CPT Codes

CPT_CODE
10021
10022
10040
10060
10061
10080
10081
10120
10121
10140
10160
10180
11000
11001
11010
11011
11012
11040
11041
11042
11043
11044
11055
11056
11057
11100
11101
11200
11201
11300
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11450
11451
11462
11463
11470
11471
11600
11601
11602
11603
11604
11606
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
11719
11720
11721
11730
11732
11740
11750
11752
11755
11760
11762
11765
11770
11771
11772
11900
11901
11920
11921
11922
11950
11951
11952
11954
11960
11970
11971
11975
11976
11977
11980
11981
11982
11983
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
12020
12021
12031
12032
12034
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052
12053
12054
12055
12056
12057
13100
13101
13102
13120
13121
13122
13131
13132
13133
13150
13151
13152
13153
13160
14000
14001
14020
14021
14040
14041
14060
14061
14300
14350
15000
15001
15050
15100
15101
15120
15121
15200
15201
15220
15221
15240
15241
15260
15261
15342
15343
15350
15351
15400
15401
15570
15572
15574
15576
15600
15610
15620
15630
15650
15732
15734
15736
15738
15740
15750
15756
15757
15758
15760
15770
15775
15776
15780
15781
15782
15783
15786
15787
15788
15789
15792
15793
15810
15811
15819
15820
15821
15822
15823
15824
15825
15826
15828
15829
15831
15832
15833
15834
15835
15836
15837
15838
15839
15840
15841
15842
15845
15850
15851
15852
15860
15876
15877
15878
15879
15920
15922
15931
15933
15934
15935
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
15956
15958
15999
16000
16010
16015
16020
16025
16030
16035
16036
17000
17003
17004
17106
17107
17108
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283
17284
17286
17304
17305
17306
17307
17310
17340
17360
17380
17999
19000
19001
19020
19030
19100
19101
19102
19103
19110
19112
19120
19125
19126
19140
19160
19162
19180
19182
19200
19220
19240
19260
19271
19272
19290
19291
19295
19316
19318
19324
19325
19328
19330
19340
19342
19350
19355
19357
19361
19364
19366
19367
19368
19369
19370
19371
19380
19396
19499
20000
20005
20100
20101
20102
20103
20150
20200
20205
20206
20220
20225
20240
20245
20250
20251
20500
20501
20520
20525
20526
20550
20551
20552
20553
20600
20605
20610
20612
20615
20650
20660
20661
20662
20663
20664
20665
20670
20680
20690
20692
20693
20694
20802
20805
20808
20816
20822
20824
20827
20838
20900
20902
20910
20912
20920
20922
20924
20926
20930
20931
20936
20937
20938
20950
20955
20956
20957
20962
20969
20970
20972
20973
20974
20975
20979
20999
21010
21015
21025
21026
21029
21030
21031
21032
21034
21040
21044
21045
21046
21047
21048
21049
21050
21060
21070
21076
21077
21079
21080
21081
21082
21083
21084
21085
21086
21087
21088
21089
21100
21110
21116
21120
21121
21122
21123
21125
21127
21137
21138
21139
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21175
21179
21180
21181
21182
21183
21184
21188
21193
21194
21195
21196
21198
21199
21206
21208
21209
21210
21215
21230
21235
21240
21242
21243
21244
21245
21246
21247
21248
21249
21255
21256
21260
21261
21263
21267
21268
21270
21275
21280
21282
21295
21296
21299
21300
21310
21315
21320
21325
21330
21335
21336
21337
21338
21339
21340
21343
21344
21345
21346
21347
21348
21355
21356
21360
21365
21366
21385
21386
21387
21390
21395
21400
21401
21406
21407
21408
21421
21422
21423
21431
21432
21433
21435
21436
21440
21445
21450
21451
21452
21453
21454
21461
21462
21465
21470
21480
21485
21490
21493
21494
21495
21497
21499
21501
21502
21510
21550
21555
21556
21557
21600
21610
21615
21616
21620
21627
21630
21632
21700
21705
21720
21725
21740
21742
21743
21750
21800
21805
21810
21820
21825
21899
21920
21925
21930
21935
22100
22101
22102
22103
22110
22112
22114
22116
22210
22212
22214
22216
22220
22222
22224
22226
22305
22310
22315
22318
22319
22325
22326
22327
22328
22505
22520
22521
22522
22548
22554
22556
22558
22585
22590
22595
22600
22610
22612
22614
22630
22632
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22851
22852
22855
22899
22900
22999
23000
23020
23030
23031
23035
23040
23044
23065
23066
23075
23076
23077
23100
