1,169.01
685.77
Percutaneous skeletal fixation of humeral epicondylar
							 fracture, medial or lateral, with manipulation
24575
2,646.58
735.39
Open treatment of humeral epicondylar fracture,
							 medial or lateral, includes internal fixation, when performed
24576
79.02
325.44
Closed treatment of humeral condylar fracture, medial
							 or lateral; without manipulation
24577
79.02
527.62
Closed treatment of humeral condylar fracture, medial
							 or lateral; with manipulation
24579
2,646.58
826.87
Open treatment of humeral condylar fracture, medial
							 or lateral, includes internal fixation, when performed
24582
1,169.01
780.18
Percutaneous skeletal fixation of humeral condylar
							 fracture, medial or lateral, with manipulation
24586
2,646.58
1,086.60
Open treatment of periarticular fracture and/or
							 dislocation of the elbow (fracture distal humerus and proximal ulna and/or
							 proximal radius);
24587
2,646.58
1,078.28
Open treatment of periarticular fracture and/or
							 dislocation of the elbow (fracture distal humerus and proximal ulna and/or
							 proximal radius); with implant arthroplasty
24600
79.02
361.80
Treatment of closed elbow dislocation; without
							 anesthesia
24605
659.86
451.05
Treatment of closed elbow dislocation; requiring
							 anesthesia
24615
2,646.58
710.77
Open treatment of acute or chronic elbow
							 dislocation
24620
79.02
543.65
Closed treatment of Monteggia type of fracture
							 dislocation at elbow (fracture proximal end of ulna with dislocation of radial
							 head), with manipulation
24635
2,646.58
838.19
Open treatment of Monteggia type of fracture
							 dislocation at elbow (fracture proximal end of ulna with dislocation of radial
							 head), includes internal fixation, when performed
24640
61.77
123.04
Closed treatment of radial head subluxation in child,
							 nursemaid elbow, with manipulation
24650
79.02
251.99
Closed treatment of radial head or neck fracture;
							 without manipulation
24655
79.02
430.32
Closed treatment of radial head or neck fracture;
							 with manipulation
24665
1,837.10
645.58
Open treatment of radial head or neck fracture,
							 includes internal fixation or radial head excision, when performed;
24666
2,646.58
726.78
Open treatment of radial head or neck fracture,
							 includes internal fixation or radial head excision, when performed; with radial
							 head prosthetic replacement
24670
79.02
281.49
Closed treatment of ulnar fracture, proximal end (eg,
							 olecranon or coronoid process[es]); without manipulation
24675
79.02
449.72
Closed treatment of ulnar fracture, proximal end (eg,
							 olecranon or coronoid process[es]); with manipulation
24685
1,837.10
648.99
Open treatment of ulnar fracture, proximal end (eg,
							 olecranon or coronoid process[es]), includes internal fixation, when
							 performed
24800
1,920.92
793.59
Arthrodesis, elbow joint; local
24802
1,920.92
979.41
Arthrodesis, elbow joint; with autogenous graft
							 (includes obtaining graft)
24900
698.89
Amputation, arm through humerus; with primary
							 closure
24920
689.10
Amputation, arm through humerus; open, circular
							 (guillotine)
24925
950.47
533.74
Amputation, arm through humerus; secondary closure or
							 scar revision
24930
725.68
Amputation, arm through humerus;
							 re-amputation
24931
760.29
Amputation, arm through humerus; with
							 implant
24935
1,046.44
Stump elongation, upper extremity
24940
I.C.
Cineplasty, upper extremity, complete
							 procedure
24999
I.C.
Unlisted procedure, humerus or elbow
25000
950.47
383.87
Incision, extensor tendon sheath, wrist (eg,
							 deQuervains disease)
25001
950.47
330.39
Incision, flexor tendon sheath, wrist (eg, flexor
							 carpi radialis)
25020
950.47
611.90
Decompression fasciotomy, forearm and/or wrist,
							 flexor OR extensor compartment; without debridement of nonviable muscle and/or
							 nerve
25023
1,304.45
1,133.38
Decompression fasciotomy, forearm and/or wrist,
							 flexor OR extensor compartment; with debridement of nonviable muscle and/or
							 nerve
25024
1,304.45
738.45
Decompression fasciotomy, forearm and/or wrist,
							 flexor AND extensor compartment; without debridement of nonviable muscle and/or
							 nerve
25025
1,304.45
1,114.49
Decompression fasciotomy, forearm and/or wrist,
							 flexor AND extensor compartment; with debridement of nonviable muscle and/or
							 nerve
25028
950.47
535.72
Incision and drainage, forearm and/or wrist; deep
							 abscess or hematoma
25031
950.47
424.42
Incision and drainage, forearm and/or wrist;
							 bursa
25035
950.47
736.94
Incision, deep, bone cortex, forearm and/or wrist
							 (eg, osteomyelitis or bone abscess)
25040
1,304.45
579.75
Arthrotomy, radiocarpal or midcarpal joint, with
							 exploration, drainage, or removal of foreign body
25065
138.64
247.11
Biopsy, soft tissue of forearm and/or wrist;
							 superficial
25066
943.36
412.76
Biopsy, soft tissue of forearm and/or wrist; deep
							 (subfascial or intramuscular)
25075
719.48
357.28
Excision, tumor, soft tissue of forearm and/or wrist
							 area; subcutaneous
25076
943.36
506.24
Excision, tumor, soft tissue of forearm and/or wrist
							 area; deep (subfascial or intramuscular)
25077
943.36
801.28
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of forearm and/or wrist area
25085
950.47
485.16
Capsulotomy, wrist (eg, contracture)
25100
950.47
360.72
Arthrotomy, wrist joint; with biopsy
25101
1,304.45
419.98
Arthrotomy, wrist joint; with joint exploration, with
							 or without biopsy, with or without removal of loose or foreign body
25105
1,304.45
511.98
Arthrotomy, wrist joint; with synovectomy
25107
1,304.45
621.29
Arthrotomy, distal radioulnar joint including repair
							 of triangular cartilage, complex
25109
950.47
502.48
Excision of tendon, forearm and/or wrist, flexor or
							 extensor, each
25110
950.47
399.58
Excision, lesion of tendon sheath, forearm and/or
							 wrist
25111
735.73
324.82
Excision of ganglion, wrist (dorsal or volar);
							 primary
25112
735.73
392.31
Excision of ganglion, wrist (dorsal or volar);
							 recurrent
25115
950.47
868.98
Radical excision of bursa, synovia of wrist, or
							 forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas,
							 rheumatoid arthritis); flexors
25116
950.47
730.34
Radical excision of bursa, synovia of wrist, or
							 forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas,
							 rheumatoid arthritis); extensors, with or without transposition of dorsal
							 retinaculum
25118
1,304.45
399.13
Synovectomy, extensor tendon sheath, wrist, single
							 compartment;
25119
1,304.45
528.41
Synovectomy, extensor tendon sheath, wrist, single
							 compartment; with resection of distal ulna
25120
1,304.45
636.14
Excision or curettage of bone cyst or benign tumor of
							 radius or ulna (excluding head or neck of radius and olecranon
							 process);
25125
1,304.45
716.23
Excision or curettage of bone cyst or benign tumor of
							 radius or ulna (excluding head or neck of radius and olecranon process); with
							 autograft (includes obtaining graft)
25126
1,304.45
732.74
Excision or curettage of bone cyst or benign tumor of
							 radius or ulna (excluding head or neck of radius and olecranon process); with
							 allograft
25130
1,304.45
462.46
Excision or curettage of bone cyst or benign tumor of
							 carpal bones;
25135
1,304.45
570.61
Excision or curettage of bone cyst or benign tumor of
							 carpal bones; with autograft (includes obtaining graft)
25136
1,304.45
506.02
Excision or curettage of bone cyst or benign tumor of
							 carpal bones; with allograft
25145
1,304.45
647.50
Sequestrectomy (eg, for osteomyelitis or bone
							 abscess), forearm and/or wrist
25150
1,304.45
598.60
Partial excision (craterization, saucerization, or
							 diaphysectomy) of bone (eg, for osteomyelitis); ulna
25151
1,304.45
716.83
Partial excision (craterization, saucerization, or
							 diaphysectomy) of bone (eg, for osteomyelitis); radius
25170
958.81
Radical resection for tumor, radius or
							 ulna
25210
1,175.77
504.06
Carpectomy; one bone
25215
1,175.77
650.11
Carpectomy; all bones of proximal row
25230
1,304.45
448.83
Radial styloidectomy (separate procedure)
25240
1,304.45
465.33
Excision distal ulna partial or complete (eg, Darrach
							 type or matched resection)
25246
194.43
Injection procedure for wrist
							 arthrography
25248
950.47
488.64
Exploration with removal of deep foreign body,
							 forearm or wrist
25250
1,304.45
519.57
Removal of wrist prosthesis; (separate
							 procedure)
25251
1,304.45
706.34
Removal of wrist prosthesis; complicated, including
							 total wrist
25259
79.02
400.77
Manipulation, wrist, under anesthesia
25260
1,304.45
758.44
Repair, tendon or muscle, flexor, forearm and/or
							 wrist; primary, single, each tendon or muscle
25263
1,304.45
750.65
Repair, tendon or muscle, flexor, forearm and/or
							 wrist; secondary, single, each tendon or muscle
25265
1,304.45
877.09
Repair, tendon or muscle, flexor, forearm and/or
							 wrist; secondary, with free graft (includes obtaining graft), each tendon or
							 muscle
25270
1,304.45
626.62
Repair, tendon or muscle, extensor, forearm and/or
							 wrist; primary, single, each tendon or muscle
25272
1,304.45
696.39
Repair, tendon or muscle, extensor, forearm and/or
							 wrist; secondary, single, each tendon or muscle
25274
1,304.45
802.19
Repair, tendon or muscle, extensor, forearm and/or
							 wrist; secondary, with free graft (includes obtaining graft), each tendon or
							 muscle
25275
1,304.45
663.99
Repair, tendon sheath, extensor, forearm and/or
							 wrist, with free graft (includes obtaining graft) (eg, for extensor carpi
							 ulnaris subluxation)
25280
1,304.45
699.79
Lengthening or shortening of flexor or extensor
							 tendon, forearm and/or wrist, single, each tendon
25290
1,304.45
655.68
Tenotomy, open, flexor or extensor tendon, forearm
							 and/or wrist, single, each tendon
25295
950.47
657.49
Tenolysis, flexor or extensor tendon, forearm and/or
							 wrist, single, each tendon
25300
1,304.45
688.93
Tenodesis at wrist; flexors of fingers
25301
1,304.45
656.04
Tenodesis at wrist; extensors of fingers
25310
1,920.92
755.10
Tendon transplantation or transfer, flexor or
							 extensor, forearm and/or wrist, single; each tendon
25312
1,920.92
848.92
Tendon transplantation or transfer, flexor or
							 extensor, forearm and/or wrist, single; with tendon graft(s) (includes
							 obtaining graft), each tendon
25315
1,920.92
903.17
Flexor origin slide (eg, for cerebral palsy, Volkmann
							 contracture), forearm and/or wrist;
25316
3,549.34
1,041.84
Flexor origin slide (eg, for cerebral palsy, Volkmann
							 contracture), forearm and/or wrist; with tendon(s) transfer
25320
1,920.92
960.23
Capsulorrhaphy or reconstruction, wrist, open (eg,
							 capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy,
							 capsulotomy and open reduction) for carpal instability
25332
1,604.48
837.85
Arthroplasty, wrist, with or without interposition,
							 with or without external or internal fixation
25335
1,920.92
968.23
Centralization of wrist on ulna (eg, radial club
							 hand)
25337
1,920.92
892.69
Reconstruction for stabilization of unstable distal
							 ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg,
							 tendon transfer, tendon graft or weave, or tenodesis) with or without open
							 reduction of distal radioulnar joint
25350
3,549.34
818.13
Osteotomy, radius; distal third
25355
1,920.92
899.17
Osteotomy, radius; middle or proximal
							 third
25360
1,304.45
799.62
Osteotomy; ulna
25365
1,304.45
1,049.41
Osteotomy; radius AND ulna
25370
1,920.92
1,121.91
Multiple osteotomies, with realignment on
							 intramedullary rod (Sofield type procedure); radius OR ulna
25375
1,920.92
1,096.65
Multiple osteotomies, with realignment on
							 intramedullary rod (Sofield type procedure); radius AND ulna
25390
1,304.45
909.18
Osteoplasty, radius OR ulna; shortening
25391
1,920.92
1,130.20
Osteoplasty, radius OR ulna; lengthening with
							 autograft
25392
1,304.45
1,128.86
Osteoplasty, radius AND ulna; shortening (excluding
							 64876)
25393
1,920.92
1,268.72
Osteoplasty, radius AND ulna; lengthening with
							 autograft
25394
735.73
759.00
Osteoplasty, carpal bone, shortening
25400
3,549.34
952.79
Repair of nonunion or malunion, radius OR ulna;
							 without graft (eg, compression technique)
25405
3,549.34
1,180.98
Repair of nonunion or malunion, radius OR ulna; with
							 autograft (includes obtaining graft)
25415
3,549.34
1,114.46
Repair of nonunion or malunion, radius AND ulna;
							 without graft (eg, compression technique)
25420
3,549.34
1,304.67
Repair of nonunion or malunion, radius AND ulna; with
							 autograft (includes obtaining graft)
25425
1,920.92
1,213.97
Repair of defect with autograft; radius OR
							 ulna
25426
1,920.92
1,226.15
Repair of defect with autograft; radius AND
							 ulna
25430
1,175.77
695.76
Insertion of vascular pedicle into carpal bone (eg,
							 Hori procedure)
25431
1,175.77
782.39
Repair of nonunion of carpal bone (excluding carpal
							 scaphoid (navicular)) (includes obtaining graft and necessary fixation), each
							 bone
25440
3,549.34
784.54
Repair of nonunion, scaphoid carpal (navicular) bone
							 with or without radial styloidectomy (includes obtaining graft and necessary
							 fixation)
25441
5,461.16
928.34
Arthroplastywith prosthetic replacement; distal
							 radius
25442
5,461.16
798.18
Arthroplasty with prosthetic replacement; distal
							 ulna
25443
2,274.08
768.48
Arthroplasty with prosthetic replacement; scaphoid
							 carpal (navicular)
25444
2,274.08
815.96
Arthroplasty with prosthetic replacement;
							 lunate
25445
2,274.08
718.00
Arthroplasty with prosthetic replacement;
							 trapezium
25446
5,461.16
1,164.70
Arthroplastywith prosthetic replacement; distal
							 radius and partial or entire carpus (total wrist)
25447
1,604.48
802.78
Arthroplasty, interposition, intercarpal or
							 carpometacarpal joints
25449
1,604.48
1,023.86
Revision of arthroplasty, including removal of
							 implant, wrist joint
25450
1,920.92
634.98
Epiphyseal arrest by epiphysiodesis or stapling;
							 distal radius OR ulna
25455
1,920.92
763.33
Epiphyseal arrest by epiphysiodesis or stapling;
							 distal radius AND ulna
25490
1,920.92
838.62
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate; radius
25491
1,920.92
879.69
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate; ulna
25492
1,920.92
1,035.97
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate; radius AND ulna
25500
79.02
254.53
Closed treatment of radial shaft fracture; without
							 manipulation
25505
79.02
492.85
Closed treatment of radial shaft fracture; with
							 manipulation
25515
1,837.10
663.47
Open treatment of radial shaft fracture, includes
							 internal fixation, when performed
25520
79.02
538.24
Closed treatment of radial shaft fracture and closed
							 treatment of dislocation of distal radioulnar joint (Galeazzi
							 fracture/dislocation)
25525
1,837.10
818.81
Open treatment of radial shaft fracture, includes
							 internal fixation, when performed, and closed treatment of distal radioulnar
							 joint dislocation (Galeazzi fracture/ dislocation), includes percutaneous
							 skeletal fixation, when performed
25526
1,837.10
1,019.35
Open treatment of radial shaft fracture, includes
							 internal fixation, when performed, and open treatment of distal radioulnar
							 joint dislocation (Galeazzi fracture/ dislocation), includes internal fixation,
							 when performed, includes repair of triangular fibrocartilage
							 complex
25530
79.02
250.22
Closed treatment of ulnar shaft fracture; without
							 manipulation
25535
79.02
471.41
Closed treatment of ulnar shaft fracture; with
							 manipulation
25545
1,837.10
631.39
Open treatment of ulnar shaft fracture, includes
							 internal fixation, when performed
25560
79.02
258.33
Closed treatment of radial and ulnar shaft fractures;
							 without manipulation
25565
79.02
513.27
Closed treatment of radial and ulnar shaft fractures;
							 with manipulation
25574
2,646.58
647.94
Open treatment of radial AND ulnar shaft fractures,
							 with internal fixation, when performed; of radius OR ulna
25575
2,646.58
879.18
Open treatment of radial AND ulnar shaft fractures,
							 with internal fixation, when performed; of radius AND ulna
25600
79.02
283.48
Closed treatment of distal radial fracture (eg,
							 Colles o Smith type) or epiphyseal separation, includes closed treatment of
							 fracture of ulnar styloid, when performed; without manipulation
25605
79.02
594.16
Closed treatment of distal radial fracture (eg,
							 Colles o Smith type) or epiphyseal separation, includes closed treatment of
							 fracture of ulnar styloid, when performed; with manipulation
25606
1,169.01
674.73
Percutaneous skeletal fixation of distal radial
							 fracture or epiphyseal separation
25607
2,646.58
691.41
Open treatment of distal radial extra-articular
							 fracture or epiphyseal separation, with internal fixation
25608
2,646.58
784.97
Open treatment of distal radial intra-articular
							 fracture or epiphyseal separation; with internal fixation of 2
							 fragments
25609
2,646.58
998.07
Open treatment of distal radial intra-articular
							 fracture or epiphyseal separation; with internal fixation of 3 or more
							 fragments
25622
79.02
292.05
Closed treatment of carpal scaphoid (navicular)
							 fracture; without manipulation
25624
79.02
455.31
Closed treatment of carpal scaphoid (navicular)
							 fracture; with manipulation
25628
1,837.10
703.61
Open treatment of carpal scaphoid (navicular)
							 fracture, includes internal fixation, when performed
25630
79.02
296.60
Closed treatment of carpal bone fracture (excluding
							 carpal scaphoid (navicular)); without manipulation, each bone
25635
79.02
429.34
Closed treatment of carpal bone fracture (excluding
							 carpal scaphoid (navicular)); with manipulation, each bone
25645
1,837.10
566.33
Open treatment of carpal bone fracture (other than
							 carpal scaphoid (navicular)), each bone
25650
79.02
307.81
Closed treatment of ulnar styloid
							 fracture
25651
1,169.01
464.58
Percutaneous skeletal fixation of ulnar styloid
							 fracture
25652
1,837.10
609.55
Open treatment of ulnar styloid fracture
25660
79.02
390.69
Closed treatment of radiocarpal or intercarpal
							 dislocation, one or more bones, with manipulation
25670
1,169.01
605.87
Open treatment of radiocarpal or intercarpal
							 dislocation, one or more bones
25671
1,169.01
515.02
Percutaneous skeletal fixation of distal radioulnar
							 dislocation
25675
79.02
419.65
Closed treatment of distal radioulnar dislocation
							 with manipulation
25676
1,169.01
628.42
Open treatment of distal radioulnar dislocation,
							 acute or chronic
25680
79.02
440.86
Closed treatment of trans-scaphoperilunar type of
							 fracture dislocation, with manipulation
25685
1,169.01
720.23
Open treatment of trans-scaphoperilunar type of
							 fracture dislocation
25690
79.02
455.32
Closed treatment of lunate dislocation, with
							 manipulation
25695
1,169.01
627.85
Open treatment of lunate dislocation
25800
3,549.34
752.71
Arthrodesis, wrist; complete, without bone graft
							 (includes radiocarpal and/or intercarpal and/or carpometacarpal
							 joints)
25805
1,920.92
862.84
Arthrodesis, wrist; with sliding graft
25810
3,549.34
864.87
Arthrodesis, wrist; with iliac or other autograft
							 (includes obtaining graft)
25820
735.73
621.51
Arthrodesis, wrist; limited, without bone graft (eg,
							 intercarpal or radiocarpal)
25825
3,549.34
756.93
Arthrodesis, wrist; with autograft (includes
							 obtaining graft)
25830
3,549.34
986.80
Arthrodesis, distal radioulnar joint with segmental
							 resection of ulna, with or without bone graft (eg, Sauve-Kapandji
							 procedure)
25900
806.59
Amputation, forearm, through radius and
							 ulna;
25905
788.64
Amputation, forearm, through radius and ulna; open,
							 circular (guillotine)
25907
950.47
709.10
Amputation, forearm, through radius and ulna;
							 secondary closure or scar revision
25909
785.80
Amputation, forearm, through radius and ulna;
							 re-amputation
25915
1,253.6
Krukenberg procedure
25920
677.35
Disarticulation through wrist;
25922
950.47
598.02
Disarticulation through wrist; secondary closure or
							 scar revision
25924
663.87
Disarticulation through wrist;
							 re-amputation
25927
812.78
Transmetacarpal amputation;
25929
672.37
563.00
Transmetacarpal amputation; secondary closure or scar
							 revision
25931
25999
950.47
760.90 I.C.
Transmetacarpal amputation; re-amputation Unlisted
							 procedure, forearm or wrist
26010
62.85
280.05
Drainage of finger abscess; simple
26011
516.57
432.40
Drainage of finger abscess; complicated (eg,
							 felon)
26020
735.73
424.01
Drainage of tendon sheath, digit and/or palm,
							 each
26025
735.73
413.63
Drainage of palmar bursa; single, bursa
26030
735.73
484.61
Drainage of palmar bursa; multiple bursa
26034
735.73
526.65
Incision, bone cortex, hand or finger (eg,
osteomyelitis or bone abscess)
26035
735.73
792.64
Decompression fingers and/or hand, injection injury
							 (eg, grease gun)
26037
561.29
Decompressive fasciotomy, hand (excludes
							 26035)
26040
1,175.77
307.58
Fasciotomy, palmar (eg, Dupuytren's contracture);
							 percutaneous
26045
1,175.77
462.33
Fasciotomy, palmar (eg, Dupuytren's contracture);
							 open, partial
26055
735.73
653.85
Tendon sheath incision (eg, for trigger
							 finger)
26060
735.73
261.77
Tenotomy, percutaneous, single, each
							 digit
26070
735.73
289.49
Arthrotomy, with exploration, drainage, or removal of
							 loose or foreign body; carpometacarpal joint
26075
735.73
311.44
Arthrotomy, with exploration, drainage, or removal of
							 loose or foreign body; metacarpophalangeal joint, each
26080
735.73
379.92
Arthrotomy, with exploration, drainage, or removal of
							 loose or foreign body; interphalangeal joint, each
26100
735.73
322.37
Arthrotomy with biopsy; carpometacarpal joint,
							 each
26105
735.73
327.99
Arthrotomy with biopsy; metacarpophalangeal joint,
							 each
26110
735.73
314.07
Arthrotomy with biopsy; interphalangeal joint,
							 each
26115
943.36
679.47
Excision, tumor or vascular malformation, soft tissue
							 of hand or finger; subcutaneous
26116
943.36
477.24
Excision, tumor or vascular malformation, soft tissue
							 of hand or finger; deep (subfascial or intramuscular)
26117
943.36
637.25
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of hand or finger
26121
1,175.77
591.78
Fasciectomy, palm only, with or without Z-plasty,
							 other local tissue rearrangement, or skin grafting (includes obtaining
							 graft)
26123
1,175.77
798.89
Fasciectomy, partial palmar with release of single
							 digit including proximal interphalangeal joint, with or without Z-plasty, other
							 local tissue rearrangement, or skin grafting (includes obtaining
							 graft);
26125
735.73
277.46
Fasciectomy, partial palmar with release of single
							 digit including proximal interphalangeal joint, with or without Z-plasty, other
							 local tissue rearrangement, or skin grafting (includes obtaining graft); each
							 additional digit (List separately in addition to code for primary
							 procedure)
26130
735.73
450.94
Synovectomy, carpometacarpal joint
26135
1,175.77
546.55
Synovectomy, metacarpophalangeal joint including
							 intrinsic release and extensor hood reconstruction, each digit
26140
735.73
498.51
Synovectomy, proximal interphalangeal joint,
							 including extensor reconstruction, each interphalangeal joint
26145
735.73
505.59
Synovectomy, tendon sheath, radical
							 (tenosynovectomy), flexor tendon, palm and/or finger, each tendon
26160
735.73
625.78
Excision of lesion of tendon sheath or joint capsule
							 (eg, cyst, mucous cyst, or ganglion), hand or finger
26170
735.73
399.74
Excision of tendon, palm, flexor or extensor, single,
							 each tendon
26180
735.73
435.19
Excision of tendon, finger, flexor or extensor, each
							 tendon
26185
735.73
511.17
Sesamoidectomy, thumb or finger (separate
							 procedure)
26200
735.73
444.51
Excision or curettage of bone cyst or benign tumor of
							 metacarpal;
26205
1,175.77
596.17
Excision or curettage of bone cyst or benign tumor of
							 metacarpal; with autograft (includes obtaining graft)
26210
735.73
435.39
Excision or curettage of bone cyst or benign tumor of
							 proximal, middle, or distal phalanx of finger;
26215
735.73
546.79
Excision or curettage of bone cyst or benign tumor of
							 proximal, middle, or distal phalanx of finger; with autograft (includes
							 obtaining graft)
26230
735.73
498.04
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis); metacarpal
26235
735.73
489.16
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of
							 finger
26236
735.73
435.47
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger
26250
735.73
571.75
Radical resection, metacarpal (eg,
							 tumor);
26255
1,175.77
894.12
Radical resection, metacarpal (eg, tumor); with
							 autograft (includes obtaining graft)
26260
735.73
540.69
Radical resection, proximal or middle phalanx of
							 finger (eg, tumor);
26261
735.73
647.90
Radical resection, proximal or middle phalanx of
							 finger (eg, tumor); with autograft (includes obtaining graft)
26262
735.73
453.66
Radical resection, distal phalanx of finger (eg,
							 tumor)
26320
719.48
341.35
Removal of implant from finger or hand
26340
79.02
319.32
Manipulation, finger joint, under anesthesia, each
							 joint
26350
1,175.77
791.14
Repair or advancement, flexor tendon, not in zone 2
							 digital flexor tendon sheath (eg, no man's land); primary or secondary without
							 free graft, each tendon
26352
1,175.77
883.96
Repair or advancement, flexor tendon, not in zone 2
							 digital flexor tendon sheath (eg, no man's land); secondary with free graft
							 (includes obtaining graft), each tendon
26356
1,175.77
1,123.96
Repair or advancement, flexor tendon, in zone 2
							 digital flexor tendon sheath (eg, no man's land); primary, without free graft,
							 each tendon
26357
1,175.77
933.57
Repair or advancement, flexor tendon, in zone 2
							 digital flexor tendon sheath (eg, no man's land); secondary, without free
							 graft, each tendon
26358
1,175.77
991.81
Repair or advancement, flexor tendon, in zone 2
							 digital flexor tendon sheath (eg, no man's land); secondary, with free graft
							 (includes obtaining graft), each tendon
26370
1,175.77
844.98
Repair or advancement of profundus tendon, with
							 intact superficialis tendon; primary, each tendon
26372
1,175.77
968.72
Repair or advancement of profundus tendon, with
							 intact superficialis tendon; secondary with free graft (includes obtaining
							 graft), each tendon
26373
1,175.77
923.34
Repair or advancement of profundus tendon, with
							 intact superficialis tendon; secondary without free graft, each
							 tendon
26390
1,175.77
877.65
Excision flexor tendon, with implantation of
							 synthetic rod for delayed tendon graft, hand or finger, each rod
26392
1,175.77
1,043.56
Removal of synthetic rod and insertion of flexor
							 tendon graft, hand or finger (includes obtaining graft), each rod
26410
735.73
632.29
Repair, extensor tendon, hand, primary or secondary;
							 without free graft, each tendon
26412
1,175.77
750.58
Repair, extensor tendon, hand, primary or secondary;
							 with free graft (includes obtaining graft), each tendon
26415
1,175.77
759.43
Excision of extensor tendon, with implantation of
							 synthetic rod for delayed tendon graft, hand or finger, each rod
26416
1,175.77
890.50
Removal of synthetic rod and insertion of extensor
							 tendon graft (includes obtaining graft), hand or finger, each rod
26418
735.73
639.25
Repair, extensor tendon, finger, primary or
							 secondary; without free graft, each tendon
26420
1,175.77
781.71
Repair, extensor tendon, finger, primary or
							 secondary; with free graft (includes obtaining graft) each tendon
26426
1,175.77
661.20
Repair of extensor tendon, central slip, secondary
							 (eg,
boutonniere deformity); using local tissue(s),
							 including lateral band(s), each finger
26428
1,175.77
813.78
Repair of extensor tendon, central slip, secondary
							 (eg, boutonniere deformity); with free graft (includes obtaining graft), each
							 finger
26432
735.73
550.77
Closed treatment of distal extensor tendon insertion,
							 with or without percutaneous pinning (eg, mallet finger)
26433
735.73
589.09
Repair of extensor tendon, distal insertion, primary
							 or secondary; without graft (eg, mallet finger)
26434
1,175.77
686.17
Repair of extensor tendon, distal insertion, primary
							 or secondary; with free graft (includes obtaining graft)
26437
735.73
673.45
Realignment of extensor tendon, hand, each
							 tendon
26440
735.73
700.52
Tenolysis, flexor tendon; palm OR finger, each
							 tendon
26442
1,175.77
999.66
Tenolysis, flexor tendon; palm AND finger, each
							 tendon
26445
735.73
660.39
Tenolysis, extensor tendon, hand OR finger, each
							 tendon
26449
1,175.77
847.23
Tenolysis, complex, extensor tendon, finger,
							 including forearm, each tendon
26450
735.73
432.49
Tenotomy, flexor, palm, open, each tendon
26455
735.73
429.33
Tenotomy, flexor, finger, open, each
							 tendon
26460
735.73
418.14
Tenotomy, extensor, hand or finger, open, each
							 tendon
26471
735.73
662.25
Tenodesis; of proximal interphalangeal joint, each
							 joint
26474
735.73
643.74
Tenodesis; of distal joint, each joint
26476
735.73
623.75
Lengthening of tendon, extensor, hand or finger, each
							 tendon
26477
735.73
631.15
Shortening of tendon, extensor, hand or finger, each
							 tendon
26478
735.73
678.59
Lengthening of tendon, flexor, hand or finger, each
							 tendon
26479
735.73
669.78
Shortening of tendon, flexor, hand or finger, each
							 tendon
26480
1,175.77
830.29
Transfer or transplant of tendon, carpometacarpal
							 area or dorsum of hand; without free graft, each tendon
26483
1,175.77
915.59
Transfer or transplant of tendon, carpometacarpal
							 area or dorsum of hand; with free tendon graft (includes obtaining graft), each
							 tendon
26485
1,175.77
885.70
Transfer or transplant of tendon, palmar; without
							 free tendon graft, each tendon
26489
1,175.77
897.34
Transfer or transplant of tendon, palmar; with free
							 tendon graft (includes obtaining graft), each tendon
26490
1,175.77
825.67
Opponensplasty; superficialis tendon transfer type,
							 each tendon
26492
1,175.77
912.60
Opponensplasty; tendon transfer with graft (includes
							 obtaining graft), each tendon
26494
1,175.77
841.32
Opponensplasty; hypothenar muscle
							 transfer
26496
1,175.77
898.47
Opponensplasty; other methods
26497
1,175.77
903.49
Transfer of tendon to restore intrinsic function;
							 ring and small finger
26498
1,175.77
1,184.35
Transfer of tendon to restore intrinsic function; all
							 four fingers
26499
1,175.77
853.47
Correction claw finger, other methods
26500
735.73
674.39
Reconstruction of tendon pulley, each tendon; with
							 local tissues (separate procedure)
26502
1,175.77
748.27
Reconstruction of tendon pulley, each tendon; with
							 tendon or fascial graft (includes obtaining graft) (separate
							 procedure)
26508
735.73
684.94
Release of thenar muscle(s) (eg, thumb
							 contracture)
26510
1,175.77
647.93
Cross intrinsic transfer, each tendon
26516
1,175.77
752.31
Capsulodesis, metacarpophalangeal joint; single
							 digit
26517
1,175.77
866.46
Capsulodesis, metacarpophalangeal joint; two
							 digits
26518
1,175.77
867.47
Capsulodesis, metacarpophalangeal joint; three or
							 four digits
26520
735.73
731.25
Capsulectomy or capsulotomy; metacarpophalangeal
							 joint, each joint
26525
735.73
734.87
Capsulectomy or capsulotomy; interphalangeal joint,
							 each joint
26530
1,604.48
528.02
Arthroplasty, metacarpophalangeal joint; each
							 joint
26531
2,274.08
613.96
Arthroplasty, metacarpophalangeal joint; with
							 prosthetic implant, each joint
26535
1,604.48
382.67
Arthroplasty, interphalangeal joint; each
							 joint
26536
2,274.08
683.62
Arthroplasty, interphalangeal joint; with prosthetic
							 implant, each joint
26540
735.73
710.16
Repair of collateral ligament, metacarpophalangeal or
							 interphalangeal joint
26541
1,175.77
853.35
Reconstruction , collateralli ga ment,
							 metacarpophalangeal joint, single; with tendon or fascial graft (includes
							 obtaining graft)
26542
735.73
729.92
Reconstruction , collateral ligament,
							 metacarpophalangeal joint, single; with local tissue (eg, adductor
							 advancement)
26545
1,175.77
744.22
Reconstruction, collateral ligament, interphalangeal
							 joint, single, including graft, each joint
26546
1,175.77
1,012.10
Repair non-union, metacarpal or phalanx (includes
							 obtaining bone graft with or without external or internal fixation)
26548
1,175.77
811.01
Repair and reconstruction, finger, volar plate,
							 interphalangeal joint
26550
1,175.77
1,548.85
Pollicization of a digit
26551
3,028.34
Transfer, toe-to-hand with microvascular anastomosis;
							 great toe wrap-around with bone graft
26553
2,861.22
Transfer, toe-to-hand with microvascular anastomosis;
							 other than great toe, single
26554
3,908.67
Transfer, toe-to-hand with microvascular anastomosis;
							 other than great toe, double
26555
1,175.77
1,394.07
Transfer, finger to another position without
							 microvascular anastomosis
26556
2,947.95
Transfer, free toe joint, with microvascular
							 anastomosis
26560
735.73
589.69
Repair of syndactyly (web finger) each web space;
							 with skin flaps
26561
1,175.77
921.44
Repair of syndactyly (web finger) each web space;
							 with skin flaps and grafts
26562
1,175.77
1,223.61
Repair of syndactyly (web finger) each web space;
							 complex (eg, involving bone, nails)
26565
1,175.77
726.11
Osteotomy; metacarpal, each
26567
1,175.77
728.20
Osteotomy; phalanx of finger, each
26568
1,175.77
958.66
Osteoplasty, lengthening, metacarpal or
							 phalanx
26580
735.73
1,272.96
Repair cleft hand
26587
735.73
932.92
Reconstruction of polydactylous digit, soft tissue
							 and bone
26590
735.73
1,322.43
Repair macrodactylia, each digit
26591
1,175.77
491.60
Repair, intrinsic muscles of hand, each
							 muscle
26593
735.73
642.96
Release, intrinsic muscles of hand, each
							 muscle
26596
735.73
726.42
Excision of constricting ring of finger, with
							 multiple Z-plasties
26600
79.02
265.35
Closed treatment of metacarpal fracture, single;
							 without manipulation, each bone
26605
79.02
313.23
Closed treatment of metacarpal fracture, single; with
							 manipulation, each bone
26607
79.02
467.29
Closed treatment of metacarpal fracture, with
							 manipulation, with external fixation, each bone
26608
1,169.01
475.98
Percutaneous skeletal fixation of metacarpal
							 fracture, each bone
26615
1,837.10
522.23
Open treatment of metacarpal fracture, single,
							 includes internal fixation, when performed, each bone
26641
79.02
346.52
Closed treatment of carpometacarpal dislocation,
							 thumb, with manipulation
26645
79.02
397.78
Closed treatment of carpometacarpal fracture
							 dislocation, thumb (Bennett fracture), with manipulation
26650
1,169.01
471.88
Percutaneous skeletal fixation of carpometacarpal
							 fracture dislocation, thumb (Bennett fracture), with manipulation
26665
1,837.10
590.41
Open treatment of carpometacarpal fracture
							 dislocation, thumb (Bennett fracture), includes internal fixation, when
							 performed
26670
79.02
320.74
Closed treatment of carpometacarpal dislocation,
							 other than thumb, with manipulation, each joint; without anesthesia
26675
79.02
431.07
Closed treatment of carpometacarpal dislocation,
							 other than thumb, with manipulation, each joint; requiring
							 anesthesia
26676
1,169.01
500.63
Percutaneous skeletal fixation of carpometacarpal
							 dislocation, other than thumb, with manipulation, each joint
26685
1,169.01
547.53
Open treatment of carpometacarpal dislocation, other
							 than thumb; includes internal fixation, when performed, each joint
26686
2,646.58
611.08
Open treatment of carpometacarpal dislocation, other
							 than thumb; complex, multiple, or delayed reduction
26700
79.02
300.67
Closed treatment of metacarpophalangeal dislocation,
							 single, with manipulation; without anesthesia
26705
79.02
397.21
Closed treatment of metacarpophalangeal dislocation,
							 single, with manipulation; requiring anesthesia
26706
79.02
427.02
Percutaneous skeletal fixation of metacarpophalangeal
							 dislocation, single, with manipulation
26715
1,169.01
526.96
Open treatment of metacarpophalangeal dislocation,
							 single, includes internal fixation, when performed
26720
79.02
188.59
Closed treatment of phalangeal shaft fracture,
							 proximal or middle phalanx, finger or thumb; without manipulation,
							 each
26725
79.02
335.54
Closed treatment of phalangeal shaft
							 fracture,
proximal or middle phalanx, finger or thumb; with
							 manipulation, with or without skin or skeletal traction, each
26727
1,169.01
468.96
Percutaneous skeletal fixation of unstable phalangeal
							 shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation,
							 each
26735
1,169.01
545.16
Open treatment of phalangeal shaft fracture, proximal
							 or middle phalanx, finger or thumb, includes internal fixation, when performed,
							 each
26740
79.02
218.54
Closed treatment of articular fracture, involving
							 metacarpophalangeal or interphalangeal joint; without manipulation,
							 each
26742
79.02
363.65
Closed treatment of articular fracture, involving
							 metacarpophalangeal or interphalangeal joint; with manipulation,
							 each
26746
1,169.01
648.37
Open treatment of articular fracture, involving
							 metacarpophalangeal or interphalangeal joint, includes internal fixation, when
							 performed, each
26750
79.02
175.09
Closed treatment of distal phalangeal fracture,
							 finger or thumb; without manipulation, each
26755
79.02
307.93
Closed treatment of distal phalangeal fracture,
							 finger or thumb; with manipulation, each
26756
1,169.01
417.05
Percutaneous skeletal fixation of distal phalangeal
							 fracture, finger or thumb, each
26765
1,169.01
441.32
Open treatment of distal phalangeal fracture, finger
							 or thumb, includes internal fixation, when performed, each
26770
79.02
259.28
Closed treatment of interphalangeal joint
							 dislocation, single, with manipulation; without anesthesia
26775
180.18
371.25
Closed treatment of interphalangeal joint
							 dislocation, single, with manipulation; requiring anesthesia
26776
1,169.01
442.51
Percutaneous skeletal fixation of interphalangeal
							 joint dislocation, single, with manipulation
26785
1,169.01
477.31
Open treatment of interphalangeal joint dislocation,
							 includes internal fixation, when performed, single
26820
1,175.77
834.75
Fusion in opposition, thumb, with autogenous graft
							 (includes obtaining graft)
26841
1,175.77
787.85
Arthrodesis, carpometacarpal joint, thumb, with or
							 without internal fixation;
26842
1,175.77
840.86
Arthrodesis, carpometacarpal joint, thumb, with or
							 without internal fixation; with autograft (includes obtaining
							 graft)
26843
1,175.77
777.80
Arthrodesis, carpometacarpal joint, digit, other than
							 thumb, each;
26844
1,175.77
861.11
Arthrodesis, carpometacarpal joint, digit, other than
							 thumb, each; with autograft (includes obtaining graft)
26850
1,175.77
743.13
Arthrodesis, metacarpophalangeal joint, with or
							 without internal fixation;
26852
1,175.77
837.09
Arthrodesis, metacarpophalangeal joint, with or
							 without internal fixation; with autograft (includes obtaining
							 graft)
26860
1,175.77
615.69
Arthrodesis, interphalangeal joint, with or without
							 internal fixation;
26861
1,175.77
105.25
Arthrodesis, interphalangeal joint, with or without
							 internal fixation; each additional interphalangeal joint (List separately in
							 addition to code for primary procedure)
26862
1,175.77
770.75
Arthrodesis, interphalangeal joint, with or without
							 internal fixation; with autograft (includes obtaining graft)
26863
1,175.77
234.75
Arthrodesis, interphalangeal joint, with or without
							 internal fixation; with autograft (includes obtaining graft), each additional
							 joint (List separately in addition to code for primary procedure)
26910
1,175.77
745.42
Amputation, metacarpal, with finger or thumb (ray
							 amputation), single, with or without interosseous transfer
26951
735.73
648.16
Amputation, finger or thumb, primary or secondary,
							 any joint or phalanx, single, including neurectomies; with direct
							 closure
26952
735.73
696.58
Amputation, finger or thumb, primary or secondary,
							 any joint or phalanx, single, including neurectomies; with local advancement
							 flaps (V-Y, hood)
26989
I.C.
Unlisted procedure, hands or fingers
26990
950.47
613.10
Incision and drainage, pelvis or hip joint area; deep
							 abscess or hematoma
26991
950.47
726.47
Incision and drainage, pelvis or hip joint area;
							 infected bursa
26992
954.20
Incision, bone cortex, pelvis and/or hip joint (eg,
							 osteomyelitis or bone abscess)
27000
950.47
448.16
Tenotomy, adductor of hip, percutaneous (separate
							 procedure)
27001
1,304.45
538.40
Tenotomy, adductor of hip, open
27003
1,304.45
577.71
Tenotomy, adductor, subcutaneous, open, with
							 obturator neurectomy
27005
721.02
Tenotomy, hip flexor(s), open (separate
							 procedure)
27006
731.27
Tenotomy, abductors and/or extensor(s) of hip, open
							 (separate procedure)
27025
873.42
Fasciotomy, hip or thigh, any type
27030
937.23
Arthrotomy, hip, with drainage (eg,
							 infection)
27033
1,920.92
969.12
Arthrotomy, hip, including exploration or removal of
							 loose or foreign body
27035
1,920.92
1,107.79
Denervation, hip joint, intrapelvic or extrapelvic
							 intra-articular branches of sciatic, femoral, or obturator nerves
27036
988.08
Capsulectomy or capsulotomy, hip, with or without
							 excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus
							 medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius,
							 iliopsoas)
27040
388.12
347.03
Biopsy, soft tissue of pelvis and hip area;
							 superficial
27041
388.12
669.20
Biopsy, soft tissue of pelvis and hip area; deep,
							 subfascial or intramuscular
27047
943.36
612.71
Excision, tumor, pelvis and hip area; subcutaneous
							 tissue
27048
943.36
463.79
Excision, tumor, pelvis and hip area; deep,
							 subfascial, intramuscular
27049
943.36
962.60
Radical resection of tumor, soft tissue of pelvis and
							 hip area (eg, malignant neoplasm)
27050
950.47
347.97
Arthrotomy, with biopsy; sacroiliac joint
27052
950.47
546.18
Arthrotomy, with biopsy; hip joint
27054
672.94
Arthrotomy with synovectomy, hip joint
27060
950.47
422.47
Excision; ischial bursa
27062
950.47
446.66
Excision; trochanteric bursa or
							 calcification
27065
950.47
490.42
Excision of bone cyst or benign tumor; superficial
							 (wing of ilium, symphysis pubis, or greater trochanter of femur) with or
							 without autograft
27066
1,304.45
797.04
Excision of bone cyst or benign tumor; deep, with or
							 without autograft
27067
1,304.45
1,002.15
Excision of bone cyst or benign tumor; with autograft
							 requiring separate incision
27070
838.43
Partial excision (craterization, saucerization) (eg,
							 osteomyelitis or bone abscess); superficial (eg, wing of ilium, symphysis
							 pubis, or greater trochanter of femur)
27071
904.63
Partial excision (craterization, saucerization) (eg,
							 osteomyelitis or bone abscess); deep (subfascial or intramuscular)
27075
2,238.88
Radical resection of tumor or infection; wing of
							 ilium, one pubic or is chial ramus or symphysis pubis
27076
1,568.84
Radical resection of tumor or infection; ilium,
							 including acetabulum, both pubic rami, or is chium and acetabulum
27077
2,617.35
Radical resection of tumor or infection; innominate
							 bone, total
27078
995.03
Radical resection of tumor or infection; ischial
							 tuberosity and greater trochanter of femur
27079
971.65
Radical resection of tumor or infection; is chial
							 tuberosity and greater trochanter of femur, with skin flaps
27080
1,304.45
476.84
Coccygectomy, primary
27086
388.12
261.20
Removal of foreign body, pelvis or hip; subcutaneous
							 tissue
27087
950.47
621.73
Removal of foreign body, pelvis or hip; deep
							 (subfascial or intramuscular)
27090
826.31
Removal of hip prosthesis; (separate
							 procedure)
27091
1,559.50
Removal of hip prosthesis; complicated, including
							 total hip prosthesis, methylmethacrylate with or without insertion of
							 spacer
27093
223.65
Injection procedure for hip arthrography; without
							 anesthesia
27095
272.66
Injection procedure for hip arthrography; with
							 anesthesia
27096
208.54
Injection procedure for sacroiliac joint,
							 arthrography and/or anesthetic/steroid
27097
1,304.45
653.47
Release or recession, hamstring, proximal
27098
1,304.45
617.38
Transfer, adductor to ischium
27100
1,920.92
808.56
Transfer external oblique muscle to greater
							 trochanter including fascial or tendon extension (graft)
27105
1,920.92
838.35
Transfer paraspinal muscle to hip (includes fascial
							 or tendon extension graft)
27110
1,920.92
931.46
Transfer iliopsoas; to greater trochanter of
							 femur
27111
1,920.92
880.18
Transfer iliopsoas; to femoral neck
27120
1,266.25
Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or
							 cup type)
27122
1,094.44
Acetabuloplasty; resection, femoral head (eg,
							 Girdlestone procedure)
27125
1,103.78
Hemiarthroplasty, hip, partial (eg, femoral stem
							 prosthesis, bipolar arthroplasty)
27130
1,420.24
Arthroplasty, acetabular and proximal femoral
							 prosthetic replacement (total hip arthroplasty), with or without autograft or
							 allograft
27132
1,660.95
Conversion of previous hip surgery to total hip
							 arthroplasty, with or without autograft or allograft
27134
1,925.06
Revision of total hip arthroplasty; both components,
							 with or without autograft or allograft
27137
1,471.23
Revision of total hip arthroplasty; acetabular
							 component only, with or without autograft or allograft
27138
1,529.81
Revision of total hip arthroplasty; femoral component
							 only, with or without allograft
27140
893.94
Osteotomy and transfer of greater trochanter of femur
							 (separate procedure)
27146
1,253.82
Osteotomy, iliac, acetabular or innominate
							 bone;
27147
1,435.81
Osteotomy, iliac, acetabular or innominate bone; with
							 open reduction of hip
27151
1,413.82
Osteotomy, iliac, acetabular or innominate bone; with
							 femoral osteotomy
27156
1,701.06
Osteotomy, iliac, acetabular or innominate bone; with
							 femoral osteotomy and with open reduction of hip
27158
1,326.09
Osteotomy, pelvis, bilateral (eg, congenital
							 malformation)
27161
1,211.48
Osteotomy, femoral neck (separate
							 procedure)
27165
1,341.98
Osteotomy, intertrochanteric or subtrochanteric
							 including internal or external fixation and/or cast
27170
1,165.34
Bone graft, femoral head, neck, intertrochanteric or
							 subtrochanteric area (includes obtaining bone graft)
27175
633.44
Treatment of slipped femoral epiphysis; by traction,
							 without reduction
27176
899.03
Treatment of slipped femoral epiphysis; by single or
							 multiple pinning, in situ
27177
1,095.48
Open treatment of slipped femoral epiphysis; single
							 or multiple pinning or bone graft (includes obtaining graft)
27178
876.43
Open treatment of slipped femoral epiphysis; closed
							 manipulation with single or multiple pinning
27179
967.54
Open treatment of slipped femoral epiphysis;
							 osteoplasty of femoral neck (Heyman type procedure)
27181
1,052.03
Open treatment of slipped femoral epiphysis;
							 osteotomy and internal fixation
27185
727.98
Epiphyseal arrest by epiphysiodesis or stapling,
							 greater trochanter of femur
27187
990.14
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate, femoral neck and proximal
							 femur
27193
79.02
456.65
Closed treatment of pelvic ring fracture,
							 dislocation, diastasis or subluxation; without manipulation
27194
659.86
721.80
Closed treatment of pelvic ring fracture,
							 dislocation, diastasis or subluxation; with manipulation, requiring more than
							 local anesthesia
27200
79.07
171.20
Closed treatment of coccygeal fracture
27202
1,837.10
780.56
Open treatment of coccygeal fracture
27215
730.06
Open treatment of iliac spine(s), tuberosity
							 avulsion, or iliac wing fracture(s) (eg, pelvic fracture(s) which do not
							 disrupt the pelvic ring), with internal fixation
27216
1,047.49
Percutaneous skeletal fixation of posterior pelvic
							 ring fracture and/or dislocation (includes ilium, sacroiliac joint and/or
							 sacrum)
27217
1,004.94
Open treatment of anterior ring fracture and/or
							 dislocation with internal fixation (includes pubic symphysis and/or
							 rami)
27218
1,342.57
Open treatment of posterior ring fracture and/or
							 dislocation with internal fixation (includes ilium, sacroiliac joint and/or
							 sacrum)
27220
79.02
514.21
Closed treatment of acetabulum (hip socket)
							 fracture(s); without manipulation
27222
968.68
Closed treatment of acetabulum (hip socket)
							 fracture(s); with manipulation, with or without skeletal traction
27226
987.40
Open treatment of posterior or anterior acetabular
							 wall fracture, with internal fixation
27227
1,644.79
Open treatment of acetabular fracture(s) involving
							 anterior or posterior (one) column, or a fracture running transversely across
							 the acetabulum, with internal fixation
27228
1,882.07
Open treatment of acetabular fracture(s) involving
							 anterior and posterior (two) columns, includes T-fracture and both column
							 fracture with complete articular detachment, or single column or transverse
							 fracture with associated acetabular wall fracture, with internal
							 fixation
27230
79.02
463.48
Closed treatment of femoral fracture, proximal end,
							 neck; without manipulation
27232
759.49
Closed treatment of femoral fracture, proximal end,
							 neck; with manipulation, with or without skeletal traction
27235
904.67
Percutaneous skeletal fixation of femoral fracture,
							 proximal end, neck
27236
1,164.54
Open treatment of femoral fracture, proximal end,
							 neck, internal fixation or prosthetic replacement
27238
79.02
444.78
Closed treatment of intertrochanteric,
							 peritrochanteric, or subtrochanteric femoral fracture; without
							 manipulation
27240
938.33
Closed treatment of intertrochanteric,
							 peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with
							 or without skin or skeletal traction
27244
1,147.95
Treatment of intertrochanteric, peritrochanteric, or
							 subtrochanteric femoral fracture; with plate/screw type implant, with or
							 without cerclage
27245
1,403.54
Treatment of intertrochanteric, peritrochanteric, or
							 subtrochanteric femoral fracture; with intramedullary implant, with or without
							 interlocking screws and/or cerclage
27246
79.02
378.86
Closed treatment of greater trochanteric fracture,
							 without manipulation
27248
753.84
Open treatment of greater trochanteric fracture,
							 includes internal fixation, when performed
27250
79.02
470.04
Closed treatment of hip dislocation, traumatic;
							 without anesthesia
27252
659.86
742.96
Closed treatment of hip dislocation, traumatic;
							 requiring anesthesia
27253
940.34
Open treatment of hip dislocation, traumatic, without
							 internal fixation
27254
1,256.41
Open treatment of hip dislocation, traumatic, with
							 acetabular wall and femoral head fracture, with or without internal or external
							 fixation
27256
79.02
297.90
Treatment of spontaneous hip dislocation
							 (developmental, including congenital or pathological), by abduction, splint or
							 traction; without anesthesia, without manipulation
27257
659.86
326.70
Treatment of spontaneous hip dislocation
							 (developmental, including congenital or pathological), by abduction, splint or
							 traction; with manipulation, requiring anesthesia
27258
1,095.65
Open treatment of spontaneous hip dislocation
							 (developmental, including congenital or pathological), replacement of femoral
							 head in acetabulum (including tenotomy, etc);
27259
1,517.80
Open treatment of spontaneous hip dislocation
							 (developmental, including congenital or pathological), replacement of femoral
							 head in acetabulum (including tenotomy, etc); with femoral shaft
							 shortening
27265
79.02
394.84
Closed treatment of post hip arthroplasty
							 dislocation; without anesthesia
27266
659.86
573.49
Closed treatment of post hip arthroplasty
							 dislocation; requiring regional or general anesthesia
27267
79.02
412.89
Closed treatment of femoral fracture, proximal end,
							 head; without manipulation
27268
504.83
Closed treatment of femoral fracture, proximal end,
							 head; with manipulation
27269
1,183.23
Open treatment of femoral fracture, proximal end,
							 head, includes internal fixation, when performed
27275
659.86
181.01
Manipulation, hip joint, requiring general
							 anesthesia
27280
1,011.82
Arthrodesis, sacroiliac joint (including obtaining
							 graft)
27282
819.03
Arthrodesis, symphysis pubis (including obtaining
							 graft)
27284
1,584.62
Arthrodesis, hip joint (including obtaining
							 graft);
27286
1,600.43
Arthrodesis, hip joint (including obtaining graft);
							 with subtrochanteric osteotomy
27290
1,538.03
Interpelviabdominal amputation (hindquarter
							 amputation)
27295
1,236.88
Disarticulation of hip
27299
I.C.
Unlisted procedure, pelvis or hip joint
27301
818.67
679.61
Incision and drainage, deep abscess, bursa, or
							 hematoma, thigh or knee region
27303
632.49
Incision, deep, with opening of bone cortex, femur or
							 knee (eg, osteomyelitis or bone abscess)
27305
950.47
465.12
Fasciotomy, iliotibial (tenotomy), open
27306
950.47
387.11
Tenotomy, percutaneous, adductor or hamstring; single
							 tendon (separate procedure)
27307
950.47
467.91
Tenotomy, percutaneous, adductor or hamstring;
							 multiple tendons
27310
1,304.45
716.07
Arthrotomy, knee, with exploration, drainage, or
							 removal of foreign body (eg, infection)
27323
388.12
263.39
Biopsy, soft tissue of thigh or knee area;
							 superficial
27324
943.36
375.60
Biopsy, soft tissue of thigh or knee area; deep
							 (subfascial or intramuscular)
27325
806.70
503.51
Neurectomy, hamstring muscle
27326
806.70
487.35
Neurectomy, popliteal (gastrocnemius)
27327
943.36
450.60
Excision, tumor, thigh or knee area;
							 subcutaneous
27328
943.36
411.30
Excision, tumor, thigh or knee area; deep,
							 subfascial, or intramuscular
27329
943.36
1,002.56
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of thigh or knee area
27330
1,304.45
400.62
Arthrotomy, knee; with synovial biopsy
							 only
27331
1,304.45
470.55
Arthrotomy, knee; including joint exploration,
							 biopsy, or removal of loose or foreign bodies
27332
1,304.45
632.32
Arthrotomy, with excision of semilunar cartilage
							 (meniscectomy) knee; medial OR lateral
27333
1,304.45
575.91
Arthrotomy, with excision of semilunar cartilage
							 (meniscectomy) knee; medial AND lateral
27334
1,304.45
673.45
Arthrotomy, with synovectomy, knee; anterior OR
							 posterior
27335
1,304.45
759.30
Arthrotomy, with synovectomy, knee; anterior AND
							 posterior including popliteal area
27340
950.47
363.93
Excision, prepatellar bursa
27345
950.47
476.26
Excision of synovial cyst of popliteal space (eg,
							 Baker's cyst)
27347
950.47
499.83
Excision of lesion of meniscus or capsule (eg, cyst,
							 ganglion), knee
27350
1,304.45
644.54
Patellectomy or hemipatellectomy
27355
1,304.45
598.47
Excision or curettage of bone cyst or benign tumor of
							 femur;
27356
1,304.45
727.71
Excision or curettage of bone cyst or benign tumor of
							 femur; with allograft
27357
1,304.45
807.37
Excision or curettage of bone cyst or benign tumor of
							 femur; with autograft (includes obtaining graft)
27358
1,304.45
285.96
Excision or curettage of bone cyst or benign tumor of
							 femur; with internal fixation (List in addition to code for primary
							 procedure)
27360
1,304.45
847.84
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or
							 bone abscess)
27365
1,204.73
Radical resection of tumor, bone, femur or
							 knee
27370
189.83
Injection procedure for knee arthrography
27372
943.36
622.53
Removal of foreign body, deep, thigh region or knee
							 area
27380
950.47
594.79
Suture of infrapatellar tendon; primary
27381
950.47
800.65
Suture of infrapatellar tendon; secondary
							 reconstruction, including fascial or tendon graft
27385
950.47
634.73
Suture of quadriceps or hamstring muscle
							 rupture;
primary
27386
950.47
832.35
Suture of quadriceps or hamstring muscle rupture;
							 secondary reconstruction, including fascial or tendon graft
27390
950.47
433.79
Tenotomy, open, hamstring, knee to hip; single
							 tendon
27391
950.47
567.78
Tenotomy, open, hamstring, knee to hip; multiple
							 tendons, one leg
27392
950.47
699.94
Tenotomy, open, hamstring, knee to hip; multiple
							 tendons, bilateral
27393
1,304.45
503.45
Lengthening of hamstring tendon; single
							 tendon
27394
1,304.45
648.35
Lengthening of hamstring tendon; multiple tendons,
							 one leg
27395
1,920.92
871.80
Lengthening of hamstring tendon; multiple tendons,
							 bilateral
27396
1,304.45
610.18
Transplant, hamstring tendon to patella; single
							 tendon
27397
1,920.92
880.72
Transplant, hamstring tendon to patella; multiple
							 tendons
27400
1,920.92
670.40
Transfer, tendon or muscle, hamstrings to femur (eg,
							 Egger's type procedure)
27403
1,304.45
637.97
Arthrotomy with meniscus repair, knee
27405
1,920.92
670.62
Repair, primary, torn ligament and/or capsule, knee;
							 collateral
27407
3,549.34
768.22
Repair, primary, torn ligament and/or capsule, knee;
							 cruciate
27409
1,920.92
950.08
Repair, primary, torn ligament and/or capsule, knee;
							 collateral and cruciate ligaments
27412
1,623.20
Autologous chondrocyte implantation, knee
27415
1,366.54
Osteochondral allograft, knee, open
27416
1,920.92
933.72
Osteochondral autograft(s), knee, open (eg,
mosaicplasty) (includes harvesting of
							 autograft[s])
27418
1,920.92
827.20
Anterior tibial tubercleplasty (eg, Maquet type
							 procedure)
27420
1,920.92
743.44
Reconstruction of dislocating patella; (eg, Hauser
							 type procedure)
27422
1,920.92
740.97
Reconstruction of dislocating patella; with extensor
							 realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type
							 procedure)
27424
1,920.92
742.00
Reconstruction of dislocating patella; with
							 patellectomy
27425
1,304.45
442.92
Lateral retinacular release, open
27427
1,920.92
712.73
Ligamentous reconstruction (augmentation), knee;
							 extra-articular
27428
3,549.34
1,086.45
Ligamentous reconstruction (augmentation), knee;
							 intra-articular (open)
27429
3,549.34
1,214.83
Ligamentous reconstruction (augmentation), knee;
							 intra-articular (open) and extra-articular
27430
1,920.92
735.28
Quadricepsplasty (eg, Bennett or Thompson
							 type)
27435
1,920.92
785.67
Capsulotomy, posterior capsular release,
							 knee
27437
1,604.48
655.11
Arthroplasty, patella; without prosthesis
27438
2,274.08
829.76
Arthroplasty, patella; with prosthesis
27440
1,604.48
728.29
Arthroplasty, knee, tibial plateau;
27441
1,604.48
770.60
Arthroplasty, knee, tibial plateau; with debridement
							 and partial synovectomy
27442
1,604.48
862.31
Arthroplasty, femoral condyles or tibial plateau(s),
							 knee;
27443
1,604.48
812.79
Arthroplasty, femoral condyles or tibial plateau(s),
							 knee; with debridement and partial synovectomy
27445
1,249.21
Arthroplasty, knee, hinge prosthesis (eg, Walldius
							 type)
27446
12,274.58
1,112.56
Arthroplasty, knee, condyle and plateau; medial OR
							 lateral compartment
27447
1,526.08
Arthroplasty, knee, condyle and plateau; medial AND
							 lateral compartments with or without patella resurfacing (total knee
							 arthroplasty)
27448
816.80
Osteotomy, femur, shaft or supracondylar; without
							 fixation
27450
1,013.82
Osteotomy, femur, shaft or supracondylar; with
							 fixation
27454
1,276.36
Osteotomy, multiple, with realignment on
							 intramedullary rod, femoral shaft (eg, Sofield type procedure)
27455
938.35
Osteotomy, proximal tibia, including fibular excision
							 or osteotomy (includes correction of genu varus (bowleg) or genu valgus
							 (knock-knee)); before epiphyseal closure
27457
963.65
Osteotomy, proximal tibia, including fibular excision
							 or osteotomy (includes correction of genu varus (bowleg) or genu valgus
							 (knock-knee)); after epiphyseal closure
27465
1,176.18
Osteoplasty, femur; shortening (excluding
							 64876)
27466
1,172.21
Osteoplasty, femur; lengthening
27468
1,317.68
Osteoplasty, femur; combined, lengthening and
							 shortening with femoral segment transfer
27470
1,168.73
Repair, nonunion or malunion, femur, distal to head
							 and neck; without graft (eg, compression technique)
27472
1,263.51
Repair, nonunion or malunion, femur, distal to head
							 and neck; with iliac or other autogenous bone graft (includes obtaining
							 graft)
27475
650.76
Arrest, epiphyseal, any method (eg, epiphysiodesis);
							 distal femur
27477
724.63
Arrest, epiphyseal, any method (eg, epiphysiodesis);
							 tibia and fibula, proximal
27479
954.62
Arrest, epiphyseal, any method (eg, epiphysiodesis);
							 combined distal femur, proximal tibia and fibula
27485
667.28
Arrest, hemiepiphyseal, distal femur or proximal
							 tibia or fibula (eg, genu varus or valgus)
27486
1,393.86
Revision of total knee arthroplasty, with or without
							 allograft; one component
27487
1,753.53
Revision of total knee arthroplasty, with or without
							 allograft; femoral and entire tibial component
27488
1,181.91
Removal of prosthesis, including total knee
							 prosthesis, methylmethacrylate with or without insertion of spacer,
							 knee
27495
1,125.23
Prophylactic treatment (nailing, pinning, plating, or
							 wiring) with or without methylmethacrylate, femur
27496
950.47
500.56
Decompression fasciotomy, thigh and/or knee, one
							 compartment (flexor or extensor or adductor);
27497
950.47
537.18
Decompression fasciotomy, thigh and/or knee, one
							 compartment (flexor or extensor or adductor); with debridement of nonviable
							 muscle and/or nerve
27498
950.47
585.13
Decompression fasciotomy, thigh and/or knee, multiple
							 compartments;
27499
950.47
656.52
Decompression fasciotomy, thigh and/or knee, multiple
							 compartments; with debridement of nonviable muscle and/or nerve
27500
79.02
507.26
Closed treatment of femoral shaft fracture, without
							 manipulation
27501
79.02
495.89
Closed treatment of supracondylar or transcondylar
							 femoral fracture with or without intercondylar extension, without
							 manipulation
27502
79.02
782.17
Closed treatment of femoral shaft fracture, with
							 manipulation, with or without skin or skeletal traction
27503
79.02
792.18
Closed treatment of supracondylar or transcondylar
							 femoral fracture with or without intercondylar extension, with manipulation,
							 with or without skin or skeletal traction
27506
1,310.20
Open treatment of femoral shaft fracture, with or
							 without external fixation, with insertion of intramedullary implant, with or
							 without cerclage and/or locking screws
27507
977.95
Open treatment of femoral shaft fracture with
							 plate/screws, with or without cerclage
27508
79.02
516.52
Closed treatment of femoral fracture, distal end,
							 medial or lateral condyle, without manipulation
27509
1,169.01
647.70
Percutaneous skeletal fixation of femoral fracture,
							 distal end, medial or lateral condyle, or supracondylar or transcondylar, with
							 or without intercondylar extension, or distal femoral epiphyseal
							 separation
27510
79.02
689.36
Closed treatment of femoral fracture, distal end,
							 medial or lateral condyle, with manipulation
27511
1,027.09
Open treatment of femoral supracondylar or
							 transcondylar fracture without intercondylar extension, includes internal
							 fixation, when performed
27513
1,290.35
Open treatment of femoral supracondylar or
							 transcondylar fracture with intercondylar extension, includes internal
							 fixation, when performed
27514
1,072.75
Open treatment of femoral fracture, distal end,
							 medial or lateral condyle, includes internal fixation, when
							 performed
27516
79.02
488.37
Closed treatment of distal femoral epiphyseal
							 separation; without manipulation
27517
79.02
662.61
Closed treatment of distal femoral epiphyseal
							 separation; with manipulation, with or without skin or skeletal
							 traction
27519
961.16
Open treatment of distal femoral epiphyseal
							 separation, includes internal fixation, when performed
27520
79.02
312.97
Closed treatment of patellar fracture, without
							 manipulation
27524
751.78
Open treatment of patellar fracture, with internal
							 fixation and/or partial or complete patellectomy and soft tissue
							 repair
27530
79.02
388.39
Closed treatment of tibial fracture, proximal
							 (plateau); without manipulation
27532
79.02
608.12
Closed treatment of tibial fracture, proximal
							 (plateau); with or without manipulation, with skeletal traction
27535
917.45
Open treatment of tibial fracture, proximal
							 (plateau); unicondylar, includes internal fixation, when performed
27536
1,171.22
Open treatment of tibial fracture, proximal
							 (plateau); bicondylar, with or without internal fixation
27538
79.02
462.53
Closed treatment of intercondylar spine(s) and/or
							 tuberosity fracture(s) of knee, with or without manipulation
27540
838.32
Open treatment of intercondylar spine(s) and/or
							 tuberosity fracture(s) of the knee, includes internal fixation, when
							 performed
27550
79.02
480.85
Closed treatment of knee dislocation; without
							 anesthesia
27552
659.86
615.38
Closed treatment of knee dislocation; requiring
							 anesthesia
27556
949.74
Open treatment of knee dislocation, includes internal
							 fixation, when performed; without primary ligamentous repair or
							 augmentation/reconstruction
27557
1,124.06
Open treatment of knee dislocation, includes internal
							 fixation, when performed; with primary ligamentous repair
27558
1,229.87
Open treatment of knee dislocation, includes internal
							 fixation, when performed; with primary ligamentous repair, with
							 augmentation/reconstruction
27560
79.02
353.43
Closed treatment of patellar dislocation; without
							 anesthesia
27562
659.86
444.13
Closed treatment of patellar dislocation; requiring
							 anesthesia
27566
1,837.10
890.01
Open treatment of patellar dislocation, with or
							 without partial or total patellectomy
27570
659.86
147.33
Manipulation of knee joint under general anesthesia
							 (includes application of traction or other fixation devices)
27580
1,436.28
Arthrodesis, knee, any technique
27590
800.54
Amputation, thigh, through femur, any
							 level;
27591
900.93
Amputation, thigh, through femur, any level;
							 immediate fitting technique including first cast
27592
681.68
Amputation, thigh, through femur, any level; open,
							 circular (guillotine)
27594
950.47
503.22
Amputation, thigh, through femur, any level;
							 secondary closure or scar revision
27596
722.34
Amputation, thigh, through femur, any level;
							 re-amputation
27598
732.01
Disarticulation at knee
27599
I.C.
Unlisted procedure, femur or knee
27600
950.47
420.07
Decompression fasciotomy, leg; anterior and/or
							 lateral compartments only
27601
950.47
434.38
Decompression fasciotomy, leg; posterior
							 compartment(s) only
27602
950.47
513.01
Decompression fasciotomy, leg; anterior and/or
							 lateral, and posterior compartment(s)
27603
818.67
531.62
Incision and drainage, leg or ankle; deep abscess or
							 hematoma
27604
950.47
464.18
Incision and drainage, leg or ankle; infected
							 bursa
27605
930.79
406.46
Tenotomy, percutaneous, Achilles tendon (separate
							 procedure); local anesthesia
27606
950.47
300.00
Tenotomy, percutaneous, Achilles tendon (separate
							 procedure); general anesthesia
27607
950.47
603.23
Incision (eg, osteomyelitis or bone abscess), leg or
							 ankle
27610
1,304.45
651.54
Arthrotomy, ankle, including exploration, drainage,
							 or removal of foreign body
27612
1,304.45
566.96
Arthrotomy, posterior capsular release, ankle, with
							 or without Achilles tendon lengthening
27613
131.28
245.09
Biopsy, soft tissue of leg or ankle area;
							 superficial
27614
943.36
561.25
Biopsy, soft tissue of leg or ankle area; deep
							 (subfascial or intramuscular)
27615
1,304.45
880.50
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of leg or ankle area
27618
719.48
483.83
Excision, tumor, leg or ankle area; subcutaneous
							 tissue
27619
943.36
775.89
Excision, tumor, leg or ankle area; deep (subfascial
							 or intramuscular)
27620
1,304.45
466.36
Arthrotomy, ankle, with joint exploration, with or
							 without biopsy, with or without removal of loose or foreign body
27625
1,304.45
599.39
Arthrotomy, with synovectomy, ankle;
27626
1,304.45
643.25
Arthrotomy, with synovectomy, ankle; including
							 tenosynovectomy
27630
950.47
545.41
Excision of lesion of tendon sheath or capsule (eg,
							 cyst or ganglion), leg and/or ankle
27635
1,304.45
594.25
Excision or curettage of bone cyst or benign tumor,
							 tibia or fibula;
27637
1,304.45
746.81
Excision or curettage of bone cyst or benign tumor,
							 tibia or fibula; with autograft (includes obtaining graft)
27638
1,304.45
779.62
Excision or curettage of bone cyst or benign tumor,
							 tibia or fibula; with allograft
27640
1,920.92
878.97
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis or exostosis); tibia
27641
1,304.45
708.30
Partial excision (craterization, saucerization, or
							 diaphysectomy) bone (eg, osteomyelitis or exostosis); fibula
27645
1,055.87
Radical resection of tumor, bone; tibia
27646
942.68
Radical resection of tumor, bone; fibula
27647
1,920.92
817.37
Radical resection of tumor, bone; talus or
							 calcaneus
27648
182.47
Injection procedure for ankle
							 arthrography
27650
1,920.92
701.87
Repair, primary, open or percutaneous, ruptured
							 Achilles tendon;
27652
3,549.34
748.08
Repair, primary, open or percutaneous, ruptured
							 Achilles tendon; with graft (includes obtaining graft)
27654
1,920.92
702.12
Repair, secondary, Achilles tendon, with or without
							 graft
27656
950.47
558.16
Repair, fascial defect of leg
27658
950.47
389.66
Repair, flexor tendon, leg; primary, without graft,
							 each tendon
27659
950.47
508.84
Repair, flexor tendon, leg; secondary, with or
							 without graft, each tendon
27664
950.47
375.44
Repair, extensor tendon, leg; primary, without graft,
							 each tendon
27665
1,304.45
427.13
Repair, extensor tendon, leg; secondary, with or
							 without graft, each tendon
27675
950.47
520.27
Repair, dislocating peroneal tendons; without fibular
							 osteotomy
27676
1,304.45
622.25
Repair, dislocating peroneal tendons; with fibular
							 osteotomy
27680
1,304.45
439.14
Tenolysis, flexor or extensor tendon, leg and/or
							 ankle; single, each tendon
27681
1,304.45
525.04
Tenolysis, flexor or extensor tendon, leg and/or
							 ankle; multiple tendons (through separate incision(s))
27685
1,304.45
623.46
Lengthening or shortening of tendon, leg or ankle;
							 single tendon (separate procedure)
27686
1,304.45
569.13
Lengthening or shortening of tendon, leg or ankle;
							 multiple tendons (through same incision), each
27687
1,304.45
470.61
Gastrocnemius recession (eg, Strayer
							 procedure)
27690
1,920.92
615.51
Transfer or transplant of single tendon (with muscle
							 redirection or rerouting); superficial (eg, anterior tibial extensors into
							 midfoot)
27691
1,920.92
732.01
Transfer or transplant of single tendon (with muscle
							 redirection or rerouting); deep (eg, anterior tibial or posterior tibial
							 through interosseous space, flexor digitorum longus, flexor hallucis longus, or
							 peroneal tendon to midfoot or hindfoot)
27692
1,920.92
111.18
Transfer or transplant of single tendon (with muscle
							 redirection or rerouting); each additional tendon (List separately in addition
							 to code for primary procedure)
27695
1,304.45
503.77
Repair, primary, disrupted ligament, ankle;
							 collateral
27696
1,304.45
596.48
Repair, primary, disrupted ligament, ankle; both
							 collateral ligaments
27698
1,304.45
663.12
Repair, secondary, disrupted ligament, ankle,
							 collateral (eg, Watson-Jones procedure)
27700
1,604.48
615.55
Arthroplasty, ankle;
27702
998.93
Arthroplasty, ankle; with implant (total
							 ankle)
27703
1,140.05
Arthroplasty, ankle; revision, total
							 ankle
27704
950.47
558.85
Removal of ankle implant
27705
1,920.92
769.38
Osteotomy; tibia
27707
950.47
399.02
Osteotomy; fibula
27709
1,304.45
1,060.07
Osteotomy; tibia and fibula
27712
1,074.24
Osteotomy; multiple, with realignment on
							 intramedullary rod (eg, Sofield type procedure)
27715
1,055.51
Osteoplasty, tibia and fibula, lengthening or
							 shortening
27720
877.74
Repair of nonunion or malunion, tibia; without graft,
							 (eg, compression technique)
27722
873.75
Repair of nonunion or malunion, tibia; with sliding
							 graft
27724
1,271.38
Repair of nonunion or malunion, tibia; with iliac or
							 other autograft (includes obtaining graft)
27725
1,184.90
Repair of nonunion or malunion, tibia; by synostosis,
							 with fibula, any method
27726
1,169.01
881.19
Repair of fibula nonunion and/or malunion with
							 internal fixation
27727
1,021.63
Repair of congenital pseudarthrosis,
							 tibia
27730
1,304.45
581.19
Arrest, epiphyseal (epiphysiodesis), open; distal
							 tibia
27732
1,304.45
415.86
Arrest, epiphyseal (epiphysiodesis), open; distal
							 fibula
27734
1,304.45
624.95
Arrest, epiphyseal (epiphysiodesis), open; distal
							 tibia and fibula
27740
1,304.45
708.58
Arrest, epiphyseal (epiphysiodesis), any method,
							 combined, proximal and distal tibia and fibula;
27742
1,920.92
645.94
Arrest, epiphyseal (epiphysiodesis), any method,
							 combined, proximal and distal tibia and fibula; and distal femur
27745
3,549.34
755.71
Prophylactic treatment (nailing, pinning, plating or
							 wiring) with or without methylmethacrylate, tibia
27750
79.02
336.76
Closed treatment of tibial shaft fracture (with or
							 without fibular fracture); without manipulation
27752
79.02
530.23
Closed treatment of tibial shaft fracture (with or
							 without fibular fracture); with manipulation, with or without skeletal
							 traction
27756
1,169.01
566.57
Percutaneous skeletal fixation of tibial shaft
							 fracture (with or without fibular fracture) (eg, pins or screws)
27758
1,837.10
880.82
Open treatment of tibial shaft fracture (with or
							 without fibular fracture), with plate/screws, with or without
							 cerclage
27759
2,646.58
997.49
Treatment of tibial shaft fracture (with or without
							 fibular fracture) by intramedullary implant, with or without interlocking
							 screws and/or cerclage
27760
79.02
326.10
Closed treatment of medial malleolus fracture;
							 without manipulation
27762
79.02
479.49
Closed treatment of medial malleolus fracture; with
							 manipulation, with or without skin or skeletal traction
27766
1,837.10
614.56
Open treatment of medial malleolus fracture, includes
							 internal fixation, when performed
27767
79.02
260.97
Closed treatment of posterior malleolus fracture;
							 without manipulation
27768
79.02
392.32
Closed treatment of posterior malleolus fracture;
							 with manipulation
27769
1,837.10
664.75
Open treatment of posterior malleolus fracture,
							 includes internal fixation, when performed
27780
79.02
290.19
Closed treatment of proximal fibula or shaft
							 fracture; without manipulation
27781
79.02
413.39
Closed treatment of proximal fibula or shaft
							 fracture; with manipulation
27784
1,837.10
668.12
Open treatment of proximal fibula or shaft fracture,
							 includes internal fixation, when performed
27786
79.02
309.22
Closed treatment of distal fibular fracture (lateral
							 malleolus); without manipulation
27788
79.02
420.92
Closed treatment of distal fibular fracture (lateral
							 malleolus); with manipulation
27792
1,837.10
682.77
Open treatment of distal fibular fracture (lateral
							 malleolus), includes internal fixation, when performed
27808
79.02
324.87
Closed treatment of bimalleolar ankle fracture (eg,
							 lateral and medial malleoli, or lateral and posterior malleoli or medial and
							 posterior malleoli); without manipulation
27810
79.02
470.47
Closed treatment of bimalleolar ankle fracture (eg,
							 lateral and medial malleoli, or lateral and posterior malleoli or medial and
							 posterior malleoli); with manipulation
27814
1,837.10
776.51
Open treatment of bimalleolar ankle fracture (eg,
							 lateral and medial malleoli, or lateral and posterior malleoli, or medial and
							 posterior malleoli), includes internal fixation, when performed
27816
79.02
306.81
Closed treatment of trimalleolar ankle fracture;
							 without manipulation
27818
79.02
485.86
Closed treatment of trimalleolar ankle fracture; with
							 manipulation
27822
1,837.10
868.19
Open treatment of trimalleolar ankle fracture,
							 includes internal fixation, when performed, medial and/or lateral malleolus;
							 without fixation of posterior lip
27823
2,646.58
980.87
Open treatment of trimalleolar ankle fracture,
							 includes internal fixation, when performed, medial and/or lateral malleolus;
							 with fixation of posterior lip
27824
79.02
300.42
Closed treatment of fracture of weight bearing
							 articular portion of distal tibia (eg, pilon or tibial plafond), with or
							 without anesthesia; without manipulation
27825
79.02
540.83
Closed treatment of fracture of weight bearing
							 articular portion of distal tibia (eg, pilon or tibial plafond), with or
							 without anesthesia; with skeletal traction and/or requiring
							 manipulation
27826
1,837.10
809.07
Open treatment of fracture of weight bearing
							 articular surface/portion of distal tibia (eg, pilon or tibial plafond), with
							 internal fixation, when performed; of fibula only
27827
2,646.58
1,098.66
Open treatment of fracture of weight bearing
							 articular surface/portion of distal tibia (eg, pilon or tibial plafond), with
							 internal fixation, when performed; of tibia only
27828
2,646.58
1,293.25
Open treatment of fracture of weight bearing
							 articular surface/portion of distal tibia (eg, pilon or tibial plafond), with
							 internal fixation, when performed; of both tibia and fibula
27829
1,837.10
640.15
Open treatment of distal tibiofibular joint
(syndesmosis) disruption, includes internal fixation,
							 when performed
27830
79.02
342.80
Closed treatment of proximal tibiofibular joint
							 dislocation; without anesthesia
27831
79.02
375.70
Closed treatment of proximal tibiofibular joint
							 dislocation; requiring anesthesia
27832
1,837.10
671.83
Open treatment of proximal tibiofibular joint
							 dislocation, includes internal fixation, when performed, or with excision of
							 proximal fibula
27840
79.02
343.32
Closed treatment of ankle dislocation; without
							 anesthesia
27842
659.86
475.66
Closed treatment of ankle dislocation; requiring
							 anesthesia, with or without percutaneous skeletal fixation
27846
1,837.10
736.46
Open treatment of ankle dislocation, with or without
							 percutaneous skeletal fixation; without repair or internal fixation
27848
1,837.10
845.30
Open treatment of ankle dislocation, with or without
							 percutaneous skeletal fixation; with repair or internal or external
							 fixation
27860
659.86
176.96
Manipulation of ankle under general anesthesia
							 (includes application of traction or other fixation apparatus)
27870
3,549.34
1,041.89
Arthrodesis, ankle, open
27871
3,549.34
694.25
Arthrodesis, tibiofibular joint, proximal or
							 distal
27880
950.47
890.23
Amputation, leg, through tibia and
							 fibula;
27881
888.18
Amputation, leg, through tibia and fibula; with
							 immediate fitting technique including application of first cast
27882
631.19
Amputation, leg, through tibia and fibula; open,
							 circular (guillotine)
27884
950.47
581.50
Amputation, leg, through tibia and fibula; secondary
							 closure or scar revision
27886
659.15
Amputation, leg, through tibia and fibula;
							 re-amputation
27888
705.70
Amputation, ankle, through malleoli of tibia and
							 fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection
							 of nerves
27889
1,304.45
684.10
Ankle disarticulation
27892
950.47
546.22
Decompression fasciotomy, leg; anterior and/or
							 lateral compartments only, with debridement of nonviable muscle and/or
							 nerve
27893
950.47
542.55
Decompression fasciotomy, leg; posterior
							 compartment(s) only, with debridement of nonviable muscle and/or
							 nerve
27894
950.47
821.49
Decompression fasciotomy, leg; anterior and/or
							 lateral, and posterior compartment(s), with debridement of nonviable muscle
							 and/or nerve
27899
I.C.
