New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.80 - State of New York Certified Surgical Fee Schedule

Current through Register Vol. 46, No. 28, July 10, 2024
The following schedule of relative values for surgery, with
					 $6 applied to each unit of value, shall constitute the
State of New
					 York Certified Surgical Fee Schedule:
INTEGUMENTARY SYSTEM
Skin, Mucous Membrane, Subcutaneous and Areolar
					 Tissues
Value
Incision
0101
Incision and drainage of infected or noninfected
								sebaceous cyst .......
2.0
(2nd lesion 50%; each additional lesion 25%)
0102
Incision and drainage of furuncle .......
2.0
0103
Acne surgery; marsupialization, opening, or removal
								of multiple milia, comedones, cysts, pustules, etc. .......
1.5
0108
Incision and drainage of carbuncle, suppurative
								hidradenitis and other cutaneous or subcutaneous abscesses simple .......
2.0
0109
extensive .......
by report
0115
Drainage of pilonidal cyst .......
2.0
0125
Drainage of onychia or paronychia .......
2.0
0126
multiple or complicated .......
by report
0130
Incision and removal of foreign body, subcutaneous
								tissues, simple .......
2.0
0131
complicated by .......
by report
0140
Drainage of hematoma, simple .......
2.0
0141
complicated .......
by report
0145
Puncture aspiration of abscess or hematoma .......
1.0
Excision
Debridement (for abrasions and burns see 0164,
								0330-0334, 0351-0356.)
0160
Debridement of extensively eczematized or infected
								skin up to 10% of the body surface .......
2.0
0161
for each additional 10% of body surface, add .......
1.0
0162
Debridement of nails, any method, five or less
								.......
2.0
0163
for each additional five or major portion thereof
								.......
1.0
0164
Debridement of abrasions .......
by report
Excision and Simple Closure-(Not reconstructive
								surgery; for reconstructive surgery see "Repair-Complex.")
(For electro-surgical methods see 0401,
et
								seq.
)
0171
Biopsy; excision of skin, subcutaneous tissue or
								mucous membrane for biopsy (including simple closure) (independent procedure)
								.......
3.0
Excision (including simple closure) of BENIGN
								cicatricial, fibrous, inflammatory, congenital, cystic, etc., lesions of skin,
								subcutaneous tissue or mucous membrane; one (see appropriate size below.)
0175
lesion
diameter
up to 1/4 inch
								.......
4.0
0176
lesion
diameter
1/4 to 1/2 .......
5.0
0177
lesion
diameter
1/2 to 3/4 .......
6.0
0178
lesion
diameter
more than 3/4 inch
								or complicated .......
by report
Excision (including simple closure) or treatment by
								any other method except radiation) of MALIGNANT lesions of skin or mucous
								membrane (except melanoma) to include local anesthesia.
Trunk, arms or legs:
0188
lesion diameter up to 1/4 inch .......
6.0
0189
lesion
diameter
1/4 to 1/2 inch
								.......
8.0
0190
lesion
diameter
1/2 to 3/4 inch
								.......
10.0
Face, scalp, ears, neck, hands, feet, genitalia:
0191
lesion
diameter
up to 1/4 inch
								.......
10.0
0192
lesion
diameter
up to 1/2 inch
								.......
15.0
0193
lesion
diameter
1/2 to 3/4 inch
								.......
20.0
Eyelids, nose, lips, mucous membrane:
0194
lesion
diameter
up to 1/4 inch
								.......
15.0
0195
lesion
diameter
1/4 to 1/2 inch
								.......
20.0
0196
lesion
diameter
1/2 to 3/4 inch
								.......
25.0
0197
Lesions over 3/4 inch, complicated or unusually
								located .......
by report
0225
Avulsion, nail, partial, or complete, simple .......
2.0
0228
Excision of nail or nail matrix, partial or
								complete, e.g., ingrown or deformed nail for permanent removal .......
10.0
0238
Excision of pilonidal cyst or sinus .......
30.0
Miscellaneous lesions (use appropriate procedure
								number and state diagnosis.)
Hemangioma (see 0175-0178, 0260-0324.)
Hidradenitis (see 0108, 0175-0178, 0260-0324.)
Lipoma (see 0175-0178, 0260-0324.)
Lymph node dissection (see 2651-2672.)
Melanoma (see 0188-0197, 0260-0324.)
Ulcer-vascular or inflammatory (see 0175-0178,
								0260-0324.)
Introduction
0242
Injection, intralesional (up to and including seven
								lesions) .......
2.0
0243
more than seven .......
3.0
Repair-Simple
0251
Wounds, recent, up to 2 1/2 inches .......
2.0
0252
for each additional inch add .......
1.0
REPAIR-COMPLEX
(e.g.,
								  reconstructive surgery, complicated wound closure, skin grafts,
								  etc.).
The following values (0260-0324) are to be applied in
								situations requiring unusual and time-consuming techniques of repair to obtain
								the maximum functional and cosmetic result. Unless otherwise noted, the stated
								values include the creation of the defect and necessary preparation for repair,
								or the debridemnet and repair of complicated laceration (excluding 0251,
								0252.)
Excision and/or repair by direct closure of lesion or
								laceration resulting in a LINEAR REPAIR:
0260
up to 1/2 inch, forehead, cheeks, chin, mouth, neck,
								axilla, genitalia, hands and feet .......
8.0
0261
eyelids, nose, ears and lips .......
10.0
(See also 0290-0294, 2737-2746.)
(For other areas see 0175-0178, 0188-0197,
								0251-0252.)
0262
1/2 inch to 1 inch, trunk .......
7.0
0263
scalp, arms and legs .......
10.0
0264
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
14.0
0265
eyelids, nose, ears and lips .......
17.0
(See also 0290-0294, 2737-2746.)
0266
1 inch to 3 inches, trunk .......
15.0
0267
scalp, arms and legs .......
22.0
0268
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
30.0
0269
eyelids, none, ears and lips .......
40.0
(See also 0290-0294, 2737-2746.)
0270
Unusual, complicated or over 3 inch linear repair
								.......
by report
Excision and/or repair by adjacent tissue transfer or
								rearrangement (e.g., Z-plasty, rotation flap, advanced flap, double pedicle
								flap, etc.):
0275
for defect up to 1 square inch, trunk .......
20.0
0276
scalp, arms and legs .......
30.0
0277
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
40.0
0278
eyelids, nose, ears and lips .......
50.0
0279
defect size between 1 square inch and 3 square
								inches, trunk .......
30.0
0280
scalp, arms and legs .......
40.0
0281
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
50.0
0282
eyelids, nose, ears and lips .......
60.0
0283
more than 3 square inches, unusual or complicated
								.......
by report
Eyelid, full thickness, excision and
								repair:
.......
0290
by advancement flaps, up to 1/4 eyelid margin
								.......
37.0
0291
over 1/4 of eyelid margin .......
50.0
0292
by transfer flaps of tarso-conjunctivea from
								opposing eyelid, up to 
								2/3
								of eyelid .......
50.0
0293
total eyelid, one or more stages, lower lid .......
75.0
0294
upper lid .......
85.0
SKIN GRAFTS-The value is to be determined
								on the basis of size and location of defect (recipient area) and type of graft.
								Unless otherwise noted, these values include creation and/or surgical
								preparation of the defect, obtaining and placing of the graft, and the care of
								the donor site.
0300
Pinch, split or full thickness skin to cover small
								ulcer, tip of digit or other minimal open area (except on face, use 0301-0304)
								up to defect size 3/4 inch diameter .......
5.0
(Values for items 0301-0304 include simple
								debridement of granulations or recent avulsions. When the recipient area for
								grafting is created by surgical excision of essentially intact skin, scar or
								other lesion (including subcutaneous tissue) add 50% to the calculated value
								for the graft. This includes primary or delayed application of the graft.)
0301
Split skin graft, up to 16 square inches (except
								0300), trunk, scalp, arms, legs, hands and feet (except multiple digits)
								.......
25.0
0302
each additional 16 square inches or part thereof
								.......
5.0
0303
face, neck, ears, genitalia or multiple digits
								.......
38.0
0304
each additional 16 square inches or part thereof
								.......
7.0
0308
Full thickness, free, up to 3 square inches,
								including direct closure of donor site, trunk .......
20.0
0309
scalp, arms and legs .......
30.0
0310
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
40.0
0311
eyelids, nose, ears and lips .......
50.0
(For each additional 3 square inches in the above
								procedures, add 50% of area value.)
Values for following items (0312-0323) do NOT include
								extensive immobilizing; for plaster casts see 1851-1890 for values for these
								services.
0312
Pedicle flap, direct flap, direct or tubed,
								(including direct closure of donor site) trunk .......
20.0
0313
scalp, arms and legs .......
30.0
0314
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
40.0
0315
eyelids, nose, ears and lips .......
50.0
0316
delay, intermediate transfer or sectioning of
								pedicle of tubed or direct flap, trunk .......
15.0
0317
scalp, arms and legs .......
22.0
0318
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
30.0
0319
eyelids, nose, ears and lips .......
37.0
0320
excision of lesion and/or preparation of recipient
								site and attachment of direct or tubed pedicle flap, trunk .......
30.0
0321
scalp, arms and legs .......
45.0
0322
forehead, cheeks, chin, mouth, neck, axilla,
								genitalia, hands and feet .......
60.0
0323
eyelids, nose, ears and lips .......
75.0
(Revision, defatting or rearranging of transferred
								pedicle or flap skin graft, see 0260-0283 inclusive.)
0324
Composite graft (full thickness of external ear or
								nasal ala) .......
25.0
0325
Derma-fat-fascia-graft (except to breast-0484)
								.......
45.0
0330
Abrasion of skin, total face, for removal of scars,
								tattoos, etc. primary .......
60.0
0331
secondary, total face .......
30.0
0333
regional ( 1/4 face, cheeks, chin, forehead or
								elsewhere) primary .......
15.0
0334
secondary, regional .......
7.5
0335
Rhytidectomy, lower eyelids .......
60.0
0336
upper eyelids .......
40.0
0337
forehead .......
50.0
0338
glabellar frown .......
40.0
0339
cheeks, chin and neck .......
150.0
0340
Facial nerve paralysis, free fascia grafts .......
100.0
0341
re-animation-muscle transfers .......
120.0
(For nerve transfers, decompression or suture, see
								5350, 6002, 6003.)
BURNS-List percentage of body surface
								involved and depth of burn. Does not include skin grafts
0351
Initial treatment, first degree, where no more than
								local treatment necessary .......
1.5
0352
Dressings, initial or subsequent under anesthesia,
								small .......
4.0
0353
under anesthesia, large or with major debridement,
								per hour .......
10.0
0354
without anesthesia, small, office or hospital
								.......
2.0
0355
without anesthesia, medium (whole face or whole
								extremity, etc.) .......
3.0
0356
without anesthesia, large (more than one extremity,
								etc.) .......
4.0
Destruction
0401
Electro-surgical destruction with or without
								surgical curettement of facial nevi, leukoplakia, actinic or senile keratoses,
								or keratoacanthomas, to include local anesthesia, one lesion .......
3.0
(50% for each additional lesion up to a total of
								three; over three, each additional lesion 25%.)
0402
complicated lesion(s) .......
by report
0403
Electro-surgical destruction (except 0401 and 0402)
								or chemocautery (Mono-, Bi-, Tricholoracetic acid, phenol, etc.) or cryocautery
								(liquid N 2, CO 2, etc.) of
								benign or pre-malignant lesions of skin or mucous membrane (except 0405 and
								0406) with or without curettement one lesion .......
2.0
(50% for second lesion; over two, each additional
								lesion 25%.)
0404
complicated lesion(s) .......
by report
flat (plane, juvenile) warts, up to fifteen .......
2.0
(Retreatment same as routine office visit.)
0406
Electro-surgical destruction of multiple
								fibro-cutaneous tags, up to fifteen .......
2.0
0408
Chemosurgery, (Mohs type technique), malignancies of
								skin, includes removal of growth and microscopic delineation of margins and
								base,
first stage
-fulguration and application of chemicals
								.......
20.0
0409
each subsequent treatment, up to five sections
								.......
5.0
0410
each additional section over five .......
1.0
0411
Cryotherapy-(CO 2 slush,
								liquid N 2) .......
1.5
0412
Electrolysis epilation, each 1/2 hour .......
3.0
Breast
Incision
0430
Puncture aspiration of cyst .......
2.0
0431
Mastotomy with exploration or drainage of abscess,
								deep .......
10.0
Excision
0441
Biopsy of breast .......
15.0
0444
Excision of cyst, fibro-adenoma or other benign
								tumor, aberrant breast tissue, duct lesion (including gynecomastia) or nipple
								lesion (including any other partial mastectomy) male or female, unilateral
								.......
15.0
0445
bilateral .......
25.0
0446
Excision of chest wall tumor involving ribs .......
70.0
0447
Excision of chest wall tumor involving ribs plus
								plastic reconstruction .......
100.0
0457
Complete (simple) mastectomy .......
30.0
0470
Radical mastectomy, including breast, pectoral
								muscles and axillary lymph nodes .......
70.0
0481
Mammoplasty, plastic operation on breasts, reduction
								or repositioning, bilateral, one stage .......
150.0
0482
two stage .......
by report
0483
augmentation, prosthetic, unilateral .......
75.0
0484
bilateral .......
100.0
0485
derma-fat fascia, unilateral .......
100.0
MUSCULOSKELETAL
								  SYSTEM
Listed values include the application of
								first cast or traction device only.
Incision
0501
Aspiration or curette biopsy of bone marrow .......
3.0
0502
Needle (trocar) biopsy vertebra .......
10.0
0506
Incision of superficial soft tissue abscess
								secondary to osteomyelitis .......
2.0
0507
deep or complicated .......
by report
0513
Sequestrectomy for osteomyelitis or bone abscess
								.......
by report
0516
Removal of metal band, plate, screw or nail
								(independent procedure) .......
15.0
(For pins, etc., see 0598, 0599.)
OSTEOTOMY-Cutting, division or
								transection of bone, with or without internal fixation
0526
Clavicle .......
40.0
0527
Humerus .......
50.0
0529
Radius .......
40.0
0530
Ulna .......
40.0
0531
Femur, neck, under age 8 .......
80.0
0532
over age 8 .......
100.0
0533
subtrochanteric .......
80.0
0534
supracondylar .......
70.0
0536
Tibia .......
55.0
0537
Smaller bones (fibula, metacarpals, metatarsals,
								etc.) .......
30.0
0538
Correction of bowlegs or knock-knees, unilateral
								.......
50.0
0539
bilateral .......
75.0
(For iliac osteotomy, see 1341, 1342.)
0540
Multiple osteotomies, single bones for realignment
								on intrameduliary rod, Scofield type procedure, humerus .......
50.0
0541
radius or ulna .......
50.0
0542
femur .......
100.0
0543
tibia .......
75.0
Excision
0549
Biopsy bone, radius, ulna, fibula, skull, sternum
								.......
10.0
0550
humerus, pelvis, femur, tibia .......
20.0
0551
vertebra .......
40.0
(For needle biopsy, see 0502.) (Value of biopsy done
								preceding definitive surgery is 50 percent of listed value.)
0552
Claviculectomy, partial .......
35.0
0553
total .......
65.0
0554
Astragalectomy .......
55.0
0556
Excision of head of radius .......
35.0
0557
Carpectomy .......
30.0
0560
Coccygectomy .......
30.0
0561
Patellectomy or hemipatellectomy .......
50.0
0563
Metatarsectomy .......
25.0
0566
Excision of chondroma, osteochondroma, or exostosis;
								humerus, pelvis, femur, tibia, radius, fibula, ulna .......
40.0
0567
small bones .......
25.0
0568
Excision of bone cyst, simple, large bones .......
40.0
0569
small bones .......
25.0
(With autogenous bone graft, add 10.0 units to 0568,
								0569.)
0576
Partial ostectomy; partial excision of bone,
								craterization, guttering or saucerization of bone; diaphysectomy; humerus,
								pelvis, femur, tibia, fibula, radius, ulna .......
50.0
0577
small bones .......
25.0
0578
Excision of tumor of mandible without replacement
								.......
75.0
(For replacement see 0619.)
0580
Radical resection of bones for tumor with bone
								graft; scapula, humerus, pelvis, femur, tibia .......