23101
23105
23106
23107
23120
23125
23130
23140
23145
23146
23150
23155
23156
23170
23172
23174
23180
23182
23184
23190
23195
23200
23210
23220
23221
23222
23330
23331
23332
23350
23395
23397
23400
23405
23406
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23470
23472
23480
23485
23490
23491
23500
23505
23515
23520
23525
23530
23532
23540
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625
23630
23650
23655
23660
23665
23670
23675
23680
23700
23800
23802
23900
23920
23921
23929
23930
23931
23935
24000
24006
24065
24066
24075
24076
24077
24100
24101
24102
24105
24110
24115
24116
24120
24125
24126
24130
24134
24136
24138
24140
24145
24147
24149
24150
24151
24152
24153
24155
24160
24164
24200
24201
24220
24300
24301
24305
24310
24320
24330
24331
24332
24340
24341
24342
24343
24344
24345
24346
24350
24351
24352
24354
24356
24360
24361
24362
24363
24365
24366
24400
24410
24420
24430
24435
24470
24495
24498
24500
24505
24515
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
24576
24577
24579
24582
24586
24587
24600
24605
24615
24620
24635
24640
24650
24655
24665
24666
24670
24675
24685
24800
24802
24900
24920
24925
24930
24931
24935
24940
24999
25000
25001
25020
25023
25024
25025
25028
25031
25035
25040
25065
25066
25075
25076
25077
25085
25100
25101
25105
25107
25110
25111
25112
25115
25116
25118
25119
25120
25125
25126
25130
25135
25136
25145
25150
25151
25170
25210
25215
25230
25240
25246
25248
25250
25251
25259
25260
25263
25265
25270
25272
25274
25275
25280
25290
25295
25300
25301
25310
25312
25315
25316
25320
25332
25335
25337
25350
25355
25360
25365
25370
25375
25390
25391
25392
25393
25394
25400
25405
25415
25420
25425
25426
25430
25431
25440
25441
25442
25443
25444
25445
25446
25447
25449
25450
25455
25490
25491
25492
25500
25505
25515
25520
25525
25526
25530
25535
25545
25560
25565
25574
25575
25600
25605
25611
25620
25622
25624
25628
25630
25635
25645
25650
25651
25652
25660
25670
25671
25675
25676
25680
25685
25690
25695
25800
25805
25810
25820
25825
25830
25900
25905
25907
25909
25915
25920
25922
25924
25927
25929
25931
25999
26010
26011
26020
26025
26030
26034
26035
26037
26040
26045
26055
26060
26070
26075
26080
26100
26105
26110
26115
26116
26117
26121
26123
26125
26130
26135
26140
26145
26160
26170
26180
26185
26200
26205
26210
26215
26230
26235
26236
26250
26255
26260
26261
26262
26320
26340
26350
26352
26356
26357
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418
26420
26426
26428
26432
26433
26434
26437
26440
26442
26445
26449
26450
26455
26460
26471
26474
26476
26477
26478
26479
26480
26483
26485
26489
26490
26492
26494
26496
26497
26498
26499
26500
26502
26504
26508
26510
26516
26517
26518
26520
26525
26530
26531
26535
26536
26540
26541
26542
26545
26546
26548
26550
26551
26553
26554
26555
26556
26560
26561
26562
26565
26567
26568
26580
26587
26590
26591
26593
26596
26600
26605
26607
26608
26615
26641
26645
26650
26665
26670
26675
26676
26685
26686
26700
26705
26706
26715
26720
26725
26727
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
26820
26841
26842
26843
26844
26850
26852
26860
26861
26862
26863
26910
26951
26952
26989
26990
26991
26992
27000
27001
27003
27005
27006
27025
27030
27033
27035
27036
27040
27041
27047
27048
27049
27050
27052
27054
27060
27062
27065
27066
27067
27070
27071
27075
27076
27077
27078
27079
27080
27086
27087
27090
27091
27093
27095
27096
27097
27098
27100
27105
27110
27111
27120
27122
27125
27130
27132
27134
27137
27138
27140
27146
27147
27151
27156
27158
27161
27165
27170
27175
27176
27177
27178
27179
27181
27185
27187
27193
27194
27200
27202
27215
27216
27217
27218
27220
27222
27226
27227
27228
27230
27232
27235
27236
27238
27240
27244
27245
27246
27248
27250
27252
27253
27254
27256
27257
27258
27259
27265
27266
27275
27280
27282
27284
27286
27290
27295
27299
27301
27303
27305
27306
27307
27310
27315
27320
27323
27324
27327
27328
27329
27330
27331
27332
27333
27334
27335
27340
27345
27347
27350
27355
27356
27357
27358
27360
27365
27370
27372
27380
27381
27385
27386
27390
27391
27392
27393