Unlisted procedure, leg or ankle
28001
128.34
264.42
Incision and drainage, bursa, foot
28002
950.47
483.98
Incision and drainage below fascia, with or without
							 tendon sheath involvement, foot; single bursal space
28003
950.47
661.81
Incision and drainage below fascia, with or without
							 tendon sheath involvement, foot; multiple areas
28005
930.79
618.80
Incision, bone cortex (eg, osteomyelitis or bone
							 abscess), foot
28008
930.79
417.44
Fasciotomy, foot and/or toe
28010
96.35
230.06
Tenotomy, percutaneous, toe; single
							 tendon
28011
930.79
324.14
Tenotomy, percutaneous, toe; multiple
							 tendons
28020
930.79
502.27
Arthrotomy, including exploration, drainage, or
							 removal of loose or foreign body; intertarsal or tarsometatarsal
							 joint
28022
930.79
458.67
Arthrotomy, including exploration, drainage, or
							 removal of loose or foreign body;
metatarsophalangeal joint
28024
930.79
439.74
Arthrotomy, including exploration, drainage, or
							 removal of loose or foreign body; interphalangeal joint
28035
806.70
498.88
Release, tarsal tunnel (posterior tibial nerve
							 decompression)
28043
943.36
333.94
Excision, tumor, foot; subcutaneous
							 tissue
28045
930.79
467.12
Excision, tumor, foot; deep, subfascial,
							 intramuscular
28046
930.79
841.46
Radical resection of tumor (eg, malignant neoplasm),
							 soft tissue of foot
28050
930.79
437.29
Arthrotomy with biopsy; intertarsal or
							 tarsometatarsal joint
28052
930.79
409.99
Arthrotomy with biopsy; metatarsophalangeal
							 joint
28054
930.79
385.64
Arthrotomy with biopsy; interphalangeal
							 joint
28055
806.70
397.27
Neurectomy, intrinsic musculature of foot
28060
930.79
490.66
Fasciectomy, plantar fascia; partial (separate
							 procedure)
28062
930.79
579.56
Fasciectomy, plantar fascia; radical (separate
							 procedure)
28070
930.79
487.24
Synovectomy; intertarsal or tarsometatarsal joint,
							 each
28072
930.79
479.95
Synovectomy; metatarsophalangeal joint,
							 each
28080
930.79
466.97
Excision, interdigital (Morton) neuroma, single,
							 each
28086
930.79
552.70
Synovectomy, tendon sheath, foot; flexor
28088
930.79
445.10
Synovectomy, tendon sheath, foot;
							 extensor
28090
930.79
444.29
Excision of lesion, tendon, tendon sheath, or capsule
							 (including synovectomy) (eg, cyst or ganglion); foot
28092
930.79
409.48
Excision of lesion, tendon, tendon sheath, or capsule
							 (including synovectomy) (eg, cyst or ganglion); toe(s), each
28100
930.79
589.48
Excision or curettage of bone cyst or benign tumor,
							 talus or calcaneus;
28102
1,978.29
549.04
Excision or curettage of bone cyst or benign tumor,
							 talus or calcaneus; with iliac or other autograft (includes obtaining
							 graft)
28103
1,978.29
450.10
Excision or curettage of bone cyst or benign tumor,
							 talus or calcaneus; with allograft
28104
930.79
490.24
Excision or curettage of bone cyst or benign tumor,
							 tarsal or metatarsal, except talus or calcaneus;
28106
1,978.29
475.23
Excision or curettage of bone cyst or benign tumor,
							 tarsal or metatarsal, except talus or calcaneus; with iliac or other autograft
							 (includes obtaining graft)
28107
1,978.29
541.33
Excision or curettage of bone cyst or benign tumor,
							 tarsal or metatarsal, except talus or calcaneus; with allograft
28108
930.79
411.40
Excision or curettage of bone cyst or benign tumor,
							 phalanges of foot
28110
930.79
436.59
Ostectomy, partial excision, fifth metatarsal head
							 (bunionette) (separate procedure)
28111
930.79
500.78
Ostectomy, complete excision; first metatarsal
							 head
28112
930.79
472.48
Ostectomy, complete excision; other metatarsal head
							 (second, third or fourth)
28113
930.79
551.51
Ostectomy, complete excision; fifth metatarsal
							 head
28114
930.79
1,014.78
Ostectomy, complete excision; all metatarsal heads,
							 with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton
							 type procedure)
28116
930.79
709.86
Ostectomy, excision of tarsal coalition
28118
930.79
557.06
Ostectomy, calcaneus;
28119
930.79
497.96
Ostectomy, calcaneus; for spur, with or without
							 plantar fascial release
28120
930.79
569.60
Partial excision (craterization, saucerization,
							 sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or
							 calcaneus
28122
930.79
639.61
Partial excision (craterization, saucerization,
							 sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal
							 or metatarsal bone, except talus or calcaneus
28124
216.23
455.25
Partial excision (craterization, saucerization,
							 sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx
							 of toe
28126
930.79
369.32
Resection, partial or complete, phalangeal base, each
							 toe
28130
930.79
651.72
Talectomy (astragalectomy)
28140
930.79
613.73
Metatarsectomy
28150
930.79
415.00
Phalangectomy, toe, each toe
28153
930.79
382.87
Resection, condyle(s), distal end of phalanx, each
							 toe
28160
930.79
394.48
Hemiphalangectomy or interphalangeal joint excision,
							 toe, proximal end of phalanx, each
28171
930.79
621.97
Radical resection of tumor, bone; tarsal (except
							 talus or calcaneus)
28173
930.79
718.16
Radical resection of tumor, bone;
							 metatarsal
28175
930.79
528.51
Radical resection of tumor, bone; phalanx of
							 toe
28190
136.06
244.50
Removal of foreign body, foot;
							 subcutaneous
28192
719.48
459.19
Removal of foreign body, foot; deep
28193
388.12
517.37
Removal of foreign body, foot;
							 complicated
28200
930.79
452.76
Repair, tendon, flexor, foot; primary or secondary,
							 without free graft, each tendon
28202
930.79
609.66
Repair, tendon, flexor, foot; secondary with free
							 graft, each tendon (includes obtaining graft)
28208
930.79
432.96
Repair, tendon, extensor, foot; primary or secondary,
							 each tendon
28210
1,978.29
561.65
Repair, tendon, extensor, foot; secondary with free
							 graft, each tendon (includes obtaining graft)
28220
203.73
428.46
Tenolysis, flexor, foot; single tendon
28222
930.79
494.59
Tenolysis, flexor, foot; multiple tendons
28225
930.79
377.16
Tenolysis, extensor, foot; single tendon
28226
930.79
442.57
Tenolysis, extensor, foot; multiple
							 tendons
28230
200.78
414.39
Tenotomy, open, tendon flexor; foot, single or
							 multiple tendon(s) (separate procedure)
28232
191.96
371.03
Tenotomy, open, tendon flexor; toe, single tendon
							 (separate procedure)
28234
930.79
382.53
Tenotomy, open, extensor, foot or toe, each
							 tendon
28238
1,978.29
659.74
Reconstruction (advancement), posterior tibial tendon
							 with excision of accessory tarsal navicular bone (eg, Kidner type
							 procedure)
28240
930.79
420.31
Tenotomy, lengthening, or release, abductor hallucis
							 muscle
28250
930.79
531.74
Division of plantar fascia and muscle (eg, Steindler
							 stripping) (separate procedure)
28260
930.79
650.20
Capsulotomy, midfoot; medial release only (separate
							 procedure)
28261
930.79
931.56
Capsulotomy, midfoot; with tendon
							 lengthening
28262
930.79
1,328.42
Capsulotomy, midfoot; extensive, including posterior
							 talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot
							 deformity)
28264
1,978.29
821.32
Capsulotomy, midtarsal (eg, Heyman type
							 procedure)
28270
930.79
454.72
Capsulotomy; metatarsophalangeal joint, with or
							 without tenorrhaphy, each joint (separate procedure)
28272
183.86
375.50
Capsulotomy; interphalangeal joint, each joint
							 (separate procedure)
28280
930.79
512.40
Syndactylization, toes (eg, webbing or Kelikian type
							 procedure)
28285
930.79
442.95
Correction, hammertoe (eg, interphalangeal fusion,
							 partial or total phalangectomy)
28286
930.79
435.00
Correction, cock-up fifth toe, with plastic skin
							 closure (eg, Ruiz-Mora type procedure)
28288
930.79
552.48
Ostectomy, partial, exostectomy or condylectomy,
							 metatarsal head, each metatarsal head
28289
930.79
708.38
Hallux rigidus correction with cheilectomy,
							 debridement and capsular release of the first metatarsophalangeal
							 joint
28290
1,314.58
552.20
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; simple exostectomy (eg, Silver type procedure)
28292
1,314.58
735.12
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; Keller, McBride, or Mayo type procedure
28293
1,314.58
993.27
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; resection of joint with implant
28294
1,314.58
716.27
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; with tendon transplants (eg, Joplin type procedure)
28296
1,314.58
761.81
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric
							 type procedures)
28297
1,314.58
804.37
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; Lapidus-type procedure
28298
1,314.58
685.15
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; by phalanx osteotomy
28299
1,314.58
874.59
Correction, hallux valgus (bunion), with or without
							 sesamoidectomy; by double osteotomy
28300
1,978.29
675.30
Osteotomy; calcaneus (eg, Dwyer or Chambers type
							 procedure), with or without internal fixation
28302
930.79
672.50
Osteotomy; talus
28304
1,978.29
758.00
Osteotomy, tarsal bones, other than calcaneus or
							 talus;
28305
1,978.29
689.15
Osteotomy, tarsal bones, other than calcaneus or
							 talus; with autograft (includes obtaining graft) (eg, Fowler type)
28306
930.79
578.16
Osteotomy, with or without lengthening, shortening or
							 angular correction, metatarsal; first metatarsal
28307
930.79
712.34
Osteotomy, with or without lengthening, shortening or
							 angular correction, metatarsal; first metatarsal with autograft (other than
							 first toe)
28308
930.79
518.36
Osteotomy, with or without lengthening, shortening or
							 angular correction, metatarsal; other than first metatarsal, each
28309
1,978.29
898.03
Osteotomy, with or without lengthening, shortening or
							 angular correction, metatarsal; multiple (eg, Swanson type cavus foot
							 procedure)
28310
930.79
514.17
Osteotomy, shortening, angular or rotational
							 correction; proximal phalanx, first toe (separate procedure)
28312
930.79
470.98
Osteotomy, shortening, angular or rotational
							 correction; other phalanges, any toe
28313
930.79
483.70
Reconstruction, angular deformity of toe, soft tissue
							 procedures only (eg, overlapping second toe, fifth toe, curly toes)
28315
930.79
453.03
Sesamoidectomy, first toe (separate
							 procedure)
28320
1,978.29
644.06
Repair, nonunion or malunion; tarsal
							 bones
28322
1,978.29
760.64
Repair, nonunion or malunion; metatarsal, with or
							 without bone graft (includes obtaining graft)
28340
930.79
600.17
Reconstruction, toe, macrodactyly; soft tissue
							 resection
28341
930.79
681.54
Reconstruction, toe, macrodactyly; requiring
							 bone
resection
28344
930.79
442.29
Reconstruction, toe(s); polydactyly
28345
930.79
546.21
Reconstruction, toe(s); syndactyly, with or without
							 skin graft(s), each web
28360
957.08
Reconstruction, cleft foot
28400
79.02
247.39
Closed treatment of calcaneal fracture; without
							 manipulation
28405
79.02
393.07
Closed treatment of calcaneal fracture; with
							 manipulation
28406
1,169.01
537.61
Percutaneous skeletal fixation of calcaneal fracture,
							 with manipulation
28415
2,646.58
1,166.71
Open treatment of calcaneal fracture, includes
							 internal fixation, when performed;
28420
1,837.10
1,208.49
Open treatment of calcaneal fracture, includes
							 internal fixation, when performed; with primary iliac or other autogenous bone
							 graft (includes obtaining graft)
28430
79.02
232.41
Closed treatment of talus fracture; without
							 manipulation
28435
79.02
315.17
Closed treatment of talus fracture; with
							 manipulation
28436
1,169.01
432.81
Percutaneous skeletal fixation of talus fracture,
							 with manipulation
28445
1,837.10
1,080.13
Open treatment of talus fracture, includes internal
							 fixation, when performed
28446
1,978.29
1,147.79
Open osteochondral autograft, talus (includes
							 obtaining graft[s])
28450
79.02
213.98
Treatment of tarsal bone fracture (except talus and
							 calcaneus); without manipulation, each
28455
79.02
285.52
Treatment of tarsal bone fracture (except talus and
							 calcaneus); with manipulation, each
28456
1,169.01
288.43
Percutaneous skeletal fixation of tarsal bone
							 fracture (except talus and calcaneus), with manipulation, each
28465
1,837.10
612.88
Open treatment of tarsal bone fracture (except talus
							 and calcaneus), includes internal fixation, when performed, each
28470
79.02
213.18
Closed treatment of metatarsal fracture; without
							 manipulation, each
28475
79.02
263.26
Closed treatment of metatarsal fracture; with
							 manipulation, each
28476
1,169.01
348.35
Percutaneous skeletal fixation of metatarsal
							 fracture, with manipulation, each
28485
1,837.10
527.06
Open treatment of metatarsal fracture, includes
							 internal fixation, when performed, each
28490
75.39
136.79
Closed treatment of fracture great toe, phalanx or
							 phalanges; without manipulation
28495
79.02
168.09
Closed treatment of fracture great toe, phalanx or
							 phalanges; with manipulation
28496
1,169.01
452.79
Percutaneous skeletal fixation of fracture great toe,
							 phalanx or phalanges, with manipulation
28505
1,169.01
646.46
Open treatment of fracture, great toe, phalanx or
							 phalanges, includes internal fixation, when performed
28510
58.84
116.54
Closed treatment of fracture, phalanx or phalanges,
							 other than great toe; without manipulation, each
28515
75.75
151.43
Closed treatment of fracture, phalanx or phalanges,
							 other than great toe; with manipulation, each
28525
1,169.01
561.05
Open treatment of fracture, phalanx or phalanges,
							 other than great toe, includes internal fixation, when performed,
							 each
28530
56.26
111.49
Closed treatment of sesamoid fracture
28531
1,169.01
413.94
Open treatment of sesamoid fracture, with or without
							 internal fixation
28540
79.02
198.25
Closed treatment of tarsal bone dislocation, other
							 than talotarsal; without anesthesia
28545
1,169.01
229.81
Closed treatment of tarsal bone dislocation, other
							 than talotarsal; requiring anesthesia
28546
1,169.01
472.33
Percutaneous skeletal fixation of tarsal bone
							 dislocation, other than talotarsal, with manipulation
28555
1,837.10
832.04
Open treatment of tarsal bone dislocation, includes
							 internal fixation, when performed
28570
79.02
178.17
Closed treatment of talotarsal joint dislocation;
							 without anesthesia
28575
79.02
319.52
Closed treatment of talotarsal joint dislocation;
							 requiring anesthesia
28576
1,169.01
363.28
Percutaneous skeletal fixation of talotarsal joint
							 dislocation, with manipulation
28585
1,169.01
845.28
Open treatment of talotarsal joint dislocation,
							 includes internal fixation, when performed
28600
79.02
208.73
Closed treatment of tarsometatarsal joint
							 dislocation; without anesthesia
28605
79.02
268.47
Closed treatment of tarsometatarsal joint
							 dislocation; requiring anesthesia
28606
1,169.01
396.79
Percutaneous skeletal fixation of tarsometatarsal
							 joint dislocation, with manipulation
28615
1,837.10
768.47
Open treatment of tarsometatarsal joint dislocation,
							 includes internal fixation, when performed
28630
62.52
143.43
Closed treatment of metatarsophalangeal joint
							 dislocation; without anesthesia
28635
659.86
172.65
Closed treatment of metatarsophalangeal joint
							 dislocation; requiring anesthesia
28636
1,169.01
297.56
Percutaneous skeletal fixation of metatarsophalangeal
							 joint dislocation, with manipulation
28645
1,169.01
571.73
Open treatment of metatarsophalangeal joint
							 dislocation, includes internal fixation, when performed
28660
28665
47.07
659.86
105.49
149.06
Closed treatment of interphalangeal joint
							 dislocation; without anesthesia Closed treatment of interphalangeal joint
							 dislocation;
28666
1,169.01
205.43
requiring anesthesia Percutaneous skeletal fixation
							 of interphalangeal joint dislocation, with manipulation
28675
1,169.01
553.87
Open treatment of interphalangeal joint dislocation,
							 includes internal fixation, when performed
28705
1,978.29
1,311.21
Arthrodesis; pantalar
28715
3,549.34
976.48
Arthrodesis; triple
28725
1,978.29
811.34
Arthrodesis; subtalar
28730
1,978.29
841.89
Arthrodesis, midtarsal or tarsometatarsal, multiple
							 or transverse;
28735
1,978.29
802.01
Arthrodesis, midtarsal or tarsometatarsal, multiple
							 or transverse; with osteotomy (eg, flatfoot correction)
28737
1,978.29
710.25
Arthrodesis, with tendon lengthening and advancement,
							 midtarsal, tarsal navicular-cuneiform (eg, Miller type procedure)
28740
1,978.29
847.26
Arthrodesis, midtarsal or tarsometatarsal, single
							 joint
28750
1,978.29
841.61
Arthrodesis, great toe; metatarsophalangeal
							 joint
28755
930.79
490.50
Arthrodesis, great toe; interphalangeal
							 joint
28760
1,978.29
747.28
Arthrodesis, with extensor hallucis longus transfer
							 to first metatarsal neck, great toe, interphalangeal joint (eg, Jones type
							 procedure)
28800
578.36
Amputation, foot; midtarsal (eg, Chopart type
							 procedure)
28805
729.45
Amputation, foot; transmetatarsal
28810
930.79
444.93
Amputation, metatarsal, with toe, single
28820
930.79
535.06
Amputation, toe; metatarsophalangeal
							 joint
28825
930.79
466.62
Amputation, toe; interphalangeal joint
28890
189.01
363.60
Extracorporeal shock wave, high energy, performed by
							 a physician, requiring anesthesia other than local, including ultrasound
							 guidance, involving the plantar fascia
28899
I.C.
Unlisted procedure, foot or toes
29000
48.85
249.75
Application of halo type body cast (see 20661-20663
							 for insertion)
29010
102.38
260.11
Application of Risser jacket, localizer, body;
							 only
29015
102.38
242.11
Application of Risser jacket, localizer, body;
							 including head
29020
48.85
241.53
Application of turnbuckle jacket, body;
							 only
29025
48.85
260.37
Application of turnbuckle jacket, body; including
							 head
29035
102.38
237.29
Application of body cast, shoulder to
							 hips;
29040
48.85
218.69
Application of body cast, shoulder to hips; including
							 head, Minerva type
29044
102.38
256.40
Application of body cast, shoulder to hips; including
							 one thigh
29046
102.38
272.54
Application of body cast, shoulder to hips; including
							 both thighs
29049
44.49
89.98
Application, cast; figure-of-eight
29055
102.38
203.25
Application, cast; shoulder spica
29058
48.85
114.72
Application, cast; plaster Velpeau
29065
47.81
94.04
Application, cast; shoulder to hand (long
							 arm)
29075
45.59
87.72
Application, cast; elbow to finger (short
							 arm)
29085
46.71
92.36
Application, cast; hand and lower forearm
							 (gauntlet)
29086
37.51
70.22
Application, cast; finger (eg,
							 contracture)
29105
42.66
86.69
Application of long arm splint (shoulder to
							 hand)
29125
36.41
67.81
Application of short arm splint (forearm to hand);
							 static
29126
40.82
79.48
Application of short arm splint (forearm to hand);
							 dynamic
29130
16.55
39.58
Application of finger splint; static
29131
24.28
50.06
Application of finger splint; dynamic
29200
24.28
53.77
Strapping; thorax
29220
25.01
54.81
Strapping; low back
29240
27.95
61.02
Strapping; shoulder (eg, Velpeau)
29260
25.74
52.96
Strapping; elbow or wrist
29280
26.84
51.91
Strapping; hand or finger
29305
102.38
232.15
Application of hip spica cast; one leg
29325
102.38
249.08
Application of hip spica cast; one and one-half spica
							 or both legs
29345
62.89
134.16
Application of long leg cast (thigh to
							 toes);
29355
61.04
136.44
Application of long leg cast (thigh to toes); walker
							 or ambulatory type
29358
74.65
150.22
Application of long leg cast brace
29365
59.57
120.85
Application of cylinder cast (thigh to
							 ankle)
29405
44.13
89.25
Application of short leg cast (below knee to
							 toes);
29425
44.86
95.60
Application of short leg cast (below knee to toes);
							 walking or ambulatory type
29435
56.64
117.17
Application of patellar tendon bearing (PTB)
							 cast
29440
24.64
52.70
Adding walker to previously applied cast
29445
61.77
146.20
Application of rigid total contact leg
							 cast
29450
48.85
149.53
Application of clubfoot cast with molding or
							 manipulation, long or short leg
29505
41.19
77.97
Application of long leg splint (thigh to ankle or
							 toes)
29515
33.46
69.51
Application of short leg splint (calf to
							 foot)
29520
27.58
53.86
Strapping; hip
29530
26.48
54.10
Strapping; knee
29540
17.65
41.30
Strapping; ankle and/or foot
29550
18.02
40.40
Strapping; toes
29580
25.01
52.18
Strapping; Unna boot
29590
20.23
53.96
Denis-Browne splint strapping
29700
33.83
64.21
Removal or bivalving; gauntlet, boot or body
							 cast
29705
29.05
66.21
Removal or bivalving; full arm or full leg
							 cast
29710
52.22
117.57
Removal or bivalving; shoulder or hip spica, Minerva,
							 or Risser jacket,
etc.
29715
43.39
89.57
Removal or bivalving; turnbuckle jacket
29720
42.66
80.21
Repair of spica, body cast or jacket
29730
28.31
64.65
Windowing of cast
29740
40.08
93.81
Wedging of cast (except clubfoot casts)
29750
29799
38.98
98.10 I.C.
Wedging of clubfoot cast Unlisted procedure, casting
							 or strapping
29800
1,286.14
526.42
Arthroscopy, temporomandibular joint, diagnostic,
							 with or without synovial biopsy (separate procedure)
29804
1,286.14
645.30
Arthroscopy, temporomandibular joint,
							 surgical
29805
1,286.14
472.27
Arthroscopy, shoulder, diagnostic, with or without
							 synovial biopsy (separate procedure)
29806
2,042.57
I
2,070.03
Arthroscopy, shoulder, surgical;
							 capsulorrhaphy
29807
2,042.57
I
2,267.25
Arthroscopy, shoulder, surgical; repair of SLAP
							 lesion
29819
2,042.57
587.62
Arthroscopy, shoulder, surgical; with removal of
							 loose body or foreign body
29820
2,042.57
542.03
Arthroscopy, shoulder, surgical; synovectomy,
							 partial
29821
2,042.57
592.25
Arthroscopy, shoulder, surgical; synovectomy,
							 complete
29822
1,286.14
576.71
Arthroscopy, shoulder, surgical; debridement,
							 limited
29823
2,042.57
I
1,997.99
Arthroscopy, shoulder, surgical; debridement,
							 extensive
29824
1,286.14
667.28
Arthroscopy, shoulder, surgical; distal
							 claviculectomy including distal articular surface (Mumford
							 procedure)
29825
2,042.57
587.16
Arthroscopy, shoulder, surgical; with lysis and
							 resection of adhesions, with or without manipulation
29826
2,042.57
I
2,131.39
Arthroscopy, shoulder, surgical; decompression of
							 subacromial space with partial acromioplasty, with or without coracoacromial
							 release
29827
2,042.57
I
3,673.44
Arthroscopy, shoulder, surgical; with rotator cuff
							 repair
29828
2,042.57
885.42
Arthroscopy, shoulder, surgical; biceps
							 tenodesis
29830
1,286.14
454.16
Arthroscopy, elbow, diagnostic, with or without
							 synovial biopsy (separate procedure)
29834
1,286.14
494.75
Arthroscopy, elbow, surgical; with removal of loose
							 body or foreign body
29835
1,286.14
506.76
Arthroscopy, elbow, surgical; synovectomy,
							 partial
29836
1,286.14
580.39
Arthroscopy, elbow, surgical; synovectomy,
							 complete
29837
1,286.14
529.70
Arthroscopy, elbow, surgical; debridement,
							 limited
29838
1,286.14
593.32
Arthroscopy, elbow, surgical; debridement,
							 extensive
29840
1,286.14
445.26
Arthroscopy, wrist, diagnostic, with or without
							 synovial biopsy (separate procedure)
29843
1,286.14
474.75
Arthroscopy, wrist, surgical; for infection, lavage
							 and drainage
29844
1,286.14
496.62
Arthroscopy, wrist, surgical; synovectomy,
							 partial
29845
1,286.14
566.49
Arthroscopy, wrist, surgical; synovectomy,
							 complete
29846
1,286.14
521.54
Arthroscopy, wrist, surgical; excision and/or repair
							 of triangular fibrocartilage and/or joint debridement
29847
2,042.57
540.01
Arthroscopy, wrist, surgical; internal fixation for
							 fracture or instability
29848
1,286.14
489.22
Endoscopy, wrist, surgical, with release of
							 transverse carpal ligament
29850
1,286.14
541.38
Arthroscopically aided treatment of intercondylar
							 spine(s) and/or tuberosity fracture(s) of the knee, with or without
							 manipulation; without internal or external fixation (includes
							 arthroscopy)
29851
2,042.57
931.75
Arthroscopically aided treatment of intercondylar
							 spine(s) and/or tuberosity fracture(s) of the knee, with or without
							 manipulation; with internal or external fixation (includes
							 arthroscopy)
29855
2,042.57
786.98
Arthroscopically aided treatment of tibial fracture,
							 proximal (plateau); unicondylar, includes internal fixation, when performed
							 (includes arthroscopy)
29856
2,042.57
1,000.05
Arthroscopically aided treatment of tibial fracture,
							 proximal (plateau); bicondylar, includes internal fixation, when performed
							 (includes arthroscopy)
29860
2,042.57
646.72
Arthroscopy, hip, diagnostic with or without synovial
							 biopsy (separate procedure)
29861
2,042.57
7 03.60
Arthroscopy, hip, surgical; with removal of loose
							 body or foreign body
29862
2,042.57
794.56
Arthroscopy, hip, surgical; with debridement/shaving
							 of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection
							 of labrum
29863
2,042.57
785.34
Arthroscopy, hip, surgical; with
							 synovectomy
29866
2,042.57
1,045.48
Arthroscopy, knee, surgical; osteochondral
							 autograft(s) (eg, mosaicplasty) (includes harvesting of the
							 autograft[s])
29867
1,262.67
Arthroscopy, knee, surgical; osteochondral allograft
							 (eg, mosaicplasty)
29868
1,684.74
Arthroscopy, knee, surgical; meniscal transplantation
							 (includes arthrotomy for meniscal insertion), medial or lateral
29870
1,286.14
408.46
Arthroscopy, knee, diagnostic, with or without
							 synovial biopsy (separate procedure)
29871
1,286.14
511.29
Arthroscopy, knee, surgical; for infection, lavage
							 and drainage
29873
1,286.14
519.42
Arthroscopy, knee, surgical; with lateral
							 release
29874
1,286.14
532.52
Arthroscopy, knee, surgical; for removal of loose
							 body or foreign body (eg, osteochondritis dissecans fragmentation, chondral
							 fragmentation)
29875
1,286.14
496.99
Arthroscopy, knee, surgical; synovectomy, limited
							 (eg, plica or shelf resection) (separate procedure)
29876
1,286.14
643.04
Arthroscopy, knee, surgical; synovectomy, major, two
							 or more compartments (eg, medial or lateral)
29877
1,286.14
I
1,859.32
Arthroscopy, knee, surgical; debridement/shaving of
							 articular cartilage (chondroplasty)
29879
1,286.14
650.96
Arthroscopy, knee, surgical; abrasion arthroplasty
							 (includes chondroplasty where necessary) or multiple drilling or
							 microfracture
29880
1,286.14
I
1,736.57
Arthroscopy, knee, surgical; with meniscectomy
							 (medial AND lateral, including any meniscal shaving)
29881
1,286.14
I
1,826.52
Arthroscopy, knee, surgical; with meniscectomy
							 (medial OR lateral, including any meniscal shaving)
29882
1,286.14
682.91
Arthroscopy, knee, surgical; with meniscus repair
							 (medial OR lateral)
29883
1,286.14
837.67
Arthroscopy, knee, surgical; with meniscus repair
							 (medial AND lateral)
29884
1,286.14
607.01
Arthroscopy, knee, surgical; with lysis of adhesions,
							 with or without manipulation (separate procedure)
29885
2,042.57
735.03
Arthroscopy, knee, surgical; drilling for
							 osteochondritis dissecans with bone grafting, with or without internal fixation
							 (including debridement of base of lesion)
29886
1,286.14
620.60
Arthroscopy, knee, surgical; drilling for intact
							 osteochondritis dissecans lesion
29887
1,286.14
730.72
Arthroscopy, knee, surgical; drilling for intact
							 osteochondritis dissecans lesion with internal fixation
29888
2,042.57
I
2,900.23
Arthroscopically aided anterior cruciate ligament
							 repair/augmentation or reconstruction
29889
2,042.57
1,199.89
Arthroscopically aided posterior cruciate ligament
							 repair/augmentation or reconstruction
29891
2,042.57
690.88
Arthroscopy, ankle, surgical, excision of
							 osteochondral defect of talus and/or tibia, including drilling of the
							 defect
29892
2,042.57
711.50
Arthroscopically aided repair of large
							 osteochondritis dissecans lesion, talar dome fracture, or tibial plafond
							 fracture, with or without internal fixation (includes arthroscopy)
29893
930.79
574.45
Endoscopic plantar fasciotomy
29894
1,286.14
517.09
Arthroscopy, ankle (tibiotalar and fibulotalar
							 joints), surgical; with removal of loose body or foreign body
29895
1,286.14
503.78
Arthroscopy, ankle (tibiotalar and fibulotalar
							 joints), surgical; synovectomy, partial
29897
1,286.14
528.18
Arthroscopy, ankle (tibiotalar and fibulotalar
							 joints), surgical; debridement, limited
29898
1,286.14
587.77
Arthroscopy, ankle (tibiotalar and fibulotalar
							 joints), surgical; debridement, extensive
29899
2,042.57
1,046.31
Arthroscopy, ankle (tibiotalar and fibulotalar
							 joints), surgical; with ankle arthrodesis
29900
1,286.14
466.73
Arthroscopy, metacarpophalangeal joint, diagnostic,
							 includes synovial biopsy
29901
1,286.14
513.44
Arthroscopy, metacarpophalangeal joint, surgical;
							 with debridement
29902
1,286.14
532.39
Arthroscopy, metacarpophalangeal joint, surgical;
							 with reduction of displaced ulnar collateral ligament (eg, Stenar
							 lesion)
29904
1,286.14
598.79
Arthroscopy, subtalar joint, surgical; with removal
							 of loose body or foreign body
29905
1,286.14
646.96
Arthroscopy, subtalar joint, surgical; with
							 synovectomy
29906
1,286.14
681.67
Arthroscopy, subtalar joint, surgical; with
							 debridement
29907
2,042.57
828.91
Arthroscopy, subtalar joint, surgical; with subtalar
							 arthrodesis
29999
I.C.
Unlisted procedure, arthroscopy
30000
111.73
239.06
Drainage abscess or hematoma, nasal, internal
							 approach
30020
111.73
224.33
Drainage abscess or hematoma, nasal
							 septum
30100
83.85
139.14
Biopsy, intranasal
30110
131.28
224.85
Excision, nasal polyp(s), simple
30115
729.71
432.48
Excision, nasal polyp(s), extensive
30117
729.71
837.85
Excision or destruction (eg, laser), intranasal
							 lesion; internal approach
30118
1,071.47
767.05
Excision or destruction (eg, laser), intranasal
							 lesion; external approach (lateral rhinotomy)
30120
729.71
509.42
Excision or surgical planing of skin of nose for
							 rhinophyma
30124
332.81
282.71
Excision dermoid cyst, nose; simple, skin,
							 subcutaneous
30125
1,782.06
627.30
Excision dermoid cyst, nose; complex, under bone or
							 cartilage
30130
729.71
384.40
Excision inferior turbinate, partial or complete, any
							 method
30140
1,071.47
435.40
Submucous resection inferior turbinate, partial or
							 complete, any method
30150
1,782.06
811.85
Rhinectomy; partial
30160
1,782.06
803.28
Rhinectomy; total
30200
66.92
112.20
Injection into turbinate(s), therapeutic
30210
84.58
146.58
Displacement therapy (Proetz type)
30220
332.81
288.38
Insertion, nasal septal prosthesis
							 (button)
30300
28.19
243.88
Removal foreign body, intranasal; office type
							 procedure
30310
729.71
210.94
Removal foreign body, intranasal; requiring general
							 anesthesia
30320
729.71
475.77
Removal foreign body, intranasal; by lateral
							 rhinotomy
30400
1,782.06
1,069.48
Rhinoplasty, primary; lateral and alar cartilages
							 and/or elevation of nasal tip
30410
1,782.06
1,287.04
Rhinoplasty, primary; complete, external parts
							 including bony pyramid, lateral and alar cartilages, and/or elevation of nasal
							 tip
30420
1,782.06
1,388.18
Rhinoplasty, primary; including major septal
							 repair
30430
1,071.47
968.71
Rhinoplasty, secondary; minor revision (small amount
							 of nasal tip work)
30435
1,782.06
1,262.54
Rhinoplasty, secondary; intermediate revision (bony
							 work with osteotomies)
30450
1,782.06
1,613.69
Rhinoplasty, secondary; major revision (nasal tip
							 work and osteotomies)
30460
1,782.06
781.86
Rhinoplasty for nasal deformity secondary to
							 congenital cleft lip and/or palate, including columellar lengthening; tip
							 only
30462
1,782.06
1,566.75
Rhinoplasty for nasal deformity secondary to
							 congenital cleft lip and/or palate, including columellar lengthening; tip,
							 septum, osteotomies
30465
1,782.06
979.02
Repair of nasal vestibular stenosis (eg, spreader
							 grafting, lateral nasal wall reconstruction)
30520
1,782.06
586.44
Septoplasty or submucous resection, with or without
							 cartilage scoring, contouring or replacement with graft
30540
1,071.47
697.31
Repair choanal atresia; intranasal
30545
1,782.06
973.23
Repair choanal atresia; transpalatine
30560
1,782.06
278.22
Lysis intranasal synechia
30580
111.73
623.87
Repair fistula; oromaxillary (combine with 31030 if
							 antrotomy is included)
30600
1,782.06
578.04
Repair fistula; oronasal
30620
1,782.06
626.52
Septal or other intranasal dermatoplasty (does not
							 include obtaining graft)
30630
1,782.06
624.29
Repair nasal septal perforations
30801
1,071.47
234.84
Cautery and/or ablation, mucosa of inferior
							 turbinates, unilateral or bilateral, any method; superficial
30802
332.81
295.26
Cauteryand/or ablation, mucosa of inferior
							 turbinates, unilateral or bilateral, any method; intramural
30901
332.81
105.37
Control nasal hemorrhage, anterior, simple (limited
							 cautery and/or packing) any method
30903
48.17
194.56
Control nasal hemorrhage, anterior, complex
							 (extensive cautery and/or packing) any method
30905
50.28
244.04
Control nasal hemorrhage, posterior, with posterior
							 nasal packs and/or cautery, any method; initial
30906
50.28
277.90
Control nasal hemorrhage, posterior, with posterior
							 nasal packs and/or cautery, any method; subsequent
30915
50.28
571.54
Ligation arteries; ethmoidal
30920
1,154.79
813.45
Ligation arteries; internal maxillary artery,
							 transantral
30930
1,154.79
122.33
Fracture nasal inferior turbinate(s),
							 therapeutic
30999
729.71
I.C.
Unlisted procedure, nose
31000
111.43
182.11
Lavage by cannulation; maxillary sinus (antrum
							 puncture or natural ostium)
31002
332.81
207.10
Lavage by cannulation; sphenoid sinus
31020
1,071.47
505.24
Sinusotomy, maxillary (antrotomy);
							 intranasal
31030
1,782.06
725.60
Sinusotomy, maxillary (antrotomy); radical
							 (Caldwell-Luc) without removal of antrochoanal polyps
31032
1,782.06
571.09
Sinusotomy, maxillary (antrotomy); radical
							 (Caldwell-Luc) with removal of antrochoanal polyps
31040
1,071.47
751.74
Pterygomaxillary fossa surgery, any
							 approach
31050
1,782.06
491.95
Sinusotomy, sphenoid, with or without
							 biopsy;
31051
1,782.06
645.54
Sinusotomy, sphenoid, with or without biopsy; with
							 mucosal stripping or removal of polyp(s)
31070
1,071.47
437.82
Sinusotomy frontal; external, simple (trephine
							 operation)
31075
1,782.06
782.07
Sinusotomy frontal; transorbital, unilateral (for
							 mucocele or osteoma, Lynch type)
31080
1,782.06
1,021.04
Sinusotomy frontal; obliterative without osteoplastic
							 flap, brow incision (includes ablation)
31081
1,782.06
1,227.85
Sinusotomy frontal; obliterative, without
							 osteoplastic flap, coronal incision (includes ablation)
31084
1,782.06
1,146.85
Sinusotomy frontal; obliterative, with osteoplastic
							 flap, brow incision
31085
1,782.06
1,232.63
Sinusotomy frontal; obliterative, with osteoplastic
							 flap, coronal incision
31086
1,782.06
1,115.75
Sinusotomyfrontal; nonobliterative, with osteoplastic
							 flap, brow incision
31087
1,782.06
1,091.42
Sinusotomyfrontal; nonobliterative, with osteoplastic
							 flap, coronal incision
31090
1,782.06
997.56
Sinusotomy, unilateral, three or more paranasal
							 sinuses (frontal, maxillary, ethmoid, sphenoid)
31200
1,782.06
563.85
Ethmoidectomy; intranasal, anterior
31201
1,782.06
732.85
Ethmoidectomy; intranasal, total
31205
1,782.06
870.06
Ethmoidectomy; extranasal, total
31225
1,772.93
Maxillectomy; without orbital
							 exenteration
31230
1,991.56
Maxillectomy; with orbital exenteration (en
							 bloc)
31231
72.02
200.89
Nasal endoscopy, diagnostic, unilateral or bilateral
							 (separate procedure)
31233
72.02
277.43
Nasal/sinus endoscopy, diagnostic with maxillary
							 sinusoscopy (via inferior meatus or canine fossa puncture)
31235
760.42
317.95
Nasal/sinus endoscopy, diagnostic with sphenoid
							 sinusoscopy (via puncture of sphenoidal face or cannulation of
							 ostium)
31237
760.42
342.58
Nasal/sinus endoscopy, surgical; with biopsy,
							 polypectomy or debridement (separate procedure)
31238
760.42
350.92
Nasal/sinus endoscopy, surgical; with control of
							 nasal hemorrhage
31239
1,015.27
665.59
Nasal/sinus endoscopy, surgical; with
							 dacryocystorhinostomy
31240
760.42
165.35
Nasal/sinus endoscopy, surgical; with concha bullosa
							 resection
31254
1,015.27
281.92
Nasal/sinus endoscopy, surgical; with ethmoidectomy,
							 partial (anterior)
31255
1,015.27
415.67
Nasal/sinus endoscopy, surgical; with ethmoidectomy,
							 total (anterior and posterior)
31256
1,015.27
205.07
Nasal/sinus endoscopy, surgical, with maxillary
							 antrostomy;
31267
1,015.27
329.14
Nasal/sinus endoscopy, surgical, with maxillary
							 antrostomy; with removal of tissue from maxillary sinus
31276
1,015.27
523.18
Nasal/sinus endoscopy, surgical with frontal sinus
							 exploration, with or without removal of tissue from frontal sinus
31287
1,015.27
240.47
Nasal/sinus endoscopy, surgical, with
							 sphenoidotomy;
31288
1,015.27
278.45
Nasal/sinus endoscopy, surgical, with sphenoidotomy;
							 with removal of tissue from the sphenoid sinus
31290
1,159.21
Nasal/sinus endoscopy, surgical, with repair of
							 cerebrospinal fluid leak; ethmoid region
31291
1,221.51
Nasal/sinus endoscopy, surgical, with repair of
							 cerebrospinal fluid leak; sphenoid region
31292
1,005.29
Nasal/sinus endoscopy, surgical; with medial or
							 inferior orbital wall decompression
31293
1,093.21
Nasal/sinus endoscopy, surgical; with medial orbital
							 wall and inferior orbital wall decompression
31294
1,254.75
Nasal/sinus endoscopy, surgical; with optic nerve
							 decompression
31299
I.C.
Unlisted procedure, accessory sinuses
31300
1,071.47
1,252.21
Laryngotomy (thyrotomy, laryngofissure); with removal
							 of tumor or laryngocele, cordectomy
31320
1,782.06
676.54
Laryngotomy (thyrotomy, laryngofissure);
							 diagnostic
31360
1,898.35
Laryngectomy; total, without radical neck
							 dissection
31365
2,371.19
Laryngectomy; total, with radical neck
							 dissection
31367
2,108.09
Laryngectomy; subtotal supraglottic, without radical
							 neck dissection
31368
2,375.45
Laryngectomy; subtotal supraglottic, with radical
							 neck dissection
31370
2,004.92
Partial laryngectomy (hemilaryngectomy);
							 horizontal
31375
1,883.83
Partial laryngectomy (hemilaryngectomy);
							 laterovertical
31380
1,865.93
Partial laryngectomy (hemilaryngectomy);
							 anterovertical
31382
2,034.66
Partial laryngectomy (h em ilaryngectomy);
							 antero-latero-vertical
31390
2,666.41
Pharyngolaryngectomy, with radical neck dissection;
							 without reconstruction
31395
2,866.62
Pharyngolaryngectomy, with radical neck dissection;
							 with reconstruction
31400
1,782.06
1,021.65
Arytenoidectomy or arytenoidopexy, external
							 approach
31420
1,782.06
828.85
Epiglottidectomy
31500
109.89
106.74
Intubation, endotracheal, emergency
							 procedure
31502
59.71
35.20
Tracheotomy tube change prior to establishment of
							 fistula tract
31505
36.75
88.61
Laryngoscopy, indirect; diagnostic (separate
							 procedure)
31510
760.42
220.40
Laryngoscopy, indirect; with biopsy
31511
72.02
218.91
Laryngoscopy, indirect; with removal of foreign
							 body
31512
760.42
218.30
Laryngoscopy, indirect; with removal of
							 lesion
31513
72.02
135.25
Laryngoscopy, indirect; with vocal cord
							 injection
31515
760.42
220.77
Laryngoscopy direct, with or without tracheoscopy;
							 for aspiration
31525
760.42
259.49
Laryngoscopy direct, with or without tracheoscopy;
							 diagnostic, except newborn
31526
1,015.27
162.16
Laryngoscopy direct, with or without tracheoscopy;
							 diagnostic, with operating microscope or telescope
31527
1,015.27
194.93
Laryngoscopy direct, with or without tracheoscopy;
							 with insertion of obturator
31528
760.42
145.07
Laryngoscopy direct, with or without tracheoscopy;
							 with dilation, initial
31529
760.42
166.22
Laryngoscopy direct, with or without tracheoscopy;
							 with dilation, subsequent
31530
1,015.27
202.34
Laryngoscopy, direct, operative, with foreign body
							 removal;
31531
1,015.27
219.76
Laryngoscopy, direct, operative, with foreign body
							 removal; with operating microscope or telescope
31535
1,015.27
194.85
Laryngoscopy, direct, operative, with
							 biopsy;
31536
1,015.27
217.81
Laryngoscopy, direct, operative, with biopsy; with
							 operating microscope or telescope
31540
1,015.27
249.52
Laryngoscopy, direct, operative, with excision of
							 tumor and/or stripping of vocal cords or epiglottis;
31541
1,015.27
273.12
Laryngoscopy, direct, operative, with excision of
							 tumor and/or stripping of vocal cords or epiglottis; with operating microscope
							 or telescope
31545
1,015.27
363.82
Laryngoscopy, direct, operative, with operating
							 microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of
							 vocal cord; reconstruction with local tissue flap(s)
31546
1,015.27
548.91
Laryngoscopy, direct, operative, with operating
							 microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of
							 vocal cord; reconstruction with graft(s) (includes obtaining
							 autograft)
31560
1,015.27
320.94
La ryngoscopy, dire ct, operative , with
							 arytenoidectomy;
31561
1,015.27
350.38
La ryngoscopy, dire ct, operative , with
							 arytenoidectomy; with operating microscope or telescope
31570
760.42
369.84
Laryngoscopy, direct, with injection into vocal
							 cord(s), therapeutic;
31571
1,015.27
257.66
Laryngoscopy, direct, with injection into vocal
							 cord(s), therapeutic; with operating microscope or telescope
31575
66.19
123.11
Laryngoscopy, flexible fiberoptic;
							 diagnostic
31576
1,015.27
236.70
Laryngoscopy, flexible fiberoptic; with
							 biopsy
31577
178.49
254.95
Laryngoscopy, flexible fiberoptic; with removal of
							 foreign body
31578
1,015.27
294.42
Laryngoscopy, flexible fiberoptic; with removal of
							 lesion
31579
122.09
235.37
Laryngoscopy, flexible or rigid fiberoptic, with
							 stroboscopy
31580
1,782.06
1,208.58
Laryngoplasty; for laryngeal web, two stage, with
							 keel insertion and removal
31582
1,782.06
1,947.03
Laryngoplasty; for laryngeal stenosis, with graft or
							 core mold, including tracheotomy
31584
1,515.96
Laryngoplasty; with open reduction of
							 fracture
31587
957.73
Laryngoplasty, cricoid split
31588
1,782.06
1,132.53
Laryngoplasty, not otherwise specified (eg, for
							 burns, reconstruction after partial laryngectomy)
31590
1,782.06
937.91
Laryngeal reinnervation by neuromuscular
							 pedicle
31595
1,782.06
784.02
Section recurrent laryngeal nerve, therapeutic
							 (separate procedure), unilateral
31599
I.C.
Unlisted procedure, larynx
31600
394.90
Tracheostomy, planned (separate
							 procedure);
31603
332.81
221.28
Tracheostomy, emergency procedure;
							 transtracheal
31605
332.81
179.91
Tracheostomy, emergency procedure; cricothyroid
							 membrane
31610
709.09
Tracheostomy, fenestration procedure with skin
							 flaps
31611
1,071.47
541.33
Construction of tracheoesophageal fistula and
							 subsequent insertion of an alaryngeal speech prosthesis (eg, voice button,
							 Blom-Singer prosthesis)
31612
1,071.47
83.64
Tracheal puncture, percutaneous with transtracheal
							 aspiration and/or injection
31613
1,071.47
450.06
Tracheostoma revision; simple, without flap
							 rotation
31614
1,782.06
727.73
Tracheostoma revision; complex, with flap
							 rotation
31615
444.98
190.77
Tracheobronchoscopy through established tracheostomy
							 incision
31620
319.44
Endobronchial ultrasound (EBUS) during bronchoscopic
							 diagnostic or therapeutic intervention(s) (List separately in addition to code
							 for primary procedure(s))
31622
444.98
351.17
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; diagnostic, with or without cell washing (separate
							 procedure)
31623
444.98
387.60
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with brushing or protected brushings
31624
444.98
358.15
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with bronchial alveolar lavage
31625
444.98
380.18
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with bronchial or endobronchial biopsy(s), single or
							 multiple sites
31628
444.98
456.88
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with transbronchial lung biopsy(s), single
							 lobe
31629
444.98
749.25
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with transbronchial needle aspiration biopsy(s),
							 trachea, main stem and/or lobar bronchus(i)
31630
1,075.44
208.26
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with tracheal/bronchial dilation or closed reduction of
							 fracture
31631
1,075.44
232.24
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with placement of tracheal stent(s) (includes
							 tracheal/bronchial dilation as required)
31632
444.98
78.77
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with transbronchial lung biopsy(s), each additional lobe
							 (List separately in addition to code for primary procedure)
31633
444.98
93.59
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with transbronchial needle aspiration biopsy(s), each
							 additional lobe (List separately in addition to code for primary
							 procedure)
31635
444.98
393.02
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with removal of foreign body
31636
1,075.44
227.45
Bronchoscopy, rigid or flexible, with or
							 without
fluoroscopic guidance; with placement of bronchial
							 stent(s) (includes tracheal/bronchial dilation as required), initial
							 bronchus
31637
444.98
79.94
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; each additional major bronchus stented (List separately
							 in addition to code for primary procedure)
31638
1,075.44
254.22
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with revision of tracheal or bronchial stent inserted at
							 previous session (includes tracheal/bronchial dilation as required)
31640
1,075.44
264.96
Bronchoscopy, rigid or flexible, with or without
							 fluoroscopic guidance; with excision of tumor
31641
1,075.44
259.68
Bronchoscopy (rigid or flexible); with destruction of
							 tumor or relief of stenosis by any method other than excision (eg, laser
							 therapy, cryotherapy)
31643
444.98
177.17
Bronchoscopy (rigid or flexible); with placement of
							 catheter(s) for intracavitary radioelement application
31645
444.98
339.61
Bronchoscopy (rigid or flexible); with therapeutic
							 aspiration of tracheobronchial tree, initial (eg, drainage of lung
							 abscess)
31646
444.98
310.64
Bronchoscopy (rigid or flexible); with therapeutic
							 aspiration of tracheobronchial tree, subsequent
31656
31715
444.98
377.31
53.81
Bronchoscopy (rigid or flexible); with injection of
							 contrast material for segmental bronchography (fiberscope only)
Transtracheal injection for bronchography
31717
178.49
401.08
Catheterization with bronchial brush
							 biopsy
31720
17.32
52.10
Catheter aspiration (separate procedure);
							 nasotracheal
31725
93.67
Catheter aspiration (separate procedure);
							 tracheobronchial with fiberscope, bedside
31730
178.49
746.62
Transtracheal (percutaneous) introduction of needle
							 wire dilator/stent or indwelling tube for oxygen therapy
31750
1,782.06
1,356.06
Tracheoplasty; cervical
31755
1,782.06
1,742.69
Tracheoplasty; tracheopharyngeal fistulization, each
							 stage
31760
1,357.80
Tracheoplasty; intrathoracic
31766
1,797.66
Carinal reconstruction
31770
1,319.01
Bronchoplasty; graft repair
31775
1,418.03
Bronchoplasty; excision stenosis and
							 anastomosis
31780
1,179.14
Excision tracheal stenosis and anastomosis;
							 cervical
31781
1,414.87
Excision tracheal stenosis and anastomosis;
							 cervicothoracic
31785
1,083.17
Excision of tracheal tumor or carcinoma;
							 cervical
31786
1,486.98
Excision of tracheal tumor or carcinoma;
							 thoracic
31800
713.11
Suture of tracheal wound or injury;
							 cervical
31805
819.63
Suture of tracheal wound or injury;
							 intrathoracic
31820
729.71
432.89
Surgical closure tracheostomy or fistula; without
							 plastic repair
31825
1,071.47
602.18
Surgical closure tracheostomy or fistula; with
							 plastic repair
31830
1,071.47
437.46
Revision of tracheostomy scar
31899
I.C.
Unlisted procedure, trachea, bronchi
32035
694.96
Thoracostomy; with rib resection for
							 empyema
32036
752.95
Thoracostomy; with open flap drainage for
							 empyema
32095
621.24
Thoracotomy, limited, for biopsy of lung or
							 pleura
32100
957.69
Thoracotomy, major; with exploration and
							 biopsy
32110
1,429.77
Thoracotomy, major; with control of traumatic
							 hemorrhage and/or repair of lung tear
32120
855.06
Thoracotomy, major; for postoperative
							 complications
32124
906.71
Thoracotomy, major; with open intrapleural
							 pneumonolysis
32140
970.83
Thoracotomy, major; with cyst(s) removal, with or
							 without a pleural procedure
32141
1,393.80
Thoracotomy, major; with excision-plication of
							 bullae, with or without any pleural procedure
32150
978.41
Thoracotomy, major; with removal of intrapleural
							 foreign body or fibrin deposit
32151
1,001.82
Thoracotomy, major; with removal of intrapulmonary
							 foreign body
32160
739.73
Thoracotomy, major; with cardiac massage
32200
1,095.09
Pneumonostomy; with open drainage of abscess or
							 cyst
32201
1,077.34
Pneumonostomy; with percutaneous drainage of abscess
							 or cyst
32215
794.53
Pleural scarification for repeat
							 pneumothorax
32220
1,581.32
Decortication, pulmonary (separate procedure);
							 total
32225
977.82
Decortication, pulmonary (separate procedure);
							 partial
32310
907.12
Pleurectomy, parietal (separate
							 procedure)
32320
1,572.33
Decortication and parietal pleurectomy
32400
417.18
161.59
Biopsy, pleura; percutaneous needle
32402
561.14
Biopsy, pleura; open
32405
417.18
100.49
Biopsy, lung or mediastinum, percutaneous
							 needle
32420
232.48
110.25
Pneumocentesis, puncture of lung for
							 aspiration
32421
232.48
180.64
Thoracentesis, puncture of pleural cavity for
							 aspiration, initial or subsequent
32422
232.48
218.76
Thoracentesis with insertion of tube, includes water
							 seal (eg, for pneumothorax), when performed (separate procedure)
32440
1,586.47
Removal of lung, total pneumonectomy;
32442
2,811.02
Removal of lung, total pneumonectomy; with resection
							 of segment of trachea followed by broncho-tracheal anastomosis (sleeve
							 pneumonectomy)
32445
3,131.31
Removal of lung, total pneumonectomy;
							 extrapleural
32480
1,495.02
Removal of lung, other than total pneumonectomy;
							 single lobe (lobectomy)
32482
1,594.23
Removal of lung, other than total pneumonectomy; two
							 lobes (bilobectomy)
32484
1,437.32
Removal of lung, other than total pneumonectomy;
							 single segment (segmentectomy)
32486
2,208.47
Removal of lung, other than total pneumonectomy; with
							 circumferential resection of segment of bronchus followed by broncho-bronchial
							 anastomosis (sleeve lobectomy)
32488
2,252.25
Removal of lung, other than total pneumonectomy; all
							 remaining lung following previous removal of a portion of lung (completion
							 pneumonectomy)
32491
1,476.98
Removal of lung, other than total pneumonectomy;
							 excision-plication of emphysematous lung(s) (bullous or non-bullous) for lung
							 volume reduction, sternal split or transthoracic approach, with or without any
							 pleural procedure
32500
1,454.58
Removal of lung, other than total pneumonectomy;
							 wedge resection, single or multiple
32501
245.55
Resection and repair of portion of bronchus
							 (bronchoplasty) when performed at time of lobectomy or segmentectomy (List
							 separately in addition to code for primary procedure)
32503
1,835.61
Resection of apical lung tumor (eg, Pancoast tumor),
							 including chest wall resection, rib(s) resection(s), neurovascular dissection,
							 when performed; without chest wall reconstruction(s)
32504
2,089.83
Resection of apical lung tumor (eg, Pancoast tumor),
							 including chest wall resection, rib(s) resection(s), neurovascular dissection,
							 when performed; with chest wall reconstruction
32540
1,580.21
Extrapleura l enucleation of em pye ma
							 (empyemectomy)
32550
1,372.36
959.08
Insertion of indwelling tunneled pleural catheter
							 with cuff
32551
178.61
Tube thoracostomy, includes water seal (eg, for
							 abscess, hemothorax, empyema), when performed (separate procedure)
32560
346.79
Chemical pleurodesis (eg, for recurrent or persistent
							 pneumothorax)
32601
311.78
Thoracoscopy, diagnostic (separate procedure); lungs
							 and pleural space, without biopsy
32602
338.32
Thoracoscopy, diagnostic (separate procedure); lungs
							 and pleural space, with biopsy
32603
433.51
Thoracoscopy, diagnostic (separate procedure);
							 pericardial sac, without biopsy
32604
486.49
Thoracoscopy, diagnostic (separate procedure);
							 pericardial sac, with biopsy
32605
392.36
Thoracoscopy, diagnostic (separate procedure);
							 mediastinal space, without biopsy
32606
468.02
Thoracoscopy, diagnostic (separate procedure);
							 mediastinal space, with biopsy
32650
691.25
Thoracoscopy, surgical; with pleurodesis (eg,
							 mechanical or chemical)
32651
1,038.36
Thoracoscopy, surgical; with partial pulmonary
							 decortication
32652
1,561.72
Thoracoscopy, surgical; with total pulmonary
							 decortication, including intrapleural pneumonolysis
32653
1,006.62
Thoracoscopy, surgical; with removal of intrapleural
							 foreign body or fibrin deposit
32654
1,103.46
Thoracoscopy, surgical; with control of traumatic
							 hemorrhage
32655
931.27
Thoracoscopy, surgical; with excision-plication of
							 bullae, including any pleural procedure
32656
826.85
Thoracoscopy, surgical; with parietal
							 pleurectomy
32657
813.06
Thoracoscopy, surgical; with wedge resection of lung,
							 single or multiple
32658
744.68
Thoracoscopy, surgical; with removal of clot or
							 foreign body from pericardial sac
32659
758.66
Thoracoscopy, surgical; with creation of pericardial
							 window or partial resection of pericardial sac for drainage
32660
1,059.72
Thoracoscopy, surgical; with total
							 pericardiectomy
32661
829.44
Thoracoscopy, surgical; with excision of pericardial
							 cyst, tumor, or mass
32662
930.68
Thoracoscopy, surgical; with excision of mediastinal
							 cyst, tumor, or mass
32663
1,384.35
Thoracoscopy, surgical; with lobectomy, total or
							 segmental
32664
860.06
Thoracoscopy, surgical; with thoracic
							 sympathectomy
32665
1,181.45
Thoracoscopy, surgical; with esophagomyotomy (Heller
							 type)
32800
921.96
Repair lung hernia through chest wall
32810
898.20
Closure of chest wall following open flap drainage
							 for empyema (Clagett type procedure)
32815
2,479.06
Open closure of major bronchial fistula
32820
1,361.59
Major reconstruction, chest wall
							 (posttraumatic)
32850
I.C.
Donor pneumonectomy(s) (including cold preservation),
							 from cadaver donor
32851
2,666.99
Lung transplant, single; without cardiopulmonary
							 bypass
32852
2,988.20
Lung transplant, single; with cardiopulmonary
							 bypass
32853
3,178.94
Lung transplant, double (bilateral sequential or en
							 bloc); without cardiopulmonary bypass
32854
3,449.32
Lung transplant, double (bilateral sequential or en
							 bloc); with cardiopulmonary bypass
32855
I.C.
Backbench standard preparation of cadaver donor lung
							 allograft prior to transplantation, including dissection of allograft from
							 surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary
							 artery, and bronchus; unilateral
32856
I.C.
Backbench standard preparation of cadaver donor lung
							 allograft prior to transplantation, including dissection of allograft from
							 surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary
							 artery, and bronchus; bilateral
32900
1,344.83
Resection of ribs, extrapleural, all
							 stages
32905
1,338.73
Thoracoplasty, Schede type or extrapleural (all
							 stages);
32906
1,647.22
Thoracoplasty, Schede type or extrapleural (all
							 stages); with closure of bronchopleural fistula
32940
1,224.94
Pneumonolysis, extraperiosteal, including filling or
							 packing procedures
32960
232.48
144.95
Pneumothorax, therapeutic, intrapleural injection of
							 air
32997
352.61
Total lung lavage (unilateral)
32998
1,921.50
3,438.66
Ablation therapy for reduction or eradication of one
							 or more pulmonary tumor(s) including pleura or chest wall when involved by
							 tumor extension, percutaneous, radiofrequency, unilateral
32999
I.C.
Unlisted procedure, lungs and pleura
33010
232.48
122.56
Pericardiocentesis; initial
33011
232.48
125.62
Pericardiocentesis; subsequent
33015
540.09
Tube pericardiostomy
33020
864.53
Pericardiotomy for removal of clot or foreign body
							 (primary procedure)
33025
801.08
Creation of pericardial window or partial resection
							 for drainage
33030
1,274.94
Pericardiectomy, subtotal or complete; without
							 cardiopulmonary bypass
33031
1,409.48
Pericardiectomy, subtotal or complete; with
							 cardiopulmonary bypass
33050
990.03
Excision of pericardial cyst or tumor
33120
1,554.03
Excision of intracardiac tumor, resection with
							 cardiopulmonary bypass
33130
1,360.14
Resection of external cardiac tumor
33140
1,538.51
Transmyocardial laser revascularization, by
							 thoracotomy; (separate procedure)
33141
161.72
Transmyocardial laser revascularization, by
							 thoracotomy; performed at the time of other open cardiac procedure(s) (List
							 separately in addition to code for primary procedure)
33202
780.09
Insertion of epicardial electrode(s); open incision
							 (eg, thoracotomy, median sternotomy, subxiphoid approach)
33203
799.09
Insertion of epicardial electrode(s); endoscopic
							 approach (eg, thoracoscopy, pericardioscopy)
33206
7,572.99
485.65
Insertion or replacement of permanent pacemaker with
							 transvenous electrode(s); atrial
33207
7,572.99
518.21
Insertion or replacement of permanent pacemaker with
							 transvenous electrode(s); ventricular
33208
8,772.15
554.32
Insertion or replacement of permanent pacemaker with
							 transvenous electrode(s); atrial and ventricular
33210
4,047.81
185.27
Insertion or replacement of temporary transvenous
							 single chamber cardiac electrode or pacemaker catheter (separate
							 procedure)
33211
4,047.81
188.78
Insertion or replacement of temporary transvenous
							 dual chamber pacing electrodes (separate procedure)
33212
6,350.39
363.50
Insertion or replacement of pacemaker pulse generator
							 only; single chamber, atrial or ventricular
33213
6,912.08
413.37
Insertion or replacement of pacemaker pulse generator
							 only; dual chamber
33214
8,772.15
519.14
Upgrade of implanted pacemaker system, conversion of
							 single chamber system to dual chamber system (includes removal of previously
							 placed pulse generator, testing of existing lead, insertion of new lead,
							 insertion of new pulse generator)
33215
1,071.63
331.32
Repositioning of previously implanted transvenous
							 pacemaker or pacing cardioverter-defibrillator (right atrial or right
							 ventricular) electrode
33216
4,047.81
410.31
Insertion of a transvenous electrode; single chamber
							 (one electrode) permanent pacemaker or single chamber pacing
							 cardioverter-defibrillator
33217
4,047.81
408.34
Insertion of a transvenous electrode; dual chamber
							 (two electrodes) permanent pacemaker or dual chamber pacing
							 cardioverter-defibrillator
33218
1,071.63
424.81
Repair of single transvenous electrode for a single
							 chamber, permanent pacemaker or single chamber pacing
							 cardioverter-defibrillator
33220
1,071.63
426.16
Repair of two transvenous electrodes for a dual
							 chamber permanent pacemaker or dual chamber pacing
							 cardioverter-defibrillator
33222
672.37
381.57
Revision or relocation of skin pocket for
							 pacemaker
33223
672.37
453.25
Revision of skin pocket for single or dual chamber
							 pacing cardioverter-defibrillator
33224
16,765.50
529.67
Insertion of pacing electrode, cardiac venous system,
							 for left ventricular pacing, with attachment to previously placed pacemaker or
							 pacing cardioverter-defibrillator pulse generator (including revision of
							 pocket, removal, insertion, and/or replacement of generator)
33225
16,765.50
472.81
Insertion of pacing electrode, cardiac venous system,
							 for left ventricular pacing, at time of insertion of pacing
							 cardioverter-defibrillator or pacemaker pulse generator (including upgrade to
							 dual chamber system) (List separately in addition to code for primary
							 procedure)
33226
1,071.63
511.05
Repositioning of previously implanted cardiac venous
							 system (left ventricular) electrode (including removal, insertion and/or
							 replacement of generator)
33233
1,071.63
270.80
Removal of permanent pacemaker pulse
							 generator
33234
1,071.63
524.16
Removal of transvenous pacemaker electrode(s); single
							 lead system, atrial or ventricular
33235
1,071.63
684.50
Removal of transvenous pacemaker electrode(s); dual
							 lead system
33236
800.28
Removal of permanent epicardial pacemaker and
							 electrodes by thoracotomy; single lead system, atrial or
							 ventricular
33237
880.75
Removal of permanent epicardial pacemaker and
							 electrodes by thoracotomy; dual lead system
33238
956.76
Removal of permanent transvenous electrode(s) by
							 thoracotomy
33240
22,075.11
498.58
Insertion of single or dual chamber pacing
							 cardioverter-defibrillator pulse generator
33241
1,071.63
253.87
Subcutaneous removal of single or dual chamber pacing
							 cardioverter-defibrillator pulse generator
33243
1,378.09
Removal of single or dual chamber pacing
							 cardioverter-defibrillator electrode(s); by thoracotomy
33244
924.29
Removal of single or dual chamber pacing
							 cardioverter-defibrillator electrode(s); by transvenous extraction
33249
26,786.01
962.13
Insertion or repositioning of electrode lead(s) for
							 single or dual chamber pacing cardioverter-defibrillator and insertion of pulse
							 generator
33250
1,480.30
Operative ablation of supraventricular arrhythmogenic
							 focus or pathway (eg, Wolff-Parkinson-White, atrioventricular node re-entry),
							 tract(s) and/or focus (foci); without cardiopulmonary bypass
33251
1,612.27
Operative ablation of supraventricular arrhythmogenic
							 focus or pathway (eg, Wolff-Parkinson-White, atrioventricular node re-entry),
							 tract(s) and/or focus (foci); with cardiopulmonary bypass
33254
1,355.20
Operative tissue ablation and reconstruction of
							 atria, limited (eg, modified maze procedure)
33255
1,628.52
Operative tissue ablation and reconstruction of
							 atria, extensive (eg, maze procedure); without cardiopulmonary
							 bypass
33256
1,939.42
Operative tissue ablation and reconstruction of
							 atria, extensive (eg, maze procedure); with cardiopulmonary bypass
33257
607.25
Operative tissue ablation and reconstruction of
							 atria, performed at the time of other cardiac procedure(s), limited (eg,
							 modified maze procedure) (List separately in addition to code for primary
							 procedure)
33258
683.96
Operative tissue ablation and reconstruction of
							 atria, performed at the time of other cardiac procedure(s), extensive (eg, maze
							 procedure), without cardiopulmonary bypass (List separately in addition to code
							 for primary procedure)
33259
895.16
Operative tissue ablation and reconstruction of
							 atria, performed at the time of other cardiac procedure(s), extensive (eg, maze
							 procedure), with cardiopulmonary bypass (List separately in addition to code
							 for primary procedure)
33261
1,626.94
Operative ablation of ventricular arrhythmogenic
							 focus with cardiopulmonary bypass
33265
1,355.20
Endoscopy, surgical; operative tissue ablation and
							 reconstruction of atria, limited (eg, modified maze procedure), without
							 cardiopulmonary bypass
33266
1,846.10
Endoscopy, surgical; operative tissue ablation and
							 reconstruction of atria, extensive (eg, maze procedure), without
							 cardiopulmonary bypass
33282
4,398.16
357.46
Implantation of patient-activated cardiac event
							 recorder
33284
388.12
266.79
Removal of an implantable, patient-activated cardiac
							 event recorder
33300
2,171.66
Repair of cardiac wound; without bypass
33305
3,540.70
Repair of cardiac wound; with cardiopulmonary
							 bypass
33310
1,180.88
Cardiotomy, exploratory (includes removal of foreign
							 body, atrial or ventricular thrombus); without bypass
33315
1,476.56
Cardiotomy, exploratory (includes removal of foreign
							 body, atrial or ventricular thrombus); with cardiopulmonary bypass
33320
1,065.92
Suture repair of aorta or great vessels; without
							 shunt or cardiopulmonary bypass
33321
1,212.27
Suture repair of aorta or great vessels; with shunt
							 bypass
33322
1,373.85
Suture repair of aorta or great vessels; with
							 cardiopulmonary bypass
33330
1,399.13
Insertion of graft, aorta or great vessels; without
							 shunt, or cardiopulmonary bypass
33332
1,385.78
Insertion of graft, aorta or great vessels; with
							 shunt bypass
33335
1,876.67
Insertion of graft, aorta or great vessels; with
							 cardiopulmonary bypass
33400
2,232.10
Valvuloplasty, aortic valve; open, with
							 cardiopulmonary bypass
33401
1,487.72
Valvuloplasty, aortic valve; open, with inflow
							 occlusion
33403
1,591.00
Valvuloplasty, aortic valve; using transventricular
							 dilation, with cardiopulmonary bypass
33404
1,808.02
Construction of apical-aortic conduit
33405
2,335.25
Replacement, aortic valve, with cardiopulmonary
							 bypass; with prosthetic valve other than homograft or stentless
							 valve
33406
2,821.07
Replacement, aortic valve, with cardiopulmonary
							 bypass; with allograft valve (freehand)
33410
2,482.95
Replacement, aortic valve, with cardiopulmonary
							 bypass; with stentless tissue valve
33411
3,196.43
Replacement, aortic valve; with aortic annulus
							 enlargement, noncoronary cusp
33412
2,529.22
Replacement, aortic valve; with transventricular
							 aortic annulus enlargement (Konno procedure)
33413
3,256.81
Replacement, aortic valve; by translocation of
							 autologous pulmonary valve with allograft replacement of pulmonary valve (Ross
							 procedure)
33414
2,132.53
Repair of left ventricular outflow tract obstruction
							 by patch enlargement of the outflow tract
33415
1,973.37
Resection or incision of subvalvular tissue for
							 discrete subvalvular aortic stenosis
33416
1,996.67
Ventriculomyotomy (-myectomy) for idiopathic
							 hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)
33417
1,701.57
Aortoplasty (gusset) for supravalvular
							 stenosis
33420
1,369.66
Valvotomy, mitral valve; closed heart
33422
1,704.89
Valvotomy, mitral valve; open heart, with
							 cardiopulmonary bypass
33425
2,529.42
Valvuloplasty, mitral valve, with cardiopulmonary
							 bypass;
33426
2,381.21
Valvuloplasty, mitral valve, with cardiopulmonary
							 bypass; with prosthetic ring
33427
2,516.08
Valvuloplasty, mitral valve, with cardiopulmonary
							 bypass; radical reconstruction, with or without ring
33430
2,710.92
Replacement, mitral valve, with cardiopulmonary
							 bypass
33460
2,225.70
Valvectomy, tricuspid valve, with cardiopulmonary
							 bypass
33463
2,812.09
Valvuloplasty, tricuspid valve; without ring
							 insertion
33464
2,319.57
Valvuloplasty, tricuspid valve; with ring
							 insertion
33465
2,563.58
Replacement, tricuspid valve, with cardiopulmonary
							 bypass
33468
1,907.68
Tricuspid valve repositioning and plication for
							 Ebstein anomaly
33470
1,187.33
Valvotomy, pulmonary valve, closed heart;
							 transventricular
33471
1,372.68
Valvotomy, pulmonary valve, closed heart; via
							 pulmonary artery
33472
1,363.76
Valvotomy, pulmonary valve, open heart; with inflow
							 occlusion
33474
1,985.97
Valvotomy, pulmonary valve, open heart; with
							 cardiopulmonary bypass
33475
2,291.55
Replacement, pulmonary valve
33476
1,488.39
Right ventricular resection for infundibular
							 stenosis, with or without commissurotomy
33478
1,605.62
Outflow tract augmentation (gusset), with or without
							 commissurotomy or infundibular resection
33496
1,687.30
Repair of non-structural prosthetic valve dysfunction
							 with cardiopulmonary bypass (separate procedure)
33500
1,583.68
Repair of coronary arteriovenous or arteriocardiac
							 chamber fistula; with cardiopulmonary bypass
33501
1,095.32
Repair of coronary arteriovenous or arteriocardiac
							 chamber fistula; without cardiopulmonary bypass
33502
1,300.44
Repair of anomalous coronary artery from pulmonary
							 artery origin; by ligation
33503
1,322.10
Repair of anomalous coronary artery from pulmonary
							 artery origin; by graft, without cardiopulmonary bypass
33504
1,480.05
Repair of anomalous coronary artery from pulmonary
							 artery origin; by graft, with cardiopulmonary bypass
33505
2,020.81
Repair of anomalous coronary artery from pulmonary
							 artery origin; with construction of intrapulmonary artery tunnel (Takeuchi
							 procedure)
33506
2,058.11
Repair of anomalous coronary artery from pulmonary
							 artery origin; by translocation from pulmonary artery to aorta
33507
1,761.45
Repair of anomalous (eg, intramural) aortic origin of
							 coronary artery by unroofing or translocation
33508
16.39
Endoscopy, surgical, including video-assisted harvest
							 of vein(s) for coronary artery bypass procedure (List separately in addition to
							 code for primary procedure)
33510
1,996.15
Coronary artery bypass, vein only; single coronary
							 venous graft
33511
2,164.69
Coronary artery bypass, vein only; two coronary
							 venous grafts
33512
2,410.19
Coronary artery bypass, vein only; three coronary
							 venous grafts
33513
2,478.21
Coronary artery bypass, vein only; four coronary
							 venous grafts
33514
2,595.98
Coronary artery bypass, vein only; five coronary
							 venous grafts
33516
2,695.43
Coronary artery bypass, vein only; six or more
							 coronary venous grafts
33517
179.13
Coronary artery bypass, using venous graft(s) and
							 arterial graft(s); single vein graft (List separately in addition to code for
							 primary procedure)
33518
383.31
Coronary artery bypass, using venous graft(s) and
							 arterial graft(s); two venous grafts (List separately in addition to code for
							 primary procedure)
33519
514.99
Coronary artery bypass, using venous graft(s) and
							 arterial graft(s); three venous grafts (List separately in addition to code for
							 primary procedure)
33521
628.34
Coronary artery bypass, using venous graft(s) and
							 arterial graft(s); four venous grafts (List separately in addition to code for
							 primary procedure)
33522
721.17
Coronary artery bypass, using venous graft(s) and
							 arterial graft(s); five venous grafts (List separately in addition to code for
							 primary procedure)
33523
827.36
Coronary artery bypass, using venous graft(s) and
							 arterial graft(s); six or more venous grafts (List separately in addition to
							 code for primary procedure)
33530
484.10
Reoperation, coronary artery bypass procedure or
							 valve procedure, more than one month after original operation (List separately
							 in addition to code for primary procedure)
33533
1,953.59
Coronary artery bypass, using arterial graft(s);
							 single arterial graft
33534
2,246.25
Coronary artery bypass, using arterial graft(s); two
							 coronary arterial grafts
33535
2,467.53
Coronary artery bypass, using arterial graft(s);
							 three coronary arterial grafts
33536
2,633.08
Coronary artery bypass, using arterial graft(s); four
							 or more coronary arterial grafts
33542
2,461.01
Myocardial resection (eg, ventricular
							 aneurysmectomy)
33545
2,923.84
Repair of postinfarction ventricular septal defect,
							 with or without myocardial resection
33548
2,897.85
Surgical ventricular restoration procedure, includes
							 prosthetic patch, when performed (eg, ventricular remodeling, SVR, SAVER, Dor
							 procedures)
33572
234.60
Coronary endarterectomy, open, any method, of left
							 anterior descending, circumflex, or right coronary artery performed in
							 conjunction with coronary artery bypass graft procedure, each vessel (List
							 separately in addition to primary procedure)
33600
1,729.89
Closure of atrioventricular valve (mitral or
							 tricuspid) by suture or patch
33602
1,654.39
Closure of semilunar valve (aortic or pulmonary) by
							 suture or patch
33606
1,792.42
Anastomosis of pulmonary artery to aorta
							 (Damus-Kaye-Stansel procedure)
33608
1,846.02
Repair of complex cardiac anomaly other than
							 pulmonary atresia with ventricular septal defect by construction or replacement
							 of conduit from right or left ventricle to pulmonary artery
33610
1,828.38
Repair of complex cardiac anomalies (eg, single
							 ventricle with subaortic obstruction) by surgical enlargement of ventricular
							 septal defect
33611
1,953.06
Repair of double outlet right ventricle with
							 intraventricular tunnel repair;
33612
2,083.20
Repair of double outlet right ventricle with
							 intraventricular tunnel repair; with repair of right ventricular outflow tract
							 obstruction
33615
1,970.91
Repair of complex cardiac anomalies (eg, tricuspid
							 atresia) by closure of atrial septal defect and anastomosis of atria or vena
							 cava to pulmonary artery (simple Fontan procedure)
33617
2,189.37
Repair of complex cardiac anomalies (eg, single
							 ventricle) by modified Fontan procedure
33619
2,745.94
Repair of single ventricle with aortic outflow
							 obstruction and aortic arch hypoplasia (hypoplastic left heart syndrome) (eg,
							 Norwood procedure)
33641
1,575.37
Repair atrial septal defect, secundum, with
							 cardiopulmonary bypass, with or without patch
33645
1,585.82
Direct or patch closure, sinus venosus, with or
							 without anomalous pulmonary venous drainage
33647
1,712.17
Repair of atrial septal defect and ventricular septal
							 defect, with direct or patch closure
33660
1,801.35
Repair of incomplete or partial atrioventricular
							 canal (ostium primum atrial septal defect), with or without atrioventricular
							 valve repair
33665
1,905.88
Repair of intermediate or transitional
							 atrioventricular canal, with or without atrioventricular valve
							 repair
33670
2,051.60
Repair of complete atrioventricular canal, with or
							 without prosthetic valve
33675
2,098.49
Closure of multiple ventricular septal
							 defects;
33676
2,161.13
Closure of multiple ventricular septal defects; with
							 pulmonary valvotomy or infundibular resection (acyanotic)
33677
2,245.77
Closure of multiple ventricular septal defects; with
							 removal of pulmonary artery band, with or without gusset
33681
1,866.16
Closure of single ventricular septal defect, with or
							 without patch;
33684
1,891.92
Closure of single ventricular septal defect, with or
							 without patch; with pulmonary valvotomy or infundibular resection
							 (acyanotic)
33688
1,834.13
Closure of single ventricular septal defect, with or
							 without patch; with removal of pulmonary artery band, with or without
							 gusset
33690
1,181.41
Banding of pulmonary artery
33692
1,980.13
Complete repair tetralogy of Fallot without pulmonary
							 atresia;
33694
1,928.79
Complete repair tetralogy of Fallot without pulmonary
							 atresia; with transannular patch
33697
2,134.93
Complete repair tetralogy of Fallot with pulmonary
							 atresia including construction of conduit from right ventricle to pulmonary
							 artery and closure of ventricular septal defect
33702
1,567.55
Repair sinus of Valsalva fistula, with
							 cardiopulmonary bypass;
33710
1,747.52
Repair sinus of Valsalva fistula, with
							 cardiopulmonary bypass; with repair of ventricular septal defect
33720
1,570.27
Repair sinus of Valsalva aneurysm, with
							 cardiopulmonary bypass
33722
1,594.21
Closure of aortico-left ventricular
							 tunnel
33724
1,538.31
Repair of isolated partial anomalous pulmonary venous
							 return (eg, Scimitar Syndrome)
33726
2,024.39
Repair of pulmonary venous stenosis
33730
2,001.65
Complete repair of anomalous pulmonary venous return
							 (supracardiac, intracardiac, or infracardiac types)
33732
1,693.37
Repair of cortriatriatum or supravalvular mitral ring
							 by resection of left atrial membrane
33735
1,270.35
Atrial septectomy or septostomy; closed heart
							 (Blalock-Hanlon type operation)
33736
1,468.02
Atrial septectomy or septostomy; open heart with
							 cardiopulmonary bypass
33737
1,321.84
Atrial septectomy or septostomy; open heart, with
							 inflow occlusion
33750
1,239.96
Shunt; subclavian to pulmonary artery
							 (Blalock-Taussig type operation)
33755
1,245.92
Shunt; ascending aorta to pulmonary artery (Waterston
							 type operation)
33762
1,294.34
Shunt; descending aorta to pulmonary artery
							 (Potts-Smith type operation)
33764
1,297.80
Shunt; central, with prosthetic graft
33766
1,374.16
Shunt; superior vena cava to pulmonary artery for
							 flow to one lung (classical Glenn procedure)
33767
1,438.67
Shunt; superior vena cava to pulmonary artery for
							 flow to both lungs (bidirectional Glenn procedure)
33768
412.38
Anastomosis, cavopulmonary, second superior vena cava
							 (List separately in addition to primary procedure)
33770
2,116.49
Repair of transposition of the great arteries with
							 ventricular septal defect and subpulmonary stenosis; without surgical
							 enlargement of ventricular septal defect
33771
2,142.18
Repair of transposition of the great arteries with
							 ventricular septal defect and subpulmonary stenosis; with surgical enlargement
							 of ventricular septal defect
33774
1,839.67
Repair of transposition of the great arteries, atrial
							 baffle procedure (eg, Mustard or Senning type) with cardiopulmonary
							 bypass;
33775
1,848.14
Repair of transposition of the great arteries, atrial
							 baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass;
							 with removal of pulmonary band
33776
1,931.28
Repair of transposition of the great arteries, atrial
							 baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass;
							 with closure of ventricular septal defect
33777
1,911.96
Repair of transposition of the great arteries, atrial
							 baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass;
							 with repair of subpulmonic obstruction
33778
2,373.79
Repair of transposition of the great arteries, aortic
							 pulmonary artery reconstruction (eg, Jatene type);
33779
2,201.51
Repair of transposition of the great arteries, aortic
							 pulmonary artery reconstruction (eg, Jatene type); with removal of pulmonary
							 band
33780
2,349.46
Repair of transposition of the great arteries, aortic
							 pulmonary artery reconstruction (eg, Jatene type); with closure of ventricular
							 septal defect
33781
2,215.49
Repair of transposition of the great arteries, aortic
							 pulmonary artery reconstruction (eg, Jatene type); with repair of subpulmonic
							 obstruction
33786
2,305.58
Total repair, truncus arteriosus (Rastelli type
							 operation)
33788
1,516.42
Reimplantation of an anomalous pulmonary
							 artery
33800
1,005.85
Aortic suspension (aortopexy) for tracheal
							 decompression (eg, for tracheomalacia) (separate procedure)
33802
1,086.19
Division of aberrant vessel (vascular
							 ring);
33803
1,156.83
Division of aberrant vessel (vascular ring); with
							 reanastomosis
33813
1,272.98
Obliteration of aortopulmonary septal defect; without
							 cardiopulmonary bypass
33814
1,547.83
Obliteration of aortopulmonary septal defect; with
							 cardiopulmonary bypass
33820
990.13
Repair of patent ductus arteriosus; by
							 ligation
33822
1,025.18
Repair of patent ductus arteriosus; by division,
							 younger than 18 years
33824
1,197.28
Repair of patent ductus arteriosus; by division, 18
							 years and older
33840
1,240.92
Excision of coarctation of aorta, with or without
							 associated patent ductus arteriosus; with direct anastomosis
33845
1,351.27
Excision of coarctation of aorta, with or without
							 associated patent ductus arteriosus; with graft
33851
1,291.50
Excision of coarctation of aorta, with or without
							 associated patent ductus arteriosus; repair using either left subclavian artery
							 or prosthetic material as gusset for enlargement
33852
1,495.33
Repair of hypoplastic or interrupted aortic arch
							 using autogenous or prosthetic material; without cardiopulmonary
							 bypass
33853
1,862.04
Repair of hypoplastic or interrupted aortic arch
							 using autogenous or prosthetic material; with cardiopulmonary
							 bypass
33860
3,042.52
Ascending aorta graft, with cardiopulmonary bypass,
							 with or without valve suspension;
33861
2,460.32
Ascending aorta graft, with cardiopulmonary bypass,
							 with or without valve suspension; with coronary reconstruction
33863
3,083.51
Ascending aorta graft, with cardiopulmonary bypass,
							 with or without valve suspension; with aortic root replacement using composite
							 prosthesis and coronary reconstruction
33864
3,175.94
Ascending aorta graft, with cardiopulmonary bypass
							 with valve suspension, with coronary reconstruction and valve-sparing aortic
							 annulus remodeling (eg, David Procedure, Yacoub Procedure)
33870
2,564.75
Transverse arch graft, with cardiopulmonary
							 bypass
33875
1,986.64
Descending thoracic aorta graft, with or without
							 bypass
33877
3,388.61
Repair of thoracoabdominal aortic aneurysm with
							 graft, with or without cardiopulmonary bypass
33880
1,821.23
Endovascular repair of descending thoracic aorta (eg,
							 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
33881
1,574.40
Endovascular repair of descending thoracic aorta (eg,
							 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
33883
1,157.80
Placement of proximal extension prosthesis for
							 endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm,
							 dissection, penetrating ulcer, intramural hematoma, or traumatic disruption);
							 initial extension
33884
413.00
Placement of proximal extension prosthesis for
							 endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm,
							 dissection, penetrating ulcer, intramural hematoma, or traumatic disruption);
							 each additional proximal extension (List separately in addition to code for
							 primary procedure)
33886
1,003.73
Placement of distal extension prosthesis(s) delayed
							 after endovascular repair of descending thoracic aorta
33889
819.71
Open subclavian to carotid artery transposition
							 performed in conjunction with endovascular repair of descending thoracic aorta,
							 by neck incision, unilateral
33891
1,058.81
Bypass graft, with other than vein, transcervical
							 retropharyngeal carotid-carotid, performed in conjunction with endovascular
							 repair of descending thoracic aorta, by neck incision
33910
1,645.46
Pulmonary artery embolectomy; with cardiopulmonary
							 bypass
33915
1,322.68
Pulmonary artery embolectomy; without cardiopulmonary
							 bypass
33916
1,586.71
Pulmonary endarterectomy, with or without
							 embolectomy, with cardiopulmonary bypass
33917
1,481.10
Repair of pulmonary artery stenosis by reconstruction
							 with patch or graft
33920
1,779.90
Repair of pulmonary atresia with ventricular septal
							 defect, by construction or replacement of conduit from right or left ventricle
							 to pulmonary artery
33922
1,402.41
Transection of pulmonary artery with cardiopulmonary
							 bypass
33924
291.19
Ligation and takedown of a systemic-to-pulmonary
							 artery shunt, performed in conjunction with a congenital heart procedure (List
							 separately in addition to code for primary procedure)
33925
1,921.35
Repair of pulmonary artery arborization anomalies by
							 unifocalization; without cardiopulmonary bypass
33926
2,459.91
Repair of pulmonary artery arborization anomalies by
							 unifocalization; with cardiopulmonary bypass
33930
I.C.