100.0
0581
other bones .......
65.0
Introduction
(For associated procedures, see Fractures.)
0591
Insertion of wire, pin, caliper or tongs
								(independent procedure) .......
5.0
0598
Removal buried wire or pin (independent procedure)
								.......
2.0
0599
Removal of caliper or tongs (independent procedure)
								.......
1.0
Repair
0611
Osteoplasty; shortening of bone, femur, tibia,
								humerus .......
100.0
0612
radius, ulna .......
65.0
0613
other bones .......
45.0
0614
lengthing of bone .......
100.0
0616
mandible for prognathism or micrognathism, one or
								two stages .......
100.0
BONE OR CARTILAGE GRAFT-Osteoperiosteal
								graft, periosteal graft, or cartilage graft. Includes obtaining and placing of
								graft. Unless otherwise indicated, values are for autogenous grafts. When
								non-autogenous material is used, reduce value by 5.0 units.
0617
Bone graft; femur, tibia, humerus .......
100.0
0618
radius, ulna .......
65.0
0619
skull or significant portion of mandible .......
100.0
0620
other bones, including chin, nose, malar prominences
								.......
45.0
0621
Cartilage graft, autogenous, to face, nose, ear or
								skull .......
70.0
Spinal Fusion (For fusion of childgood scoliosis, see
								0643, 0644, 0645.)
(Items 0634-0642 refer to spinal procedures at
one
interspace; for each additional interspace, add 10%)
0634
Spinal fusion, cervical region, posterior technique
								.......
90.0
0635
anterior technique .......
80.0
0636
thoracic region, posterior or posterior-lateral
								technique .......
90.0
0637
interbody technique, anterior, lateral or posterior
								.......
100.0
0638
lumbar region, posterior or posterior-laterial
								technique .......
90.0
(For interbody technique, anterior see 0642.)
0639
Spinal fusion with removal of intervertebral disc,
								cervical region, posterior, technique .......
120.0
0640
anterior interbody technique .......
80.0
0641
lumbar or thoracic region, posterior,
								posterior-lateral, or posterior interbody technique .......
120.0
0642
anterior interbody technique .......
100.0
0643
Spinal fusion for scoliosis, child or young adult
								(less than 18 years of age), up to and including five interspaces .......
120.0
0644
Harrington rod technique .......
150.0
0645
Halo technique .......
150.0
(For adult scoliotic fusion see 0634-0642.)
0647
Scapulopexy .......
65.0
0648
Patellapexy .......
50.0
0649
Pectus excavatum, infants, plastic repair .......
25.0
0650
Pectus excavatum (major) plastic repair .......
90.0
0654
Epiphyseal-diaphyseal fusion; epiphyseal arrest;
								epiphysiodesis or stapling; femur .......
55.0
0655
tibia and fibula, proximal or distal .......
55.0
0656
combined distal femur and proximal tibia and fibula
								(knee) .......
75.0
0657
combined proximal and distal, tibia and fibula
								.......
75.0
0658
combined distal femur and proximal and distal tibia
								and fibula .......
100.0
0660
Hemi-epiphyseal arrest (e.g., for genu varus or genu
								valgus) distal femur .......
45.0
(For removal and reinsertion of staples at same
								operation, use values listed above.)
(For removal of staples only, 50% of listed
								values.)
(Free of bone adhesions, callus or synostosis,
								independent procedure, see Ostectomy.)
Fractures
Skull
0681
Skull, non-operative .......
Sv. ¶*
(Depressed with operation, see 5018, 5020.)
Facial Bones
0685
Nasal, simple or compound, no reduction .......
Sv. ¶
0686
uncomplicated (digital) closed reduction .......
5.0
0687
complicated (instrumental) closed reduction .......
10.0
0688
open reduction, uncomplicated .......
25.0
0689
complicated with either internal and/or external
								skeletal fixation .......
40.0
0690
with concomitant open reduction of fractured septum
								.......
60.0
0691
Malar, simple or compound, no reduction .......
Sv. ¶
0692
closed reduction (including towel clip technique)
								.......
5.0
0693
depressed, open reduction .......
30.0
0694
complicated, depressed, open reduction with internal
								skeletal fixation and multiple surgical approaches .......
65.0
0698
Maxilla, simple or compound, no reduction .......
Sv. ¶
0699
closed reduction, with wiring of teeth .......
30.0
0701
open reduction, with wiring of teeth and/or local
								fixation .......
50.0
0702
complicated, open reduction, fixation by head cap,
								multiple surgical approaches, internal fixation, wiring teeth, etc .......
by report
(For antral approach, see 1988.)
0703
Mandible, simple or compound, no reduction .......
Sv. ¶
0704
closed reduction and wiring of teeth .......
30.0
0705
open reduction with or without wiring of teeth
								.......
50.0
0706
skeletal pinning with external fixation .......
40.0
Spine and Trunk
0720
Vertebral process, one or more .......
Sv. ¶
0721
Vertebral body, one or more not requiring reduction
								.......
Sv. ¶
0722
requiring reduction .......
30.0
0732
Sacrum, simple not requiring reduction .......
Sv. ¶
0733
compound or complex .......
by report
0735
Coccyx, simple, not requiring reduction .......
Sv. ¶
0736
compound or complicated .......
by report
0740
Clavicle, simple, no reduction .......
Sv. ¶
0741
simple, closed reduction .......
15.0
0742
compound, including uncomplicated soft tissue
								closure .......
20.0
0743
simple or compound, open reduction .......
40.0
0747
Scapula, simple, no reduction .......
Sv. ¶
0748
simple or compound, open reduction .......
55.0
0756
Sternum, simple .......
Sv. ¶
0757
compound or complicated .......
by report
0761
Ribs, simple .......
Sv. ¶
0762
compound or complicated .......
by report
Pelvis (Illum, Ischlum,
								Pubis)
0767
Fracture, simple, no reduction .......
Sv. ¶
0768
complicated, closed reduction .......
by report
0771
compound, open reduction .......
75.0
0772
Acetabulum, with or without other fractures of
								pelvis, simple, no reduction .......
Sv. ¶
0773
central, with displacement, requiring closed
								reduction .......
55.0
0775
simple or compound, open reduction .......
75.0
Upper Extremity
0778
Humerus, surgical neck, simple, not requiring
								reduction .......
Sv. ¶
0780
requiring manipulative reduction .......
30.0
0781
compound, with uncomplicated soft tissue closure
								.......
35.0
0782
simple or compound, open reduction .......
50.0
0783
shaft, simple, not requiring reduction .......
Sv. ¶
0784
simple, closed reduction .......
25.0
0785
compound, with uncomplicated soft tissue closure
								.......
30.0
0786
simple or compound, open reduction .......
45.0
0787
simple or compound, open reduction, skeletal pinning
								with external fixation .......
40.0
0788
supracondylar or dicondylar, not requiring reduction
								.......
Sv. ¶
0789
closed reduction .......
25.0
0790
compound, with uncomplicated soft tissue closure
								.......
30.0
0791
simple or compound, open reduction .......
50.0
0792
medial or lateral condyle, simple, not requiring
								reduction .......
Sv. ¶
0793
closed reduction .......
20.0
0794
compound, with uncomplicated soft tissue closure
								.......
25.0
0795
simple or compound, open reduction .......
40.0
0796
Elbow, proximal end of ulna with dislocation of
								radial head simple, (Monteggia fracture) closed reduction .......
20.0
0797
simple or compound, open reduction (See also 1292.)
								.......
55.0
0798
Radius, head, simple, no reduction .......
Sv. ¶
0799
closed reduction .......
15.0
0800
compound, with uncomplicated soft tissue closure
								.......
20.0
0801
simple or compound, open reduction or excision (See
								also 0556.) .......
35.0
0802
shaft, simple, no reduction .......
Sv. ¶
0803
simple, closed reduction .......
20.0
0804
compound, with uncomplicated soft tissue closure
								.......
25.0
0805
simple or compound, open reduction .......
40.0
0806
distal end (e.g., Colle's type), simple, no
								reduction .......
Sv. ¶
0807
closed reduction .......
15.0
0808
with severe comminution and impaction, closed
								reduction .......
20.0
0809
simple or compound, open reduction .......
40.0
0810
skeletal pinning, with external fixation .......
30.0
0811
Ulna, proximal end, olecranon process, simple, no
								reduction .......
Sv. ¶
0812
compound, with uncomplicated soft tissue closure
								.......
25.0
0813
simple or compound, open reduction and/or resection
								.......
40.0
0814
shaft, simple, no reduction .......
Sv. ¶
0815
closed reduction .......
20.0
0816
compound, with uncomplicated soft tissue closure
								.......
25.0
0817
simple or compound, open reduction .......
40.0
0818
skeletal pinning with external fixation .......
30.0
0820
Radius and ulna shaft, simple, no reduction .......
Sv. ¶
0821
simple, closed reduction .......
25.0
0822
compound, with uncomplicated soft tissue closure
								.......
30.0
0823
simple compound, open reduction .......
50.0
0824
skeletal pinning with external fixation .......
40.0
(For Colle's fracture see 0806-0810.)
0827
Carpal bones, one or more, simple reduction .......
Sv. ¶
0830
simple or compound, open reduction .......
35.0
0840
Metacarpal, simple, no reduction .......
Sv. ¶
0842
one, simple or compound, closed reduction with
								uncomplicated soft tissue closure .......
10.0
0843
more than one, simple or compound, closed reduction,
								with uncomplicated soft tissue closure .......
12.5
0844
one or more, simple or compound, open reduction
								.......
30.0
0848
skeletal pinning with external fixation .......
25.0
0852
Phalanx or phalanges, finger, proximal, middle or
								thumb, simple, no reduction .......
Sv. ¶
0853
closed reduction .......
7.5
0854
compound, with uncomplicated soft tissue closure
								.......
10.0
0855
simple or compound, open reduction .......
20.0
0856
Phalanx or phalanges, distal, simple, no reduction
								.......
Sv. ¶
0857
simple or compound, closed reduction with
								uncomplicated soft tissue closure .......
5.0
0858
simple or compound, open reduction .......
12.5
Lower Extremity
0865
Femur, neck, simple, no reduction .......
Sv. ¶
0866
with fixation or traction .......
50.0
0867
simple or compound, open reduction .......
80.0
0868
multiple pinning, with or without external fixation
								.......
80.0
0869
treatment with replacement prosthesis .......
80.0
0872
intertrochanteric, simple, no reduction .......
Sv. ¶
0873
with fixation or traction .......
45.0
0874
simple or compound, open reduction .......
80.0
0877
slipped epiphysis, no reduction, treatment by
								traction, bed rest or cast application .......
Sv. ¶
0878
open reduction, single or multiple pinning or bone
								graft .......
80.0
0879
reconstruction .......
100.0
0880
shaft, including supracondylar, simple, no reduction
								.......
Sv. ¶
0881
simple, closed reduction .......
40.0
0882
compound, with uncomplicated soft tissue closure
								.......
45.0
0883
simple or compound, open reduction .......
80.0
0884
skeletal pinning with external fixation .......
60.0
0885
distal end, medial or lateral condyle, simple, no
								reduction .......
Sv. ¶
0886
condyle or condyles, simple, closed reduction
								.......
35.0
0887
simple or compound, open reduction .......
60.0
0889
Patella, simple, no reduction .......
Sv. ¶
0890
compound, with uncomplicated soft tissue closure
								.......
25.0
0891
simple or compound, open reduction .......
50.0
0893
Tibia, proximal end, tibial plateaus, condyle,
								condyles or intercondylar spines, simple, no reduction .......
Sv. ¶
0894
closed reduction .......
25.0
0895
compound, with uncomplicated soft tissue closure
								.......
30.0
0896
simple or compound, open reduction .......
55.0
0901
shaft, simple, no reduction .......
Sv. ¶
0902
closed reduction .......
25.0
0903
compound, with uncomplicated soft tissue closure
								.......
30.0
0904
simple or compounded, open reduction .......
50.0
0905
simple or compound, open or "blind" insertion of
								intramedullary rod (e.g., Lottes nail) .......
50.0
0907
distal end, malleolus, simple, no reduction .......
Sv. ¶
0908
simple, closed reduction .......
15.0
0909
compound, with uncomplicated soft tissue closure
								.......
20.0
0910
simple or compound, open reduction .......
40.0
0914
Fibula, shaft, simple, no reduction .......
Sv. ¶
0915
compound, with uncomplicated soft tissue closure
								.......
20.0
0916
simple or compound, open reduction .......
30.0
0920
distal end, malleolus, simple, no reduction .......
Sv. ¶
0921
closed reduction .......
15.0
0922
compound, with uncomplicated soft tissue closure
								.......
20.0
0923
simple or compound, open reduction .......
40.0
0925
Tibia and fibula, shafts, simple, no reduction
								.......
Sv. ¶
0926
closed reduction .......
30.0
0927
compound, with uncomplicated soft tissue closure
								.......
35.0
0928
simple or compound, open reduction .......
60.0
0930
skeletal pinning with external fixation .......
40.0
0932
Ankle, bimalleolar (including Potts) simple, no
								reduction .......
Sv. ¶
0933
simple, closed reduction .......
25.0
0934
compound, with uncomplicated soft tissue closure
								.......
30.0
0935
simple or compound, open reduction .......
50.0
0937
trimalleolar, simple, no reduction .......
Sv. ¶
0938
closed reduction .......
30.0
0940
compound, with uncomplicated soft tissue closure
								.......
35.0
0941
simple or compound, open reduction .......
60.0
0943
Tarsal (except astragalus and os calcis) one or
								more, simple, no reduction .......
Sv. ¶
0944
closed reduction .......
10.0
0945
compound, with uncomplicated soft tissue closure
								.......
15.0
0946
simple or compound, open reduction .......
30.0
0954
Astragalus, simple, no reduction .......
Sv. ¶
0955
simple, closed reduction .......
20.0
0956
compound, with uncomplicated soft tissue closure
								.......
25.0
0957
simple or compound, open reduction .......
55.0
0960
Os calcis, simple, no reduction .......
Sv. ¶
0961
closed reduction .......
20.0
0962
compound, with uncomplicated soft tissue closure
								.......
25.0
0963
simple or compound, open reduction .......
50.0
0964
skeletal pinning with external fixation .......
40.0
0966
Metatarsal, simple, no reduction .......
Sv. ¶
0967
closed reduction .......
10.0
0968
compound, with uncomplicated soft tissue closure
								.......
15.0
0970
simple or compound, open reduction .......
25.0
0975
Phalanx or phalanges, great toe, simple, no
								reduction .......
Sv. ¶
0976
simple, closed reduction .......
5.0
0977
simple or compound, open reduction .......
15.0
0979
other than great toe, simple, no reduction .......
Sv. ¶
0981
closed reduction .......
5.0
0982
simple or compound, open reduction .......
12.5
Joints
Incision
ARTHROTOMY or capsulotomy with
								exploration, drainage, or removal of loose body, e.g., osteochondritis of
								foreign body.
1001
Shoulder .......
50.0
1002
Elbow .......
50.0
1003
Wrist .......
40.0
1005
Other joints of upper extremity .......
30.0
1006
Finger, one .......
15.0
1007
Hip .......
70.0
1008
Knee .......
50.0
(For miniscectomy, see 1082.)
1010
Ankle .......
50.0
1013
Other joints of lower extremity .......
30.0
1020
Toe, great toe .......
15.0
1026
other .......
10.0
1044
Arthrocentesis; puncture for aspiration of
								hemarthrosis, initial .......
3.0
1045
subsequent .......
2.0
1046
puncture for aspiration of joint effusion (not
								traumatic), or injection of medication, initial or subsequent .......
2.0
1050
Sesamoid bone, excision, one or more, unilateral
								.......
15.0
Excision
ARTHRECTOMY-Excision of joint (See also
								Arthrodesis.)
1065
Temporomandibular joint, unilateral .......
75.0
1074
Excision of intervertebral disc .......
90.0
(See also 5208-5211.)
(With spinal fusion, see 0639-0642.)
(For laminectomy for spondylolisthesis, see
								5225.)
1082
Meniscectomy: excision of semilunar cartilage of
								knee joint .......
50.0
1085
temporomandibular joint .......
75.0
1093
Synovectomy elbow .......