27394
27395
27396
27397
27400
27403
27405
27407
27409
27418
27420
27422
27424
27425
27427
27428
27429
27430
27435
27437
27438
27440
27441
27442
27443
27445
27446
27447
27448
27450
27454
27455
27457
27465
27466
27468
27470
27472
27475
27477
27479
27485
27486
27487
27488
27495
27496
27497
27498
27499
27500
27501
27502
27503
27506
27507
27508
27509
27510
27511
27513
27514
27516
27517
27519
27520
27524
27530
27532
27535
27536
27538
27540
27550
27552
27556
27557
27558
27560
27562
27566
27570
27580
27590
27591
27592
27594
27596
27598
27599
27600
27601
27602
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27618
27619
27620
27625
27626
27630
27635
27637
27638
27640
27641
27645
27646
27647
27648
27650
27652
27654
27656
27658
27659
27664
27665
27675
27676
27680
27681
27685
27686
27687
27690
27691
27692
27695
27696
27698
27700
27702
27703
27704
27705
27707
27709
27712
27715
27720
27722
27724
27725
27727
27730
27732
27734
27740
27742
27745
27750
27752
27756
27758
27759
27760
27762
27766
27780
27781
27784
27786
27788
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
27840
27842
27846
27848
27860
27870
27871
27880
27881
27882
27884
27886
27888
27889
27892
27893
27894
27899
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28030
28035
28043
28045
28046
28050
28052
28054
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260
28261
28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28899
29000
29010
29015
29020
29025
29035
29040
29044
29046
29049
29055
29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29220
29240
29260
29280
29305
29325
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29590
29700
29705
29710
29715
29720
29730
29740
29750
29799
29800
29804
29805
29806
29807
29819
29820
29821
29822
29823
29824
29825
29826
29827
29830
29834
29835
29836
29837
29838
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29863
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
29891
29892
29893
29894
29895
29897
29898
29899
29900
29901
29902
29999
30000
30020
30100
30110
30115
30117
30118
30120
30124
30125
30130
30140
30150
30160
30200
30210
30220
30300
30310
30320
30400
30410
30420
30430
30435
30450
30460
30462
30465
30520
30540
30545
30560
30580
30600
30620
30630
30801
30802
30901
30903
30905
30906
30915
30920
30930
30999
31000
31002
31020
31030
31032
31040
31050
31051
31070
31075
31080
31081
31084
31085
31086
31087
31090
31200
31201
31205
31225
31230
31231
31233
31235
31237
31238
31239
31240
31254
31255
31256
31267
31276
31287
31288
31290
31291
31292
31293
31294
31299
31300
31320
31360
31365
31367
31368
31370
31375
31380
31382
31390
31395
31400
31420
31500
31502
31505
31510
31511
31512
31513
31515
31520
31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31560
31561
31570
31571
31575
31576
31577
31578
31579
31580
31582
31584
31585
31586
31587
31588
31590
31595
31599
31600
31601
31603
31605
31610
31611
31612
31613
31614
31615
31622
31623
31624
31625
31628
31629
31630
31631
31635
31640
31641
31643
31645
31646
31656
31700
31708
31710
31715
31717
31720
31725
31730
31750
31755
31760
31766
31770
31775
31780
31781
31785
31786
31800
31805
31820
31825
31830
31899
32000
32002
32005
32020
32035
32036
32095
32100
32110
32120
32124
32140
32141
32150
32151
32160
32200
32201
32215
32220
32225
32310
32320
32400
32402
32405
32420
32440
32442
32445
32480
32482
32484
32486
32488
32491
32500
32501
32520
32522
32525
32540
32601
32602
32603
32604
32605
32606
32650
32651
32652
32653
32654
32655
32656
32657
32658
32659
32660
32661
32662
32663
32664
32665
32800
32810
32815
32820
32850
32851
32852
32853
32854
32900
32905
32906
32940
32960
32997
32999
33010
33011
33015
33020
33025
33030
33031
33050
33120
33130
33140
33141
33200
33201
33206
33207
33208
33210
33211
33212
33213
33214
33215
33216
33217
33218
33220
33222
33223
33224
33225
33226
33233
33234
33235
33236
33237
33238
33240
33241
33243
33244
33245
33246
33249
33250
33251
33253
33261
33282
33284
33300
33305
33310
33315
33320
33321
33322
33330
33332
33335
33400
33401
33403
33404
33405
33406
33410
33411
33412
33413
33414
33415