Donor cardiectomy-pneumonectomy (including cold
							 preservation)
33933
I.C.
Backbench standard preparation of cadaver donor
							 heart/lung allograft prior to transplantation, including dissection of
							 allograft from surrounding soft tissues to prepare aorta, superior vena cava,
							 inferior vena cava, and trachea for implantation
33935
3,568.26
Heart-lung transplant with recipient
							 cardiectomy-pneumonectomy
33940
I.C.
Donor cardiectomy (including cold
							 preservation)
33944
I.C.
Backbench standard preparation of cadaver donor heart
							 allograft prior to transplantation, including dissection of allograft from
							 surrounding soft tissues to prepare aorta, superior vena cava, inferior vena
							 cava, pulmonary artery, and left atrium for implantation
33945
4,421.24
Heart transplant, with or without recipient
							 cardiectomy
33960
973.84
Prolonged extracorporeal circulation for
							 cardiopulmonary insufficiency; initial 24 hours
33961
550.77
Prolonged extracorporeal circu lation for
							 cardiopulmonary insufficiency; each additional 24 hours (List separately in
							 addition to code for primary procedure)
33967
273.78
Insertion of intra-aortic balloon assist device,
							 percutaneous
33968
35.00
Removal of intra-aortic balloon assist device,
							 percutaneous
33970
365.63
Insertion of intra-aortic balloon assist device
							 through the femoral artery, open approach
33971
720.74
Removal of intra-aortic balloon assist device
							 including repair of femoral artery, with or without graft
33973
537.75
Insertion of intra-aortic balloon assist device
							 through the ascending aorta
33974
921.39
Removal of intra-aortic balloon assist device from
							 the ascending aorta, including repair of the ascending aorta, with or without
							 graft
33975
1,097.52
Insertion of ventricular assist device;
							 extracorporeal, single ventricle
33976
1,232.26
Insertion of ventricular assist device;
							 extracorporeal, biventricular
33977
1,241.27
Removal of ventricular assist device; extracorporeal,
							 single ventricle
33978
1,378.23
Removal of ventricular assist device; extracorporeal,
							 biventricular
33979
2,426.57
Insertion of ventricular assist device, implantable
							 intracorporeal, single ventricle
33980
3,584.50
Removal of ventricular assist device, implantable
							 intracorporeal, single ventricle
33999
I.C.
Unlisted procedure, cardiac surgery
34001
963.54
Embolectomy or thrombectomy, with or without
							 catheter; carotid, subclavian or innominate artery, by neck
							 incision
34051
993.88
Embolectomy or thrombectomy, with or without
							 catheter; innominate, subclavian artery, by thoracic incision
34101
635.03
Embolectomy or thrombectomy, with or without
							 catheter; axillary, brachial, innominate, subclavian artery, by arm
							 incision
34111
634.27
Embolectomy or thrombectomy, with or without
							 catheter; radial or ulnar artery, by arm incision
34151
1,447.08
Embolectomy or thrombectomy, with or without
							 catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal
							 incision
34201
980.40
Embolectomy or thrombectomy, with or without
							 catheter; femoropopliteal, aortoiliac artery, by leg incision
34203
1,008.42
Embolectomy or thrombectomy, with or without
							 catheter; popliteal-tibio-peroneal artery, by leg incision
34401
1,453.54
Thrombectomy, direct or with catheter; vena cava,
							 iliac vein, by abdominal incision
34421
764.88
Thrombectomy, direct or with catheter; vena cava,
							 iliac, femoropopliteal vein, by leg incision
34451
1,564.72
Thrombectomy, direct or with catheter; vena cava,
							 iliac, femoropopliteal vein, by abdominal and leg incision
34471
1,055.70
Thrombectomy, direct or with catheter; subclavian
							 vein, by neck incision
34490
637.11
Thrombectomy, direct or with catheter; axillary and
							 subclavian vein, by arm incision
34501
985.37
Valvuloplasty, femoral vein
34502
1,584.30
Reconstruction of vena cava, any method
34510
1,135.73
Venous valve transposition, any vein
							 donor
34520
1,075.33
Cross-over vein graft to venous system
34530
1,012.84
Saphenopopliteal vein anastomosis
34800
1,184.34
Endovascular repair of infrarenal abdominal aortic
							 aneurysm or dissection; using aorto-aortic tube prosthesis
34802
1,293.17
Endovascular repair of infrarenal abdominal aortic
							 aneurysm or dissection; using modular bifurcated prosthesis (one docking
							 limb)
34803
1,324.73
Endovascular repair of infrarenal abdominal aortic
							 aneurysm or dissection; using modular bifurcated prosthesis (two docking
							 limbs)
34804
1,289.97
Endovascular repair of infrarenal abdominal aortic
							 aneurysm or dissection; using unibody bifurcated prosthesis
34805
1,220.94
Endovascular repair of infrarenal abdominal aortic
							 aneurysm or dissection; using aorto-uniiliac or aorto-unifemoral
							 prosthesis
34806
102.80
Transcatheter placement of wireless physiologic
							 sensor in aneurysmal sac during endovascular repair, including radiological
							 supervision and interpretation, instrument calibration, and collection of
							 pressure data
34808
214.05
Endovascular placement of iliac artery occlusion
							 device (List separately in addition to code for primary procedure)
34812
355.25
Open femoral artery exposure for delivery of
							 endovascular prosthesis, by groin incision, unilateral
34813
246.23
Placement of femoral-femoral prosthetic graft during
							 endovascular aortic aneurysm repair (List separately in addition to code for
							 primary procedure)
34820
508.24
Open iliac artery exposure for delivery of
							 endovascular prosthesis or iliac occlusion during endovascular therapy, by
							 abdominal or retroperitoneal incision, unilateral
34825
732.73
Placement of proximal or distal extension prosthesis
							 for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false
							 aneurysm, or dissection; initial vessel
34826
211.39
Placement of proximal or distal extension prosthesis
							 for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false
							 aneurysm, or dissection; each additional vessel (List separately in addition to
							 code for primary procedure)
34830
1,888.07
Open repair of infrarenal aortic aneurysm or
							 dissection, plus repair of associated arterial trauma, following unsuccessful
							 endovascular repair; tube prosthesis
34831
1,968.68
Open repair of infrarenal aortic aneurysm or
							 dissection, plus repair of associated arterial trauma, following unsuccessful
							 endovascular repair; aorto-bi-iliac prosthesis
34832
2,046.19
Open repair of infrarenal aortic aneurysm or
							 dissection, plus repair of associated arterial trauma, following unsuccessful
							 endovascular repair; aorto-bifemoral prosthesis
34833
637.66
Open iliac artery exposure with creation of conduit
							 for delivery of aortic or iliac endovascular prosthesis, by abdominal or
							 retroperitoneal incision, unilateral
34834
291.64
Open brachial artery exposure to assist in the
							 deployment of aortic or iliac endovascular prosthesis by arm incision,
							 unilateral
34900
946.44
Endovascular graft placement for repair of iliac
							 artery (eg, aneurysm, pseudoaneurysm, arteriovenous malformation,
							 trauma)
35001
1,188.21
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm and associated occlusive disease, carotid, subclavian artery, by
							 neck incision
35002
1,241.47
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, carotid, subclavian artery, by neck incision
35005
1,107.90
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, vertebral
							 artery
35011
1,036.72
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm and associated occlusive disease, axillary-brachial artery, by arm
							 incision
35013
1,282.99
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, axillary-brachial artery, by arm incision
35021
1,251.74
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, innominate,
							 subclavian artery, by thoracic incision
35022
1,440.17
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, innominate, subclavian artery, by thoracic
							 incision
35045
1,003.10
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, radial or ulnar
							 artery
35081
1,770.01
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal
							 aorta
35082
2,240.92
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, abdominal aorta
35091
1,903.70
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta
							 involving visceral vessels (mesenteric, celiac, renal)
35092
2,666.78
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric,
							 celiac, renal)
35102
1,920.58
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta
							 involving iliac vessels (common, hypogastric, external)
35103
2,313.44
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, abdominal aorta involving iliac vessels (common,
							 hypogastric, external)
35111
1,434.34
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, splenic
							 artery
35112
1,737.13
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, splenic artery
35121
1,715.46
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, hepatic,
							 celiac, renal, or mesenteric artery
35122
2,014.34
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery
35131
1,457.54
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery
							 (common, hypogastric, external)
35132
1,758.45
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, iliac artery (common, hypogastric, external)
35141
1,163.13
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral
							 artery (profunda femoris, superficial femoral)
35142
1,383.84
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, common femoral artery (profunda femoris, superficial
							 femoral)
35151
1,309.20
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for aneurysm, pseudoaneurysm, and associated occlusive disease, popliteal
							 artery
35152
1,519.96
Direct repair of aneurysm, pseudoaneurysm, or
							 excision (partial or total) and graft insertion, with or without patch graft;
							 for ruptured aneurysm, popliteal artery
35180
846.25
Repair, congenital arteriovenous fistula; head and
							 neck
35182
1,752.98
Repair, congenital arteriovenous fistula; thorax and
							 abdomen
35184
1,055.60
Repair, congenital arteriovenous fistula;
							 extremities
35188
1,732.44
898.95
Repair, acquired or traumatic arteriovenous fistula;
							 head and neck
35189
1,660.41
Repair, acquired or traumatic arteriovenous fistula;
							 thorax and abdomen
35190
778.81
Repair, acquired or traumatic arteriovenous fistula;
							 extremities
35201
974.67
Repair blood vessel, direct; neck
35206
798.81
Repair blood vessel, direct; upper
							 extremity
35207
1,732.44
737.01
Repair blood vessel, direct; hand, finger
35211
1,400.53
Repair blood vessel, direct; intrathoracic, with
							 bypass
35216
1,843.83
Repair blood vessel, direct; intrathoracic, without
							 bypass
35221
1,427.87
Repair blood vessel, direct;
							 intra-abdominal
35226
884.91
Repair blood vessel, direct; lower
							 extremity
35231
1,209.11
Repair blood vessel with vein graft; neck
35236
1,011.71
Repair blood vessel with vein graft; upper
							 extremity
35241
1,463.44
Repair blood vessel with vein graft; intrathoracic,
							 with bypass
35246
1,572.55
Repair blood vessel with vein graft; intrathoracic,
							 without bypass
35251
1,699.85
Repair blood vessel with vein graft;
							 intra-abdominal
35256
1,065.64
Repair blood vessel with vein graft; lower
							 extremity
35261
1,068.07
Repair blood vessel with graft other than vein;
							 neck
35266
887.92
Repair blood vessel with graft other than vein; upper
							 extremity
35271
1,396.11
Repair blood vessel with graft other than vein;
							 intrathoracic, with bypass
35276
1,466.07
Repair blood vessel with graft other than vein;
							 intrathoracic, without bypass
35281
1,624.20
Repair blood vessel with graft other than vein;
							 intra-abdominal
35286
983.40
Repair blood vessel with graft other than vein; lower
							 extremity
35301
1,095.12
Thromboendarterectomy, including patch graft, if
							 performed; carotid, vertebral, subclavian, by neck incision
35302
1,133.60
Thromboendarterectomy, including patch graft, if
							 performed; superficial femoral artery
35303
1,244.13
Thromboendarterectomy, including patch graft, if
							 performed; popliteal artery
35304
1,294.28
Thromboendarterectomy, including patch graft, if
							 performed; tibioperoneal trunk artery
35305
1,244.13
Thromboendarterectomy, including patch graft, if
							 performed; tibial or peroneal artery, initial vessel
35306
460.93
Thromboendarterectomy, including patch graft, if
							 performed; each additional tibial or peroneal artery (List separately in
							 addition to code for primary procedure)
35311
1,568.32
Thromboendarterectomy, including patch graft, if
							 performed; subclavian, innominate, by thoracic incision
35321
934.01
Thromboendarterectomy, including patch graft, if
							 performed; axillary-brachial
35331
1,519.16
Thromboendarterectomy, including patch graft, if
							 performed; abdominal aorta
35341
1,444.47
Thromboendarterectomy, including patch graft, if
							 performed; mesenteric, celiac, or renal
35351
1,334.71
Thromboendarterectomy, including patch graft, if
							 performed; iliac
35355
1,087.71
Thromboendarterectomy, including patch graft, if
							 performed; iliofemoral
35361
1,642.64
Thromboendarterectomy, including patch graft, if
							 performed; combined aortoiliac
35363
1,760.12
Thromboendarterectomy, including patch graft, if
							 performed; combined aortoiliofemoral
35371
866.76
Thromboendarterectomy, including patch graft, if
							 performed; common femoral
35372
1,036.82
Thromboendarterectomy, including patch graft, if
							 performed; deep (profunda) femoral
35390
165.97
Reoperation, carotid, thromboendarterectomy, more
							 than one month after original operation (List separately in addition to code
							 for primary procedure)
35400
157.20
Angioscopy (non-coronary vessels or grafts) during
							 therapeutic intervention (List separately in addition to code for primary
							 procedure)
35450
531.12
Transluminal balloon angioplasty, open; renal or
							 other visceral artery
35452
371.01
Transluminal balloon angioplasty, open;
							 aortic
35454
325.86
Transluminal balloon angioplasty, open;
							 iliac
35456
394.09
Transluminal balloon angioplasty, open;
							 femoral-popliteal
35458
505.97
Transluminal balloon an gioplasty, open;
							 brachiocephalic trunk or branches, each vessel
35459
464.52
Transluminal balloon angioplasty, open; tibioperoneal
							 trunk and branches
35460
323.28
Transluminal balloon angioplasty, open;
							 venous
35470
3,769.87
Transluminal balloon angioplasty, percutaneous;
							 tibioperoneal trunk or branches, each vessel
35471
4,192.30
Transluminal balloon angioplasty, percutaneous; renal
							 or visceral artery
35472
2,829.17
Transluminal balloon angioplasty, percutaneous;
							 aortic
35473
2,028.15
2,670.79
Transluminal balloon angioplasty, percutaneous;
							 iliac
35474
3,679.18
Transluminal balloon angioplasty, percutaneous;
							 femoral-popliteal
35475
2,754.60
Transluminal balloon angioplasty, percutaneous;
							 brachiocephalic trunk or branches, each vessel
35476
2,028.15
2,101.39
Transluminal balloon angioplasty, percutaneous;
							 venous
35480
601.94
Transluminal peripheral atherectomy, open; renal or
							 other visceral artery
35481
418.56
Transluminal peripheral atherectomy, open;
							 aortic
35482
358.79
Transluminal peripheral atherectomy, open;
							 iliac
35483
439.11
Transluminal peripheral atherectomy, open;
							 femoral-popliteal
35484
547.57
Transluminal peripheral atherectomy, open;
							 brachiocephalic trunk or branches, each vessel
35485
511.43
Transluminal peripheral atherectomy, open;
							 tibioperoneal trunk and branches
35490
626.28
Transluminal peripheral atherectomy, percutaneous;
							 renal or other visceral artery
35491
445.99
Transluminal peripheral atherectomy, percutaneous;
							 aortic
35492
3,910.83
393.33
Transluminal peripheral atherectomy, percutaneous;
							 iliac
35493
471.59
Transluminal peripheral atherectomy, percutaneous;
							 femoral-popliteal
35494
594.85
Transluminal peripheral atherectomy, percutaneous;
							 brachiocephalic trunk or branches, each vessel
35495
547.80
Transluminal peripheral atherectomy, percutaneous;
							 tibioperoneal trunk and branches
35500
331.07
Harvest of upper extremity vein, one segment, for
							 lower extremity or coronary artery bypass procedure (List separately in
							 addition to code for primary procedure)
35501
1,562.40
Bypass graft, with vein; common carotid-ipsilateral
							 internal carotid
35506
1,356.65
Bypass graft, with vein; carotid-subclavian or
							 subclavian-carotid
35508
1,390.03
Bypass graft, with vein;
							 carotid-vertebral
35509
1,523.32
Bypass graft, with vein; carotid-contralateral
							 carotid
35510
1,304.37
Bypass graft, with vein; carotid-brachial
35511
1,234.17
Bypass graft, with vein;
							 subclavian-subclavian
35512
1,278.10
Bypass graft, with vein;
							 subclavian-brachial
35515
1,393.71
Bypass graft, with vein;
							 subclavian-vertebral
35516
1,221.51
Bypass graft, with vein;
							 subclavian-axillary
35518
1,236.56
Bypass graft, with vein;
							 axillary-axillary
35521
1,322.45
Bypass graft, with vein; axillary-femoral
35522
1,245.47
Bypass graft, with vein;
							 axillary-brachial
35523
1,307.96
Bypass graft, with vein; brachial-ulnar or
							 -radial
35525
1,178.59
Bypass graft, with vein;
							 brachial-brachial
35526
1,794.55
Bypass graft, with vein; aortosubclavian or
							 carotid
35531
2,083.61
Bypass graft, with vein; aortoceliac or
							 aortomesenteric
35533
1,620.88
Bypass graft, with vein;
							 axillary-femoral-femoral
35536
1,802.59
Bypass graft, with vein; splenorenal
35537
2,199.90
Bypass graft, with vein; aortoiliac
35538
2,455.22
Bypass graft, with vein; aortobi-iliac
35539
2,302.06
Bypass graft, with vein; aortofemoral
35540
2,564.61
Bypass graft, with vein; aortobifemoral
35548
1,254.86
Bypass graft, with vein; aortoiliofemoral,
							 unilateral
35549
1,369.99
Bypass graft, with vein; aortoiliofemoral,
							 bilateral
35551
1,539.39
Bypass graft, with vein;
							 aortofemoral-popliteal
35556
1,424.35
Bypass graft, with vein;
							 femoral-popliteal
35558
1,276.12
Bypass graft, with vein; femoral-femoral
35560
1,850.79
Bypass graft, with vein; aortorenal
35563
1,439.36
Bypass graft, with vein; ilioiliac
35565
1,373.65
Bypass graft, with vein; iliofemoral
35566
1,703.71
Bypass graft, with vein; femoral-anterior tibial,
							 posterior tibial, peroneal artery or other distal vessels
35571
1,405.59
Bypass graft, with vein; popliteal-tibial, -peroneal
							 artery or other distal vessels
35572
357.93
Harvest of femoropopliteal vein, one segment, for
							 vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral
							 artery) (List separately in addition to code for primary procedure)
35583
1,470.72
In-situ vein bypass; femoral-popliteal
35585
1,734.72
In-situ vein bypass; femoral-anterior tibial,
							 posterior tibial, or peroneal artery
35587
1,455.32
In-situ vein bypass; popliteal-tibial,
							 peroneal
35600
262.81
Harvest of upper extremity artery, one segment, for
							 coronary artery bypass procedure (List separately in addition to code for
							 primary procedure)
35601
1,471.68
Bypass graft, with other than vein; common
							 carotid-ipsilateral internal carotid
35606
1,219.96
Bypass graft, with other than vein;
							 carotid-subclavian
35612
959.98
Bypass graft, with other than vein;
							 subclavian-subclavian
35616
1,158.95
Bypass graft, with other than vein;
							 subclavian-axillary
35621
1,158.62
Bypass graft, with other than vein;
							 axillary-femoral
35623
1,420.15
Bypass graft, with other than vein;
							 axillary-popliteal or -tibial
35626
1,626.79
Bypass graft, with other than vein; aortosubclavian
							 or carotid
35631
1,935.95
Bypass graft, with other than vein; aortoceliac,
							 aortomesenteric, aortorenal
35636
1,709.27
Bypass graft, with other than vein; splenorenal
							 (splenic to renal arterial anastomosis)
35637
1,747.28
Bypass graft, with other than vein;
							 aortoiliac
35638
1,774.90
Bypass graft, with other than vein;
							 aortobi-iliac
35642
1,054.85
Bypass graft, with other than vein;
							 carotid-vertebral
35645
1,075.33
Bypass graft, with other than vein;
							 subclavian-vertebral
35646
1,796.56
Bypass graft, with other than vein;
							 aortobifemoral
35647
1,624.34
Bypass graft, with other than vein;
							 aortofemoral
35650
1,119.24
Bypass graft, with other than vein;
							 axillary-axillary
35651
1,434.80
Bypass graft, with other than vein;
							 aortofemoral-popliteal
35654
1,437.06
Bypass graft, with other than vein;
							 axillary-femoral-femoral
35656
1,135.44
Bypass graft, with other than vein;
							 femoral-popliteal
35661
1,139.67
Bypass graft, with other than vein;
							 femoral-femoral
35663
1,317.32
Bypass graft, with other than vein;
							 ilioiliac
35665
1,235.98
Bypass graft, with other than vein;
							 iliofemoral
35666
1,339.06
Bypass graft, with other than vein; femoral-anterior
							 tibial, posterior tibial, or peroneal artery
35671
1,179.28
Bypass graft, with other than vein; popliteal-tibial
							 or
-peroneal artery
35681
83.16
Bypass graft; composite, prosthetic and vein (List
							 separately in addition to code for primary procedure)
35682
370.26
Bypass graft; autogenous composite, two segments of
							 veins from two locations (List separately in addition to code for primary
							 procedure)
35683
435.85
Bypass graft; autogenous composite, three or more
							 segments of vein from two or more locations (List separately in addition to
							 code for primary procedure)
35685
208.26
Placement of vein patch or cuff at distal anastomosis
							 of bypass graft, synthetic conduit (List separately in addition to code for
							 primary procedure)
35686
173.69
Creation of distal arteriovenous fistula during lower
							 extremity bypass surgery (non-hemodialysis) (List separately in addition to
							 code for primary procedure)
35691
1,033.62
Transposition and/or reimplantation; vertebral to
							 carotid artery
35693
919.06
Transposition and/or reimplantation; vertebral to
							 subclavian artery
35694
1,079.51
Transposition and/or reimplantation; subclavian to
							 carotid artery
35695
1,115.16
Transposition and/or reimplantation; carotid to
							 subclavian artery
35697
155.22
Reimplantation, visceral artery to infrarenal aortic
							 prosthesis, each artery (List separately in addition to code for primary
							 procedure)
35700
159.31
Reoperation, femoral-popliteal or femoral
							 (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal
							 vessels, more than one month after original operation (List separately in
							 addition to code for primary procedure)
35701
562.33
Exploration (not followed by surgical repair), with
							 or without lysis of artery; carotid artery
35721
482.51
Exploration (not followed by surgical repair), with
							 or without lysis of artery; femoral artery
35741
523.62
Exploration (not followed by surgical repair), with
							 or without lysis of artery; popliteal artery
35761
1,327.08
393.10
Exploration (not followed by surgical repair), with
							 or without lysis of artery; other vessels
35800
499.20
Exploration for postoperative hemorrhage, thrombosis
							 or infection; neck
35820
1,778.30
Exploration for postoperative hemorrhage, thrombosis
							 or infection; chest
35840
643.74
Exploration for postoperative hemorrhage, thrombosis
							 or infection; abdomen
35860
423.59
Exploration for postoperative hemorrhage, thrombosis
							 or infection; extremity
35870
1,330.32
Repair of graft-enteric fistula
35875
1,732.44
623.72
Thrombectomy of arterial or venous graft (other than
							 hemodialysis graft or fistula);
35876
1,732.44
987.41
Thrombectomy of arterial or venous graft (other than
							 hemodialysis graft or fistula); with revision of arterial or venous
							 graft
35879
972.71
Revision, lower extremity arterial bypass, without
							 thrombectomy, open; with vein patch angioplasty
35881
1,081.40
Revision, lower extremity arterial bypass, without
							 thrombectomy, open; with segmental vein interposition
35883
1,274.54
Revision, femoral anastomosis of synthetic arterial
							 bypass graft in groin, open; with nonautogenous patch graft (eg, Dacron, ePTFE,
							 bovine pericardium)
35884
1,352.60
Revision, femoral anastomosis of synthetic arterial
							 bypass graft in groin, open; with autogenous vein patch graft
35901
536.05
Excision of infected graft; neck
35903
608.91
Excision of infected graft; extremity
35905
1,821.78
Excision of infected graft; thorax
35907
1,992.28
Excision of infected graft; abdomen
36000
29.92
Introduction of needle or intracatheter,
							 vein
36002
106.32
189.39
Injection procedures (eg, thrombin) for
							 percutaneous
treatment of extremity pseudoaneurysm
36005
404.92
Injection procedure for extremity
							 venography
(including introduction of needle or
							 intracatheter)
36010
789.05
Introduction of catheter, superior or inferior vena
							 cava
36011
1,207.55
Selective catheter placement, venous system; first
							 order branch (eg, renal vein, jugular vein)
36012
1,029.35
Selective catheter placement, venous system; second
							 order, or more selective, branch (eg, left adrenal vein, petrosal
							 sinus)
36013
1,017.78
Introduction of catheter, right heart or main
							 pulmonary artery
36014
1,008.66
Selective catheter placement, left or right pulmonary
							 artery
36015
1,098.25
Selective catheter placement, segmental or
							 subsegmental pulmonary artery
36100
647.59
Introduction of needle or intracatheter, carotid or
							 vertebral artery
36120
531.26
Introduction of needle or intracatheter; retrograde
							 brachial artery
36140
608.73
Introduction of needle or intracatheter; extremity
							 artery
36145
598.03
Introduction of needle or intracatheter;
							 arteriovenous shunt created for dialysis (cannula, fistula, or
							 graft)
36160
670.11
Introduction of needle or intracatheter, aortic,
							 translumbar
36200
805.33
Introduction of catheter, aorta
36215
1,387.75
Selective catheter placement, arterial system; each
							 first order thoracic or brachiocephalic branch, within a vascular
							 family
36216
1,504.71
Selective catheter placement, arterial system;
							 initial second order thoracic or brachiocephalic branch, within a vascular
							 family
36217
2,561.12
Selective catheter placement, arterial system;
							 initial third order or more selective thoracic or brachiocephalic branch,
							 within a vascular family
36218
240.49
Selective catheter placement, arterial system;
							 additional second order, third order, and beyond, thoracic or brachiocephalic
							 branch, within a vascular family (List in addition to code for initial second
							 or third order vessel as appropriate)
36245
1,570.76
Selective catheter placement, arterial system; each
							 first order abdominal, pelvic, or lower extremity artery branch, within a
							 vascular family
36246
1,513.25
Selective catheter placement, arterial system;
							 initial second order abdominal, pelvic, or lower extremity artery branch,
							 within a vascular family
36247
2,409.20
Selective catheter placement, arterial system;
							 initial third order or more selective abdominal, pelvic, or lower extremity
							 artery branch, within a vascular family
36248
202.74
Selective catheter placement, arterial system;
							 additional second order, third order, and beyond, abdominal, pelvic, or lower
							 extremity artery branch, within a vascular family (List in addition to code for
							 initial second or third order vessel as appropriate)
36260
1,290.34
593.05
Insertion of implantable intra-arterial infusion pump
							 (eg, for chemotherapy of liver)
36261
1,071.63
365.13
Revision of implanted intra-arterial infusion
							 pump
36262
1,071.63
280.12
Removal of implanted intra-arterial infusion
							 pump
36299
I.C.
Unlisted procedure, vascular injection
36410
20.25
Venipuncture, age 3 years or older, necessitating
							 physician's skill (separate procedure), for diagnostic or therapeutic purposes
							 (not to be used for routine venipuncture)
36415
I.C.
Collection of venous blood by
							 venipuncture
36416
I.C.
Collection of capillary blood specimen (eg, finger,
							 heel, ear stick)
36425
9.57
37.41
Venipuncture, cutdown; age one or over
36455
35.44
126.13
Exchange transfusion, blood; other than
							 newborn
36460
341.78
Transfusion, intrauterine, fetal
36468
35.44
I.C.
Single or multiple injections of sclerosing
							 solutions, spider veins (telangiectasia); limb or trunk
36469
35.44
I.C.
Single or multiple injections of sclerosing
							 solutions, spider veins (telangiectasia); face
36470
35.44
158.18
Injection of sclerosing solution; single
							 vein
36471
35.44
190.12
Injection of sclerosing solution; multiple veins,
							 same leg
36475
1,904.22
2,247.36
Endovenous ablation therapy of incompetent vein,
							 extremity, inclusive of all imaging guidance and monitoring, percutaneous,
							 radiofrequency; first vein treated
36476
1,154.79
443.46
Endovenous ablation therapy of incompetent vein,
							 extremity, inclusive of all imaging guidance and monitoring, percutaneous,
							 radiofrequency; second and subsequent veins treated in a single extremity, each
							 through separate access sites (List separately in addition to code for primary
							 procedure)
36478
1,154.79
1,938.97
Endovenous ablation therapy of incompetent vein,
							 extremity, inclusive of all imaging guidance and monitoring, percutaneous,
							 laser; first vein treated
36479
1,154.79
451.28
Endovenous ablation therapy of incompetent vein,
							 extremity, inclusive of all imaging guidance and monitoring, percutaneous,
							 laser; second and subsequent veins treated in a single extremity, each through
							 separate access sites (List separately in addition to code for primary
							 procedure)
36481
368.95
Percutaneous portal vein catheterization by any
							 method
36500
186.13
Venous catheterization for selective organ blood
							 sampling
36511
514.17
91.73
Therapeutic apheresis; for white blood
							 cells
36512
514.17
92.65
Therapeutic apheresis; for red blood
							 cells
36513
514.17
93.96
Therapeutic apheresis; for platelets
36514
514.17
694.23
Therapeutic apheresis; for plasma
							 pheresis
36515
1,367.62
2,636.16
Therapeutic apheresis; with extracorporeal
							 immunoadsorption and plasma reinfusion
36516
1,367.62
3,121.03
Therapeutic apheresis; with extracorporeal selective
							 adsorption or selective filtration and plasma reinfusion
36522
1,367.62
1,668.22
Photopheresis, extracorporeal
36556
487.51
286.21
Insertion of non-tunneled centrally inserted central
							 venous catheter; age five years or older
36558
1,077.30
1,007.52
Insertion of tunneled centrally inserted central
							 venous catheter, without subcutaneous port or pump; age five years or
							 older
36561
1,290.34
1,416.26
Insertion of tunneled centrally inserted central
							 venous access device, with subcutaneous port; age five years or
							 older
36563
1,290.34
1,385.15
Insertion of tunneled centrally inserted central
							 venous access device with subcutaneous pump
36565
1,290.34
1,194.40
Insertion of tunneled centrally inserted central
							 venous access device, requiring two catheters via two separate venous access
							 sites; without subcutaneous port or pump (eg, Tesio type catheter)
36566
4,811.43
3,402.87
Insertion of tunneled centrally inserted central
							 venous access device, requiring two catheters via two separate venous access
							 sites; with subcutaneous port(s)
36569
487.51
339.86
Insertion of peripherally inserted central venous
							 catheter (PICC), without subcutaneous port or pump; age five years or
							 older
36571
1,077.30
1,528.60
Insertion of peripherally inserted central venous
							 access device, with subcutaneous port; age five years or older
36575
253.00
198.25
Repair of tunneled or non-tunneled central venous
							 access catheter, without subcutaneous port or pump, central or peripheral
							 insertion site
36576
487.51
411.26
Repair of central venous access device, with
							 subcutaneous port or pump, central or peripheral insertion site
36578
1,077.30
593.18
Replacement, catheter only, of central venous access
							 device, with subcutaneous port or pump, central or peripheral insertion
							 site
36580
487.51
301.28
Replacement, complete, of a non-tunneled centrally
							 inserted central venous catheter, without subcutaneous port or pump, through
							 same venous access
36581
1,077.30
929.44
Replacement, complete, of a tunneled centrally
							 inserted central venous catheter, without subcutaneous port or pump, through
							 same venous access
36582
1,290.34
1,278.59
Replacement, complete, of a tunneled centrally
							 inserted central venous access device, with subcutaneous port, through same
							 venous access
36583
1,290.34
1,281.68
Replacement, complete, of a tunneled centrally
							 inserted central venous access device, with subcutaneous pump, through same
							 venous access
36584
487.51
298.44
Replacement, complete, of a peripherally inserted
							 central venous catheter (PICC), without subcutaneous port or pump, through same
							 venous access
36585
1,077.30
1,329.83
Replacement, complete, of a peripherally inserted
							 central venous access device, with subcutaneous port, through same venous
							 access
36589
253.00
179.06
Removal of tunneled central venous catheter, without
							 subcutaneous port or pump
36590
487.51
287.64
Removal of tunneled central venous access device,
							 with subcutaneous port or pump, central or peripheral insertion
36591
25.15
Collection of blood specimen from a completely
							 implantable venous access device
36592
31.14
Collection of blood specimen using established
							 central or peripheral catheter, venous, not otherwise specified
36593
22.06
38.71
Declotting by thrombolytic agent of implanted
							 vascular access device or catheter
36595
1,077.30
775.56
Mechanical removal of pericatheter obstructive
							 material (eg, fibrin sheath) from central venous device via separate venous
							 access
36596
487.51
171.17
Mechanical removal of intraluminal (intracatheter)
							 obstructive material from central venous device through device
							 lumen
36597
487.51
145.59
Repositioning of previously placed central venous
							 catheter under fluoroscopic guidance
36598
89.36
138.61
Contrast injection(s) for radiologic evaluation of
							 existing central venous access device, including fluoroscopy, image
							 documentation and report
36600
34.08
Arterial puncture, withdrawal of blood for
							 diagnosis
36620
50.11
Arterial catheterization or cannulation for sampling,
							 monitoring or transfusion (separate procedure); percutaneous
36625
103.77
Arterial catheterization or cannulation for sampling,
							 monitoring or transfusion (separate procedure); cutdown
36640
1,290.34
122.64
Arterial catheterization for prolonged infusion
							 therapy (chemotherapy), cutdown
36660
71.33
Catheterization, umbilical artery, newborn, for
							 diagnosis or therapy
36680
49.59
62.22
Placement of needle for intraosseous
							 infusion
36800
1,327.08
167.33
Insertion of cannula for hemodialysis, other purpose
							 (separate procedure); vein to vein
36810
1,327.08
217.74
Insertion of cannula for hemodialysis, other purpose
							 (separate procedure); arteriovenous, external (Scribner type)
36815
1,327.08
150.58
Insertion of cannula for hemodialysis, other purpose
							 (separate procedure); arteriovenous, external revision, or closure
36818
1,732.44
702.29
Arteriovenous anastomosis, open; by upper arm
							 cephalic vein transposition
36819
1,732.44
814.73
Arteriovenous anastomosis, open; by upper arm basilic
							 vein transposition
36820
1,732.44
817.65
Arteriovenous anastomosis, open; by forearm vein
							 transposition
36821
1,732.44
547.20
Arteriovenous anastomosis, open; direct, any site
							 (eg, Cimino type) (separate procedure)
36822
398.68
Insertion of cannula(s) for prolonged extracorporeal
							 circulation for cardiopulmonary insufficiency
(ECMO) (separate procedure)
36823
1,280.49
Insertion of arterial and venous cannula(s) for
							 isolated extracorporeal circulation including regional chemotherapy perfusion
							 to an extremity, with or without hyperthermia, with removal of cannula(s) and
							 repair of arteriotomy and venotomy sites
36825
1,732.44
595.47
Creation of arteriovenous fistula by other than
							 direct arteriovenous anastomosis (separate procedure); autogenous
							 graft
36830
1,732.44
674.89
Creation of arteriovenous fistula by other than
							 direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg,
							 biological collagen, thermoplastic graft)
36831
1,732.44
470.48
Thrombectomy, open, arteriovenous fistula without
							 revision, autogenous or nonautogenous dialysis graft (separate
							 procedure)
36832
1,732.44
596.37
Revision, open, arteriovenous fistula; without
							 thrombectomy, autogenous or nonautogenous dialysis graft (separate
							 procedure)
36833
1,732.44
671.96
Revision, open, arteriovenous fistula; with
							 thrombectomy, autogenous or nonautogenous dialysis graft (separate
							 procedure)
36834
1,732.44
627.52
Plastic repair of arteriovenous aneurysm (separate
							 procedure)
36835
36838
1,327.08
1,206.02
468.55
Insertion of Thomas shunt (separate procedure) Distal
							 revascularization and interval ligation (DRIL), upper extremity hemodialysis
							 access (steal syndrome)
36860
110.93
190.22
External cannula declotting (separate procedure);
							 without balloon catheter
36861
1,327.08
156.27
External cannuladeclotting (separate procedure); with
							 balloon catheter
36870
1,808.38
2,345.77
Thrombectomy, percutaneous, arteriovenous fistula,
							 autogenous or nonautogenous graft (includes mechanical thrombus extraction and
							 intra-graft thrombolysis)
37140
1,365.16
Venous anastomosis, open; portocaval
37145
1,480.54
Venous anastomosis, open; renoportal
37160
1,270.10
Venous anastomosis, open;
							 caval-mesenteric
37180
1,443.19
Venous anastomosis, open; splenorenal,
							 proximal
37181
1,523.70
Venous anastomosis, open; splenorenal, distal
							 (selective decompression of esophagogastric varices, any technique)
37182
894.76
Insertion of transvenous intrahepatic portosystemic
							 shunt(s) (TIPS) (includes venous access, hepatic and portal vein
							 catheterization, portography with hemodynamic evaluation, intrahepatic tract
							 formation/dilatation, stent placement and all associated imaging guidance and
							 documentation)
37183
427.28
Revision of transvenous intrahepatic portosystemic
							 shunt(s) (TIPS) (includes venous access, hepatic and portal vein
							 catheterization, portography with hemodynamic evaluation, intrahepatic tract
							 recanulization/dilatation, stent placement and all associated imaging guidance
							 and documentation)
37184
1,732.44
3,113.44
Primary percutaneous transluminal mechanical
							 thrombectomy, noncoronary, arterial or arterial bypass graft, including
							 fluoroscopic guidance and intraprocedural pharmacological thrombolytic
							 injection(s); initial vessel
37185
1,732.44
1,022.74
Primary percutaneous transluminal mechanical
							 thrombectomy, noncoronary, arterial or arterial bypass graft, including
							 fluoroscopic guidance and intraprocedural pharmacological thrombolytic
							 injection(s); second and all subsequent vessel(s) within the same vascular
							 family (List separately in addition to code for primary mechanical thrombectomy
							 procedure)
37186
1,732.44
2,119.04
Secondary percutaneous transluminal thrombectomy (eg,
							 nonprimary mechanical, snare basket, suction technique), noncoronary, arterial
							 or arterial bypass graft, including fluoroscopic guidance and intraprocedural
							 pharmacological thrombolytic injections, provided in conjunction with another
							 percutaneous intervention other than primary mechanical thrombectomy (List
							 separately in addition to code for primary procedure)
37187
1,732.44
3,016.62
Percutaneous transluminal mechanical thrombectomy,
							 vein(s), including intraprocedural pharmacological thrombolytic injections and
							 fluoroscopic guidance
37188
1,732.44
2,605.95
Percutaneous transluminal mechanical thrombectomy,
							 vein(s), including intraprocedural pharmacological thrombolytic injections and
							 fluoroscopic guidance, repeat treatment on subsequent day during course of
							 thrombolytic therapy
37195
I.C.
Thrombolysis, cerebral, by intravenous
							 infusion
37200
1,290.34
236.17
Transcatheter biopsy
37201
292.57
Transcatheter therapy, infusion for thrombolysis
							 other than coronary
37202
353.31
Transcatheter therapy, infusion other than for
							 thrombolysis, any type (eg, spasmolytic, vasoconstrictive)
37203
1,290.34
1,630.90
Transcatheter retrieval, percutaneous, of
							 intravascular foreign body (eg, fractured venous or arterial
							 catheter)
37204
942.08
Transcatheter occlusion or embolization (eg, for
							 tumor destruction, to achieve hemostasis, to occlude a vascular malformation),
							 percutaneous, any method, non-central nervous system, non-head or
							 neck
37205
2,889.89
Transcatheter placement of an intravascular stent(s)
							 (except coronary, carotid, and vertebral vessel), percutaneous; initial
							 vessel
37206
1,714.00
Transcatheter placement of an intravascular stent(s)
							 (except coronary, carotid, and vertebral vessel), percutaneous; each additional
							 vessel (List separately in addition to code for primary procedure)
37207
444.93
Transcatheter placement of an intravascular stent(s)
							 (non-coronary vessel), open; initial vessel
37208
213.13
Transcatheter placement of an intravascular stent(s)
							 (non-coronary vessel), open; each additional vessel (List separately in
							 addition to code for primary procedure)
37209
116.52
Exchange of a previously placed intravascular
							 catheter during thrombolytic therapy
37210
4,214.51
Uterine fibroid embolization (UFE, embolization of
							 the uterine arteries to treat uterine fibroids, leiomyomata), percutaneous
							 approach inclusive of vascular access, vessel selection, embolization, and all
							 radiological supervision and interpretation, intraprocedural roadmapping, and
							 imaging guidance necessary to complete the procedure
37215
1,139.38
Transcatheter placement of intravascular stent(s),
							 cervical carotid artery, percutaneous; with distal embolic
							 protection
37216
1,010.32
Transcatheter placement of intravascular
							 stent(s),
cervical carotid artery, percutaneous; without distal
							 embolic protection
37250
112.98
Intravascular ultrasound (non-coronary vessel) during
							 diagnostic evaluation and/or therapeutic intervention; initial vessel (List
							 separately in addition to code for primary procedure)
37251
84.26
Intravascular ultrasound (non-coronary vessel) during
							 diagnostic evaluation and/or therapeutic intervention; each additional vessel
							 (List separately in addition to code for primary procedure)
37500
1,904.22
720.94
Vascular endoscopy, surgical, with ligation of
							 perforator veins, subfascial (SEPS)
37501
I.C.
Unlisted vascular endoscopy procedure
37565
696.19
Ligation, internal jugular vein
37600
729.63
Ligation; external carotid artery
37605
828.94
Ligation; internal or common carotid
							 artery
37606
551.39
Ligation; internal or common carotid artery, with
							 gradual occlusion, as with Selverstone or Crutchfield clamp
37607
1,154.79
388.26
Ligation or banding of angioaccess arteriovenous
							 fistula
37609
719.48
314.13
Ligation or biopsy, temporal artery
37615
472.68
Ligation, major artery (eg, post-traumatic, rupture);
							 neck
37616
1,083.49
Ligation, major artery (eg, post-traumatic, rupture);
							 chest
37617
1,291.48
Ligation, major artery (eg, post-traumatic, rupture);
							 abdomen
37618
383.87
Ligation, major artery (eg, post-traumatic, rupture);
							 extremity
37620
676.42
Interruption, partial or complete, of inferior vena
							 cava by suture, ligation, plication, clip, extravascular, intravascular
							 (umbrella device)
37650
1,154.79
522.70
Ligation of femoral vein
37660
1,216.03
Ligation of common iliac vein
37700
1,154.79
263.48
Ligation and division of long saphenous vein at
							 saphenofemoral junction, or distal interruptions
37718
1,154.79
418.43
Ligation, division, and stripping, short saphenous
							 vein
37722
1,904.22
488.07
Ligation, division, and stripping, long (greater)
							 saphenous veins from saphenofemoral junction to knee or below
37735
1,904.22
648.19
Ligation and division and complete stripping of long
							 or short saphenous veins with radical excision of ulcer and skin graft and/or
							 interruption of communicating veins of lower leg, with excision of deep
							 fascia
37760
1,154.79
634.15
Ligation of perforator veins, subfascial, radical
							 (Linton type), with or without skin graft, open
37765
1,154.79
463.15
Stab phlebectomy of varicose veins, one extremity;
							 ten - 20 stab incisions
37766
1,154.79
559.19
Stab phlebectomy of varicose veins, one extremity;
							 more than 20 incisions
37780
1,154.79
268.61
Ligation and division of short saphenous vein at
							 saphenopopliteal junction (separate procedure)
37785
1,154.79
381.22
Ligation, division, and/or excision of varicose vein
							 cluster(s), one leg
37788
1,346.72
Penile revascularization, artery, with or without
							 vein graft
37790
1,516.30
522.56
Penile venous occlusive procedure
37799
I.C.
Unlisted procedure, vascular surgery
38100
1,021.96
Splenectomy; total (separate procedure)
38101
1,035.52
Splenectomy; partial (separate procedure)
38102
248.25
plenectomy; total, en bloc for extensive disease, in
							 conjunction with other procedure (List in addition to code for primary
							 procedure)
38115
1,131.00
Repair of ruptured spleen (splenorrhaphy) with
							 or
without partial splenectomy
38120
976.41
Laparoscopy, surgical, splenectomy
38129
I.C.
Unlisted laparoscopy procedure, spleen
38200
139.90
Injection procedure for splenoportography
38204
91.26
Management of recipient hematopoietic progenitor cell
							 donor search and cell acquisition
38205
514.17
80.93
Blood-derived hematopoietic progenitor cell
							 harvesting for transplantation, per collection; allogenic
38206
514.17
81.39
Blood-derived hematopoietic progenitor cell
							 harvesting for transplantation, per collection; autologous
38207
49.10
Transplant preparation of hematopoietic progenitor
							 cells; cryopreservation and storage
38208
31.23
Transplant preparation of hematopoietic progenitor
							 cells; thawing of previously frozen harvest, without washing
38209
13.56
Transplant preparation of hematopoietic progenitor
							 cells; thawing of previously frozen harvest, with washing
38210
87.18
Transplant preparation of hematopoietic progenitor
							 cells; specific cell depletion within harvest, T-cell depletion
38211
78.54
Transplant preparation of hematopoietic
							 progenitor
cells; tumor cell depletion
38212
52.03
Transplant preparation of hematopoietic progenitor
							 cells; red blood cell removal
38213
13.56
Transplant preparation of hematopoietic progenitor
							 cells; platelet depletion
38214
44.53
Transplant preparation of hematopoietic progenitor
							 cells; plasma (volume) depletion
38215
52.03
Transplant preparation of hematopoietic progenitor
							 cells; cell concentration in plasma, mononuclear, or buffy coat
							 layer
38220
117.68
185.66
Bone marrow; aspiration only
38221
123.56
203.53
Bone marrow; biopsy, needle or trocar
38230
1,367.62
324.64
Bone marrow harvesting for
							 transplantation
38240
1,367.62
124.89
Bone marrow or blood-derived peripheral stem cell
							 transplantation; allogenic
38241
514.17
125.35
Bone marrow or blood-derived peripheral stem cell
							 transplantation; autologous
38242
516.57
94.38
Bone marrow or blood-derived peripheral stem cell
							 transplantation; allogeneic donor lymphocyte infusions
38300
818.67
281.42
Drainage of lymph node abscess or lymphadenitis;
							 simple
38305
1,025.97
448.86
Drainage of lymph node abscess or lymphadenitis;
							 extensive
38308
1,025.97
422.80
Lymphangiotomy or other operations on lymphatic
							 channels
38380
554.11
Suture and/or ligation of thoracic duct; cervical
							 approach
38381
808.50
Suture and/or ligation of thoracic duct; thoracic
							 approach
38382
657.67
Suture and/or ligation of thoracic duct; abdominal
							 approach
38500
1,025.97
314.29
Biopsy or excision of lymph node(s); open,
							 superficial
38505
317.95
137.36
Biopsy or excision of lymph node(s); by needle,
							 superficial (eg, cervical, inguinal, axillary)
38510
1,025.97
501.77
Biopsy or excision of lymph node(s); open, deep
							 cervical node(s)
38520
1,025.97
441.98
Biopsy or excision of lymph node(s); open, deep
							 cervical node(s) with excision scalene fat pad
38525
1,025.97
396.36
Biopsy or excision of lymph node(s); open, deep
							 axillary node(s)
38530
1,025.97
511.67
Biopsy or excision of lymph node(s); open, internal
							 mammary node(s)
38542
1,980.76
419.81
Dissection, deep jugular node(s)
38550
1,025.97
453.75
Excision of cystic hygroma, axillary or cervical;
							 without deep neurovascular dissection
38555
1,025.97
947.01
Excision of cystic hygroma, axillary or cervical;
							 with deep neurovascular dissection
38562
674.39
Limited lymphadenectomy for staging (separate
							 procedure); pelvic and para-aortic
38564
665.77
Limited lymphadenectomy for staging (separate
							 procedure); retroperitoneal (aortic and/or splenic)
38570
2,034.73
534.83
Laparoscopy, surgical; with retroperitoneal lymph
							 node sampling (biopsy), single or multiple
38571
3,113.22
822.67
Laparoscopy, surgical; with bilateral total pelvic
							 lymphadenectomy
38572
2,034.73
932.55
Laparoscopy, surgical; with bilateral total pelvic
							 lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or
							 multiple
38589
I.C.
Unlisted laparoscopy procedure, lymphatic
							 system
38700
1,025.97
748.18
Suprahyoid lymphadenectomy
38720
1,227.25
Cervical lymphadenectomy (complete)
38724
1,326.01
Cervical lymphadenectomy (modified radical neck
							 dissection)
38740
1,980.76
629.22
Axillary lymphadenectomy; superficial
38745
1,980.76
799.19
Axillary lymphadenectomy; complete
38746
257.70
Thoracic lymphadenectomy, regional, including
							 mediastinal and peritracheal nodes (List separately in addition to code for
							 primary procedure)
38747
253.46
Abdominal lymphadenectomy, regional, including
							 celiac, gastric, portal, peripancreatic, with or without para-aortic and vena
							 caval nodes (List separately in addition to code for primary
							 procedure)
38760
1,025.97
789.24
Inguinofemoral lymphadenectomy, superficial,
							 including Cloquets node (separate procedure)
38765
1,212.90
Inguinofemoral lymphadenectomy, superficial,
							 in
continuity with pelvic lymphadenectomy, including
							 external iliac, hypogastric, and obturator nodes (separate
							 procedure)
38770
806.04
Pelvic lymphadenectomy, including external iliac,
							 hypogastric, and obturator nodes (separate procedure)
38780
1,028.57
Retroperitoneal transabdominal lymphadenectomy,
							 extensive, including pelvic, aortic, and renal nodes (separate
							 procedure)
38790
82.46
Injection procedure; lymphangiography
38792
40.73
Injection procedure; for identification of sentinel
							 node
38794
315.93
Cannulation, thoracic duct
38999
I.C.
Unlisted procedure, hemic or lymphatic
							 system
39000
487.69
Mediastinotomy with exploration, drainage, removal of
							 foreign body, or biopsy; cervical approach
39010
819.81
Mediastinotomy with exploration, drainage, removal of
							 foreign body, or biopsy; transthoracic approach, including either transthoracic
							 or median sternotomy
39200
890.57
Excision of mediastinal cyst
39220
1,138.03
Excision of mediastinal tumor
39400
504.85
Mediastinoscopy, with or without biopsy
39499
I.C.
Unlisted procedure, mediastinum
39501
810.22
Repair, laceration of diaphragm, any
							 approach
39502
964.76
Repair, paraesophageal hiatus hernia, transabdominal,
							 with or without fundoplasty, vagotomy, and/or pyloroplasty, except
							 neonatal
39503
5,438.71
Repair, neonatal diaphragmatic hernia, with or
							 without chest tube insertion and with or without creation of ventral
							 hernia
39520
976.47
Repair, diaphragmatic hernia (esophageal hiatal);
							 transthoracic
39530
924.52
Repair, diaphragmatic hernia (esophageal hiatal);
							 combined, thoracoabdominal
39531
976.11
Repair, diaphragmatic hernia (esophageal hiatal);
							 combined, thoracoabdominal, with dilation of stricture (with or without
							 gastroplasty)
39540
823.70
Repair, diaphragmatic hernia (other than neonatal),
							 traumatic; acute
39541
884.23
Repair, diaphragmatic hernia (other than neonatal),
							 traumatic; chronic
39545
886.20
Imbrication of diaphragm for eventration,
							 transthoracic or transabdominal, paralytic or nonparalytic
39560
762.06
Resection, diaphragm; with simple repair (eg, primary
							 suture)
39561
1,177.21
Resection, diaphragm; with complex repair (eg,
							 prosthetic material, local muscle flap)
39599
I.C.
Unlisted procedure, diaphragm
40490
68.03
128.31
Biopsy of lip
40500
729.71
500.52
Vermilionectomy (lip shave), with mucosal
							 advancement
40510
1,071.
7
483.99
Excision of lip; transverse wedge excision with
							 primary closure
40520
729.71
511.03
Excision of lip; V-excision with primary direct
							 linear closure
40525
1,071.47
553.19
Excision of lip; full thickness, reconstruction with
							 local flap (eg, Estlander or fan)
40527
1,071.47
653.88
Excision of lip; full thickness, reconstruction with
							 cross lip flap (Abbe-Estlander)
40530
1,071.47
556.98
Resection of lip, more than one-fourth, without
							 reconstruction
40650
332.81
431.50
Repair lip, full thickness; vermilion
							 only
40652
332.81
508.30
Repair lip, full thickness; up to half vertical
							 height
40654
332.81
585.67
Repair lip, full thickness; over one-half vertical
							 height, or complex
40700
1,782.06
913.72
Plastic repair of cleft lip/nasal deformity; primary,
							 partial or complete, unilateral
40701
1,782.06
1,071.86
Plastic repair of cleft lip/nasal deformity; primary
							 bilateral, one stage procedure
40702
1,782.06
841.52
Plastic repair of cleft lip/nasal deformity; primary
							 bilateral, one of two stages
40720
1,782.06
997.33
Plastic repair of cleft lip/nasal deformity;
							 secondary, by recreation of defect and reclosure
40761
1,782.06
1,044.47
Plastic repair of cleft lip/nasal deformity; with
							 cross lip pedicle flap (Abbe-Estlander type), including sectioning and
							 inserting of pedicle
40799
I.C.
Unlisted procedure, lips
40800
62.85
201.02
Drainage of abscess, cyst, hematoma, vestibule of
							 mouth; simple
40801
332.81
301.87
Drainage of abscess, cyst, hematoma, vestibule of
							 mouth; complicated
40804
28.19
211.56
Removal of embedded foreign body, vestibule of mouth;
							 simple
40805
176.51
324.20
Removal of embedded foreign body, vestibule of mouth;
							 complicated
40806
78.33
109.82
Incision of labial frenum (frenotomy)
40808
111.73
180.53
Biopsy, vestibule of mouth
40810
120.61
200.74
Excision of lesion of mucosa and submucosa, vestibule
							 of mouth; without repair
40812
151.87
278.04
Excision of lesion of mucosa and submucosa, vestibule
							 of mouth; with simple repair
40814
729.71
374.95
Excision of lesion of mucosa and submucosa, vestibule
							 of mouth; with complex repair
40816
1,071.47
393.32
Excision of lesion of mucosa and submucosa, vestibule
							 of mouth; complex, with excision of underlying muscle
40818
111.73
352.32
Excision of mucosa of vestibule of mouth as donor
							 graft
40819
332.81
299.93
Excision of frenum, labial or buccal (frenumectomy,
							 frenulectomy, frenectomy)
40820
169.52
260.33
Destruction of lesion or scar of vestibule of mouth
							 by physical methods (eg, laser, thermal, cryo, chemical)
40830
111.73
245.06
Closure of laceration, vestibule of mouth; 2.5 cm or
							 less
40831
332.81
322.19
Closure of laceration, vestibule of mouth; over 2.5
							 cm or complex
40840
1,071.47
796.82
Vestibuloplasty; anterior
40842
1,071.47
807.41
Vestibuloplasty; posterior, unilateral
40843
1,071.47
1,008.78
Vestibuloplasty; posterior, bilateral
40844
1,782.06
1,339.14
Vestibuloplasty; entire arch
40845
1,782.06
1,475.17
Vestibuloplasty; complex (including ridge extension,
							 muscle repositioning)
40899
I.C.
Unlisted procedure, vestibule of mouth
41000
89.36
160.97
Intraoral incision and drainage of abscess, cyst, or
							 hematoma of tongue or floor of mouth; lingual
41005
111.73
223.59
Intraoral incision and drainage of abscess, cyst, or
							 hematoma of tongue or floor of mouth; sublingual, superficial
41006
1,071.47
357.68
Intraoral incision and drainage of abscess, cyst, or
							 hematoma of tongue or floor of mouth; sublingual, deep,
							 supramylohyoid
41007
729.71
357.69
Intraoral incision and drainage of abscess, cyst, or
							 hematoma of tongue or floor of mouth; submental space
41008
729.71
363.42
Intraoral incision and drainage of abscess, cyst, or
							 hematoma of tongue or floor of mouth; submandibular space
41009
111.73
386.58
Intraoral incision and drainage of abscess, cyst, or
							 hematoma of tongue or floor of mouth; masticator space
41010
332.81
207.44
Incision of lingual frenum (frenotomy)
41015
111.73
419.63
Extraoral incision and drainage of abscess, cyst, or
							 hematoma of floor of mouth; sublingual
41016
332.81
428.70
Extraoral incision and drainage of abscess, cyst, or
							 hematoma of floor of mouth; submental
41017
332.81
432.84
Extraoral incision and drainage of abscess, cyst, or
							 hematoma of floor of mouth; submandibular
41018
332.81
492.76
Extraoral incision and drainage of abscess, cyst, or
							 hematoma of floor of mouth; masticator space
41019
1,071.47
470.48
Placement of needles, catheters, or other device(s)
							 into the head and/or neck region (percutaneous, transoral, or transnasal) for
							 subsequent interstitial radioelement application
41100
93.77
169.33
Biopsy of tongue; anterior two-thirds
41105
91.57
167.67
Biopsy of tongue; posterior one-third
41108
84.58
145.40
Biopsy of floor of mouth
41110
122.09
208.95
Excision of lesion of tongue without
							 closure
41112
729.71
327.13
Excision of lesion of tongue with closure; anterior
							 two-thirds
41113
729.71
356.60
Excision of lesion of tongue with closure; posterior
							 one-third
41114
1,071.47
632.96
Excision of lesion of tongue with closure; with local
							 tongue flap
41115
137.54
237.63
Excision of lingual frenum (frenectomy)
41116
729.71
319.53
Excision, lesion of floor of mouth
41120
1,071.47
1,078.78
Glossectomy; less than one-half tongue
41130
1,296.19
Glossectomy; hemiglossectomy
41135
2,113.08
Glossectomy; partial, with unilateral radical neck
							 dissection
41140
2,208.85
Glossectomy; complete or total, with or without
							 tracheostomy, without radical neck dissection
41145
2,726.91
Glossectomy; complete or total, with or without
							 tracheostomy, with unilateral radical neck dissection
41150
2,165.97
Glossectomy; composite procedure with resection floor
							 of mouth and mandibular resection, without radical neck dissection
41153
2,323.76
Glossectomy; composite procedure with resection floor
							 of mouth, with suprahyoid neck dissection
41155
2,823.96
Glossectomy; composite procedure with resection floor
							 of mouth, mandibular resection, and radical neck dissection (Commando
							 type)
41250
111.73
223.18
Repair of laceration 2.5 cm or less; floor of mouth
							 and/or anterior two-thirds of tongue
41251
111.73
240.36
Repair of laceration 2.5 cm or less; posterior
							 one-third of tongue
41252
332.81
305.94
Repair of laceration of tongue, floor of mouth, over
							 2.6 cm or complex
41500
1,071.47
481.44
Fixation of tongue, mechanical, other than suture
							 (eg, K-wire)
41510
729.71
455.65
Suture of tongue to lip for micrognathia (Douglas
							 type procedure)
41520
332.81
342.94
Frenoplasty (surgical revision of frenum, eg, with
							 Z-plasty)
41599
I.C.
Unlisted procedure, tongue, floor of
							 mouth
41800
62.85
215.21
Drainage of abscess, cyst, hematoma from
							 dentoalveolar structures
41805
134.22
216.06
Removal of embedded foreign body from dentoalveolar
							 structures; soft tissues
41806
172.83
321.09
Removal of embedded foreign body from dentoalveolar
							 structures; bone
41820
332.81
I.C.
Gingivectomy, excision gingiva, each
							 quadrant
41821
332.81
I.C.
Operculectomy, excision pericoronal
							 tissues
41822
159.60
289.75
Excision of fibrous tuberosities, dentoalveolar
							 structures
41823
221.01
414.66
Excision of osseous tuberosities, dentoalveolar
							 structures
41825
123.93
206.16
Excision of lesion or tumor (except listed above),
							 dentoalveolar structures; without repair
41826
138.27
262.29
Excision of lesion or tumor (except listed above),
							 dentoalveolar structures; with simple repair
41827
1,071.47
417.35
Excision of lesion or tumor (except listed above),
							 dentoalveolar structures; with complex repair
41828
144.89
301.19
Excision of hyperplastic alveolar mucosa, each
							 quadrant (specify)
41830
201.15
380.37
Alveolectomy, including curettage of osteitis or
							 sequestrectomy
41850
729.71
I.C.
Destruction of lesion (except excision),
							 dentoalveolar structures
41870
1,071.47
I.C.
Periodontal mucosal grafting
41872
203.36
362.54
Gingivoplasty, each quadrant (specify)
41874
193.06
362.00
Alveoloplasty, each quadrant (specify)
41899
I.C.
Unlisted procedure, dentoalveolar
							 structures
42000
111.73
162.27
Drainage of abscess of palate, uvula
42100
80.17
149.65
Biopsy of palate, uvula
42104
112.53
202.32
Excision, lesion of palate, uvula; without
							 closure
42106
140.84
256.63
Excision, lesion of palate, uvula; with simple
							 primary closure
42107
1,071.47
448.30
Excision, lesion of palate, uvula; with local flap
							 closure
42120
1,782.06
968.78
Resection of palate or extensive resection of
							 lesion
42140
332.81
251.25
Uvulectomy, excision of uvula
42145
1,071.47
693.03
Palatopharyngoplasty (eg, uvulopalatopharyngoplasty,
							 uvulopharyngoplasty)
42160
147.46
251.81
Destruction of lesion, palate or uvula (thermal, cryo
							 or chemical)
42180
111.73
240.55
Repair, laceration of palate; up to 2 cm
42182
1,782.06
323.99
Repair, laceration of palate; over 2 cm or
							 complex
42200
1,782.06
895.37
Palatoplasty for cleft palate, soft and/or hard
							 palate only
42205
1,782.06
912.05
Palatoplasty for cleft palate, with closure of
							 alveolar ridge; soft tissue only
42210
1,782.06
1,073.98
Palatoplasty for cleft palate, with closure of
							 alveolar ridge; with bone graft to alveolar ridge (includes obtaining
							 graft)
42215
1,782.06
722.19
Palatoplasty for cleft palate; major
							 revision
42220
1,782.06
585.47
Palatoplasty for cleft palate; secondary lengthening
							 procedure
42225
1,030.37
Palatoplasty for cleft palate; attachment pharyngeal
							 flap
42226
42227
1,782.06
980.64
992.53
Lengthening of palate, and pharyngeal flap
							 Lengthening of palate, with island flap
42235
729.71
803.37
Repair of anterior palate, including vomer
							 flap
42260
1,071.47
841.51
Repair of nasolabial fistula
42280
77.22
155.62
Maxillary impression for palatal
							 prosthesis
42281
42299
729.71
201.93 I.C.
Insertion of pin-retained palatal prosthesis Unlisted
							 procedure, palate, uvula
42300
729.71
208.54
Drainage of abscess; parotid, simple
42305
729.71
428.68
Drainage of abscess; parotid, complicated
42310
111.73
162.79
Drainage of abscess; submaxillary or sublingual,
							 intraoral
42320
111.73
248.77
Drainage of abscess; submaxillary,
							 external
42330
120.25
232.81
Sialolithotomy; submandibular (submaxillary),
							 sublingual or parotid, uncomplicated, intraoral
42335
196.00
368.86
Sialolithotomy; submandibular (submaxillary),
							 complicated, intraoral
42340
729.71
464.67
Sialolithotomy; parotid, extraoral or complicated
							 intraoral
42400
66.92
112.20
Biopsy of salivary gland; needle
42405
729.71
304.60
Biopsy of salivary gland; incisional
42408
729.71
453.86
Excision of sublingual salivary cyst
							 (ranula)
42409
729.71
331.86
Marsupialization of sublingual salivary cyst
							 (ranula)
42410
1,782.06
617.23
Excision of parotid tumor or parotid gland; lateral
							 lobe, without nerve dissection
42415
1,782.06
1,105.87
Excision of parotid tumor or parotid gland; lateral
							 lobe, with dissection and preservation of facial nerve
42420
1,782.06
1,267.41
Excision of parotid tumor or parotid gland; total,
							 with dissection and preservation of facial nerve
42425
1,782.06
841.26
Excision of parotid tumor or parotid gland; total, en
							 bloc removal with sacrifice of facial nerve
42426
1,354.08
Excision of parotid tumor or parotid gland; total,
							 with unilateral radical neck dissection
42440
1,782.06
457.70
Excision of submandibular (submaxillary)
							 gland
42450
1,071.47
454.31
Excision of sublingual gland
42500
1,071.47
432.04
Plastic repair of salivary duct, sialodochoplasty;
							 primary or simple
42505
1,782.06
560.60
Plastic repair of salivary duct, sialodochoplasty;
							 secondary or complicated
42507
1,782.06
521.43
Parotid duct diversion, bilateral (Wilke type
							 procedure);
42508
1,782.06
723.86
Parotid duct diversion, bilateral (Wilke type
							 procedure); with excision of one submandibular gland
42509
1,782.06
865.67
Parotid duct diversion, bilateral (Wilke type
							 procedure); with excision of both submandibular glands
42510
1,782.06
640.11
Parotid duct diversion, bilateral (Wilke type
							 procedure); with ligation of both submandibular (Wharton's) ducts
42550
171.35
Injection procedure for sialography
42600
729.71
481.69
Closure salivary fistula
42650
43.76
83.16
Dilation salivary duct
42660
51.49
105.72
Dilation and catheterization of salivary duct, with
							 or without injection
42665
1,071.47
305.91
Ligation salivary duct, intraoral
42699
I.C.
Unlisted procedure, salivary glands or
							 ducts
42700
111.73
189.23
Incision and drainage abscess;
							 peritonsillar
42720
729.71
447.73
Incision and drainage abscess; retropharyngeal or
							 parapharyngeal, intraoral approach
42725
1,782.06
798.67
Incision and drainage abscess; retropharyngeal or
							 parapharyngeal, external approach
42800
85.32
158.68
Biopsy; oropharynx
42802
729.71
261.69
Biopsy; hypopharynx
42804
729.71
214.48
Biopsy; nasopharynx, visible lesion,
							 simple
42806
1,071.47
240.34
Biopsy; nasopharynx, survey for unknown primary
							 lesion
42808
729.71
230.36
Excision or destruction of lesion of pharynx, any
							 method
42809
28.19
172.22
Removal of foreign body from pharynx
42810
1,071.47
396.15
Excision branchial cleft cyst or vestige, confined to
							 skin and subcutaneous tissues
42815
1,782.06
556.96
Excision branchial cleft cyst, vestige, or fistula,
							 extending beneath subcutaneous tissues and/or into pharynx
42821
994.57
307.24
Tonsillectomy and adenoidectomy; age 12 or
							 over
42826
994.57
255.82
Tonsillectomy, primary or secondary; age 12 or
							 over
42831
994.57
227.07
Adenoidectomy, primary; age 12 or over
42836
994.57
246.73
Adenoidectomy, secondary; age 12 or over
42842
961.93
Radical resection of tonsil, tonsillar pillars,
							 and/or retromolar trigone; without closure
42844
1,364.67
Radical resection of tonsil, tonsillar pillars,
							 and/or retromolar trigone; closure with local flap (eg, tongue,
							 buccal)
42845
2,185.08
Radical resection of tonsil, tonsillar pillars,
							 and/or retromolar trigone; closure with other flap
42860
994.57
190.38
Excision of tonsil tags
42870
994.57
596.61
Excision or destruction lingual tonsil, any method
							 (separate procedure)
42890
994.57
1,354.53
Limited pharyngectomy
42892
994.57
1,755.95
Resection of lateral pharyngeal wall or pyriform
							 sinus direct closure by advancement of lateral and posterior pharyngeal
							 walls
42894
2,252.58
Resection of pharyngeal wall requiring closure with
							 myocutaneous flap
42900
332.81
346.93
Suture pharynx for wound or injury
42950
1,071.47
828.13
Pharyngoplasty (plastic or reconstructive operation
							 on pharynx)
42953
1,061.13
Pharyngoesophageal repair
42955
1,071.47
772.63
Pharyngostomy (fistulization of pharynx, external for
							 feeding)
42960
50.28
170.62
Control oropharyngeal hemorrhage, primary or
							 secondary (eg, post-tonsillectomy); simple
42961
425.02
Control oropharyngeal hemorrhage, primary or
							 secondary (eg, post-tonsillectomy); complicated, requiring
							 hospitalization
42962
1,782.06
522.43
Control oropharyngeal hemorrhage, primary or
							 secondary (eg, post-tonsillectomy); with secondary surgical
							 intervention
42970
50.28
386.94
Control of nasopharyngeal hemorrhage, primary or
							 secondary (eg, postadenoidectomy); simple, with posterior nasal packs, with or
							 without anterior packs and/or cautery
42971
459.98
Control of nasopharyngeal hemorrhage, primary or
							 secondary (eg, postadenoidectomy); complicated, requiring
							 hospitalization
42972
729.71
521.93
Control of nasopharyngeal hemorrhage, primary or
							 secondary (eg, postadenoidectomy); with secondary surgical
							 intervention
42999
I.C.