70.0
1101
hip .......
80.0
1102
knee .......
70.0
1103
ankle .......
50.0
Introduction
1131
Injection procedure for arthography .......
3.0
Repair
ARTHROPLASTY-Plastic or reconstructive
								operation on joint, any type unless otherwise specified.
1141
Shoulder (See also 1200, 1201.) .......
80.0
1142
Elbow .......
80.0
1143
Wrist .......
80.0
1144
Finger, one joint .......
30.0
1148
Hip, cup .......
100.0
1149
replacement prosthesis, primary for fracture .......
80.0
1150
secondary reconstruction .......
100.0
(For acetabuloplasty, either 1148 or 1150, add 25% to
								listed values.)
1151
Knee .......
100.0
1152
Ankle .......
75.0
1154
Toe, one joint .......
20.0
1159
Metatarsal-phalangeal joint; bunion operation,
								Silver type .......
20.0
1160
Keller, McBride, etc., types .......
30.0
1162
Joplin type .......
35.0
1163
Club foot corrective procedure, medial release,
								Brockman type .......
30.0
ARTHRODESIS-Fusion of joint (For spine
								see 0634-0645.)
1166
Shoulder .......
90.0
1167
Elbow .......
70.0
1168
Wrist .......
60.0
1170
Finger, thumb, one joint .......
20.0
1175
Hip .......
100.0
1176
Knee .......
80.0
1177
Ankle .......
70.0
1178
Toe, one or more joints .......
15.0
1179
Hammer toe operation, one toe (
e.g.,
inter-phalangeal fusion, filleting, phalanectomy)
								.......
20.0
1183
Tarsal joints, one or more (
e.g.,
Grice procedure) .......
50.0
1184
Other joints, lower extremity .......
40.0
1185
Foot, triple arthrodesis, unilateral under age 14
								years .......
50.0
1186
over age 14 years .......
60.0
With tendon transplantation see 1585, 1586
Suture
CAPSULORRAPHY OR RECONSTRUCTION
1200
Shoulder, suture or repair of joint capsule for
								recurrent dislocation (independent procedure), Putti-Platt, Magnusen types
								.......
70.0
1201
Bankart type .......
80.0
1206
Patella (See also 0561, 1352, 1632.) .......
60.0
1211
Knee, suture of a torn, ruptured or severed
								collateral ligament .......
55.0
1212
suture of a torn, ruptured or severed cruciate
								ligament .......
55.0
1213
suture of torn, ruptured or severed collateral and
								cruciate ligaments .......
75.0
1214
reconstruction of a collateral or cruciate ligament
								.......
65.0
1215
both collateral or cruciate ligaments .......
85.0
1216
Ankle, reconstruction of a collateral ligament,
								ankle .......
45.0
1217
both ligaments .......
60.0
1218
Hand, reconstruction, metacarpophalangeal or
								interphalangeal ligaments .......
35.0
Manipulation
Manipulation of joint under general anesthesia,
								including application of fixation apparatus (dislocation excluded).
(For club feet and turnbuckle casts, see section on
								cast.)
1221
Shoulder .......
5.0
1222
Elbow .......
4.0
1223
Wrist .......
4.0
1224
Digits, one or more, under anesthesia, where no
								other surgical procedure is performed .......
2.5
1226
Hip .......
6.0
1227
Knee .......
5.0
1228
Ankle .......
4.0
1232
Spine .......
6.0
Dislocations
1251
Temporomandibular, simple, closed reduction, initial
								.......
5.0
1252
subsequent .......
1.0
1255
Vertebra, cervical, simple, closed reduction, using
								traction .......
Sv. ¶
1256
closed reduction with anesthesia .......
55.0
1262
thoracic, simple, closed reduction with anesthesia
								.......
55.0
1264
simple or compound, open reduction .......
100.0
1267
lumbar, simple, closed reduction with anesthesia
								.......
55.0
1270
simple or compound, open reduction .......
100.0
1273
Clavicle, sternoclavicular, simple, no reduction
								.......
Sv. ¶
1274
closed reduction with anesthesia .......
10.0
1275
simple or compound, open reduction .......
40.0
1278
acromioclavicular, simple, no reduction .......
Sv. ¶
1279
closed reduction with anesthesia .......
10.0
1281
simple or compound, open reduction .......
40.0
1284
Shoulder (humerus), simple, closed reduction without
								anesthesia .......
Sv. ¶
1285
with anesthesia .......
5.0
1286
simple or compound, open reduction .......
55.0
1290
Elbow, simple, closed reduction .......
5.0
1291
compound, with uncomplicated soft tissue closure
								.......
25.0
1292
simple or compound, open reduction .......
55.0
1295
Wrist, carpal, one bone, simple, closed reduction
								.......
5.0
1296
compound, with uncomplicated soft tissue closure
								.......
25.0
1297
simple or compound, open reduction .......
45.0
1298
more than one bone, simple, closed reduction .......
7.0
1300
compound, with uncomplicated soft tissue closure
								.......
25.0
1301
simple or compound, open reduction .......
45.0
1304
Metacarpal, one bone, simple, closed reduction
								.......
3.0
1305
compound, with uncomplicated soft tissue closure
								.......
10.0
1306
simple or compound, open reduction .......
20.0
1315
Finger, one, one or more joints, simple, closed
								reduction .......
3.0
1316
compound, with uncomplicated soft tissue closure
								.......
7.5
1317
simple or compound, open reduction .......
15.0
1326
Thumb, simple, closed reduction .......
4.0
1327
compound, with uncomplicated soft tissue closure
								.......
10.0
1328
simple or compound, open reduction .......
20.0
1332
Hip (femur), simple, closed reduction .......
20.0
1334
simple or compound, open reduction .......
60.0
1338
congenital, abduction splinting or traction in any
								form .......
Sv. ¶
1339
congenital, closed reduction with anesthesia .......
20.0
1340
congenital, open reduction and replacement of
								femoral head in acetabulum .......
60.0
1341
iliac or acetabular osteotomy, (
e.g.,
Pemberton or Salter type), under age 8 .......
80.0
1342
over age 8 .......
100.0
(For dislocated or slipped femoral head epiphyses,
								see 0877-0879.)
1344
Knee (femoral-tibial joint), simple, closed
								reduction .......
20.0
1345
compound, with uncomplicated soft tissue closure
								.......
25.0
1346
simple or compound, open reduction .......
60.0
1350
Patella, simple, closed reduction .......
3.0
1351
compound, with uncomplicated soft tissue closure
								.......
15.0
1352
simple or compound, open reduction (with or without
								partial or total patellectomy) .......
50.0
(See also 0561, 1206 and 1632.)
1354
Distal tibial-fibular joint (ankle mortise), open
								reduction and fixation .......
45.0
1355
Ankle, simple, closed reduction .......
10.0
1356
compound, with uncomplicated soft tissue closure
								.......
25.0
1357
simple or compound, open reduction .......
50.0
1361
Tarsal, simple, closed reduction .......
10.0
1362
compound, with uncomplicated soft tissue closure
								.......
17.5
1363
simple or compound, open reduction .......
45.0
1371
Astragalo-tarsal, simple, closed reduction .......
10.0
1372
compound, with uncomplicated soft tissue closure
								.......
17.5
1373
simple or compound, open reduction .......
45.0
1376
Metatarsal, one bone, simple, closed reduction
								.......
7.0
1377
compound, with uncomplicated soft tissue closure
								.......
12.0
1378
simple or compound, open reduction .......
25.0
1385
Toe, one, simple, closed reduction .......
2.0
1386
compound, with uncomplicated soft tissue closure
								.......
7.0
1387
simple or compound, open reduction .......
15.0
1391
multiple joints and/or toes, simple, closed
								reduction .......
7.0
1392
compound, with uncomplicated soft tissue closure
								.......
12.0
1393
simple or compound, open reduction .......
20.0
Bursae
Incision
1401
Drainage of infected bursa .......
3.0
1406
Removal of subdeltoid calcium deposits .......
25.0
1410
Removal of subtrochanteric calcium deposits .......
30.0
1413
Needle puncture of bursa, with or without
								aspiration, injection or irregation, initial or subsequent .......
2.0
Excision
1430
Radical excision of bursa, hand, wrist or forearm, (
i.e.,
tenosynovitis fungosa, Tbc., and other granulomas)
								.......
50.0
1431
Excision of bursa, olecranon .......
20.0
1433
prepatellar .......
20.0
1435
subacromial (subdeltoid) .......
25.0
1436
peritrochanteric, femur .......
30.0
(For popliteal see 1562.)
Muscles
Incision
1450
Removal of foreign body in muscle, with anesthesia
								.......
by report
1454
Division of scalenus anticus, without resection of
								cervical rib .......
35.0
1456
with resection of cervical rib .......
50.0
1458
Division of sternocleidomastoid for torticollis open
								operation .......
35.0
1460
Muscle biopsy, superficial .......
5.0
1462
deep .......
10.0
Suture
1495
Suture of ruptured diaphragm, chronic,
								transabdominal .......
70.0
1496
transthoracic or combined .......
80.0
1497
acute, traumatic .......
by report
(For other specific muscles, see 1633, 1640,
								1654.)
Tendons, Tendon Sheaths and
								  Fascia
Incision
1511
Drainage of tendon sheath, acute suppurative
								tenosynovitis, one digit .......
3.0
1514
single palmar and/or ulnar or radial bursa .......
30.0
1515
multiple or complicated .......
by report
1517
Injection of medication, tendon sheath .......
2.0
1519
Incision of fibrous sheath of tendon for stenosing
								tenosynovitis, including freeing of tendons or removal of foreign body .......
20.0
1531
Division of iliotibial band, open operation .......
30.0
1534
Stripping of ilium (Soutter operation) .......
40.0
Tenotomy
1535
Tenotomy, subcutaneous, corrective, single digit
								.......
5.0
1536
multiple digits .......
7.5
1537
adductor, hip .......
10.0
1538
open, elbow to shoulder, single .......
20.0
1539
multiple .......
25.0
1540
elbow to wrist, single .......
15.0
1541
multiple .......
25.0
1542
knee to hip, single .......
30.0
1543
multiple .......
40.0
1544
knee to thigh, single .......
15.0
1545
multiple .......
30.0
Excision
1550
Excision of lesion of tendon or fibrous sheath, or
								ganglion, digits only .......
10.0
1553
in other locations .......
15.0
(For radical excision of bursa, forearm,
i.e.,
tenosynovitis fungosa, Tbc., and other granulomas, see
								1430.)
1562
Excision of synovial cyst of popliteal space
								(Baker's cyst) .......
30.0
1570
Fasciotomy, palmar plantar, subcutaneous .......
10.0
1573
Fasciectomy, for Dupuytren's contracture, partial
								.......
30.0
1574
radical, including finger extensions and vertical
								bands .......
50.0
Repair
Includes necessary initial dressing (including cast
								and/or splint application.)
1580
Repair or suture of an extensor tendon, primary or
								late, hand or foot, distal to wrist or ankle .......
12.0
1582
forearm or leg .......
18.0
1583
Repair or suture of a flexor tendon, primary or
								late, finger, hand or forearm foot or leg .......
30.0
1585
Transfer, transplant or free tendon graft, distal to
								elbow, or distal to knee, single .......
40.0
1586
multiple .......
50.0
1587
elbow to shoulder or knee to hip, single .......
50.0
1588
multiple .......
60.0
1589
Tenolysis, single .......
25.0
1590
multiple (any number through same incision) .......
30.0
1591
Lengthening or shortening of tendon (
e.g.
Achilles' tendon) .......
30.0
(Retrieve or reroute tendon through separate
								incision, add 25 percent of appropriate fee.)
1593
Multiple tendons and/or other structures through
								same incision or wound .......
by report
1612
Free fascial graft for reconstruction of tendon
								pulley or gliding surface, etc. .......
15.0
1616
Abdominal fascial transplants, bilateral (Lowman
								type procedure) .......
75.0
(For free fascial graft to face see 0340.)
1618
Fascia lata transplants, other .......
by report
1632
Patellar (extensor mechanism) advancement, with or
								without patellectomy .......
60.0
1633
Ruptured quadirceps insertion .......
45.0
1635
Ruptured Achilles' tendon from insertion at heel
								.......
45.0
1639
Ruptured long head of biceps, proximal .......
35.0
1640
Ruptured biceps tendon from insertion at elbow
								.......
45.0
1641
Flexor-plasty, elbow (e.g., Steindler type
								advancement or extensor release) .......
30.0
1654
Repair ruptured supraspinatus tendon or
								musculotendinous cuff shoulder, acute .......
50.0
1655
Repair of complete shoulder cuff avulsion, chronic
								.......
70.0
Extremities
Incision
1681
Drainage of felon, superficial .......
2.0
1682
in hospital .......
5.0
(For drainage of single or multiple infected spaces
								of hand, lumbrical, hypothenar, thenar, middle palmar, etc. with or without
								tendon sheath involvement, see 1514, 1515.)
Amputation
UPPER EXTREMITY:
1701
Interthoracoscapular .......
100.0
1703
Disarticulation of shoulder .......
75.0
1705
Arm through humerus .......
40.0
1708
Forearm, through radius and ulna .......
40.0
1709
Open (Guillotine) arm .......
35.0
1710
secondary closure or minor scar revision .......
5.0
1711
reamputation .......
40.0
1713
Cineplasty, complete procedure .......
75.0
1718
Disarticulation through wrist or amputation of hand
								through metacarpal bones .......
40.0
1725
Metacarpal, with finger or thumb, one, with or
								without split or Wolff graft, or skin-plasty and/or tenodesis, with or without
								resection of digital nerves .......
30.0
1737
Digit (finger or thumb), any joint or phalanx, one,
								with or without split or Wolff graft, or skin-plasty and/or tenodesis, with or
								without resection of digital nerves .......
15.0
LOWER EXTREMITY:
1745
Interpelviabdominal .......
by report
1748
Disarticulation of hip .......
80.0
1750
Disarticulation of knee .......
40.0
1752
Thigh, through femur, including supracondylar
								.......
60.0
1760
open (Guillotine) .......
50.0
1761
secondary closure or minor revision .......
5.0
1763
reamputation .......
60.0
1767
Leg, through tibia and fibula .......
50.0
1771
open (Guillotine) .......
40.0
1772
secondary closure or minor revision .......
5.0
1774
re-amputation .......
50.0
1778
Ankle (Syme, Pirogoff types), with skin-plasty and
								resection of nerves .......
50.0
1782
Midtarsal .......
35.0
1785
Foot, transmetatarsal .......
35.0
1788
Metatarsal with toe, with or without split or Wolff
								graft, or skin-plasty and/or tenodesis, with or without resection of digital
								nerves .......
25.0
1802
Toe, one, with or without split or Wolff graft, or
								skin-plasty and/or tenodesis, with or without resection of digital nerves
								.......
10.0
1803
more than one .......
15.0
Repair
1811
Freeing of web fingers, with flaps .......
35.0
1815
with skin graft .......
45.0
1816
complex .......
by report
Plaster Casts (Independent
								  Procedure Only)
(Excluding Cost of
								  Materials)
1840
Club-foot cast
with molding or
								manipulation, long or short leg, under age of 24 months, single .......
2.0
1841
bilateral .......
3.5
(If over age 24 months, see casts, general.)
1842
Wedging
club-foot cast
single
								.......
1.0
1843
bilateral .......
1.5
(For children 10 years of age or under, reduce listed
								values 1851-1890 by 30%.)
1851
Molded plaster to forearm (splint) .......
2.0
1854
Elbow to fingers (short arm) .......
2.0
1856
Hand and wrist (gauntlet) .......
2.0
1860
Shoulder to hand (full arm) .......
3.0
1862
Shoulder spica .......
6.0
1863
Thigh-foot, molded splint .......
3.0
1864
Leg-foot, molded splint .......
2.0
1865
Ankle (foot to midleg) (short leg) .......
3.0
1867
Knee (foot to thigh) (long leg) .......
4.0
1871
Ambulatory leg cast (walking boot cast) .......
3.5
1878
Hip spica, unilateral .......
7.0
1882
bilateral .......
8.0
1884
Body, shoulder to hips .......
8.0
1885
including head .......
10.0
1886
Risser jacket, localizer, body only .......
12.5
1887
including head .......
15.0
1888
Turnbuckle jacket, body only for scoliosis .......
12.5
1889
including head .......
15.0
1890
"Halo" type fixation and cast .......
20.0
1891
Unna boot .......
2.0
1896
large, (e.g., long leg, shoulder or hip spica,
								Minerva, Calot jacket, turnbuckle, etc.) .......
2.0
1897
Repair of spica, body cast or jacket .......
3.0
(For change of cast, unit value will be that of
								application only.)
RESPIRATORY
								  SYSTEM
Nose
Incision
1901
Drainage of nasal abscess or hematoma .......
2.0
1905
Drainage of septal abscess or hematoma .......
2.5
Excision
1911
Biopsy, soft tissue, nose .......
3.0
1916
Excision of nasal polyp(s) one or more, unilateral
								or bilateral, one or more stages, office .......
7.0
1917
complicated, requiring hospitalization .......
20.0
(For excision of nasopharyngeal fibroma, see
								3006.)
1924
Excision or surgical planning of skin of nose for
								rhinophyma .......
35.0
1928
Submucous resection, classic, nasal septum .......
30.0
(For septoplasty, see 1952.)
1935
Resection of inferior turbinate (submucous),
								complete or partial, unilateral or bilateral (independent procedure) .......
15.0
Endoscopy
1941
Removal of intranasal foreign body by rhinoscopy
								.......
2.0
1942
by lateral rhinotomy .......
by report
Repair
See also Repair-Complex 0260-0324, and 0620,
								0621.)
1950
Rhinoplasty, lateral and alar cartilages and/or
								elevation of nasal tip .......
40.0
1951
complete, external parts including bony pyramid,
								lateral and alar cartilages, and/or elevation of nasal tip .......
80.0
1952
including major septal repair .......
90.0
1953
secondary minor revision .......
15.0
(For total or major partial reconstruction, see
								0260-0324, 0620, 0621.)
(For nasal bridge collapse, bone or cartilage graft,
								see 0620, 0621.)
1954
Septoplasty, (not 1928) independent procedure
								.......
40.0
1959
Repair choanal altresia, intranasal .......
10.0
1960
transpalantine .......
60.0
1961
Lysis of synechia .......
2.0
1962
Repair of oromaxillary fistula .......
by report
1963
with radical antrotomy .......
50.0
1964
Repair oronasal fistula .......
20.0
1965
Reconstruction, functional, of the internal nose
								.......
40.0
Destruction
1966
Cauterization of turbinates, unilateral or bilateral
								(independent procedure) .......
2.0
Manipulation
(For reduction of fracture, see 0685-0690.)
1971
Nasal hemorrhage, anterior, control of, unilateral
								or bilateral, with or without cauterization or anterior packs .......
2.0
1973
posterior, with cauterzation or posterior nasal
								packs, with or without anterior pack, initial .......
10.0
1974
subsequent .......
2.0
1978
by ligation of anterior ethmoidal artery .......
30.0
Accessory
								  Sinuses
Incision
1981
Antrum lavage. puncture or natural ostium,
								unilateral .......
2.0
1982
bilateral .......
3.0
1983
Antroscopy .......
4.0
1985
Antrotomy, intranasal, unilateral .......
15.0
1986
bilateral .......
25.0
1988
Radical (Caldwell-Luc), unilateral .......
50.0
1989
bilateral .......
65.0
1991
Sphenoid sinusotomy .......
30.0
1992
Frontal sinusotomy, external, simple (trephine
								operation) .......
20.0
1993
transorbital, unilateral .......
40.0
1994
radical, obliterative .......
60.0
1995
Combined external frontal, ethmoidal and sphenoidal
								sinusotomy, unilateral .......
80.0
Excision
2006
Ethmoidectomy, intranasal or external, unilateral
								.......
30.0
2017
Maxillectomy, unilateral, with or without orbital
								exenteration and/or lateral rhinotomy .......
100.0
2019
Hypophisectomy, transeptal .......
70.0
(See also 5130.)
Larynx
Incision
2041
Laryngofissure with removal of tumor or laryngocele
								.......
60.0
2042
Thyrotomy, diagnostic .......
35.0
2043
for laryngeal web, two stage, with Keel insertion,
								(McNaught type) .......
90.0
2044
for laryngeal stenosis with graft or core mold,
								including tracheotomy .......
by report
Excision
2051
Laryngectomy, without neck dissection .......
100.0
2054
with neck dissection .......
140.0
2055
Hemilaryngectomy .......
60.0
2056
Arytenoidectomy, external approach (See also 2084.)
								.......
70.0
2057
Epiglottidectomy, external approach .......
60.0
2058
endoral approach .......
25.0
Introduction
2060
Injection procedure for bronchography, indirect
								method .......
3.0
2061
with insertion of catheter, (independent procedure)
								.......
4.0
2062
Endotracheal intubation, emergency procedure .......
5.0
Endoscopy
2070
Laryngoscopy, indirect with biopsy .......
4.0
2071
direct, diagnostic (independent procedure) .......
10.0
2072
operative, including foreign body removal .......
30.0
2073
with biopsy .......
15.0
2074
including excision of tumor .......
25.0
2075
with Lynch suspension .......
30.0
2084
Endoscopic arytenoidectomy .......
50.0
Trachea and
								  Bronchi
Incision
2101
Tracheotomy (independent procedure) .......
20.0
2102
Tracheal fenestration .......
50.0
Endoscopy
2111
Bronchoscopy, diagnostic .......
15.0
2113
with biopsy .......
20.0
2117
with removal of foreign body .......
25.0
2120
with excision of tumor .......
25.0
2121
with therapeutic aspiration of bronchus .......
15.0
2122
with drainage of lung abscess or cavity, initial
								.......
15.0
2123
with injection of contrast media .......
15.0
2124
subsequent .......
10.0
2126
Catheterization for bronchospirometry (independent
								procedure) (exclusive of gas analysis) .......
10.0
2127
Tracheal aspiration (independent procedure) under
								direct vision .......
10.0
2128
indirect .......
1.0
Repair
2131
Tracheoplasty: plastic operation on trachea,
								cervical .......
by report
2132
intrathoracic .......
by report
2133
Bronchoplasty, graft repair .......
by report
2134
excision of stenosis and anastomosis .......
by report
2135
with lobectomy and anastomosis .......
by report
Suture
2141
Tracheorrhaphy: suture of external tracheal wound or
								injury, depending on structure and extent of injury, cervical .......
by report
2142
intrathoracic .......
by report
2144
Closure of tracheostomy or tracheal fistula .......
25.0
2147
Closure of tracheo-esophageal fistula .......
90.0
2148
complicated .......
by report
Incision
2151
Thoracotomy, exploratory, including biopsy .......
50.0
2152
including control of hemorrhage and/or repair of
								lung fistula .......
75.0
2153
for postoperative complications .......
75.0
2154
with open drainage of empyema cavity by rib
								resection (independent procedure) .......
40.0
2155
with cyst removal .......
75.0
2157
with closed drainage of empyema cavity; tube
								drainage with negative pressure (independent procedure), in hospital .......
5.0
2160
with removal of intrapleural foreign body or fibrin
								body .......
70.0
2161
with cardiac massage .......
by report
2163
with open intrapleural pneumonolysis (See also
								2207.) .......
75.0
2170
Pneumonotomy, with open drainage of pulmonary
								abscess or cyst .......
60.0
2173
with removal of foreign body from lung .......
75.0
2177
Decortication, pulmonary, total .......
100.0
2180
Pneumonocentesis: puncture of lung for aspiration
								biopsy .......
5.0
2183
Thoracentesis: puncture of pleural cavity for
								aspiration, initial or subsequent .......
3.0
Excision
2191
Pneumonectomy, total .......
100.0
2193
Lobectomy, total, subtotal or segmental .......
100.0
2194
with concomitant decortication .......
125.0
2195
Wedge resection, single or multiple .......
80.0
2196
Pulmonary resection with concomitant thoracoplasty
								.......
150.0
2197
Pleurectomy, any type (independent procedure)
								.......
50.0
Endoscopy
2201
Thoracoscopy, exploratory (independent procedure)
								.......
20.0
2204
with biopsy .......
20.0
2207
Closed intrapleural pneumonolysis .......
30.0
Surgical Collapse
								Therapy
Thoracoplasty
2211
Extrapleural resection of ribs, any type, first
								stage .......
60.0
2212
second stage .......
30.0
2213
third stage .......
30.0
2217
Extrapleural pneumonolysis, including associated
								filling or packing procedures .......
60.0
2218
Extraperiosteal pneumonolysis, including associated
								filling or packing procedures .......
70.0
2221
Pneumothorax: intrapleural injection of air, initial
								.......
5.0
2222
subsequent .......
2.0
CARDIOVASCULAR
								  SYSTEM
Heart and
								  Pericardium
Values for principal surgeon only.
Incision
2301
Cardiotomy, exploratory (includes removal of foreign
								body) .......
100.0
2305
Pericardiotomy with exploration, drainage or removal
								of foreign body .......
100.0
2309
pericardiocentesis, initial .......
5.0
2310
subsequent .......
4.0
2311
Blalock-Hanlon procedure (creation of atrial-septal
								defect) (closed) .......
150.0
Excision
2316
Pericardiectomy, extensive .......
120.0
2317
Excision intracardiac tumor .......
200.0
2319
Infundibular stenosis .......
by report
Introduction
Listed values include usual preassessment
								of clinical problem and recording of intracardiac pressures.
2330
Catheterization of heart, including recording of
								intracardiac pressures where indicated (independent procedure) right .......
35.0
2331
left, percutaneous .......
15.0
2332
trans-septal .......
20.0
2333
retrograde .......
20.0
2334
combined left and right .......
45.0
2335
final evaluation and report only .......
5.0
Suture
2337
Cardiorrhaphy: suture of heart wound or injury
								.......
100.0
Repair
2340
Aortic valve, valvotomy (commissurotomy) (closed)
								.......
150.0
2341
valvuloplasty for stenosis or insufficiency (open)
								.......
200.0
2342
replacement (open) .......
200.0
2343
Pulmonic valve, valvotomy (commissurotomy) (closed)
								.......
150.0
2344
valvotomy; infundibular stenosis (open) .......
200.0
2345
Mitral valve, valvotomy (commissurotomy) (closed)
								.......
140.0
2346
valvuloplasty for stenosis or insufficiency (open)
								.......
200.0
2347
replacement (open) .......
200.0
2348
Tricuspid valve .......
by report
2349
Coronary endarterectomy, myocardial
								revascularization by implantation or anastomosis .......
100.0
2350
Myocardial aneurysm .......
200.0
2351
Atrial septal defect (secundum type; endocardial
								cushion defect) (open) .......
180.0
2352
Ventricular septal defect (open) .......
180.0
2353
Tetralogy of Fallot (with or without previous shunt)
								(open) .......
200.0
2354
Aortic sinus of Valsalva fistula (open) .......
200.0
2355
Repair anomaleus pulmonary venous connection, total
								(open) .......
200.0
2356
Insert internal pacemaker with myocardial
								electrodes, initial .......
100.0
2357
replacement or repair .......
30.0
2358
Pervenous or transvenous insertion of a pacemaker
								and subcutaneous implantation of a battery .......
50.0
2359
Subcutaneous implantation of a battery (used with
								code 2330, right heart catheterization, currently in fee schedule) .......
18.75
Arteries and
								  Veins
Incision
Arteriotomy - With removal of
								embolus:
2373
Trunk .......
80.0
2374
Neck .......
60.0
2375
Extremity .......
60.0
Phlebotomy - With removal of
								thrombus:
2380
Trunk .......
70.0
2381
Extremity .......
45.0
Excision
2390
Thromboendarterectomy, abdominal aorta and iliac
								arteries and/or femoral arteries .......
150.0
2392
femoral and/or popliteal arteries .......
120.0
2394
carotid artery .......
120.0
2400
Excision and graft or bypass graft of arch of aorta
								.......
by report
2404
Excision and graft, thoracic aorta .......
150.0
2408
abdominal aorta .......
150.0
2412
extremity .......
120.0
2420
Excision of arteriovenous fistula (See also 2474.)
								.......
by report
Introduction
2441
Venopuncture, withdrawal of venous blood,
								intravenous injection (femoral, internal or external jugular or sagittal sinus)
								for diagnostic study or introduction of intravenous therapy, up to three years
								of age .......
2.0
2442
scalp vein, for fluid therapy or indirect
								transfusion, up to three years of age .......
3.0
2443
Exposure of and incision into vein ("cutdown") for
								fluid therapy or indirect transfusion, under one year of age .......
4.0
2445
Blood transfusion, indirect method .......
2.0
2446
replacement type, infant, initial or subsequent
								.......
30.0
2448
direct method .......
5.0
2450
"push" transfusion, given under two years of age
								.......
5.0
2454
Injection of sclerosing solution into vein of leg,
								one .......
1.0
2455
two or more injections, same leg .......
2.0
Repair
2460
Repair aneurysm of aorta, lateral repair .......
150.0
2464
dissecting ("window" operation) .......
150.0
2466
Banding of pulmonary artery .......
100.0
2472
Repair of aortic arch anomalies (vascular ring)
								.......
120.0
2473
Repair of atrial septal defect .......
200.0
2474
Repair of arterio-venous fistula, plastic procedure
								.......
by report
(For aortic anastomosis, see also 2400-2408,
								2472.)
2475
Excision of coarctation of aorta with primary
								anastomosis (See also 2400-2408.) .......
150.0
2478
Pulmonary-subclavian anastomosis, Potts .......
150.0
2482
Blalock .......
120.0
2486
Pulmonary-superiorcaval anastomosis, Glenn .......
150.0
2487
Baffes procedure: inferior cava to left atrium-right
								pulmonary vein to right antrium .......
150.0
2490
Portocaval anastomosis .......
100.0
2496
Splenorenal anastomosis .......
100.0
Suture
2511
Arteriorrhaphy: suture of wound or injury of artery
								(independent procedure), trunk .......
60.0
2512
extremity .......
30.0
2515
Phleborrhaphy: suture of wound or injury of vein
								(independent procedure), trunk .......
60.0
2516
extremity .......
20.0
2520
Ligation and division of ductus arteriosus .......
100.0
2522
Ligation of carotid artery .......
40.0
2525
Ligation and division of inferior vena cava .......
60.0
2526
Ligation of femoral vein .......
25.0
2530
Ligation and division of common iliac vein .......
50.0
2558
Ligation and division of long saphenous vein at
								saphenofemoral junction, with or without retrograde injection or distal
								interruptions .......
20.0
2561
Ligation and division and complete stripping of long
								or short saphenous veins, unilateral .......
30.0
2562
bilateral .......
50.0
2563
long and short saphenous veins, unilateral .......
40.0
2565
bilateral .......
60.0
2576
Ligation and division of short saphenous vein at
								saphenopopliteal junction (independent procedure) .......
12.5
2581
minor varicose vein of leg, initial .......
5.0
2585
subsequent .......
3.0
Hemodialysis-Related Surgical
								Procedures
2590
Insertion of initial arterio-venous shunt (Including
								revisions during 21 follow-up days) .......
50.0
2591
Revision of either arterial or venous cannula
								.......
31.25
2592
Construction of arterio-venous fistula .......
50.0
HEMIC AND LYMPHATIC
								  SYSTEMS
Spleen
Excision
2601
Splenectomy .......
60.0
Introduction
2610
Injection procedure for splenoportography .......
10.0
Lymph Nodes and Lymphatic
								  Channels
Incision
2631
Drainage of lymph node abscess or lymphadenitis,
								simple .......
3.0
2632
extensive .......
by report
Excision
2641
Biopsy or excision of lymph node (independent
								procedure) (except 2642) .......
5.0
2642
anterior scalene .......
15.0
Radical Lymphadenectomy
(Radical resection of lymph nodes):
2651
Supra-hyoid, unilateral .......
50.0
2652
bilateral .......
60.0
2655
Cervical (complete), unilateral .......
80.0
2658
Axilla .......
50.0
2671
Groin, superficial .......
50.0
2672
deep, with common iliac dissection .......
80.0
2673
Retroperitoneal, extensive, including pelvic, aortic
								and renal dissection .......
100.0
Introduction
2676
Injection procedure for lymph-angiography,
								unilateral .......