Unlisted procedure, pharynx, adenoids, or
							 tonsils
43020
534.14
Esophagotomy, cervical approach, with removal of
							 foreign body
43030
729.71
521.66
Cricopharyngeal myotomy
43045
1,279.28
Esophagotomy, thoracic approach, with removal of
							 foreign body
43100
617.22
Excision of lesion, esophagus, with primary repair;
							 cervical approach
43101
996.22
Excision of lesion, esophagus, with primary repair;
							 thoracic or abdominal approach
43107
2,453.25
Total or near total esophagectomy, without
							 thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or
							 without pyloroplasty (transhiatal)
43108
3,835.21
Total or near total esophagectomy, without
							 thoracotomy; with colon interposition or small intestine reconstruction,
							 including intestine mobilization, preparation and anastomosis(es)
43112
2,625.81
Total or near total esophagectomy, with thoracotomy;
							 with pharyngogastrostomy or cervical esophagogastrostomy, with or without
							 pyloroplasty
43113
3,790.72
Total or near total esophagectomy, with thoracotomy;
							 with colon interposition or small intestine reconstruction, including intestine
							 mobilization, preparation, and anastomosis(es)
43116
4,342.10
Partial esophagectomy, cervical, with free intestinal
							 graft, including microvascular anastomosis, obtaining the graft and intestinal
							 reconstruction
43117
2,388.05
Partial esophagectomy, distal two-thirds, with
							 thoracotomy and separate abdominal incision, with or without proximal
							 gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty
							 (Ivor Lewis)
43118
3,218.86
Partial esophagectomy, distal two-thirds, with
							 thoracotomy and separate abdominal incision, with or without proximal
							 gastrectomy; with colon interposition or small intestine reconstruction,
							 including intestine mobilization, preparation, and anastomosis(es)
43121
2,601.54
Partial esophagectomy, distal two-thirds, with
							 thoracotomy only, with or without proximal gastrectomy, with thoracic
							 esophagogastrostomy, with or without pyloroplasty
43122
2,423.66
Partial esophagectomy, thoracoabdominal or abdominal
							 approach, with or without proximal gastrectomy; with esophagogastrostomy, with
							 or without pyloroplasty
43123
3,873.76
Partial esophagectomy, thoracoabdominal or abdominal
							 approach, with or without proximal gastrectomy; with colon interposition or
							 small intestine reconstruction, including intestine mobilization, preparation,
							 and anastomosis(es)
43124
3,324.28
Total or partial esophagectomy, without
							 reconstruction (any approach), with cervical esophagostomy
43130
779.30
Diverticulectomy of hypopharynx or esophagus, with or
							 without myotomy; cervical approach
43135
1,375.65
Diverticulectomy of hypopharynx or esophagus, with or
							 without myotomy; thoracic approach
43200
379.98
239.07
Esophagoscopy, rigid or flexible; diagnostic, with or
							 without collection of specimen(s) by brushing or washing (separate
							 procedure)
43201
379.98
311.98
Esophagoscopy, rigid or flexible; with directed
							 submucosal injection(s), any substance
43202
379.98
315.74
Esophagoscopy, rigid or flexible; with biopsy, single
							 or multiple
43204
379.98
218.38
Esophagoscopy, rigid or flexible; with injection
							 sclerosis of esophageal varices
43205
379.98
219.84
Esophagoscopy, rigid or flexible; with band ligation
							 of esophageal varices
43215
379.98
152.44
Esophagoscopy, rigid or flexible; with removal of
							 foreign body
43216
379.98
183.22
Esophagoscopy, rigid or flexible; with removal of
							 tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar
							 cautery
43217
379.98
418.42
Esophagoscopy, rigid or flexible; with removal of
							 tumor(s), polyp(s), or other lesion(s) by snare technique
43219
1,116.3
7
169.54
Esophagoscopy, rigid or flexible; with insertion of
							 plastic tube or stent
43220
379.98
125.13
Esophagoscopy, rigid or flexible; with balloon
							 dilation (less than 30 mm diameter)
43226
43227
379.98
379.98
138.98
205.07
Esophagoscopy, rigid or flexible; with insertion of
							 guide wire followed by dilation over guide wire Esophagoscopy, rigid or
							 flexible; with control of
bleeding (eg, injection, bipolar cautery, unipolar
							 cautery, laser, heater probe, stapler, plasma coagulator)
43228
1,131.65
217.74
Esophagoscopy, rigid or flexible; with ablation of
							 tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy
							 forceps, bipolar cautery or snare technique
43231
379.98
186.23
Esophagoscopy, rigid or flexible; with endoscopic
							 ultrasound examination
43232
379.98
259.47
Esophagoscopy, rigid or flexible; with
							 transendoscopic ultrasound-guided intramural or transmural fine needle
							 aspiration/biopsy(s)
43234
379.98
311.23
Upper gastrointestinal endoscopy, simple primary
							 examination (eg, with small diameter flexible endoscope) (separate
							 procedure)
43235
379.98
328.02
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; diagnostic,
							 with or without collection of specimen(s) by brushing or washing (separate
							 procedure)
43236
379.98
407.94
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with directed
							 submucosal injection(s), any substance
43237
379.98
235.31
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic
							 ultrasound examination limited to the esophagus
43238
379.98
288.77
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with
							 transendoscopic ultrasound-guided intramural or transmural fine needle
							 aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination
							 limited to the esophagus)
43239
379.98
375.69
Upper gastrointestinal endoscopy
							 including
esophagus, stomach, and either the duodenum and/or
							 jejunum as appropriate; with biopsy, single or multiple
43240
379.98
386.45
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with transmural
							 drainage of pseudocyst
43241
379.98
152.26
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with
							 transendoscopic intraluminal tube or catheter placement
43242
379.98
412.88
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with
							 transendoscopic ultrasound-guided intramural or transmural fine needle
							 aspiration/biopsy(s) (includes endoscopic ultrasound examination of the
							 esophagus, stomach, and either the duodenum and/or jejunum as
							 appropriate)
43243
379.98
261.32
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with injection
							 sclerosis of esophageal and/or gastric varices
43244
379.98
289.50
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with band
							 ligation of esophageal and/or gastric varices
43245
379.98
183.57
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with dilation
							 of gastric outlet for obstruction (eg, balloon, guide wire, bougie)
43246
379.98
245.14
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with directed
							 placement of percutaneous gastrostomy tube
43247
379.98
196.22
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with removal of
							 foreign body
43248
379.98
185.33
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with insertion
							 of guide wire followed by dilation of esophagus over guide wire
43249
379.98
170.51
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with balloon
							 dilation of esophagus (less than 30 mm diameter)
43250
379.98
184.25
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with removal of
							 tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar
							 cautery
43251
379.98
212.93
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with removal of
							 tumor(s), polyp(s), or other lesion(s) by snare technique
43255
379.98
276.44
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with control of
							 bleeding, any method
43256
1,116.37
248.91
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with
							 transendoscopic stent placement (includes predilation)
43257
1,131.65
298.46
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with delivery
							 of thermal energy to the muscle of lower esophageal sphincter and/or gastric
							 cardia, for treatment of gastroesophageal reflux disease
43258
379.98
260.64
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with ablation
							 of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy
							 forceps, bipolar cautery or snare technique
43259
379.98
295.40
Upper gastrointestinal endoscopy including esophagus,
							 stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic
							 ultrasound examination, including the esophagus, stomach, and either the
							 duodenum and/or jejunum as appropriate
43260
936.26
338.94
Endoscopic retrograde cholangiopancreatography
							 (ERCP); diagnostic, with or without collection of specimen(s) by brushing or
							 washing (separate procedure)
43261
936.26
356.40
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with biopsy, single or multiple
43262
936.26
418.21
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with sphincterotomy/papillotomy
43263
936.26
412.04
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with pressure measurement of sphincter of Oddi (pancreatic duct or
							 common bile duct)
43264
936.26
501.60
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with endoscopic retrograde removal of calculus/calculi from biliary
							 and/or pancreatic ducts
43265
936.26
563.07
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with endoscopic retrograde destruction, lithotripsy of
							 calculus/calculi, any method
43267
936.26
410.39
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with endoscopic retrograde insertion of nasobiliary or nasopancreatic
							 drainage tube
43268
1,116.37
424.20
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with endoscopic retrograde insertion of tube or stent into bile or
							 pancreatic duct
43269
1,116.37
463.20
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with endoscopic retrograde removal of foreign body and/or change of
							 tube or stent
43271
936.26
417.75
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with endoscopic retrograde balloon dilation of ampulla, biliary and/or
							 pancreatic duct(s)
43272
936.26
419.13
Endoscopic retrograde cholangiopancreatography
							 (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to
							 removal by hot biopsy forceps, bipolar cautery or snare technique
43280
1,003.27
Laparoscopy, surgical, esophagogastric fundoplasty
							 (eg, Nissen, Toupet procedures)
43289
I.C.
Unlisted laparoscopy procedure, esophagus
43300
619.60
Esophagoplasty (plastic repair or reconstruction),
							 cervical approach; without repair of tracheoesophageal fistula
43305
1,098.24
Esophagoplasty (plastic repair or reconstruction),
							 cervical approach; with repair of tracheoesophageal fistula
43310
1,482.61
Esophagoplasty (plastic repair or reconstruction),
							 thoracic approach; without repair of tracheoesophageal fistula
43312
1,628.65
Esophagoplasty (plastic repair or reconstruction),
							 thoracic approach; with repair of tracheoesophageal fistula
43313
2,644.05
Esophagoplasty for congenital defect (plastic repair
							 or reconstruction), thoracic approach; without repair of congenital
							 tracheoesophageal fistula
43314
2,803.42
Esophagoplasty for congenital defect (plastic repair
							 or reconstruction), thoracic approach; with repair of congenital
							 tracheoesophageal fistula
43320
1,283.68
Esophagogastrostomy (cardioplasty), with or without
							 vagotomy and pyloroplasty, transabdominal or transthoracic approach
43324
1,257.24
Esophagogastric fundoplasty (eg, Nissen, Belsey IV,
							 Hill procedures)
43325
1,240.51
Esophagogastric fundoplasty; with fundic patch
							 (Thal-Nissen procedure)
43326
1,267.46
Esophagogastric fundoplasty; with gastroplasty (eg,
							 Collis)
43330
1,214.98
Esophagomyotomy (Heller type); abdominal
							 approach
43331
1,322.56
Esophagomyotomy (Heller type); thoracic
							 approach
43340
1,274.49
Esophagojejunostomy (without total gastrectomy);
							 abdominal approach
43341
1,363.29
Esophagojejunostomy (without total gastrectomy);
							 thoracic approach
43350
1,097.71
Esophagostomy, fistulization of esophagus, external;
							 abdominal approach
43351
1,296.22
Esophagostomy, fistulization of esophagus, external;
							 thoracic approach
43352
1,041.45
Esophagostomy, fistulization of esophagus, external;
							 cervical approach
43360
2,201.25
Gastrointestinal reconstruction for previous
							 esophagectomy, for obstructing esophageal lesion or fistula, or for previous
							 esophageal exclusion; with stomach, with or without pyloroplasty
43361
2,494.81
Gastrointestinal reconstruction for previous
							 esophagectomy, for obstructing esophageal lesion or fistula, or for previous
							 esophageal exclusion; with colon interposition or small intestine
							 reconstruction, including intestine mobilization, preparation, and
							 anastomosis(es)
43400
1,458.62
Ligation, direct, esophageal varices
43401
1,429.62
Transection of esophagus with repair, for esophageal
							 varices
43405
1,389.61
Ligation or stapling at gastroesophageal junction for
							 pre-existing esophageal perforation
43410
959.52
Suture of esophageal wound or injury; cervical
							 approach
43415
1,628.39
Suture of esophageal wound or injury; transthoracic
							 or transabdominal approach
43420
953.80
Closure of esophagostomy or fistula; cervical
							 approach
43425
1,411.74
Closure of esophagostomy or fistula; transthoracic or
							 transabdominal approach
43450
261.12
172.85
Dilation of esophagus, by unguided sound or bougie,
							 single or multiple passes
43453
261.12
339.77
Dilation of esophagus, over guide wire
43456
261.12
710.06
Dilation of esophagus, by balloon or dilator,
							 retrograde
43458
379.98
424.20
Dilation of esophagus with balloon (30 mm diameter or
							 larger) for achalasia
43460
213.26
Esophagogastric tamponade, with balloon (Sengstaaken
							 type)
43496
I.C.
Free jejunum transfer with microvascular
							 anastomosis
43499
I.C.
Unlisted procedure, esophagus
43500
713.55
Gastrotomy; with exploration or foreign body
							 removal
43501
1,224.06
Gastrotomy; with suture repair of bleeding
							 ulcer
43502
1,390.00
Gastrotomy; with suture repair of pre-existing
							 esophagogastric laceration (eg, Mallory-Weiss)
43510
918.63
Gastrotomy; with esophageal dilation and insertion of
							 permanent intraluminal tube (eg, Celestin or Mousseaux-Barbin)
43520
655.49
Pyloromyotomy, cutting of pyloric muscle
							 (Fredet-Ramstedt type operation)
43600
379.98
102.09
Biopsy of stomach; by capsule, tube, peroral (one or
							 more specimens)
43605
757.94
Biopsy of stomach; by laparotomy
43610
893.63
Excision, local; ulcer or benign tumor of
							 stomach
43611
1,108.73
Excision, local; malignant tumor of
							 stomach
43620
1,803.51
Gastrectomy, total; with
							 esophagoenterostomy
43621
2,027.42
Gastrectomy, total; with Roux-en-Y
							 reconstruction
43622
2,068.85
Gastrectomy, total; with formation of intestinal
							 pouch, any type
43631
1,330.76
Gastrectomy, partial, distal; with
							 gastroduodenostomy
43632
1,755.38
Gastrectomy, partial, distal; with
							 gastrojejunostomy
43633
1,680.91
Gastrectomy, partial, distal; with Roux-en-Y
							 reconstruction
43634
1,849.93
Gastrectomy, partial, distal; with formation of
							 intestinal pouch
43635
106.51
Vagotomy when performed with partial distal
							 gastrectomy (List separately in addition to code(s) for primary
							 procedure)
43640
1,067.15
Vagotomy including pyloroplasty, with or without
							 gastrostomy; truncal or selective
43641
1,084.59
Vagotomy including pyloroplasty, with or without
							 gastrostomy; parietal cell (highly selective)
43644
1,583.72
Laparoscopy, surgical, gastric restrictive procedure;
							 with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or
							 less)
43645
1,695.00
Laparoscopy, surgical, gastric restrictive procedure;
							 with gastric bypass and small intestine reconstruction to limit
							 absorption
43647
I.C.
Laparoscopy, surgical; implantation or replacement of
							 gastric neurostimulator electrodes, antrum
43648
I.C.
Laparoscopy, surgical; revision or removal of gastric
							 neurostimulator electrodes, antrum
43651
601.61
Laparoscopy, surgical; transection of vagus nerves,
							 truncal
43652
713.31
Laparoscopy, surgical; transection of vagus nerves,
							 selective or highly selective
43653
2,034.73
515.24
Laparoscopy, surgical; gastrostomy, without
							 construction of gastric tube (eg, Stamm procedure) (separate
							 procedure)
43659
I.C.
Unlisted laparoscopy procedure, stomach
43752
40.22
Naso- or oro-gastric tube placement, requiring
							 physician's skill and fluoroscopic guidance (includes fluoroscopy, image
							 documentation and report)
43760
144.72
219.38
Change of gastrostomy tube, percutaneous, without
							 imaging or endoscopic guidance
43761
379.98
123.16
Repositioning of the gastric feeding tube, through
							 the duodenum for enteric nutrition
43770
1,023.07
Laparoscopy, surgical, gastric restrictive procedure;
							 placement of adjustable gastric restrictive device (eg, gastric band and
							 subcutaneous port components)
43771
1,165.94
Laparoscopy, surgical, gastric restrictive procedure;
							 revision of adjustable gastric restrictive device component only
43772
877.00
Laparoscopy, surgical, gastric restrictive procedure;
							 removal of adjustable gastric restrictive device component only
43773
1,165.78
Laparoscopy, surgical, gastric restrictive procedure;
							 removal and replacement of adjustable gastric restrictive device component
							 only
43774
883.33
Laparoscopy, surgical, gastric restrictive procedure;
							 removal of adjustable gastric restrictive device and subcutaneous port
							 components
43800
848.38
Pyloroplasty
43810
915.29
Gastroduodenostomy
43820
1,159.20
Gastrojejunostomy; without vagotomy
43825
1,181.03
Gastrojejunostomy; with vagotomy, any
							 type
43830
635.11
Gastrostomy, open; without construction of gastric
							 tube (eg, Stamm procedure) (separate procedure)
43831
534.25
Gastrostomy, open; neonatal, for feeding
43832
969.02
Gastrostomy, open; with construction of gastric tube
							 (eg, Janeway procedure)
43840
1,180.17
Gastrorrhaphy, suture of perforated duodenal or
							 gastric ulcer, wound, or injury
43842
1,121.65
Gastric restrictive procedure, without gastric
							 bypass, for morbid obesity; vertical-banded gastroplasty
43843
1,152.49
Gastric restrictive procedure, without gastric
							 bypass, for morbid obesity; other than vertical-banded gastroplasty
43845
1,797.03
Gastric restrictive procedure with partial
							 gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100
							 cm common channel) to limit absorption (biliopancreatic diversion with duodenal
							 switch)
43846
1,486.08
Gastric restrictive procedure, with gastric bypass
							 for
morbid obesity; with short limb (150 cm or less)
							 Roux-en-Y gastroenterostomy
43847
1,627.38
Gastric restrictive procedure, with gastric bypass
							 for morbid obesity; with small intestine reconstruction to limit
							 absorption
43848
1,760.43
Revision, open, of gastric restrictive procedure for
							 morbid obesity, other than adjustable gastric restrictive device (separate
							 procedure)
43850
1,480.18
Revision of gastroduodenal anastomosis
							 (gastroduodenostomy) with reconstruction; without vagotomy
43855
1,540.34
Revision of gastroduodenal anastomosis
							 (gastroduodenostomy) with reconstruction; with vagotomy
43860
1,494.88
Revision of gastrojejunal anastomosis
							 (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or
							 intestine resection; without vagotomy
43865
1,558.43
Revision of gas trojejunal anastomosis
							 (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or
							 intestine resection; with vagotomy
43870
379.98
643.65
Closure of gastrostomy, surgical
43880
1,463.00
Closure of gastrocolic fistula
43881
I.C.
Implantation or replacement of gastric
							 neurostimulator electrodes, antrum, open
43882
I.C.
Revision or removal of gastric neurostimulat or
							 electrodes, antrum, open
43886
903.02
313.94
Gastric restrictive procedure, open; revision of
							 subcutaneous port component only
43887
202.27
294.00
Gastric restrictive procedure, open; removal of
							 subcutaneous port component only
43888
903.02
416.50
Gastric restrictive procedure, open; removal and
							 replacement of subcutaneous port component only
43999
I.C.
Unlisted procedure, stomach
44005
998.08
Enterolysis (freeing of intestinal adhesion)
							 (separate procedure)
44010
786.00
Duodenotomy, for exploration, biopsy(s), or foreign
							 body removal
44015
135.85
Tube or needle catheter jejunostomy for enteral
							 alimentation, intraoperative, any method (List separately in addition to
							 primary procedure)
44020
881.61
Enterotomy, small intestine, other than duodenum; for
							 exploration, biopsy(s), or foreign body removal
44021
889.13
Enterotomy, small intestine, other than duodenum; for
							 decompression (eg, Baker tube)
44025
895.93
Colotomy, for exploration, biopsy(s), or foreign body
							 removal
44050
854.03
Reduction of volvulus, intussusception, internal
							 hernia, by laparotomy
44055
1,355.20
Correction of malrotation by lysis of duodenal bands
							 and/or reduction of midgut volvulus (eg, Ladd procedure)
44100
379.98
111.01
Biopsy of intestine by capsule, tube, peroral (one or
							 more specimens)
44110
770.27
Excision of one or more lesions of small or large
							 intestine not requiring anastomosis, exteriorization, or fistulization; single
							 enterotomy
44111
898.14
Excision of one or more lesions of small or large
							 intestine not requiring anastomosis, exteriorization, or fistulization;
							 multiple enterotomies
44120
1,102.83
Enterectomy, resection of small intestine; single
							 resection and anastomosis
44121
229.74
Enterectomy, resection of small intestine; each
							 additional resection and anastomosis (List separately in addition to code for
							 primary procedure)
44125
1,077.16
Enterectomy, resection of small intestine; with
							 enterostomy
44126
2,213.22
Enterectomy, resection of small intestine for
							 congenital atresia, single resection and anastomosis of proximal segment of
							 intestine; without tapering
44127
2,571.22
Enterectomy, resection of small intestine for
							 congenital atresia, single resection and anastomosis of proximal segment of
							 intestine; with tapering
44128
232.94
Enterectomy, resection of small intestine for
							 congenital atresia, single resection and anastomosis of proximal segment of
							 intestine; each additional resection and anastomosis (List separately in
							 addition to code for primary procedure)
44130
1,133.62
Enteroenterostomy, anastomosis of intestine, with or
							 without cutaneous enterostomy (separate procedure)
44132
I.C.
Donor enterectomy (including cold preservation),
							 open; from cadaver donor
44133
I.C.
Donor enterectomy (including cold preservation),
							 open; partial, from living donor
44135
I.C.
Intestinal allotransplantation; from cadaver
							 donor
44136
I.C.
Intestinal allotransplantation; from living
							 donor
44137
I.C.
Removal of transplanted intestinal allograft,
							 complete
44139
114.91
Mobilization (take-down) of splenic flexure performed
							 in conjunction with partial colectomy (List separately in addition to primary
							 procedure)
44140
1,232.88
Colectomy, partial; with anastomosis
44141
1,595.60
Colectomy, partial; with skin level cecostomy or
							 colostomy
44143
1,517.63
Colectomy, partial; with end colostomy and closure of
							 distal segment (Hartmann type procedure)
44144
1,567.29
Colectomy, partial; with resection, with colostomy or
							 ileostomy and creation of mucofistula
44145
1,537.17
Colectomy, partial; with coloproctostomy (low pelvic
							 anastomosis)
44146
1,905.89
Colectomy, partial; with coloproctostomy (low pelvic
							 anastomosis), with colostomy
44147
1,670.89
Colectomy, partial; abdominal and transanal
							 approach
44150
1,682.14
Colectomy, total, abdominal, without proctectomy;
							 with ileostomy or ileoproctostomy
44151
1,919.61
Colectomy, total, abdominal, without proctectomy;
							 with continent ileostomy
44155
1,882.89
Colectomy, total, abdominal, with proctectomy; with
							 ileostomy
44156
2,068.92
Colectomy, total, abdominal, with proctectomy; with
							 continent ileostomy
44157
2,116.62
Colectomy, total, abdominal, with proctectomy; with
							 ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when
							 performed
44158
2,170.31
Colectomy, total, abdominal, with proctectomy; with
							 ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop
							 ileostomy, and rectal mucosectomy, when performed
44160
1,131.73
Colectomy, partial, with removal of terminal ileum
							 with ileocolostomy
44180
851.48
Laparoscopy, surgical, enterolysis (freeing of
							 intestinal adhesion) (separate procedure)
44186
605.61
Laparoscopy, surgical; jejunostomy (eg, for
							 decompression or feeding)
44187
1,025.83
Laparoscopy, surgical; ileostomy or jejunostomy,
							 non-tube
44188
1,125.90
Laparoscopy, surgical, colostomy or skin level
							 cecostomy
44202
1,276.36
Laparoscopy, surgical; enterectomy, resection of
							 small intestine, single resection and anastomosis
44203
228.98
Laparoscopy, surgical; each additional small
							 intestine resection and anastomosis (List separately in addition to code for
							 primary procedure)
44204
1,424.43
Laparoscopy, surgical; colectomy, partial, with
							 anastomosis
44205
1,246.36
Laparoscopy, surgical; colectomy, partial, with
							 removal of terminal ileum with ileocolostomy
44206
1,615.70
Laparoscopy, surgical; colectomy, partial, with end
							 colostomy and closure of distal segment (Hartmann type procedure)
44207
1,692.52
Laparoscopy, surgical; colectomy, partial, with
							 anastomosis, with coloproctostomy (low pelvic anastomosis)
44208
1,851.42
Laparoscopy, surgical; colectomy, partial, with
							 anastomosis, with coloproctostomy (low pelvic anastomosis) with
							 colostomy
44210
1,653.41
Laparoscopy, surgical; colectomy, total, abdominal,
							 without proctectomy, with ileostomy or ileoproctostomy
44211
2,034.69
Laparoscopy, surgical; colectomy, total, abdominal,
							 with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or
							 J), with loop ileostomy, includes rectal mucosectomy, when
							 performed
44212
1,902.20
Laparoscopy, surgical; colectomy, total, abdominal,
							 with proctectomy, with ileostomy
44213
180.56
Laparoscopy, surgical, mobilization (take-down) of
							 splenic flexure performed in conjunction with partial colectomy (List
							 separately in addition to primary procedure)
44227
1,537.09
Laparoscopy, surgical, closure of enterostomy, large
							 or small intestine, with resection and anastomosis
44238
I.C.
Unlisted laparoscopy procedure, intestine (except
							 rectum)
44300
768.09
Placement, enterostomy or cecostomy, tube open (eg,
							 for feeding or decompression) (separate procedure)
44310
958.30
Ileostomy or jejunostomy, non-tube
44312
903.02
544.97
Revision of ileostomy; simple (release of superficial
							 scar) (separate procedure)
44314
926.58
Revision of ileostomy; complicated (reconstruction
							 in-depth) (separate procedure)
44316
1,273.24
Continent ileostomy (Kock procedure) (separate
							 procedure)
44320
1,093.26
Colostomy or skin level cecostomy;
44322
902.03
Colostomy or skin level cecostomy; with multiple
							 biopsies (eg, for congenital megacolon) (separate procedure)
44340
903.02
552.79
Revision of colostomy; simple (release of superficial
							 scar) (separate procedure)
44345
959.13
Revision of colostomy; complicated (reconstruction
							 in-depth) (separate procedure)
44346
1,071.98
Revision of colostomy; with repair of paracolostomy
							 hernia (separate procedure)
44360
425.84
153.96
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; diagnostic, with or without
							 collection of specimen(s) by brushing or washing (separate
							 procedure)
44361
425.84
169.19
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with biopsy, single or
							 multiple
44363
425.84
201.36
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with removal of foreign
							 body
44364
425.84
215.08
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with removal of tumor(s), polyp(s),
							 or other lesion(s) by snare technique
44365
425.84
191.55
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with removal of tumor(s), polyp(s),
							 or other lesion(s) by hot biopsy forceps or bipolar cautery
44366
425.84
254.18
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with control of bleeding (eg,
							 injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler,
							 plasma coagulator)
44369
425.84
258.23
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s),
							 or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar
							 cautery or snare technique
44370
1,116.37
279.12
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with transendoscopic stent placement
							 (includes predilation)
44372
425.84
249.56
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with placement of percutaneous
							 jejunostomy tube
44373
425.84
200.44
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, not including ileum; with conversion of percutaneous
							 gastrostomy tube to percutaneous jejunostomy tube
44376
425.84
295.40
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, including ileum; diagnostic, with or without collection of
							 specimen(s) by brushing or washing (separate procedure)
44377
425.84
313.23
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, including ileum; with biopsy, single or
							 multiple
44378
425.84
403.21
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, including ileum; with control of bleeding (eg, injection,
							 bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma
							 coagulator)
44379
1,116.37
430.71
Small intestinal endoscopy, enteroscopy beyond second
							 portion of duodenum, including ileum; with transendoscopic stent placement
							 (includes predilation)
44380
425.84
68.17
Ileoscopy, through stoma; diagnostic, with or without
							 collection of specimen(s) by brushing or washing (separate
							 procedure)
44382
425.84
80.56
Ileoscopy, through stoma; with biopsy, single or
							 multiple
44383
1,116.37
172.96
Ileoscopy, through stoma; with transendoscopic stent
							 placement (includes predilation)
44385
395.43
256.73
Endoscopic evaluation of small intestinal (abdominal
							 or pelvic) pouch; diagnostic, with or without collection of specimen(s) by
							 brushing or washing (separate procedure)
44386
395.43
384.47
Endoscopic evaluation of small intestinal (abdominal
							 or pelvic) pouch; with biopsy, single or multiple
44388
395.43
361.83
Colonoscopy through stoma; diagnostic, with or
							 without collection of specimen(s) by brushing or washing (separate
							 procedure)
44389
395.43
431.17
Colonoscopy through stoma; with biopsy, single or
							 multiple
44390
395.43
495.82
Colonoscopy through stoma; with removal of foreign
							 body
44391
395.43
564.24
Colonoscopy through stoma; with control of bleeding
							 (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe,
							 stapler, plasma coagulator)
44392
395.43
461.55
Colonoscopy through stoma; with removal of tumor(s),
							 polyp(s), or other lesion(s) by hot biopsy forceps or bipolar
							 cautery
44393
395.43
521.33
Colonoscopy through stoma; with ablation of tumor(s),
							 polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps,
							 bipolar cautery or snare technique
44394
395.43
537.89
Colonoscopy through stoma; with removal of tumor(s),
							 polyp(s), or other lesion(s) by snare technique
44397
1,116.37
263.30
Colonoscopy through stoma; with transendoscopic stent
							 placement (includes predilation)
44500
144.72
25.45
Introduction of long gastrointestinal tube (eg,
							 Miller-Abbott) (separate procedure)
44602
1,227.49
Suture of small intestine (enterorrhaphy) for
							 perforated ulcer, diverticulum, wound, injury or rupture; single
							 perforation
44603
1,403.32
Suture of small intestine (enterorrhaphy) for
							 perforated ulcer, diverticulum, wound, injury or rupture; multiple
							 perforations
44604
968.31
Suture of large intestine (colorrhaphy) for
							 perforated ulcer, diverticulum, wound, injury or rupture (single or multiple
							 perforations); without colostomy
44605
1,199.97
Suture of large intestine (colorrhaphy) for
							 perforated ulcer, diverticulum, wound, injury or rupture (single or multiple
							 perforations); with colostomy
44615
983.60
Intestinal stricturoplasty (enterotomy and
							 enterorrhaphy) with or without dilation, for intestinal obstruction
44620
784.69
Closure of enterostomy, large or small
							 intestine;
44625
929.77
Closure of enterostomy, large or small intestine;
							 with resection and anastomosis other than colorectal
44626
1,478.24
Closure of enterostomy, large or small intestine;
							 with resection and colorectal anastomosis (eg, closure of Hartmann type
							 procedure)
44640
1,288.89
Closure of intestinal cutaneous fistula
44650
1,338.61
Closure of enteroenteric or enterocolic
							 fistula
44660
1,294.33
Closure of enterovesical fistula; without intestinal
							 or bladder resection
44661
1,451.66
Closure of enterovesical fistula; with intestine
							 and/or bladder resection
44680
972.83
Intestinal plication (separate procedure)
44700
944.28
Exclusion of small intestine from pelvis by mesh or
							 other prosthesis, or native tissue (eg, bladder or omentum)
44701
158.82
Intraoperative colonic lavage (List separately in
							 addition to code for primary procedure)
44715
I.C.
Backbench standard preparation of cadaver or living
							 donor intestine allograft prior to transplantation, including mobilization and
							 fashioning of the superior mesenteric artery and vein
44720
250.39
Backbench reconstruction of cadaver or living donor
							 intestine allograft prior to transplantation; venous anastomosis,
							 each
44721
364.28
Backbench reconstruction of cadaver or living donor
							 intestine allograft prior to transplantation; arterial anastomosis,
							 each
44799
I.C.
Unlisted procedure, intestine
44800
702.12
Excision of Meckel's diverticulum (diverticulectomy)
							 or omphalomesenteric duct
44820
767.57
Excision of lesion of mesentery (separate
							 procedure)
44850
683.01
Suture of mesentery (separate procedure)
44899
I.C.
Unlisted procedure, Meckel's diverticulum and the
							 mesentery
44900
688.30
Incision and drainage of appendiceal abscess;
							 open
44901
1,219.89
Incision and drainage of appendiceal abscess;
							 percutaneous
44950
590.85
Appendectomy;
44955
79.87
Appendectomy; when done for indicated purpose at time
							 of other major procedure (not as separate procedure) (List separately in
							 addition to code for primary procedure)
44960
787.35
Appendectomy; for ruptured appendix with abscess or
							 generalized peritonitis
44970
543.97
Laparoscopy, surgical, appendectomy
44979
I.C.
Unlisted laparoscopy procedure, appendix
45000
487.69
377.79
Transrectal drainage of pelvic abscess
45005
487.69
260.81
Incision and drainage of submucosal abscess,
							 rectum
45020
487.69
484.28
Incision and drainage of deep supralevator,
							 pelvirectal, or retrorectal abscess
45100
1,016.44
267.61
Biopsy of anorectal wall, anal approach (eg,
							 congenital megacolon)
45108
1,016.44
325.09
Anorectal myomectomy
45110
1,702.79
Proctectomy; complete, combined abdominoperineal,
							 with colostomy
45111
998.75
Proctectomy; partial resection of rectum,
							 transabdominal approach
45112
1,739.39
Proctectomy, combined abdominoperineal, pull-through
							 procedure (eg, colo-anal anastomosis)
45113
1,790.89
Proctectomy, partial, with rectal mucosectomy,
							 ileoanal anastomosis, creation of ileal reservoir (S or J), with or without
							 loop ileostomy
45114
1,633.96
Proctectomy, partial, with anastomosis; abdominal and
							 transsacral approach
45116
1,480.23
Proctectomy, partial, with anastomosis; transsacral
							 approach only (Kraske type)
45119
1,791.72
Proctectomy, combined abdominoperineal pull-through
							 procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg,
							 J-pouch), with diverting enterostomy when performed
45120
1,429.66
Proctectomy, complete (for congenital megacolon),
							 abdominal and perineal approach; with pull-through procedure and anastomosis
							 (eg, Swenson, Duhamel, or Soave type operation)
45121
1,571.69
Proctectomy, complete (for congenital megacolon),
							 abdominal and perineal approach; with subtotal or total colectomy, with
							 multiple biopsies
45123
1,011.82
Proctectomy, partial, without anastomosis, perineal
							 approach
45126
2,652.87
Pelvic exenteration for colorectal malignancy, with
							 proctectomy (with or without colostomy), with removal of bladder and ureteral
							 transplantations, and/or hysterectomy, or cervicectomy, with or without removal
							 of tube(s), with or without removal of ovary(s), or any combination
							 thereof
45130
990.47
Excision of rectal procidentia, with anastomosis;
							 perineal approach
45135
1,218.71
Excision of rectal procidentia, with anastomosis;
							 abdominal and perineal approach
45136
1,693.72
Excision of ileoanal reservoir with
							 ileostomy
45150
1,016.44
360.28
Division of stricture of rectum
45160
1,016.44
903.48
Excision of rectal tumor by proctotomy, transsacral
							 or transcoccygeal approach
45170
1,016.44
710.52
Excision of rectal tumor, transanal
							 approach
45190
1,016.44
618.57
Destruction of rectal tumor (eg, electrodesiccation,
							 electrosurgery, laser ablation, laser resection, cryosurgery) transanal
							 approach
45300
63.99
108.60
Proctosigmoidoscopy, rigid; diagnostic, with or
							 without collection of specimen(s) by brushing or washing (separate
							 procedure)
45303
388.93
941.52
Proctosigmoidoscopy, rigid; with dilation (eg,
							 balloon, guide wire, bougie)
45305
388.93
179.92
Proctosigmoidoscopy, rigid; with biopsy, single or
							 multiple
45307
959.15
205.87
Proctosigmoidoscopy, rigid; with removal of foreign
							 body
45308
388.93
174.77
Proctosigmoidoscopy, rigid; with removal of single
							 tumor, polyp, or other lesion by hot biopsy forceps or bipolar
							 cautery
45309
388.93
203.72
Proctosigmoidoscopy, rigid; with removal of single
							 tumor, polyp, or other lesion by snare technique
45315
388.93
219.69
Proctosigmoidoscopy, rigid; with removal of multiple
							 tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or
							 snare technique
45317
388.93
206.26
Proctosigmoidoscopy, rigid; with control of bleeding
							 (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe,
							 stapler, plasma coagulator)
45320
959.15
211.02
Proctosigmoidoscopy, rigid; with ablation of
							 tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy
							 forceps, bipolar cautery or snare technique (eg, laser)
45321
959.15
96.33
Proctosigmoidoscopy, rigid; with decompression of
							 volvulus
45327
1,116.37
109.90
Proctosigmoidoscopy, rigid; with transendoscopic
							 stent placement (includes predilation)
45330
88.25
145.64
Sigmoidoscopy, flexible; diagnostic, with or without
							 collection of specimen(s) by brushing or washing (separate
							 procedure)
45331
227.79
188.33
Sigmoidoscopy, flexible; with biopsy, single or
							 multiple
45332
227.79
308.48
Sigmoidoscopy, flexible; with removal of foreign
							 body
45333
388.93
308.18
Sigmoidoscopy, flexible; with removal of tumor(s),
							 polyp(s), or other lesion(s) by hot biopsy forceps or bipolar
							 cautery
45334
388.93
160.88
Sigmoidoscopy, flexible; with control of bleeding
							 (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe,
							 stapler, plasma coagulator)
45335
227.79
250.15
Sigmoidoscopy, flexible; with directed submucosal
							 injection(s), any substance
45337
227.79
138.42
Sigmoidoscopy, flexible; with decompression of
							 volvulus, any method
45338
388.93
341.97
Sigmoidoscopy, flexible; with removal of tumor(s),
							 polyp(s), or other lesion(s) by snare technique
45339
388.93
326.73
Sigmoidoscopy, flexible; with ablation of tumor(s),
							 polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps,
							 bipolar cautery or snare technique
45340
388.93
447.38
Sigmoidoscopy, flexible; with dilation by balloon,
							 one or more strictures
45341
388.93
152.92
Sigmoidoscopy, flexible; with endoscopic ultrasound
							 examination
45342
388.93
232.42
Sigmoidoscopy, flexible; with transendoscopic
							 ultrasound guided intramural or transmural fine needle
							 aspiration/biopsy(s)
45345
1,116.37
167.81
Sigmoidoscopy, flexible; with transendoscopic stent
							 placement (includes predilation)
45355
395.43
198.75
Colonoscopy, rigid or flexible, transabdominal via
							 colotomy, single or multiple
45378
395.43
423.58
Colonoscopy, flexible, proximal to splenic flexure;
							 diagnostic, with or without collection of specimen(s) by brushing or washing,
							 with or without colon decompression (separate procedure)
45379
395.43
533.72
Colonoscopy, flexible, proximal to splenic flexure;
							 with removal of foreign body
45380
395.43
506.04
Colonoscopy, flexible, proximal to splenic flexure;
							 with biopsy, single or multiple
45381
395.43
493.58
Colonoscopy, flexible, proximal to splenic flexure;
							 with directed submucosal injection(s), any substance
45382
395.43
673.41
Colonoscopy, flexible, proximal to splenic flexure;
							 with control of bleeding (eg, injection, bipolar cautery, unipolar cautery,
							 laser, heater probe, stapler, plasma coagulator)
45383
395.43
593.74
Colonoscopy, flexible, proximal to splenic flexure;
							 with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal
							 by hot biopsy forceps, bipolar cautery or snare technique
45384
395.43
493.72
Colonoscopy, flexible, proximal to splenic flexure;
							 with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or
							 bipolar cautery
45385
395.43
565.92
Colonoscopy, flexible, proximal to splenic flexure;
							 with removal of tumor(s), polyp(s), or other lesion(s) by snare
							 technique
45386
395.43
738.01
Colonoscopy, flexible, proximal to splenic flexure;
							 with dilation by balloon, one or more strictures
45387
1,116.37
334.12
Colonoscopy, flexible, proximal to splenic flexure;
							 with transendoscopic stent placement (includes predilation)
45391
395.43
291.78
Colonoscopy, flexible, proximal to splenic flexure;
							 with endoscopic ultrasound examination
45392
395.43
367.07
Colonoscopy, flexible, proximal to splenic flexure;
							 with transendoscopic ultrasound guided intramural or transmural fine needle
							 aspiration/biopsy(s)
45395
1,841.46
Laparoscopy, surgical; proctectomy, complete,
							 combined abdominoperineal, with colostomy
45397
1,985.63
Laparoscopy, surgical; proctectomy, combined
							 abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with
							 creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when
							 performed
45400
1,063.52
Laparoscopy, surgical; proctopexy (for
							 prolapse)
45402
1,416.51
Laparoscopy, surgical; proctopexy (for prolapse),
							 with sigmoid resection
45499
I.C.
Unlisted laparoscopy procedure, rectum
45500
1,016.44
467.45
Proctoplasty; for stenosis
45505
1,347.83
510.58
Proctoplasty; for prolapse of mucous
							 membrane
45520
35.44
123.84
Perirectal injection of sclerosing solution for
							 prolapse
45540
961.61
Proctopexy (eg, for prolapse); abdominal
							 approach
45541
837.64
Proctopexy (eg, for prolapse); perineal
							 approach
45550
1,339.24
Proctopexy (eg, for prolapse); with sigmoid
							 resection, abdominal approach
45560
1,347.83
667.27
Repair of rectocele (separate procedure)
45562
1,011.10
Exploration, repair, and presacral drainage for
							 rectal injury;
45563
1,478.19
Exploration, repair, and presacral drainage for
							 rectal injury; with colostomy
45800
1,126.33
Closure of rectovesical fistula;
45805
1,300.02
Closure of rectovesical fistula; with
							 colostomy
45820
1,123.21
Closure of rectourethral fistula;
45825
1,333.03
Closure of rectourethral fistula; with
							 colostomy
45900
214.22
182.78
Reduction of procidentia (separate procedure) under
							 anesthesia
45905
1,016.44
156.81
Dilation of anal sphincter (separate procedure) under
							 anesthesia other than local
45910
1,016.44
185.83
Dilation of rectal stricture (separate procedure)
							 under anesthesia other than local
45915
487.69
312.96
Removal of fecal impaction or foreign body (separate
							 procedure) under anesthesia
45990
45999
1,016.44
I.C.
101.53
Anorectal exam, surgical, requiring anesthesia
							 (general, spinal, or epidural), diagnostic Unlisted procedure,
							 rectum
46020
1,016.44
238.55
Placement of seton
46030
214.22
121.10
Removal of anal seton, other marker
46040
1,016.44
475.27
Incision and drainage of ischiorectal and/or
							 perirectal abscess (separate procedure)
46045
1,016.44
371.29
Incision and drainage of intramural, intramuscular,
							 or submucosal abscess, transanal, under anesthesia
46050
487.69
177.61
Incision and drainage, perianal abscess,
							 superficial
46060
1,016.44
409.42
Incision and drainage of ischiorectal or intramural
							 abscess, with fistulectomy or fistulotomy, submuscular, with or without
							 placement of seton
46070
487.69
200.54
Incision, anal septum (infant)
46080
1,016.44
219.55
Sphincterotomy, anal, division of sphincter (separate
							 procedure)
46083
89.73
165.29
Incision of thrombosed hemorrhoid,
							 external
46200
1,016.44
363.87
Fissurectomy, with or without
							 sphincterotomy
46210
1,016.44
354.28
Cryptectomy; single
46211
1,016.44
466.71
Cryptectomy; multiple (separate
							 procedure)
46220
1,016.44
181.48
Papillectomy or excision of single tag, anus
							 (separate procedure)
46221
117.31
232.59
Hemorrhoidectomy, by simple ligature (eg, rubber
							 band)
46230
1,016.44
248.86
Excision of external hemorrhoid tags and/or multiple
							 papillae
46250
1,016.44
415.90
Hemorrhoidectomy, external, complete
46255
1,016.44
464.31
Hemorrhoidectomy, internal and external,
							 simple;
46257
1,016.44
367.77
Hemorrhoidectomy, internal and external, simple; with
							 fissurectomy
46258
1,016.44
400.96
Hemorrhoidectomy, internal and external, simple; with
							 fistulectomy, with or without fissurectomy
46260
1,016.44
416.91
Hemorrhoidectomy, internal and external, complex or
							 extensive;
46261
1,016.44
466.00
Hemorrhoidectomy, internal and external, complex or
							 extensive; with fissurectomy
46262
1,016.44
484.51
Hemorrhoidectomy, internal and external, complex or
							 extensive; with fistulectomy, with or without fissurectomy
46270
1,016.44
439.92
Surgical treatment of anal fistula
(fistulectomy/fistulotomy); subcutaneous
46275
1,016.44
456.03
Surgical treatment of anal fistula
(fistulectomy/fistulotomy); submuscular
46280
1,016.44
407.27
Surgical treatment of anal fistula
(fistulectomy/fistulotomy); complex or multiple, with
							 or without placement of seton
46285
1,016.44
431.53
Surgical treatment of anal fistula
(fistulectomy/fistulotomy); second stage
46288
1,016.44
477.84
Closure of anal fistula with rectal advancement
							 flap
46320
83.10
165.19
Enucleation or excision of external thrombotic
							 hemorrhoid
46500
105.18
192.43
Injection of sclerosing solution,
							 hemorrhoids
46505
214.22
256.51
Chemodenervation of internal anal
							 sphincter
46600
28.19
87.94
Anoscopy; diagnostic, with or without collection of
							 specimen(s) by brushing or washing (separate procedure)
46604
388.93
537.25
Anoscopy; with dilation (eg, balloon, guide wire,
							 bougie)
46606
140.47
219.96
Anoscopy; with biopsy, single or multiple
46608
388.93
236.98
Anoscopy; with removal of foreign body
46610
959.15
228.17
Anoscopy; with removal of single tumor, polyp, or
							 other lesion by hot biopsy forceps or bipolar cautery
46611
388.93
184.94
Anoscopy; with removal of single tumor, polyp, or
							 other lesion by snare technique
46612
959.15
286.99
Anoscopy; with removal of multiple tumors, polyps, or
							 other lesions by hot biopsy forceps, bipolar cautery or snare
							 technique
46614
78.33
138.18
Anoscopy; with control of bleeding (eg, injection,
							 bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma
							 coagulator)
46615
959.15
158.23
Anoscopy; with ablation of tumor(s), polyp(s), or
							 other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery
							 or snare technique
46700
1,016.44
574.09
Anoplasty, plastic operation for stricture;
							 adult
46705
455.33
Anoplasty, plastic operation for stricture;
							 infant
46706
1,347.83
153.74
Repair of anal fistula with fibrin glue
46710
974.25
Repair of ileoanal pouch fistula/sinus (eg, perineal
							 or vaginal), pouch advancement; transperineal approach
46712
2,018.87
Repair of ileoanal pouch fistula/sinus (eg, perineal
							 or vaginal), pouch advancement; combined transperineal and transabdominal
							 approach
46715
453.48
Repair of low imperforate anus; with anoperineal
							 fistula (cut-back procedure)
46716
1,037.16
Repair of low imperforate anus; with transposition of
							 anoperineal or anovestibular fistula
46730
1,668.44
Repair of high imperforate anus without fistula;
							 perineal or sacroperineal approach
46735
1,971.04
Repair of high imperforate anus without fistula;
							 combined transabdominal and sacroperineal approaches
46740
1,869.96
Repair of high imperforate anus with rectourethral or
							 rectovaginal fistula; perineal or sacroperineal approach
46742
2,167.15
Repair of high imperforate anus with rectourethral or
							 rectovaginal fistula; combined transabdominal and sacroperineal
							 approaches
46744
3,091.84
Repair of cloacal anomaly by anorectovaginoplasty and
							 urethroplasty, sacroperineal approach
46746
3,479.67
Repair of cloacal anomaly by anorectovaginoplasty and
							 urethroplasty, combined abdominal and sacroperineal approach;
46748
3,550.83
Repair of cloacal anomaly by anorectovaginoplasty and
							 urethroplasty, combined abdominal and sacroperineal approach; with vaginal
							 lengthening by intestinal graft or pedicle flaps
46750
1,347.83
692.38
Sphincteroplasty, anal, for incontinence or prolapse;
							 adult
46751
582.22
Sphincteroplasty, anal, for incontinence or prolapse;
							 child
46753
1,016.44
523.22
Graft (Thiersch operation) for rectal incontinence
							 and/or prolapse
46754
1,016.44
270.19
Removal of Thiersch wire or suture, anal
							 canal
46760
1,347.83
983.70
Sphincteroplasty, anal, for incontinence, adult;
							 muscle transplant
46761
1,347.83
847.69
Sphincteroplasty, anal, for incontinence, adult;
							 levator muscle imbrication (Park posterior anal repair)
46762
1,347.83
827.68
Sphincteroplasty, anal, for incontinence, adult;
							 implantation artificial sphincter
46900
114.73
213.92
Destruction of lesion(s), anus (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple;
							 chemical
46910
124.66
225.92
Destruction of lesion(s), anus (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple;
							 electrodesiccation
46916
65.22
226.74
Destruction of lesion(s), anus (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple;
							 cryosurgery
46917
889.48
482.90
Destruction of lesion(s), anus (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple; laser
							 surgery
46922
889.48
241.55
Destruction of lesion(s), anus (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical
							 excision
46924
889.48
523.41
Destruction of lesion(s), anus (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser
							 surgery, electrosurgery, cryosurgery, chemosurgery)
46934
195.26
383.86
Destruction of hemorrhoids, any method;
							 internal
46935
134.59
258.67
Destruction of hemorrhoids, any method;
							 external
46936
204.09
392.44
Destruction of hemorrhoids, any method; internal and
							 external
46937
1,016.44
238.61
Cryosurgery of rectal tumor; benign
46938
1,347.83
399.25
Cryosurgery of rectal tumor; malignant
46940
89.00
197.84
Curettage or cautery of anal fissure, including
							 dilation of anal sphincter (separate procedure); initial
46942
85.32
182.47
Curettage or cautery of anal fissure, including
							 dilation of anal sphincter (separate procedure); subsequent
46945
148.19
263.91
Ligation of internal hemorrhoids; single
							 procedure
46946
487.69
289.26
Ligation of internal hemorrhoids; multiple
							 procedures
46947
1,347.83
343.87
Hemorrhoidopexy (eg, for prolapsing internal
							 hemorrhoids) by stapling
46999
I.C.
Unlisted procedure, anus
47000
417.18
315.64
Biopsy of liver, needle; percutaneous
47001
98.60
Biopsy of liver, needle; when done for indicated
							 purpose at time of other major procedure (List separately in addition to code
							 for primary procedure)
47010
1,096.99
Hepatotomy; for open drainage of abscess or cyst, one
							 or two stages
47011
190.58
Hepatotomy; for percutaneous drainage of abscess or
							 cyst, one or two stages
47015
1,042.76
Laparotomy, with aspiration and/or injection of
							 hepatic parasitic (eg, amoebic or echinococcal) cyst(s) or
							 abscess(es)
47100
766.66
Biopsy of liver, wedge
47120
2,137.59
Hepatectomy, resection of liver; partial
							 lobectomy
47122
3,168.14
Hepatectomy, resection of liver;
							 trisegmentectomy
47125
2,845.06
Hepatectomy, resection of liver; total left
							 lobectomy
47130
3,056.68
Hepatectomy, resection of liver; total right
							 lobectomy
47133
I.C.
Donor hepatectomy (including cold preservation), from
							 cadaver donor
47135
4,506.60
Liver allotransplantation; orthotopic, partial or
							 whole, from cadaver or living donor, any age
47136
3,843.84
Liver allotransplantation; heterotopic, partial or
							 whole, from cadaver or living donor, any age
47140
3,187.84
Donor hepatectomy (including cold preservation), from
							 living donor; left lateral segment only (segments II and III)
47141
3,792.12
Donor hepatectomy (including cold preservation), from
							 living donor; total left lobectomy (segments II, III and IV)
47142
4,168.62
Donor hepatectomy (including cold preservation), from
							 living donor; total right lobectomy (segments V, VI, VII and VIII)
47143
I.C.
Backbench standard preparation of cadaver donor whole
							 liver graft prior to allotransplantation, including cholecystectomy, if
							 necessary, and dissection and removal of surrounding soft tissues to prepare
							 the vena cava, portal vein, hepatic artery, and common bile duct for
							 implantation; without trisegment or lobe split
47144
I.C.
Backbench standard preparation of cadaver donor whole
							 liver graft prior to allotransplantation, including cholecystectomy, if
							 necessary, and dissection and removal of surrounding soft tissues to prepare
							 the vena cava, portal vein, hepatic artery, and common bile duct for
							 implantation; with trisegment split of whole liver graft into two partial liver
							 grafts (ie, left lateral segment (segments II and III) and right trisegment
							 (segments I and IV through VIII))
47145
I.C.
Backbench standard preparation of cadaver donor whole
							 liver graft prior to allotransplantation, including cholecystectomy, if
							 necessary, and dissection and removal of surrounding soft tissues to prepare
							 the vena cava, portal vein, hepatic artery, and common bile duct for
							 implantation; with lobe split of whole liver graft into two partial liver
							 grafts (ie, left lobe (segments II, III, and IV) and right lobe (segments I and
							 V through VIII))
47146
312.13
Backbench reconstruction of cadaver or living donor
							 liver graft prior to allotransplantation; venous anastomosis, each
47147
363.82
Backbench reconstruction of cadaver or living donor
							 liver graft prior to allotransplantation; arterial anastomosis,
							 each
47300
1,019.32
Marsupialization of cyst or abscess of
							 liver
47350
1,247.04
Management of liver hemorrhage; simple suture of
							 liver wound or injury
47360
1,691.08
Management of liver hemorrhage; complex suture of
							 liver wound or injury, with or without hepatic artery ligation
47361
2,794.11
Management of liver hemorrhage; exploration of
							 hepatic wound, extensive debridement, coagulation and/or suture, with or
							 without packing of liver
47362
1,289.24
Management of liver hemorrhage; re-exploration of
							 hepatic wound for removal of packing
47370
1,146.56
Laparoscopy, surgical, ablation of one or more liver
							 tumor(s); radiofrequency
47371
1,153.12
Laparoscopy, surgical, ablation of one or more liver
							 tumor(s); cryosurgical
47379
I.C.
Unlisted laparoscopic procedure, liver
47380
1,333.48
Ablation, open, of one or more liver tumor(s);
							 radiofrequency
47381
1,364.87
Ablation, open, of one or more liver tumor(s);
							 cryosurgical
47382
1,921.50
830.02
Ablation, one or more liver tumor(s), percutaneous,
							 radiofrequency
47399
I.C.
Unlisted procedure, liver
47400
1,938.28
Hepaticotomy or hepaticostomy with exploration,
							 drainage, or removal of calculus
47420
1,225.85
Choledochotomy or choledochostomy with exploration,
							 drainage, or removal of calculus, with or without cholecystotomy; without
							 transduodenal sphincterotomy or sphincteroplasty
47425
1,238.34
Choledochotomy or choledochostomy with exploration,
							 drainage, or removal of calculus, with or without cholecystotomy; with
							 transduodenal sphincterotomy or sphincteroplasty
47460
1,165.85
Transduodenal sphincterotomy or sphincteroplasty,
							 with or without transduodenal extraction of calculus (separate
							 procedure)
47480
779.58
Cholecystotomy or cholecystostomy with exploration,
							 drainage, or removal of calculus (separate procedure)
47490
537.67
Percutaneous cholecystostomy
47500
101.36
Injection procedure for percutaneous transhepatic
							 cholangiography
47505
39.12
Injection procedure for cholangiography through an
							 existing catheter (eg, percutaneous transhepatic or T-tube)
47510
1,282.04
506.74
Introduction of percutaneous transhepatic catheter
							 for biliary drainage
47511
1,282.04
618.18
Introduction of percutaneous transhepatic stent for
							 internal and external biliary drainage
47525
686.16
888.89
Change of percutaneous biliary drainage
							 catheter
47530
686.16
1,696.69
Revision and/or reinsertion of transhepatic
							 tube
47550
156.53
Biliary endoscopy, intraoperative (choledochoscopy)
							 (List separately in addition to code for primary procedure)
47552
1,282.04
330.32
Biliary endoscopy, percutaneous via T-tube or other
							 tract; diagnostic, with or without collection of specimen(s) by brushing and/or
							 washing (separate procedure)
47553
1,282.04
326.98
Biliary endoscopy, percutaneous via T-tube or other
							 tract; with biopsy, single or multiple
47554
1,282.04
490.58
Biliary endoscopy, percutaneous via T-tube or other
							 tract; with removal of calculus/calculi
47555
1,282.04
391.40
Biliary endoscopy, percutaneous via T-tube or other
							 tract; with dilation of biliary duct stricture(s) without stent
47556
1,282.04
442.23
Biliary endoscopy, percutaneous via T-tube or other
							 tract; with dilation of biliary duct stricture(s) with stent
47560
1,537.09
252.84
Laparoscopy, surgical; with guided transhepatic
							 cholangiography, without biopsy
47561
1,537.09
276.85
Laparoscopy, surgical; with guided transhepatic
							 cholangiography with biopsy
47562
2,034.73
676.97
Laparoscopy, surgical; cholecystectomy
47563
2,034.73
696.53
Laparoscopy, surgical; cholecystectomy with
							 cholangiography
47564
2,034.73
803.27
Laparoscopy, surgical; cholecystectomy with
							 exploration of common duct
47570
716.26
Laparoscopy, surgical;
							 cholecystoenterostomy
47579
I.C.
Unlisted laparoscopy procedure, biliary
							 tract
47600
953.81
Cholecystectomy;
47605
897.75
Cholecystectomy; with cholangiography
47610
1,144.74
Cholecystectomy with exploration of common
							 duct;
47612
1,153.88
Cholecystectomy with exploration of common duct; with
							 choledochoenterostomy
47620
1,250.96
Cholecystectomy with exploration of common duct; with
							 transduodenal sphincterotomy or sphincteroplasty, with or without
							 cholangiography
47630
1,282.04
567.63
Biliary duct stone extraction, percutaneous via
							 T-tube tract, basket, or snare (eg, Burhenne technique)
47700
960.42
Exploration for congenital atresia of bile ducts,
							 without repair, with or without liver biopsy, with or
without cholangiography
47701
1,596.55
Portoenterostomy (eg, Kasai procedure)
47711
1,421.45
Excision of bile duct tumor, with or without primary
							 repair of bile duct; extrahepatic
47712
1,818.85
Excision of bile duct tumor, with or without
							 primary
repair of bile duct; intrahepatic
47715
1,198.14
Excision of choledochal cyst
47720
1,034.35
Cholecystoenterostomy; direct
47721
1,215.74
Cholecystoenterostomy; with
							 gastroenterostomy
47740
1,177.29
Cholecystoenterostomy; Roux-en-Y
47741
1,333.67
Cholecys to en terostomy; Roux-en-Y with
gastroenterostomy
47760
1,954.31
Anastomosis, of extrahepatic biliary ducts
							 and
gastrointestinal tract
47765
2,513.11
Anastomosis, of intrahepatic ducts and
gastrointestinal tract
47780
2,126.42
Anastomosis, Roux-en-Y, of extrahepatic biliary
							 ducts
and gastrointestinal tract
47785
2,743.16
Anastomosis, Roux-en-Y, of intrahepatic biliary
							 ducts
and gastrointestinal tract
47800
1,437.55
Reconstruction, plastic, of extrahepatic biliary
							 ducts
with end-to-end anastomosis
47801
1,012.82
Placement of choledochal stent
47802
1,378.03
U-tube hepaticoenterostomy
47900
1,248.97
Suture of extrahepatic biliary duct for
							 pre-existing
injury (separate procedure)
47999
I.C.
Unlisted procedure, biliary tract
48000
1,705.34
Placement of drains, peripancreatic, for
							 acute
pancreatitis;
48001
2,104.38
Placement of drains, peripancreatic, for
							 acute
pancreatitis; with cholecystostomy, gastrostomy,
							 and
jejunostomy
48020
1,054.11
Removal of pancreatic calculus
48100
805.12
Biopsy of pancreas, open (eg, fine needle
							 aspiration,
needle core biopsy, wedge biopsy)
48102
417.18
572.31
Biopsy of pancreas, percutaneous needle
48105
2,585.65
Resection or debridement of pancreas and
peripancreatic tissue for acute necrotizing
							 pancreatitis
48120
1,004.08
Excision of lesion of pancreas (eg, cyst,
							 adenoma)
48140
1,420.46
Pancreatectomy, distal subtotal, with or
							 without
splenectomy; without
							 pancreaticojejunostomy
48145
1,472.07
Pancreatectomy, distal subtotal, with or
							 without
splenectomy; with pancreaticojejunostomy
48146
1,694.04
Pancreatectomy, distal, near-total with preservation
							 of duodenum (Child-type procedure)
48148
1,124.30
Excision of ampulla of Vater
48150
2,850.34
Pancreatectomy, proximal subtotal with total duode
							 nectomy , partialgas trectomy,
choledochoenterostomy and gastrojejunostomy
							 (Whipple-type procedure); with pancreatojejunostomy
48152
2,635.18
Pancreatectomy, proximal subtotal with total
							 duodenectomy, partial gastrectomy,
choledochoenterostomy and gastrojejunostomy
							 (Whipple-type procedure) ; without pancreatojejunostomy
48153
2,847.52
Pancreatectomy, proximal subtotal with near-total
							 duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing,
							 Whipple-type procedure); with pancreatojejunostomy
48154
2,649.76
Pancreatectomy, proximal subtotal with near-total
							 duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing,
							 Whipple-type procedure); without pancreatojejunostomy
48155
1,640.98
Pancreatectomy, total
48160
I.C.
Pancreatectomy, total or subtotal, with autologous
							 transplantation of pancreas or pancreatic islet cells
48400
100.99
Injection procedure for intraoperative
							 pancreatography (List separately in addition to code for primary
							 procedure)
48500
1,021.66
Marsupialization of pancreatic cyst
48510
983.47
External drainage, pseudocyst of pancreas;
							 open
48511
1,089.30
External drainage, pseudocyst of pancreas;
							 percutaneous
48520
989.86
Internal anastomosis of pancreatic cyst to
							 gastrointestinal tract; direct
48540
1,190.53
Internal anastomosis of pancreatic cyst to
							 gastrointestinal tract; Roux-en-Y
48545
1,203.33
Pancreatorrhaphy for injury
48547
1,613.11
Duodenal exclusion with gastrojejunostomy for
							 pancreatic injury
48548
1,514.16
Pancreaticojejunostomy, side-to-side anastomosis
							 (Puestow-type operation)
48550
I.C.
Donor pancreatectomy (including cold preservation),
							 with or without duodenal segment for transplantation
48551
I.C.
Backbench standard preparation of cadaver donor
							 pancreas allograft prior to transplantation, including dissection of allograft
							 from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct,
							 ligation of mesenteric vessels, and Y-graft arterial anastomoses from iliac
							 artery to superior mesenteric artery and to splenic artery
48552
215.94
Backbench reconstruction of cadaver donor pancreas
							 allograft prior to transplantation, venous anastomosis, each
48554
2,282.86
Transplantation of pancreatic allograft
48556
1,117.40
Removal of transplanted pancreatic
							 allograft
48999
I.C.
Unlisted procedure, pancreas
49000
713.79
Exploratory laparotomy, exploratory celiotomy with or
							 without biopsy(s) (separate procedure)
49002
49010
902.64
869.34
Reopening of recent laparotomy Exploration,
							 retroperitoneal area with or without biopsy(s) (separate procedure)
49020
1,450.98
Drainage of peritoneal abscess or localized
							 peritonitis, exclusive of appendiceal abscess; open
49021
1,058.19
Drainage of peritoneal abscess or localized
							 peritonitis, exclusive of appendiceal abscess; percutaneous
49040
909.05
Drainage of subdiaphragmatic or subphrenic abscess;
							 open
49041
1,051.56
Drainage of subdiaphragmatic or subphrenic abscess;
							 percutaneous
49060
1,019.22
Drainage of retroperitoneal abscess; open
49061
1,039.34
Drainage of retroperitoneal abscess;
							 percutaneous
49062
698.05
Drainage of extraperitoneal lymphocele to peritoneal
							 cavity, open
49080
232.48
203.15
Peritoneocentesis, abdominal paracentesis, or
							 peritoneal lavage (diagnostic or therapeutic); initial
49081
232.48
172.76
Peritoneocentesis, abdominal paracentesis, or
							 peritoneal lavage (diagnostic or therapeutic); subsequent
49180
417.18
190.48
Biopsy, abdominal or retroperitoneal mass,
							 percutaneous needle
49203
1,103.48
Excision or destruction, open, intra-abdominal
							 tumors, cysts or endometriomas, one or more peritoneal, mesenteric, or
							 retroperitoneal primary or secondary tumors; largest tumor five cm diameter or
							 less
49204
1,402.53
Excision or destruction, open, intra-abdominal
							 tumors, cysts or endometriomas, one or more peritoneal, mesenteric, or
							 retroperitoneal primary or secondary tumors; largest tumor 5.1-10.0 cm
							 diameter
49205
1,602.60
Excision or destruction, open, intra-abdominal
							 tumors, cysts or endometriomas, one or more peritoneal, mesenteric, or
							 retroperitoneal primary or secondary tumors; largest tumor greater than 10.0 cm
							 diameter
49215
2,032.51
Excision of presacral or sacrococcygeal
							 tumor
49220
893.72
Staging laparotomy for Hodgkins disease or lymphoma
							 (includes splenectomy, needle or open biopsies of both liver lobes, possibly
							 also removal of abdominal nodes, abdominal node and/or bone marrow biopsies,
							 ovarian repositioning)
49250
1,148.25
535.19
Umbilectomy, omphalectomy, excision of umbilicus
							 (separate procedure)
49255
725.26
Omentectomy, epiploectomy, resection of omentum
							 (separate procedure)
49320
1,537.09
310.18
Laparoscopy, abdomen, peritoneum, and omentum,
							 diagnostic, with or without collection of specimen(s) by brushing or washing
							 (separate procedure)
49321
1,537.09
324.69
Laparoscopy, surgical; with biopsy (single or
							 multiple)
49322
1,537.09
354.11
Laparoscopy, surgical; with aspiration of cavity or
							 cyst (eg, ovarian cyst) (single or multiple)
49323
593.11
Laparoscopy, surgical; with drainage of lymphocele to
							 peritoneal cavity
49324
364.38
Laparo scopy, surgical; with insertion of
							 intraperitoneal cannula or catheter, permanent
49325
390.87
Laparoscopy, surgical; with revision of previously
							 placed intraperitoneal cannula or catheter, with removal of intraluminal
							 obstructive material if performed
49326
175.04
Laparoscopy, surgical; with omentopexy (omental
							 tacking procedure) (List separately in addition to code for primary
							 procedure)
49329
I.C.
Unlisted laparoscopy procedure, abdomen, peritoneum
							 and omentum
49400
196.18
Injection of air or contrast into peritoneal cavity
							 (separate procedure)
49402
1,148.25
780.52
Removal of peritoneal foreign body from peritoneal
							 cavity
49419
1,327.08
425.40
Insertion of intraperitoneal cannula or catheter,
							 with subcutaneous reservoir, permanent (ie, totally implantable)
49420
1,372.36
134.10
Insertion of intraperitoneal cannula or catheter for
							 drainage or dialysis; temporary
49421
1,372.36
367.13
Insertion of intraperitoneal cannula or catheter for
							 drainage or dialysis; permanent
49422
1,071.63
365.19
Removal of permanent intraperitoneal cannula or
							 catheter
49423
686.16
678.07
Exchange of previously placed abscess or cyst
							 drainage catheter under radiological guidance (separate procedure)
49424
183.64
Contrast injection for assessment of abscess or cyst
							 via previously placed drainage catheter or tube (separate
							 procedure)
49425
710.71
Insertion of peritoneal-venous shunt
49426
1,148.25
605.56
Revision of peritoneal-venous shunt
49427
46.75
Injection procedure (eg, contrast media) for
							 evaluation of previously placed peritoneal-venous shunt
49428
415.07
Ligation of peritoneal-venous shunt
49429
1,071.63
431.32
Removal of peritoneal-venous shunt
49435
113.75
Insertion of subcutaneous extension to
							 intraperitoneal cannula or catheter with remote chest exit site (List
							 separately in addition to code for primary procedure)
49436
176.64
Delayed creation of exit site from embedded
							 subcutaneous segment of intraperitoneal cannula or catheter
49440
379.98
1,310.87
Insertion of gastrostomy tube, percutaneous, under
							 fluoroscopic guidance including contrast injection(s), image documentation and
							 report
49441
379.98
1,558.38
Insertion of duodenostomy or jejunostomy tube,
							 percutaneous, under fluoroscopic guidance including contrast injection(s),
							 image documentation and report
49442
1,269.61
Insertion of cecostomy or other colonic tube,
							 percutaneous, under fluoroscopic guidance including contrast injection(s),
							 image documentation and report
49446
379.98
1,305.01
Conversion of gastrostomy tube to gastro-jejunostomy
							 tube, percutaneous, under fluoroscopic guidance including contrast
							 injection(s), image documentation and report
49450
144.72
921.99
Replacement of gastrostomy or cecostomy (or other
							 colonic) tube, percutaneous, under fluoroscopic guidance including contrast
							 injection(s), image documentation and report
49451
144.72
973.34
Replacement of duodenostomy or jejunostomy tube,
							 percutaneous, under fluoroscopic guidance including contrast injection(s),
							 image documentation and report
49452
144.72
1,185.17
Replacement of gastro-jejunostomy tube, percutaneous,
							 under fluoroscopic guidance including contrast injection(s), image
							 documentation and report
49460
144.72
982.00
Mechanical removal of obstructive material from
							 gastrostomy, duodenostomy, jejunostomy,
gastro-jejunostomy, or cecostomy (or other colonic)
							 tube, any method, under fluoroscopic guidance including contrast injection(s),
							 if performed, image documentation and report
49465
1,370.98
201.12
Contrast injection(s) for radiological evaluation of
							 existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or
							 cecostomy (or other colonic) tube, from a percutaneous approach including image
							 documentation and report
49505
1,370.98
I
758.85
Repair initial inguinal hernia, age five years or
							 older; reducible
49507
1,370.98
583.30
Repair initial inguinal hernia, age five years or
							 older; incarcerated or strangulated
49520
1,370.98
579.25
Repair recurrent inguinal hernia, any age;
							 reducible
49521
1,370.98
704.87
Repair recurrent inguinal hernia, any age;
							 incarcerated or strangulated
49525
1,370.98
524.75
Repair inguinal hernia, sliding, any age
49540
1,370.98
619.52
Repair lumbar hernia
49550
1,370.98
528.02
Repair initial femoral hernia, any age;
							 reducible
49553
1,370.98
576.12
Repair initial femoral hernia, any age; incarcerated
							 or strangulated
49555
1,370.98
548.54
Repair recurrent femoral hernia;
							 reducible
49557
1,370.98
664.07
Repair recurrent femoral hernia; incarcerated or
							 strangulated
49560
1,370.98
680.42
Repair initial incisional or ventral hernia;
							 reducible
49561
1,370.98
851.99
Repair initial incisional or ventral hernia;
							 incarcerated or strangulated
49565
1,370.98
702.23
Repair recurrent incisional or ventral hernia;
							 reducible
49566
1,370.98
860.47
Repair recurrent incisional or ventral hernia;
							 incarcerated or strangulated
49568
1,370.98
252.54
Implantation of mesh or other prosthesis for
							 incisional or ventral hernia repair or mesh for closure of debridement for
							 necrotizing soft tissue infection (List separately in addition to code for the
							 incisional or ventral hernia repair)
49570
1,370.98
376.83
Repair epigastric hernia (eg, preperitoneal fat);
							 reducible (separate procedure)
49572
1,370.98
459.89
Repair epigastric hernia (eg, preperitoneal fat);
							 incarcerated or strangulated
49585
1,370.98
403.35
Repair umbilical hernia, age five years or older;
							 reducible
49587
1,370.98
476.36
Repair umbilical hernia, age five years or older;
							 incarcerated or strangulated
49590
1,370.98
522.81
Repair spigelian hernia
49600
1,370.98
677.44
Repair of small omphalocele, with primary
							 closure
49605
4,537.88
Repair of large omphalocele or gastroschisis; with or
							 without prosthesis
49606
1,052.51
Repair of large omphalocele or gastroschisis; with
							 removal of prosthesis, final reduction and closure, in operating
							 room
49610
643.03
Repair of omphalocele (Gross type operation); first
							 stage
49611
596.84
Repair of omphalocele (Gross type operation); second
							 stage
49650
2,034.73
I
789.44
Laparoscopy, surgical; repair initial inguinal
							 hernia
49651
2,034.73
507.31
Laparoscopy, surgical; repair recurrent inguinal
							 hernia
49659
I.C.
Unlisted laparoscopy procedure, hernioplasty,
							 herniorrhaphy, herniotomy
49900
755.29
Suture, secondary, of abdominal wall for evisceration
							 or dehiscence
49904
1,461.22
Omental flap, extra-abdominal (eg, for reconstruction
							 of sternal and chest wall defects)
49905
337.37
Omental flap, intra-abdominal (List separately in
							 addition to code for primary procedure)
49906
I.C.
Free omental flap with microvascular
							 anastomosis
49999
I.C.
Unlisted procedure, abdomen, peritoneum and
							 omentum
50010
717.28
Renal exploration, not necessitating other specific
							 procedures
50020
1,024.39
Drainage of perirenal or renal abscess;
							 open
50021
1,105.60
Drainage of perirenal or renal abscess;
							 percutaneous
50040
953.49
Nephrostomy, nephrotomy with drainage
50045
945.56
Nephrotomy, with exploration
50060
1,180.38
Nephrolithotomy; removal of calculus
50065
1,209.66
Nephrolithotomy; secondary surgical operation for
							 calculus
50070
1,233.76
Nephrolithotomy; complicated by congenital kidney
							 abnormality
50075
1,511.57
Nephrolithotomy; removal of large staghorn calculus
							 filling renal pelvis and calyces (including anatrophic
							 pyelolithotomy)
50080
905.68
Percuta neousnep hrostolithotomy or
							 pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting,
							 or basket extraction; up to 2 cm
50081
1,324.29
Percutaneous nephrostolithotomy or pyelostolithotomy,
							 with or without dilation, endoscopy, lithotripsy, stenting, or basket
							 extraction; over 2 cm
50100
981.82
Transection or repositioning of aberrant renal
							 vessels (separate procedure)
50120
984.21
Pyelotomy; with exploration
50125
1,030.05
Pyelotomy; with drainage, pyelostomy
50130
1,070.32
Pyelotomy; with removal of calculus (pyelolithotomy,
							 pelviolithotomy, including coagulum pyelolithotomy)
50135
1,163.05
Pyelotomy; complicated (eg, secondary operation,
							 congenital kidney abnormality)
50200
417.18
151.67
Renal biopsy; percutaneous, by trocar or
							 needle
50205
697.28
Renal biopsy; by surgical exposure of
							 kidney
50220
1,058.85
Nephrectomy, including partial ureterectomy, any open
							 approach including rib resection;
50225
1,227.84
Nephrectomy, including partial ureterectomy, any open
							 approach including rib resection; complicated because of previous surgery on
							 same kidney
50230
1,320.31
Nephrectomy, including partial ureterectomy, any open
							 approach including rib resection; radical, with regional lymphadenectomy and/or
							 vena caval thrombectomy
50234
1,344.21
Nephrectomy with total ureterectomy and bladder cuff;
							 through same incision
50236
1,522.06
Nephrectomy with total ureterectomy and bladder cuff;
							 through separate incision
50240
1,363.80
Nephrectomy, partial
50250
1,270.33
Ablation, open, one or more renal mass lesion(s),
							 cryosurgical, including intraoperative ultrasound, if performed
50280
976.76
Excision or unroofing of cyst(s) of
							 kidney
50290
915.35
Excision of perinephric cyst
50300
I.C.
Donor nephrectomy (including cold preservation); from
							 cadaver donor, unilateral or bilateral
50320
1,359.85
Donor nephrectomy (including cold preservation);
							 open, from living donor
50323
I.C.
Backbench standard preparation of cadaver donor renal
							 allograft prior to transplantation, including dissection and removal of
							 perinephric fat, diaphragmatic and retroperitoneal attachments, excision of
							 adrenal gland, and preparation of ureter(s), renal vein(s), and renal
							 artery(s), ligating branches, as necessary
50325
I.C.