10.0
2677
bilateral .......
15.0
MEDIASTINUM
Incision
2680
Mediastinotomy with exploration or drainage,
								cervical approach .......
40.0
2681
transthoracic .......
80.0
2683
Foreign body removal, cervical approach .......
70.0
2684
transthoracic .......
80.0
Excision
2691
Excision of mediastinal cyst .......
80.0
2693
Excision of mediastinal tumor .......
100.0
2696
Ligation or repair, thoracic duct .......
75.0
DIGESTIVE
								  SYSTEM
Mouth
Incision
2701
Drainage of sublingual abscess .......
2.0
2705
Drainage of Ludwig's angina .......
8.0
Lips
Excision
(For excision of mucocele see 0175-0178 or
								0260-0269.)
(For excision of small lesion of lip see 0175-0178 or
								0260-0269.)
2737
Vermilionectomy ("lip peel") .......
40.0
2739
Transverse wedge excision, lip .......
25.0
2743
V-excision of large lesion of lip up to one-half lip
								.......
25.0
2746
Resection of more than one-half lip without plastic
								closure .......
25.0
(With plastic closure, primary or secondary see
								0260-0324.)
Repair (Cheiloplasty)
2754
Plastic repair of cleft lip, primary, unilateral
								.......
70.0
2758
bilateral, one stage .......
90.0
2759
bilateral, two stages, per stage .......
60.0
(For secondary, local revision, unilateral or
								bilateral see 0260-0324.)
2762
Plastic repair (secondary) of unilateral cleft lip
								by recreation of defect and reclosure .......
70.0
2765
Plastic repair (secondary) of bilateral harelip by
								recreation of defect and reclosure-per major stage .......
60.0
(For plastic or reconstruction operation on lip see
								also 0260-0324.)
Tongue
Incision (Glossotomy)
2771
Drainage of lingual abscess .......
2.0
Excision (Glossectomy)
2781
Biopsy of tongue, anterior third .......
3.0
2782
posterior two-thirds .......
5.0
2785
Partial glossectomy or hemiglossectomy .......
40.0
2787
Complete or total glossectomy .......
70.0
Repair (Glossoplasty)
(For plastic repair of tongue see 0260-0324.)
Suture (Glossorrhaphy)
(For suture of injury see 0251, 0260-0270.)
Teeth and
								  Gums
Incision
2815
Drainage of alveolar abscess, acute with cellulitis,
								intraoral .......
2.0
2820a
General anesthesia for multiple extractions in
								hospital
Palate and
								  Uvula
Incision
2871
Incision and drainage of abscess of palate .......
2.0
Excision
2881
Biopsy of palate .......
3.0
(For excision of local lesion of palate see
								0175-0196, 0260-0270)
(For graft or flap closure see 0275-0283,
								0300-0304)
2885
Resection of palate or extensive excision of lesion
								of palate .......
40.0
(For resection of palate with reconstruction see
								0277-0283, 0312-0323.)
2887
Uvulectomy: excision of uvula .......
3.0
Repair
2890
Palatoplasty: plastic operation for cleft palate,
								partial .......
60.0
2892
complete, including alveolar ridge .......
80.0
2895
major revision .......
60.0
2897
secondary lengthening procedure .......
70.0
2898
attachment pharyngeal flap .......
60.0
2899
alveolar ridge, anterior palate defect .......
30.0
(For secondary minor revision see 0260-0270,
								0277-0283.)
Suture
For suture of palate injury see 0260-0270,
								0277-0283.)
Salivary Glands and
								  Ducts
Incision
2911
Drainage of parotid abscess .......
5.0
2912
Drainage of submaxillary abscess .......
5.0
2914
Sialolithotomy, submaxillary or parotid,
								uncomplicated .......
3.0
2915
Sialolithotomy, submaxillary, complicated .......
10.0
2916
Sialolithotomy, parotid extraoral .......
25.0
Excision
2921
Biopsy of salivary gland .......
5.0
2927
Excision of parotid tumor or gland, superficial
								without nerve dissection .......
20.0
2928
with nerve dissection .......
60.0
2934
Excision of parotid gland, total, with dissection of
								facial nerve .......
70.0
2937
with sacrifice of facial nerve .......
60.0
2938
Excision of submaxillary tumor and/or gland .......
40.0
Repair
								(Sialodochoplasty)
2941
Plastic repair of salivary duct, simple .......
35.0
2942
complicated .......
by report
Introduction
2945
Injection procedure for sialography .......
1.0
Suture
2951
Closure of salivary fistula .......
40.0
Manipulation
2961
Dilation of salivary duct; ptyalectasis .......
1.0
Pharynx, Adenoids and
								  Tonsils
Incision
2970
Drainage of peritonsillar abscess .......
3.0
2971
Drainage of retropharyngeal or parapharyngeal
								abscess, intraoral .......
10.0
2973
external approach .......
by report
Excision
2981
Biopsy of oropharynx .......
3.0
2982
hypopharynx .......
5.0
2983
nasopharynx .......
5.0
(For larynx, see 2070 or 2073.)
2984
Excision of pharyngoesophageal diverticulum, single
								stage .......
50.0
2985
multiple stages .......
60.0
2989
Excision branchial cleft cyst or vestige, confined
								to skin and subcutaneous tissues .......
15.0
2990
extending beneath subcutaneous tissues .......
50.0
2992
Tonsillectomy, with or without adenoidectomy, under
								age 18 years .......
15.0
2993
18 years or over .......
20.0
2994
Adenoidectomy (independent procedure), primary or
								secondary .......
10.0
3000
Excision of tonsil tag(s), hospital .......
10.0
3002
office .......
6.0
3004
Excision of lingual tonsil (independent procedure)
								.......
10.0
3005
Excision of nasopharyngeal fibroma .......
by report
Suture
3006
Suture of wound or injury of pharynx .......
by report
Repair
3011
Pharyngoplasty: plastic or reconstructive operation
								on pharynx .......
by report
(For pharyngeal flap, see 2898.)
Esophagus
Incision
3031
Esophagotomy, cervical .......
60.0
3032
for removal of foreign body, cervical .......
60.0
3033
thoracic .......
80.0
Excision
3043
Esophagectomy: resection of esophagus, transpleural
								or extrapleural (upper two-thirds) .......
120.0
3045
Esophagogastrectomy, combined thoraco-abdominal
								.......
120.0
3046
Local excision, end-to-end anastomosis .......
90.0
Endoscopy
3051
Esophagoscopy, diagnostic .......
15.0
3053
with insertion of radioactive substance .......
20.0
3055
with biopsy .......
20.0
3057
with foreign body removal .......
25.0
3061
with dilation, direct .......
20.0
3063
subsequent dilation .......
15.0
(See also 3092, 3095.)
Repair
3071
Esophagoplasty: plastic repair or reconstruction of
								esophagus .......
by report
3072
Esophagogastrostomy (cardioplasty) .......
80.0
3073
Esophagomyotomy (Heller type) .......
80.0
3074
Esophagoduodenostomy (including total gastrectomy)
								.......
100.0
3075
Esophagojejunostomy, including total gastrectomy
								.......
100.0
3076
Esophagostomy: fistulization of esophagus, external
								.......
60.0
Suture
3077
Direct ligation of esophageal varices .......
80.0
3081
Suture of esophageal wound, injury or rupture,
								cervical approach .......
by report
3083
transthoracic .......
70.0
3086
Closure of esophagostomy or other external
								esophageal fistula, cervical .......
45.0
3087
thoracic .......
70.0
Manipulation
3092
Dilation of esophagus by sound, bougie or bag,
								indirect, initial .......
5.0
3095
subsequent .......
3.0
(For direct see 3061 and 3063.)
Stomach
Incision
3101
Gastrotomy with exploration or foreign body removal
								.......
50.0
3105
Pyloromyotomy: cutting of pyloric muscle
								(Fredet-Ramsted type operation) .......
50.0
Excision
3111
Biopsy by laparotomy .......
50.0
3112
Local excision of ulcer or tumor .......
60.0
3114
Total gastrectomy .......
100.0
3115
Subtotal or hemi-gastrectomy, without vagotomy
								.......
80.0
3116
with vagotomy .......
90.0
3117
Vagotomy and pylorplasty .......
70.0
(See also 3131.)
Endoscopy (independent
								procedure)
3121
Gastroscopy, diagnostic .......
15.0
3123
with biopsy .......
15.0
Suture
3131
Pyloroplasty .......
50.0
3133
Gastroduodenostomy .......
60.0
3135
Gastrojejunostomy .......
60.0
3136
with vagotomy .......
75.0
3137
Gastrostomy .......
40.0
3141
Gastrorrhaphy: suture of perforated duodenal or
								gastric ulcer, wound or injury .......
50.0
3144
Revision of gastroduodenal anatomosis
								(gastroduodenostomy) with reconstruction, without vagotomy .......
90.0
3145
with vagotomy .......
100.0
3146
Revision of gastrojejunal anastomosis
								(gastrojejunostomy) with reconstruction, without vagotomy .......
90.0
3147
with vagotomy .......
100.0
3153
Closure of gastrostomy, surgical .......
40.0
Intestines (Except
								  Rectum)
Incision
3161
Enterotomy with exploration or foreign body removal,
								small bowel .......
60.0
3162
large bowel .......
65.0
3166
Exteriorization of intestine (Mikulicz resection of
								colon, with or without crushing of spur) .......
70.0
Excision
3171
Excision of one or more lesions of small or large
								bowel not requiring anastomosis, exteriorization or fistulization, single
								enterotomy .......
60.0
3172
multiple enterotomies .......
70.0
3174
Enterectomy: resection of small intestine with
								anastomosis .......
70.0
3176
with enterostomy .......
70.0
3178
Colectomy, partial resection of large intestine in
								two stages, including first stage colostomy or cecostomy .......
100.0
3179
Colectomy, partial, with anastomosis with or without
								concomitant proximal colostomy .......
80.0
3180
total, with ileostomy or ilioproctostomy .......
110.0
3181
with proctectomy and ileostomy .......
120.0
3191
Enteroenterostomy; anastomosis of intestine .......
60.0
ENTEROSTOMY - External fistulization of
								intestines (independent procedure):
3193
small bowel (ileostomy or jejunostomy) .......
50.0
3195
large bowel, (colostomy or cecostomy) .......
50.0
3197
small or large bowel, for ulcerative colitis .......
75.0
3200
Reduction of volvulus, intussusception, internal
								hernia, by laparotomy .......
60.0
3203
Revision of colostomy, simple, (release of
								superficial scar) .......
5.0
3204
complicated (reconstruction in depth) .......
25.0
Destruction
3211
Enterolysis (freeing of intestinal adhesion) .......
40.0
3212
with acute bowel obstruction .......
60.0
3213
Intestinal plication (Noble type) .......
60.0
Suture
3220
Suture of intestine (enterorrhaphy), large or small,
								for perforated ulcer, wound, injury or rupture, single .......
60.0
3221
multiple .......
by report
3222
Suture of intestine with colostomy .......
70.0
3225
Closure of enterostomy, large or small intestine
								.......
40.0
3227
Closure of fecal fistula .......
by report
Meckel's Diverticulum and the
								  Mesentery
Excision
3231
Excision of Meckel's diverticulum (diverticulectomy)
								.......
50.0
3235
Excision of lesion of mesentery .......
50.0
(With bowel resection, see 3174.)
Suture
3241
Suture of mesentery .......
40.0
Appendix
Incision
3251
Incision and drainage of appendicular abscess,
								transabdominal .......
30.0
Excision
3261
Appendectomy .......
40.0
Rectum
Incision
3282
Transrectal drainage of pelvic abscess .......
15.0
3283
Incision and drainage of deep supralevator,
								pelvirectal or retrorectal abscess .......
20.0
(See also 3357, 3358.)
Excision
3291
Complete proctectomy, combined abdomino-perineal,
								one or two stages .......
100.0
3292
Complete proctectomy for congenital megacolon
								(Swenson type procedure) .......
100.0
3294
Excision of rextal procidentia, with anastomosis,
								perineal approach .......
60.0
3295
abdominal and perineal approach .......
100.0
3296
Division of stricture in rectum .......
20.0
3298
Perineal excision of primary or recurrent malignant
								tumor (Kraske type) .......
80.0
3299
Local excision of extensive villous papilloma of
								rectum .......
40.0
Endoscopy (independent
								procedure)
3310
Proctosigmoidoscopy, diagnostic, initial .......
3.0
3311
subsequent .......
2.0
3312
with biopsy, initial .......
5.0
3313
subsequent for same lesion .......
3.0
3314
with removal of papilloma or polyp, initial .......
7.0
3315
subsequent for same lesion .......
5.0
3316
with removal of multiple papillomas or polyps
								.......
9.0
3317
complicated .......
by report
3318
Endoscopic control of hemmorrhage .......
by report
3319
Endoscopic removal of foreign body, anus or rectum
								.......
by report
Repair
3320
Proctoplasty, for stenosis .......
40.0
3321
for prolapse of mucous membrane .......
40.0
3322
Perirectal injection of sclerosing solution for
								prolapse, in hospital .......
10.0
3323
Proctopexy for prolapse, abdominal approach .......
60.0
3325
Proctopexy combined with sigmoid resection,
								abdominal approach .......
90.0
Suture
3331
Closure of rectovesical fistula .......
60.0
(See also 3965.)
3333
Closure of rectourethral fistula .......
70.0
(See also 4026.)
3335
Closure of rectovaginal fistula .......
60.0
(When a colostomy is part of the above procedures,
								add 10 units.)
Manipulation
3341
Reduction of procidentia (independent procedure)
								.......
2.0
Anus
Incision
3351
Fistulotomy or fistulectomy, subcutaneous .......
10.0
3352
submuscular .......
40.0
3353
complex or multiple .......
by report
3354
second stage .......
10.0
3355
Remove seton, office .......
2.0
3356
Incision and drainage of ischiorectal abscess
								(independent procedure) .......
10.0
3357
Incision and drainage, perianal abscess (See also
								3283.) .......
2.0
3358
Incision and drainage of ischiorectal abscess with
								fistulotomy or fistulectomy, submuscular (See also 3283.) .......
40.0
3364
Sphincterotomy, anal: division of anal sphincter
								(independent procedure) .......
5.0
Excision
3371
Fissurectomy, with or without sphincterotomy .......
20.0
3372
Cryptectomy, single, office .......
5.0
3373
multiple, hospital procedure .......
30.0
3374
Papillectomy or excision of single tab (independent
								procedure), office .......
3.0
3375
Excision of external hemorrhoidal tags and/or
								multple papillae, office .......
5.0
3377
Hemorrhoidectomy, external, complete .......
20.0
3380
internal and external .......
30.0
3381
radical (Buie or amputative type) .......
40.0
3382
Fistulotomy or fistulectomy, submuscular, and
								hemorrhoidectomy .......
40.0
3386
Fissurectomy and hemorrhoidectomy .......
30.0
3392
Enucleation or excision of external thrombotic
								hemorrhoid .......
3.0
Introduction
3401
Hemorrhoids, injection of sclerosing solution
								.......
2.0
Endoscopy (independent
								procedure)
3411
Anoscopy, diagnostic with or without biopsy .......
1.0
(For with removal of foreign body see 3319.)
(For control of hemorrhage, endoscopic, see
								3318.)
Repair
3420
Anoplasty: plastic operation for stricture .......
40.0
3421
infant, minor thin septum .......
5.0
3422
Construction of anus for congenital absence,
								perineal approach .......
50.0
3423
combined abdominal and perineal approach .......
80.0
3425
Sphincteroplasty, anal, for incontinence .......
40.0
3426
muscle transplant .......
by report
3427
Thiersch procedure for incontinence and/or prolapse
								.......
25.0
Destruction
3433
Condyloma, single or multiple, internal and
								external, in hospital .......
20.0
3434
external, electrodesiccation, initial .......
3.0
3435
subsequent .......
2.0
Liver
Incision
3456
Aspiration biopsy of liver .......
5.0
Excision
3464
Hepatectomy, partial: resection of liver .......
80.0
Repair
3471
Marsupialization of cyst or abscess of liver .......
70.0
Suture
3481
Hepatorrhaphy: suture of liver wound or injury
								.......
60.0
Biliary
								  Tract
Incision
3491
Hepaticotomy or hepaticostomy with exploration,
								drainage or removal of calculus .......
70.0
3495
Choledochotomy or choledochostomy with exploration,
								drainage or removal of calculus, with or without cholecystotomy .......
70.0
3500
Duodenocholedochotomy: transduodenal
								choledocholithotomy .......
80.0
3501
Transduodenal sphincterotomy .......
80.0
3504
Cholecystotomy or cholecystostomy with exploration,
								drainage or removal of calculus .......
50.0
Introduction
3509
Injection procedure for percutaneous trans-hepatic
								cholangiography (independent procedure) .......
10.0
Excision
3515
Cholecystectomy .......
60.0
3517
with open exploration of common duct .......
70.0
Repair
3518
Exploration for congenital atresia of bile ducts
								.......
50.0
3519
Direct anastomosis of gallbladder and
								gastrointestinal tract .......
65.0
3520
Roux-en-y anastomosis of gallbladder and
								gastrointestinal tract .......
65.0
3521
Direct anastomosis of extrahepatic biliary ducts and
								gastrointestinal tract .......
75.0
3522
Roux-en-y anastomosis of extrahepatic biliary ducts
								and gastrointestinal tract .......
85.0
3523
Plastic reconstruction of extrahepatic biliary ducts
								with end-to-end anastomosis .......
80.0
Pancreas
Incision
3541
Abdominal drainage of pancreatitis .......
50.0
3544
Removal of calculus .......
70.0
Excision
3550
Pancreatectomy, subtotal .......
80.0
3551
subtotal (Whipple type) .......
140.0
3552
.......
140.0
3553
Pancreatico-jejunostomy .......
80.0
Repair
3565
Marsupialization of cyst of pancreas .......
60.0
3566
Internal direct anastomosis of cyst to
								gastrointestinal tract .......
70.0
3567
Rouxeny internal anastomosis, cyst to
								gastrointestinal tract .......
80.0
Abdomen, Peritoneum and
								  Omentum
Incision
3571
Exploratory laparotomy: exploratory celiotomy
								.......
40.0
3573
Drainage of peritoneal abscess or localized
								peritonitis exclusive of appendicular abscess .......
40.0
3575
Subdiaphragmatic or subphrenic abscess .......
50.0
3578
Retroperitoneal abscess .......
40.0
3588
Peritoneocentesis: abdominal paracentesis, initial
								.......
4.0
3590
subsequent .......
3.0
Excision
3591
Trans-peritoneal excision of intra-abdominal or
								retroperitoneal tumors or cysts .......
70.0
Endoscopy
3595
Peritoneoscopy .......
15.0
Introduction
3611
Pneumoperitoneum: intraperitoneal injection of air,
								initial .......
4.0
3612
subsequent .......
2.0
3614
Injection procedure for retroperitoneal
								pneumography, unilateral or bilateral (independent procedure) .......
5.0
3615
Injection procedure for pelvic pneumography
								(independent procedure) .......
4.0
(See also 4462.)
Repair
Hernioplasty, Herniorrhaphy,
								Herniotomy:
3631
Inguinal, unilateral .......
35.0
3633
with orchiectomy .......
40.0
3634
with excision of hydrocele .......
40.0
3635
recurrent .......
40.0
3646
Femoral, unilateral .......
35.0
3651
recurrent .......
45.0
3661
Ventral, incisional .......
45.0
3662
recurrent .......
50.0
3663
Epigastric .......
35.0
3664
recurrent .......
45.0
3665
Umbilical, under age five years .......
30.0
3666
over age five years .......
35.0
3667
Omphalocele, in newborn, one stage .......
40.0
3668
Gross type procedure, first stage .......
50.0
3669
second stage .......
50.0
(For diaphragmatic hernia, see 1495, 1496.)
Suture
3734
Secondary suture of abdominal wall for evisceration
								or disruption .......
20.0
(For suture of ruptured diaphragm, see 1495,
								1496.)
URINARY
								  SYSTEM
Kidney
Incision
3802
Drainage of perirenal abscess (independent
								procedure) .......
50.0
3808
Nephrotomy with drainage: nephrostomy .......
80.0
3811
Nephrolithotomy, removal of calculus .......
80.0
3812
large (staghorn) calculus .......
90.0
3813
Division or transection of aberrant renal vessels
								(independent procedure) .......
70.0
3815
Pyelotomy with exploration .......
70.0
3816
Pyelotomy with drainage, pyelostomy .......
70.0
3817
Pyelotomy with removal of calculus; pyelolithotomy;
								pelviolithotomy .......
70.0
Excision
3820
Renal biopsy, trochar or needle .......
5.0
3821
Nephrectomy, including partial ureterectomy .......
80.0
3822
with total ureterectomy through same or separate
								incision .......
100.0
3824
Heminephrectomy .......
100.0
3827
Excision of cyst of kidney .......
70.0
3829
Aspiration or injection of renal cyst or renal
								pelvis .......
5.0
Introduction
(For perirenal insufflation, unilateral or bilateral,
								see 3614.)
Repair
3831
Pyeloplasty: plastic operation on renal pelvis with
								or without plastic operation on ureter or nephropexy .......
80.0
3835
Nephropexy: fixation or suspension of kidney
								(independent procedure) .......
70.0
Suture
3841
Nephrorrhaphy: suture of kidney wound or injury
								.......
80.0
3845
Closure of nephrostomy, pyelostomy or other renal
								fistula (e.g., renocolic fistula) .......
80.0
3846
Symphysiotomy for horseshoe kidney .......
100.0
Transplant
3850
Kidney transplant .......
125.0
Ureter
Incision
3851
Ureterotomy with exploration or drainage
								(independent procedure) .......
70.0
3857
Ureterolithotomy, upper three quarters of ureter
								.......
70.0
3858
lower one quarter .......
80.0
Excision
3861
Ureterectomy, with bladder cuff (independent
								procedure) .......
80.0
Repair
3871
Ureteroplasty: plastic operation on ureter
								(stricture) .......
80.0
3872
Ureterolysis, with or without repositioning of
								ureter, unilateral .......
70.0
3873
bilateral .......
90.0
3874
Ureteropyelostomy: anastomosis of ureter and renal
								pelvis .......
80.0
3875
Ureteroureterostomy .......
80.0
3876
Ureteroneocystostomy: anastomosis of ureter to
								bladder, unilateral .......
80.0
3877
bilateral .......
100.0
3880
Ureteroenterostomy: anastomosis of ureter to
								intestine, unilateral .......
80.0
3881
bilateral .......
100.0
3884
Ureterostomy: transplantation of ureter to skin,
								unilateral .......
70.0
3885
bilateral .......
90.0
Suture
3891
Ureterorrhaphy: suture of ureter (independent
								procedure) .......
80.0
3895
Closure of fistula of ureter .......
by report
Bladder
Incision
3900
Aspiration of bladder by needle or trochar .......
5.0
3902
with insertion of suprapubic catheter .......
10.0
3904
Cystotomy or cystostomy with fulguration .......
60.0
3905
Cystotomy with drainage; cystostomy .......
50.0
3907
Cystotomy with removal of calculus (cystolithotomy)
								without vesical neck resection .......
50.0
3908
Drainage of perivesical or prevesical space abscess
								.......
50.0
Excision
3911
Cystectomy, partial .......
70.0
3912
with re-implantation of ureter into bladder
								(ureteroneocystostomy) .......
80.0
3913
complete .......
100.0
3914
radical with ureteral transplants .......
120.0
3915
with ureteral-ileo conduit .......
140.0
3918
Transurethral resection, vesical neck, female or
								child (See also 4321.) .......
50.0
3919
Cystotomy for excision of vesical neck (independent
								procedure) .......
60.0
3920
Excision of bladder diverticulum (independent
								procedure) .......
70.0
3922
Excision of bladder tumor (See also 3904.) .......
60.0
3924
Transurethral resection of bladder tumors, large
								(For small tumors, see 3936, 3937.) .......
60.0
Introduction
3926
Bladder irrigation, simple, lavage and/or
								instillation .......
1.0
3927
Injection procedure for cystography or
								urethro-cystography .......
1.0
Cystoscopy (independent
								procedure):
3930
Diagnostic, office, initial .......
5.0
3931
subsequent within 30 days .......
3.0
3932
with ureteral catheterization .......
8.0
3933
hospital .......
8.0
3934
with ureteral catheterization .......
15.0
(For Howard or Stamey type renal function test see
								3948.)
3935
With biopsy .......
10.0
3936
With fulguration or treatment of minor (less than
								0.5 cm.) lesion, with or without biopsy .......
10.0
3937
With fulguration of small bladder tumors (0.5 cm. to
								2 cm.) (For larger tumors, see 3924.) .......
25.0
3938
With subsequent fulguration of bladder tumor .......
10.0
3939
With insertion of radioactive substance, with or
								without biopsy or fulguration .......
30.0
3940
With dilatation of bladder for interstitial
								cystitis, general anesthesia .......
15.0
3942
With ureteral meatotomy .......
20.0
3943
With resection of fulguration of ureterocele .......
20.0
3944
With removal of foreign body from urethra or bladder
								.......
20.0
3945
With removal of calculus from ureter .......
30.0
3946
With manipulation of ureteral calculus, primary
								.......
20.0
3947
subsequent .......
10.0
3948
Differential quantitative and chemical renal
								function test (e.g., Howard or Stamey type) .......
Destruction
3951
Litholaplaxy: crushing of calculus in bladder and
								removal of fragments .......
50.0
Repair
3952
Cystoplasty; plastic operation on bladder (anterior
								Y-plasty, vesical fundus resection, etc.) any procedure .......
80.0
Suture
3961
Cystorrhaphy: suture of bladder wound, injury or
								rupture .......
60.0
3963
Closure of cycstostomy (independent procedure)
								.......
30.0
3965
Closure of vesicovaginal, vesicouterine, or
								vesicoenteric fistula (See also 3331.) .......
60.0
Urethra
Incision
3971
Urethrotomy, external (independent procedure)
								anterior .......
10.0
3973
perineal, external .......
25.0
3977
Meatotomy: cutting of meatus (independent procedure)
								.......
3.0
3978
Drainage of deep periurethral abscess, hospital
								.......
10.0
3979
Drainage of simple perineal urinary extravasation
								(independent procedure), uncomplicated .......
15.0
3980
complicated, with or without diversion of urinary
								stream .......
50.0
(See also 3908.)
Excision
(For excision or fulguration of urethral caruncle,
								see 4437.)
3987
Excision or fulguration of carcinoma of urethra
								.......
by report
3991
Excision or diverticulum of urethra (independent
								procedure) .......
50.0
3994
Excision of fulguration of urethral polyps, distal
								3/4 inch of urethra .......
5.0
(For posterior urethra, see 4006.)
Endoscopy
4000
Urethroscopy, diagnostic .......
5.0
4001
with removal of calculus or foreign body .......
20.0
4004
with internal urethrotomy .......
20.0
4006
with fulguration of posterior urethra .......
10.0
4008
subsequent, within 30 days .......
5.0
Repair
4011
Urethroplasty: plastic operation on urethra (except
								4132 and 4135) .......
by report
Suture
4021
Urethrorrhaphy: suture of urethral wound or injury
								.......
by report
4023
Closure of urethrostomy or fistula of urethra
								(independent procedure) .......
30.0
4025
Closure of urethrovaginal fistula .......
50.0
4026
Closure of urethrorectal fistula (See also 3333.)
								.......
70.0
Manipulation
4031
Dilation of urethral stricture by passage of sound,
								initial, male .......
3.0
4032
subsequent within 30 days .......
1.5
4033
Dilation of urethral stricture by passage of
								filiform and follower, male .......
5.0
4034
subsequent within 30 days .......
2.5
4035
Passage of filiform and follower for acute vesical
								retention, male .......
5.0
4036
Dilation of female urethra including suppository
								and/or installation .......
2.0
4037
subsequent within 30 days .......
1.0
MALE GENITAL
								  SYSTEM
Penis
Incision
4101
Dorsal or lateral "slit" of prepuce (independent
								procedure) .......
3.0
Excision
4111
Biopsy of penis (independent procedure) .......
3.0
4114
Amputation of penis, partial .......
40.0
4115
complete .......
60.0
4116
radical .......
100.0
(For local excision of lesion of penis, see
								Integumentary System.)
4122
Circumcision, clamp procedure, newborn .......
3.0
4123
except newborn .......
5.0
4124
surgical excision other than clamp or dorsal slit,
								any age (except newborn) .......
10.0
(For excision or fulguration of warts, see 0403,
								0405.)
Repair
4131
Plastic operation on penis for hypospadias,
								straightening of chordee .......
30.0
(For urethroplasty for hypospadias, see 0260 to
								0324.)
4134
Plastic operation on penis for injury .......
by report
4135
Plastic operation on penis for epispadias with
								exstrophy of bladder .......
by report
4136
Plastic operation for penile epispadias distal to
								external sphincter .......
50.0
Testis
Excision
4140
Biopsy, needle (independent procedure) .......
2.0
4141
incisional (independent procedure) .......
10.0
4143
Orchiectomy, simple unilateral .......
20.0
4144
bilateral .......
30.0
4145
with superficial inguinal node dissection,
								unilateral .......
50.0
(For radical retroperitoneal node dissection, see
								2673.)
Repair
4152
Reduction of torsion of testis by surgical means
								.......
30.0
4153
with fixation of contralateral testis .......
45.0
4154
Fixation of contralateral testis (independent
								procedure) .......
20.0
4156
Orchiopexy, any type, with or without hernia repair
								.......
50.0
4157
second stage (Torek type) .......
10.0
(For orchiectomy with repair of hernia, see
								3633.)
Epididymis
Incision
4161
Drainage of abscess of epididymis .......
3.0
Excision
4171
Biopsy of epididymis, needle .......
2.0
4172
Exploration of epididymis with or without biopsy
								.......
10.0
4174
Excision of spermatocele with or without
								epididymectomy .......
30.0
4176
Epididymectomy, unilateral .......
30.0
Repair
4181
Epididymovasostomy (anastomosis of epididymis to vas
								deferens), unilateral .......
40.0
4182
bilateral .......
50.0
Tunica
								  Vaginalis
Incision
4191
Puncture aspiration of hydrocele with or without
								injection of medication .......
2.0
4200
Repair of hydrocele (Bottle type) .......
20.0
4201
Excision of hydrocele, unilateral .......
30.0
4202
with hernia repair .......
40.0
Scrotum
Incision
4211
Drainage of scrotal abscess .......
2.0
4215
Removal of foreign body in scrotum .......
by report
Excision
(For local excision of lesion of skin of scrotum, see
								0175-0197, 0260-0270.)
4224
Resection of scrotum .......
by report
4227
Scrotoplasty; plastic operation on scrotum .......
by report
Vas
								  Deferens
Incision
4231
Vasotomy: incision or transection of vas, unilateral
								or bilateral (independent procedure) .......
15.0
Excision
4241
Vasectomy, unilateral or bilateral (independent
								procedure) .......
15.0
Repair
4251
Vasovasostomy unilateral .......
30.0
4252
bilateral .......
40.0
Suture
4261
Ligation (percutaneous of vas deferens (independent
								procedure) .......
5.0
Spermatic
								  Cord
Excision
4271
Excision of hydrocele of spermatic cord (independent
								procedure), unilateral .......
30.0
4275
Excision of varicocele (independent procedure),
								unilateral .......
30.0
4278
with hernia repair .......
40.0
Seminal Vesicles
Incision
4281
Vesiculotomy, unilateral .......
by report
Excision
4291
Vesiculectomy .......
80.0
Prostate
Incision
4300
Biopsy, prostate, needle, single or multiple .......
5.0
4301
incisional, perineal approach .......
30.0
4302
transrectal .......
20.0
4303
Prostatotomy: external drainage of prostatic abscess
								.......
30.0
4304
Prostatolithotomy: removal of prostatic calculus
								(independent procedure) .......
70.0
Excision
4311
Prostatectomy, perineal, subtotal .......
80.0
4313
radical .......
100.0
4316
suprapubic, one or two stages .......
80.0
4318
retropubic .......
80.0
4319
radical .......
100.0
Endoscopy
4321
Transurethral resection of prostate, including
								control of postoperative bleeding, complete (See also 3918.) .......