Backbench standard preparation of living donor renal
							 allograft (open or laparoscopic) prior to transplantation, including dissection
							 and removal of perinephric fat and preparation of ureter(s), renal vein(s), and
							 renal artery(s), ligating branches, as necessary
50327
201.42
Backbench reconstruction of cadaver or living donor
							 renal allograft prior to transplantation; venous anastomosis, each
50328
177.00
Backbench reconstruction of cadaver or living donor
							 renal allograft prior to transplantation; arterial anastomosis,
							 each
50329
171.70
Backbench reconstruction of cadaver or living donor
							 renal allograft prior to transplantation; ureteral anastomosis,
							 each
50340
851.78
Recipient nephrectomy (separate
							 procedure)
50360
2,281.75
Renal allotransplantation, implantation of graft;
							 without recipient nephrectomy
50365
2,558.23
Renal allotransplantation, implantation of graft;
							 with recipient nephrectomy
50370
1,064.20
Removal of transplanted renal allograft
50380
1,737.84
Renal autotransplantation, reimplantation of
							 kidney
50382
1,107.15
1,636.82
Removal (via snare/capture) and replacement of
							 internally dwelling ureteral stent via percutaneous approach, including
							 radiological supervision and interpretation
50384
801.80
1,466.95
Removal (via snare/capture) of internally dwelling
							 ureteral stent via percutaneous approach, including radiological supervision
							 and interpretation
50385
801.80
1,569.99
Removal (via snare/capture) and replacement of
							 internally dwelling ureteral stent via transurethral approach, without use of
							 cystoscopy, including radiological supervision and interpretation
50386
266.95
1,010.69
Removal (via snare/capture) of internally dwelling
							 ureteral stent via transurethral approach, without use of cystoscopy, including
							 radiological supervision and interpretation
50387
686.16
781.64
Removal and replacement of externally accessible
							 transnephric ureteral stent (eg, external/internal stent) requiring
							 fluoroscopic guidance, including radiological supervision and
							 interpretation
50389
266.95
487.05
Removal of nephrostomy tube, requiring fluoroscopic
							 guidance (eg, with concurrent indwelling ureteral stent)
50390
417.18
101.36
Aspiration and/or injection of renal cyst or pelvis
							 by needle, percutaneous
50391
46.27
139.24
Instillation(s) of therapeutic agent into renal
							 pelvis and/or ureter through established nephrostomy, pyelostomy or
							 ureterostomy tube (eg, anticarcinogenic or antifungal agent)
50392
801.80
191.02
Introduction of intracatheter or catheter into renal
							 pelvis for drainage and/or injection, percutaneous
50393
1,107.15
232.04
Introduction of ureteral catheter or stent into
							 ureter through renal pelvis for drainage and/or injection,
							 percutaneous
50394
132.39
Injection procedure for pyelography (as
							 nephrostogram, pyelostogram, antegrade pyeloureterograms) through nephrostomy
							 or pyelostomy tube, or indwelling ureteral catheter
50395
801.80
191.78
Introduction of guide into renal pelvis and/or ureter
							 with dilation to establish nephrostomy tract, percutaneous
50396
89.72
124.97
Manometric studies through nephrostomy or pyelostomy
							 tube, or indwelling ureteral catheter
50398
686.16
700.62
Change of nephrostomy or pyelostomy tube
50400
1,195.59
Pyeloplasty (Foley Y-pyeloplasty), plastic operation
							 on renal pelvis, with or without plastic operation on ureter, nephropexy,
							 nephrostomy, pyelostomy, or ureteral splinting; simple
50405
1,435.38
Pyeloplasty (Foley Y-pyeloplasty), plastic operation
							 on renal pelvis, with or without plastic operation on ureter, nephropexy,
							 nephrostomy, pyelostomy, or ureteral splinting; complicated (congenital kidney
							 abnormality, secondary pyeloplasty, solitary kidney, calycoplasty)
50500
1,173.02
Nephrorrhaphy, suture of kidney wound or
							 injury
50520
1,068.04
Closure of nephrocutaneous or pyelocutaneous
							 fistula
50525
1,360.45
Closure of nephrovisceral fistula (eg, renocolic),
							 including visceral repair; abdominal approach
50526
1,365.92
Closure of nephrovisceral fistula (eg, renocolic),
							 including visceral repair; thoracic approach
50540
1,191.95
Symphysiotomy for horseshoe kidney with or without
							 pyeloplasty and/or other plastic procedure, unilateral or bilateral (one
							 operation)
50541
955.46
Laparoscopy, surgical; ablation of renal
							 cysts
50542
1,209.45
Laparoscopy, surgical; ablation of renal mass
							 lesion(s)
50543
1,541.51
Laparoscopy, surgical; partial
							 nephrectomy
50544
1,301.23
Laparoscopy, surgical; pyeloplasty
50545
1,393.56
Laparoscopy, surgical; radical nephrectomy (includes
							 removal of Gerota's fascia and surrounding fatty tissue, removal of regional
							 lymph nodes, and adrenalectomy)
50546
1,240.08
Laparoscopy, surgical; nephrectomy, including partial
							 ureterectomy
50547
1,521.62
Laparoscopy, surgical; donor nephrectomy (including
							 cold preservation), from living donor
50548
1,404.51
Laparoscopy, surgical; nephrectomy with total
							 ureterectomy
50549
I.C.
Unlisted laparoscopy procedure, renal
50551
266.95
403.99
Renal endoscopy through established nephrostomy or
							 pyelostomy, with or without irrigation, instillation, or ureteropyelography,
							 exclusive of radiologic service;
50553
1,107.15
419.77
Renal endoscopy through established nephrostomy or
							 pyelostomy, with or without irrigation, instillation, or ureteropyelography,
							 exclusive of radiologic service; with ureteral catheterization, with or without
							 dilation of ureter
50555
266.95
463.94
Renal endoscopy through established nephrostomy or
							 pyelostomy, with or without irrigation, instillation, or ureteropyelography,
							 exclusive of radiologic service; with biopsy
50557
1,107.15
466.23
Renal endoscopy through established nephrostomy or
							 pyelostomy, with or without irrigation, instillation, or ureteropyelography,
							 exclusive of radiologic service; with fulguration and/or incision, with or
							 without biopsy
50561
1,107.15
525.84
Renal endoscopy through established nephrostomy or
							 pyelostomy, with or without irrigation, instillation, or ureteropyelography,
							 exclusive of radiologic service; with removal of foreign body or
							 calculus
50562
266.95
616.82
Renal endoscopy through established nephrostomy or
							 pyelostomy, with or without irrigation, instillation, or ureteropyelography,
							 exclusive of radiologic service; with resection of tumor
50570
266.95
515.15
Renal endoscopy through nephrotomy or pyelotomy, with
							 or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service;
50572
266.95
558.15
Renal endoscopy through nephrotomy or pyelotomy, with
							 or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with ureteral catheterization, with or without dilation of
							 ureter
50574
266.95
595.19
Renal endoscopy through nephrotomy or pyelotomy, with
							 or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with biopsy
50575
1,612.24
749.80
Renal endoscopy through nephrotomy or pyelotomy, with
							 or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy,
							 dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic
							 junction and insertion of endopyelotomy stent)
50576
801.80
592.17
Renal endoscopy through nephrotomy or pyelotomy, with
							 or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with fulguration and/or incision, with or without
							 biopsy
50580
801.80
637.64
Renal endoscopy through nephrotomy or pyelotomy, with
							 or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with removal of foreign body or calculus
50590
1,855.90
1,027.54
Lithotripsy, extracorporeal shock wave
50592
1,921.50
5,413.46
Ablation, one or more renal tumor(s), percutaneous,
							 unilateral, radiofrequency
50593
5,603.15
Ablation, renal tumor(s), unilateral, percutaneous,
							 cryotherapy
50600
965.02
Ureterotomy with exploration or drainage (separate
							 procedure)
50605
948.75
Ureterotomy for insertion of indwelling stent, all
							 types
50610
994.24
Ureterolithotomy; upper one-third of
							 ureter
50620
938.88
Ureterolithotomy; middle one-third of
							 ureter
50630
914.94
Ureterolithotomy; lower one-third of
							 ureter
50650
1,069.70
Ureterectomy, with bladder cuff (separate
							 procedure)
50660
1,183.83
Ureterectomy, total, ectopic ureter, combination
							 abdominal, vaginal and/or perineal approach
50684
233.19
Injection procedure fo r ureterography or
							 ureteropyelography through ureterostomy or indwelling ureteral
							 catheter
50686
46.27
186.95
Manometric studies through ureterostomy or indwelling
							 ureteral catheter
50688
686.16
88.88
Change of ureterostomy tube or externally accessible
							 ureteral stent via ileal conduit
50690
117.19
Injection procedure for visualization of ileal
							 conduit and/or ureteropyelography, exclusive of radiologic service
50700
968.26
Ureteroplasty, plastic operation on ureter (eg,
							 stricture)
50715
1,161.42
Ureterolysis, with or without repositioning of ureter
							 for retroperitoneal fibrosis
50722
1,012.05
Ureterolysis for ovarian vein syndrome
50725
1,118.15
Ureterolysis for retrocaval ureter, with
							 reanastomosis of upper urinary tract or vena cava
50727
527.37
Revision of urinary-cutaneous anastomosis (any type
							 urostomy);
50728
722.76
Revision of urinary-cutaneous anastomosis (any type
							 urostomy); with repair of fascial defect and hernia
50740
1,123.52
Ureteropyelostomy, anastomosis of ureter and renal
							 pelvis
50750
1,199.41
Ureterocalycostomy, anastomosis of ureter to renal
							 calyx
50760
1,130.72
Ureteroureterostomy
50770
1,196.90
Transureteroureterostomy, anastomosis of ureter to
							 contralateral ureter
50780
1,128.64
Ureteroneocystostomy; anastomosis of single ureter to
							 bladder
50782
1,143.83
Ureteroneocystostomy; anastomosis of duplicated
							 ureter to bladder
50783
1,182.34
Ureteroneocystostomy; with extensive ureteral
							 tailoring
50785
1,245.66
Ureteroneocystostomy; with vesico-psoas hitch or
							 bladder flap
50800
949.75
Ureteroenterostomy, direct anastomosis of ureter to
							 intestine
50810
1,286.12
Ureterosigmoidostomy, with creation of sigmoid
							 bladder and establishment of abdominal or perineal colostomy, including
							 intestine anastomosis
50815
1,257.34
Ureterocolon conduit, including intestine
							 anastomosis
50820
1,344.42
Ureteroileal conduit (ileal bladder), including
							 intestine anastomosis (Bricker operation)
50825
1,702.32
Continent diversion, including intestine anastomosis
							 using any segment of small and/or large intestine (Kock pouch or Camey
							 enterocystoplasty)
50830
1,857.31
Urinary undiversion (eg, taking down of ureteroileal
							 conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or
							 ureteroneocystostomy)
50840
1,270.26
Replacement of all or part of ureter by intestine
							 segment, including intestine anastomosis
50845
1,287.75
Cutaneous appendico-vesicostomy
50860
981.25
Ureterostomy, transplantation of ureter to
							 skin
50900
867.52
Ureterorrhaphy, suture of ureter (separate
							 procedure)
50920
912.01
Closure of ureterocutaneous fistula
50930
1,124.42
Closure of ureterovisceral fistula (including
							 visceral repair)
50940
902.89
Deligation of ureter
50945
1,026.49
Laparoscopy, surgical; ureterolithotomy
50947
2,034.73
1,445.98
Laparoscopy, surgical; ureteroneocystostomy with
							 cystoscopy and ureteral stent placement
50948
2,034.73
1,317.63
Laparoscopy, surgical; ureteroneocystostomy without
							 cystoscopy and ureteral stent placement
50949
I.C.
Unlisted laparoscopy procedure, ureter
50951
266.95
421.23
Ureteral endoscopy through established ureterostomy,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service;
50953
266.95
440.55
Ureteral endoscopy through established ureterostomy,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with ureteral catheterization, with or without dilation of
							 ureter
50955
1,107.15
510.56
Ureteral endoscopy through established ureterostomy,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with biopsy
50957
1,107.15
474.64
Ureteral endoscopy through established ureterostomy,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with fulguration and/or incision, with or without
							 biopsy
50961
1,107.15
427.94
Ureteral endoscopy through established ureterostomy,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with removal of foreign body or calculus
50970
266.95
390.21
Ureteral endoscopy through ureterotomy, with or
							 without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service;
50972
266.95
376.63
Ureteral endoscopy through ureterotomy, with or
							 without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with ureteral catheterization, with or without dilation of
							 ureter
50974
801.80
490.27
Ureteral endoscopy through ureterotomy, with or
							 without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with biopsy
50976
801.80
487.35
Ureteral endoscopy through ureterotomy, with or
							 without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with fulguration and/or incision, with or without
							 biopsy
50980
1,107.15
374.50
Ureteral endoscopy through ureterotomy, with or
							 without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with removal of foreign body or calculus
51020
1,107.15
484.86
Cystotomy or cystostomy; with fulguration and/or
							 insertion of radioactive material
51030
1,107.15
483.51
Cystotomy or cystostomy; with cryosurgical
							 destruction of intravesical lesion
51040
1,107.15
309.22
Cystostomy, cystotomy with drainage
51045
266.95
486.77
Cystotomy, with insertion of ureteral catheter or
							 stent (separate procedure)
51050
1,107.15
489.60
Cystolithotomy, cystotomy with removal of calculus,
							 without vesical neck resection
51060
605.18
Transvesical ureterolithotomy
51065
1,107.15
598.12
Cystotomy, with calculus basket extraction and/or
							 ultrasonic or electrohydraulic fragmentation of ureteral calculus
51080
818.67
425.91
Drainage of perivesical or prevesical space
							 abscess
51100
33.83
70.48
Aspiration of bladder; by needle
51101
46.27
148.75
Aspiration of bladder; by trocar or
							 intracatheter
51102
864.33
372.82
Aspiration of bladder; with insertion of suprapubic
							 catheter
51500
1,370.98
651.35
Excision of urachal cyst or sinus, with or without
							 umbilical hernia repair
51520
1,107.15
617.54
Cystotomy; for simple excision of vesical neck
							 (separate procedure)
51525
887.73
Cystotomy; for excision of bladder diverticulum,
							 single or multiple (separate procedure)
51530
797.54
Cystotomy; for excision of bladder tumor
51535
817.25
Cystotomy for excision, incision, or repair of
							 ureterocele
51550
978.45
Cystectomy, partial; simple
51555
1,298.01
Cystectomy, partial; complicated (eg, postradiation,
							 previous surgery, difficult location)
51565
1,336.36
Cystectomy, partial, with reimplantation of ureter(s)
							 into bladder (ureteroneocystostomy)
51570
1,518.85
Cystectomy, complete; (separate
							 procedure)
51575
1,881.35
Cystectomy, complete; with bilateral pelvic
							 lymphadenectomy, including external iliac, hypogastric, and obturator
							 nodes
51580
1,959.50
Cystectomy, complete, with ureterosigmoidostomy or
							 ureterocutaneous transplantations;
51585
2,178.76
Cystectomy, complete, with ureterosigmoidostomy or
							 ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy,
							 including external iliac, hypogastric, and obturator nodes
51590
1,989.82
Cystectomy, complete, with ureteroileal conduit or
							 sigmoid bladder, including intestine anastomosis;
51595
2,257.47
Cystectomy, complete, with ureteroileal conduit or
							 sigmoid bladder, including intestine anastomosis; with bilateral pelvic
							 lymphadenectomy, including external iliac, hypogastric, and obturator
							 nodes
51596
2,424.14
Cystectomy, complete, with continent diversion, any
							 open technique, using any segment of small and/or large intestine to construct
							 neobladder
51597
2,345.32
Pelvic exenteration, complete, for vesical, prostatic
							 or urethral malignancy, with removal of bladder and ureteral transplantations,
							 with or without hysterectomy and/or abdominoperineal resection of rectum and
							 colon and colostomy, or any combination thereof
51600
245.41
Injection procedure for cystography or voiding
							 urethrocystography
51605
41.00
Injection procedure and placement of chain for
							 contrast and/or chain urethrocystography
51610
134.61
Injection procedure for retrograde
							 urethrocystography
51700
57.00
103.19
Bladder irrigation, simple, lavage and/or
							 instillation
51701
28.19
78.57
Insertion of non-indwelling bladder catheter (eg,
							 straight catheterization for residual urine)
51702
28.19
101.58
Insertion of temporary indwelling bladder catheter;
							 simple (eg, Foley)
51703
46.27
168.26
Insertion of temporary indwelling bladder catheter;
							 complicated (eg, altered anatomy, fractured catheter/balloon)
51705
79.07
136.23
Change of cystostomy tube; simple
51710
686.16
193.98
Change of cystostomy tube; complicated
51715
1,331.1
1
327.52
Endoscopic injection of implant material into the
							 submucosal tissues of the urethra and/or bladder neck
51720
61.77
132.74
Bladder instillation of anticarcinogenic agent
							 (including retention time)
51725
136.16
282.35
79.09
203.26
Simple cystometrogram (CMG) (eg, spinal
							 manometer)
51726
136.16
400.25
89.90
310.35
Complex cystometrogram (eg, calibrated electronic
							 equipment)
51736
19.86
57.61
32.45
25.15
Simple uroflowmetry (UFR) (eg, stop-watch flow rate,
							 mechanical uroflowmeter)
51741
22.80
89.63
60.49
29.14
Complex uroflowmetry (eg, calibrated electronic
							 equipment)
51772
89.72
305.84
84.78
221.05
Urethral pressure profile studies (UPP) (urethral
							 closure pressure profile), any technique
51784
46.27
243.45
80.23
163.22
Electromyography studies (EMG) of anal or urethral
							 sphincter, other than needle, any technique
51785
89.72
263.86
79.93
183.93
Needle electromyography studies (EMG) of anal or
							 urethral sphincter, any technique
51792
46.27
297.63
58.07
239.56
Stimulus evoked response (eg, measurement of
							 bulbocavernosus reflex latency time)
51795
89.72
381.03
80.23
300.80
Voiding pressure studies (VP); bladder voiding
							 pressure, any technique
51797
89.72
221.59
49.78
171.80
Voiding pressure studies (VP); intra-abdominal
							 voiding pressure (AP) (rectal, gastric, intraperitoneal) (List separately in
							 addition to code for primary procedure)
51798
17.28
24.03
Measurement of post-voiding residual urine and/or
							 bladder capacity by ultrasound, non-imaging
51800
1,077.09
Cystoplasty or cystourethroplasty, plastic operation
							 on bladder and/or vesical neck (anterior Y-plasty, vesical fundus resection),
							 any procedure, with or without wedge resection of posterior vesical
							 neck
51820
1,130.35
Cystourethroplasty with unilateral or bilateral
							 ureteroneocystostomy
51840
677.43
Anterior vesicourethropexy, or urethropexy (eg,
							 Marshall-Marchetti-Krantz, Burch); simple
51841
806.22
Anterior vesicourethropexy, or urethropexy (eg,
							 Marshall-Marchetti-Krantz, Burch); complicated (eg, secondary
							 repair)
51845
611.91
Abdomino-vaginal vesical neck suspension, with or
							 without endoscopic control (eg, Stamey, Raz, modified Pereyra)
51860
748.89
Cystorrhaphy, suture of bladder wound, injury or
							 rupture; simple
51865
917.79
Cystorrhaphy, suture of bladder wound, injury or
							 rupture; complicated
51880
1,107.15
488.00
Closure of cystostomy (separate
							 procedure)
51900
853.78
Closure of vesicovaginal fistula, abdominal
							 approach
51920
802.94
Closure of vesicouterine fistula;
51925
1,137.29
Closure of vesicouterine fistula; with
							 hysterectomy
51940
1,653.32
Closure, exstrophy of bladder
51960
1,428.00
Enterocystoplasty, including intestinal
							 anastomosis
51980
736.81
Cutaneous vesicostomy
51990
772.41
Laparoscopy, surgical; urethral suspension for stress
							 incontinence
51992
2,034.73
839.30
Laparoscopy, surgical; sling operation for stress
							 incontinence (eg, fascia or synthetic)
51999
I.C.
Unlisted laparoscopy procedure, bladder
52000
266.95
240.51
Cystourethroscopy (separate procedure)
52001
801.80
430.33
Cystourethroscopy with irrigation and evacuation of
							 multiple obstructing clots
52005
801.80
346.07
Cystourethroscopy, with ureteral catheterization,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service;
52007
1,107.15
734.77
Cystourethroscopy, with ureteral catheterization,
							 with or without irrigation, instillation, or ureteropyelography, exclusive of
							 radiologic service; with brush biopsy of ureter and/or renal pelvis
52010
266.95
542.99
Cystourethroscopy, with ejaculatory duct
							 catheterization, with or without irrigation, instillation, or duct radiography,
							 exclusive of radiologic service
52204
801.80
618.71
Cystourethroscopy, with biopsy(s)
52214
1,107.15
1,469.40
Cystourethroscopy, with fulguration (including
							 cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa,
							 urethra, or periurethral glands
52224
1,107.15
1,392.01
Cystourethroscopy, with fulguration (including
							 cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm)
							 lesion(s) with or without biopsy
52234
1,107.15
257.85
Cystourethroscopy, with fulguration (including
							 cryosurgery or laser surgery) and/or resection of SMALL bladder tumor(s) (0.5
							 up to 2.0 cm)
52235
1,107.15
302.83
Cystourethroscopy, with fulguration (including
							 cryosurgery or laser surgery) and/or resection of MEDIUM bladder tumor(s) (2.0
							 to 5.0 cm)
52240
1,107.15
528.04
Cystourethroscopy, with fulguration (including
							 cryosurgery or laser surgery) and/or resection of LARGE bladder
							 tumor(s)
52250
1,107.15
253.57
Cystourethroscopy with insertion of radioactive
							 substance, with or without biopsy or fulguration
52260
801.80
218.76
Cystourethroscopy, with dilation of bladder for
							 interstitial cystitis; general or conduction (spinal) anesthesia
52265
266.95
586.59
Cystourethroscopy, with dilation of bladder for
							 interstitial cystitis; local anesthesia
52270
801.80
537.55
Cystourethroscopy, with internal urethrotomy;
							 female
52275
1,107.15
742.15
Cystourethroscopy, with internal urethrotomy;
							 male
52276
1,107.15
277.98
Cystourethroscopy with direct vision internal
							 urethrotomy
52277
1,107.15
341.34
Cystourethroscopy, with resection of external
							 sphincter (sphincterotomy)
52281
801.80
386.51
Cystourethroscopy, with calibration and/or dilation
							 of urethral stricture or stenosis, with or without meatotomy, with or without
							 injection procedure for cystography, male or female
52282
1,612.24
351.34
Cystourethroscopy, with insertion of urethral
							 stent
52283
1,107.15
319.26
Cystourethroscopy, with steroid injection into
							 stricture
52285
801.80
322.65
Cystourethroscopyfor treatment of the female urethral
							 syndrome with any or all of the following: urethral meatotomy, urethral
							 dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis,
							 lateral incisions of the bladder neck, and fulguration
52290
801.80
255.72
Cystourethroscopy; with ureteral meatotomy,
							 unilateral or bilateral
52300
1,107.15
294.99
Cystourethroscopy; with resection or fulguration of
							 orthotopic ureterocele(s), unilateral or bilateral
52301
1,107.15
308.82
Cystourethroscopy; with resection or fulguration of
							 ectopic ureterocele(s), unilateral or bilateral
52305
1,107.15
292.23
Cystourethroscopy; with incision or resection of
							 orifice of bladder diverticulum, single or multiple
52310
801.80
302.16
Cystourethroscopy, with removal of foreign body,
							 calculus, or ureteral stent from urethra or bladder (separate procedure);
							 simple
52315
1,107.15
540.75
Cystourethroscopy, with removal of foreign body,
							 calculus, or ureteral stent from urethra or bladder (separate procedure);
							 complicated
52317
1,107.15
1,302.60
Litholapaxy: crushing or fragmentation of calculus by
							 any means in bladder and removal of fragments; simple or small (less than 2.5
							 cm)
52318
1,107.15
497.24
Litholapaxy: crushing or fragmentation of calculus by
							 any means in bladder and removal of fragments; complicated or large (over 2.5
							 cm)
52320
1,107.15
258.40
Cystourethroscopy (including ureteral
							 catheterization); with removal of ureteral calculus
52325
1,107.15
335.94
Cystourethroscopy (including ureteral
							 catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or
							 electro-hydraulic technique)
52327
1,107.15
967.67
Cystourethroscopy (including ureteral
							 catheterization); with subureteric injection of implant material
52330
1,107.15
1,546.34
Cystourethroscopy (including ureteral
							 catheterization); with manipulation, without removal of ureteral
							 calculus
52332
1,107.15
520.86
Cystourethroscopy, with insertion of indwelling
							 ureteral stent (eg, Gibbons or double-J type)
52334
1,107.15
268.50
Cystourethroscopy with insertion of ureteral guide
							 wire through kidney to establish a percutaneous nephrostomy,
							 retrograde
52341
1,107.15
342.56
Cystourethroscopy; with treatment of ureteral
							 stricture (eg, balloon dilation, laser, electrocautery, and
							 incision)
52342
1,107.15
368.35
Cystourethroscopy; with treatment of ureteropelvic
							 junction stricture (eg, balloon dilation, laser, electrocautery, and
							 incision)
52343
1,107.15
404.80
Cystourethroscopy; with treatment of intra-renal
							 stricture (eg, balloon dilation, laser, electrocautery, and
							 incision)
52344
1,107.15
437.34
Cystourethroscopy with ureteroscopy; with treatment
							 of ureteral stricture (eg, balloon dilation, laser, electrocautery, and
							 incision)
52345
1,107.15
463.59
Cystourethroscopy with ureteroscopy; with treatment
							 of ureteropelvic junction stricture (eg, balloon dilation, laser,
							 electrocautery, and incision)
52346
1,107.15
517.89
Cystourethroscopy with ureteroscopy; with treatment
							 of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and
							 incision)
52351
1,107.15
329.40
Cystourethroscopy, with ureteroscopy and/or
							 pyeloscopy; diagnostic
52352
1,107.15
386.41
Cystourethroscopy, with ureteroscopy and/or
							 pyeloscopy; with removal or manipulation of calculus (ureteral catheterization
							 is included)
52353
1,612.24
444.44
Cystourethroscopy, with ureteroscopy and/or
							 pyeloscopy; with lithotripsy (ureteral catheterization is included)
52354
1,107.15
411.30
Cystourethroscopy, with ureteroscopy and/or
							 pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic
							 lesion
52355
1,107.15
489.53
Cystourethroscopy, with ureteroscopy and/or
							 pyeloscopy; with resection of ureteral or renal pelvic tumor
52400
1,107.15
573.75
Cystourethroscopy with incision, fulguration, or
							 resection of congenital posterior urethral valves, or congenital obstructive
							 hypertrophic mucosal folds
52402
1,107.15
280.30
Cystourethroscopy with transurethral resection or
							 incision of ejaculatory ducts
52450
1,107.15
487.51
Transurethral incision of prostate
52500
1,107.15
571.03
Transurethral resection of bladder neck (separate
							 procedure)
52601
1,612.24
853.81
Transurethral electrosurgical resection of prostate,
							 including control of postoperative bleeding, complete (vasectomy, meatotomy,
							 cystourethroscopy, urethral calibration and/or dilation, and internal
							 urethrotomy are included)
52606
1,107.15
526.96
Transurethral fulguration for postoperative bleeding
							 occurring after the usual follow-up time
52612
1,612.24
547.86
Transurethral resection of prostate; first stage of
							 two-stage resection (partial resection)
52614
1,612.24
481.73
Transurethral resection of prostate; second stage of
							 two-stage resection (resection completed)
52620
1,612.24
434.48
Transurethral resection; of residual obstructive
							 tissue after 90 days postoperative
52630
1,612.24
460.13
Transurethral resection; of regrowth of obstructive
							 tissue longer than one year postoperative
52640
1,107.15
419.18
Transurethral resection; of postoperative bladder
							 neck contracture
52647
2,020.10
3,070.83
Laser coagulation of prostate, including control of
							 postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy,
							 urethral calibration and/or dilation, and internal urethrotomy are included if
							 performed)
52648
2,020.10
3,114.08
Laser vaporization of prostate, including control of
							 postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy,
							 urethral calibration and/or dilation, internal urethrotomy and transurethral
							 resection of prostate are included if performed)
52649
1,048.15
Laser enucleation of the prostate with morcellation,
							 including control of postoperative bleeding, complete (vasectomy, meatotomy,
							 cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy
							 and transurethral resection of prostate are included if performed)
52700
1,107.15
452.66
Transurethral drainage of prostatic
							 abscess
53000
855.80
159.73
Urethrotomy or urethrostomy, external (separate
							 procedure); pendulous urethra
53010
855.80
310.83
Urethrotomy or urethrostomy, external (separate
							 procedure); perineal urethra, external
53020
855.80
101.61
Meatotomy, cutting of meatus (separate procedure);
							 except infant
53040
855.80
415.51
Drainage of deep periurethral abscess
53060
76.85
195.07
Drainage of Skene's gland abscess or cyst
53080
855.80
499.76
Drainage of perineal urinary extravasation;
							 uncomplicated (separate procedure)
53085
855.80
676.88
Drainage of perineal urinary extravasation;
							 complicated
53200
855.80
163.93
Biopsy of urethra
53210
1,331.11
803.67
Urethrectomy, total, including cystostomy;
							 female
53215
855.80
966.55
Urethrectomy, total, including cystostomy;
							 male
53220
1,331.11
472.01
Excision or fulguration of carcinoma of
							 urethra
53230
1,331.11
628.89
Excision of urethral diverticulum (separate
							 procedure); female
53235
855.80
664.40
Excision of urethral diverticulum (separate
							 procedure); male
53240
1,331.11
447.22
Marsupialization of urethral diverticulum, male or
							 female
53250
855.80
410.63
Excision of bulbourethral gland (Cowper's
							 gland)
53260
855.80
218.09
Excision or fulguration; urethral polyp(s), distal
							 urethra
53265
855.80
244.20
Excision or fulguration; urethral
							 caruncle
53270
855.80
222.42
Excision or fulguration; Skene's glands
53275
855.80
280.13
Excision or fulguration; urethral
							 prolapse
53400
1,331.11
833.50
Urethroplasty; first stage, for fistula,
							 diverticulum, or stricture (eg, Johannsen type)
53405
1,331.11
907.74
Urethroplasty; second stage (formation of urethra),
							 including urinary diversion
53410
1,331.11
1,018.09
Urethroplasty, one-stage reconstruction of male
							 anterior urethra
53415
1,157.42
Urethroplasty, transpubic or perineal, one stage, for
							 reconstruction or repair of prostatic or membranous urethra
53420
1,331.11
850.68
Urethroplasty, two-stage reconstruction or repair of
							 prostatic or membranous urethra; first stage
53425
1,331.11
977.72
Urethroplasty, two-stage reconstruction or repair of
							 prostatic or membranous urethra; second stage
53430
1,331.11
988.77
Urethroplasty, reconstruction of female
							 urethra
53431
1,331.11
1,198.48
Urethroplasty with tubularization of posterior
							 urethra and/or lower bladder for incontinence (eg, Tenago, Leadbetter
							 procedure)
53440
4,775.24
901.42
Sling operation for correction of male urinary
							 incontinence (eg, fascia or synthetic)
53442
1,331.11
795.94
Removal or revision of sling for male urinary
							 incontinence (eg, fascia or synthetic)
53444
4,775.24
828.12
Insertion of tandem cuff (dual cuff)
53445
8,643.94
913.53
Insertion of inflatable urethral/bladder neck
							 sphincter, including placement of pump, reservoir, and cuff
53446
1,331.11
674.63
Removal of inflatable urethral/bladder neck
							 sphincter, including pump, reservoir, and cuff
53447
8,643.94
852.21
Re mova l a nd rep la cem en t of in f l a tab le
							 urethral/bladder neck sphincter including pump, reservoir, and cuff at the same
							 operative session
53448
1,331.17
Removal and replacement of inflatable
							 urethral/bladder neck sphincter including pump, reservoir, and cuff through an
							 infected field at the same operative session including irrigation and
							 debridement of infected tissue
53449
1,331.11
637.01
Repair of inflatable urethral/bladder neck sphincter,
							 including pump, reservoir, and cuff
53450
1,331.11
425.66
Urethromeatoplasty, with mucosal
							 advancement
53460
855.80
477.33
Urethromeatoplasty, with partial excision of distal
							 urethral segment (Richardson type procedure)
53500
779.85
Urethrolysis, transvaginal, secondary, open,
							 including cystourethroscopy (eg, postsurgical obstruction,
							 scarring)
53502
855.80
506.16
Urethrorrhaphy, suture of urethral wound or injury,
							 female
53505
1,331.11
507.44
Urethrorrhaphy, suture of urethral wound or injury;
							 penile
53510
855.80
668.12
Urethrorrhaphy, suture of urethral wound or injury;
							 perineal
53515
1,331.11
832.45
Urethrorrhaphy, suture of urethral wound or injury;
							 prostatomembranous
53520
1,331.11
583.31
Closure of urethrostomy or urethrocutaneous fistula,
							 male (separate procedure)
53600
41.92
96.48
Dilation of urethral stricture by passage of sound or
							 urethral dilator, male; initial
53601
46.27
96.32
Dilation of urethral stricture by passage of sound or
							 urethral dilator, male; subsequent
53605
801.80
67.57
Dilation of urethral stricture or vesical neck by
							 passage of sound or urethral dilator, male, general or conduction (spinal)
							 anesthesia
53620
67.67
143.76
Dilation of urethral stricture by passage of filiform
							 and follower, male; initial
53621
71.34
138.39
Dilation of urethral stricture by passage of filiform
							 and follower, male; subsequent
53660
46.27
86.04
Dilation of female urethra including suppository
							 and/or instillation; initial
53661
46.27
85.92
Dilation of female urethra including suppository
							 and/or instillation; subsequent
53665
855.80
39.71
Dilation of female urethra, general or conduction
							 (spinal) anesthesia
53850
2,020.10
3,660.13
Transurethral destruction of prostate tissue; by
							 microwave thermotherapy
53852
2,020.10
3,497.13
Transurethral destruction of prostate tissue; by
							 radiofrequency thermotherapy
53853
1,107.15
2,144.47
Transurethral destruction of prostate tissue; by
							 water-induced thermotherapy
53899
I.C.
Unlisted procedure, urinary system
54000
855.80
185.44
Slitting of prepuce, dorsal or lateral (separate
							 procedure); newborn
54001
855.80
223.56
Slitting of prepuce, dorsal or lateral (separate
							 procedure); except newborn
54015
818.67
325.93
Incision and drainage of penis, deep
54050
65.22
131.95
Destruction of lesion(s), penis (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple;
							 chemical
54055
65.09
125.86
Destruction of lesion(s), penis (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple;
							 electrodesiccation
54056
35.44
138.26
Destruction of lesion(s), penis (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple;
							 cryosurgery
54057
889.48
157.11
Destruction of lesion(s), penis (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple; laser
							 surgery
54060
889.48
213.16
Destruction of lesion(s), penis (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical
							 excision
54065
889.48
223.91
Destruction of lesion(s), penis (eg, condyloma,
							 papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser
							 surgery, electrosurgery, cryosurgery, chemosurgery)
54100
719.48
209.64
Biopsy of penis; (separate procedure)
54105
943.36
317.43
Biopsy of penis; deep structures
54110
1,516.30
654.19
Excision of penile plaque (Peyronie
							 disease);
54111
1,516.30
834.27
Excision of penile plaque (Peyronie disease); with
							 graft to 5 cm in length
54112
1,516.30
978.43
Excision of penile plaque (Peyronie disease); with
							 graft greater than 5 cm in length
54115
818.67
479.11
Removal foreign body from deep penile tissue (eg,
							 plastic implant)
54120
1,516.30
654.22
Amputation of penis; partial
54125
841.06
Amputation of penis; complete
54130
1,239.40
Amputation of penis, radical; with bilateral
							 inguinofemoral lymphadenectomy
54135
1,570.80
Amputation of penis, radical; in continuity with
							 bilateral pelvic lymphadenectomy, including external iliac, hypogastric and
							 obturator nodes
54150
997.67
213.74
Circumcision, using clamp or other device with
							 regional dorsal penile or ring block
54161
997.67
205.76
Circumcision, surgical excision other than clamp,
							 device, or dorsal slit; older than 28 days of age
54162
997.67
317.24
Lysis or excision of penile post-circumcision
							 adhesions
54163
997.67
229.79
Repair incomplete circumcision
54164
997.67
203.54
Frenulotomy of penis
54200
69.87
127.19
Injection procedure for Peyronie disease;
54205
1,516.30
565.78
Injection procedure for Peyronie disease; with
							 surgical exposure of plaque
54220
89.72
252.50
Irrigation of corpora cavernosa for
							 priapism
54230
105.52
Injection procedure for corpora
							 cavernosography
54231
61.41
151.31
Dynamic cavernosometry, including intracavernosal
							 injection of vasoactive drugs (eg, papaverine, phentolamine)
54235
43.02
96.88
Injection of corpora cavernosa with pharmacologic
							 agent(s) (eg, papaverine, phentolamine)
54240
29.79
107.82
68.74 39.08
Penile plethysmography
54250
10.30
129.98
116.50 13.49
Nocturnal penile tumescence and/or rigidity
							 test
54300
1,516.30
683.36
Plastic operation of penis for straightening of
							 chordee (eg, hypospadias), with or without mobilization of urethra
54304
1,516.30
800.32
Plastic operation on penis for correction of chordee
							 or for first stage hypospadias repair with or without transplantation of
							 prepuce and/or skin flaps
54308
1,516.30
698.34
Urethroplasty for second stage hypospadias repair
							 (including urinary diversion); less than 3 cm
54312
1,516.30
892.47
Urethroplasty for second stage hypospadias repair
							 (including urinary diversion); greater than 3 cm
54316
1,516.30
1,058.92
Urethroplasty for second stage hypospadias repair
							 (including urinary diversion) with free skin graft obtained from site other
							 than genitalia
54318
1,516.30
705.35
Urethroplasty for third stage hypospadias repair to
							 release penis from scrotum (eg, third stage Cecil repair)
54322
1,516.30
831.86
One stage distal hypospadias repair (with or without
							 chordee or circumcision); with simple meatal advancement (eg, Magpi,
							 V-flap)
54324
1,516.30
1,035.61
One stage distal hypospadias repair (with or without
							 chordee or circumcision); with urethroplasty by local skin flaps (eg,
							 flip-flap, prepucial flap)
54326
1,516.30
999.12
One stage distal hypospadias repair (with or without
							 chordee or circumcision); with urethroplasty by local skin flaps and
							 mobilization of urethra
54328
1,516.30
985.73
One stage distal hypospadias repair (with or without
							 chordee or circumcision); with extensive dissection to correct chordee and
							 urethroplasty with local skin flaps, skin graft patch, and/or island
							 flap
54332
1,068.01
One stage proximal penile or penoscrotal hypospadias
							 repair requiring extensive dissection to correct chordee and urethroplasty by
							 use of skin graft tube and/or is land flap
54336
1,203.32
One stage perineal hypospadias repair requiring
							 extensive dissection to correct chordee and urethroplasty by use of skin graft
							 tube and/or island flap
54340
1,516.30
608.34
Repair of hypospadias complications (ie, fistula,
							 stricture, diverticula); by closure, incision, or excision, simple
54344
1,516.30
1,021.20
Repair of hypospadias complications (ie, fistula,
							 stricture, diverticula); requiring mobilization of skin flaps and urethroplasty
							 with flap or patch graft
54348
1,516.30
1,082.09
Repair of hypospadias complications (ie, fistula,
							 stricture, diverticula); requiring extensive dissection and urethroplasty with
							 flap, patch or tubed graft (includes urinary diversion)
54352
1,516.30
1,532.95
Repair of hypospadias cripple requiring extensive
							 dissection and excision of previously constructed structures including
							 re-release of chordee and reconstruction of urethra and penis by use of local
							 skin as grafts and island flaps and skin brought in as flaps or
							 grafts
54360
1,516.30
767.32
Plastic operation on penis to correct
							 angulation
54380
1,516.30
843.83
Plastic operation on penis for epispadias distal to
							 external sphincter;
54385
1,516.30
1,035.20
Plastic operation on penis for epispadias distal to
							 external sphincter; with incontinence
54390
1,205.01
Plastic operation on penis for epispadias distal to
							 external sphincter; with exstrophy of bladder
54400
4,775.24
561.99
Insertion of penile prosthesis; non-inflatable
(semi-rigid)
54401
8,643.94
691.63
Insertion of penile prosthesis; inflatable
(self-contained)
54405
8,643.94
842.91
Insertion of multi-component, inflatable penile
							 prosthesis, including placement of pump, cylinders, and reservoir
54406
1,516.30
761.09
Removal of all components of a multi-component,
							 inflatable penile prosthesis without replacement of prosthesis
54408
1,516.30
817.50
Repair of component(s) of a multi-component,
							 inflatable penile prosthesis
54410
8,643.94
962.96
Removal and replacement of all component(s) of a
							 multi-component, inflatable penile prosthesis at the same operative
							 session
54411
1,054.59
Removal and replacement of all components of a
							 multi-component inflatable penile prosthesis through an infected field at the
							 same operative session, including irrigation and debridement of infected
							 tissue
54415
1,516.30
550.88
Removal of non-inflatable (semi-rigid) or inflatable
							 (self-contained) penile prosthesis, without replacement of
							 prosthesis
54416
8,643.94
733.99
Removal and replacement of non-inflatable
(semi-rigid) or inflatable (self-contained) penile
							 prosthesis at the same operative session
54417
925.41
Removal and replacement of non-inflatable
							 (semi-rigid) or inflatable (self-contained) penile prosthesis through an
							 infected field at the same operative session, including irrigation and
							 debridement of infected tissue
54420
1,516.30
741.14
Corpora cavernosa-saphenous vein shunt (priapism
							 operation), unilateral or bilateral
54430
672.32
Corpora cavernosa-corpus spongiosum shunt (priapism
							 operation), unilateral or bilateral
54435
1,516.30
439.91
Corpora cavernosa-glans penis fistulization (eg,
							 biopsy needle, Winter procedure, rongeur, or punch) for priapism
54440
1,516.30
I.C.
Plastic operation of penis for injury
54450
136.16
82.06
Foreskin manipulation including lysis of preputial
							 adhesions and stretching
54500
606.71
78.10
Biopsy of testis, needle (separate
							 procedure)
54505
997.67
226.91
Biopsy of testis, incisional (separate
							 procedure)
54512
997.67
560.76
Excision of extraparenchymal lesion of
							 testis
54520
997.67
343.83
Orchiectomy, simple (including subcapsular), with or
							 without testicular prosthesis, scrotal or inguinal approach
54522
997.67
613.50
Orchiectomy, partial
54530
1,370.98
574.70
Orchiectomy, radical, for tumor; inguinal
							 approach
54535
760.68
Orchiectomy, radical, for tumor; with abdominal
							 exploration
54550
1,370.98
509.00
Exploration for undescended testis (inguinal or
							 scrotal area)
54560
997.67
712.30
Exploration for undescended testis with abdominal
							 exploration
54600
997.67
472.03
Reduction of torsion of testis, surgical, with or
							 without fixation of contralateral testis
54620
997.67
317.53
Fixation of contralateral testis (separate
							 procedure)
54640
1,370.98
486.02
Orchiopexy, inguinal approach, with or without hernia
							 repair
54650
707.22
Orchiopexy, abdominal approach, for intra-abdominal
							 testis (eg, Fowler-Stephens)
54660
997.67
374.68
Insertion of testicular prosthesis (separate
							 procedure)
54670
997.67
429.89
Suture or repair of testicular injury
54680
997.67
828.22
Transplantation of testis(es) to thigh (because of
							 scrotal destruction)
54690
2,034.73
668.74
Laparoscopy, surgical; orchiectomy
54692
3,113.22
803.40
Laparoscopy, surgical; orchiopexy for intra-abdominal
							 testis
54699
I.C.
Unlisted laparoscopy procedure, testis
54700
997.67
225.27
Incision and drainage of epididymis, testis and/or
							 scrotal space (eg, abscess or hematoma)
54800
193.36
135.24
Biopsy of epididymis, needle
54830
997.67
385.30
Excision of local lesion of epididymis
54840
997.67
340.75
Excision of spermatocele, with or without
							 epididymectomy
54860
997.67
435.62
Epididymectomy; unilateral
54861
997.67
588.66
Epididymectomy; bilateral
54865
997.67
371.28
Exploration of epididymis, with or without
							 biopsy
54900
997.67
761.66
Epididymovasostomy, anastomosis of epididymis to vas
							 deferens; unilateral
54901
997.67
1,115.55
Epididymovasostomy, anastomosis of epididymis to vas
							 deferens; bilateral
55000
72.07
142.34
Puncture aspiration of hydrocele, tunica vaginalis,
							 with or without injection of medication
55040
1,370.98
354.34
Excision of hydrocele; unilateral
55041
1,370.98
526.98
Excision of hydrocele; bilateral
55060
997.67
393.42
Repair of tunica vaginalis hydrocele (Bottle
							 type)
55100
516.57
251.82
Drainage of scrotal wall abscess
55110
997.67
400.51
Scrotal exploration
55120
997.67
368.36
Removal of foreign body in scrotum
55150
997.67
503.84
Resection of scrotum
55175
997.67
377.02
Scrotoplasty; simple
55180
997.67
714.96
Scrotoplasty; complicated
55200
997.67
631.64
Vasotomy, cannulization with or without incision of
							 vas, unilateral or bilateral (separate procedure)
55250
997.67
565.02
Vasectomy, unilateral or bilateral (separate
							 procedure), including postoperative semen examination(s)
55300
197.42
Vasotomy for vasograms, seminal vesiculograms, or
							 epididymograms, unilateral or bilateral
55400
997.67
528.14
Vasovasostomy, vasovasorrhaphy
55450
228.72
444.99
Ligation (percutaneous) of vas deferens, unilateral
							 or bilateral (separate procedure)
55500
997.67
392.98
Excision of hydrocele of spermatic cord, unilateral
							 (separate procedure)
55520
997.67
408.94
Excision of lesion of spermatic cord (separate
							 procedure)
55530
997.67
371.16
Excision of varicocele or ligation of spermatic veins
							 for varicocele; (separate procedure)
55535
1,370.98
445.34
Excision of varicocele or ligation of spermatic veins
							 for varicocele; abdominal approach
55540
1,370.98
493.18
Excision of varicocele or ligation of spermatic veins
							 for varicocele; with hernia repair
55550
2,034.73
439.93
Laparoscopy, surgical, with ligation of spermatic
							 veins for varicocele
55559
I.C.
Unlisted laparoscopy procedure, spermatic
							 cord
55600
997.67
443.69
Vesiculotomy;
55605
518.66
Vesiculotomy; complicated
55650
746.41
Vesiculectomy, any approach
55680
997.67
363.75
Excision of Mullerian duct cyst
55700
493.08
273.20
Biopsy, prostate; needle or punch, single or
							 multiple, any approach
55705
493.08
284.26
Biopsy, prostate; incisional, any
							 approach
55720
1,107.15
490.58
Prostatotomy, external drainage of prostatic abscess,
							 any approach; simple
55725
1,107.15
606.63
Prostatotomy, external drainage of prostatic abscess,
							 any approach; complicated
55801
1,122.93
Prostatectomy, perineal, subtotal (including control
							 of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or
							 dilation, and internal urethrotomy)
55810
1,361.91
Prostatectomy, perineal radical;
55812
1,654.65
Prostatectomy, perineal radical; with lymph node
							 biopsy(s) (limited pelvic lymphadenectomy)
55815
1,829.01
Prostatectomy, perineal radical; with bilateral
							 pelvic lymphadenectomy, including external iliac, hypogastric and obturator
							 nodes
55821
905.92
Prostatectomy (including control of postoperative
							 bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and
							 internal urethrotomy); suprapubic, subtotal, one or two stages
55831
980.92
Prostatectomy (including control of postoperative
							 bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and
							 internal urethrotomy); retropubic, subtotal
55840
1,388.45
Prostatectomy, retropubic radical, with or without
							 nerve sparing;
55842
1,486.39
Prostatectomy, retropubic radical, with or without
							 nerve sparing; with lymph node biopsy(s) (limited pelvic
							 lymphadenectomy)
55845
1,696.20
Prostatectomy, retropubic radical, with or without
							 nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac,
							 hypogastric, and obturator nodes
55860
864.33
910.79
Exposure of prostate, any approach, for insertion of
							 radioactive substance;
55862
1,150.45
Exposure of prostate, any approach, for insertion of
							 radioactive substance; with lymph node biopsy(s) (limited pelvic
							 lymphadenectomy)
55865
1,380.09
Exposure of prostate, any approach, for insertion of
							 radioactive substance; with bilateral pelvic lymphadenectomy, including
							 external iliac, hypogastric and obturator nodes
55866
1,802.73
Laparoscopy, surgical prostatectomy, retropubic
							 radical, including nerve sparing
55870
73.92
185.40
Electroejaculation
55873
7,263.53
1,198.11
Cryosurgical ablation of the prostate (includes
							 ultrasonic guidance for interstitial cryosurgical probe placement)
55875
1,612.24
795.95
Transperineal placement of needles or catheters into
							 prostate for interstitial radioelement application, with or without
							 cystoscopy
55876
76.12
162.74
Placement of interstitial device(s) for radiation
							 therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any
							 approach), single or multiple
55899
I.C.
Unlisted procedure, male genital system
55920
1,148.25
445.64
Placement of needles or catheters into pelvic organs
							 and/or genitalia (except prostate) for subsequent interstitial radioelement
							 application
56405
45.97
112.48
Incision and drainage of vulva or perineal
							 abscess
56420
60.41
140.39
Incision and drainage of Bartholin's gland
							 abscess
56440
849.98
182.87
Marsupialization of Bartholin's gland
							 cyst
56441
849.98
154.95
Lysis of labial adhesions
56442
849.98
49.09
Hymenotomy, simple incision
56501
62.89
137.03
Destruction of lesion(s), vulva; simple (eg, laser
							 surgery, electrosurgery, cryosurgery, chemosurgery)
56515
889.48
227.03
Destruction of lesion(s), vulva; extensive (eg, laser
							 surgery, electrosurgery, cryosurgery, chemosurgery)
56605
36.78
87.48
Biopsyof vulva or perineum (separate procedure); one
							 lesion
56606
15.45
40.67
Biopsy of vulva or perineum (separate procedure);
							 each separate additional lesion (List separately in addition to code for
							 primary procedure)
56620
849.98
526.41
Vulvectomy simple; partial
56625
849.98
589.54
Vulvectomy simple; complete
56630
847.49
Vulvectomy, radical, partial;
56631
1,083.02
Vulvectomy, radical, partial; with unilateral
							 inguinofemoral lymphadenectomy
56632
1,242.60
Vulvectomy, radical, partial; with bilateral
							 inguinofemoral lymphadenectomy
56633
1,101.55
Vulvectomy, radical, complete;
56634
1,169.80
Vulvectomy, radical, complete; with unilateral
							 inguinofemoral lymphadenectomy
56637
1,386.16
Vulvectomy, radical, complete; with bilateral
							 inguinofemoral lymphadenectomy
56640
1,376.11
Vulvectomy, radical, complete, with inguinofemoral,
							 iliac, and pelvic lymphadenectomy
56700
849.98
187.10
Partial hymenectomy or revision of hymenal
							 ring
56740
849.98
294.47
Excision of Bartholin's gland or cyst
56800
849.98
242.09
Plastic repair of introitus
56805
849.98
1,132.31
Clitoroplasty for intersex state
56810
849.98
260.02
Perineoplasty, repair of perineum, nonobstetrical
							 (separate procedure)
56820
45.97
114.15
Colposcopy of the vulva;
56821
60.31
153.43
Colposcopy of the vulva; with biopsy(s)
57000
849.98
191.01
Colpotomy; with exploration
57010
849.98
426.31
Colpotomy; with drainage of pelvic
							 abscess
57020
271.63
96.19
Colpocentesis (separate procedure)
57022
516.57
167.18
Incision and drainage of vaginal hematoma;
							 obstetrical/postpartum
57023
818.67
306.23
Incision and drainage of vaginal hematoma;
							 non-obstetrical (eg, post-trauma, spontaneous bleeding)
57061
58.10
121.04
Destruction of vaginal lesion(s); simple (eg, laser
							 surgery, electrosurgery, cryosurgery, chemosurgery)
57065
849.98
198.51
Destruction of vaginal lesion(s); extensive (eg,
							 laser surgery, electrosurgery, cryosurgery, chemosurgery)
57100
37.14
92.12
Biopsyof vaginal mucosa; simple (separate
							 procedure)
57105
849.98
142.17
Biopsy of vaginal mucosa; extensive, requiring suture
							 (including cysts)
57106
467.53
Vaginectomy, partial removal of vaginal
							 wall;
57107
1,364.88
Vaginectomy, partial removal of vaginal wall; with
							 removal of paravaginal tissue (radical vaginectomy)
57109
1,555.86
Vaginectomy, partial removal of vaginal wall; with
							 removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic
							 lymphadenectomy and para-aortic lymph node sampling (biopsy)
57110
887.05
Vaginectomy, complete removal of vaginal
							 wall;
57111
1,590.57
Vaginectomy, complete removal of vaginal wall; with
							 removal of paravaginal tissue (radical vaginectomy)
57112
1,652.13
Vaginectomy, complete removal of vaginal wall; with
							 removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic
							 lymphadenectomy and para-aortic lymph node sampling (biopsy)
57120
508.49
Colpocleisis (Le Fort type)
57130
849.98
186.82
Excision of vaginal septum
57135
849.98
199.76
Excision of vaginal cyst or tumor
57150
30.89
59.54
Irrigation of vagina and/or application of medicament
							 for treatment of bacterial, parasitic, or fungoid disease
57155
271.63
430.21
Insertion of uterine tandems and/or vaginal ovoids
							 for clinical brachytherapy
57160
37.88
80.79
Fitting and insertion of pessary or other
							 intravaginal support device
57170
5.85
81.32
Diaphragm or cervical cap fitting with
							 instructions
57180
60.41
152.84
Introduction of any hemostatic agent or pack for
							 spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate
							 procedure)
57200
849.98
297.29
Colporrhaphy, suture of injury of vagina
							 (nonobstetrical)
57210
849.98
365.00
Colpoperineorrhaphy, suture of injury of vagina
							 and/or perineum (nonobstetrical)
57220
1,908.63
319.00
Plastic operation on urethral sphincter, vaginal
							 approach (eg, Kelly urethral plication)
57230
1,448.95
390.58
Plastic repair of urethrocele
57240
1,448.95
622.53
Anterior colporrhaphy, repair of cystocele with or
							 without repair of urethrocele
57250
1,448.95
607.78
Posterior colporrhaphy, repair of rectocele with or
							 without perineorrhaphy
57260
1,448.95
765.16
Combined anteroposterior colporrhaphy;
57265
1,908.63
865.53
Combined anteroposterior colporrhaphy; with
							 enterocele repair
57267
1,448.95
265.89
Insertion of mesh or other prosthesis for repair of
							 pelvic floor defect, each site (anterior, posterior compartment), vaginal
							 approach (List separately in addition to code for primary
							 procedure)
57268
1,448.95
474.81
Repair of enterocele, vaginal approach (separate
							 procedure)
57270
783.90
Repair of enterocele, abdominal approach (separate
							 procedure)
57280
947.84
Colpopexy, abdominal approach
57282
505.38
Colpopexy, vaginal; extra-peritoneal approach
							 (sacrospinous, iliococcygeus)
57283
680.03
Colpopexy, vaginal; intra-peritoneal approach
							 (uterosacral, levator myorrhaphy)
57284
831.21
Paravaginal defect repair (including repair of
							 cystocele, if performed); open abdominal approach
57285
649.72
Paravaginal defect repair (including repair of
							 cystocele, if performed); vaginal approach
57287
1,448.95
691.77
Removal or revision of sling for stress incontinence
							 (eg, fascia or synthetic)
57288
1,908.63
809.26
Sling operation for stress incontinence (eg, fascia
							 or synthetic)
57289
1,448.95
762.74
Pereyra procedure, including anterior
							 colporrhaphy
57291
1,448.95
545.46
Construction of artificial vagina; without
							 graft
57292
817.79
Construction of artificial vagina; with
							 graft
57295
487.62
Revision (including removal) of prosthetic vaginal
							 graft; vaginal approach
57296
919.36
Revision (including removal) of prosthetic vaginal
							 graft; open abdominal approach
57300
1,448.95
519.71
Closure of rectovaginal fistula; vaginal or transanal
							 approach
57305
858.95
Closure of rectovaginal fistula; abdominal
							 approach
57307
961.56
Closure of rectovaginal fistula; abdominal approach,
							 with concomitant colostomy
57308
623.51
Closure of rectovaginal fistula; transperineal
							 approach, with perineal body reconstruction, with or without levator
							 plication
57310
477.87
Closure of urethrovaginal fistula;
57311
541.68
Clos u re of ure t hro va g inal f ist ula; wi th
							 bulbocavernosus transplant
57320
1,448.95
542.31
Closure of vesicovaginal fistula; vaginal
							 approach
57330
776.73
Closure of vesicovaginal fistula; transvesical and
							 vaginal approach
57335
1,123.99
Vaginoplasty for intersex state
57400
849.98
133.63
Dilation of vagina under anesthesia
57410
849.98
106.57
Pelvic examination under anesthesia
57415
849.98
157.70
Removal of impacted vaginal foreign body (separate
							 procedure) under anesthesia
57420
47.44
119.70
Colposcopy of the entire vagina, with cervix if
							 present;
57421
63.25
162.38
Colposcopy of the entire vagina, with cervix if
							 present; with biopsy(s) of vagina/cervix
57423
895.85
Paravaginal defect repair (including repair of
							 cystocele, if performed), laparoscopic approach
57425
942.41
Laparoscopy, surgical, colpopexy (suspension of
							 vaginal apex)
57452
45.23
113.22
Colposcopy of the cervix including upper/adjacent
							 vagina;
57454
55.52
157.91
Colposcopy of the cervix including upper/adjacent
							 vagina; with biopsy(s) of the cervix and endocervical curettage
57455
59.21
149.24
Colposcopy of the cervix including upper/adjacent
							 vagina; with biopsy(s) of the cervix
57456
57.00
141.10
Colposcopy of the cervix including upper/adjacent
							 vagina; with endocervical curettage
57460
186.08
339.72
Colposcopy of the cervix including upper/adjacent
							 vagina; with loop electrode biopsy(s) of the cervix
57461
196.00
375.19
Colposcopy of the cervix including upper/adjacent
							 vagina; with loop electrode conization of the cervix
57500
83.85
149.51
Biopsy of cervix, single or multiple, or local
							 excision of lesion, with or without fulguration (separate
							 procedure)
57505
51.11
107.78
Endocervical curettage (not done as part of a
							 dilation and curettage)
57510
52.59
137.59
Cautery of cervix; electro or thermal
57511
60.41
151.16
Cautery of cervix; cryocautery, initial or
							 repeat
57513
849.98
147.94
Cautery of cervix; laser ablation
57520
849.98
321.77
Conization of cervix, with or without fulguration,
							 with or without dilation and curettage, with or without repair; cold knife or
							 laser
57522
849.98
272.13
Conization of cervix, with or without fulguration,
							 with or without dilation and curettage, with or without repair; loop electrode
							 excision
57530
1,448.95
343.72
Trachelectomy (cervicectomy), amputation of cervix
							 (separate procedure)
57531
1,670.11
Radical trachelectomy, with bilateral total pelvic
							 lymphadenectomy and para-aortic lymph node sampling biopsy, with or without
							 removal of tube(s), with or without removal of ovary(s)
57540
763.81
Excision of cervical stump, abdominal
							 approach;
57545
808.94
Excision of cervical stump, abdominal approach; with
							 pelvic floor repair
57550
1,448.95
404.36
Excision of cervical stump, vaginal
							 approach;
57555
595.10
Excision of cervical stump, vaginal approach; with
							 anterior and/or posterior repair
57556
1,908.63
561.45
Excision of cervical stump, vaginal approach; with
							 repair of enterocele
57558
849.98
128.60
Dilation and curettage of cervical stump
57700
849.98
303.20
Cerclage of uterine cervix,
							 nonobstetrical
57720
849.98
308.36
Trachelorrhaphy, plastic repair of uterine cervix,
							 vaginal approach
57800
27.21
63.05
Dilation of cervical canal, instrumental (separate
							 procedure)
58100
45.23
114.25
Endometrial sampling (biopsy) with or without
							 endocervical sampling (biopsy), without cervical dilation, any method (separate
							 procedure)
58110
50.62
Endometrial sampling (biopsy) performed in
							 conjunction with colposcopy (List separately in addition to code for primary
							 procedure)
58120
849.98
247.63
Dilation and curettage, diagnostic and/or therapeutic
							 (nonobstetrical)
58140
895.89
Myomectomy, excision of fibroid tumor(s) of uterus,
							 one to four intramural myoma(s) with total weight of 250 g or less and/or
							 removal of surface myomas; abdominal approach
58145
1,448.95
537.46
Myomectomy, excision of fibroid tumor(s) of uterus,
							 one to four intramural myoma(s) with total weight of 250 g or less and/or
							 removal of surface myomas; vaginal approach
58146
1,137.41
Myomectomy, excision of fibroid tumor(s) of uterus,
							 five or more intramural myomas and/or intramural myomas with total weight
							 greater than 250 g, abdominal approach
58150
966.17
Total abdominal hysterectomy (corpus and cervix),
							 with or without removal of tube(s), with or without removal of
							 ovary(s);
58152
1,228.22
Total abdominal hysterectomy (corpus and cervix),
							 with or without removal of tube(s), with or without removal of ovary(s); with
							 colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)
58180
929.65
Supracervical abdominal hysterectomy (subtotal
							 hysterectomy), with or without removal of tube(s), with or without removal of
							 ovary(s)
58200
1,279.20
Total abdominal hysterectomy, including partial
							 vaginectomy, with para-aortic and pelvic lymph node sampling, with or without
							 removal of tube(s), with or without removal of ovary(s)
58210
1,702.05
Radical abdominal hysterectomy, with bilateral total
							 pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or
							 without removal of tube(s), with or without removal of ovary(s)
58240
2,611.96
Pelvic exenteration for gynecologic malignancy, with
							 total abdominal hysterectomy or cervicectomy, with or without removal of
							 tube(s), with or without removal of ovary(s), with removal of bladder and
							 ureteral transplantations, and/or abdominoperineal resection of rectum and
							 colon and colostomy, or any combination thereof
58260
812.96
Vaginal hysterectomy, for uterus 250 g or
							 less;
58262
907.21
Vaginal hysterectomy, for uterus 250 g or less; with
							 removal of tube(s), and/or ovary(s)
58263
976.46
Vaginal hysterectomy, for uterus 250 g or less; with
							 removal of tube(s), and/or ovary(s), with repair of enterocele
58267
1,037.51
Vaginal hysterectomy, for uterus 250 g or less; with
							 colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or
							 without endoscopic control
58270
870.31
Vaginal hysterectomy, for uterus 250 g or less; with
							 repair of enterocele
58275
965.51
Vaginal hysterectomy, with total or partial
							 vaginectomy;
58280
1,033.27
Vaginal hysterectomy, with total or partial
							 vaginectomy; with repair of enterocele
58285
1,288.26
Vaginal hysterectomy, radical (Schauta type
							 operation)
58290
1,136.88
Vaginal hysterectomy, for uterus greater than 250
							 g;
58291
1,232.97
Vaginal hysterectomy, for uterus greater than 250 g;
							 with removal of tube(s) and/or ovary(s)
58292
1,301.76
Vaginal hysterectomy, for uterus greater than 250 g;
							 with removal of tube(s) and/or ovary(s), with repair of enterocele
58293
1,352.33
Vaginal hysterectomy, for uterus greater than 250 g;
							 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with
							 or without endoscopic control
58294
1,196.93
Vaginal hysterectomy, for uterus greater than 250 g;
							 with repair of enterocele
58300
85.49
Insertion of intrauterine device (IUD)
58301
43.39
102.17
Removal of intrauterine device (IUD)
58340
155.18
Catheterization and introduction of saline or
							 contrast material for saline infusion sonohysterography (SIS) or
							 hysterosalpingography
58345
849.98
276.22
Transcervical introduction of fallopian tube catheter
							 for diagnosis and/or re-establishing patency (any method), with or without
							 hysterosalpingography
58346
849.98
448.46
Insertion of Heyman capsules for clinical
							 brachytherap
58350
1,448.95
104.12
Chromotubation of oviduct, including
							 materials
58353
1,448.95
1,481.5
Endometrial ablation, thermal, without hysteroscopic
							 guidance
58356
1,925.44
2,654.98
Endometrial cryoablation with ultrasonic guidance,
							 including endometrial curettage, when performed
58400
443.04
Uterine suspension, with or without shortening of
							 round ligaments, with or without shortening of sacrouterine ligaments;
							 (separate procedure)
58410
786.93
Uterine suspension, with or without shortening of
							 round ligaments, with or without shortening of sacrouterine ligaments; with
							 presacral sympathectomy
58520
766.02
Hysterorrhaphy, repair of ruptured uterus
							 (nonobstetrical)
58540
888.11
Hysteroplasty, repair of uterine anomaly (Strassman
							 type)
58541
829.97
Laparoscopy, surgical, supracervical hysterectomy, fo
							 uterus 250 g or less;
58542
917.26
Laparoscopy, surgical, supracervical hysterectomy, fo
							 uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58543
932.26
Laparoscopy, surgical, supracervical hysterectomy, fo
							 uterus greater than 250 g;
58544
1,006.68
Laparoscopy, surgical, supracervical hysterectomy, fo
							 uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58545
1,537.09
880.97
Laparoscopy, surgical, myomectomy, excision; 1 to 4
							 intramural myomas with total weight of 250 g or less and/or removal of surface
							 myomas
58546
2,034.73
1,114.41
Laparoscopy, surgical, myomectomy, excision; 5 or
							 more intramural myomas and/or intramural myomas with total weight greater than
							 250 g
58548
1,753.28
Laparoscopy, surgical, with radical hysterectomy,
							 with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling
							 (biopsy), with removal of tube(s) and ovary(s), if performed
58550
3,113.22
871.83
Laparoscopy, surgical, with vaginal hysterectomy, for
							 uterus 250 g or less;
58552
2,034.73
960.32
Laparoscopy, surgical, with vaginal hysterectomy, for
							 uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58553
1,118.96
Laparoscopy, surgical, with vaginal hysterectomy, for
							 uterus greater than 250 g;
58554
1,281.93
Laparoscopy, surgical, with vaginal hysterectomy, for
							 uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58555
967.84
239.84
Hysteroscopy, diagnostic (separate
							 procedure)
58558
967.84
312.41
Hysteroscopy, surgical; with sampling (biopsy) of
							 endometrium and/or polypectomy, with or without D & C
58559
967.84
342.51
Hysteroscopy, surgical; with lysis of intrauterine
							 adhesions (any method)
58560
1,528.55
388.11
Hysteroscopy, surgical; with division or resection of
							 intrauterine septum (any method)
58561
1,528.55
547.66
Hysteroscopy, surgical; with removal of
							 leiomyomata
58562
967.84
331.75
Hysteroscopy, surgical; with removal of impacted
							 foreign body
58563
1,528.55
2,383.86
Hysteroscopy, surgical; with endometrial ablation
							 (eg, endometrial resection, electrosurgical ablation,
							 thermoablation)
58565
1,908.63
2,384.35
Hysteroscopy, surgical; with bilateral fallopian tube
							 cannulation to induce occlusion by placement of permanent implants
58570
889.65
Laparoscopy, surgical, with total hysterectomy, for
							 uterus 250 g or less;
58571
973.70
Laparoscopy, surgical, with total hysterectomy, for
							 uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58572
1,100.55
Laparoscopy, surgical, with total hysterectomy, for
							 uterus greater than 250 g;
58573
1,240.51
Laparoscopy, surgical, with total hysterectomy, for
							 uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58578
I.C.
Unlisted laparoscopy procedure, uterus
58579
I.C.
Unlisted hysteroscopy procedure, uterus
58600
1,448.95
363.93
Ligation or transection of fallopian tube(s),
							 abdominal or vaginal approach, unilateral or bilateral
58660
2,034.73
660.59
Laparoscopy, surgical; with lysis of adhesions
							 (salpingolysis, ovariolysis) (separate procedure)
58661
2,034.73
635.41
Laparoscopy, surgical; with removal of adnexal
							 structures (partial or total oophorectomy and/or salpingectomy)
58662
2,034.73
697.88
Laparoscopy, surgical; with fulguration or excision
							 of lesions of the ovary, pelvic viscera, or peritoneal surface by any
							 method
58670
2,034.73
363.31
Laparoscopy, surgical; with fulguration of oviducts
							 (with or without transection)
58671
2,034.73
363.61
Laparoscopy, surgical; with occlusion of oviducts by
							 device (eg, band, clip, or Falope ring)
58672
2,034.73
739.96
Laparoscopy, surgical; with fimbrioplasty
58673
2,034.73
797.88
Laparoscopy, surgical; with salpingostomy
							 (salpingoneostomy)
58679
I.C.
Unlisted laparoscopy procedure, oviduct,
							 ovary
58700
747.86
Salpingectomy, complete or partial, unilateral or
							 bilateral (separate procedure)
58720
704.05
Salpingo-oophorectomy, complete or partial,
							 unilateral or bilateral (separate procedure)
58740
859.86
Lysis of adhesions (salpingolysis,
							 ovariolysis)
58750
895.57
Tubotubal anastomosis
58752
883.32
Tubouterine implantation
58760
809.91
Fimbrioplasty
58770
845.08
Salpingostomy (salpingoneostomy)
58800
849.98
325.78
Drainage of ovarian cyst(s), unilateral or bilateral
							 (separate procedure); vaginal approach
58805
1,448.95
398.25
Drainage of ovarian cyst(s), unilateral or bilateral
							 (separate procedure); abdominal approach
58820
1,448.95
316.02
Drainage of ovarian abscess; vaginal approach,
							 open
58822
673.47
Drainage of ovarian abscess; abdominal
							 approach
58823
1,073.66
Drainage of pelvic abscess, transvaginal or
							 transrectal approach, percutaneous (eg, ovarian, pericolic)
58825
683.91
Transposition, ovary(s)
58900
849.98
406.81
Biopsy of ovary, unilateral or bilateral (separate
							 procedure)
58920
692.55
Wedge resection or bisection of ovary, unilateral or
							 bilateral
58925
715.02
Ovarian cystectomy, unilateral or
							 bilateral
58940
491.85
Oophorectomy, partial or total, unilateral or
							 bilateral;
58943
1,093.99
Oophorectomy, partial or total, unilateral or
							 bilateral; for ovarian, tubal or primary peritoneal malignancy, with
							 para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal
							 biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or
							 without omentectomy
58950
1,044.16
Resection (initial) of ovarian, tubal or primary
							 peritoneal malignancy with bilateral salpingo-oophorectomy and
							 omentectomy;
58951
1,341.88
Resection (initial) of ovarian, tubal or primary
							 peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy;
							 with total abdominal hysterectomy, pelvic and limited para-aortic
							 lymphadenectomy
58952
1,514.45
Resection (initial) of ovarian, tubal or primary
							 peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy;
							 with radical dissection for debulking (ie, radical excision or destruction,
							 intra-abdominal or retroperitoneal tumors)
58953
1,877.45
Bilateral salpingo-oophorectomy with omentectomy,
							 total abdominal hysterectomy and radical dissection for debulking;
58954
2,037.48
Bilateral salpingo-oophorectomy with omentectomy,
							 total abdominal hysterectomy and radical dissection for debulking; with pelvic
							 lymphadenectomy and limited para-aortic lymphadenectomy
58956
1,328.51
Bilateral salpingo-oophorectomy with total
							 omentectomy, total abdominal hysterectomy for malignancy
58957
1,418.68
Resection (tumor debulking) of recurrent ovarian,
							 tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal
							 tumors), with omentectomy, if performed;
58958
1,567.67
Resection (tumor debulking) of recurrent ovarian,
							 tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal
							 tumors), with omentectomy, if performed; with pelvic lymphadenectomy and
							 limited para-aortic lymphadenectomy
58960
902.31
Laparotomy, for staging or restaging of ovarian,
							 tubal, or primary peritoneal malignancy (second look), with or without
							 omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum,
							 diaphragmatic assessment with pelvic and limited para-aortic
							 lymphadenectomy
58970
123.27
228.81
Follicle puncture for oocyte retrieval, any
							 method
58974
123.27
I.C.
Embryo transfer, intrauterine
58976
123.27
250.84
Gamete, zygote, or embryo intrafallopian transfer,
							 any method
58999
I.C.
Unlisted procedure, female genital system
							 (nonobstetrical)
59000
70.24
141.59
Amniocentesis; diagnostic
59001
271.63
180.79
Amniocentesis; therapeutic amniotic fluid reduction
							 (includes ultrasound guidance)
59012
123.27
203.71
Cordocentesis (intrauterine), any method
59015
54.42
158.82
Chorionic villus sampling, any method
59020
25.74
72.67
37.46
35.22
Fetal contraction stress test
59025
13.23
47.45
30.28
17.17
Fetal non-stress test
59030
110.11
Fetal scalp blood sampling
59050
50.95
Fetal monitoring during labor by consulting physician
							 (ie, non-attending physician) with written report; supervision and
							 interpretation
59051
41.87
Fetal monitoring during labor by consulting physician
							 (ie, non-attending physician) with written report; interpretation
							 only
59070
123.27
406.86
Transabdominal amnioinfusion, including ultrasound
							 guidance
59072
123.27
438.78
Fetal umbilical cord occlusion, including ultrasound
							 guidance
59074
375.56
Fetal fluid drainage (eg, vesicocentesis,
							 thoracocentesis, paracentesis), including ultrasound guidance
59076
123.27
438.78
Fetal shunt placement, including ultrasound
							 guidance
59100
1,448.95
817.33
Hysterotomy, abdominal (eg, for hydatidiform mole,
							 abortion)
59121
784.00
Surgical treatment of ectopic pregnancy; tubal or
							 ovarian, without salpingectomy and/or oophorectomy
59160
849.98
233.91
Curettage, postpartum
59200
38.98
81.46
Insertion of cervical dilator (eg, laminaria,
							 prostaglandin) (separate procedure)
59300
80.17
199.71
Episiotomy or vaginal repair, by other than attending
							 physician
59320
849.98
153.91
Cerclage of cervix, during pregnancy;
							 vaginal
59325
241.87
Cerclage of cervix, during pregnancy;
							 abdominal
59350
274.62
Hysterorrhaphy of ruptured uterus
59400
1,756.97
Routine obstetric care including antepartum care,
							 vaginal delivery (with or without episiotomy, and/or forceps) and postpartum
							 care
59409
764.35
Vaginal delivery only (with or without episiotomy
							 and/or forceps);
59410
885.78
Vaginal delivery only (with or without episiotomy
							 and/or forceps); including postpartum care
59412
849.98
103.51
External cephalic version, with or without
							 tocolysis
59414
849.98
91.22
Delivery of placenta (separate procedure)
59510
1,988.69
Routine obstetric care including antepartum care,
							 cesarean delivery, and postpartum care
59514
903.36
Cesarean delivery only;
59515
1,068.52
Cesarean delivery only; including postpartum
							 care
59525
477.65
Subtotal or total hysterectomy after cesarean
							 delivery (List separately in addition to code for primary
							 procedure)
59610
1,848.42
Routine obstetric care including antepartum care,
							 vaginal delivery (with or without episiotomy, and/or forceps) and postpartum
							 care, after previous cesarean delivery
59612
857.25
Vaginal delivery only, after previous cesarean
							 deliver (with or without episiotomy and/or forceps);
59614
960.12
Vaginal delivery only, after previous cesarean
							 deliver (with or without episiotomy and/or forceps); including postpartum
							 care
59618
2,079.49
Routine obstetric care including antepartum care,
							 cesarean delivery, and postpartum care, following attempted vaginal delivery
							 after previous cesarean delivery
59620
985.32
Cesarean delivery only, following attempted vaginal
							 delivery after previous cesarean delivery;
59622
1,160.54
Cesarean delivery only, following attempted vaginal
							 delivery after previous cesarean delivery; including postpartum
							 care
59812
849.98
308.16
Treatment of incomplete abortion, any trimester,
							 completed surgically
59820
849.98
383.89
Treatment of missed abortion, completed surgically;
							 first trimester
59821
849.98
389.72
Treatment of missed abortion, completed surgically;
							 second trimester
59830
436.20
Treatment of septic abortion, completed
							 surgically
59840
849.98
218.87
Induced abortion, by dilation and
							 curettage
59841
849.98
379.24
Induced abortion, by dilation and
							 evacuation
59850
371.45
Induced abortion, by one or more intra-amniotic
							 injections (amniocentesis-injections), including hospital admission and visits,
							 delivery of fetus and secundines;
59851
402.05
Induced abortion, by one or more intra-amniotic
							 injections (amniocentesis-injections), including hospital admission and visits,
							 delivery of fetus and secundines; with dilation and curettage and/or
							 evacuation
59852
539.16
Induced abortion, by one or more intra-amniotic
							 injections (amniocentesis-injections), including hospital admission and visits,
							 delivery of fetus and secundines; with hysterotomy (failed intra-amniotic
							 injection)
59855
413.65
Induced abortion, by one or more vaginal
							 suppositories (eg, prostaglandin) with or without cervical dilation (eg,
							 laminaria), including hospital admission and visits, delivery of fetus and
							 secundines;
59856
487.77
Induced abortion, by one or more vaginal
							 suppositories (eg, prostaglandin) with or without cervical dilation (eg,
							 laminaria), including hospital admission and visits, delivery of fetus and
							 secundines; with dilation and curettage and/or evacuation
59857
570.48
Induced abortion, by one or more vaginal
							 suppositories (eg, prostaglandin) with or without cervical dilation (eg,
							 laminaria), including hospital admission and visits, delivery of fetus and
							 secundines; with hysterotomy (failed medical evacuation)
59866
123.27
237.33
Multifetal pregnancy reduction(s) (MPR)
59870
849.98
464.98
Uterine evacuation and curettage for hydatidiform
							 mole
59871
849.98
134.66
Removal of cerclage suture under anesthesia (other
							 than local)
59897
I.C.
Unlisted fetal invasive procedure, including
							 ultrasound guidance
59898
I.C.
Unlisted laparoscopy procedure, maternity care and
							 delivery
59899
I.C.
Unlisted procedure, maternity care and
							 delivery
60000
332.81
157.79
Incision and drainage of thyroglossal duct cyst,
							 infected
60100
49.64
118.86
Biopsy thyroid, percutaneous core needle
60200
1,980.76
632.83
Excision of cyst or adenoma of thyroid, or
							 transection of isthmus
60210
667.50
Partial thyroid lobectomy, unilateral; with or
							 without isthmusectomy
60212
952.13
Partial thyroid lobectomy, unilateral; with
							 contralateral subtotal lobectomy, including isthmusectomy
60220
731.21
Total thyroid lobectomy, unilateral; with or without
							 isthmusectomy
60225
879.60
Total thyroid lobectomy, unilateral; with
							 contralateral subtotal lobectomy, including isthmusectomy
60240
929.92
Thyroidectomy, total or complete
60252
1,251.42
Thyroidectomy, total or subtotal for malignancy; with
							 limited neck dissection
60254
1,628.24
Thyroidectomy, total or subtotal for malignancy; with
							 radical neck dissection
60260
1,048.48
Thyroidectomy, removal of all remaining thyroid
							 tissue following previous removal of a portion of thyroid
60270
1,312.74
Thyroidectomy, including substernal thyroid; sternal
							 split or transthoracic approach
60271
1,013.57
Thyroidectomy, including substernal thyroid; cervical
							 approach
60280
1,980.76
433.10
Excision of thyroglossal duct cyst or
							 sinus;
60281
1,980.76
576.10
Excision of thyroglossal duct cyst or sinus;
							 recurrent
60300
61.41
112.08
Aspiration and/or injection, thyroid cyst
60500
958.28
Parathyroidectomy or exploration of
							 parathyroid(s);
60502
1,207.28
Parathyroidectomy or exploration of parathyroid(s);
							 re-exploration
60505
1,329.30
Parathyroidectomy or exploration of parathyroid(s);
							 with mediastinal exploration, sternal split or transthoracic
							 approach
60512
232.38
Parathyroid autotransplantation (List separately in
							 addition to code for primary procedure)
60520
1,000.88
Thymectomy, partial or total; transcervical approach
							 (separate procedure)
60521
1,143.89
Thymectomy, partial or total; sternal split or
							 transthoracic approach, without radical mediastinal dissection (separate
							 procedure)
60522
1,376.48
Thymectomy, partial or total; sternal split or
							 transthoracic approach, with radical mediastinal dissection (separate
							 procedure)
60540
1,028.50
Adrenalectomy, partial or complete, or exploration of
							 adrenal gland with or without biopsy, transabdominal, lumbar or dorsal
							 (separate procedure);
60545
1,175.49
Adrenalectomy, partial or complete, or exploration of
							 adrenal gland with or without biopsy, transabdominal, lumbar or dorsal
							 (separate procedure); with excision of adjacent retroperitoneal
							 tumor
60600
1,374.86
Excision of carotid body tumor; without excision of
							 carotid artery
60605
1,724.28
Excision of carotid body tumor; with excision of
							 carotid artery
60650
1,143.08
Laparoscopy, surgical, with adrenalectomy, partial or
							 complete, or exploration of adrenal gland with or without biopsy,
							 transabdominal, lumbar or dorsal
60659
I.C.