80.0
FEMALE GENITAL
								  SYSTEM
Vulva and
								  Introitus
Incision
4403
Incision and drainage, abscess of vulva .......
5.0
4405
Incision and drainage of Bartholin's gland abscess,
								unilateral .......
5.0
Excision
4421
Biopsy of vulva (independent procedure) .......
3.0
(For local excision or fulguration of lesion(s) of
								external genitalia, see 0175-0197, 0260-0324, 0401-0406.)
4423
Vulvectomy, complete, bilateral .......
55.0
4424
partial, less than 80% of vulvar area .......
40.0
4425
radical, including unilateral regional lymph nodes
								.......
100.0
4426
including bilateral regional lymph nodes .......
150.0
4428
Clitoridotomy: circumcision, female .......
7.5
4429
Clitoridectomy .......
10.0
4431
Hymenectomy, partial excision of hymen .......
10.0
4433
Excision of Bartholin's gland or cyst .......
20.0
4434
Marsupialization or cautery destruction of
								Bartholin's gland or cyst .......
15.0
4436
Excision or fulguration of Skene's glands .......
7.0
4437
Excision or fulguration of urethral caruncle .......
7.0
(For excision of urethral diverticulum see
								3991.)
(For excision or fulguration of urethral carcinoma
								see 3987.)
Repair
4441
Episioplasty: plastic repair of vulva
								(non-obstetrical) .......
20.0
4443
Plastic operation on urethral sphincter, vaginal
								approach .......
30.0
4445
Plastic repair of urethra for mucosal prolapse
								(independent procedure) .......
by report
4447
Plastic repair of urethrocele (independent
								procedure) .......
30.0
Suture
(For eposiorrhaphy or episioperineorrhaphy: for
								recent injury of vulva and/or perineum [nonobstetrical], see 4480.)
Vagina
Incision
4461
Colpotomy with exploration or drainage of pelvic
								abscess .......
15.0
4462
Colpocentesis (independent procedure) .......
4.0
4463
Puncture and aspiration of cul de sac .......
3.0
4471
Biopsy of vaginal mucosa (independent procedure)
								.......
3.0
(For excision and/or fulguration of local lesion(s)
								see 0175-0197, 0401-0406.)
4473
Colpocleisis, complete obliteration of vagina
								.......
50.0
4475
Le Fort type .......
35.0
4477
Excision of vaginal septum .......
by report
Introduction
4478
Irrigation and/or application of any medicament for
								treatment of bacterial, parasitic or fungoid disease .......
1.0
Repair
4479
Colporrhaphy: suture of injury of vagina
								(nonobstetrical) .......
by report
4480
Colpoperineorrhaphy: suture of injury of vagina
								and/or perineum (nonobstetrical) .......
by report
4481
Anterior colporrhaphy, repair of cystocele with or
								without repair of urethrocele (independent procedure) .......
35.0
4484
Posterior colporrhaphy, repair of rectocele
								(independent procedure) .......
30.0
4485
with perineoplasty or perineorrhaphy .......
35.0
4488
Combined anterior-posterior colporrhaphy .......
50.0
4492
Urethral suspension, abdominal approach
								(Marshall-Marchetti type) .......
40.0
4493
Repair of enterocele (independent procedure)
								abdominal approach .......
45.0
4494
vaginal approach .......
45.0
4495
Colpopexy, abdominal approach .......
45.0
4497
Construction of artificial vagina (vaginal atresia
								or absence) with or without graft .......
by report
(For closure of vaginal fistulae, see 3335, 3965,
								4025.)
Manipulation
4511
Dilation of vagina under anesthesia .......
2.0
4512
Pelvic examination under anesthesia .......
2.0
Endoscopy
4521
Culdoscopy (independent procedure) .......
15.0
Oviduct
Incision
4531
Transection of Fallopian tube, unilateral or
								bilateral, abdominal or vaginal approach .......
40.0
4532
post-partum, during same hospitalization .......
30.0
Excision
4541
Salpingectomy, complete or partial, unilateral or
								bilateral (independent procedure) .......
45.0
4545
Salpingo-oophorectomy, complete or partial,
								unilateral or bilateral (independent procedure) .......
45.0
4551
Salpingoplasty, unilateral or bilateral (independent
								procedure) .......
50.0
Oviduct
Incision
4561
Drainage of ovarian cyst, vaginal approach,
								unilateral or bilateral .......
25.0
4562
abdominal approach, unilateral or bilateral .......
40.0
4564
Drainage of ovarian abscess, vaginal approach
								.......
20.0
4565
abdominal approach .......
40.0
Excision
4566
Biopsy of ovary, unilateral or bilateral
								(independent procedure) .......
45.0
4568
Partial oophorectomy, bilateral or unilateral
								.......
45.0
Cervix
								  Uteri
Excision
(For radical surgical procedures, see 4620,
								4626.)
4571
Biopsy or local excision of lesion, with or without
								fulguration, quadrant biopsy (independent procedure) .......
3.0
4572
Cauterization of cervix, office .......
3.0
4573
Biopsy of cervix, circumferential (cone) with or
								without dilation and curettage, with or without Sturmdorff type repair .......
20.0
4575
Trachelectomy: cervicectomy: amputation of cervix
								(independent procedure) .......
20.0
4577
total excision of cervical stump, with or without
								pelvic floor repair, abdominal approach .......
50.0
4578
vaginal approach .......
60.0
Introduction
*4581
Insertion of any hemostatic agent for control of
								hemorrhage (independent procedure) .......
3.0
(For insertion of any radioactive material, see
								7615.)
4583
Insertion of intracervical or intrauterine device
								.......
3.0
Repair
4585
Tracheloplasty: surgical repair of incompetent
								cervix, loop type .......
8.0
4586
Shirodkar type .......
20.0
4587
Trachelorrhaphy, plastic repair of uterine cervix,
								vaginal approach .......
by report
Manipulation
4588
Dilation of cervical canal, instrumental
								(independent procedure) .......
3.0
4589
Dilation and curettement of cervical canal .......
15.0
Corpus
								  Uteri
Excision
4610
Endometrial biopsy (independent procedure) .......
3.0
4612
Dilation and curettage, diagnostic and/or
								therapeutic (nonobstetrical) .......
15.0
4613
Myomectomy: excision of fibroid tumor of uterus
								(independent procedure, nonobstetrical) .......
50.0
4614
Total hysterectomy (corpus and cervix) with or
								without tubes, and/or ovaries, one or both .......
60.0
4618
Supracervical hysterectomy: subtotal hysterectomy,
								with or without tubes, and/or ovaries, one or both .......
55.0
4620
Radical hysterectomy for cancer including regional
								lymph nodes .......
100.0
4626
plus removal of bladder and ureteral
								transplantations and/or abdominoperineal resection of rectum and colon and
								colostomy or any combination thereof .......
by report
4631
Vaginal hysterectomy .......
60.0
4632
with plastic repair of vagina, anterior and/or
								posterior colporrhaphy .......
70.0
4634
with repair of enterocele .......
75.0
Introduction
*4675
Insufflation of uterus and tubes with air or CO 
								2 .......
*3.0
*4676
Injection procedure for hystero-salpingography
								.......
*3.0
Repair
4683
Uterine suspension with or without shortening of
								round ligaments (independent procedure) .......
40.0
4684
with presacral sympathectomy .......
45.0
4685
with interposition operation, with or without pelvic
								floor repair .......
50.0
4690
with shortening of endopelvic fascia: parametrial
								fixation with or without pelvic floor repair (Manchester type) .......
50.0
4692
with shortening of sacro-uterine ligaments .......
50.0
4694
Hysterosalpingostomy: anastomosis of tubes of uterus
								.......
50.0
4695
Hysterorrhaphy: repair of ruptured uterus
								(nonobstetrical) .......
40.0
Perineum
Excision
4710
Biopsy of perineum (independent procedure) .......
3.0
(For excision of local lesion see 0175-0178,
								0260-0324.)
Incision
*4720
Incision and drainage of perineal abscess
								(nonobstetrical) .......
*3.0
Repair
4731
Perincoplasty: repair of perineum (independent
								procedure) .......
15.0
4735
third degree laceration, old (independent procedure)
								.......
40.0
(Also see 4441, 4480.)
4742
Perineorrhaphy, postpartum, by other than delivering
								physician .......
20.0
4745
Repair of perineal fistula .......
25.0
(For repair of recent injury of perineum,
								nonobstetrical, see 4480.)
MATERNITY
(Fees for all maternity procedures include prenatal
								and postpartum care unless otherwise specified.)
Incision
4801
Classic cesarean section .......
50.0
4802
Low cervical (lower uterine segment) cesarean
								section .......
50.0
4803
Cesarean section and hysterectomy, total or subtotal
								.......
60.0
4804
Extraperitoneal cesarean section .......
60.0
Excision
4809
Hysterotomy induced abortion .......
50.0
4811
Ectopic pregnancy, tubal, requiring salpingectomy
								and/or oophorectomy, abdominal or vaginal approach .......
50.0
4812
ovarian, requiring oophorectomy .......
by report
4815
Hysterotomy, abdominal, for removal of hydatidiform
								mole .......
45.0
Manipulation
4821
Total obstetrical care including antepartum care,
								obstetrical delivery and postpartum care (with or without low forceps, and/or
								episiotomy) .......
35.0
4822
Obstetrical delivery (with or without low forceps,
								and/or episiotomy) and including hospital postpartum care .......
20.0
4823
Antepartum care only (independent procedure) .......
Sv.!
4824
Postpartum care only (independent procedure) .......
Sv.!
4841
Amniocentesis, diagnostic .......
5.0
4842
Amniocentesis with hypertonic solution including
								terminal curettage, induced abortion .......
40.0
4843
Dilation and curettage, and/or suction, induced
								abortion .......
20.0
4850
Abortion, first trimester, completed medically
								.......
Sv.!
4851
(incomplete) completed surgically, (dilataion and
								curettage) .......
15.0
4853
second trimester, completed medically .......
Sv.!
4854
(incomplete) completed surgically, (dilatation and
								curettage) .......
15.0
4856
missed, first or second trimester, completed
								medically or surgically .......
by report
4858
incomplete, septic, requiring dilatation and
								curettage and additional care .......
by report
4870
Dilatation and curettage of uterus for postpartum
								bleeding .......
15.0
ENDOCRINE
								  SYSTEM
Thyroid
								  Gland
Incision
4904
Incision and drainage of thyroglossal cyst
								(infected) .......
3.0
Excision
4911
Local excision of small cyst or adenoma of thyroid
								.......
40.0
4912
Total thyroid lobectomy, unilateral .......
50.0
4914
Thyroidectomy, total or complete .......
70.0
4917
subtotal or partial .......
60.0
4924
total or subtotal for malignancy with radical neck
								dissection .......
100.0
4925
total or subtotal for malignancy with limited neck
								dissection .......
80.0
4937
secondary, unilateral .......
60.0
4938
bilateral .......
70.0
4941
Excision of thyroglossal duct, cyst or sinus .......
45.0
Parathyroid, Thymus, Pituitary, Pineal,
								Adrenal Glands and Carotid Body
(For hypophysectomy, see 2019 and 5130.)
Excision
4971
Parathyroidectomy or exploration of parathyroid
								.......
70.0
4972
with mediastinal exploration with or without
								splitting of sternum .......
90.0
4985
Adrenalectomy, transabdominal, lumbar or dorsal,
								unilateral .......
80.0
4986
bilateral, one stage .......
100.0
4987
two stages .......
120.0
4989
Biopsy adrenal, unilateral .......
60.0
4990
bilateral .......
70.0
4993
Excision of carotid body tumor, with excision of
								carotid artery .......
100.0
4994
without excision of carotid artery .......
70.0
NERVOUS
								  SYSTEM
Skull, Meninges and
								  Brain
CRANIOTOMY FOLLOWING TRAUMA:
Incision
5001
Burr holes, unilateral, exploratory for subdural
								puncture, not followed by surgery .......
30.0
5002
multiple, bilateral, not followed by surgery .......
50.0
5003
Evacuation of hematoma, subdural, extradural, or
								intracerebral by burr holes only .......
90.0
5004
requiring craniotomy .......
100.0
5012
Removal of foreign body from brain .......
100.0
Excision
5015
Removal of brain scar .......
by report
Repair
5018
Elevation of depressed skull fracture, simple
								.......
75.0
5020
with debridement of brain and repair of dura .......
100.0
5022
Cranioplasty for skull defect, bone, metal or
								plastic .......
100.0
5024
Repair of dura by graft, including repair for
								cerebrospinal rhinorrhea .......
100.0
CRANIOTOMY FOR NON-TRAUMATIC CAUSES:
Incision
5101
Burr holes, exploratory or ventricular puncture, not
								followed by surgery .......
30.0
5102
Ventricular puncture through previous burr holes or
								fontanelle .......
5.0
5106
Craniotomy for drainage of brain abscess .......
75.0
5108
Subsequent tapping (aspiration) abscess in operating
								room .......
10.0
5110
at bedside .......
5.0
5112
Suboccipital craniectomy for tractotomy or section
								of 5th, 8th, 9th or other cranial nerves .......
125.0
5113
Intratemporal (mastoid) craniectomy for
								decompression, neurolysis or excision of acoustic nerve tumor .......
100.0
5114
Craniotomy for surgery of sensory root of grasserian
								ganglion .......
100.0
5116
Craniotomy for lobotomy, unilateral .......
40.0
5117
bilateral .......
60.0
5119
Craniotomy for orbital decompression, unilateral
								.......
100.0
5121
Cisternal puncture (independent procedure) .......
3.0
5122
Subdural tap through fontanelle (infant) .......
3.0
Excision
(For trans-septal hypophysectomy see 2019.)
5130
Osteoplastic craniotomy for excision of brain tumor,
								abscess, or cyst, supratentorial .......
125.0
5132
Suboccipital craniectomy for brain tumor .......
150.0
5134
Osteoplastic craniotomy for arteriovenous
								malformation .......
by report
5136
Osteoplastic craniotomy for obliteration of aneurysm
								.......
150.0
5140
Craniotomy for pallidectomy, any method, including
								localizing techniques, single or multiple stages .......
100.0
5144
for topectomy .......
100.0
5146
for excision of choroid plexus .......
50.0
5148
Craniectomy for osteomyelitis of skull .......
by report
Introduction
5152
Burr holes with ventriculography, not followed by
								surgery .......
30.0
5153
followed by surgery .......
20.0
5154
Ventriculography through fontanelle or previous burr
								holes .......
10.0
5155
Ventricular puncture with introduction of dye and
								recovery by spinal puncture .......
12.0
5159
Injection procedure for pneumoencephalography
								.......
10.0
Repair
5160
Ventriculocisternostomy .......
100.0
5162
Repair of encephalocele .......
by report
5166
Ventriculoauricular shunt .......
100.0
5167
replacement or irrigation of obstructed valve
								.......
90.0
5168
replacement or irrigation of ventricular catheter
								.......
30.0
5169
removal of shunt in toto without replacement .......
30.0
5170
Ventriculo-auricular-peritoneal-pleural-uretera l
								shunt .......
100.0
5171
co-surgeon .......
80.0
5174
Craniectomy for craniostenosis, single suture
								.......
75.0
5175
multiple sutures .......
100.0
Spine and Spinal
								  Cord
Incision
5190
Laminectomy for decompression of the spinal cord and
								nerve roots (See also 5208-5210, 5225.) .......
100.0
5192
Cordotomy, cervico-dorsal .......
100.0
5194
Rhizotomy .......
75.0
5198
Spinal puncture, lumbar, simple (independent
								procedure) .......
2.0
5199
diagnostic, initial, with study of hydrodynamics
								.......
4.0
(Add one unit to value assigned to 5198 and 5199 if
								patient is under 4 years.)
Excision
5206
Laminectomy for lesion of spinal cord or meninges
								.......
100.0
5208
Laminotomy for removal of intervertebral discs,
								cervical .......
90.0
5209
thoracic .......
90.0
5210
lumbar .......
90.0
5211
Excision of intervertebral discs, anterior approach,
								cervical .......
80.0
(See also 0634-0642.)
Introduction
5214
Injection procedure for myelography .......
10.0
5216
for discography .......