Unlisted laparoscopy procedure, endocrine
							 system
60699
I.C.
Unlisted procedure, endocrine system
61020
381.03
129.87
Ventricular puncture through previous burr hole,
							 fontanelle, suture, or implanted ventricular catheter/reservoir; without
							 injection
61026
381.03
129.27
Ventricular puncture through previous burr hole,
							 fontanelle, suture, or implanted ventricular catheter/reservoir; with injection
							 of medication or other substance for diagnosis or treatment
61050
381.03
110.55
Cisternal or lateral cervical (C1-C2) puncture;
							 without injection (separate procedure)
61055
381.03
139.85
Cisternal or lateral cervical (C1-C2) puncture; with
							 injection of medication or other substance for diagnosis or treatment (eg,
							 C1-C2)
61070
144.72
85.19
Puncture of shunt tubing or reservoir for aspiration
							 or injection procedure
61105
427.38
Twist drill hole for subdural or ventricular
							 puncture
61107
309.38
Twist drill hole(s) for subdural, intracerebral, or
							 ventricular puncture; for implanting ventricular catheter, pressure recording
							 device, or other intracerebral monitoring device
61108
828.84
Twist drill hole(s) for subdural, intracerebral, or
							 ventricular puncture; for evacuation and/or drainage of subdural
							 hematoma
61120
682.11
Burr hole(s) for ventricular puncture (including
							 injection of gas, contrast media, dye, or radioactive material)
61140
1,174.53
Burr hole(s) or trephine; with biopsy of brain or
							 intracranial lesion
61150
1,256.06
Burr hole(s) or trephine; with drainage of brain
							 abscess or cyst
61151
922.29
Burr hole(s) or trephine; with subsequent tapping
							 (aspiration) of intracranial abscess or cyst
61154
1,171.54
Burr hole(s) with evacuation and/or drainage of
							 hematoma, extradural or subdural
61156
1,170.01
Burr hole(s); with aspiration of hematoma or cyst,
							 intracerebral
61210
360.47
Burr hole(s); for implanting ventricular catheter,
							 reservoir, EEG electrode(s), pressure recording device, or other cerebral
							 monitoring device (separate procedure)
61215
1,621.15
452.03
Insertion of subcutaneous reservoir, pump or
							 continuous infusion system for connection to ventricular catheter
61250
800.32
Burr hole(s) or trephine, supratentorial,
							 exploratory, not followed by other surgery
61253
886.67
Burr hole(s) or trephine, infratentorial, unilateral
							 or bilateral
61304
1,548.73
Craniectomy or craniotomy, exploratory;
							 supratentoria
61305
1,852.83
Craniectomy or craniotomy, exploratory; infratentoria
							 (posterior fossa)
61312
1,914.19
Craniectomy or craniotomy for evacuation of hematoma,
							 supratentorial; extradural or subdural
61313
1,841.86
Craniectomy or craniotomy for evacuation of hematoma,
							 supratentorial; intracerebral
61314
1,694.09
Craniectomy or craniotomy for evacuation of hematoma,
							 infratentorial; extradural or subdural
61315
1,948.39
Craniectomy or craniotomy for evacuation of hematoma,
							 infratentorial; intracerebellar
61316
83.73
Incision and subcutaneous placement of cranial bone
							 graft (List separately in addition to code for primary procedure)
61320
1,798.63
Craniectomy or craniotomy, drainage of intracranial
							 abscess; supratentorial
61321
1,993.02
Craniectomy or craniotomy, drainage of intracranial
							 abscess; infratentorial
61322
2,155.45
Craniectomy or craniotomy, decompressive, with or
							 without duraplasty, for treatment of intracranial hypertension, without
							 evacuation of associated intraparenchymal hematoma; without
							 lobectomy
61323
2,201.98
Craniectomy or craniotomy, decompressive, with or
							 without duraplasty, for treatment of intracranial hypertension, without
							 evacuation of associated intraparenchymal hematoma; with lobectomy
61330
61332
1,782.06
1,775.14
1,510.26
Decompression of orbit only, transcranial approach
							 Exploration of orbit (transcranial approach); with biopsy
61333
1,768.90
Exploration of orbit (transcranial approach); with
							 removal of lesion
61334
1,782.06
1,170.70
Exploration of orbit (transcranial approach); with
							 removal of foreign body
61340
1,353.00
Subtemporal cranial decompression (pseudotumor
							 cerebri, slit ventricle syndrome)
61343
2,065.85
Craniectomy, suboccipital with cervical laminectomy
							 for decompression of medulla and spinal cord, with or without dural graft (eg,
							 Arnold-Chiari malformation)
61345
1,900.99
Other cranial decompression, posterior
							 fossa
61440
1,858.46
Craniotomy for section of tentorium cerebelli
							 (separate procedure)
61450
1,768.24
Craniectomy, subtemporal, for section, compression,
							 or decompression of sensory root of gasserian ganglion
61458
1,890.60
Craniectomy, suboccipital; for exploration or
							 decompression of cranial nerves
61460
1,922.53
Craniectomy, suboccipital; for section of one or more
							 cranial nerves
61470
1,759.02
Craniectomy, suboccipital; for medullary
							 tractotomy
61480
1,695.02
Craniectomy, suboccipital; for mesencephalic
							 tractotomy or pedunculotomy
61490
1,790.67
Craniotomy for lobotomy, including
							 cingulotomy
61500
1,268.42
Craniectomy; with excision of tumor or other bone
							 lesion of skull
61501
1,079.76
Craniectomy; for osteomyelitis
61510
2,040.77
Craniectomy, trephination, bone flap craniotomy; for
							 excision of brain tumor, supratentorial, except meningioma
61512
2,413.34
Craniectomy, trephination, bone flap craniotomy; for
							 excision of meningioma, supratentorial
61514
1,785.50
Craniectomy, trephination, bone flap craniotomy; for
							 excision of brain abscess, supratentorial
61516
1,745.18
Craniectomy, trephination, bone flap craniotomy; for
							 excision or fenestration of cyst, supratentorial
61517
84.30
Implantation of brain intracavitary chemotherapy
							 agent (List separately in addition to code for primary procedure)
61518
2,597.64
Craniectomy for excision of brain tumor,
							 infratentorial or posterior fossa; except meningioma, cerebellopontine angle
							 tumor, or midline tumor at base of skull
61519
2,793.31
Craniectomy for excision of brain tumor,
							 infratentorial or posterior fossa; meningioma
61520
3,574.11
Craniectomy for excision of brain tumor,
							 infratentorial or posterior fossa; cerebellopontine angle tumor
61521
3,008.07
Craniectomy for ex cision of brain tumor,
							 infratentorial or posterior fossa; midline tumor at base of skull
61522
2,041.89
Craniectomy, infratentorial or posterior fossa; for
							 excision of brain abscess
61524
1,952.90
Craniectomy, infratentorial or posterior fossa; for
							 excision or fenestration of cyst
61526
3,249.89
Craniectomy, bone flap craniotomy, transtemporal
							 (mastoid) for excision of cerebellopontine angle tumor;
61530
2,760.97
Craniectomy, bone flap craniotomy, transtemporal
							 (mastoid) for excision of cerebellopontine angle tumor; combined with
							 middle/posterior fossa craniotomy/craniectomy
61531
1,120.53
Subdural implantation of strip electrodes through one
							 or more burr or trephine hole(s) for long-term seizure monitoring
61533
1,419.45
Craniotomy with elevation of bone flap; for subdural
							 implantation of an electrode array, for long-term seizure
							 monitoring
61534
1,524.67
Craniotomy with elevation of bone flap; for excision
							 of epileptogenic focus without electrocorticography during surgery
61535
910.30
Craniotomy with elevation of bone flap; for removal
							 of epidural or subdural electrode array, without excision of cerebral tissue
							 (separate procedure)
61536
2,441.86
Craniotomy with elevation of bone flap; for excision
							 of cerebral epileptogenic focus, with electrocorticography during surgery
							 (includes removal of electrode array)
61537
2,180.51
Craniotomy with elevation of bone flap; for
							 lobectomy, temporal lobe, without electrocorticography during
							 surgery
61538
2,326.67
Craniotomy with elevation of bone flap; for
							 lobectomy, temporal lobe, with electrocorticography during surgery
61539
2,211.66
Craniotomy with elevation of bone flap; for
							 lobectomy, other than temporal lobe, partial or total, with
							 electrocorticography during surgery
61540
2,090.42
Craniotomy with elevation of bone flap; for
							 lobectomy, other than temporal lobe, partial or total, without
							 electrocorticography during surgery
61541
1,993.14
Craniotomy with elevation of bone flap; for
							 transection of corpus callosum
61542
2,165.19
Craniotomy with elevation of bone flap; for total
							 hemispherectomy
61543
1,987.60
Craniotomy with elevation of bone flap; for partial
							 or subtotal (functional) hemispherectomy
61544
1,756.84
Craniotomy with elevation of bone flap; for excision
							 or coagulation of choroid plexus
61545
2,980.11
Craniotomy with elevation of bone flap; for excision
							 of craniopharyngioma
61546
2,155.21
Craniotomy for hypophysectomy or excision of
							 pituitary tumor, intracranial approach
61548
1,458.87
Hypophysectomy or excision of pituitary tumor,
							 transnasal or transseptal approach, nonstereotactic
61550
846.06
Craniectomy for craniosynostosis; single cranial
							 suture
61552
1,213.59
Craniectomy for craniosynostosis; multiple cranial
							 sutures
61556
1,526.34
Craniotomy for craniosynostosis; frontal or parietal
							 bone flap
61557
1,591.97
Craniotomy for craniosynostosis; bifrontal bone
							 flap
61558
1,605.54
Extensive craniectomy for multiple cranial suture
							 craniosynostosis (eg, cloverleaf skull); not requiring bone grafts
61559
2,277.43
Extensive craniectomy for multiple cranial suture
							 craniosynostosis (eg, cloverleaf skull); recontouring with multiple osteotomies
							 and bone autografts (eg, barrel-stave procedure) (includes obtaining
							 grafts)
61563
1,775.14
Excision, intra and extracranial, benign tumor of
							 cranial bone (eg, fibrous dysplasia); without optic nerve
							 decompression
61564
2,277.30
Excision, intra and extracranial, benign tumor of
							 cranial bone (eg, fibrous dysplasia); with optic nerve
							 decompression
61566
2,103.67
Craniotomy with elevation of bone flap; for selective
							 amygdalohippocampectomy
61567
2,368.91
Craniotomy with elevation of bone flap; for multiple
							 subpial transections, with electrocorticography during surgery
61570
1,719.96
Craniectomy or craniotomy; with excision of foreign
							 body from brain
61571
1,854.79
Craniectomy or craniotomy; with treatment of
							 penetrating wound of brain
61575
2,226.42
Transoral approach to skull base, brain stem or upper
							 spinal cord for biopsy, decompression or excision of lesion;
61576
3,495.09
Transoral approach to skull base, brain stem or upper
							 spinal cord for biopsy, decompression or excision of lesion; requiring
							 splitting of tongue and/or mandible (including tracheostomy)
61580
2,388.29
Craniofacial approach to anterior cranial fossa;
							 extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without
							 maxillectomy or orbital exenteration
61581
2,625.61
Craniofacial approach to anterior cranial fossa;
							 extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy,
							 sphenoidectomy and/or maxillectomy
61582
2,738.95
Craniofacial approach to anterior cranial fossa;
							 extradural, including unilateral or bifrontal craniotomy, elevation of frontal
							 lobe(s), osteotomy of base of anterior cranial fossa
61583
2,761.68
Craniofacial approach to anterior cranial fossa;
							 intradural, including unilateral or bifrontal craniotomy, elevation or
							 resection of frontal lobe, osteotomy of base of anterior cranial
							 fossa
61584
2,693.37
Orbitocranial approach to anterior cranial fossa,
							 extradural, including supraorbital ridge osteotomy and elevation of frontal
							 and/or temporal lobe(s); without orbital exenteration
61585
2,848.88
Orbitocranial approach to anterior cranial fossa,
							 extradural, including supraorbital ridge osteotomy and elevation of frontal
							 and/or temporal lobe(s); with orbital exenteration
61586
2,103.57
Bicoronal, transzygomatic and/or LeFort I osteotomy
							 approach to anterior cranial fossa with or without internal fixation, without
							 bone graft
61590
2,989.78
Infratemporal pre-auricular approach to middle
							 cranial fossa (parapharyngeal space, infratemporal and midline skull base,
							 nasopharynx), with or without disarticulation of the mandible, including
							 parotidectomy, craniotomy, decompression and/or mobilization of the facial
							 nerve and/or petrous carotid artery
61591
3,015.93
Infratemporal post-auricular approach to middle
							 cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous
							 sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection
							 of sigmoid sinus, with or without decompression and/or mobilization of contents
							 of auditory canal or petrous carotid artery
61592
2,996.42
Orbitocranial zygomatic approach to middle cranial
							 fossa (cavernous sinus and carotid artery, clivus, basilar artery or petrous
							 apex) including osteotomy of zygoma, craniotomy, extra- or intradural elevation
							 of temporal lobe
61595
2,266.60
Transtemporal approach to posterior cranial fossa,
							 jugular foramen or midline skull base, including mastoidectomy, decompression
							 of sigmoid sinus and/or facial nerve, with or without mobilization
61596
2,488.92
Transcochlear approach to posterior cranial fossa,
							 jugular foramen or midline skull base, including labyrinthectomy,
							 decompression, with or without mobilization of facial nerve and/or petrous
							 carotid artery
61597
2,720.71
Transcondylar (far lateral) approach to posterior
							 cranial fossa, jugular foramen or midline skull base, including occipital
							 condylectomy, mastoidectomy, resection of C1-C3 vertebral body(s),
							 decompression of vertebral artery, with or without mobilization
61598
2,458.84
Transpetrosal approach to posterior cranial fossa,
							 clivus or foramen magnum, including ligation of superior petrosal sinus and/or
							 sigmoid sinus
61600
2,042.41
Resection or excision of neoplastic, vascular or
							 infectious lesion of base of anterior cranial fossa; extradural
61601
2,245.38
Resection or excision of neoplastic, vascular or
							 infectious lesion of base of anterior cranial fossa; intradural, including
							 dural repair, with or without graft
61605
2,145.67
Resection or excision of neoplastic, vascular or
							 infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex;
							 extradural
61606
2,827.14
Resection or excision of neoplastic, vascular or
							 infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex;
							 intradural, including dural repair, with or without graft
61607
2,631.58
Resection or excision of neoplastic, vascular or
							 infectious lesion of parasellar area, cavernous sinus, clivus or midline skull
							 base; extradural
61608
3,091.93
Resection or excision of neoplastic, vascular or
							 infectious lesion of parasellar area, cavernous sinus, clivus or midline skull
							 base; intradural, including dural repair, with or without graft
61609
600.48
Transection or ligation, carotid artery in cavernous
							 sinus; without repair (List separately in addition to code for primary
							 procedure)
61610
1,799.27
Transection or ligation, carotid artery in cavernous
							 sinus; with repair by anastomosis or graft (List separately in addition to code
							 for primary procedure)
61611
436.69
Transection or ligation, carotid artery in petrous
							 canal; without repair (List separately in addition to code for primary
							 procedure)
61612
1,533.57
Transection or ligation, carotid artery in petrous
							 canal; with repair by anastomosis or graft (List separately in addition to code
							 for primary procedure)
61613
3,022.15
Obliteration of carotid aneurysm, arteriovenous
							 malformation, or carotid-cavernous fistula by dissection within cavernous
							 sinus
61615
2,371.84
Resection or excision of neoplastic, vascular or
							 infectious lesion of base of posterior cranial fossa, jugular foramen, foramen
							 magnum, or C1-C3 vertebral bodies; extradural
61616
3,125.61
Resection or excision of neoplastic, vascular or
							 infectious lesion of base of posterior cranial fossa, jugular foramen, foramen
							 magnum, or C1-C3 vertebral bodies; intradural, including dural repair, with or
							 without graft
61618
1,226.42
Secondary repair of dura for cerebrospinal fluid
							 leak, anterior, middle or posterior cranial fossa following surgery of the
							 skull base; by free tissue graft (eg, pericranium, fascia, tensor fascia lata,
							 adipose tissue, homologous or synthetic grafts)
61619
1,420.39
Secondary repair of dura for cerebrospinal fluid
							 leak, anterior, middle or posterior cranial fossa following surgery of the
							 skull base; by local or regionalized vascularized pedicle flap or myocutaneous
							 flap (including galea, temporalis, frontalis or occipitalis muscle)
61623
550.71
Endovascular temporary balloon arterial occlusion,
							 head or neck (extracranial/intracranial) including selective catheterization of
							 vessel to be occluded, positioning and inflation of occlusion balloon,
							 concomitant neurological monitoring, and radiologic supervision and
							 interpretation of all angiography required for balloon occlusion and to exclude
							 vascular injury post occlusion
61624
1,072.05
Transcatheter permanent occlusion or embolization
							 (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular
							 malformation), percutaneous, any method; central nervous system (intracranial,
							 spinal cord)
61626
868.61
Transcatheter permanent occlusion or embolization
							 (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular
							 malformation), percutaneous, any method; non-central nervous system, head or
							 neck (extracranial, brachiocephalic branch)
61630
1,249.97
Balloon angioplasty, intracranial (eg,
							 atherosclerotic stenosis), percutaneous
61635
1,367.03
Transcatheter placement of intravascular stent(s),
							 intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if
							 performed
61640
572.18
Balloon dilatation of intracranial vasospasm,
							 percutaneous; initial vessel
61641
201.36
Balloon dilatation of intracranial vasospasm,
							 percutaneous; each additional vessel in same vascular family (List separately
							 in addition to code for primary procedure)
61642
402.26
Balloon dilatation of intracranial vasospasm,
							 percutaneous; each additional vessel in different vascular family (List
							 separately in addition to code for primary procedure)
61680
2,131.16
Surgery of intracranial arteriovenous malformation;
							 supratentorial, simple
61682
4,013.98
Surgery of intracranial arteriovenous malformation;
							 supratentorial, complex
61684
2,700.97
Surgery of intracranial arteriovenous malformation;
							 infratentorial, simple
61686
4,300.37
Surgery of intracranial arteriovenous malformation;
							 infratentorial, complex
61690
2,038.05
Surgery of intracranial arteriovenous malformation;
							 dural, simple
61692
3,454.02
Surgery of intracranial arteriovenous malformation;
							 dural, complex
61697
3,847.68
Surgery of complex intracranial aneurysm,
							 intracranial approach; carotid circulation
61698
4,065.83
Surgery of complex intracranial aneurysm,
							 intracranial approach; vertebrobasilar circulation
61700
3,305.50
Surgery of simple intracranial aneurysm, intracranial
							 approach; carotid circulation
61702
3,599.87
Surgery of simple intracranial aneurysm, intracranial
							 approach; vertebrobasilar circulation
61703
1,232.88
Surgery of intracranial aneurysm, cervical approach
							 by application of occluding clamp to cervical carotid artery
							 (Selverstone-Crutchfield type)
61705
2,427.16
Surgery of aneurysm, vascular malformation or
							 carotid-cavernous fistula; by intracranial and cervical occlusion of carotid
							 artery
61708
2,032.26
Surgery of aneurysm, vascular malformation or
							 carotid-cavernous fistula; by intracranial electrothrombosis
61710
1,831.91
Surgery of aneurysm, vascular malformation or
							 carotid-cavernous fistula; by intra-arterial embolization, injection procedure,
							 or balloon catheter
61711
2,467.41
Anastomosis, arterial, extracranial-intracranial (eg,
							 middle cerebral/cortical) arteries
61720
1,092.85
Creation of lesion by stereotactic method, including
							 burr hole(s) and localizing and recording techniques, single or multiple
							 stages; globus pallidus or thalamus
61735
1,331.61
Creation of lesion by stereotactic method, including
							 burr hole(s) and localizing and recording techniques, single or multiple
							 stages; subcortical structure(s) other than globus pallidus or
							 thalamus
61750
1,311.77
Stereotactic biopsy, aspiration, or excision,
							 including burr hole(s), for intracranial lesion;
61751
1,284.02
Stereotactic biopsy, aspiration, or excision,
							 including burr hole(s), for intracranial lesion; with computed tomography
							 and/or magnetic resonance guidance
61760
1,400.04
Stereotactic implantation of depth electrodes into
							 the cerebrum for long-term seizure monitoring
61770
1,404.77
Stereotactic localization, including burr hole(s),
							 with insertion of catheter(s) or probe(s) for placement of radiation
							 source
61790
806.70
790.63
Creation of lesion by stereotactic method,
							 percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical,
							 radiofrequency); gasserian ganglion
61791
647.43
1,019.11
Creation of lesion by stereotactic method,
							 percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical,
							 radiofrequency); trigeminal medullary tract
61793
1,192.64
Stereotactic radiosurgery (particle beam, gamma ray
							 or linear accelerator), one or more sessions
61795
240.91
Stereotactic computer-assisted volumetric
							 (navigational) procedure, intracranial, extracranial, or spinal (List
							 separately in addition to code for primary procedure)
61850
907.35
Twist drill or burr hole(s) for implantation of
							 neurostimulator electrodes, cortical
61860
1,449.50
Craniectomy or craniotomy for implantation of
							 neurostimulator electrodes, cerebral, cortical
61863
1,421.68
Twist drill, burr hole, craniotomy, or craniectomy
							 with stereotactic implantation of neurostimulator electrode array in
							 subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus,
							 periventricular, periaqueductal gray), without use of intraoperative
							 microelectrode recording; first array
61864
407.20
Twist drill, burr hole, craniotomy, or craniectomy
							 with stereotactic implantation of neurostimulator electrode array in
							 subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus,
							 periventricular, periaqueductal gray), without use of intraoperative
							 microelectrode recording; each additional array (List separately in addition to
							 primary procedure)
61867
2,077.07
Twist drill, burr hole, craniotomy, or craniectomy
							 with stereotactic implantation of neurostimulator electrode array in
							 subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus,
							 periventricular, periaqueductal gray), with use of intraoperative
							 microelectrode recording; first array
61868
593.01
Twist drill, burr hole, craniotomy, or craniectomy
							 with stereotactic implantation of neurostimulator electrode array in
							 subcortical site (eg, thalamus, globus pallidus, subthalamic nucleus,
							 periventricular, periaqueductal gray), with use of intraoperative
							 microelectrode recording; each additional array (List separately in addition to
							 primary procedure)
61870
1,116.96
Craniectomy for implantation of neurostimulator
							 electrodes, cerebellar; cortical
61875
966.90
Craniectomy for implantation of neurostimulator
							 electrodes, cerebellar; subcortical
61880
1,004.30
508.48
Revision or removal of intracranial neurostimulator
							 electrodes
61885
1,004.30
584.21
Insertion or replacement of cranial neurostimulator
							 pulse generator or receiver, direct or inductive coupling; with connection to a
							 single electrode array
61886
1,004.30
733.71
Insertion or replacement of cranial neurostimulator
							 pulse generator or receiver, direct or inductive coupling; with connection to
							 two or more electrode arrays
61888
1,004.30
381.73
Revision or removal of cranial neurostimulator pulse
							 generator or receiver
62000
806.38
Elevation of depressed skull fracture; simple,
							 extradural
62005
1,137.99
Elevation of depressed skull fracture; compound or
							 comminuted, extradural
62010
1,422.61
Elevation of depressed skull fracture; with repair of
							 dura and/or debridement of brain
62100
1,516.62
Craniotomy for repair of dural/cerebrospinal fluid
							 leak, including surgery for rhinorrhea/otorrhea
62115
1,528.33
Reduction of craniomegalic skull (eg, treated
							 hydrocephalus); not requiring bone grafts or cranioplasty
62116
1,648.24
Reduction of craniomegalic skull (eg, treated
							 hydrocephalus); with simple cranioplasty
62117
1,747.82
Reduction of craniomegalic skull (eg, treated
							 hydrocephalus); requiring craniotomy and reconstruction with or without bone
							 graft (includes obtaining grafts)
62120
1,747.04
Repair of encephalocele, skull vault, including
							 cranioplasty
62121
1,591.41
Craniotomy for repair of encephalocele, skull
							 base
62140
987.70
Cranioplasty for skull defect; up to 5 cm
							 diameter
62141
1,080.97
Cranioplasty for skull defect; larger than 5 cm
							 diameter
62142
822.48
Removal of bone flap or prosthetic plate of
							 skull
62143
966.90
Replacement of bone flap or prosthetic plate of
							 skull
62145
1,304.38
Cranioplasty for skull defect with reparative brain
							 surgery
62146
1,136.04
Cranioplasty with autograft (includes obtaining bone
							 grafts); up to 5 cm diameter
62147
1,345.03
Cranioplasty with autograft (includes obtaining bone
							 grafts); larger than 5 cm diameter
62148
119.50
Incision and retrieval of subcutaneous cranial bone
							 graft for cranioplasty (List separately in addition to code for primary
							 procedure)
62160
186.27
Neuroendoscopy, intracranial, for placement or
							 replacement of ventricular catheter and attachment to shunt system or external
							 drainage (List separately in addition to code for primary
							 procedure)
62161
1,434.31
Neuroendoscopy, intracranial; with dissection of
							 adhesions, fenestration of septum pellucidum or intraventricular cysts
							 (including placement, replacement, or removal of ventricular
							 catheter)
62162
1,766.66
Neuroendoscopy, intracranial; with fenestration or
							 excision of colloid cyst, including placement of external ventricular catheter
							 for drainage
62163
1,121.55
Neuroendoscopy, intracranial; with retrieval of
							 foreign body
62164
1,871.31
Neuroendoscopy, intracranial; with excision of brain
							 tumor, including placement of external ventricular catheter for
							 drainage
62165
1,457.96
Neuroendoscopy, intracranial; with excision of
							 pituitary tumor, transnasal or trans-sphenoidal approach
62180
1,483.31
Ventriculocisternostomy (Torkildsen type
							 operation)
62190
828.82
Creation of shunt;
							 subarachnoid/subdural-atrial,
-jugular, -auricular
62192
902.86
Creation of shunt;
							 subarachnoid/subdural-peritoneal,
-pleural, other terminus
62194
381.03
349.93
Replacement or irrigation, subarachnoid/subdural
							 catheter
62200
1,290.31
Ventriculocisternostomy, third ventricle;
62201
1,108.52
Ventriculocisternostomy, third ventricle;
							 stereotactic, neuroendoscopic method
62220
960.45
Creation of shunt; ventriculo-atrial, -jugular,
							 -auricular
62223
973.76
Creation of shunt; ventriculo-peritoneal, -pleural,
							 other terminus
62225
470.75
Replacement or irrigation, ventricular
							 catheter
62230
1,621.15
784.05
Replacement or revision of cerebrospinal fluid shunt,
							 obstructed valve, or distal catheter in shunt system
62252
47.81
106.13
45.69
60.44
Reprogramming of programmable cerebrospinal
							 shunt
62256
544.75
Removal of complete cerebrospinal fluid shunt system;
							 without replacement
62258
1,057.40
Removal of complete cerebrospinal fluid shunt system;
							 with replacement by similar or other shunt at same operation
62263
647.43
741.14
Percutaneous lysis of epidural adhesions using
							 solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg,
							 catheter) including radiologic localization (includes contrast when
							 administered), multiple adhesiolysis sessions; 2 or more days
62264
647.43
466.47
Percutaneous lysis of epidural adhesions using
							 solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg,
							 catheter) including radiologic localization (includes contrast when
							 administered), multiple adhesiolysis sessions; 1 day
62268
381.03
594.16
Percutaneous aspiration, spinal cord cyst or
							 syrinx
62269
417.18
664.06
Biopsy of spinal cord, percutaneous
							 needle
62270
183.07
172.99
Spinal puncture, lumbar, diagnostic
62272
183.07
206.60
Spinal puncture, therapeutic, for drainage of
							 cerebrospinal fluid (by needle or catheter)
62273
183.07
178.11
Injection, epidural, of blood or clot
							 patch
62280
315.26
364.83
Injection/infusion of neurolytic substance (eg,
							 alcohol, phenol, iced saline solutions), with or without other therapeutic
							 substance; subarachnoid
62281
315.26
320.67
Injection/infusion of neurolytic substance (eg,
							 alcohol, phenol, iced saline solutions), with or without other therapeutic
							 substance; epidural, cervical or thoracic
62282
315.26
370.94
Injection/infusion of neurolytic substance (eg,
							 alcohol, phenol, iced saline solutions), with or without other therapeutic
							 substance; epidural, lumbar, sacral (caudal)
62284
258.08
Injection procedure for myelography and/or computed
							 tomography, spinal (other than C1-C2 and posterior fossa)
62287
1,486.81
547.49
Aspiration or decompression procedure, percutaneous,
							 of nucleus pulposus of intervertebral disc, any method, single or multiple
							 levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous
							 laser discectomy)
62290
377.21
Injection procedure for discography, each level;
							 lumbar
62291
341.43
Injection procedure for discography, each level;
							 cervical or thoracic
62292
381.03
505.57
Injection procedure for chemonucleolysis, including
							 discography, intervertebral disc, single or multiple levels, lumbar
62294
381.03
751.19
Injection procedure, arterial, for occlusion of
							 arteriovenous malformation, spinal
62310
315.26
248.32
Injection, single (not via indwelling catheter), not
							 including neurolytic substances, with or without contrast (for either
							 localization or epidurography), of diagnostic or therapeutic substance(s)
							 (including anesthetic, antispasmodic, opioid, steroid, other solution),
							 epidural or subarachnoid; cervical or thoracic
62311
315.26
229.72
Injection, single (not via indwelling catheter), not
							 including neurolytic substances, with or without contrast (for either
							 localization or epidurography), of diagnostic or therapeutic substance(s)
							 (including anesthetic, antispasmodic, opioid, steroid, other solution),
							 epidural or subarachnoid; lumbar, sacral (caudal)
62318
315.26
276.23
Injection, including catheter placement, continuous
							 infusion or intermittent bolus, not including neurolytic substances, with or
							 without contrast (for either localization or epidurography), of diagnostic or
							 therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid,
							 other solution), epidural or subarachnoid; cervical or thoracic
62319
315.26
246.19
Injection, including catheter placement, continuous
							 infusion or intermittent bolus, not including neurolytic substances, with or
							 without contrast (for either localization or epidurography), of diagnostic or
							 therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid,
							 other solution), epidural or subarachnoid; lumbar, sacral (caudal)
62350
1,621.15
487.36
Implantation, revision or repositioning of tunneled
							 intrathecal or epidural catheter, for long-term medication administration via
							 an external pump or implantable reservoir/infusion pump; without
							 laminectomy
62351
801.60
Implantation, revision or repositioning of tunneled
							 intrathecal or epidural catheter, for long-term medication administration via
							 an external pump or implantable reservoir/infusion pump; with
							 laminectomy
62355
647.43
400.36
Removal of previously implanted intrathecal or
							 epidural catheter
62360
1,621.15
270.70
Implantation or replacement of device for intrathecal
							 or epidural drug infusion; subcutaneous reservoir
62361
11,790.17
432.64
Implantation or replacement of device for intrathecal
							 or epidural drug infusion; nonprogrammable pump
62362
11,790.17
535.90
Implantation or replacement of device for intrathecal
							 or epidural drug infusion; programmable pump, including preparation of pump,
							 with or without programming
62365
1,486.81
418.10
Removal of subcutaneous reservoir or pump, previously
							 implanted for intrathecal or epidural infusion
62367
19.13
41.22
Electronic analysis of programmable, implanted pump
							 for intrathecal or epidural drug infusion (includes evaluation of reservoir
							 status, alarm status, drug prescription status); without
							 reprogramming
62368
23.16
56.40
Electronic analysis of programmable, implanted pump
							 for intrathecal or epidural drug infusion (includes evaluation of reservoir
							 status, alarm status, drug prescription status); with reprogramming
63001
1,154.56
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments;
							 cervical
63003
1,165.17
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments;
							 thoracic
63005
1,110.10
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for
							 spondylolisthesis
63011
1,037.78
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral
63012
1,133.46
Laminectomy with removal of abnormal facets and/or
							 pars inter-articularis with decompression of cauda equina and nerve roots for
							 spondylolisthesis, lumbar (Gill type procedure)
63015
1,395.33
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), more than 2 vertebral segments;
							 cervical
63016
1,424.77
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), more than 2 vertebral segments;
							 thoracic
63017
1,173.00
Laminectomy with exploration and/or decompression of
							 spinal cord and/or cauda equina, without facetectomy, foraminotomy or
							 discectomy (eg, spinal stenosis), more than 2 vertebral segments;
							 lumbar
63020
1,109.66
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc; one interspace, cervical
63030
I
2,974.28
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc; one interspace, lumbar (including open or
							 endoscopically-assisted approach)
63035
195.21
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc; each additional interspace, cervical or lumbar
							 (List separately in addition to code for primary procedure)
63040
1,348.03
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc, reexploration, single interspace;
							 cervical
63042
1,268.02
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc, reexploration, single interspace;
							 lumbar
63043
I.C.
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc, reexploration, single interspace; each
							 additional cervical interspace (List separately in addition to code for primary
							 procedure)
63044
I.C.
Laminotomy (hemilaminectomy), with decompression of
							 nerve root(s), including partial facetectomy, foraminotomy and/or excision of
							 herniated intervertebral disc, reexploration, single interspace; each
							 additional lumbar interspace (List separately in addition to code for primary
							 procedure)
63045
1,204.42
Laminectomy, facetectomy and foraminotomy (unilateral
							 or bilateral with decompression of spinal cord, cauda equina and/or nerve
							 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment;
							 cervical
63046
1,151.06
Laminectomy, facetectomy and foraminotomy (unilateral
							 or bilateral with decompression of spinal cord, cauda equina and/or nerve
							 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment;
							 thoracic
63047
I
3,399.04
Laminectomy, facetectomy and foraminotomy (unilateral
							 or bilateral with decompression of spinal cord, cauda equina and/or nerve
							 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment;
							 lumbar
63048
208.64
Laminectomy, facetectomy and foraminotomy (unilateral
							 or bilateral with decompression of spinal cord, cauda equina and/or nerve
							 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment;
							 each additional segment, cervical, thoracic, or lumbar (List separately in
							 addition to code for primary procedure)
63050
1,431.55
Laminoplasty, cervical, with decompression of the
							 spinal cord, two or more vertebral segments;
63051
1,617.79
Laminoplasty, cervical, with decompression of the
							 spinal cord, two or more vertebral segments; with reconstruction of the
							 posterior bony elements (including the application of bridging bone graft and
							 non-segmental fixation devices (eg, wire, suture, mini-plates), when
							 performed)
63055
1,547.36
Transpedicular approach with decompression of spinal
							 cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single
							 segment; thoracic
63056
1,436.03
Transpedicular approach with decompression of spinal
							 cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single
							 segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg,
							 far lateral herniated intervertebral disc)
63057
322.15
Transpedicular approach with decompression of spinal
							 cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single
							 segment; each additional segment, thoracic or lumbar (List separately in
							 addition to code for primary procedure)
63064
1,698.06
Costovertebral approach with decompression of spinal
							 cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single
							 segment
63066
197.81
Costovertebral approach with decompression of spinal
							 cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each
							 additional segment (List separately in addition to code for primary
							 procedure)
63075
I
3,880.72
Discectomy, anterior, with decompression of spinal
							 cord and/or nerve root(s), including osteophytectomy; cervical, single
							 interspace
63076
249.10
Discectomy, anterior, with decompression of spinal
							 cord and/or nerve root(s), including osteophytectomy; cervical, each additional
							 interspace (List separately in addition to code for primary
							 procedure)
63077
1,445.93
Discectomy, anterior, with decompression of spinal
							 cord and/or nerve root(s), including osteophytectomy; thoracic, single
							 interspace
63078
197.59
Discectomy, anterior, with decompression of spinal
							 cord and/or nerve root(s), including osteophytectomy; thoracic, each additional
							 interspace (List separately in addition to code for primary
							 procedure)
63081
1,693.61
Vertebral corpectomy (vertebral body resection),
							 partial or complete, anterior approach with decompression of spinal cord and/or
							 nerve root(s); cervical, single segment
63082
268.73
Vertebral corpectomy (vertebral body resection),
							 partial or complete, anterior approach with decompression of spinal cord and/or
							 nerve root(s); cervical, each additional segment (List separately in addition
							 to code for primary procedure)
63085
1,804.21
Vertebral corpectomy (vertebral body resection),
							 partial or complete, transthoracic approach with decompression of spinal cord
							 and/or nerve root(s); thoracic, single segment
63086
190.12
Vertebral corpectomy (vertebral body resection),
							 partial or complete, transthoracic approach with decompression of spinal cord
							 and/or nerve root(s); thoracic, each additional segment (List separately in
							 addition to code for primary procedure)
63087
2,293.98
Vertebral corpectomy (vertebral body resection),
							 partial or complete, combined thoracolumbar approach with decompression of
							 spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single
							 segment
63088
258.61
Vertebral corpectomy (vertebral body resection),
							 partial or complete, combined thoracolumbar approach with decompression of
							 spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each
							 additional segment (List separately in addition to code for primary
							 procedure)
3090
1,877.97
Vertebral corpectomy (vertebral body resection),
							 partial or complete, transperitoneal or retroperitoneal approach with
							 decompression of spinal cord, cauda equina or nerve root(s), lower thoracic,
							 lumbar, or sacral; single segment
3091
177.68
Vertebral corpectomy (vertebral body resection),
							 partial or complete, transperitoneal or retroperitoneal approach with
							 decompression of spinal cord, cauda equina or nerve root(s), lower thoracic,
							 lumbar, or sacral; each additional segment (List separately in addition to code
							 for primary procedure)
3101
2,165.16
Vertebral corpectomy (vertebral body resection),
							 partial or complete, lateral extracavitary approach with decompression of
							 spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments);
							 thoracic, single segment
3102
2,160.56
Vertebral corpectomy (vertebral body resection),
							 partial or complete, lateral extracavitary approach with decompression of
							 spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments);
							 lumbar, single segment
3103
282.83
Vertebral corpectomy (vertebral body resection),
							 partial or complete, lateral extracavitary approach with decompression of
							 spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments);
							 thoracic or lumbar, each additional segment (List separately in addition to
							 code for primary procedure)
3170
1,413.07
Laminectomy with myelotomy (eg, Bischof or DREZ
							 type), cervical, thoracic, or thoracolumbar
3172
1,305.70
Laminectomy with drainage of intramedullary
							 cyst/syrinx; to subarachnoid space
3173
1,603.55
Laminectomy with drainage of intramedullary
							 cyst/syrinx; to peritoneal or pleural space
3180
1,320.15
Laminectomy and section of dentate ligaments, with or
							 without dural graft, cervical; one or two segments
3182
1,351.65
Laminectomy and section of dentate ligaments, with or
							 without dural graft, cervical; more than two segments
3185
1,054.46
Laminectomy with rhizotomy; one or two
							 segments
3190
1,192.24
Laminectomywith rhizotomy; more than two
							 segments
3191
1,167.73
Laminectomy with section of spinal accessory
							 nerve
3194
1,375.62
Laminectomy with cordotomy, with section of one
							 spinothalamic tract, one stage; cervical
3195
1,414.26
Laminectomy with cordotomy, with section of one
							 spinothalamic tract, one stage; thoracic
3196
1,657.13
Laminectomy with cordotomy, with section of both
							 spinothalamic tracts, one stage; cervical
3197
1,431.91
Laminectomy with cordotomy, with section of both
							 spinothalamic tracts, one stage; thoracic
3198
1,608.62
Laminectomy with cordotomy with section of both
							 spinothalamic tracts, two stages within 14 days; cervical
3199
1,671.03
Laminectomy with cordotomy with section of both
							 spinothalamic tracts, two stages within 14 days; thoracic
63200
1,415.09
Laminectomy, with release of tethered spinal cord,
							 lumbar
63250
2,703.94
Laminectomy for excision or occlusion of
							 arteriovenous malformation of spinal cord; cervical
63251
2,847.80
Laminectomy for excision or occlusion of
							 arteriovenous malformation of spinal cord; thoracic
63252
2,830.88
Laminectomy for excision or occlusion of
							 arteriovenous malformation of spinal cord; thoracolumbar
63265
1,565.05
Laminectomy for excision or evacuation of intraspinal
							 lesion other than neoplasm, extradural; cervical
63266
1,611.52
Laminectomy for excision or evacuation of intraspinal
							 lesion other than neoplasm, extradural; thoracic
63267
1,301.85
Laminectomyfor excision or evacuation of intraspinal
							 lesion other than neoplasm, extradural; lumbar
63268
1,287.58
Laminectomy for excision or evacuation of intraspinal
							 lesion other than neoplasm, extradural; sacral
63270
1,927.35
Laminectomy for excision of intraspinal lesion other
							 than neoplasm, intradural; cervical
63271
1,935.68
Laminectomy for excision of intraspinal lesion other
							 than neoplasm, intradural; thoracic
63272
1,787.29
Laminectomy for excision of intraspinal lesion other
							 than neoplasm, intradural; lumbar
63273
1,726.04
Laminectomy for excision of intraspinal lesion other
							 than neoplasm, intradural; sacral
63275
1,686.30
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; extradural, cervical
63276
1,674.03
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; extradural, thoracic
63277
1,477.86
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; extradural, lumbar
63278
1,447.19
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; extradural, sacral
63280
1,988.64
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, extramedullary, cervical
63281
1,971.72
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, extramedullary, thoracic
63282
1,857.48
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, extramedullary, lumbar
63283
1,772.02
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, sacral
63285
2,445.54
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, intramedullary, cervical
63286
2,445.11
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, intramedullary, thoracic
63287
2,567.18
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; intradural, intramedullary, thoracolumbar
63290
2,577.67
Laminectomy for biopsy/excision of intraspinal
							 neoplasm; combined extradural-intradural lesion, any level
63295
304.48
Osteoplastic reconstruction of dorsal spinal
							 elements, following primary intraspinal procedure (List separately in addition
							 to code for primary procedure)
63300
1,736.84
Vertebral corpectomy (vertebral body resection),
							 partial or complete, for excision of intraspinal lesion, single segment;
							 extradural, cervical
63301
1,919.84
Vertebral corpectomy (vertebral body resection),
							 partial or complete, for excision of intraspinal lesion, single segment;
							 extradural, thoracic by transthoracic approach
63302
1,906.93
Vertebral corpectomy (vertebral body resection),
							 partial or complete, for excision of intraspinal lesion, single segment;
							 extradural, thoracic by thoracolumbar approach
63303
2,016.25
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
2,145.63
Vertebral corpectomy (vertebral body resection),
							 partial or complete, for excision of intraspinal lesion, single segment;
							 intradural, cervical
63305
2,210.39
Vertebral corpectomy (vertebral body resection),
							 partial or complete, for excision of intraspinal lesion, single segment;
							 intradural, thoracic by transthoracic approach
63306
2,251.56
Vertebral corpectomy (vertebral body resection),
							 partial or complete, for excision of intraspinal lesion, single segment;
							 intradural, thoracic by thoracolumbar approach
63307
2,050.67
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
322.52
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)
63600
806.70
775.64
Creation of lesion of spinal cord by stereotactic
							 method, percutaneous, any modality (including stimulation and/or
							 recording)
63610
806.70
2,018.72
Stereotactic stimulation of spinal cord,
							 percutaneous, separate procedure not followed by other surgery
63615
806.70
1,083.02
Stereotactic biopsy, aspiration, or excision of
							 lesion, spinal cord
63650
3,714.19
414.74
Percutaneous implantation of neurostimulator
							 electrode array, epidural
63655
4,911.13
797.56
Laminectomy for implantation of neurostimulator
							 electrodes, plate/paddle, epidural
63660
1,004.30
419.96
Revision or removal of spinal neurostimulator
							 electrode percutaneous array(s) or plate/paddle(s)
63685
15,677.98
479.69
Insertion or replacement of spinal neurostimulator
							 pulse generator or receiver, direct or inductive coupling
63688
1,538.02
397.89
Revision or removal of implanted spinal
							 neurostimulator pulse generator or receiver
63700
1,163.43
Repair of meningocele; less than 5 cm
							 diameter
63702
1,265.15
Repair of meningocele; larger than 5 cm
							 diameter
63704
1,461.97
Repair of myelomeningocele; less than 5 cm
							 diameter
63706
1,687.67
Repair of myelomeningocele; larger than 5 cm
							 diameter
63707
860.65
Repair of dural/cerebrospinal fluid leak, not
							 requiring laminectomy
63709
1,045.82
Repair of dural/cerebrospinal fluid leak or
							 pseudomeningocele, with laminectomy
63710
1,043.36
Dural graft, spinal
63740
874.39
Creation of shunt, lumbar,
							 subarachnoid-peritoneal,
-pleural, or other; including laminectomy
63741
580.50
Creation of shunt, lumbar, subarachnoid-peritoneal,
							 -pleural, or other; percutaneous, not requiring laminectomy
63744
1,621.15
613.07
Rep lac e m en t, irr i gat io n or rev ision of
							 lumbosubarachnoid shunt
63746
253.00
511.11
Removal of entire lumbosubarachnoid shunt system
							 without replacement
64400
60.67
116.40
Injection, anesthetic agent; trigeminal nerve, any
							 division or branch
64402
55.52
114.88
Injection, anesthetic agent; facial nerve
64405
48.17
107.76
Injection, anesthetic agent; greater occipital
							 nerve
64408
55.52
120.64
Injection, anesthetic agent; vagus nerve
64410
315.26
153.24
Injection, anesthetic agent; phrenic
							 nerve
64412
87.88
152.69
Injection, anesthetic agent; spinal accessory
							 nerve
64413
57.74
122.92
Injection, anesthetic agent; cervical
							 plexus
64415
183.07
150.35
Injection, anesthetic agent; brachial plexus,
							 single
64416
315.26
169.74
Injection, anesthetic agent; brachial plexus,
							 continuous infusion by catheter (including catheter placement) including daily
							 management for anesthetic agent administration
64417
183.07
155.11
Injection, anesthetic agent; axillary
							 nerve
64418
83.10
151.19
Injection, anesthetic agent; suprascapular
							 nerve
64420
183.07
187.22
Injection, anesthetic agent; intercostal nerve,
							 single
64421
183.07
282.51
Injection, anesthetic agent; intercostal nerves,
							 multiple, regional block
64425
54.06
131.31
Injection, anesthetic agent; ilioinguinal,
							 iliohypogastric nerves
64430
315.26
165.62
Injection, anesthetic agent; pudendal
							 nerve
64435
83.10
158.33
Injection, anesthetic agent; paracervical (uterine)
							 nerve
64445
79.07
152.49
Injection, anesthetic agent; sciatic nerve,
							 single
64446
647.43
163.31
Injection, anesthetic agent; sciatic nerve,
							 continuous infusion by catheter (including catheter placement), including daily
							 management for anesthetic agent administration
64447
183.07
67.72
Injection, anesthetic agent; femoral nerve,
							 single
64448
147.73
Injection, anesthetic agent; femoral nerve,
							 continuous infusion by catheter (including catheter placement) including daily
							 management for anesthetic agent administration
64449
146.88
Injection, anesthetic agent; lumbar plexus, posterior
							 approach, continuous infusion by catheter (including catheter placement)
							 including daily management for anesthetic agent administration
64450
45.97
105.25
Injection, anesthetic agent; other peripheral nerve
							 or branch
64470
315.26
321.00
Injection, anesthetic agent and/or steroid,
							 paravertebral facet joint or facet joint nerve; cervical or thoracic, single
							 level
64472
183.07
128.37
Injection, anesthetic agent and/or steroid,
							 paravertebral facet joint or facet joint nerve; cervical or thoracic, each
							 additional level (List separately in addition to code for primary
							 procedure)
64475
315.26
293.25
Injection, anesthetic agent and/or steroid,
							 paravertebral facet joint or facet joint nerve; lumbar or sacral, single
							 level
64476
103.73
109.66
Injection, anesthetic agent and/or steroid,
							 paravertebral facet joint or facet joint nerve; lumbar or sacral, each
							 additional level (List separately in addition to code for primary
							 procedure)
64479
315.26
337.39
Injection, anesthetic agent and/or steroid,
							 transforaminal epidural; cervical or thoracic, single level
64480
183.07
156.84
Injection, anesthetic agent and/or steroid,
							 transforaminal epidural; cervical or thoracic, each additional level (List
							 separately in addition to code for primary procedure)
64483
315.26
337.89
Injection, anesthetic agent and/or steroid,
							 transforaminal epidural; lumbar or sacral, single level
64484
183.07
160.58
Injection, anesthetic agent and/or steroid,
							 transforaminal epidural; lumbar or sacral, each additional level (List
							 separately in addition to code for primary procedure)
64505
43.39
103.75
Injection, anesthetic agent; sphenopalatine
							 ganglion
64508
98.55
163.69
Injection, anesthetic agent; carotid sinus (separate
							 procedure)
64510
315.26
167.11
Injection, anesthetic agent; stellate ganglion
							 (cervical sympathetic)
64517
315.26
180.59
Injection, anesthetic agent; superior hypogastric
							 plexus
64520
315.26
226.16
Injection, anesthetic agent; lumbar or thoracic
							 (paravertebral sympathetic)
64530
64550
315.26
223.57
17.49
Injection, anesthetic agent; celiac plexus, with or
							 without radiologic monitoring Application of surface (transcutaneous)
							 neurostimulator
64553
14,145.64
211.07
Percutaneous implantation of neurostimulator
							 electrodes; cranial nerve
64555
3,714.19
219.21
Percutaneous implantation of neurostimulator
							 electrodes; peripheral nerve (excludes sacral nerve)
64560
3,714.19
203.85
Percutaneous implantation of neurostimulator
							 electrodes; autonomic nerve
64561
3,714.19
1,400.02
Percutaneous implantation of neurostimulator
							 electrodes; sacral nerve (transforaminal placement)
64565
3,714.19
197.23
Percutaneous implantation of neurostimulator
							 electrodes; neuromuscular
64573
14,145.64
566.03
Incision for implantation of neurostimulator
							 electrodes; cranial nerve
64575
4,911.13
276.58
Incision for implantation of neurostimulator
							 electrodes; peripheral nerve (excludes sacral nerve)
64577
4,911.13
375.09
Incision for implantation of neurostimulator
							 electrodes; autonomic nerve
64580
4,911.13
296.21
Incision for implantation of neurostimulator
							 electrodes; neuromuscular
64581
4,911.13
790.31
Incision for implantation of neurostimulator
							 electrodes; sacral nerve (transforaminal placement)
64585
1,004.30
472.85
Revision or removal of peripheral neurostimulator
							 electrodes
64590
12,045.40
399.93
Insertion or replacement of peripheral or gastric
							 neurostimulator pulse generator or receiver, direct or inductive
							 coupling
64595
1,538.02
453.00
Revision or removal of peripheral or gastric
							 neurostimulator pulse generator or receiver
64600
647.43
468.47
Destruction by neurolytic agent, trigeminal nerve;
							 supraorbital, infraorbital, mental, or inferior alveolar branch
64605
647.43
601.74
Destruction by neurolytic agent, trigeminal nerve;
							 second and third division branches at foramen ovale
64610
647.43
707.34
Destruction by neurolytic agent, trigeminal nerve;
							 second and third division branches at foramen ovale under radiologic
							 monitoring
64612
74.65
164.34
Chemodenervation of muscle(s); muscle(s) innervated
							 by facial nerve (eg, for blepharospasm, hemifacial spasm)
64613
79.07
169.86
Chemodenervation of muscle(s); neck muscle(s) (eg,
							 for spasmodic torticollis, spasmodic dysphonia)
64614
89.00
189.50
Chemodenervation of muscle(s); extremity(s) and/or
							 trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple
							 sclerosis)
64620
315.26
296.04
Destruction by neurolytic agent, intercostal
							 nerve
64622
647.43
380.53
Destruction by neurolytic agent, paravertebral facet
							 joint nerve; lumbar or sacral, single level
64623
315.26
142.39
Destruction by neurolytic agent, paravertebral facet
							 joint nerve; lumbar or sacral, each additional level (List separately in
							 addition to code for primary procedure)
64626
647.43
424.56
Destruction by neurolytic agent, paravertebral facet
							 joint nerve; cervical or thoracic, single level
64627
103.73
200.50
Destruction by neurolytic agent, paravertebral facet
							 joint nerve; cervical or thoracic, each additional level (List separately in
							 addition to code for primary procedure)
64630
315.26
236.28
Destruction by neurolytic agent; pudendal
							 nerve
64640
121.36
255.50
Destruction by neurolytic agent; other peripheral
							 nerve or branch
64650
29.05
62.06
Chemodenervation of eccrine glands; both
							 axillae
64653
30.53
70.65
Chemodenervation of eccrine glands; other area(s)
							 (eg, scalp, face, neck), per day
64680
647.43
347.77
Destruction by neurolytic agent, with or without
							 radiologic monitoring; celiac plexus
64681
647.43
462.41
Destruction by neurolytic agent, with or without
							 radiologic monitoring; superior hypogastric plexus
64702
806.70
435.06
Neuroplasty; digital, one or both, same
							 digit
64704
806.70
327.58
Neuroplasty; nerve of hand or foot
64708
806.70
449.65
Neuroplasty, major peripheral nerve, arm or leg;
							 other than specified
64712
806.70
515.89
Neuroplasty, major peripheral nerve, arm or leg;
							 sciatic nerve
64713
806.70
714.66
Neuroplasty, major peripheral nerve, arm or leg;
							 brachial plexus
64714
806.70
589.58
Neuroplasty, major peripheral nerve, arm or leg;
							 lumbar plexus
64716
806.70
516.39
Neuroplasty and/or transposition; cranial nerve
							 (specify)
64718
806.70
I
1,425.12
Neuroplasty and/or transposition; ulnar nerve at
							 elbow
64719
806.70
389.34
Neuroplasty and/or transposition; ulnar nerve at
							 wrist
64721
806.70
I
1,033.44
Neuroplasty and/or transposition; median nerve at
							 carpal tunnel
64722
806.70
315.23
Decompression; unspecified nerve(s)
							 (specify)
64726
806.70
288.81
Decompression; plantar digital nerve
64727
806.70
181.91
Internal neurolysis, requiring use of operating
							 microscope (List separately in addition to code for neuroplasty) (Neuroplasty
							 includes external neurolysis)
64732
806.70
358.38
Transection or avulsion of; supraorbital
							 nerve
64734
806.70
407.92
Transection or avulsion of; infraorbital
							 nerve
64736
806.70
368.87
Transection or avulsion of; mental nerve
64738
806.70
459.22
Transection or avulsion of; inferior alveolar nerve
							 by osteotomy
64740
806.70
462.08
Transection or avulsion of; lingual nerve
64742
806.70
459.01
Transection or avulsion of; facial nerve,
							 differential or complete
64744
806.70
407.31
Transection or avulsion of; greater occipital
							 nerve
64746
806.70
437.54
Transection or avulsion of; phrenic nerve
64752
472.98
Transection or avulsion of; vagus nerve (vagotomy),
							 transthoracic
64755
822.65
Transection or avulsion of; vagus nerves limited to
							 proximal stomach (selective proximal vagotomy, proximal gastric vagotomy,
							 parietal cell vagotomy, supra- or highly selective vagotomy)
64760
446.63
Transection or avulsion of; vagus nerve (vagotomy),
							 abdominal
64761
806.70
433.27
Transection or avulsion of; pudendal
							 nerve
64763
806.70
492.31
Transection or avulsion of obturator nerve,
							 extrapelvic, with or without adductor tenotomy
64766
1,486.8
1
580.35
Transection or avulsion of obturator nerve,
							 intrapelvic, with or without adductor tenotomy
64771
806.70
568.45
Transection or avulsion of other cranial nerve,
							 extradural
64772
806.70
537.29
Transection or avulsion of other spinal nerve,
							 extradural
64774
806.70
397.69
Excision of neuroma; cutaneous nerve, surgically
							 identifiable
64776
806.70
381.55
Excision of neuroma; digital nerve, one or both, same
							 digit
64778
806.70
182.11
Excision of neuroma; digital nerve, each additional
							 digit (List separately in addition to code for primary procedure)
64782
806.70
440.70
Excision of neuroma; hand or foot, except digital
							 nerve
64783
806.70
215.60
Excision of neuroma; hand or foot, each additional
							 nerve, except same digit (List separately in addition to code for primary
							 procedure)
64784
806.70
698.71
Excision of neuroma; major peripheral nerve, except
							 sciatic
64786
1,486.81
1,049.32
Excision of neuroma; sciatic nerve
64787
806.70
250.39
Implantation of nerve end into bone or muscle (List
							 separately in addition to neuroma excision)
64788
806.70
370.44
Excision of neurofibroma or neurolemmoma; cutaneous
							 nerve
64790
806.70
798.28
Excision of neurofibroma or neurolemmoma; major
							 peripheral nerve
64792
1,486.81
1,005.49
Excision of neurofibroma or neurolemmoma; extensive
							 (including malignant type)
64795
806.70
186.94
Biopsy of nerve
64802
806.70
587.13
Sympathectomy, cervical
64804
905.63
Sympathectomy, cervicothoracic
64809
838.37
Sympathectomy, thoracolumbar
64818
644.57
Sympathectomy, lumbar
64820
806.70
731.52
Sympathectomy; digital arteries, each
							 digit
64821
1,175.77
670.38
Sympathectomy; radial artery
64822
1,175.77
667.11
Sympathectomy; ulnar artery
64823
1,175.77
751.81
Sympathectomy; superficial palmar arch
64831
1,486.81
706.84
Suture of digital nerve, hand or foot; one
							 nerve
64832
1,486.81
338.98
Suture of digital nerve, hand or foot; each
							 additional digital nerve (List separately in addition to code for primary
							 procedure)
64834
1,486.81
723.44
Suture of one nerve; hand or foot, common sensory
							 nerve
64835
1,486.81
784.22
Suture of one nerve; median motor thenar
64836
1,486.81
785.64
Suture of one nerve; ulnar motor
64837
1,486.81
375.95
Suture of each additional nerve, hand or foot (List
							 separately in addition to code for primary procedure)
64840
1,486.81
877.79
Suture of posterior tibial nerve
64856
1,486.81
980.83
Suture of major peripheral nerve, arm or leg, except
							 sciatic; including transposition
64857
1,486.81
1,025.71
Suture of major peripheral nerve, arm or leg, except
							 sciatic; without transposition
64858
1,486.81
1,172.21
Suture of sciatic nerve
64859
1,486.81
255.87
Suture of each additional major peripheral nerve
							 (List separately in addition to code for primary procedure)
64861
1,486.81
1,331.97
Suture of brachial plexus
64862
1,486.81
1,352.14
Suture of lumbar plexus
64864
1,486.81
865.96
Suture of facial nerve; extracranial
64865
1,486.81
1,166.62
Suture of facial nerve; infratemporal, with or
							 without grafting
64866
1,190.42
Anastomosis; facial-spinal accessory
64868
1,036.54
Anastomosis; facial-hypoglossal
64870
1,486.81
1,004.33
Anastomosis; facial-phrenic
64872
1,486.81
119.44
Suture of nerve; requiring secondary or delayed
							 suture (List separately in addition to code for primary
							 neurorrhaphy)
64874
1,486.81
178.31
Suture of nerve; requiring extensive mobilization, or
							 transposition of nerve (List separately in addition to code for nerve
							 suture)
64876
1,486.81
202.34
Suture of nerve; requiring shortening of bone of
							 extremity (List separatelyin addition to code for nerve suture)
64885
1,486.81
1,119.53
Nerve graft (includes obtaining graft), head or neck;
							 up to 4 cm in length
64886
1,486.81
1,320.59
Nerve graft (includes obtaining graft), head or neck;
							 more than 4 cm length
64890
1,486.81
1,055.79
Nerve graft (includes obtaining graft), single
							 strand, hand or foot; up to 4 cm length
64891
1,486.81
1,033.57
Nerve graft (includes obtaining graft), single
							 strand, hand or foot; more than 4 cm length
64892
1,486.81
1,021.56
Nerve graft (includes obtaining graft), single
							 strand, arm or leg; up to 4 cm length
64893
1,486.81
1,098.86
Nerve graft (includes obtaining graft), single
							 strand, arm or leg; more than 4 cm length
64895
1,486.81
1,245.47
Nerve graft (includes obtaining graft), multiple
							 strands (cable), hand or foot; up to 4 cm length
64896
1,486.81
1,361.18
Nerve graft (includes obtaining graft), multiple
							 strands (cable), hand or foot; more than 4 cm length
64897
1,486.81
1,221.59
Nerve graft (includes obtaining graft), multiple
							 strands (cable), arm or leg; up to 4 cm length
64898
1,486.81
1,329.50
Nerve graft (includes obtaining graft), multiple
							 strands (cable), arm or leg; more than 4 cm length
64901
1,486.81
594.15
Nerve graft, each additional nerve; single strand
							 (List separately in addition to code for primary procedure)
64902
1,486.81
694.10
Nerve graft, each additional nerve; multiple strands
							 (cable) (List separately in addition to code for primary procedure)
64905
1,486.81
928.43
Nerve pedicle transfer; first stage
64907
1,486.81
1,208.97
Nerve pedicle transfer; second stage
64910
806.70
649.39
Nerve repair; with synthetic conduit or vein
							 allograft (eg, nerve tube), each nerve
64911
787.29
Nerve repair; with autogenous vein graft (includes
							 harvest of vein graft), each nerve
64999
I.C.
Unlisted procedure, nervous system
65091
1,685.83
600.08
Evisceration of ocular contents; without
							 implant
65093
1,685.83
603.98
Evisceration of ocular contents; with
							 implant
65101
1,685.83
689.80
Enucleation of eye; without implant
65103
1,685.83
717.12
Enucleation of eye; with implant, muscles not
							 attached to implant
65105
1,685.83
786.57
Enucleation of eye; with implant, muscles attached to
							 implant
65110
1,685.83
1,128.42
Exenteration of orbit (does not include skin graft),
							 removal of orbital contents; only
65112
1,685.83
1,337.22
Exenteration of orbit (does not include skin graft),
							 removal of orbital contents; with therapeutic removal of bone
65114
1,685.83
1,378.80
Exenteration of orbit (does not include skin graft),
							 removal of orbital contents; with muscle or myocutaneous flap
65125
837.04
471.45
Modification of ocular implant with placement or
							 replacement of pegs (eg, drilling receptacle for prosthesis appendage)
							 (separate procedure)
65130
1,086.26
678.70
Insertion of ocular implant secondary; after
							 evisceration, in scleral shell
65135
1,086.26
690.21
Insertion of ocular implant secondary; after
							 enucleation, muscles not attached to implant
65140
1,685.83
747.37
Insertion of ocular implant secondary; after
							 enucleation, muscles attached to implant
65150
1,086.26
553.26
Reinsertion of ocular implant; with or without
							 conjunctival graft
65155
1,685.83
795.23
Reinsertion of ocular implant; with use of foreign
							 material for reinforcement and/or attachment of muscles to implant
65175
837.04
612.98
Removal of ocular implant
65205
22.06
52.76
Removal of foreign body, external eye; conjunctival
							 superficial
65210
27.95
64.86
Removal of foreign body, external eye; conjunctival
							 embedded (includes concretions), subconjunctival, or scleral
							 nonperforating
65220
38.86
54.28
Removal of foreign body, external eye; corneal,
							 without slit lamp
65222
30.53
71.16
Removal of foreign body, external eye; corneal, with
							 slit lamp
65235
722.66
622.02
Removal of foreign body, intraocular; from anterior
							 chamber of eye or lens
65260
814.89
860.16
Removal of foreign body, intraocular; from posterior
							 segment, magnetic extraction, anterior or posterior route
65265
1,244.34
963.98
Removal of foreign body, intraocular; from posterior
							 segment, nonmagnetic extraction
65270
837.04
276.30
Repair of laceration; conjunctiva, with or without
							 nonperforating laceration sclera, direct closure
65272
1,035.68
481.19
Repair of laceration; conjunctiva, by mobilization
							 and rearrangement, without hospitalization
65273
338.05
Repair of laceration; conjunctiva, by mobilization
							 and rearrangement, with hospitalization
65275
1,035.68
507.87
Repair of laceration; cornea, nonperforating, with or
							 without removal foreign body
65280
814.89
591.79
Repair of laceration; cornea and/or sclera,
							 perforating, not involving uveal tissue
65285
1,662.75
916.92
Repair of laceration; cornea and/or sclera,
							 perforating, with reposition or resection of uveal tissue
65286
228.66
684.92
Repair of laceration; application of tissue glue,
							 wounds of cornea and/or sclera
65290
1,078.29
437.37
Repair of wound, extraocular muscle, tendon and/or
							 Tenon's capsule
65400
722.66
619.91
Excision of lesion, cornea (keratectomy, lamellar,
							 partial), except pterygium
65410
722.66
139.28
Biopsy of cornea
65420
722.66
512.84
Excision or transposition of pterygium; without
							 graft
65426
1,035.68
630.20
Excision or transposition of pterygium; with
							 graft
65430
38.86
107.06
Scraping of cornea, diagnostic, for smear and/or
							 culture
65435
34.20
75.42
Removal of corneal epithelium; with or without
							 chemocauterization (abrasion, curettage)
65436
722.66
347.88
Removal of corneal epithelium; with application of
							 chelating agent (eg, EDTA)
65450
97.37
297.30
Destruction of lesion of cornea by cryotherapy,
							 photocoagulation or thermocauterization
65600
173.20
361.31
Multiple punctures of anterior cornea (eg, for
							 corneal erosion, tattoo)
65710
1,675.35
990.48
Keratoplasty (corneal transplant);
							 lamellar
65730
1,675.35
1,095.79
Keratoplasty (corneal transplant); penetrating
							 (except in aphakia)
65750
1,675.35
1,108.61
Keratoplasty (corneal transplant); penetrating (in
							 aphakia)
65755
1,675.35
1,102.26
Keratoplasty (corneal transplant); penetrating (in
							 pseudophakia)
65760
I.C.
Keratomileusis
65765
I.C.
Keratophakia
65767
I.C.
Epikeratoplasty
65770
65771
3,789.74
I.C.
1,260.93
Keratoprosthesis Radial keratotomy
65772
722.66
414.53
Corneal relaxing incision for correction of
							 surgically induced astigmatism
65775
722.66
497.31
Corneal wedge resection for correction of surgically
							 induced astigmatism
65780
1,675.35
811.63
Ocular surface reconstruction; amniotic membrane
							 transplantation
65781
1,675.35
1,203.64
Ocular surface reconstruction; limbal stem cell
							 allograft (eg, cadaveric or living donor)
65782
1,675.35
1,041.25
Ocular surface reconstruction; limbal conjunctival
							 autograft (includes obtaining graft)
65800
722.66
141.56
Paracentesis of anterior chamber of eye (separate
							 procedure); with diagnostic aspiration of aqueous
65805
722.66
157.21
Paracentesis of anterior chamber of eye (separate
							 procedure); with therapeutic release of aqueous
65810
1,035.68
416.20
Paracentesis of anterior chamber of eye (separate
							 procedure); with removal of vitreous and/or discission of anterior hyaloid
							 membrane, with or without air injection
65815
1,035.68
619.64
Paracentesis of anterior chamber of eye (separate
							 procedure); with removal of blood, with or without irrigation and/or air
							 injection
65820
228.66
690.83
Goniotomy
65850
1,035.68
762.06
Trabeculotomy ab externo
65855
143.05
318.36
Trabeculoplastybylaser surgery, one or more sessions
							 (defined treatment series)
65860
133.86
294.95
Severing adhesions of anterior segment, laser
							 technique (separate procedure)
65865
722.66
439.15
Severing adhesions of anterior segment of eye,
							 incisional technique (with or without injection of air or liquid) (separate
							 procedure); goniosynechiae
65870
1,035.68
534.39
Severing adhesions of anterior segment of eye,
							 incisional technique (with or without injection of air or liquid) (separate
							 procedure); anterior synechiae, except goniosynechiae
65875
1,035.68
566.76
Severing adhesions of anterior segment of eye,
							 incisional technique (with or without injection of air or liquid) (separate
							 procedure); posterior synechiae
65880
722.66
596.11
Severing adhesions of anterior segment of eye,
							 incisional technique (with or without injection of air or liquid) (separate
							 procedure); corneovitreal adhesions
65900
722.66
875.73
Removal of epithelial downgrowth, anterior chamber of
							 eye
65920
1,035.68
704.78
Removal of implanted material, anterior segment of
							 eye
65930
1,035.68
582.41
Removal of blood clot, anterior segment of
							 eye
66020
722.66
184.87
Injection, anterior chamber of eye (separate
							 procedure); air or liquid
66030
228.66
166.21
Injection, anterior chamber of eye (separate
							 procedure); medication
66130
1,035.68
670.12
Excision of lesion, sclera
66150
1,035.68
780.68
Fistulization of sclera for glaucoma; trephination
							 with iridectomy
66155
1,035.68
777.46
Fistulization of sclera for glaucoma;
thermocauterization with iridectomy
66160
1,035.68
878.53
Fistulization of sclera for glaucoma; sclerectomy
							 with punch or scissors, with iridectomy
66165
1,035.68
764.38
Fistulization of sclera for glaucoma; iridencleisis
							 or iridotasis
66170
1,035.68
1,062.72
Fistulization of sclera for glaucoma; trabeculectomy
							 ab externo in absence of previous surgery
66172
1,035.68
1,332.37
Fistulization of sclera for glaucoma; trabeculectomy
							 ab externo with scarring from previous ocular surgery or trauma (includes
							 injection of antifibrotic agents)
66180
1,774.58
1,039.12
Aqueous shunt to extraocular reservoir (eg, Molteno,
							 Schocket, Denver-Krupin)
66185
1,774.58
663.09
Revision of aqueous shunt to extraocular
							 reservoir
66220
1,662.75
646.78
Repair of scleral staphyloma; without
							 graft
66225
1,774.58
827.20
Repair of scleral staphyloma; with graft
66250
722.66
727.18
Revision or repair of operative wound of anterior
							 segment, any type, early or late, major or minor procedure
66500
228.66
330.89
Iridotomy by stab incision (separate procedure);
							 except transfixion
66505
228.66
361.04
Iridotomy by stab incision (separate procedure); with
							 transfixion as for iris bombe
66600
1,035.68
729.84
Iridectomy, with corneoscleral or corneal section;
							 for removal of lesion
66605
1,035.68
949.06
Iridectomy, with corneoscleral or corneal section;
							 with cyclectomy
66625
228.66
390.74
Iridectomy, with corneoscleral or corneal section;
							 peripheral for glaucoma (separate procedure)
66630
1,035.68
506.24
Iridectomy, with corneoscleral or corneal section;
							 sector for glaucoma (separate procedure)
66635
1,035.68
510.70
Iridectomy, with corneoscleral or corneal section;
							 optical (separate procedure)
66680
1,035.68
459.11
Repair of iris, ciliary body (as for
							 iridodialysis)
66682
1,035.68
559.96
Suture of iris, ciliary body (separate procedure)
							 with retrieval of suture through small incision (eg, McCannel
							 suture)
66700
722.66
410.56
Ciliary body destruction; diathermy
66710
722.66
404.28
Ciliary body destruction; cyclophotocoagulation,
							 transscleral
66711
722.66
565.55
Ciliary body destruction; cyclophotocoagulation,
							 endoscopic
66720
722.66
430.57
Ciliary body destruction; cryotherapy
66740
1,035.68
401.05
Ciliary body destruction; cyclodialysis
66761
194.90
416.68
Iridotomy/iridectomy by laser surgery (eg, for
							 glaucoma) (one or more sessions)
66762
197.48
433.78
Iridoplasty by photocoagulation (one or more
							 sessions) (eg, for improvement of vision, for widening of anterior chamber
							 angle)
66770
213.29
479.39
Destruction of cyst or lesion iris or ciliary body
							 (nonexcisional procedure)
66820
228.66
380.14
Discission of secondary membranous cataract
							 (opacified posterior lens capsule and/or anterior hyaloid); stab incision
							 technique (Ziegler or Wheeler knife)
66821
232.38
298.92
Discission of secondary membranous cataract
							 (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg,
							 YAG laser) (one or more stages)
66825
1,035.68
700.69
Repositioning of intraocular lens prosthesis,
							 requiring an incision (separate procedure)
66830
228.66
633.84
Removal of secondary membranous cataract (opacified
							 posterior lens capsule and/or anterior hyaloid) with corneo-scleral section,
							 with or without iridectomy (iridocapsulotomy, iridocapsulectomy)
66840
666.62
621.16
Removal of lens material; aspiration technique, one
							 or more stages
66850
1,282.70
704.15
Removal of lens material; phacofragmentation
							 technique (mechanical or ultrasonic) (eg, phacoemulsification), with
							 aspiration
66852
1,282.70
752.67
Removal of lens material; pars plana approach, with
							 or without vitrectomy
66920
1,282.70
673.05
Removal of lens material; intracapsular
66930
1,282.70
762.26
Removal of lens material; intracapsular, for
							 dislocated lens
66940
666.62
695.11
Removal of lens material; extracapsular (other than
							 66840, 66850, 66852)
66982
1,066.48
958.35
Extracapsular cataract removal with insertion of
							 intraocular lens prosthesis (one stage procedure), manual or mechanical
							 technique (eg, irrigation and aspiration or phacoemulsification), complex,
							 requiring devices or techniques not generally used in routine cataract surgery
							 (eg, iris expansion device, suture support for intraocular lens, or primary
							 posterior capsulorrhexis) or performed on patients in the amblyogenic
							 developmental stage
66983
1,066.48
642.89
Intracapsular cataract extraction with insertion of
							 intraocular lens prosthesis (one stage procedure)
66984
1,066.48
684.39
Extracapsular cataract removal with insertion of
							 intraocular lens prosthesis (one stage procedure), manual or mechanical
							 technique (eg, irrigation and aspiration or phacoemulsification)
66985
1,066.48
678.55
Insertion of intraocular lens prosthesis (secondary
							 implant), not associated with concurrent cataract removal
66986
1,066.48
833.34
Exchange of intraocular lens
66990
81.73
Use of ophthalmic endoscope (List separately in
							 addition to code for primary procedure)
66999
I.C.
Unlisted procedure, anterior segment of
							 eye
67005
1,244.34
422.65
Removal of vitreous, anterior approach (open sky
							 technique or limbal incision); partial removal
67010
1,244.34
486.95
Removal of vitreous, anterior approach (open sky
							 technique or limbal incision); subtotal removal with mechanical
							 vitrectomy
67015
1,244.34
529.04
Aspiration or release of vitreous, subretinal or
							 choroidal fluid, pars plana approach (posterior sclerotomy)
67025
1,244.34
673.34
Injection of vitreous substitute, pars plana or
							 limbal approach (fluid-gas exchange), with or without aspiration (separate
							 procedure)
67027
1,662.75
759.94
Implantation of intravitreal drug delivery system
							 (eg, ganciclovir implant), includes concomitant removal of vitreous
67028
89.00
201.49
Intravitreal injection of a pharmacologic agent
							 (separate procedure)
67030
814.89
472.72
Discission of vitreous strands (without removal),
							 pars plana approach
67031
232.38
353.80
Severing of vitreous strands, vitreous face
							 adhesions, sheets, membranes or opacities, laser surgery (one or more
							 stages)
67036
1,662.75
859.70
Vitrectomy, mechanical, pars plana
							 approach;
67039
1,662.75
1,107.45
Vitrectomy, mechanical, pars plana approach; with
							 focal endolaser photocoagulation
67040
1,662.75
1,273.05
Vitrectomy, mechanical, pars plana approach; with
							 endolaser panretinal photocoagulation
67041
1,662.75
1,151.81
Vitrectomy, mechanical, pars plana approach; with
							 removal of preretinal cellular membrane (eg, macular pucker)
67042
1,662.75
1,314.43
Vitrectomy, mechanical, pars plana approach; with
							 removal of internal limiting membrane of retina (eg, for repair of macular
							 hole, diabetic macular edema), includes, if performed, intraocular tamponade
							 (ie, air, gas or silicone oil)
67043
1,662.75
1,382.86
Vitrectomy, mechanical, pars plana approach; with
							 removal of subretinal membrane (eg, choroidal neovascularization), includes, if
							 performed, intraocular tamponade (ie, air, gas or silicone oil) and laser
							 photocoagulation
67101
323.60
710.23
Repair of retinal detachment, one or more sessions;
							 cryotherapy or diathermy, with or without drainage of subretinal
							 fluid
67105
232.38
652.90
Repair of retinal detachment, one or more sessions;
							 photocoagulation, with or without drainage of subretinal fluid
67107
1,662.75
1,078.61
Repair of retinal detachment; scleral buckling (such
							 as lamellar scleral dissection, imbrication or encircling procedure), with or
							 without implant, with or without cryotherapy, photocoagulation, and drainage of
							 subretinal fluid
67108
1,662.75
1,428.12
Repair of retinal detachment; with vitrectomy, any
							 method, with or without air or gas tamponade, focal endolaser photocoagulation,
							 cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of
							 lens by same technique
67110
351.92
796.25
Repair of retinal detachment; by injection of air or
							 other gas (eg, pneumatic retinopexy)
67112
1,662.75
1,176.32
Repair of retinal detachment; by scleral buckling or
							 vitrectomy, on patient having previous ipsilateral retinal detachment repair(s)
							 using scleral buckling or vitrectomy techniques
67113
1,662.75
1,520.34
Repair of complex retinal detachment (eg,
proliferative vitreoretinopathy, stage C-1 or
							 greater, diabetic traction retinal detachment, retinopathy of prematurity,
							 retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling,
							 may include air, gas, or silicone oil tamponade, cryotherapy, endolaser
							 photocoagulation, drainage of subretinal fluid, scleral buckling, and/or
							 removal of lens
67115
814.89
440.10
Release of encircling material (posterior
							 segment)
67120
814.89
611.81
Removal of implanted material, posterior segment;
							 extraocular
67121
1,244.34
804.88
Removal of implanted material, posterior segment;
							 intraocular
67141
184.70
471.79
Prophylaxis of retinal detachment (eg, retinal break,
							 lattice degeneration) without drainage, one or more sessions; cryotherapy,
							 diathermy
67145
203.36
473.29
Prophylaxis of retinal detachment (eg, retinal break,
							 lattice degeneration) without drainage, one or more sessions; photocoagulation
							 (laser or xenon arc)
67208
216.23
537.07
Destruction of localized lesion of retina (eg,
							 macular edema, tumors), one or more sessions; cryotherapy,
							 diathermy
67210
229.47
619.64
Destruction of localized lesion of retina (eg,
							 macular edema, tumors), one or more sessions; photocoagulation
67218
814.89
1,242.21
Destruction of localized lesion of retina (eg,
							 macular edema, tumors), one or more sessions; radiation by implantation of
							 source (includes removal of source)
67220
184.70
955.97
Destruction of localized lesion of choroid (eg,
							 choroidal neovascularization); photocoagulation (eg, laser), one or more
							 sessions
67221
133.12
290.41
Destruction of localized lesion of choroid (eg,
							 choroidal neovascularization); photodynamic therapy (includes intravenous
							 infusion)
67225
8.83
27.69
Destruction of localized lesion of choroid (eg,
							 choroidal neovascularization); photodynamic therapy, second eye, at single
							 session (List separately in addition to code for primary eye
							 treatment)
67227
1,244.34
551.38
Destruction of extensive or progressive retinopathy
							 (eg, diabetic retinopathy), one or more sessions, cryotherapy,
							 diathermy
67228
232.38
1,062.81
Treatment of extensive or progressive retinopathy,
							 one or more sessions; (eg, diabetic retinopathy), photocoagulation
67250
837.04
724.64
Scleral reinforcement (separate procedure); without
							 graft
67255
1,244.34
775.21
Scleral reinforcement (separate procedure); with
							 graft
67299
I.C.
Unlisted procedure, posterior segment
67311
1,078.29
535.36
Strabismus surgery, recession or resection procedure;
							 one horizontal muscle
67312
1,078.29
634.37
Strabismus surgery, recession or resection procedure;
							 two horizontal muscles
67314
1,078.29
597.26
Strabismus surgery, recession or resection procedure;
							 one vertical muscle (excluding superior oblique)
67316
1,078.29
712.91
Strabismus surgery, recession or resection procedure;
							 two or more vertical muscles (excluding superior oblique)
67318
1,078.29
626.16
Strabismus surgery, any procedure, superior oblique
							 muscle
67320
1,078.29
280.26
Transposition procedure (eg, for paretic extraocular
							 muscle), any extraocular muscle (specify) (List separately in addition to code
							 for primary procedure)
67331
1,078.29
265.22
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
1,078.29
288.79
Strabismus surgery on patient with scarring of
							 extraocular muscles (eg, prior ocular injury, strabismus or retinal detachment
							 surgery) or restrictive myopathy (eg, dysthyroid ophthalmopathy) (List
							 separately in addition to code for primary procedure)
67334
1,078.29
261.27
Strabismus surgery by posterior fixation suture
							 technique, with or without muscle recession (List separately in addition to
							 code for primary procedure)
67335
1,078.29
134.94
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
1,078.29
312.23
Strabismus surgery involving exploration and/or
							 repair of detached extraocular muscle(s) (List separately in addition to code
							 for primary procedure)
67343
1,078.29
583.65
Release of extensive scar tissue without detaching
							 extraocular muscle (separate procedure)
67345
87.52
216.39
Chemodenervation of extraocular muscle
67346
67399
614.25
183.04 I.C.
Biopsy of extraocular muscle Unlisted procedure,
							 ocular muscle
67400
1,086.26
867.27
Orbitotomy without bone flap (frontal or
							 transconjunctival approach); for exploration, with or without
							 biopsy
67405
1,086.26
737.49
Orbitotomy without bone flap (frontal or
							 transconjunctival approach); with drainage only
67412
1,086.26
809.48
Orbitotomy without bone flap (frontal or
							 transconjunctival approach); with removal of lesion
67413
1,086.26
807.81
Orbitotomy without bone flap (frontal or
							 transconjunctival approach); with removal of foreign body
67414
1,685.83
1,171.52
Orbitotomy without bone flap (frontal or
							 transconjunctival approach); with removal of bone for decompression
67415
837.04
94.55
Fine needle aspiration of orbital
							 contents
67420
1,685.83
1,500.81
Orbitotomy with bone flap or window, lateral approach
							 (eg, Kroenlein); with removal of lesion
67430
1,685.83
1,153.44
Orbitotomy with bone flap or window, lateral approach
							 (eg, Kroenlein); with removal of foreign body
67440
1,685.83
1,119.69
Orbitotomy with bone flap or window, lateral approach
							 (eg, Kroenlein); with drainage
67445
1,685.83
1,274.08
Orbitotomy with bone flap or window, lateral approach
							 (eg, Kroenlein); with removal of bone for decompression
67450
1,685.83
1,157.67
Orbitotomy with bone flap or window, lateral approach
							 (eg, Kroenlein); for exploration, with or without biopsy
67500
97.37
79.20
Retrobulbar injection; medication (separate
							 procedure, does not include supply of medication)
67505
129.69
75.70
Retrobulbar injection; alcohol
67515
25.01
80.00
Injection of medication or other substance into
							 Tenon's capsule
67550
1,685.83
901.43
Orbital implant (implant outside muscle cone);
							 insertion
67560
1,086.26
912.29
Orbital implant (implant outside muscle cone);
							 removal or revision
67570
1,685.83
1,071.70
Optic nerve decompression (eg, incision or
							 fenestration of optic nerve sheath)
67599
I.C.
Unlisted procedure, orbit
67700
129.69
286.84
Blepharotomy, drainage of abscess, eyelid
67710
166.58
245.98
Severing of tarsorrhaphy
67715
837.04
256.33
Canthotomy (separate procedure)
67800
55.16
118.60
Excision of chalazion; single
67801
66.92
151.00
Excision of chalazion; multiple, same lid
67805
86.42
187.94
Excision of chalazion; multiple, different
							 lids
67808
837.04
328.16
Excision of chalazion; under general anesthesia
							 and/or requiring hospitalization, single or multiple
67810
129.69
219.87
Biopsy of eyelid
67820
19.13
49.38
Correction of trichiasis; epilation, by forceps
							 only
67825
57.74
122.16
Correction of trichiasis; epilation by other than
							 forceps (eg, by electrosurgery, cryotherapy, laser surgery)
67830
325.54
280.22
Correction of trichiasis; incision of lid
							 margin
67835
837.04
401.08
Correction of trichiasis; incision of lid margin,
							 with free mucous membrane graft
67840
172.47
289.20
Excision of lesion of eyelid (except chalazion)
							 without closure or with simple direct closure
67850
122.46
213.76
Destruction of lesion of lid margin (up to 1
							 cm)
67875
325.54
178.91
Temporary closure of eyelids by suture (eg, Frost
							 suture)
67880
722.66
435.86
Construction of intermarginal adhesions, median
							 tarsorrhaphy, or canthorrhaphy;
67882
837.04
529.65
Construction of intermarginal adhesions, median
							 tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate
67900
837.04
618.16
Repair of brow ptosis (supraciliary, mid-forehead or
							 coronal approach)
67901
837.04
602.64
Repair of blepharoptosis; frontalis muscle technique
							 with suture or other material (eg, banked fascia)
67902
837.04
620.06
Repair of blepharoptosis; frontalis muscle technique
							 with autologous fascial sling (includes obtaining fascia)
67903
837.04
606.11
Repair of blepharoptosis; (tarso) levator resection
							 or advancement, internal approach
67904
837.04
689.28
Repair of blepharoptosis; (tarso) levator resection
							 or advancement, external approach
67906
837.04
465.96
Repair of blepharoptosis; superior rectus technique
							 with fascial sling (includes obtaining fascia)
67908
837.04
465.91
Repair of blepharoptosis; conjunctivo-tarso-Muller's
							 muscle-levator resection (eg, Fasanella-Servat type)
67909
837.04
522.97
Reduction of overcorrection of ptosis
67911
837.04
487.27
Correction of lid retraction
67912
837.04
959.40
Correction of lagophthalmos, with implantation of
							 upper eyelid lid load (eg, gold weight)
67914
837.04
387.48
Repair of ectropion; suture
67915
189.38
351.44
Repair of ectropion; thermocauterization
67916
837.04
523.60
Repair of ectropion; excision tarsal
							 wedge
67917
837.04
567.73
Repair of ectropion; extensive (eg, tarsal strip
							 operations)
67921
837.04
370.88
Repair of entropion; suture
67922
184.97
341.98
Repair of entropion; thermocauterization
67923
837.04
546.89
Repair of entropion; excision tarsal
							 wedge
67924
837.04
572.93
Repair of entropion; extensive (eg, tarsal strip or
							 capsulopalpebral fascia repairs operation)
67930
185.33
361.28
Suture of recent wound, eyelid, involving lid margin,
							 tarsus, and/or palpebral conjunctiva direct closure; partial
							 thickness
67935
837.04
577.42
Suture of recent wound, eyelid, involving lid margin,
							 tarsus, and/or palpebral conjunctiva direct closure; full thickness
67938
97.37
260.08
Removal of embedded foreign body, eyelid
67950
837.04
563.67
Canthoplasty (reconstruction of canthus)
67961
837.04
562.93
Excision and repair of eyelid, involving lid margin,
							 tarsus, conjunctiva, canthus, or full thickness, may include preparation for
							 skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up
							 to one-fourth of lid margin
67966
837.04
707.96
Excision and repair of eyelid, involving lid margin,
							 tarsus, conjunctiva, canthus, or full thickness, may include preparation for
							 skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over
							 one-fourth of lid margin
67971
1,086.2
6
662.65
Reconstruction of eyelid, full thickness by transfer
							 of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, one
							 stage or first stage
67973
1,086.2
6
857.14
Reconstruction of eyelid, full thickness by transfer
							 of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, one stage
							 or first stage
67974
1,086.2
6
853.35
Reconstruction of eyelid, full thickness by transfer
							 of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, one stage
							 or first stage
67975
837.04
626.33
Reconstruction of eyelid, full thickness by transfer
							 of tarsoconjunctival flap from opposing eyelid; second stage
67999
I.C.
Unlisted procedure, eyelids
68020
48.54
110.01
Incision of conjunctiva, drainage of cyst
68040
23.90
60.60
Expression of conjunctival follicles (eg, for
							 trachoma)
68100
102.96
177.53
Biopsy of conjunctiva
68110
131.64
229.05
Excision of lesion, conjunctiva; up to 1
							 cm
68115
837.04
321.90
Excision of lesion, conjunctiva; over 1
							 cm
68130
722.66
531.06
Excision of lesion, conjunctiva; with adjacent
							 sclera
68135
62.52
144.45
Destruction of lesion, conjunctiva
68200
18.02
39.88
Subconjunctival injection
68320
837.04
698.38
Conjunctivoplasty; with conjunctival graft or
							 extensive rearrangement
68325
1,086.26
591.91
Conjunctivoplasty; with buccal mucous membrane graft
							 (includes obtaining graft)
68326
1,086.26
575.14
Conjunctivoplasty, reconstruction cul-de-sac; with
							 conjunctival graft or extensive rearrangement
68328
1,086.26
646.84
Conjunctivoplasty, reconstruction cul-de-sac; with
							 buccal mucous membrane graft (includes obtaining graft)
68330
1,035.68
586.98
Repair of symblepharon; conjunctivoplasty, without
							 graft
68335
1,086.26
575.89
Repair of symblepharon; with free graft conjunctiva
							 or buccal mucous membrane (includes obtaining graft)
68340
837.04
534.25
Repair of symblepharon; division of symblepharon,
							 with or without insertion of conformer or contact lens
68360
1,035.68
511.92
Conjunctival flap; bridge or partial (separate
							 procedure)
68362
1,035.68
582.85
Conjunctival flap; total (such as Gunderson thin flap
							 or purse string flap)
68371
722.66
384.94
Harvesting conjunctival allograft, living
							 donor
68399
I.C.
Unlisted procedure, conjunctiva
68400
129.69
298.29
Incision, drainage of lacrimal gland
68420
198.21
330.60
Incision, drainage of lacrimal sac (dacryocystotomy
							 or dacryocystostomy)
68440
61.41
111.14
Snip incision of lacrimal punctum
68500
1,086.26
886.18
Excision of lacrimal gland (dacryoadenectomy), except
							 for tumor; total
68505
1,086.26
890.82
Excision of lacrimal gland (dacryoadenectomy), except
							 for tumor; partial
68510
837.04
452.55
Biopsy of lacrimal gland
68520
1,086.26
624.39
Excision of lacrimal sac
							 (dacryocystectomy)
68525
837.04
240.36
Biopsy of lacrimal sac
68530
253.00
447.83
Removal of foreign body or dacryolith, lacrimal
							 passages
68540
1,086.26
834.41
Excision of lacrimal gland tumor; frontal
							 approach
68550
1,086.26
1,015.56
Excision of lacrimal gland tumor; involving
							 osteotomy
68700
1,086.26
537.05
Plastic repair of canaliculi
68705
129.69
239.72
Correction of everted punctum, cautery
68720
1,086.26
686.34
Dacryocystorhinostomy (fistulization of lacrimal sac
							 to nasal cavity)
68745
1,086.26
688.30
Conjunctivorhinostomy (fistulization of conjunctiva
							 to nasal cavity); without tube
68750
1,086.26
711.20
Conjunctivorhinostomy (fistulization of conjunctiva
							 to nasal cavity); with insertion of tube or stent
68760
97.37
203.29
Closure of the lacrimal punctum; by
							 thermocauterization, ligation, or laser surgery
68761
75.39
143.27
Closure of the lacrimal punctum; by plug,
							 each
68770
837.04
492.45
Closure of lacrimal fistula (separate
							 procedure)
68801
38.86
119.89
Dilation of lacrimal punctum, with or without
							 irrigation
68810
97.37
255.27
Probing of nasolacrimal duct, with or without
							 irrigation;
68811
837.04
189.98
Probing of nasolacrimal duct, with or without
							 irrigation; requiring general anesthesia
68815
837.04
453.11
Probing of nasolacrimal duct, with or without
							 irrigation; with insertion of tube or stent
68816
468.12
694.08
Probing of nasolacrimal duct, with or without
							 irrigation; with transluminal balloon catheter dilation
68840
57.00
116.50
Probing of lacrimal canaliculi, with or without
							 irrigation
68850
65.34
Injection of contrast medium for
							 dacryocystography
68899
I.C.
Unlisted procedure, lacrimal system
69000
62.85
186.35
Drainage external ear, abscess or hematoma;
							 simple
69005
108.85
214.06
Drainage external ear, abscess or hematoma;
							 complicated
69020
62.85
240.77
Drainage external auditory canal, abscess
69100
65.45
110.49
Biopsy external ear
69105
91.57
145.73
Biopsy external auditory canal
69110
719.48
463.01
Excision external ear; partial, simple
							 repair
69120
1,071.47
416.28
Excision external ear; complete
							 amputation
69140
1,071.47
903.99
Excision exostosis(es), external auditory
							 canal
69145
719.48
391.81
Excision soft tissue lesion, external auditory
							 canal
69150
332.81
1,069.75
Radical excision external auditory canal lesion;
							 without neck dissection
69155
1,686.59
Radical excision external auditory canal lesion; with
							 neck dissection
69200
28.19
132.57
Removal foreign body from external auditory canal;
							 without general anesthesia
69205
943.36
103.81
Removal foreign body from external auditory canal;
							 with general anesthesia
69210
22.06
49.94
Removal impacted cerumen (separate procedure), one or
							 both ears
69220
35.44
143.67
Debridement, mastoidectomy cavity, simple (eg,
							 routine cleaning)
69222
143.79
232.05
Debridement, mastoidectomy cavity, complex (eg, with
							 anesthesia or more than routine cleaning)
69310
1,782.06
1,127.78
Reconstruction of external auditory canal
(meatoplasty) (eg, for stenosis due to injury,
							 infection) (separate procedure)
69399
I.C.
Unlisted procedure, external ear
69400
91.57
145.05
Eustachian tube inflation, transnasal; with
							 catheterization
69401
50.74
86.53
Eustachian tube inflation, transnasal; without
							 catheterization
69405
131.64
261.55
Eustachian tube catheterization,
							 transtympanic
69420
111.73
198.52
Myringotomy including aspiration and/or eustachian
							 tube inflation
69421
729.71
156.76
Myringotomy including aspiration and/or eustachian
							 tube inflation requiring general anesthesia
69424
83.10
135.14
Ventilating tube removal requiring general
							 anesthesia
69433
117.68
204.23
Tympanostomy (requiring insertion of ventilating
							 tube), local or topical anesthesia
69436
729.71
169.96
Tympanostomy (requiring insertion of ventilating
							 tube), general anesthesia
69440
1,071.47
690.41
Middle ear exploration through postauricular or ear
							 canal incision
69450
1,782.06
542.42
Tympanolysis, transcanal
69501
1,782.06
740.16
Transmastoid antrotomy (simple
							 mastoidectomy)
69502
1,071.47
975.75
Mastoidectomy; complete
69505
1,782.06
1,244.79
Mastoidectomy; modified radical
69511
1,782.06
1,274.67
Mastoidectomy; radical
69530
1,782.06
1,688.16
Petrous apicectomy including radical
							 mastoidectomy
69535
140.47
2,712.65
Resection temporal bone, external
							 approach
69540
1,782.06
220.48
Excision aural polyp
69550
1,782.06
1,074.71
Excision aural glomus tumor; transcanal
69552
69554
1,782.06
2,557.82
1,614.72
Excision aural glomus tumor; transmastoid Excision
							 aural glomus tumor; extended (extratemporal)
69601
1,782.06
1,053.12
Revision mastoidectomy; resulting in complete
							 mastoidectomy
69602
1,782.06
1,098.43
Revision mastoidectomy; resulting in modified radical
							 mastoidectomy
69603
1,782.06
1,316.26
Revision mastoidectomy; resulting in radical
							 mastoidectomy
69604
1,782.06
1,124.32
Revision mastoidectomy; resulting in
							 tympanoplasty
69605
1,782.06
1,604.86
Revision mastoidectomy; with apicectomy
69610
192.33
403.57
Tympanic membrane repair, with or without site
							 preparation of perforation for closure, with or without patch
69620
1,071.47
724.43
Myringoplasty (surgery confined to drumhead and donor
							 area)
69631
1,782.06
886.36
Tympanoplasty without mastoidectomy (including
							 canalplasty, atticotomy and/or middle ear surgery), initial or revision;
							 without ossicular chain reconstruction
69632
1,782.06
1,085.37
Tympanoplasty without mastoidectomy (including
							 canalplasty, atticotomy and/or middle ear surgery), initial or revision; with
							 ossicular chain reconstruction (eg, postfenestration)
69633
1,782.06
1,046.94
Tympanoplasty without mastoidectomy (including
							 canalplasty, atticotomy and/or middle ear surgery), initial or revision; with
							 ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular
							 replacement prosthesis (PORP), total ossicular replacement prosthesis
							 (TORP))
69635
1,782.06
1,250.39
Tympanoplasty with antrotomy or mastoidotomy
							 (including canalplasty, atticotomy, middle ear surgery, and/or tympanic
							 membrane repair); without ossicular chain reconstruction
69636
1,782.06
1,422.40
Tympanoplasty with antrotomy or mastoidotomy
							 (including canalplasty, atticotomy, middle ear surgery, and/or tympanic
							 membrane repair); with ossicular chain reconstruction
69637
1,782.06
1,414.67
Tympanoplasty with antrotomy or mastoidotomy
							 (including canalplasty, atticotomy, middle ear surgery, and/or tympanic
							 membrane repair); with ossicular chain reconstruction and synthetic prosthesis
							 (eg, partial ossicular replacement prosthesis (PORP), total
69641
1,782.06
1,048.68
Tympanoplasty with mastoidectomy (including
							 canalplasty, middle ear surgery, tympanic membrane repair); without ossicular
							 chain reconstruction
69642
1,782.06
1,350.89
Tympanoplasty with mastoidectomy (including
							 canalplasty, middle ear surgery, tympanic membrane repair); with ossicular
							 chain reconstruction
69643
1,782.06
1,232.09
Tympanoplasty with mastoidectomy (including
							 canalplasty, middle ear surgery, tympanic membrane repair); with intact or
							 reconstructed wall, without ossicular chain reconstruction
69644
1,782.06
1,525.80
Tympanoplasty with mastoidectomy (including
							 canalplasty, middle ear surgery, tympanic membrane repair); with intact or
							 reconstructed canal wall, with ossicular chain reconstruction
69645
1,782.06
1,494.88
Tympanoplasty with mastoidectomy (including
							 canalplasty, middle ear surgery, tympanic membrane repair); radical or
							 complete, without ossicular chain reconstruction
69646
1,782.06
1,584.45
Tympanoplasty with mastoidectomy (including
							 canalplasty, middle ear surgery, tympanic membrane repair); radical or
							 complete, with ossicular chain reconstruction
69650
1,071.47
802.76
Stapes mobilization
69660
1,782.06
935.85
Stapedectomy or stapedotomy with reestablishment of
							 ossicular continuity, with or without use of foreign material;
69661
1,782.06
1,226.07
Stapedectomy or stapedotomy with reestablishment of
							 ossicular continuity, with or without use of foreign material; with footplate
							 drill out
69662
1,782.06
1,170.69
Revision of stapedectomy or stapedotomy
69666
1,782.06
813.50
Repair oval window fistula
69667
1,782.06
815.22
Repair round window fistula
69670
1,782.06
953.02
Mastoid obliteration (separate procedure)
69676
1,782.06
843.41
Tympanic neurectomy
69700
1,782.06
715.66
Closure postauricular fistula, mastoid (separate
							 procedure)
69710
I.C.
Implantation or replacement of electromagnetic bone
							 conduction hearing device in temporal bone
69711
1,782.06
871.74
Removal or repair of electromagnetic bone conduction
							 hearing device in temporal bone
69714
1,782.06
1,085.38
Implantation, osseointegrated implant, temporal bone,
							 with percutaneous attachment to external speech processor/cochlear stimulator;
							 without mastoidectomy
69715
1,782.06
1,339.39
Implantation, osseointegrated implant, temporal bone,
							 with percutaneous attachment to external speech processor/cochlear stimulator;
							 with mastoidectomy
69717
1,782.06
1,157.52
Replacement (including removal of existing device),
							 osseointegrated implant, temporal bone, with percutaneous attachment to
							 external speech processor/cochlear stimulator; without
							 mastoidectomy
69718
1,782.06
1,407.91
Replacement (including removal of existing device),
							 osseointegrated implant, temporal bone, with percutaneous attachment to
							 external speech processor/cochlear stimulator; with mastoidectomy
69720
1,782.06
1,189.52
Decompression facial nerve, intratemporal; lateral to
							 geniculate ganglion
69725
1,889.00
Decompression facial nerve, intratemporal; including
							 medial to geniculate ganglion
69740
1,782.06
1,166.32
Suture facial nerve, intratemporal, with or without
							 graft or decompression; lateral to geniculate ganglion
69745
69799
1,782.06
I.C.
1,185.04
Suture facial nerve, intratemporal, with or without
							 graft or decompression; including medial to geniculate ganglion Unlisted
							 procedure, middle ear
69801
1,782.06
754.22
Labyrinthotomy, with or without cryosurgery including
							 other nonexcisional destructive procedures or perfusion of vestibuloactive
							 drugs (single or multiple perfusions); transcanal
69802
1,782.06
1,045.89
Labyrinthotomy, with or without cryosurgery including
							 other nonexcisional destructive procedures or perfusion of vestibuloactive
							 drugs (single or multiple perfusions); with mastoidectomy
69805
1,782.06
1,054.61
Endolymphatic sac operation; without
							 shunt
69806
1,782.06
950.87
Endolymphatic sac operation; with shunt
69820
1,782.06
876.41
Fenestration semicircular canal
69840
1,782.06
941.26
Revision fenestration operation
69905
1,782.06
923.19
Labyrinthectomy; transcanal
69910
1,782.06
1,028.43
Labyrinthectomy; with mastoidectomy
69915
1,782.06
1,544.64
Vestibular nerve section, translabyrinthine
							 approach
69930
25,420.43
1,283.32
Cochlear device implantation, with or without
							 mastoidectomy
69949
I.C.
Unlisted procedure, inner ear
69950
1,828.97
Vestibular nerve section, transcranial
							 approach
69955
2,011.27
Total facial nerve decompression and/or repair (may
							 include graft)
69960
1,937.08
Decompression internal auditory canal
69970
2,157.75
Removal of tumor, temporal bone
69979
I.C.
Unlisted procedure, temporal bone, middle fossa
							 approach
69990
215.24
Microsurgical techniques, requiring use of operating
							 microscope (List separately in addition to code for primary
							 procedure)
88000
I.C.
Necropsy (autopsy), gross examination only; without
							 CNS
88005
I.C.
Necropsy (autopsy), gross examination only; with
							 brain
88007
I.C.
Necropsy (autopsy), gross examination only; with
							 brain and spinal cord
88020
I.C.
Necropsy (autopsy), gross and microscopic; without
							 CNS
88025
I.C.
Necropsy (autopsy), gross and microscopic; with
							 brain
88027
I.C.
Necropsy (autopsy), gross and microscopic; with brain
							 and spinal cord
88036
I.C.
Necropsy (autopsy), limited, gross and/or
							 microscopic; regional
88037
I.C.
Necropsy (autopsy), limited, gross and/or
							 microscopic; single organ
88040
I.C.
Necropsy (autopsy); forensic examination
88045
I.C.
Necropsy (autopsy); coroner's call
88099
I.C.
Unlisted necropsy (autopsy) procedure
88300
26.81
4.41 2
2.39
Level I - Surgical pathology, gross examination
							 only
88302
58.73
7.04
51.69
Level II - Surgical pathology, gross and microscopic
							 examination Appendix, incidental Fallopian tube, sterilization Fingers/toes,
							 amputation, traumatic Foreskin, newborn Hernia sac, any location Hydrocele sac
							 Nerve Skin, plastic repair Sympathetic ganglion Testis, castration Vaginal
							 mucosa, incidental Vas deferens, sterilization
88304
72.39
11.03
61.36
Level III - Surgical pathology, gross and microscopic
							 examination Abortion, induced Abscess Aneurysm -arterial/ventricular Anus, tag
							 Appendix, other than incidental Artery, atheromatous plaque Bartholin's gland
							 cyst Bone fragment(s), other than pathologic fracture Bursa/synovial cyst
							 Carpal tunnel tissue Cartilage, shavings Cholesteatoma Colon, colostomy stoma
							 Conjunctiva - biopsy/pterygium Cornea Diverticulum - esophagus/small intestine
							 Dupuytren's contracture tissue Femoral head, other than fracture
							 Fissure/fistula Foreskin, other than newborn Gallbladder Ganglion cyst Hematoma
							 Hemorrhoids Hydatid of Morgagni Intervertebral disc Joint, loose body Meniscus
							 Mucocele, salivary Neuroma -Morton's/traumatic Pilonidal cyst/sinus Polyps,
							 inflammatory - nasal/sinusoidal Skin - cyst/tag/debridement Soft tissue,
							 debridement Soft tissue, lipoma Spermatocele Tendon/tendon sheath Testicular
							 appendage Thrombus or embolus Tonsil and/or adenoids Varicocele Vas deferens,
							 other than sterilization Vein, varicosity
88305
118.38
38.47
79.91
Level IV - Surgical pathology, gross and microscopic
							 examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy
							 Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy,
							 not requiring microscopic evaluation of surgical margins Breast, reduction
							 mammoplasty Bronchus, biopsy Cell block, any source Cervix, biopsy Colon,
							 biopsy Duodenum, biopsy Endocervix, curettings/biopsy Endometrium,
							 curettings/biopsy Esophagus, biopsy Extremity, amputation, traumatic Fallopian
							 tube, biopsy Fallopian tube, ectopic pregnancy Femoral head, fracture
							 Fingers/toes, amputation, non-traumatic Gingiva/oral mucosa, biopsy Heart valve
							 Joint, resection Kidney, biopsy Larynx, biopsy Leiomyoma(s), uterine myomectomy
							 - without uterus Lip, biopsy/wedge resection Lung, transbronchial biopsy Lymph
							 node, biopsy Muscle, biop sy Nasal mu cosa, biopsy Nasopharynx/oropharynx,
							 biopsy Nerve, biopsy Odontogenic/dental cyst Omentum, biopsy Ovary with or
							 without tube, non-neoplastic Ovary, biopsy/wedge resection Parathyroid gland
							 Peritoneum, biopsy Pituitary tumor Placenta, other than third trimester
							 Pleura/pericardium - biopsy/tissue Polyp, cervical/endometrial Polyp,
							 colorectal Polyp, stomach/smallintestineProstate,needlebiopsy
Prostate, TUR Salivary gland, biopsy Sinus, paranasal
							 biopsy Skin, other than cyst/tag/debridement/plastic repair Small intestine,
							 biopsy Soft tissue, other than tumor/mass/lipoma/debridement Spleen
							 Stomach,
biopsy Synovium Testis, other than
							 tumor/biopsy/castration Thyroglossal duct/brachial cleft cyst Tongue, biopsy
							 Tonsil, biopsy Trachea, biopsy Ureter, biopsy Urethra, biopsy Urinary
							 bladder,
88307
232.33
82.78
149.55
biopsy Uterus, with or without tubes and ovaries, for
							 prolapse Vagina, biopsy Vulva/labia, biopsy
Level V - Surgical pathology, gross and
							 microscopic
examination Adrenal, resection Bone -
biopsy/curettings Bone fragment(s), pathologic
							 fracture Brain, biopsy Brain/meninges, tumor resection Breast, excision of
							 lesion, requiring microscopic evaluation of surgical margins Breast, mastectomy
							 - partial/simple Cervix, conization Colon, segmental resection, other than for
							 tumor Extremity,
amputation, non-traumatic Eye, enucleation Kidney,
							 partial/total nephrectomy Larynx, partial/total resection Liver, biopsy -
							 needle/wedge Liver, partial resection Lung, wedge biopsy Lymph nodes, regional
							 resection Mediastinum, mass Myocardium, biopsy Odontogenic tumor Ovary with or
							 without tube, neoplastic Pancreas, biopsy Placenta, third trimester
Prostate, except radical resection Salivary gland
							 Sentinel lymph node Small intestine, resection, other than for tumor Soft
							 tissue mass (except lipoma) -biopsy/simple excision Stomach - subtotal/total
							 resection, other than for tumor Testis, biopsy Thymus,
88309
342.83
139.4
203.40
tumor Thyroid, total/lobe Ureter, resection Urinary
							 bladder, TUR Uterus, with or without tubes and ovaries, other than
							 neoplastic/prolapse
Level VI - Surgical pathology, gross and
							 microscopic
examination Bone resection Breast, mastectomy -with
							 regional lymph nodes Colon, segmental resection for tumor Colon, total
							 resection Esophagus, partial/total resection Extremity, disarticulation Fetus,
							 with dissection Larynx, partial/total resection - with
regional lymph nodes Lung - total/lobe/segment
							 resection Pancreas, total/subtotal resection Prostate, radical resection Small
							 intestine, resection for tumor Soft tissue tumor, extensive resection Stomach
							 -subtotal/total resection for tumor Testis, tumor
Tongue/tonsil -resection for tumor Urinary bladder,
							 partial/total resection Uterus, with or without tubes and ovaries, neoplastic
							 Vulva, total/subtotal resection
88311
88312
19.38
106.79
12.18
27.32
7.20
79.47
Decalcification procedure (List separately in
							 addition to code for surgical pathology examination)
Special stains (List separately in addition to code
							 for
primary service); Group I for microorganisms (eg,
							 Gridley, acid fast, methenamine silver), each
88313
82.44
12.18
70.26
Special stains (List separately in addition to code
							 for primary service); Group II, all other (eg, iron, trichrome), except
							 immunocytochemistry and immunoperoxidase stains, each
88314
109.08
23.33
85.75
Special stains (List separately in addition to code
							 for primary service); histochemical staining with frozen section(s)
88318
121.10
21.84
99.26
Determinative histochemistry to identify chemical
							 components (eg, copper, zinc)
88319
172.11
27.44
144.67
Determinative histochemistry or cytochemistry to
							 identify enzyme constituents, each
88321
91.67
Consultation and report on referred slides prepared
							 elsewhere
88323
156.64
87.92
68.72
Consultation and report on referred material
							 requiring preparation of slides
88325
210.35
Consultation, comprehensive, with review of records
							 and specimens, with report on referred material
88329
53.85
Pathology consultation during surgery;
88331
96.42
62.08
34.34
Pathology consultation during surgery; first tissue
							 block, with frozen section(s), single specimen
88332
42.98
30.87
12.11
Pathology consultation during surgery; each
							 additional tissue block with frozen section(s)
88333
98.60
62.88
35.72
Pathology consultation during surgery; cytologic
							 examination (eg, touch prep, squash prep), initial site
88334
57.88
36.57
21.31
Pathology consultation during surgery; cytologic
							 examination (eg, touch prep, squash prep), each additional site
88342
109.69
43.27
66.42
Immunohist ochemistry (includ i n g t i ssue
							 immunoperoxidase), each antibody
88346
110.95
43.61
67.34
Immunofluorescent study, each antibody; direct
							 method
88347
90.24
42.69
47.55
Immunofluorescent study, each antibody; indirect
							 method
88348
691.10
77.75
613.35
Electron microscopy; diagnostic
88349
326.91
39.74
287.17
Electron microscopy; scanning
88355
343.23
91.96
251.27
Morphometric analysis; skeletal muscle
88356
328.36
149.06
179.31
Morphometric analysis; nerve
88358
82.18
48.32
33.86
Morphometric analysis; tumor (eg, DNA
							 ploidy)
88360
131.09
56.39
74.70
Morphometric analysis, tumor immunohistochemistry
							 (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or
							 semiquantitative, each antibody; manual
88361
179.33
60.78
118.55
Morphometric analysis, tumor immunohistochemistry
							 (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or
							 semiquantitative, each antibody; using computer-assisted technology
88362
301.82
111.31
190.51
Nerve teasing preparations
88365
168.13
60.28
107.85
In situ hybridization (eg, FISH), each
							 probe
88367
259.71
63.68
196.04
Morphometric analysis, in situ hybridization
							 (quantitative or semi-quantitative) each probe; using computer-assisted
							 technology
88368
221.24
69.39
151.85
Morphometric analysis, in situ hybridization
							 (quantitative or semi-quantitative) each probe; manual
88371
18.46
Protein analysis of tissue by Western Blot, with
							 interpretation and report;
88372
19.38
Protein analysis of tissue by Western Blot, with
							 interpretation and report; immunological probe for band identification,
							 each
88380
179.89
75.15
104.74
Microdissection (ie, sample preparation of
							 microscopically identified target); laser capture
88381
248.43
56.82
191.62
Microdissection (ie, sample preparation of
							 microscopically identified target); manual
88384
I.C.
I.C.
I.C.
Array-based evaluation of multiple molecular probes;
							 11 through 50 probes
88385
575.85
74.19
501.66
Array-based evaluation of multiple molecular probes;
							 51 through 250 probes
88386
586.80
93.28
493.52
Array-based evaluation of multiple molecular probes;
							 251 through 500 probes
88399
I.C.
I.C.
I.C.
Unlisted surgical pathology procedure
(9)
Homemakers
.
Code
Fee
40.06(9) Homemaker -
							 Description
S5130
4.38
Homemaker service, NOS; per 15 minutes
(10)
Medicine / Podiatric Care
.
Code
GL Fee
PC Fee
TC Fee
40.06(10) - Medical Service
							 Description
90281
I.C.
Immune globulin (Ig), human, for intramuscular
							 use
90283
I.C.
Immune globulin (IgIV), human, for intravenous
							 use
90284
I.C.
Immune globulin (SCIg), human, for use in
							 subcutaneous infusions, 100 mg, each
90287
I.C.
Botulinum antitoxin, equine, any route
90288
I.C.
Botulism immune globulin, human, for intravenous
							 use
90291
I.C.
Cytomegalovirus immune globulin (CMV-IgIV), human,
							 for intravenous use
90296
I.C.
Diphtheria antitoxin, equine, any route
90371
I.C.
Hepatitis B immune globulin (HBIg), human, for
							 intramuscular use
90375
I.C.
Rabies immune globulin (RIg), human, for
							 intramuscular and/or subcutaneous use
90376
I.C.
Rabies immune globulin, heat-treated (RIg-HT), human,
							 for intramuscular and/or subcutaneous use
90378
I.C.
Respiratory syncytial virus immune globulin
							 (RSV-IgIM), for intramuscular use, 50 mg, each
90379
I.C.
Respiratory syncytial virus immune globulin
							 (RSV-IgIV), human, for intravenous use
90384
I.C.
Rho(D) immune globulin (RhIg), human, full-dose, for
							 intramuscular use
90385
I.C.
Rho(D) immune globulin (RhIg), human, mini-dose, for
							 intramuscular use
90386
I.C.
Rho(D) immune globulin (RhIgIV), human, for
							 intravenous use
90389
I.C.
Tetanus immune globulin (TIg), human, for
							 intramuscular use
90393
I.C.
Vaccinia immune globulin, human, for intramuscular
							 use
90396
I.C.
Varicella-zoster immune globulin, human, for
							 intramuscular use
90399
I.C.
Unlisted immune globulin
90471
23.59
Immunization administration (includes
							 percutaneous,
intradermal, subcutaneous, or intramuscular
							 injections); one vaccine (single or combination vaccine/toxoid)
90472
11.40
Immunization administration (includes
							 percutaneous,
intradermal, subcutaneous, or intramuscular
							 injections); each additional vaccine (single or combination vaccine/toxoid)
							 (List separately in addition to code for primary procedure)
90473
14.39
Immunization administration by intranasal or oral
							 route; one vaccine (single or combination vaccine/toxoid)
90474
9.56
Immunization administration by intranasal or oral
							 route; each additional vaccine (single or combination vaccine/toxoid) (List
							 separately in addition to code for primary procedure)
90476
I.C.
Adenovirus vaccine, type 4, live, for oral
							 use
90477
I.C.
Adenovirus vaccine, type 7, live, for oral
							 use
90581
I.C.
Anthrax vaccine, for subcutaneous use
90585
I.C.
Bacillus Calmette-Guerin vaccine (BCG) for
							 tuberculosis, live, for percutaneous use
90586
I.C.
Bacillus Calmette-Guerin vaccine (BCG) for bladder
							 cancer, live, for intravesical use
90632
I.C.
Hepatitis A vaccine, adult dosage, for intramuscular
							 use
90633
I.C.
Hepatitis A vaccine, pediatric/adolescent dosage-2
							 dose schedule, for intramuscular use
90634
I.C.
Hepatitis A vaccine, pediatric/adolescent dosage-3
							 dose schedule, for intramuscular use
90636
I.C.
Hepatitis A and hepatitis B vaccine (HepA-HepB),
							 adult dosage, for intramuscular use
90645
I.C.
Hemophilus influenza b vaccine (Hib), HbOC conjugate
							 (4 dose schedule), for intramuscular use
90646
I.C.
Hemophilus influenza b vaccine (Hib), PRP-D
							 conjugate, for booster use only, intramuscular use
90647
I.C.
Hemophilus influenza b vaccine (Hib), PRP-OMP
							 conjugate (3 dose schedule), for intramuscular use
90648
I.C.
Hemophilus influenza b vaccine (Hib), PRP-T conjugate
							 (4 dose schedule), for intramuscular use
90649
I.C.
Human Papilloma virus (HPV) vaccine, types 6, 11, 16,
							 18 (quadrivalent), three dose schedule, for intramuscular use
90675
I.C.
Rabies vaccine, for intramuscular use
90676
I.C.
Rabies vaccine, for intradermal use
90680
I.C.
Rotavirus vaccine, pentavalent, thee dose schedule,
							 live, for oral use
90703
I.C.
Tetanus toxoid adsorbed, for intramuscular
							 use
90716
I.C.
Varicella virus vaccine, live, for subcutaneous
							 use
90740
I.C.
Hepatitis B vaccine, dialysis or immunosuppressed
							 patient dosage (three dose schedule), for intramuscular use
90743
I.C.
Hepatitis B vaccine, adolescent (two dose schedule),
							 for intramuscular use
90744
I.C.
Hepatitis B vaccine, pediatric/adolescent dosage
							 (three dose schedule), for intramuscular use
90746
I.C.
Hepatitis B vaccine, adult dosage, for intramuscular
							 use
90747
I.C.
Hepatitis B vaccine, dialysis or immunosuppressed
							 patient dosage (four dose schedule), for intramuscular use
90748
I.C.
Hepatitis B and Hemophilus influenza b vaccine
							 (HepB-Hib), for intramuscular use
90749
I.C.
Unlisted vaccine/toxoid
90760
70.96
Intravenous infusion, hydration; initial, 31 minutes
							 to one hour
90761
20.84
Intravenous infusion, hydration; each additional hour
							 (List separately in addition to code for primary procedure)
90765
87.06
Intravenous infusion, for therapy, prophylaxis, or
							 diagnosis (specify substance or drug); initial, up to one hour
90766
26.68
Intravenous infusion, for therapy, prophylaxis, or
							 diagnosis (specify substance or drug); each additional hour (List separately in
							 addition to code for primary procedure)
90767
44.05
Intravenous infusion, for therapy, prophylaxis, or
							 diagnosis (specify substance or drug); additional sequential infusion, up to 1
							 hour (List separately in addition to code for primary procedure)
90768
24.95
Intravenous infusion, for therapy, prophylaxis, or
							 diagnosis (specify substance or drug); concurrent infusion (List separately in
							 addition to code for primary procedure)
90769
189.86
Subcutaneous infusion for therapy or prophylaxis
							 (specify substance or drug); initial, up to one hour, including pump set-up and
							 establishment of subcutaneous infusion site(s)
90770
17.47
Subcutaneous infusion for therapy or prophylaxis
							 (specify substance or drug); each additional hour (List separately in addition
							 to code for primary procedure)
90771
85.91
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)
90772
23.59
Therapeutic, prophylactic or diagnostic injection
							 (specify substance or drug); subcutaneous or intramuscular
90773
20.67
Therapeutic, prophylactic or diagnostic injection
							 (specify substance or drug); intra-arterial
90774
68.10
Therapeutic, prophylactic or diagnostic injection
							 (specify substance or drug); intravenous push, single or initial
							 substance/drug
90775
29.47
Therapeutic, prophylactic or diagnostic injection
							 (specify substance or drug); each additional sequential intravenous push of a
							 new substance/drug (List separately in addition to code for primary
							 procedure)
90776
I.C.
Therapeutic, prophylactic or diagnostic injection
							 (specify substance or drug); each additional sequential intravenous push of the
							 same substance/drug provided in a facility (List separately in addition to code
							 for primary procedure)
90779
I.C.
Unlisted therapeutic, prophylactic or diagnostic
							 intravenous or intra-arterial injection or infusion
90862
56.51
Pharmacologic management, including prescription,
							 use, and review of medication with no more than minimal medical
							 psychotherapy
90901
40.37
Biofeedback training by any modality
90911
99.85
Biofeedback training, perineal muscles, anorectal or
							 urethral sphincter, including EMG and/or manometry
90935
70.47
Hemodialysis procedure with single physician
							 evaluation
90937
114.18
Hemodialysis procedure requiring repeated
							 evaluation(s) with or without substantial revision of dialysis
							 prescription
90940
I.C.
Hemodialysis access flow study to determine blood
							 flow in grafts and arteriovenous fistulae by an indicator method
90945
73.44
Dialysis procedure other than hemodialysis (eg,
							 peritoneal dialysis, hemofiltration, or other continuous renal replacement
							 therapies), with single physician evaluation
90947
116.81
Dialysis procedure other than hemodialysis (eg,
							 peritoneal dialysis, hemofiltration, or other continuous renal replacement
							 therapies) requiring repeated physician evaluations, with or without
							 substantial revision of dialysis prescription
90989
I.C.
Dialysis training, patient, including helper where
							 applicable, any mode, completed course
90993
I.C.
Dialysis training, patient, including helper where
							 applicable, any mode, course not completed, per training session
90997
91.32
Hemoperfusion (eg, with activated charcoal or
							 resin)
90999
I.C.
Unlisted dialysis procedure, inpatient or
							 outpatient
91000
82.74
36.87
45.87
Esophageal intubation and collection of washings for
							 cytology, including preparation of specimens (separate procedure)
91010
232.23
67.03
65.20
Esophageal motility (manometric study of the
							 esophagus and/or gastroesophageal junction) study;
91011
299.06
81.85
217.21
Esophageal motility (manometric study of the
							 esophagus and/or gastroesophageal junction) study; with mecholyl or similar
							 stimulant
91012
311.50
79.26
232.24
Esophageal motility (manometric study of the
							 esophagus and/or gastroesophageal junction) study; with acid perfusion
							 studies
91020
268.01
76.58
191.43
Gastric motility (manometric) studies
91022
226.13
77.04
149.09
Duodenal motility (manometric) study
91030
155.76
49.30
106.46
Esophagus, acid perfusion (Bernstein) test for
							 esophagitis
91034
252.59
52.41
200.18
Esophagus, gastroesophageal reflux test; with nasal
							 catheter pH electrode(s) placement, recording, analysis and
							 interpretation
91035
568.80
85.08
483.71
Esophagus, gastroesophageal reflux test; with mucosal
							 attached telemetry pH electrode placement, recording, analysis and
							 interpretation
91037
184.01
52.87
131.14
Esophageal function test, gastroesophageal reflux
							 test with nasal catheter intraluminal impedance electrode(s) placement,
							 recording, analysis and interpretation;
91038
157.15
60.07
97.08
Esophageal function test, gastroesophageal reflux
							 test with nasal catheter intraluminal impedance electrode(s) placement,
							 recording, analysis and interpretation; prolonged (greater than one hour, up to
							 24 hours)
91040
470.76
49.19
421.58
Esophageal balloon distension provocation
							 study
91052
151.83
42.60
109.23
Gastric analysis test with injection of stimulant of
							 gastric secretion (eg, histamine, insulin, pentagastrin, calcium and
							 secretin)
91055
161.23
46.48
114.75
Gastric intubation, washings, and preparing slides
							 for cytology (separate procedure)
91065
72.17
10.35
61.82
Breath hydrogen test (eg, for detection of lactase
							 deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal
							 gastrointestinal transit)
91100
152.66
I.C.
I.C.
Intestinal bleeding tube, passage, positioning and
							 monitoring
91105
100.53
I.C.
I.C.
Gastric intubation, and aspiration or lavage for
							 treatment (eg, for ingested poisons)
91110
1,115.00
194.64
920.36
Gastrointestinal tract imaging, intraluminal (eg,
							 capsule endoscopy), esophagus through ileum, with physician interpretation and
							 report
91111
902.81
55.76
847.06
Gastrointestinal tract imaging, intraluminal (eg,
							 capsule endoscopy), esophagus with physician interpretation and
							 report
91120
493.94
49.49
444.45
Rectal sensation, tone, and compliance test (ie,
							 response to graded balloon distention)
91122
283.06
92.41
190.65
Anorectal manometry
91123
I.C.
I.C.
I.C.
Pulsed irrigation of fecal impaction
91132
I.C.
28.48
I.C.
Electrogastrography, diagnostic,
							 transcutaneous;
91133
I.C.
36.32
I.C.
Electrogastrography, diagnostic, transcutaneous; with
							 provocative testing
91299
I.C.
I.C.
I.C.
Unlisted diagnostic gastroenterology
							 procedure
92002
74.37
Ophthalmological services: medical examination and
							 evaluation with initiation of diagnostic and treatment program; intermediate,
							 new patient
92004
138.37
Ophthalmological services: medical examination and
							 evaluation with initiation of diagnostic and treatment program; comprehensive,
							 new patient, one or more visits
92012
78.50
Ophthalmological services: medical examination and
							 evaluation, with initiation or continuation of diagnostic and treatment
							 program; intermediate, established patient
92014
113.36
Ophthalmological services: medical examination and
							 evaluation, with initiation or continuation of diagnostic and treatment
							 program; comprehensive, established patient, one or more visits
92015
49.64
Determination of refractive state
92018
131.64
Ophthalmological examination and evaluation, under
							 general anesthesia, with or without manipulation of globe for passive range of
							 motion or other manipulation to facilitate diagnostic examination;
							 complete
92019
66.80
Ophthalmological examination and evaluation, under
							 general anesthesia, with or without manipulation of globe for passive range of
							 motion or other manipulation to facilitate diagnostic examination;
							 limited
92020
26.28
Gonioscopy (separate procedure)
92025
35.10
17.77
17.33
Computerized corneal topography, unilateral or
							 bilateral, with interpretation and report
92060
58.98
36.13
22.85
Sensorimotor examination with multiple measurements
							 of ocular deviation (eg, restrictive or paretic muscle with diplopia) with
							 interpretation and report (separate procedure)
92065
44.99
18.46
26.54
Orthoptic and/or pleoptic training, with continuing
							 medical direction and evaluation
92070
70.07
Fitting of contact lens for treatment of disease,
							 including supply of lens
92081
56.62
18.57
38.04
Visual field examination, unilateral or bilateral,
							 with interpretation and report; limited examination (eg, tangent screen,
							 Autoplot, arc perimeter, or single stimulus level automated test, such as
							 Octopus three or seven equivalent)
92082
74.08
22.69
51.39
Visual field examination, unilateral or bilateral,
							 with interpretation and report; intermediate examination (eg, at least two
							 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold
							 screening program, Humphrey suprathreshold automatic diagnostic test, Octopus
							 program 33)
92083
85.33
26.12
59.22
Visual field examination, unilateral or bilateral,
							 with interpretation and report; extended examination (eg, Goldmann visual
							 fields with at least three isopters plotted and static determination within the
							 central 30/, or quantitative, automated threshold periimetry, Octopus program
							 G-1, 32 or 42,
Humphrey Visual field analyzer full threshold
							 programs; 30-2, 24-2, or 30/60-2)
92100
91.39
Serial tonometry (separate procedure) with multiple
							 measurements of intraocular pressure over an extended time period with
							 interpretation and report, same day (eg, diurnal curve or medical treatment of
							 acute elevation of intraocular pressure)
92120
75.20
Tonography with interpretation and report, recording
							 indentation tonometer method or perilimbal suction method
92130
84.87
Tonography with water provocation
92135
48.91
18.23
30.68
Scanning computerized ophthalmic diagnostic imaging,
							 posterior segment, (eg, scanning laser) with interpretation and report,
							 unilateral
92136
91.72
28.86
62.86
Ophthalmic biometry by partial coherence
							 interferometry with intraocular lens power calculation
92140
60.64
Provocative tests for glaucoma, with interpretation
							 and report, without tonography
92225
23.86
Ophthalmoscopy, extended, with retinal drawing (eg,
							 for retinal detachment, melanoma), with interpretation and report;
							 initial
92226
21.69
Ophthalmoscopy, extended, with retinal drawing (eg,
							 for retinal detachment, melanoma), with interpretation and report;
							 subsequent
92230
71.72
Fluorescein angioscopy with interpretation and
							 report
92235
142.36
43.44
98.92
Fluorescein angiography (includes multiframe imaging)
							 with interpretation and report
92240
281.90
59.17
222.73
Indocyanine-green angiography (includes multiframe
							 imaging) with interpretation and report
92250
80.52
22.69
57.83
Fundus photography with interpretation and
							 report
92260
18.18
Ophthalmodynamometry
92265
86.53
40.82
45.71
Needle oculoelectromyography, one or more extraocular
							 muscles, one or both eyes, with interpretation and report
92270
94.51
41.44
53.07
Electro-oculography with interpretation and
							 report
92275
136.32
53.33
82.99
Electroretinography with interpretation and
							 report
92283
48.29
8.87
39.42
Color vision examination, extended, eg, anomaloscope
							 or equivalent
92284
77.84
11.72
66.12
Dark adaptation examination with interpretation and
							 report
92285
48.39
10.81
37.58
External ocular photography with interpretation and
							 report for documentation of medical progress (eg, close-up photography, slit
							 lamp photography, goniophotography, stereo-photography)
92286
141.57
34.64
106.92
Special anterior segment photography with
							 interpretation and report; with specular endothelial microscopy and cell
							 count
92287
126.76
Special anterior segment photography with
							 interpretation and report; with fluorescein angiography
92311
92.09
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation; corneal
							 lens for aphakia, one eye
92312
102.38
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation; corneal
							 lens for aphakia, both eyes
92313
89.09
Prescription of optical and physical characteristics
							 of and fitting of contact lens, with medical supervision of adaptation;
							 corneoscleral lens
92315
65.37
Prescription of optical and physical characteristics
							 of contact lens, with medical supervision of adaptation and direction of
							 fitting by independent technician; corneal lens for aphakia, one
							 eye
92316
82.27
Prescription of optical and physical characteristics
							 of contact lens, with medical supervision of adaptation and direction of
							 fitting by independent technician; corneal lens for aphakia, both
eyes
92352
41.47
Fitting of spectacle prosthesis for aphakia;
							 monofocal
92353
48.05
Fitting of spectacle prosthesis for aphakia;
							 multifocal
92354
213.81
Fitting of spectacle mounted low vision aid; single
							 element system
92355
110.31
Fitting of spectacle mounted low vision aid;
							 telescopic or other compound lens system
92358
29.12
Prosthesis service for aphakia, temporary (disposable
							 or loan, including materials)
92371
20.39
Repair and refitting spectacles; spectacle prosthesis
							 for aphakia
92499
I.C.
Unlisted ophthalmological service or
							 procedure
92502
99.54
Otolaryngologic examination under general
							 anesthesia
92504
31.76
Binocular microscopy (separate diagnostic
							 procedure)
92531
I.C.
Spontaneous nystagmus, including gaze
92532
I.C.
Positional nystagmus test
92533
I.C.
Caloric vestibular test, each irrigation (binaural,
							 bithermal stimulation constitutes four tests)
92534
I.C.
Optokinetic nystagmus test
92541
65.03
21.16
43.87
Spontaneous nystagmus test, including gaze and
							 fixation nystagmus, with recording
92542
68.32
17.55
50.77
Positional nystagmus test, minimum of 4 positions,
							 with recording
92543
32.09
5.56
26.54
Caloric vestibular test, each irrigation (binaural,
							 bithermal stimulation constitutes four tests), with recording
92544
54.42
13.78
40.64
Optokinetic nystagmus test, bidirectional, foveal or
							 peripheral stimulation, with recording
92545
50.18
12.30
37.88
Oscillating tracking test, with recording
92546
98.25
14.80
83.45
Sinusoidal vertical axis rotational
							 testing
92547
5.94
Use of vertical electrodes (List separately in
							 addition to code for primary procedure)
92548
112.70
26.88
85.83
Computerized dynamic posturography
92603
155.79
Diagnostic analysis of cochlear implant, age 7 years
							 or older; with programming
92604
93.57
Diagnostic analysis of cochlear implant, age 7 years
							 or older; subsequent reprogramming
92605
I.C.
Evaluation for prescription of non-speech-generating
							 augmentative and alternative communication device
92606
I.C.
Therapeutic service(s) for the use of
							 non-speech-generating device, including programming and
							 modification
92607
179.17
Evaluation for prescription for speech-generating
							 augmentative and alternative communication device, face-to-face with the
							 patient; first hour
92608
34.64
Evaluation for prescription for speech-generating
							 augmentative and alternative communication device, face-to-face with the
							 patient; each additional 30 minutes (List separately in addition to code for
							 primary procedure)
92609
94.18
Therapeutic services for the use of speech-generating
							 device, including programming and modification
92610
120.69
Evaluation of oral and pharyngeal swallowing
							 function
92611
126.21
Motion fluoroscopic evaluation of swallowing function
							 by cine or video recording
92612
176.20
Flexible fiberoptic endoscopic evaluation of
							 swallowing by cine or video recording;
92613
40.47
Flexible fiberoptic endoscopic evaluation of
							 swallowing by cine or video recording; physician interpretation and report
							 only
92614
157.79
Flexible fiberoptic endoscopic evaluation, laryngeal
							 sensory testing by cine or video recording;
92615
35.90
Flexible fiberoptic endoscopic evaluation, laryngeal
							 sensory testing by cine or video recording; physician interpretation and report
							 only
92616
216.96
Flexible fiberoptic endoscopic evaluation of
							 swallowing and laryngeal sensory testing by cine or video
							 recording;
92617
44.58
Flexible fiberoptic endoscopic evaluation of
							 swallowing and laryngeal sensory testing by cine or video recording; physician
							 interpretation and report only
92620
72.68
Evaluation of central auditory function, with report;
							 initial 60 minutes
92621
17.45
Evaluation of central auditory function, with report;
							 each additional 15 minutes
92625
72.22
Assessment of tinnitus (includes pitch, loudness
							 matching, and masking)
92626
98.46
Evaluation of auditory rehabilitation status; first
							 hour
92627
23.61
Evaluation of auditory rehabilitation status; each
							 additional 15 minutes (List separately in addition to code for primary
							 procedure)
92630
I.C.
Auditory rehabilitation; prelingual hearing
							 loss
92633
I.C.
Auditory rehabilitation; postlingual hearing
							 loss
92640
61.98
Diagnostic analysis with programming of auditory
							 brainstem implant, per hour
92700
I.C.
Unlisted otorhinolaryngological service or
							 procedure
92950
309.02
Cardiopulmonary resuscitation (eg, in cardiac
							 arrest)
92953
11.67
Temporary transcutaneous pacing
92960
324.71
Cardioversion, elective, electrical conversion of
							 arrhythmia; external
92961
269.43
Cardioversion, elective, electrical conversion of
							 arrhythmia; internal (separate procedure)
92970
182.63
Cardioassist-method of circulatory assist;
							 internal
92971
106.88
Cardioassist-method of circulatory assist;
							 external
92973
188.85
Percutaneous transluminal coronary thrombectomy (List
							 separately in addition to code for primary procedure)
92974
173.16
Transcatheter placement of radiation delivery device
							 for subsequent coronary intravascular brachytherapy (List separately in
							 addition to code for primary procedure)
92975
415.46
Thrombolysis, coronary; by intracoronary infusion,
							 including selective coronary angiography
92977
238.87
Thrombolysis, coronary; by intravenous
							 infusion
92978
I.C.
101.92
I.C.
Intravascular ultrasound (coronary vessel or graft)
							 during diagnostic evaluation and/or therapeutic intervention including imaging
							 supervision, interpretation and report; initial vessel (List separately in
							 addition to code for primary procedure)
92979
I.C.
81.80
I.C.
Intravascular ultrasound (coronary vessel or graft)
							 during diagnostic evaluation and/or therapeutic intervention including imaging
							 supervision, interpretation and report; each additional vessel (List separately
							 in addition to code for primary procedure)
92980
863.21
Transcatheter placement of an intracoronary stent(s),
							 percutaneous, with or without other therapeutic intervention, any method;
							 single vessel
92981
239.56
Transcatheter placement of an intracoronary stent(s),
							 percutaneous, with or without other therapeutic intervention, any method; each
							 additional vessel (List separately in addition to code for primary
							 procedure)
92982
640.48
Percutaneous transluminal coronary balloon
							 angioplasty; single vessel
92984
170.76
Percutaneous transluminal coronary balloon
							 angioplasty; each additional vessel (List separately in addition to code for
							 primary procedure)
92986
1,445.83
Percutaneous balloon valvuloplasty; aortic
							 valve
92987
1,497.88
Percutaneous balloon valvuloplasty; mitral
							 valve
92990
1,141.16
Percutaneous balloon valvuloplasty; pulmonary
							 valve
92992
I.C.
Atrial septectomy or septostomy; transvenous method,
							 balloon (eg, Rashkind type) (includes cardiac catheterization)
92993
I.C.
Atrial septectomy or septostomy; blade method (Park
							 septostomy) (includes cardiac catheterization)
92995
704.25
Percutaneous transluminal coronary atherectomy, by
							 mechanical or other method, with or without balloon angioplasty; single
							 vessel
92996
183.81
Percutaneous transluminal coronary atherectomy, by
							 mechanical or other method, with or without balloon angioplasty; each
							 additional vessel (List separately in addition to code for primary
							 procedure)
92997
661.29
Percutaneous transluminal pulmonary artery balloon
							 angioplasty; single vessel
92998
332.58
Percutaneous transluminal pulmonary artery balloon
							 angioplasty; each additional vessel (List separately in addition to code for
							 primary procedure)
93000
26.04
Electrocardiogram, routine ECG with at least 12
							 leads; with interpretation and report
93005
17.17
Electrocardiogram, routine ECG with at least 12
							 leads; tracing only, without interpretation and report
93010
8.87
Electrocardiogram, routine ECG with at least 12
							 leads; interpretation and report only
93012
239.68
Telephonic transmission of post-symptom
							 electrocardiogram rhythm strip(s), 24-hour attended monitoring, per 30 day
							 period of time; tracing only
93014
28.02
Telephonic transmission of post-symptom
							 electrocardiogram rhythm strip(s), 24-hour attended monitoring, per 30 day
							 period of time; physician review with interpretation and report
							 only
93015
119.10
Cardiovascular stress test using maximal or
							 submaximal treadmill or bicycle exercise, continuous electrocardiographic
							 monitoring, and/or pharmacological stress; with physician supervision, with
							 interpretation and report
93016
25.17
Cardiovascular stress test using maximal or
							 submaximal treadmill or bicycle exercise, continuous electrocardiographic
							 monitoring, and/or pharmacological stress; physician supervision only, without
							 interpretation and report
93017
77.40
Cardiovascular stress test using maximal or
							 submaximal treadmill or bicycle exercise, continuous electrocardiographic
							 monitoring, and/or pharmacological stress; tracing only, without interpretation
							 and report
93018
16.53
Cardiovascular stress test using maximal or
							 submaximal treadmill or bicycle exercise, continuous electrocardiographic
							 monitoring, and/or pharmacological stress; interpretation and report
							 only
93024
134.68
4.62
70.06
Ergonovine provocation test
93025
295.39
2.16
253.23
Microvolt T-wave alternans for assessment of
							 ventricular arrhythmias
93040
15.27
Rhythm ECG, one to three leads; with interpretation
							 and report
93041
7.20
Rhythm ECG, one to three leads; tracing only without
							 interpretation and report
93042
8.06
Rhythm ECG, one to three leads; interpretation and
							 report only
93224
161.65
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage, with visual
							 superimposition scanning; includes recording, scanning analysis with report,
							 physician review and interpretation
93225
50.73
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage, with visual
							 superimposition scanning; recording (includes hook-up, recording, and
							 disconnection)
93226
81.98
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage, with visual
							 superimposition scanning; scanning analysis with report
93227
28.94
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage, with visual
							 superimposition scanning; physician review and interpretation
93230
168.24
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage without superimposition
							 scanning utilizing a device capable of producing a full miniaturized printout;
							 includes recording, microprocessor-based analysis
93231
54.85
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage without superimposition
							 scanning utilizing a device capable of producing a full miniaturized printout;
							 recording (includes hook-up, recording, and disconnection)
93232
85.37
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage without superimposition
							 scanning utilizing a device capable of producing a full miniaturized printout;
							 microprocessor-based analysis with report
93233
28.02
Electrocardiographic monitoring for 24 hours by
							 continuous original ECG waveform recording and storage without superimposition
							 scanning utilizing a device capable of producing a full miniaturized printout;
							 physician review and interpretation
93235
I.C.
Electrocardiographic monitoring for 24 hours by
							 continuous computerized monitoring and non-continuous recording, and real-time
							 data analysis utilizing a device capable of producing intermittent full-sized
							 waveform tracings, possibly patient activated; includes monitoring and
							 real-time data analysis with report, physician review and
							 interpretation
93236
I.C.
Electrocardiographic monitoring for 24 hours by
							 continuous computerized monitoring and non-continuous recording, and real-time
							 data analysis utilizing a device capable of producing intermittent full-sized
							 waveform tracings, possibly patient activated; includes monitoring and
							 real-time data analysis with report,
93237
24.71
Electrocardiographic monitoring for 24 hours by
							 continuous computerized monitoring and non-continuous recording, and real-time
							 data analysis utilizing a device capable of producing intermittent full-sized
							 waveform tracings, possibly patient activated; physician review and
							 interpretation
93268
330.39
Patient demand single or multiple event recording
							 with presymptom memory loop, 24-hour attended monitoring, per 30 day period of
							 time; includes transmission, physician review and interpretation
93270
37.38
Patient demand single or multiple event recording
							 with presymptom memory loop, 24-hour attended monitoring, per 30 day period of
							 time; recording (includes hook-up, recording, and disconnection)
93271
265.45
Patient demand single or multiple event recording
							 with presymptom memory loop, 24-hour attended monitoring, per 30 day period of
							 time; monitoring, receipt of transmissions, and analysis
93272
27.56
Patient demand single or multiple event recording
							 with presymptom memory loop, 24-hour attended monitoring, per 30 day period of
							 time; physician review and interpretation only
93278
54.94
13.44
41.50
Signal-averaged electrocardiography (SAECG), with or
							 without ECG
93303
255.46
68.60
186.86
Transthoracic echocardiography for congenital cardiac
							 anomalies; complete
93304
153.00
39.55
113.44
Transthoracic echocardiography for congenital cardiac
							 anomalies; follow-up or limited study
93307
221.94
50.72
171.21
Echocardiography, transthoracic, real-time with image
							 documentation (2D) with or without M-mode recording; complete
93308
132.14
29.28
102.86
Echocardiography, transthoracic, real-time with image
							 documentation (2D) with or without M-mode recording; follow-up or limited
							 study
93312
361.45
118.02
243.44
Echocardiography, transesophageal, real time with
							 image documentation (2D) (with or without M-mode recording); including probe
							 placement, image acquisition, interpretation and report
93313
42.06
Echocardiography, transesophageal, real time with
							 image documentation (2D) (with or without M-mode recording); placement of
							 transesophageal probe only
93314
316.31
67.35
248.96
Echocardiography, transesophageal, real time with
							 image documentation (2D) (with or without M-mode recording); image acquisition,
							 interpretation and report only
93315
I.C.
151.01
I.C.
Transesophageal echocardiography for congenital
							 cardiac anomalies; including probe placement, image acquisition, interpretation
							 and report
93316
45.44
Transesophageal echocardiography for congenital
							 cardiac anomalies; placement of transesophageal probe only
93317
I.C.
92.96
I.C.
Transesophageal echocardiography for congenital
							 cardiac anomalies; image acquisition, interpretation and report
							 only
93318
I.C.
110.15
I.C.
Echocardiography, transesophageal (TEE) for
							 monitoring purposes, including probe placement, real time 2-dimensional image
							 acquisition and interpretation leading to ongoing (continuous) assessment of
							 (dynamically changing) cardiac pumping function and to therapeutic measures on
							 an immediate time basis
93320
98.34
21.10
77.24
Doppler echocardiography, pulsed wave and/or
							 continuous wave with spectral display (List separately in addition to codes for
							 echocardiographic imaging); complete
93321
48.78
8.64
40.14
Doppler echocardiography, pulsed wave and/or
							 continuous wave with spectral display (List separately in addition to codes for
							 echocardiographic imaging); follow-up or limited study (List separately in
							 addition to codes for echocardiographic imaging)
93325
91.84
4.07
87.76
Doppler echocardiography color flow velocity mapping
							 (List separately in addition to codes for echocardiography)
93350
226.69
82.41
144.28
Echocardiography, transthoracic, real-time with image
							 documentation (2D), with or without M-mode recording, during rest and
							 cardiovascular stress test using treadmill, bicycle exercise and/or
							 pharmacologically induced stress, with interpretation and report
93501
987.64
172.01
815.63
Right heart catheterization
93503
105.35
Insertion and placement of flow directed catheter
							 (eg, Swan-Ganz) for monitoring purposes
93505
728.68
249.33
479.35
Endomyocardial biopsy
93508
1,170.01
246.08
923.94
Catheter placement in coronary artery(s), arterial
							 coronary conduit(s), and/or venous coronary bypass graft(s) for coronary
							 angiography without concomitant left heart catheterization
93510
1,774.58
259.13
1,515.45
Left heart catheterization, retrograde, from the
							 brachial artery, axillary artery or femoral artery; percutaneous
93511
I.C.
299.26
I.C.
Left heart catheterization, retrograde, from the
							 brachial artery, axillary artery or femoral artery; by cutdown
93514
I.C.
394.98
I.C.
Left heart catheterization by left ventricular
							 puncture
93524
I.C.
411.06
I.C.
Combined transseptal and retrograde left heart
							 catheterization
93526
2,288.94
354.39
1,934.55
Combined right heart catheterization and retrograde
							 left heart catheterization
93527
I.C.
428.75
I.C.
Combined right heart catheterization and transseptal
							 left heart catheterization through intact septum (with or without retrograde
							 left heart catheterization)
93528
I.C.
520.23
I.C.
Combined right heart catheterization with left
							 ventricular puncture (with or without retrograde left heart
							 catheterization)
93529
I.C.
285.29
I.C.
Combined right heart catheterization and left heart
							 catheterization through existing septal opening (with or without retrograde
							 left heart catheterization)
93530
I.C.
239.77
I.C.
Right heart catheterization, for congenital cardiac
							 anomalies
93531
I.C.
466.92
I.C.
Combined right heart catheterization and retrograde
							 left heart catheterization, for congenital cardiac anomalies
93532
I.C.
543.58
I.C.
Combined right heart catheterization and transseptal
							 left heart catheterization through intact septum with or without retrograde
							 left heart catheterization, for congenital cardiac anomalies
93533
I.C.
379.67
I.C.
Combined right heart catheterization and transseptal
							 left heart catheterization through existing septal opening, with or without
							 retrograde left heart catheterization, for congenital cardiac
							 anomalies
93539
74.25
Injection procedure during cardiac catheterization;
							 for selective opacification of arterial conduits (eg, internal mammary),
							 whether native or used for bypass
93540
217.04
Injection procedure during cardiac catheterization;
							 for selective opacification of aortocoronary venous bypass grafts, one or more
							 coronary arteries
93541
16.18
Injection procedure during cardiac catheterization;
							 for pulmonary angiography
93542
132.18
Injection procedure during cardiac catheterization;
							 for selective right ventricular or right atrial angiography
93543
73.26
Injection procedure during cardiac catheterization;
							 for selective left ventricular or left atrial angiography
93544
53.48
Injection procedure during cardiac catheterization;
							 for aortography
93545
152.50
Injection procedure during cardiac catheterization;
							 for selective coronary angiography (injection of radiopaque material may be by
							 hand)
93555
203.99
45.59
158.40
Imaging supervision, interpretation and report for
							 injection procedure(s) during cardiac catheterization; ventricular and/or
							 atrial angiography
93556
299.98
46.73
253.25
Imaging supervision, interpretation and report for
							 injection procedure(s) during cardiac catheterization; pulmonary angiography,
							 aortography, and/or selective coronary angiography including venous bypass
							 grafts and arterial conduits (whether native or used in bypass)
93561
I.C.
24.58
I.C.
Indicator dilution studies such as dye or thermal
							 dilution, including arterial and/or venous catheterization; with cardiac output
							 measurement (separate procedure)
93562
I.C.
7.60
I.C.
Indicator dilution studies such as dye or thermal
							 dilution, including arterial and/or venous catheterization; subsequent
							 measurement of cardiac output
93571
I.C.
101.00
I.C.
Intravascular Doppler velocity and/or pressure
							 derived coronar flow reserve measurement (coronary vessel or graft) during
							 coronary angiography including pharmacologically induced stress; initial vessel
							 (List separately in addition to code for primary procedure)
93572
I.C.
78.90
I.C.
Intravascular Doppler velocity and/or pressure
							 derived coronary flow reserve measurement (coronary vessel or graft) during
							 coronary angiography including pharmacologically induced stress; each
							 additional vessel (List separatelyin addition to code for primary
							 procedure)
93580
1,037.66
Percutaneous transcatheter closure of congenital
							 interatrial communication (ie, Fontan fenestration, atrial septal defect) with
							 implant
93581
1,366.68
Percutaneous transcatheter closure of a congenital
							 ventricular septal defect with implant
93600
I.C.
121.37
I.C.
Bundle of His recording
93602
I.C.
120.29
I.C.
Intra-atrial recording
93603
I.C.
120.12
I.C.
Right ventricular recording
93609
I.C.
286.27
I.C.
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
I.C.
170.60
I.C.
Intra-atrial pacing
93612
I.C.
169.98
I.C.
Intraventricular pacing
93613
402.02
Intracardiac electrophysiologic 3-dimensional mapping
							 (List separately in addition to code for primary procedure)
93615
I.C.
53.11
I.C.
Esophageal recording of atrial electrogram with or
							 without ventricular electrogram(s);
93616
I.C.
69.68
I.C.
Esophageal recording of atrial electrogram with or
							 without ventricular electrogram(s); with pacing
93618
I.C.
244.78
I.C.
Induction of arrhythmia by electrical
							 pacing
93619
I.C.
427.35
I.C.
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
I.C.
670.33
I.C.
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
I.C.
120.38
I.C.
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
I.C.
176.42
I.C.
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
I.C.
163.14
I.C.
Programmed stimulation and pacing after intravenous
							 drug infusion (List separately in addition to code for primary
							 procedure)
93624
I.C.
284.25
I.C.
Electrophysiologic follow-up study with pacing and
							 recording to test effectiveness of therapy, including induction or attempted
							 induction of arrhythmia
93631
I.C.
415.26
I.C.
Intra-operative epicardial and endocardial pacing and
							 mapping to localize the site of tachycardia or zone of slow conduction for
							 surgical correction
93640
I.C.
200.22
I.C.
Electrophysiologic evaluation of single or dual
							 chamber pacing cardioverter-defibrillator leads including defibrillation
							 threshold evaluation (induction of arrhythmia, evaluation of sensing
							 and
93641
I.C.
339.15
I.C.
pacing for arrhythmia termination) at time of initial
							 implant Electrophysiologic evaluation of single or dual chamber
							 pacing
cardioverter-defibrillator leads including
							 defibrillation threshold evaluation (induction of arrhythmia, evaluation of
							 sensing and pacing for arrhythmia termination) at time of initial
							 implant
93642
I.C.
282.04
287.38
Electrophysiologic evaluation of single or dual
							 chamber pacing cardioverter-defibrillator (includes defibrillation threshold
							 evaluation, induction of arrhythmia, evaluation of sensing and pacing for
							 arrhythmia termination, and programming or reprogramming
93650
615.71
Intracardiac catheter ablation of atrioventricular
							 node function, atrioventricular conduction for creation of complete heart
							 block, with or without temporary pacemaker placement
93651
930.00
Intracardiac catheter ablation of arrhythmogenic
							 focus; for treatment of supraventricular tachycardia by ablation of fast or
							 slow atrioventricular pathways, accessory atrioventricular connections or other
							 atrial foci, singly or in combination
93652
1,013.24
Intracardiac catheter ablation of arrhythmogenic
							 focus; for treatment of ventricular tachycardia
93660
191.66
105.45
86.21
Evaluation of cardiovascular function with tilt table
							 evaluation, with continuous ECG monitoring and intermittent blood pressure
							 monitoring, with or without pharmacological intervention
93662
I.C.
157.67
I.C.
Intracardiac echocardiography during
							 therapeutic/diagnostic intervention, including imaging supervision and
							 interpretation (List separately in addition to code for primary
							 procedure)
93668
19.17
Peripheral arterial disease (PAD) rehabilitation, per
							 session
93701
45.07
9.33
35.74
Bioimpedance, thoracic, electrical
93720
52.55
Plethysmography, total body; with interpretation and
							 report
93721
44.14
Plethysmography, total body; tracing only, without
							 interpretation and report
93722
8.41
Plethysmography, total body; interpretation and
							 report only
93724
387.74
269.15
118.58
Electronic analysis of antitachycardia pacemaker
							 system (includes electrocardiographic recording, programming of device,
							 induction and termination of tachycardia via implanted pacemaker, and
							 interpretation of recordings)
93727
37.69
Electronic analysis of implantable loop recorder
							 (ILR) system (includes retrieval of recorded and stored ECG data, physician
							 review and interpretation of retrieved ECG data and reprogramming)
93731
50.00
24.87
25.13
Electronic analysis of dual-chamber pacemaker system
							 (includes evaluation of programmable parameters at rest and during activity
							 where applicable, using electrocardiographic recording and interpretation of
							 recordings at rest and during exercise, analysis of event markers and device
							 response); without reprogramming
93732
80.00
51.64
28.36
Electronic analysis of dual-chamber pacemaker system
							 (includes evaluation of programmable parameters at rest and during activity
							 where applicable, using electrocardiographic recording and interpretation of
							 recordings at rest and during exercise, analysis of event markers and device
							 response); with reprogramming
93733
47.49
9.33
38.16
Electronic analysis of dual chamber internal
							 pacemaker system (may include rate, pulse amplitude and duration, configuration
							 of wave form, and/or testing of sensory function of pacemaker), telephonic
							 analysis
93734
41.49
21.10
20.39
Electronic analysis of single chamber pacemaker
							 system (includes evaluation of programmable parameters at rest and during
							 activity where applicable, using electrocardiographic recording and
							 interpretation of recordings at rest and during exercise, analysis of event
							 markers and device response); without reprogramming
93735
65.73
41.05
24.67
Electronic analysis of single chamber pacemaker
							 system (includes evaluation of programmable parameters at rest and during
							 activity where applicable, using electrocardiographic recording and
							 interpretation of recordings at rest and during exercise, analysis of event
							 markers and device response); with reprogramming
93736
43.58
8.18
35.40
Electronic analysis of single chamber internal
							 pacemaker system (may include rate, pulse amplitude and duration, configuration
							 of wave form, and/or testing of sensory function of pacemaker), telephonic
							 analysis
93740
11.13
7.60
3.52
Temperature gradient studies
93741
74.98
44.78
30.20
Electronic analysis of pacing
							 cardioverter-defibrillator (includes interrogation, evaluation of pulse
							 generator status, evaluation of programmable parameters at rest and during
							 activity where applicable, using electrocardiographic recording and
							 interpretation of recordings at rest and during exercise, analysis of event
							 markers and device response); single chamber or wearable
							 cardioverter-defibrillator system, without reprogramming
93742
83.34
51.30
32.04
Electronic analysis of pacing
							 cardioverter-defibrillator (includes interrogation, evaluation of pulse
							 generator status, evaluation of programmable parameters at rest and during
							 activity where applicable, using electrocardiographic recording and
							 interpretation of recordings at rest and during exercise, analysis of event
							 markers and device response); single chamber or wearable
							 cardioverter-defibrillator system, with reprogramming
93743
90.66
57.70
32.96
Electronic analysis of pacing
							 cardioverter-defibrillator (includes interrogation, evaluation of pulse
							 generator status, evaluation of programmable parameters at rest and during
							 activity where applicable, using electrocardiographic recording and
							 interpretation of recordings at rest and during exercise, analysis of event
							 markers and device response); dual chamber or wearable
							 cardioverter-defibrillator system, without reprogramming
93744
99.30
66.34
32.96
Electronic analysis of pacing
							 cardioverter-defibrillator (includes interrogation, evaluation of pulse
							 generator status, evaluation of programmable parameters at rest and during
							 activity where applicable, using electrocardiographic recording and
							 interpretation of recordings at rest and during exercise, analysis of event
							 markers and device response); dual chamber or wearable
							 cardioverter-defibrillator system, with reprogramming
93745
I.C.
I.C.
I.C.
Initial set-up and programming by a physician 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
93760
I.C.
Thermogram; cephalic
93762
I.C.