10.0
Repair
5225
Laminectomy for spondylolisthesis (See also 5190.)
								.......
100.0
5227
Repair of meningocele .......
75.0
5229
Repair of meningomyelocele .......
90.0
5231
Lumbar subarachnoid-peritoneal-ureteral shunt
								.......
80.0
5232
co-surgeon .......
75.0
5233
Application crutchfield tongs or other skeletal
								traction device .......
5.0
Peripheral Nerves, Other
								  Extracranial Nerves and Ganglia
Incision
(For transection of trigeminal or glossopharyngeal
								nerves, see 5112, 5114.)
5252
Phrenic nerve transection or avulsion .......
15.0
5255
Transection, spinal nerve .......
40.0
5257
Transection, occipital nerve .......
40.0
Excision
(For excision of tender scar, skin and subcutaneous
								tissues with or without tiny neuroma, see 0175, 0178, 0265, 0266.)
5273
Excision of surgically identifiable neuroma of
								cutaneous nerve .......
8.0
5274
digital nerve, one or both, same digit .......
10.0
5275
hand or foot, one (add 10 percent each additional)
								.......
15.0
5276
arm or leg .......
25.0
5277
Avulsion infraorbital nerve .......
20.0
5280
Stoefel's neurectomy .......
40.0
5282
Obturator neurectomy .......
40.0
Introduction
5290
Alcohol injection, subarachnoid .......
5.0
5294
2nd or 3rd branch of trigeminal nerve .......
7.5
5295
under x-ray control (excluding x-ray charge) .......
10.0
Nerve Block
5298
Paravertebral block, lumbar or thoracic .......
5.0
5300
Sympathetic block (cervical) .......
5.0
5302
Stellate ganglion .......
5.0
5311
Brachial plexus block .......
5.0
5312
Intercostal nerves .......
3.0
5313
Lumbar, sacral and coccygeal nerves .......
5.0
5314
Pudendal nerve .......
5.0
5315
Splanchnic nerves .......
5.0
5316
Ilioinguinal and iliohypogastric nerves .......
5.0
5317
Sciatic nerve .......
3.0
5318
Phrenic nerve .......
3.0
5319
Other peripheral nerves .......
3.0
Repair
NEURORRHAPHY-suture of nerve.
Primary
5320
Digital, one (add 25 percent each additional nerve)
								.......
15.0
5822
Hand or foot (except motor thenar or ulnar motor)
								.......
20.0
5323
Motor thenar or ulnar motor .......
30.0
5325
Arm or leg (except sciatic) .......
40.0
5326
Sciatic .......
by report
5328
Brachial or lumbar plexus .......
by report
5330
Cranial, extra-cranial .......
75.0
(For facial nerve, see 6002, 6003.)
Secondary or delayed anastomosis or reanastomosis
								including local advancement to overcome gap. (Add 25 percent to primary
								repair.)
Secondary or delayed anastomosis involving
								additional procedures such as nerve graft and/or rerouting of nerve to overcome
								gap .......
by report
(See 6003 for facial nerve.)
NEUROPLASTIES: plastic procedure on
								intact nerve.
5335
Freeing nerve from scar, including internal and
								external lysis and transposition away from scarred area, digital, one or both
								.......
15.0
5337
hand or foot .......
20.0
5339
arm or leg (except sciatic) .......
40.0
5340
sciatic .......
by report
5341
brachial or lumbar plexus .......
by report
5343
cranial, extra-cranial .......
75.0
(For facial nerve, see 6002, 6003.)
5345
Transplantation ulnar nerve, elbow (independent
								procedure) (includes neurolysis) .......
25.0
5347
Median nerve decompression at carpal tunnel, simple
								.......
30.0
(If complex, see also 1550, 1553.)
NEURO-ANASTOMOSIS to establish other than
								normal anatomical continuity.
5350
Spinal accessory-facial, hypoglossal-facial, spinal
								accessory-hypoglossal, etc. .......
75.0
Vegetative Nervous
								  System
Excision
SYMPATHECTOMIES:
5371
Cervical, unilateral .......
60.0
5372
bilateral .......
80.0
5375
Cervico-thoracic (Smithwicke type, supra- and
								infra-diaphragmatic), unilateral .......
70.0
5376
bilateral, concomitant or delayed .......
100.0
5381
Lumbar, unilateral .......
55.0
5382
bilateral .......
75.0
5385
Splanchnicectomy (Peet type) unilateral .......
65.0
5386
bilateral .......
80.0
5390
Presacral neurectomy, hypogastric plexus .......
50.0
Eyeball
Incision
5420
Goniotomy .......
50.0
Excision
5421
Enucleation of eyeball with or without sphere
								implant .......
40.0
5422
with integrated implant .......
50.0
5424
Secondary implantation of integrated implant .......
60.0
5427
Evisceration of eyeball .......
40.0
5428
with implantation in scleral shell .......
50.0
5431
Suture of eyeball for wound or injury .......
by report
Cornea
Incision
5441
Keratotomy, any type .......
10.0
5443
Paracentesis of cornea .......
10.0
5445
Removal of foreign body from surface of cornea
								.......
2.0
5448
under slit lamp .......
3.0
Excision
5451
Keratectomy, partial .......
30.0
5452
complete .......
40.0
5457
Pterygium .......
25.0
Introduction
5461
Tattoo of cornea, mechanical or chemical .......
30.0
5465
Curettage and cauterization of corneal ulcer .......
5.0
5466
Iontophoresis of corneal ulcer .......
5.0
Repair
5471
Keratoplasty, (corneal transplant) lamellar .......
100.0
5472
partial or complete, penetrating .......
110.0
Suture
5481
Suture of perforated cornea .......
by report
Scelera
Incision
5491
Sclerotomy, operative incision, with removal of
								intraocular foreign body (with or without magnet) .......
50.0
5492
with removal of foreign body from anterior chamber
								(with or without magnet) .......
50.0
5495
Sclerotomy, posterior .......
30.0
5496
Aspiration of anterior chamber, diagnostic .......
4.0
Excision
5501
Sclerectomy for glaucoma, with scissors, punch or
								trephination .......
60.0
5503
Scleral resection .......
100.0
Introduction
5511
Irrigation and/or air injection into anterior
								chamber .......
15.0
Suture
5521
Suture of sclera for wound or injury .......
by report
Iris and Ciliary
								  Body
Incision
5531
Iridotomy .......
20.0
5532
with transfixion of iris; iris bombe .......
20.0
5534
Iridotomy-performed with photocoagulator .......
10.0
Excision
5541
Excision of lesion of iris .......
60.0
5542
and/or ciliary body (iridocylectomy) .......
80.0
5544
Iridectomy; basal, optical or preliminary .......
50.0
5546
peripheral .......
50.0
Repair
5552
Iridodialysis .......
40.0
5561
Repair of prolapsed iris with suture of perforated
								sclera or cornea .......
by report
Manipulation
5571
Iridenclesis or comparable procedure .......
50.0
Destruction
5580
Diathermy of the ciliary body; cyclodiathermy
								.......
30.0
5582
Cyclodialysis .......
50.0
Crystalline
								  Lens
Incision
5601
Discission (needling of lens), initial .......
20.0
5602
subsequent .......
10.0
5603
Aspiration of lens material for congenital cataract,
								one or more stages .......
60.0
Excision
5611
Extraction of lens, intracapsular, extracapsular or
								linear, unilateral .......
80.0
5616
Removal of dislocated lens .......
80.0
Crystalline
								  Lens
Introduction
5622
Transplantation of vitreous .......
50.0
Retina
Repair
5630
Reattachment of retina, electrocoagulation, scleral
								resection, buckling or partial tubing .......
100.0
5631
encircling tube, initial .......
100.0
5632
subsequent .......
by report
5633
Removal of encirclng tube .......
40.0
5634
Reattachment of retina, light coagulation of retinal
								break(s), one or more stages during same period of hospitalization .......
40.0
5635
with drainage of subretinal fluid .......
50.0
5636
Light coagulation of retina for tumor, Eales
								disease, etc., initial .......
40.0
5637
subsequent .......
20.0
Retina
Incision, Excision and
								Repair
5641
Any type of muscle operation involving one or more
								muscles in one or both eyes done in one stage .......
60.0
5647
Muscle transplant (Hummelscheim type, etc. .......
70.0
Orbit
Incision
5651
Orbitomy with exploration .......
60.0
5652
with drainage of intraorbital abscess .......
60.0
5653
with removal of intraorbital foreign body .......
60.0
5662
Excision of benign lesion of orbit, requiring bone
								flap .......
90.0
5664
Exenteration or evisceration of orbital contents
								with or without graft .......
60.0
5665
including orbital bone .......
by report
Introduction
5671
Orbital injection of alcohol for hemorrhagic
								glaucoma or intractable pain .......
10.0
Repair
(For plastic repair of orbit, see 0260-0324,
								0619-0621.)
Eyelids
Incision
5691
Blepharotomy with drainage of abscess of eyelid
								.......
2.0
5692
with drainage of Meibomian glands; hordeolum (stye)
								.......
2.0
Excision
(For blepharectomy, see 0175-0197, 0260-0324,)
5702
Excision or incision of Meibomian gland (chalazion),
								single .......
5.0
5703
multiple, same lid .......
6.0
5704
multiple, different lids .......
7.0
(For excision of lesion of eyelid, malignant, see
								0194-0197, 0260-0324.)
5712
Epilation, electrolysis .......
4.0
(For excision of xantholasma, 0175-0178,
								0260-0324.)
Repair
(Blepharoplasty: plastic repair of eyelid with or
								without graft, any type, see 0251, 0252, 0260-0324.)
(Canthoplasty: plastic repair of canthus, see 0251,
								0252, 0260-0324.)
(Plastic restoration of eyebrow, by graft, see
								0308-0324.)
(Tarsoplasty: plastic repair of tarsal cartilage, see
								0261-0275.)
(Reposition of ciliary base, see 0260-0324.)
5727
Blepharoptosis repair, superior rectus, levator, or
								frontalis methods, unilateral .......
60.0
5728
fascia sling method .......
40.0
5729
lid suture method .......
25.0
5730
Cautery puncture for entropion or ectropion .......
5.0
5731
Ectropion repair (
e.g.,
Kuhnt-Szymanowski type) .......
40.0
5732
Entropion repair (
e.g.,
Wheeler
								type) .......
40.0
Suture
(
Blepharorrhaphy:
suture of eyelid,
								see 0251, 0261-0269.)
(
Tarsorrhaphy:
suture of tarsal
								cartilage see 0251, 0261-0269.)
(
Canthorrhaphy:
suture of palpebral
								fissure of canthus, see 0251, 0261-0269.)
Conjunctiva
Incision
5741
Removal of foreign body from surface of conjunctiva
								.......
1.0
5742
embedded in conjunctiva .......
2.0
5743
Suture of conjunctiva .......
5.0
Excision
5751
Biopsy of conjunctiva .......
5.0
5753
Excision of lesion of conjunctiva,
e.g.,
cyst .......
5.0
(For epithelioma, see 0175-0196, 0261-0269.)
For nevus see 0175-0196, 0261-0269.)
Repair
5760
Conjunctivoplasty, free graft using conjunctiva
								.......
50.0
5762
using buccal mucous membrane .......
60.0
5774
Flap operation of corneal ulcer .......
20.0
5775
Flap operation: "flapping" of conjunctiva for
								perforating injuries or operative wound .......
20.0
(For repair of symblepharon without graft, see
								0175-0178, 0260-0276.)
Lacrimal
								  Tract
Incision
5801
Drainage of lacrimal gland (abscess) .......
10.0
5803
Drainage of lacrimal sac, (dacryocystotomy or
								dacryocystostomy) .......
7.5
Excision
5811
Excision of lacrimal gland (dacryoadenectomy)
								.......
50.0
5813
Excision of lacrimal sac (dacryocystectomy) .......
50.0
5815
Excision of lacrimal gland tumor .......
60.0
Introduction
5821
Catheterization of nasolacrimal duct with
								implantation of tube or stent .......
10.0
5823
Injection procedure for dacryocystography .......
3.0
Repair
5831
Plastic operation on canaliculi .......
by report
5833
Dacryocystorrhinostomy: fistulization of lacrimal
								sac into nasal cavity, with or without anterior ethmoidectomy .......
70.0
5835
Closure of punctum by cautery .......
4.0
Manipulation
5841
Dilation of punctum .......
2.0
5843
Probing of nasolocrimal duct .......
3.0
5846
Probing and/or irrigation of canaliculus .......
*2.0
EAR
External
								  Ear
Incision
5901
Drainage of abscess or hematoma of auricle, simple
								.......
2.0
5902
complicated, including suppurative chondritis
								.......
by report
5905
Drainage of abscess of external auditory canal
								.......
2.0
Excision
5911
Biopsy of ear .......
3.0
(For local destruction or excision of lesion of ear,
								see 0175-0197.)
(For plastic closure see 0260-0324.)
5916
Excision; ear, partial, simple repair .......
10.0
5917
Complete amputation, auricle .......
20.0
5920
Excision; osteoma, external canal, simple .......
5.0
5923
Excision of exostosis of external auditory canal,
								endaural or post-aural approach, complicated .......
50.0
5924
Radical excision of malignant lesion of external
								auditory canal .......
by report
5926
with neck dissection .......
by report
Endoscopy
5931
Otoscopy with removal of foreign body in external
								auditory canal .......
2.0
Repair
(
Otolasty:
plastic operation on
								ear, see 0260-0324.)
(
Reconstruction of ear
with graft
								of skin plus cartilage, bone or other implant, see 0260-0324, 0620 and
								0621.)
5947
Otoplasty, of cartilage ("lop-ear"), with or without
								reduction in size, unilateral .......
50.0
5948
bilateral .......
70.0
5949
Reconstruct external auditory canal for congenital
								astresia, single stage .......
100.0
Suture
(For suture of wound or injury of ear, see 0251,
								0252, 0260-0270.)
Middle
								  Ear
Introduction
5955
Eustachian tube catheterization and insufflation,
								unilateral or bilateral .......
1.5
Incision
5961
Myringotomy; tympanotomy; plicotomy, with or without
								Eustachian inflation and/or aspiration .......
3.0
5962
Tympanotomy, diagnostic, exploratory for middle ear
								exposure .......
50.0
5963
with insertion of tube for serous otitis media,
								unilateral .......
5.0
5964
with insertion of collar button tube for muco-serous
								otitis media, unilateral or bilateral .......
25.0
5968
Tympanolysis, transtympanic .......
80.0
Excision
5971
Mastoidectomy, simple .......
50.0
5972
Mastoidectomy, modified radical or radical, without
								skin graft .......
80.0
5975
with skin graft .......
90.0
5980
Petrous apicectomy including radical mastoidectomy
								.......
by report
5982
Removal of middle ear polyp .......
10.0
Repair
5990
Revision of radical mastoidectomy, with or without
								skin graft .......
90.0
5991
Patching tympanic membrane, with or without
								cauterization .......
2.0
5992
Myringoplasty, uncomplicated .......
80.0
5993
Tympanoplasty without mastoidectomy (may include
								change in contours of external auditory canal and be combined with middle ear,
								including ossicular chain construction and/or attic surgery), post auricular or
								endaural approach .......
100.0
5994
Typanoplasty with mastoidectomy .......
120.0
5996
Incudo-stapedial arthrodesis, with or without graft
								.......
70.0
5997
Stapes mobilization, primary or secondary .......
70.0
5998
Stapedectomy with insertion of prosthetic stapes
								with fenestration of the oval window .......
100.0
5999
Mastoid obliteration .......
80.0
Suture
6001
Closure of fistula, mastoid (independent procedure)
								.......
25.0
6002
Decompression, intratemporal, facial nerve, with or
								without neurolysis .......
100.0
(See also 5330.)
6003
Suture and/or graft, facial nerve, intratemporal
								.......
120.0
Internal
								  Ear
Incision
6011
Labyrinthotomy, any type .......
100.0
6012
Fenestration of semicircular canal .......
100.0
6014
Revision of fenestration operation .......
60.0
Excision
6021
Labyrinthectomy .......
100.0
Footnotes
* Value is to be calculated as
					 the sum of the various services rendered (e.g., hospital visit, application of
					 cast or splint, detention with patient, office visit, etc.).