Thermogram; peripheral
93770
8.36
7.60
0.76
Determination of venous pressure
93784
81.53
Ambulatory blood pressure monitoring, utilizing a
							 system such as magnetic tape and/or computer disk, for 24 hours or longer;
							 including recording, scanning analysis, interpretation and report
93786
39.88
Ambulatory blood pressure monitoring, utilizing a
							 system such as magnetic tape and/or computer disk, for 24 hours or longer;
							 recording only
93788
22.39
Ambulatory blood pressure monitoring, utilizing a
							 system such as magnetic tape and/or computer disk, for 24 hours or longer;
							 scanning analysis with report
93790
19.26
Ambulatory blood pressure monitoring, utilizing a
							 system such as magnetic tape and/or computer disk, for 24 hours or longer;
							 physician review with interpretation and report
93797
20.71
Physician services for outpatient cardiac
							 rehabilitation; without continuous ECG monitoring (per session)
93798
30.57
Physician services for outpatient cardiac
							 rehabilitation; with continuous ECG monitoring (per session)
93799
I.C.
I.C.
I.C.
Unlisted cardiovascular service or
							 procedure
93875
123.42
11.03
112.38
Noninvasive physiologic studies of extracranial
							 arteries, complete bilateral study (eg, periorbital flow direction with
							 arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral
							 analysis)
93880
301.44
30.89
270.55
Duplex scan of extracranial arteries; complete
							 bilateral study
93882
197.28
20.84
176.44
Duplex scan of extracranial arteries; unilateral or
							 limited study
93886
362.26
48.62
313.63
Transcranial Doppler study of the intracranial
							 arteries; complete study
93888
241.11
32.33
208.78
Transcranial Doppler study of the intracranial
							 arteries; limited study
93890
309.07
52.51
256.56
Transcranial Doppler study of the intracranial
							 arteries; vasoreactivity study
93892
328.92
59.01
269.91
Transcranial Doppler study of the intracranial
							 arteries; emboli detection without intravenous microbubble
							 injection
93893
329.38
59.01
270.37
Transcranial Doppler study of the intracranial
							 arteries; emboli
detection with intravenous microbubble
							 injection
93922
146.51
12.82
133.70
Noninvasive physiologic studies of upper or lower
							 extremity arteries, single level, bilateral (eg, ankle/brachial indices,
							 Doppler waveform analysis, volume plethysmography, transcutaneous oxygen
							 tension measurement)
93923
223.38
23.01
200.37
Noninvasive physiologic studies of upper or lower
							 extremity arteries, multiple levels or with provocative functional maneuvers,
							 complete bilateral study (eg, segmental blood pressure measurements, segmental
							 Doppler waveform analysis, segmental volume plethsmography, segmental
							 transcutaneous oxygen tension measurements with postural provicative tests,
							 measurements with reactive hyperemia)
93924
272.77
26.40
246.38
Noninvasive physiologic studies of lower extremity
							 arteries, at rest and following treadmill stress testing, complete bilateral
							 study
93925
372.10
29.75
342.35
Duplex scan of lower extremity arteries or arterial
							 bypass grafts; complete bilateral study
93926
233.14
20.04
213.10
Duplex scan of lower extremity arteries or arterial
							 bypass grafts; unilateral or limited study
93930
294.96
23.81
271.15
Duplex scan of upper extremity arteries or arterial
							 bypass grafts; complete bilateral study
93931
194.97
16.09
178.88
Duplex scan of upper extremity arteries or arterial
							 bypass grafts; unilateral or limited study
93965
149.63
17.61
132.02
Noninvasive physiologic studies of extremity veins,
							 complete bilateral study (eg, Doppler waveform analysis with responses to
							 compression and other maneuvers, phleborheography, impedance
							 plethysmography)
93970
300.75
35.14
265.60
Duplex scan of extremity veins including responses to
							 compression and other maneuvers; complete bilateral study
93971
200.64
23.17
177.48
Duplex scan of extremity veins including responses to
							 compression and other maneuvers; unilateral or limited study
93975
448.31
93.43
354.88
Duplex scan of arterial inflow and venous outflow of
							 abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete
							 study
93976
256.63
61.68
194.95
Duplex scan of arterial inflow and venous outflow of
							 abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited
							 study
93978
278.11
34.12
243.99
Duplex scan of aorta, inferior vena cava, iliac
							 vasculature, or bypass grafts; complete study
93979
192.96
22.83
170.13
Duplex scan of aorta, inferior vena cava, iliac
							 vasculature, or bypass grafts; unilateral or limited study
93980
200.72
64.87
135.85
Duplex scan of arterial inflow and venous outflow of
							 penile vessels; complete study
93981
156.56
22.53
134.03
Duplex scan of arterial inflow and venous outflow of
							 penile vessels; follow-up or limited study
93982
47.37
Noninvasive physiologic study of implanted wireless
							 pressure sensor in aneurysmal sac following endovascular repair, complete study
							 including recording, analysis of pressure and waveform tracings, interpretation
							 and report
93990
228.52
13.12
215.40
Duplex scan of hemodialysis access (including
							 arterial inflow, body of access and venous outflow)
94002
86.29
Ventilation assist and management, initiation of
							 pressure or volume preset ventilators for assisted or controlled breathing;
							 hospital inpatient/observation, initial day
94003
63.30
Ventilation assist and management, initiation of
							 pressure or volume preset ventilators for assisted or controlled breathing;
							 hospital inpatient/observation, each subsequent day
94004
45.93
Ventilation assist and management, initiation of
							 pressure or volume preset ventilators for assisted or controlled breathing;
							 nursing facility, per day
94005
85.23
Home ventilator management care plan oversight of a
							 patient (patient not present) in home, domiciliary or rest home (eg, assisted
							 living) requiring review of status, review of laboratories and other studies
							 and revision of orders and respiratory care plan
94010
39.38
8.41
30.98
Spirometry, including graphic record, total and timed
							 vital capacity, expiratory flow rate measurement(s), with or without maximal
							 voluntary ventilation
94014
54.56
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
							 physician review and interpretation
94015
29.30
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
25.26
Patient-initiated spirometric recording per 30-day
							 period of time; physician review and interpretation only
94060
67.46
14.57
52.89
Bronchodilation responsiveness, spirometry as in
							 94010, pre-and post-bronchodilator administration
94070
65.81
28.75
37.06
Bronchospasm provocation evaluation, multiple
							 spirometric determinations as in 94010, with administered agents (eg,
							 antigen[s], cold air, methacholine)
94150
24.62
3.61
21.01
Vital capacity, total (separate
							 procedure)
94200
26.29
5.44
20.85
Maximum breathing capacity, maximal voluntary
							 ventilation
94240
44.74
12.40
32.34
Functional residual capacity or residual volume:
							 helium method, nitrogen open circuit method, or other method
94250
31.05
5.44
25.62
Expired gas collection, quantitative, single
							 procedure (separate procedure)
94260
36.32
6.12
30.20
Thoracic gas volume
94350
42.14
12.40
29.74
Determination of maldistribution of inspired gas:
							 multiple breath nitrogen washout curve including alveolar nitrogen or helium
							 equilibration time
94360
48.72
12.40
36.32
Determination of resistance to airflow, oscillatory
							 or plethysmographic methods
94370
40.16
12.40
27.76
Determination of airway closing volume, single breath
							 tests
94375
41.86
14.57
27.30
Respiratory flow volume loop
94400
59.62
19.62
40.00
Breathing response to CO2 (CO2 response
							 curve)
94450
57.20
18.86
38.34
Breathing response to hypoxia (hypoxia response
							 curve)
94452
64.26
14.87
49.39
High altitude simulation test (HAST), with physician
							 interpretation and report;
94453
88.50
19.32
69.18
High altitude simulation test (HAST), with physician
							 interpretation and report; with supplemental oxygen titration
94610
63.05
Intrapulmonary surfactant administration by a
							 physician through endotracheal tube
94620
101.23
31.04
70.20
Pulmonary stress testing; simple (eg, 6-minute walk
							 test, prolonged exercise test for bronchospasm with pre- and post-spirometry
							 and oximetry)
94621
177.09
70.53
106.56
Pulmonary stress testing; complex (including
							 measurements of CO2 production, O2 uptake, and electrocardiographic
							 recordings)
94640
16.25
Pressurized or nonpressurized inhalation treatment
							 for acute airway obstruction or for sputum induction for diagnostic purposes
							 (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent
							 positive pressure breathing [IPPB] device)
94642
I.C.
Aerosol inhalation of pentamidine for pneumocystis
							 carinii pneumonia treatment or prophylaxis
94644
44.79
Continuous inhalation treatment with aerosol
							 medication for acute airway obstruction; first hour
94645
16.71
Continuous inhalation treatment with aerosol
							 medication for acute airway obstruction; each additional hour (List separately
							 in addition to code for primary procedure)
94660
60.75
Continuous positive airway pressure ventilation
							 (CPAP), initiation and management
94662
36.51
Continuous negative pressure ventilation (CNP),
							 initiation and management
94664
17.77
Demonstration and/or evaluation of patient
							 utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB
							 device
94667
25.89
Manipulation chest wall, such as cupping, percussing,
							 and vibration to facilitate lung function; initial demonstration and/or
							 evaluation
94668
22.69
Manipulation chest wall, such as cupping, percussing,
							 and vibration to facilitate lung function; subsequent
94680
78.18
12.40
65.78
Oxygen uptake, expired gas analysis; rest and
							 exercise, direct, simple
94681
93.12
9.43
83.69
Oxygen uptake, expired gas analysis; including CO2
							 output, percentage oxygen extracted
94690
73.85
3.61
70.24
Oxygen uptake, expired gas analysis; rest, indirect
							 (separate procedure)
94720
60.69
12.40
48.29
Carbon monoxide diffusing capacity (eg, single
							 breath, steady state)
94725
102.07
12.40
89.67
Membrane diffusion capacity
94750
80.70
10.91
69.78
Pulmonary compliance study (eg, plethysmography,
							 volume and pressure measurements)
94760
2.90
Noninvasive ear or pulse oximetry for oxygen
							 saturation; single determination
94761
5.94
Noninvasive ear or pulse oximetry for oxygen
							 saturation; multiple determinations (eg, during exercise)
94762
33.38
Noninvasive ear or pulse oximetry for oxygen
							 saturation; by continuous overnight monitoring (separate procedure)
94770
43.42
7.26
36.16
Carbon dioxide, expired gas determination by infrared
							 analyzer
94799
I.C.
I.C.
I.C.
Unlisted pulmonary service or procedure
95004
6.62
Percutaneous tests (scratch, puncture, prick) with
							 allergenic extracts, immediate type reaction, including test interpretation and
							 report by a physician, specify number of tests
95010
20.15
Percutaneous tests (scratch, puncture, prick)
							 sequential and incremental, with drugs, biologicals or venoms, immediate type
							 reaction, specify number of tests
95012
22.85
Nitric oxide expired gas determination
95015
13.71
Intracutaneous (intradermal) tests, sequential and
							 incremental, with drugs, biologicals, or venoms, immediate type reaction,
							 specify number of tests
95024
8.01
Intracutaneous (intradermal) tests with allergenic
							 extracts, immediate type reaction, including test interpretation and report by
							 a physician, specify number of tests
95027
6.16
Intracutaneous (intradermal) tests, sequential and
							 incremental, with allergenic extracts for airborne allergens, immediate type
							 reaction, including test interpretation and report by a physician, specify
							 number of tests
95028
12.73
Intracutaneous (intradermal) tests with allergenic
							 extracts, delayed type reaction, including reading, specify number of
							 tests
95044
8.58
Patch or application test(s) (specify number of
							 tests)
95052
9.51
Photo patch test(s) (specify number of
							 tests)
95056
32.98
Photo tests
95060
25.45
Ophthalmic mucous membrane tests
95065
21.01
Direct nasal mucous membrane test
95070
71.94
Inhalation bronchial challenge testing (not including
							 necessary pulmonary function tests); with histamine, methacholine, or similar
							 compounds
95071
90.35
Inhalation bronchial challenge testing (not including
							 necessary pulmonary function tests); with antigens or gases,
							 specify
95075
67.86
Ingestion challenge test (sequential and incremental
							 ingestion of test items, eg, food, drug or other substance such as
							 metabisulfite)
95115
14.87
Professional services for allergen immunotherapy not
							 including provision of allergenic extracts; single injection
95117
18.55
Professional services for allergen immunotherapy not
							 including provision of allergenic extracts; two or more injections
95120
I.C.
Professional services for allergen immunotherapy in
							 prescribing physicians office or institution, including provision of allergenic
							 extract; single injection
95125
I.C.
Professional services for allergen immunotherapy in
							 prescribing physicians office or institution, including provision of allergenic
							 extract; two or more injections
95130
I.C.
Professional services for allergen immunotherapy in
							 prescribing physicians office or institution, including provision of allergenic
							 extract; single stinging insect venom
95131
I.C.
Professional services for allergen immunotherapy in
							 prescribing physicians office or institution, including provision of allergenic
							 extract; two stinging insect venoms
95132
I.C.
Professional services for allergen immunotherapy in
							 prescribing physicians office or institution, including provision of allergenic
							 extract; three stinging insect venoms
95133
I.C.
Professional services for allergen immunotherapy in
							 prescribing physicians office or institution, including provision of allergenic
							 extract; four stinging insect venoms
95134
I.C.
Professional services for allergen immunotherapy in
							 prescribing
physicians office or institution, including provision
							 of allergenic extract; five stinging insect venoms
95144
12.93
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy, single dose
							 vial(s) (specify number of vials)
95145
18.00
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy (specify
							 number of doses); single stinging insect venom
95146
28.12
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy (specify
							 number of doses); two single stinging insect venoms
95147
27.20
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy (specify
							 number of doses); three single stinging insect venoms
95148
38.25
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy (specify
							 number of doses); four single stinging insect venoms
95149
50.68
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy (specify
							 number of doses); five single stinging insect venoms
95165
12.93
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy; single or
							 multiple antigens (specify number of doses)
95170
10.17
Professional services for the supervision of
							 preparation and provision of antigens for allergen immunotherapy; whole body
							 extract of biting insect or other arthropod (specify number of
							 doses)
95180
154.98
Rapid desensitization procedure, each hour (eg,
							 insulin, penicillin, equine serum)
95199
I.C.
Unlisted allergy/clinical immunologic service or
							 procedure
95250
175.21
Ambulatory continuous glucose monitoring of
							 interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; sensor
							 placement, hook-up, calibration of monitor, patient training, removal of
							 sensor, and printout of recording
95251
39.75
Ambulatory continuous glucose monitoring of
							 interstitial tissue fluid via a subcutaneous sensor for up to 72 hours;
							 physician interpretation and report
95805
635.86
93.58
542.28
Multiple sleep latency or maintenance of wakefulness
							 testing, recording, analysis and interpretation of physiological measurements
							 of sleep during multiple trials to assess sleepiness
95806
235.91
82.55
153.36
Sleep study, simultaneous recording of ventilation,
							 respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a
							 technologist
95807
627.68
80.71
546.98
Sleep study, simultaneous recording of ventilation,
							 respiratory effort, ECG or heart rate, and oxygen saturation, attended by a
							 technologist
95808
773.45
131.66
641.79
Polysomnography; sleep staging with one - three
							 additional parameters of sleep, attended by a technologist
95810
947.96
173.15
774.82
Polysomnography; sleep staging with four or more
							 additional parameters of sleep, attended by a technologist
95811
1,042.93
185.89
857.05
Polysomnography; sleep staging with four or more
							 additional parameters of sleep, with initiation of continuous positive airway
							 pressure therapy or bilevel ventilation, attended by a technologist
95812
270.73
56.16
214.57
Electroencephalogram (EEG) extended monitoring; 41-60
							 minutes
95813
330.64
88.92
241.72
Electroencephalogram (EEG) extended monitoring;
							 greater than one hour
95816
248.34
56.16
192.17
Electroencephalogram (EEG); including recording awake
							 and drowsy
95819
251.56
56.16
195.40
Electroencephalogram (EEG); including recording awake
							 and asleep
95822
275.47
56.16
219.31
Electroencephalogram (EEG); recording in coma or
							 sleep only
95824
I.C.
38.43
I.C.
Electroencephalogram (EEG); cerebral death evaluation
							 only
95827
370.29
54.48
315.81
Electroencephalogram (EEG); all night
							 recording
95829
1,510.86
319.97
1,190.89
Electrocorticogram at surgery (separate
							 procedure)
95830
205.41
I.C.
I.C.
Insertion by physician of sphenoidal electrodes for
							 electroencephalographic (EEG) recording
95831
29.65
Muscle testing, manual (separate procedure) with
							 report; extremity (excluding hand) or trunk
95832
26.61
Muscle testing, manual (separate procedure) with
							 report; hand, with or without comparison with normal side
95833
41.50
Muscle testing, manual (separate procedure) with
							 report; total evaluation of body, excluding hands
95834
48.08
Muscle testing, manual (separate procedure) with
							 report; total evaluation of body, including hands
95851
20.03
Range of motion measurements and report (separate
							 procedure); each extremity (excluding hand) or each trunk section
							 (spine)
95852
15.56
Range of motion measurements and report (separate
							 procedure); hand, with or without comparison with normal side
95857
45.85
Tensilon test for myasthenia gravis
95860
94.25
51.31
42.95
Needle electromyography; one extremity with or
							 without related paraspinal areas
95861
126.90
81.84
45.06
Needle electromyography; two extremities with or
							 without related paraspinal areas
95863
152.12
97.84
54.27
Needle electromyography; three extremities with or
							 without related paraspinal areas
95864
184.71
104.70
80.00
Needle electromyography; four extremities with or
							 without related paraspinal areas
95865
122.26
85.00
37.26
Needle electromyography; larynx
95866
93.09
66.41
26.67
Needle electromyography; hemidiaphragm
95867
76.94
41.22
35.72
Needle electromyography; cranial nerve supplied
							 muscle(s), unilateral
95868
105.42
62.04
43.38
Needle electromyography; cranial nerve supplied
							 muscles, bilateral
95869
46.05
19.68
26.38
Needle electromyography; thoracic paraspinal muscles
							 (excluding T1 or T12)
95870
45.13
19.68
25.45
Needle electromyography; limited study of muscles in
							 one extremity or non-limb (axial) muscles (unilateral or bilateral), other than
							 thoracic paraspinal, cranial nerve supplied muscles, or sphincters
95872
168.05
135.25
32.80
Needle electromyography using single fiber electrode,
							 with quantitative measurement of jitter, blocking and/or fiber density, any/all
							 sites of each muscle studied
95873
45.59
20.14
25.45
Electrical stimulation for guidance in conjunction
							 with chemodenervation (List separately in addition to code for primary
							 procedure)
95874
44.67
20.14
24.53
Needle electromyography for guidance in conjunction
							 with chemodenervation (List separately in addition to code for primary
							 procedure)
95875
108.06
58.85
49.21
Ischemic limb exercise test with serial specimen(s)
							 acquisition for muscle(s) metabolite(s)
95900
65.71
22.30
43.41
Nerve conduction, amplitude and latency/velocity
							 study, each nerve; motor, without F-wave study
95903
72.62
31.51
41.10
Nerve conduction, amplitude and latency/velocity
							 study, each nerve; motor, with F-wave study
95904
57.45
18.19
39.26
Nerve conduction, amplitude and latency/velocity
							 study, each nerve; sensory
95920
170.53
112.74
57.79
Intraoperativeneurophysiologytesting, per hour (List
							 separately in addition to code for primary procedure)
95921
75.79
45.28
30.52
Testing of autonomic nervous system function;
							 cardiovagal innervation (parasympathetic function), including two or more of
							 the following: heart rate response to deep breathing with recorded R-R
							 interval, Valsalva ratio, and 30:15 ratio
95922
89.65
49.47
40.18
Testing of autonomic nervous system function;
							 vasomotor adrenergic innervation (sympathetic adrenergic function), including
							 beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver
							 and at least five minutes of passive tilt
95923
131.33
46.96
84.37
Testing of autonomic nervous system function;
							 sudomotor, including one or more of the following: quantitative sudomotor axon
							 reflex test (QSART), silastic sweat imprint, thermoregulatory sweat test, and
							 changes in sympathetic skin potential
95925
118.09
28.38
89.71
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
116.41
28.08
88.33
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
120.40
29.30
91.09
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
95928
214.09
77.87
136.22
Central motor evoked potential study (transcranial
							 motor stimulation); upper limbs
95929
226.06
78.33
147.73
Central motor evoked potential study (transcranial
							 motor stimulation); lower limbs
95930
125.62
18.53
107.09
Visual evoked potential (VEP) testing central nervous
							 system, checkerboard or flash
95933
72.39
31.01
41.38
Orbicularis oculi (blink) reflex, by
							 electrodiagnostic testing
95934
48.07
26.76
21.31
H-reflex, amplitude and latency study; record
							 gastrocnemius/soleus muscle
95936
44.21
28.88
15.33
H-reflex, amplitude and latency study; record muscle
							 other than gastrocnemius/soleus muscle
95937
60.17
35.18
24.99
Neuromuscular junction testing (repetitive
							 stimulation, paired stimuli), each nerve, any one method
95950
270.75
78.35
192.40
Monitoring for identification and lateralization of
							 cerebral seizure focus, electroencephalographic (eg, eight channel EEG)
							 recording and interpretation, each 24 hours
95951
I.C.
311.69
I.C.
Monitoring for localization of cerebral seizure focus
							 by cable or radio, 16 or more channel telemetry, combined
							 electroencephalographic (EEG) and video recording and interpretation (eg, for
							 presurgical localization), each 24 hours
95953
472.65
168.86
303.79
Monitoring for localization of cerebral seizure focus
							 by computerized portable 16 or more channel EEG, electroencephalographic (EEG)
							 recording and interpretation, each 24 hours
95954
287.27
121.15
166.12
Pharmacological or physical activation requiring
							 physician attendance during EEG recording of activation phase (eg, thiopental
							 activation test)
95955
157.99
50.71
107.28
Electroencephalogram (EEG) during nonintracranial
							 surgery (eg, carotid surgery)
95956
852.85
159.67
693.18
Monitoring for localization of cerebral seizure focus
							 by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG)
							 recording and interpretation, each 24 hours
95957
267.82
103.12
164.70
Digital analysis of electroencephalogram (EEG) (eg,
							 for epileptic spike analysis)
95958
389.70
219.64
170.06
Wada activation test for hemispheric function,
							 including electroencephalographic (EEG) monitoring
95961
248.61
166.42
82.19
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 physician attendance
95962
234.06
172.12
61.93
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 physician attendance (List separately in addition to code
							 for primary procedure)
95965
I.C.
420.53
I.C.
Magnetoencephalography (MEG), recording and analysis;
							 for spontaneous brain magnetic activity (eg, epileptic cerebral cortex
							 localization)
95966
I.C.
208.67
I.C.
Magnetoencephalography (MEG), recording and analysis;
							 for evoked magnetic fields, single modality (eg, sensory, motor, language, or
							 visual cortex localization)
95967
I.C.
174.13
I.C.
Magnetoencephalography (MEG), recording and analysis;
							 for evoked magnetic fields, each additional modality (eg, sensory, motor,
							 language, or visual cortex localization) (List separately in addition to code
							 for primary procedure)
95970
56.31
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, configuration
							 of wave form, battery status, electrode selectability, output modulation,
							 cycling, impedance and patient compliance measurements
95971
57.73
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, configuration
							 of wave form, battery status, electrode selectability, output modulation,
							 cycling, impedance and patient compliance measurements
95972
109.72
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, configuration
							 of wave form, battery status, electrode selectability, output modulation,
							 cycling, impedance and patient compliance measurements
95973
58.83
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, configuration
							 of wave form, battery status, electrode selectability, output modulation,
							 cycling, impedance and patient compliance measurements
95974
179.49
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, configuration
							 of wave form, battery status, electrode selectability, output modulation,
							 cycling, impedance and patient compliance measurements
95975
98.92
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, configuration
							 of wave form, battery status, electrode selectability, output modulation,
							 cycling, impedance and patient compliance measurements
95978
212.35
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, battery status,
							 electrode selectability and polarity, impedance and patient compliance
							 measurements), complex deep brain neurostimulator pulse
95979
95.22
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, rate, pulse amplitude and duration, battery status,
							 electrode selectability and polarity, impedance and patient compliance
							 measurements), complex deep brain neurostimulator pulse
95980
40.92
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, 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
95981
31.09
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, 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; subsequent, without programming
95982
45.32
Electronic analysis of implanted neurostimulator
							 pulse generator system (eg, 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; subsequent, with programming
95990
73.60
Refilling and maintenance of implantable pump or
							 reservoir for drug delivery, spinal (intrathecal, epidural) or brain
							 (intraventricular);
95991
99.43
Refilling and maintenance of implantable pump or
							 reservoir for drug delivery, spinal (intrathecal, epidural) or brain
							 (intraventricular); administered by physician
95999
I.C.
Unlisted neurological or neuromuscular diagnostic
							 procedure
96000
86.85
Comprehensive computer-based motion analysis by
							 video-taping and 3-D kinematics;
96001
104.48
Comprehensive computer-based motion analysis by
							 video-taping and 3-D kinematics; with dynamic plantar pressure measurements
							 during walking
96002
20.58
Dynamic surface electromyography, during walking or
							 other functional activities, one - 12 muscles
96003
17.84
Dynamic fine wire electromyography, during walking or
							 other functional activities, one muscle
96004
112.73
Physician review and interpretation of comprehensive
							 computer-based motion analysis, dynamic plantar pressure measurements, dynamic
							 surface electromyography during walking or other functional activities, and
							 dynamic fine wire electromyography, with written report
96020
I.C.
171.46
I.C.
Neurofunctional testing selection and administration
							 during noninvasive imaging functional brain mapping, with test administered
							 entirely by a physician or psychologist, with review of test results and
							 report
96040
45.41
Medical genetics and genetic counseling services,
							 each 30 minutes face-to-face with patient/family
96401
76.97
Chemotherapy administration, subcutaneous or
							 intramuscular; non-hormonal anti-neoplastic
96402
47.75
Chemotherapy administration, subcutaneous or
							 intramuscular; hormonal anti-neoplastic
96405
159.50
Chemotherapy administration; intralesional, up to and
							 including seven lesions
96406
180.57
Chemotherapy administration; intralesional, more than
							 seven lesions
96409
141.63
Chemotherapy administration; intravenous, push
							 technique, single or initial substance/drug
96411
79.97
Chemotherapy administration; intravenous, push
							 technique, each additional substance/drug (List separately in addition to code
							 for primary procedure)
96413
191.93
Chemotherapy administration, intravenous infusion
							 technique; up to one hour, single or initial substance/drug
96415
41.27
Chemotherapy administration, intravenous infusion
							 technique; each additional hour (List separately in addition to code for
							 primary procedure)
96416
209.33
Chemotherapy administration, intravenous infusion
							 technique; initiation of prolonged chemotherapy infusion (more than eight
							 hours), requiring use of a portable or implantable pump
96417
93.96
Chemotherapy administration, intravenous infusion
							 technique; each additional sequential infusion (different substance/drug), up
							 to one hour (List separately in addition to code for primary
							 procedure)
96420
133.40
Chemotherapy administration, intra-arterial; push
							 technique
96422
222.69
Chemotherapyadministration, intra-arterial; infusion
							 technique, up to one hour
96423
95.70
Chemotherapyadministration, intra-arterial; infusion
							 technique, each additional hour (List separately in addition to code for
							 primary procedure)
96425
218.55
Chemotherapyadministration, intra-arterial; infusion
							 technique, initiation of prolonged infusion (more than eight hours), requiring
							 the use of a portable or implantable pump
96440
400.85
Chemotherapy administration into pleural cavity,
							 requiring and including thoracentesis
96445
389.08
Chemotherapy administration into peritoneal cavity,
							 requiring and including peritoneocentesis
96450
329.72
Chemotherapy administration, into CNS (eg,
							 intrathecal), requiring and including spinal puncture
96521
168.23
Refilling and maintenance of portable
							 pump
96522
133.70
Refilling and maintenance of implantable pump or
							 reservoir for drug delivery, systemic (eg, intravenous,
							 intra-arterial)
96523
32.50
Irrigation of implanted venous access device for drug
							 delivery systems
96542
207.22
Chemotherapy injection, subarachnoid or
							 intraventricular via subcutaneous reservoir, single or multiple
							 agents
96549
I.C.
Unlisted chemotherapy procedure
96567
132.38
Photodynamic therapy by external application of light
							 to destroy premalignant and/or malignant lesions of the skin and adjacent
							 mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy
							 exposure session
96570
58.35
Photodynamic therapy by endoscopic application of
							 light to ablate abnormal tissue via activation of photosensitive drug(s); first
							 30 minutes (List separately in addition to code for endoscopy or bronchoscopy
							 procedures of lung and esophagus)
96571
28.42
Photodynamic therapy by endoscopic application of
							 light to ablate abnormal tissue via activation of photosensitive drug(s); each
							 additional 15 minutes (List separately in addition to code for endoscopy or
							 bronchoscopy procedures of lung and esophagus)
96900
23.61
Actinotherapy (ultraviolet light)
96902
21.20
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
96904
87.75
Whole body integumentary photography, for monitoring
							 of high risk patients with dysplastic nevus syndrome or a history of dysplastic
							 nevi, or patients with a personal or familial history of melanoma
96910
70.24
Photochemotherapy; tar and ultraviolet B (Goeckerman
							 treatment) or petrolatum and ultraviolet B
96912
89.87
Photochemotherapy; psoralens and ultraviolet A
							 (PUVA)
96913
121.29
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
180.71
Laser treatment for inflammatory skin disease
							 (psoriasis); total area less than 250 sq cm
96921
177.55
Laser treatment for inflammatory skin disease
							 (psoriasis); 250 sq cm to 500 sq cm
96922
259.77
Laser treatment for inflammatory skin disease
							 (psoriasis); over 500 sq cm
96999
I.C.
Unlisted special dermatological service or
							 procedure
97802
29.47
Medical nutrition therapy; initial assessment and
							 intervention, individual, face-to-face with the patient, each 15
							 minutes
97803
26.28
Medical nutrition therapy; re-assessment and
							 intervention, individual, face-to-face with the patient, each 15
							 minutes
97804
14.82
Medical nutrition therapy; group (two or more
							 individual(s)), each 30 minutes
98925
29.77
Osteopathic manipulative treatment (OMT); one to two
							 body regions involved
98926
41.04
Osteopathic manipulative treatment (OMT); three to
							 four body regions involved
98927
52.70
Osteopathic manipulative treatment (OMT); five to six
							 body regions involved
98928
61.68
Osteopathic manipulative treatment (OMT); seven to
							 eight body regions involved
98929
70.67
Osteopathic manipulative treatment (OMT); nine to ten
							 body regions involved
98960
27.00
Education and training for patient self-management by
							 a qualified, nonphysician health care professional using a standardized
							 curriculum, face-to-face with the patient (could include caregiver/family) each
							 30 minutes; individual patient
98961
13.19
Education and training for patient self-management by
							 a qualified, nonphysician health care professional using a standardized
							 curriculum, face-to-face with the patient (could include caregiver/family) each
							 30 minutes; two - four patients
98962
9.51
Education and training for patient self-management by
							 a qualified, nonphysician health care professional using a standardized
							 curriculum, face-to-face with the patient (could include caregiver/family) each
							 30 minutes; five - eight patients
98966
12.98
Telephone assessment and management service provided
							 by a qualified nonphysician health care professional to an established patient,
							 parent, or guardian not originating from a related assessment and management
							 service provided within the previous seven days nor leading to an assessment
							 and management service or procedure within the next 24 hours or soonest
							 available appointment; five - ten minutes of medical discussion
98967
24.11
Telephone assessment and management service provided
							 by a qualified nonphysician health care professional to an established patient,
							 parent, or guardian not originating from a related assessment and management
							 service provided within the previous seven days nor leading to an assessment
							 and management service or procedure within the next 24 hours or soonest
							 available appointment; 11-20 minutes of medical discussion
98968
35.71
Telephone assessment and management service provided
							 by a qualified nonphysician health care professional to an established patient,
							 parent, or guardian not originating from a related assessment and management
							 service provided within the previous seven days nor leading to an assessment
							 and management service or procedure within the next 24 hours or soonest
							 available appointment; 21-30 minutes of medical discussion
98969
I.C.
Online assessment and management service provided by
							 a qualified nonphysician health care professional to an established patient,
							 guardian, or health care provider not originating from a related assessment and
							 management service provided within the previous seven days, using the internet
							 or similar electronic communications network
99024
0.00
0.00
0.00
Postoperative follow-up visit, normally included in
							 the surgical package, to indicate that an evaluation and management service was
							 performed during a postoperative period for a reason(s) related to the original
							 procedure
99026
I.C.
Hospital mandated on call service; in-hospital, each
							 hour
99027
I.C.
Hospital mandated on call service; out-of-hospital,
							 each hour
99050
0.00
0.00
0.00
Services provided in the office at times other than
							 regularly scheduled office hours, or days when the office is normally closed
							 (eg, holidays, Saturday or Sunday), in addition to basic service
99051
0.00
0.00
0.00
Service(s) provided in the office during regularly
							 scheduled evening, weekend, or holiday office hours, in addition to basic
							 service
99053
0.00
0.00
0.00
Service(s) provided between 10:00 PM and 8:00 AM at
							 24-hour facility, in addition to basic service
99056
0.00
0.00
0.00
Service(s) typically provided in the office, provided
							 out of the office at request of patient, in addition to basic
							 service
99058
0.00
0.00
0.00
Service(s) provided on an emergency basis in the
							 office, which disrupts other scheduled office services, in addition to basic
							 service
99060
0.00
0.00
0.00
Service(s) provided on an emergency basis, out of the
							 office, which disrupts other scheduled office services, in addition to basic
							 service
99070
I.C.
Supplies and materials (except spectacles), provided
							 by the physician over and above those usually included with the office visit or
							 other services rendered (list drugs, trays, supplies, or materials
							 provided)
99071
I.C.
Educational supplies, such as books, tapes, and
							 pamphlets, provided by the physician for the patient's education at cost to
							 physician
99075
I.C.
Medical testimony
99080
I.C.
Special reports such as insurance forms, more than
							 the information conveyed in the usual medical communications or standard
							 reporting form
99082
I.C.
Unusual travel (eg, transportation and escort of
							 patient)
99090
I.C.
Analysis of clinical data stored in computers (eg,
							 ECGs, blood pressures, hematologic data)
99091
50.26
Collection and interpretation of physiologic data
							 (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or
							 transmitted by the patient and/or caregiver to the physician or other qualified
							 health care professional, requiring a minimum of 30 min
99144
I.C.
Moderate sedation services (other than those services
							 described by codes 00100-01999) provided by the same physician performing the
							 diagnostic or therapeutic service that the sedation supports, requiring the
							 presence of an independent trained observer to assist in the monitoring of the
							 patient's level of consciousness and physiological sattus; five years or older,
							 first 30 minutes intra-service time
99145
I.C.
Moderate sedation services (other than those services
							 described by codes 00100-01999) provided by the same physician performing the
							 diagnostic or therapeutic service that the sedation supports, requiring the
							 presence of an independent trained observer to assist in the monitoring of the
							 patient's level of consciousness and physiological status; each additinal 15
							 minutes intra-service time (list separately in addition to code for primary
							 service)
99149
I.C.
Moderate sedation services (other than those services
							 described by codes 00100-01999), provided by a physician other than the health
							 care professional performing the diagnostic or therapeutic service that the
							 sedation supports; age five years or older, first 30 minutes intra-service
							 time
99150
I.C.
Moderate sedation services (other than those services
							 described by codes 00100-01999), provided by a physician other than the health
							 care professional performing the diagnostic or therapeutic service that the
							 sedation supports; each additional 15 minutes (list separately in addition to
							 code for primary service)
99172
I.C.
Visual function screening, automated or
							 semi-automated bilateral quantitative determination of visual acuity, ocular
							 alignment, color vision by pseudoisochromatic plates, and field of vision (may
							 include all or some screening of the determination[s] for contrast sensitivity,
							 vision under glare)
99173
3.06
Screening test of visual acuity, quantitative,
							 bilateral
99174
I.C.
Ocular photoscreening with interpretation and report,
							 bilateral
99175
43.04
Ipecac or similar administration for individual
							 emesis and continued observation until stomach adequately emptied of
							 poison
99183
219.09
Physician attendance and supervision of hyperbaric
							 oxygen therapy, per session
99185
54.13
Hypothermia; regional
99186
92.20
Hypothermia; total body
99190
I.C.
Assembly and operation of pump with oxygenator or
							 heat exchanger (with or without ECG and/or pressure monitoring); each
							 hour
99191
I.C.
Assembly and operation of pump with oxygenator or
							 heat exchanger (with or without ECG and/or pressure monitoring); 45
							 minutes
99192
I.C.
Assembly and operation of pump with oxygenator or
							 heat exchanger (with or without ECG and/or pressure monitoring); 30
							 minutes
99195
69.64
Phlebotomy, therapeutic (separate
							 procedure)
99199
I.C.
Unlisted special service, procedure or
							 report
99201
40.20
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 problem focused history; A problem focused examination; Straightforward medical
							 decision making. Counseling and/or coordination of care with other providers 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. Physicians typically spend ten minutes face-to-face with the
							 patient and/or family.
99202
68.83
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: An
							 expanded problem focused history; An expanded problem focused examination;
							 Straightforward medical decision making. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend 20
							 minutes face-to-face with the patient and/or family.
99203
100.00
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 detailed history; A detailed examination; Medical decision making of low
							 complexity. Counseling and/or coordination of care with other providers 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. Physicians typically spend 30 minutes face-to-face with the
							 patient and/or family.
99204
150.71
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; Medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers 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. Physicians typically spend 45 minutes
							 face-to-face with the patient and/or family.
99205
188.86
Office or other outpatient visit for the evaluation
							 and management of a new patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; Medical decision making of
							 high complexity. Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s)
99211
22.67
Office or other outpatient visit for the evaluation
							 and management of an established patient, that may not require the presence of
							 a physician. Usually, the presenting problem(s) are minimal. Typically, five
							 minutes are spent performing or supervising these services.
99212
41.58
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: A problem focused history; A problem focused examination;
							 Straightforward medical decision making. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend ten minutes
							 face-to-face with the patient and/or family.
99213
65.91
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: An expanded problem focused history; An expanded problem
							 focused examination; Medical decision making of low complexity. Counseling and
							 coordination of care with other providers 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. Physicians
							 typically spend 15 minutes face-to-face with the patient and/or
							 family.
99214
98.77
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: A detailed history; A detailed examination; Medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers 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. Physicians typically spend 25
							 minutes face-to-face with the patient and/or family.
99215
132.82
Office or other outpatient visit for the evaluation
							 and management of an established patient, which requires at least two of these
							 three key components: A comprehensive history; A comprehensive examination;
							 Medical decision making of high complexity. Counseling and/or coordination of
							 care with other providers 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. Physicians typically
							 spend 40 minutes face-to-face with the patient and/or family.
99217
68.98
Observation care discharge day management (This code
							 is to be utilized by the physician to report all services provided to a patient
							 on discharge from "observation status" if the discharge is on other than the
							 initial date of "observation status." To report services to a patient
							 designated as "observation status" or "inpatient status" and discharged on the
							 same date, use the codes for Observation or Inpatient Care Services [including
							 Admission and Discharge Services, 99234-99236 as appropriate.])
99218
64.37
A detailed or comprehensive history; A detailed or
							 comprehensive examination; and Medical decision making that is straightforward
							 or of low complexity. Initial observation care, per day, for the evaluation and
							 management of a patient which requires these three key components: Counseling
							 and/or coordination of care with other providers or agencies are provided
							 consistent with the nature of the problem(s) and the patient's and/or family's
							 needs. Usually, the problem(s) requiring admission to "observation status" are
							 of low severity.
99219
105.98
Initial observation care, per day, for the evaluation
							 and management of a patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; and Medical decision making
							 of moderate complexity. Counseling and/or coordination of care with other
							 providers or agencies are provided consistent with the nature of the problem(s)
							 and the patient's and/or family's needs. Usually, the problem(s) requiring
							 admission to "observation status" are of moderate severity.
99220
149.09
Initial observation care, per day, for the evaluation
							 and management of a patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; and Medical decision making
							 of high complexity. Counseling and/or coordination of care with other providers
							 or agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the problem(s) requiring admission to
							 "observation status" are of high severity.
99221
89.30
Initial hospital care, per day, for the evaluation
							 and management of a patient, which requires these three key components: A
							 detailed or comprehensive history; A detailed or comprehensive examination; and
							 Medical decision making that is straightforward or or of low complexity.
							 Counseling and/or coordination of care with other providers or agencies are
							 provided consistent with the nature of the problem(s) and the patient's and/or
							 family's needs. Usually, the problem(s) requiring admission are of low
							 severity. Physicians typically spend 30 minutes at the bedside and on the
							 patient's hospital floor or unit.
99222
123.54
Initial hospital care, per day, for the evaluation
							 and management
of a patient, which requires these three key
							 components: A comprehensive history; A comprehensive examination; and Medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually, the problem(s)
							 requiring admission are of moderate severity. Physicians typically spend 50
							 minutes at the bedside and on the patient's hospital floor or unit.
99223
181.29
Initial hospital care, per day, for the evaluation
							 and management of a patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; and Medical decision making
							 of high complexity. Counseling and/or coordination of care with other providers
							 or agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually, the problem(s) requiring admission
							 are of high severity. Physicians typically spend 70 minutes at the bedside and
							 on the patient's hospital floor or unit.
99231
37.43
Subsequent hospital care, per day, for the evaluation
							 and management of a patient, which requires at least two of these three key
							 components: A problem focused interval history; A problem focused examination;
							 Medical decision making that is straightforward or of low complexity.
							 Counseling and/or coordination of care with other providers 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 stable, recovering or improving.
							 Physicians typically spend 15 minutes at the bedside and on the patient's
							 hospital floor or unit.
99232
67.07
Subsequent hospital care, per day, for the evaluation
							 and management of a patient, which requires at least two of these three key
							 components: An expanded problem focused interval history; An expanded problem
							 focused examination; Medical decision making of moderate complexity. Counseling
							 and/or coordination of care with other providers 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 responding inadequately to therapy or has
							 developed a minor complication. Physicians typically spend 25 minutes at the
							 bedside and on the patient's hospital floor or unit.
99233
95.86
Subsequent hospital care, per day, for the evaluation
							 and management of a patient, which requires at least two of these three key
							 components: A detailed interval history; A detailed examination; Medical
							 decision making of high complexity. Counseling and/or coordination of care with
							 other providers 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 complication or a significant new
							 problem. Physicians typically spend 35 minutes at the bedside and on the
							 patient's hospital floor or unit.
99234
129.51
Observation or inpatient hospital care, for the
							 evaluation and management of a patient including admission and discharge on the
							 same date which requires these three key components: A detailed or
							 comprehensive history; A detailed or comprehensive examination; and Medical
							 decision making that is straightforward or of low complexity. Counseling and/or
							 coordination of care with other providers 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) requiring admission are of low
							 severity.
99235
170.47
Observation or inpatient hospital care, for the
							 evaluation and management of a patient including admission and discharge on the
							 same date which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers 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) requiring admission are of
							 moderate severity.
99236
211.90
Observation or inpatient hospital care, for the
							 evaluation and management of a patient including admission and discharge on the
							 same date which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers 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) requiring admission are of
							 high severity.
99238
69.14
Hospital discharge day management; 30 minutes or
							 less
99239
99.19
Hospital discharge day management; more than 30
							 minutes
99241
53.27
Office consultation for a new or established 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 providers
99242
97.54
Office consultation for a new or established patient,
							 which requires these three key components: An expanded problem focused history;
							 An expanded problem focused examination; and Straightforward medical decision
							 making. Counseling and/or coordination of care
99243
133.45
Office consultation for a new or established patient,
							 which requires these three key components: A detailed history; A detailed
							 examination; and Medical decision making of low complexity. Counseling and/or
							 coordination of care with other providers or agencies
99244
194.44
Office consultation for a new or established patient,
							 which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers 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. Physicians typically spend 60 minutes face-to-face with the patient
							 and/or family.
99245
239.50
Office consultation for a new or established patient,
							 which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers 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. Physicians typically spend 80 minutes face-to-face with the patient
							 and/or family.
99251
48.07
Inpatient consultation for a new or established
							 patient, which requires these three key components: A problem focused history;
							 A problem focused examination; and Straightforward medical decision making.
							 Counseling and/or coordination of care with other providers 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.
							 Physicians typically spend 20 minutes at the bedside and on the patient's
							 hospital floor or unit.
99252
76.93
Inpatient consultation for a new or established
							 patient, which requires these three key components: An expanded problem focused
							 history; An expanded problem focused examination; and Straightforward medical
							 decision making. Counseling and/or coordination of care with other providers 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. Physicians typically spend 40 minutes at the bedside and on the
							 patient's hospital floor or unit.
99253
114.86
Inpatient consultation for a new or established
							 patient, which requires these three key components: A detailed history; A
							 detailed examination; and Medical decision making of low complexity. Counseling
							 and/or coordination of care with other providers 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. Physicians
							 typically spend 55 minutes at the bedside and on the patient's hospital floor
							 or unit.
99254
165.94
Inpatient consultation for a new or established
							 patient, which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers 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. Physicians typically spend 80 minutes at the bedside and on the
							 patient's hospital floor or unit.
99255
205.03
Inpatient consultation for a new or established
							 patient, which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers 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. Physicians typically spend 110 minutes at the bedside and on the
							 patient's hospital floor or unit.
99281
20.11
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: A problem
							 focused history; A problem focused examination; and Straightforward medical
							 decision making. Counseling and/or coordination of care with other providers 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.
99282
38.15
Emergency department visit for the evaluation and
							 management of a patient, which requires these three 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 providers 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.
99283
61.34
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: An expanded
							 problem focused history; An expanded problem focused examination; and Medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers 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.
99284
113.24
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components: A detailed
							 history; A detailed examination; and Medical decision making of moderate
							 complexity. Counseling and/or coordination of care with other providers 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, and require urgent evaluation by the physician but do not pose an
							 immediate significant threat to life or physiologic function.
99285
168.40
Emergency department visit for the evaluation and
							 management of a patient, which requires these three key components within the
							 constraints imposed by the urgency of the patient's clinical condition and/or
							 mental status: A comprehensive history; A comprehensive examination; and
							 Medical decision making of high complexity. Counseling and/or coordination of
							 care with other providers 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 and pose an immediate significant
							 threat to life or physiologic function.
99288
I.C.
Physician direction of emergency medical systems
							 (EMS) emergency care, advanced life support
99291
271.33
Critical care, evaluation and management of the
							 critically ill or critically injured patient; first 30-74 minutes
99292
119.24
Critical care, evaluation and management of the
							 critically ill or critically injured patient; each additional 30 minutes (List
							 separately in addition to code for primary service)
99304
80.86
Initial nursing facility care, per day, for the
							 evaluation and management of a patient, which requires these three key
							 components: A detailed or comprehensive history; A detailed or comprehensive
							 examination; and Medical decision making that is straightforward or of low
							 complexity.Counseling and/or coordination of care with other providers or
							 agencies are provided consistent with the nature of the problem(s) and the
							 patient's and/or family's needs. Usually the problem(s) requiring admission are
							 of low severity. Physicians typically spend 25 minutes with the patient and/or
							 family or caregiver
99305
111.93
Initial nursing facility care, per day, for the
							 evaluation and management of a patient, which requires these three key
							 components: A comprehensive history; A comprehensive examination; and Medical
							 decision making of moderate complexity. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually the problem(s)
							 requiring admission are of moderate severity. Physicians typically spend 35
							 minutes with the patient and/or family or caregiver
99306
143.33
Initial nursing facility care, per day, for the
							 evaluation and management of a patient, which requires these three key
							 components: A comprehensive history; A comprehensive examination; and Medical
							 decision making of high complexity. Counseling and/or coordination of care with
							 other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs. Usually the problem(s)
							 requiring admission are of high severity. Physicians typically spend 45 minutes
							 with the patient and/or family or caregiver
99307
40.20
Subsequent nursing facility care, per day, for the
							 evaluation and management of a patient, which requires at least two of these
							 three key components: A problem focused interval history; A problem focused
							 examination; Straightforward medical decision making. Counseling and/or
							 coordination of care with other providers 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 stable, recovering or improving. Physicians typically
							 spend ten minutes with the patient and/or family or caregiver.
99308
61.98
Subsequent nursing facility care, per day, for the
							 evaluation and management of a patient, which requires at least two of these
							 three 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 providers 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 responding inadequately to therapy or
							 has developed a minor complication. Physicians typically spend 15 minutes with
							 the patient and/or family or caregiver.
99309
82.80
Subsequent nursing facility care, per day, for the
							 evaluation and
management of a patient, which requires at least two
							 of these three key components: A detailed interval history; A detailed
							 examination; Medical decision making of moderate complexity. Counseling and/or
							 coordination of care with other providers or agencies are provided consistent
							 with the nature of the problem(s) and the patient's and/or family's needs.
							 Usually the patient has developed a significant complication or a significant
							 new problem. Physicians typically spend 25 minutes with the patient and/or
							 family or caregiver.
99310
120.38
Subsequent nursing facility care, per day, for the
							 evaluation and management of a patient, which requires at least two of these
							 three key components: A comprehensive interval history; A comprehensive
							 examination; Medical decision making of high complexity. Counseling and/or
							 coordination of care with other providers or agencies are provided consistent
							 with the nature of the problem(s) and the patient's and/or family's needs. The
							 patient may be unstable or may have developed a significant new problem.
							 Physicians typically spend 35 minutes with the patient and/or family or
							 caregiver.
99315
59.87
Nursing facility discharge day management; 30 minutes
							 or less
99316
78.33
Nursing facility discharge day management; more than
							 30 minutes
99318
84.28
Evaluation and management of a patient involving an
							 annual nursing facility assessment, which requires these three key components:
							 A detailed interval history; A comprehensive examination; and Medical decision
							 making that is of low to moderate complexity. Counseling and/or coordination of
							 care with other providers 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 stable, recovering or improving. Physicians typically spend 30 minutes with
							 the patient and/or family or caregiver.
99324
57.16
Domiciliary or rest home visit for the evaluation and
							 management of a new patient, which requires these three key components: A
							 problem focused history; A problem focused examination; and Straightforward
							 medical decision making. Counseling and/or coordination of care with other
							 providers 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. Physicians typically spend 20 minutes with the patient and/or
							 family or caregiver
99325
82.53
Domiciliary or rest home visit for the evaluation and
							 management of a new patient, which requires these three 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 providers or agencies are provided consistent with the nature
							 of the problem(s) and the patient's and/or family's needs. Usually the
							 problem(s) requiring admission are of low severity. Physicians typically spend
							 25 minutes with the patient and/or family or caregiver. Usually the presenting
							 problem(s) are of moderate severity. Physicians typically spend 30 minutes with
							 the patient and/or family or caregiver.
99326
132.84
Domiciliary or rest home visit for the evaluation and
							 management of a new patient, which requires these three key components: A
							 detailed history; A detailed examination; and Medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers 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. Physicians typically spend 45 minutes with the
							 patient and/or family or caregiver.
99327
172.20
Domiciliary or rest home visit for the evaluation and
							 management of a new patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; and Medical decision making
							 of moderate complexity. Counseling and/or coordination of care with other
							 providers 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. Physicians typically spend 60 minutes with the patient and/or
							 family or caregiver.
99328
203.82
Domiciliary or rest home visit for the evaluation and
							 management of a new patient, which requires these three key components: A
							 comprehensive history; A comprehensive examination; and Medical decision making
							 of high complexity. Counseling and/or coordination of care with other providers
							 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.
							 Physicians typically spend 75 minutes with the patient and/or family or
							 caregiver.
99334
57.06
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three key components: A problem focused interval history; A problem focused
							 examination; Straightforward medical decision making. Counseling and/or
							 coordination of care with other providers 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. Physicians
							 typically spend 15 minutes with the patient and/or family or
							 caregiver.
99335
87.22
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three 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 providers 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. Physicians typically spend 25 minutes with the patient and/or family
							 or caregiver.
99336
123.05
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three key components: A detailed interval history; A detailed examination;
							 Medical decision making of moderate complexity. Counseling and/or coordination
							 of care with other providers 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. Physicians typically
							 spend 40 minutes with the patient and/or family or caregiver.
99337
176.30
Domiciliary or rest home visit for the evaluation and
							 management of an established patient, which requires at least two of these
							 three 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 providers 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. Physicians typically spend 60 minutes
							 with the patient and/or family or caregiver.
99339
71.17
Individual physician supervision of a patient
							 (patient not present) in home, domiciliary or rest home (eg, assisted living
							 facility) requiring complex and multidisciplinary care modalities involving
							 regular physician development and/or revision of care plans, review of
							 subsequent reports of patient status, review of related laboratory and other
							 studies, communication (including telephone calls) for purposes of assessment
							 or care decisions with health care professional(s), family member(s), surrogate
							 decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved
							 inpatient's care, integration of new information into the medical treatment
							 plan and/or adjustment of medical therapy, within a calendar month, 15-29
							 minutes
99340
99.00
Individual physician supervision of a patient
							 (patient not present) in home, domiciliary or rest home (eg, assisted living
							 facility) requiring complex and multidisciplinary care modalities involving
							 regular physician development and/or revision of care plans, review of
							 subsequent reports of patient status, review of related laboratory and other
							 studies, communication (including telephone calls) for purposes of assessment
							 or care decisions with health care professional(s), family member(s), surrogate
							 decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved
							 inpatient's care, integration of new information into the medical treatment
							 plan and/or adjustment of medical therapy, within a calendar month, 30 minutes
							 or more
99341
56.70
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: A problem focused history;
							 A problem focused examination; and Straightforward medical decision making.
							 Counseling and/or coordination of care with other providers 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.
							 Physicians typically spend 20 minutes face-to-face with the patient and/or
							 family.
99342
82.53
Home visit for the evaluation and management of a new
							 patient, which requires these three 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 providers
							 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. Physicians typically spend 30 minutes face-to-face with the
							 patient and/or family.
99343
129.88
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: A detailed history; A
							 detailed examination; and Medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers 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. Physicians typically spend 45 minutes face-to-face with the patient
							 and/or family.
99344
169.47
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of moderate complexity.
							 Counseling and/or coordination of care with other providers 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.
							 Physicians typically spend 60 minutes face -to-face with the patient and/or
							 family.
99345
203.82
Home visit for the evaluation and management of a new
							 patient, which requires these three key components: A comprehensive history; A
							 comprehensive examination; and Medical decision making of high complexity.
							 Counseling and/or coordination of care with other providers 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.Physicians typically spend
							 75 minutes face-to-face with the patient and/or family.
99347
54.21
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 A problem focused interval history; A problem focused examination;
							 Straightforward medical decision making. Counseling and/or coordination of care
							 with other providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs.
99348
81.30
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 An expanded problem focused interval history; An expanded problem focused
							 examination; Medical decision making of low complexity.
99349
118.15
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three key components:
							 A detailed interval history; A detailed examination; Medical decision making of
							 moderate complexity. Counseling and/or coordination of care with other
							 providers 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. Physicians typically spend 15 minutes with the patient
							 and/or family.
99350
165.14
Home visit for the evaluation and management of an
							 established patient, which requires at least two of these three 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 providers or agencies are provided consistent with the nature of the
							 problem(s) and the patient's and/or family's needs.
99354
95.51
Prolonged physician service in the office or other
							 outpatient setting requiring direct (face-to-face) patient contact beyond the
							 usual service (eg, prolonged care and treatment of an acute asthmatic patient
							 in an outpatient setting); first hour (List separately in addition to code for
							 office or other Evaluation and Management procedure)
99355
93.83
Prolonged physician service in the office or other
							 outpatient setting requiring direct (face-to-face) patient contact beyond the
							 usual service (eg, prolonged care and treatment of an acute asthmatic patient
							 in an outpatient setting); each additional 30 minutes (List separately in
							 addition to code for office or other Evaluation and Management
							 procedure)
99356
86.26
Prolonged physician service in the inpatient setting,
							 requiring direct (face-to-face) patient contact beyond the usual service (eg,
							 maternal fetal monitoring for high risk delivery or other physiological
							 monitoring, prolonged care of an acutely ill inpatient); first hour (List
							 separately in addition to code for office or other Evaluation and Management
							 procedure).
99357
86.56
Prolonged physician service in the inpatient setting,
							 requiring direct (face-to-face) patient contact beyond the usual service (eg,
							 maternal fetal monitoring for high risk delivery or other physiological
							 monitoring, prolonged care of an acutely ill inpatient); each additional 30
							 minutes (List separately in addition to code for office or other Evaluation and
							 Management procedure).
99358
97.87
Prolonged evaluation and management service before
							 and/or after direct (face-to-face) patient care (eg, review of extensive
							 records and tests, communication with other professionals and/or the
							 patient/family); first hour (List separately in addition to code for other
							 physician service(s) and/or inpatient or outpatient Evaluation and Management
							 service)
99359
47.31
Prolonged evaluation and management service before
							 and/or after direct (face-to-face) patient care (eg, review of extensive
							 records and tests, communication with other professionals and/or the
							 patient/family); each additional 30 minutes (List separately in addition to
							 code for prolonged physician service)
99360
55.36
Physician standby service, requiring prolonged
							 physician attendance, each 30 minutes (eg, operative standby, standby for
							 frozen section, for cesarean/high risk delivery, for monitoring
							 EEG)
99363
118.27
Anticoagulant management for an outpatient taking
							 warfarin, physician review and interpretation of International Normalized Ratio
							 (INR) testing, patient instructions, dosage adjustment (as needed), and
							 ordering of additional tests; initial 90 days of therapy (must include a
							 minimum of 8 INR measurements)
99364
40.20
Anticoagulant management for an outpatient taking
							 warfarin, physician review and interpretation of International Normalized Ratio
							 (INR) testing, patient instructions, dosage adjustment (as needed), and
							 ordering of additional tests; each subsequent 90 days of therapy (must include
							 a minimum of three INR measurements)
99366
39.00
Medical team conference with interdisciplinary team
							 of health care professionals, face-to-face with patient and/or family, 30
							 minutes or more, participation by nonphysician qualified health care
							 professional
99367
50.56
Medical team conference with interdisciplinary team
							 of health care professionals, patient and/or family not present, 30 minutes or
							 more; participation by physician
99368
32.85
Medical team conference with interdisciplinary team
							 of health care professionals, patient and/or family not present, 30 minutes or
							 more; participation by nonphysician qualified health care
							 professional
99374
67.59
Physician supervision of a patient under care of home
							 health agency (patient not present) in home, domiciliary or equivalent
							 environment (eg, Alzheimer's facility) requiring complex and multidisciplinary
							 care modalities involving regular physician development and/or revision of care
							 plans, review of subsequent reports of patient status, review of related
							 laboratory and other studies, communication (including telephone calls) for
							 purposes of assessment of care decisions with health care professional(s),
							 family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key
							 caregiver(s) involved in patient's care, integration of new information into
							 the medical treatment plan and/or adjustment of medical therapy, within a
							 calendar month; 15-29 minutes
99375
114.10
Physician supervision of a patient under care of home
							 health agency (patient not present) in home, domiciliary or equivalent
							 environment (eg, Alzheimer's facility) requiring complex and multidisciplinary
							 care modalities involving regular physician development and/or revision of care
							 plans, review of subsequent reports of patient status, review of related
							 laboratory and other studies, communication (including telephone calls) for
							 purposes of assessment of care decisions with health care professional(s),
							 family member(s), surrogate decision maker(s) (e.g., legal guardian) and/or key
							 caregiver(s) involved in patient's care, integration of new information into
							 the medical treatment plan and/or adjustment of medical therapy, within a
							 calendar month; 30 minutes or more
99377
67.59
Physician supervision of a hospice patient (patient
							 not present) requiring complex and multidisciplinary care modalities involving
							 regular physician development and/or revision of care plans, review of
							 subsequent reports of patient status, review of related laboratory and other
							 studies, communication (including telephone calls) for purposes of assessment
							 of care decisions with health care professional(s), family member(s), surrogate
							 decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in
							 patient's care, integration of new information into the medical treatment plan
							 and/or adjustment of medical therapy, within a calendar month; 15-29
							 minutes
99378
123.30
Physician supervision of a hospice patient (patient
							 not present) requiring complex and multidisciplinary care modalities involving
							 regular physician development and/or revision of care plans, review of
							 subsequent reports of patient status, review of related laboratory and other
							 studies, communication (including telephone calls) for purposes of assessment
							 of care decisions with health care professional(s), family member(s), surrogate
							 decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in
							 patient's care, integration of new information into the medical treatment plan
							 and/or adjustment of medical therapy, within a calendar month; 30 minutes or
							 more
99379
67.29
Physician supervision of a nursing facility patient
							 (patient not present) requiring complex and multidisciplinary care modalities
							 involving regular physician development and/or revision of care plans, review
							 of subsequent reports of patient status, review of related laboratory and other
							 studies, communication (including telephone calls) for purposes of assessment
							 of care decisions with health care professional(s), family member(s), surrogate
							 decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in
							 patient's care, integration of new information into the medical treatment plan
							 and/or adjustment of medical therapy, within a calendar month; 15-29
							 minutes
99380
100.91
Physician supervision of a nursing facility patient
							 (patient not present) requiring complex and multidisciplinary care modalities
							 involving regular physician development and/or revision of care plans, review
							 of subsequent reports of patient status, review of related laboratory and other
							 studies, communication (including telephone calls) for purposes of assessment
							 of care decisions with health care professional(s), family member(s), surrogate
							 decision maker(s) (e.g., legal guardian) and/or key caregiver(s) involved in
							 patient's care, integration of new information into the medical treatment plan
							 and/or adjustment of medical therapy, within a calendar month; 30 minutes or
							 more
99441
13.28
Telephone evaluation and management service provided
							 by a physician to an established patient, parent, or guardian not originating
							 from a related E/M service provided within the previous seven days nor leading
							 to an E/M service or procedure within the next 24 hours or soonest available
							 appointment; five - ten minutes of medical discussion
99442
24.11
Telephone evaluation and management service provided
							 by a physician to an established patient, parent, or guardian not originating
							 from a related E/M service provided within the previous seven days nor leading
							 to an E/M service or procedure within the next 24 hours or soonest available
							 appointment; 11-20 minutes of medical discussion
99443
35.71
Telephone evaluation and management service provided
							 by a physician to an established patient, parent, or guardian not originating
							 from a related E/M service provided within the previous seven days nor leading
							 to an E/M service or procedure within the next 24 hours or soonest available
							 appointment; 21-30 minutes of medical discussion
99444
I.C.
Online evaluation and management service provided by
							 a physician to an established patient, guardian, or health care provider not
							 originating from a related E/M service provided within the previous seven days,
							 using the Internet or similar electronic communications network
99450
I.C.
Basic life and/or disability examination that
							 includes: Measurement of height, weight, and blood pressure; Completion of a
							 medical history following a life insurance pro forma; Collection of blood
							 sample and/or urinalysis complying with "chain of custody" protocols; and
							 completion of necessary documentatioin/certificates
99455
I.C.
Work related or medical disability examination by the
							 treating physician that includes: Completion of a medical history commensurate
							 with the patient's condition; Performance of an examination commensurate with
							 the patient's condition; Formulation of a diagnosis, assessment of capabilities
							 and stability, and calculation of impairment; development of future medical
							 treatment plan; and completion of necessary documentation/certification and
							 report.
99456
I.C.
Work related or medical disability examination by
							 other than the treating physician that includes: Completion of a medical
							 history commensurate with the patient's condition; Performance of an
							 examination commensurate with the patient's condition; Formulation of a
							 diagnosis, assessment of capabilities and stability, and calculation of
							 impairment; development of future medical treatment plan; and completion of
							 necessary documentation/certification and report.
99499
I.C.
Unlisted evaluation and management
							 service
99503
I.C.
Home visit for respiratory therapy care (eg,
							 bronchodilator, oxygen therapy, respiratory assessment, apnea
							 evaluation)
99504
I.C.
Home visit for mechanical ventilation
							 care
99505
I.C.
Home visit for stoma care and maintenance including
							 colostomy and cystostomy
99506
I.C.
Home visit for intramuscular injections
99507
I.C.
Home visit for care and maintenance of catheter(s)
							 (eg, urinary, drainage, and enteral)
99509
I.C.
Home visit for assistance with activities of daily
							 living and personal care
99511
I.C.
Home visit for fecal impaction management and enema
							 administration
99512
I.C.
Home visit for hemodialysis
99600
I.C.
Unlisted home visit service or procedure
(11)
Psychological Services
.
Code
Unit
40.06(11) - Psychological Services
							 Description
90801
124.41
Psychiatric diagnostic interview
							 examination
90802
131.71
Interactive psychiatric diagnostic interview
							 examination using play equipment, physical devices, language interpreter, or
							 other mechanisms of communication
90804
51.88
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an office or outpatient facility, approximately
							 20 to 30 minutes face-to-face with the patient;
90805
57.25
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an office or outpatient facility, approximately
							 20 to 30 minutes face-to-face with the patient; with medical evaluation and
							 management services
90806
72.77
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an office or outpatient facility, approximately
							 45 to 50 minutes face-to-face with the patient;
90807
80.54
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an office or outpatient facility, approximately
							 45 to 50 minutes face-to-face with the patient; with medical evaluation and
							 management services
90808
107.17
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an office or outpatient facility, approximately
							 75 to 80 minutes face-to-face with the patient;
90809
114.22
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an office or outpatient facility, approximately
							 75 to 80 minutes face-to-face with the patient; with medical evaluation and
							 management services
90810
55.06
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an office or outpatient facility, approximately 20
							 to 30 minutes face-to-face with the patient;
90811
63.68
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an office or outpatient facility, approximately 20
							 to 30 minutes face-to-face with the patient; with medical
							 evaluation
90812
79.69
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an office or outpatient facility, approximately 45
							 to 50 minutes face-to-face with the patient;
90813
87.10
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an office or outpatient facility, approximately 45
							 to 50 minutes face-to-face with the patient; with medical
							 evaluation
90814
113.37
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an office or outpatient facility, approximately 75
							 to 80 minutes face-to-face with the patient;
90815
120.41
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an office or outpatient facility, approximately 75
							 to 80 minutes face-to-face with the patient; with medical
							 evaluation
90816
48.26
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 20 to 30 minutes face-to-face with the
							 patient;
90817
52.91
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 20 to 30 minutes face-to-face with the
							 patient; with medical evaluation and management
90818
71.77
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 45 to 50 minutes face-to-face with the
							 patient;
90819
76.29
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 45 to 50 minutes face-to-face with the
							 patient; with medical evaluation and management
90821
106.08
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 75 to 80 minutes face-to-face with the
							 patient;
90822
110.47
Individual psychotherapy, insight oriented, behavior
							 modifying and/or supportive, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 75 to 80 minutes face-to-face with the
							 patient; with medical evaluation and management
90823
51.93
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 20 to 30 minutes face-to-face with the
							 patient;
90824
57.17
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 20 to 30 minutes face-to-face with the
							 patient;
90826
76.30
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 45 to 50 minutes face-to-face with the
							 patient;
90827
79.96
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 45 to 50 minutes face-to-face with the
							 patient;
90828
110.47
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 75 to 80 minutes face-to-face with the
							 patient;
90829
113.90
Individual psychotherapy, interactive, using play
							 equipment, physical devices, language interpreter, or other mechanisms of
							 non-verbal communication, in an inpatient hospital, partial hospital or
							 residential care setting, approximately 75 to 80 minutes face-to-face with the
							 patient;
90845
66.20
Psychoanalysis
90846
70.89
Family psychotherapy (without the patient
							 present)
90847
88.52
Family psychotherapy (conjoint psychotherapy) (with
							 patient present)
90849
27.10
Multiple-family group psychotherapy
90853
25.42
Group psychotherapy (other than of a multiple-family
							 group)
90857
29.02
Interactive group psychotherapy
90862
44.32
Pharmacologic management, including prescription,
							 use, and review of medication with no more than minimal medical
							 psychotherapy
90865
124.36
Narcosynthesis for psychiatric diagnostic and
							 therapeutic purposes (eg, sodium amobarbital (Amytal) interview)
90870
120.96
Electroconvulsive therapy (includes necessary
							 monitoring)
90875
58.71
Individual psychophysiological therapy incorporating
							 biofeedback training by any modality (face-to-face with the patient), with
							 psychotherapy (eg, insight oriented, behavior modifying or supportive
							 psychotherapy); approximately 20-30 minutes
90876
85.27
Individual psychophysiological therapy incorporating
							 biofeedback training by any modality (face-to-face with the patient), with
							 psychotherapy (eg, insight oriented, behavior modifying or supportive
							 psychotherapy); approximately 45-50 minutes
90880
89.07
Hypnotherapy
90885
37.28
Psychiatric evaluation of hospital records, other
							 psychiatric reports, psychometric and/or projective tests, and other
							 accumulated data for medical diagnostic purposes
90887
66.21
Interpretation or explanation of results of
							 psychiatric, other medical examinations and procedures, or other accumulated
							 data to family or other responsible persons, or advising them how to assist
							 patient
90889
26.79
Preparation of report of patient's psychiatric
							 status, history, treatment, or progress (other than for legal or consultative
							 purposes) for other physicians, agencies, or insurance carriers
96101
69.04
Psychological testing (includes psychodiagnostic
							 assessment of emotionality, intellectual abilities, personality and
							 psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist's or
							 physician's time, both face-to-face time administering test
96102
45.39
Psychological testing (includes psychodiagnostic
							 assessment of emotionality, intellectual abilities, personality and
							 psychopathology, eg, MMPI and WAIS), with qualified health care professional
							 interpretation and report, administered by technician, per hour
96103
34.34
Psychological testing (includes psychodiagnostic
							 assessment of emotionality, intellectual abilities, personality and
							 psychopathology, eg, MMPI), administered by a computer, with qualified health
							 care professional interpretation and report
96105
65.97
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
96110
10.73
Developmental testing; limited (eg, Developmental
							 Screening Test II, Early Language Milestone Screen), with interpretation and
							 report
96111
105.27
Developmental testing; extended (includes assessment
							 of motor, language, social, adaptive and/or cognitive functioning by
							 standardized developmental instruments) with interpretation and
							 report
96116
78.59
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
96118
94.11
Neuropsychological testing (eg, 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
96119
64.81
Neuropsychological testing (eg, 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
96120
57.81
Neuropsychological testing (eg, Wisconsin Card
							 Sorting Test), administered by a computer, with qualified health care
							 professional interpretation and report
96125
76.72
Standardized cognitive performance testing (eg, 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
96150
18.68
Health and behavior assessment (eg, health-focused
							 clinical interview, behavioral observations, psychophysiological monitoring,
							 health-oriented questionnaires), each 15 minutes face-to-face with the patient;
							 initial assessment
96151
18.14
Health and behavior assessment (eg, health-focused
							 clinical interview, behavioral observations, psychophysiological monitoring,
							 health-oriented questionnaires), each 15 minutes face-to-face with the patient;
							 re-assessment
96152
17.25
Health and behavior intervention, each 15 minutes,
							 face-to-face; individual
96153
4.00
Health and behavior intervention, each 15 minutes,
							 face-to-face; group (two or more patients)
96154
16.98
Health and behavior intervention, each 15 minutes,
							 face-to-face; family (with the patient present)
96155
17.31
Health and behavior intervention, each 15 minutes,
							 face-to-face; family (without the patient present)
99358
76.76
Prolonged evaluation and management service before
							 and/or after direct (face-to-face) patient care (eg, review of extensive
							 records and tests, communication with other professionals and/or the
							 patient/family); first hour (List separately in addition to code(s) for other
							 physician service(s) and. or inpatient or outpatient evaluation and management
							 service)
99359
37.11
Prolonged evaluation and management service before
							 and/or after direct (face-to-face) patient care (eg, review of extensive
							 records and tests, communication with other professionals and/or the
							 patient/family); each additional 30 minutes (List separately in addition to
							 code for prolonged physician service)
99368
25.76
Medical team conference with interdisciplinary team
							 of health care professionals, patient and/or family not present, 30 minutes or
							 more; participation by nonphysician qualified health care
							 professional
(12)
Restorative Services
.
Code
Unit
40.06(12) - Restorative Services
							 Description
16000
54.51
Initial treatment, first degree burn, when no more
							 than local treatment is required
16020
66.97
Dressings and/or debridement of partial-thickness
							 burns, initial or subsequent; small (less than 5% total body surface
							 area)
16025
114.88
Dressings and/or debridement of partial-thickness
							 burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5%
							 to 10% total body surface area)
16030
138.94
Dressings and/or debridement of partial-thickness
							 burns, initial or subsequent; large (eg, more than one extremity, or greater
							 than 10% total body surface area)
92506
196.25
Evaluation of speech, language, voice, communication,
							 and/or auditory processing
92507
56.92
Treatment of speech, language, voice, communication,
							 and/or auditory processing disorder; individual
92508
26.46
Treatment of speech, language, voice, communication,
							 and/or auditory processing disorder; group, two or more individuals
92511
140.15
Nasopharyngoscopy with endoscope (separate
							 procedure)
92512
54.10
Nasal function studies (eg,
							 rhinomanometry)
92516
55.72
Facial nerve function studies (eg,
							 electroneuronography)
92520
47.02
Laryngeal function studies (ie, aerodynamic testing
							 and acoustic testing)
92526
75.87
Treatment of swallowing dysfunction and/or oral
							 function for feeding
92531
I.C.
Spontaneous nystagmus, including gaze
92532
I.C.
Positional nystagmus test
92533
I.C.
Caloric vestibular test, each irrigation (binaural,
							 bithermal stimulation constitutes four tests)
92534
I.C.
Optokinetic nystagmus test
97001
85.89
Physical therapy evaluation
97002
31.86
Physical therapy re-evaluation
97003
92.59
Occupational therapy evaluation
97004
38.75
Occupational therapy re-evaluation
97005
I.C.
Athletic training evaluation
97006
I.C.
Athletic training re-evaluation
97012
12.05
Application of a modality to one or more areas;
							 traction, mechanical
97014
11.61
Application of a modality to one or more areas;
							 electrical stimulation (unattended)
97016
12.70
Application of a modality to one or more areas;
							 vasopneumatic devices
97018
6.57
Application of a modality to one or more areas;
							 paraffin bath
97022
14.61
Application of a modality to one or more areas;
							 whirlpool
97024
4.39
Application of a modality to one or more areas;
							 diathermy (eg, microwave)
97026
4.03
Application of a modality to one or more areas;
							 infrared
97028
5.29
Application of a modality to one or more areas;
							 ultraviolet
97032
13.50
Application of a modality to one or more areas;
							 electrical stimulation (manual), each 15 minutes
97033
20.30
Application of a modality to one or more areas;
							 iontophoresis, each 15 minutes
97034
12.05
Application of a modality to one or more areas;
							 contrast baths, each 15 minutes
97035
9.51
Application of a modality to one or more areas;
							 ultrasound, each 15 minutes
97036
21.56
Application of a modality to one or more areas;
							 Hubbard tank, each 15 minutes
97039
I.C.
Unlisted modality (specify type and time if constant
							 attendance)
97110
23.10
Therapeutic procedure, one or more areas, each 15
							 minutes; therapeutic exercises to develop strength and endurance, range of
							 motion and flexibility
97112
24.32
Therapeutic procedure, one 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
28.77
Therapeutic procedure, one or more areas, each 15
							 minutes; aquatic therapy with therapeutic exercises
97116
20.43
Therapeutic procedure, one or more areas, each 15
							 minutes; gait training (includes stair climbing)
97124
18.73
Therapeutic procedure, one or more areas, each 15
							 minutes; massage, including effleurage, petrissage and/or tapotement (stroking,
							 compression, percussion)
97139
I.C.
Unlisted therapeutic procedure (specify)
97140
21.61
Manual therapy techniques (eg, mobilization/
							 manipulation, manual lymphatic drainage, manual traction), one or more regions,
							 each 15 minutes
97150
14.76
Therapeutic procedure(s), group (two or more
							 individuals)
97530
24.78
Therapeutic activities, direct (one-on-one) patient
							 contact by the provider (use of dynamic activities to improve functional
							 performance), each 15 minutes
97532
19.70
Development of cognitive skills to improve attention,
							 memory, problem solving (includes compensatory training), direct (one-on-one)
							 patient contact by the provider, each 15 minutes
97533
21.15
Sensory integrative techniques to enhance sensory
							 processing and promote adaptive responses to environmental demands, direct
							 (one-on-one) patient contact by the provider, each 15 minutes
97535
25.04
Self-care/home management training (eg, 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 by provider, each 15 minutes
97537
22.14
Community/work reintegration training (eg, shopping,
							 transportation, money management, avocational activities and/or work
							 environment/modification analysis, work task analysis, use of assistive
							 technology device/adaptive equipment), direct one-on-one contact by provider
							 each 15 minutes
97542
22.51
Wheelchair management (eg, assessment, fitting,
							 training), each 15 minutes
97545
114.82
Work hardening/conditioning; initial two
							 hours
97546
57.41
Work hardening/conditioning; each additional hour
							 (List separately in addition to code for primary procedure)
97597
48.72
Removal of devitalized tissue from wound(s),
							 selective debridement, without anesthesia (eg, high pressure waterjet
							 with/without suction, sharp selective debridement with scissors, scalpel and
							 forceps), with or without topical application(s), wound assessment and
							 instruction(s) for ongoing care, may include use of a whirlpool, per session;
							 total wound(s) surface area less than or equal to 20 square
							 centimeters
97598
60.08
Removal of devitalized tissue from wound(s),
							 selective debridement, without anesthesia (eg, high pressure waterjet
							 with/without suction, sharp selective debridement with scissors, scalpel and
							 forceps), with or without topical application(s), wound assessment and
							 instruction(s) for ongoing care, may include use of a whirlpool, per session;
							 total wound(s) surface area greater than 20 square centimeters
97602
I.C.
Removal of devitalized tissue from wound(s),
							 non-selective debridement, without anesthesia (eg, wet-to-moist dressings,
							 enzymatic, abrasion), including topical application(s), wound assessment, and
							 instruction(s) for ongoing care, per session
97605
28.70
Negative pressure wound therapy (eg, 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
30.65
Negative pressure wound therapy (eg, 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
97750
24.19
Physical performance test or measurement (eg,
							 musculoskeletal, functional capacity), with written report, each 15
							 minutes
97755
27.32
Assistive technology assessment (eg, to restore,
							 augment or compensate for existing function, optimize functional tasks and/or
							 maximize environmental accessibility), direct one-on-one contact by provider,
							 with written report, each 15 minutes
97760
26.60
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
97761
23.47
Prosthetic training, upper and/or lower extremity(s),
							 each 15 minutes
97762
28.24
Checkout for orthotic/prosthetic use, established
							 patient, each 15 minutes
97799
I.C.
Unlisted physical medicine/rehabilitation service or
							 procedure
G0237
12.81
Therapeutic procedures to increase strength or
							 endurance of respiratory muscles, face-to-face, one-on-one, each 15 minutes
							 (includes monitoring)
CPT Codes 29000 through 29750 are incorporated by reference and
				shall be paid at the listed fee.