33416
33417
33420
33422
33425
33426
33427
33430
33460
33463
33464
33465
33468
33470
33471
33472
33474
33475
33476
33478
33496
33500
33501
33502
33503
33504
33505
33506
33508
33510
33511
33512
33513
33514
33516
33517
33518
33519
33521
33522
33523
33530
33533
33534
33535
33536
33542
33545
33572
33600
33602
33606
33608
33610
33611
33612
33615
33617
33619
33641
33645
33647
33660
33665
33670
33681
33684
33688
33690
33692
33694
33697
33702
33710
33720
33722
33730
33732
33735
33736
33737
33750
33755
33762
33764
33766
33767
33770
33771
33774
33775
33776
33777
33778
33779
33780
33781
33786
33788
33800
33802
33803
33813
33814
33820
33822
33824
33840
33845
33851
33852
33853
33860
33861
33863
33870
33875
33877
33910
33915
33916
33917
33918
33919
33920
33922
33924
33930
33935
33940
33945
33960
33961
33967
33968
33970
33971
33973
33974
33975
33976
33977
33978
33979
33980
33999
34001
34051
34101
34111
34151
34201
34203
34401
34421
34451
34471
34490
34501
34502
34510
34520
34530
34800
34802
34804
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
34900
35001
35002
35005
35011
35013
35021
35022
35045
35081
35082
35091
35092
35102
35103
35111
35112
35121
35122
35131
35132
35141
35142
35151
35152
35161
35162
35180
35182
35184
35188
35189
35190
35201
35206
35207
35211
35216
35221
35226
35231
35236
35241
35246
35251
35256
35261
35266
35271
35276
35281
35286
35301
35311
35321
35331
35341
35351
35355
35361
35363
35371
35372
35381
35390
35400
35450
35452
35454
35456
35458
35459
35460
35470
35471
35472
35473
35474
35475
35476
35480
35481
35482
35483
35484
35485
35490
35491
35492
35493
35494
35495
35500
35501
35506
35507
35508
35509
35511
35515
35516
35518
35521
35526
35531
35533
35536
35541
35546
35548
35549
35551
35556
35558
35560
35563
35565
35566
35571
35572
35582
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35636
35641
35642
35645
35646
35647
35650
35651
35654
35656
35661
35663
35665
35666
35671
35681
35682
35683
35685
35686
35691
35693
35694
35695
35700
35701
35721
35741
35761
35800
35820
35840
35860
35870
35875
35876
35879
35881
35901
35903
35905
35907
36000
36002
36005
36010
36011
36012
36013
36014
36015
36100
36120
36140
36145
36160
36200
36215
36216
36217
36218
36245
36246
36247
36248
36260
36261
36262
36299
36400
36405
36406
36410
36415
36416
36420
36425
36430
36440
36450
36455
36460
36468
36469
36470
36471
36481
36488
36489
36490
36491
36493
36500
36510
36511
36512
36513
36514
36515
36516
36522
36530
36531
36532
36533
36534
36535
36536
36537
36540
36550
36600
36620
36625
36640
36660
36680
36800
36810
36815
36819
36820
36821
36822
36823
36825
36830
36831
36832
36833
36834
36835
36860
36861
36870
37140
37145
37160
37180
37181
37182
37183
37195
37200
37201
37202
37203
37204
37205
37206
37207
37208
37209
37250
37251
37500
37501
37565
37600
37605
37606
37607
37609
37615
37616
37617
37618
37620
37650
37660
37700
37720
37730
37735
37760
37780
37785
37788
37790
37799
38100
38101
38102
38115
38120
38129
38200
38204
38205
38206
38207
38208
38209
38210
38211
38212
38213
38214
38215
38220
38221
38230
38240
38241
38242
38300
38305
38308
38380
38381
38382
38500
38505
38510
38520
38525
38530
38542
38550
38555
38562
38564
38570
38571
38572
38589
38700
38720
38724
38740
38745
38746
38747
38760
38765
38770
38780
38790
38792
38794
38999
39000
39010
39200
39220
39400
39499
39501
39502
39503
39520
39530
39531
39540
39541
39545
39560
39561
39599
40490
40500
40510
40520
40525
40527
40530
40650
40652
40654
40700
40701
40702
40720
40761
40799
40800
40801
40804
40805
40806
40808
40810
40812
40814
40816
40818
40819
40820
40830
40831
40840
40842
40843
40844
40845
40899
41000
41005
41006
41007
41008
41009
41010
41015
41016
41017
41018
41100
41105
41108
41110
41112
41113
41114
41115
41116
41120
41130
41135
41140
41145
41150
41153
41155
41250
41251
41252
41500
41510
41520
41599
41800
41805
41806
41820
41821
41822
41823
41825
41826
41827
41828
41830
41850
41870
41872
41874
41899
42000
42100
42104
42106
42107
42120
42140
42145
42160
42180
42182
42200
42205
42210
42215
42220
42225
42226
42227
42235
42260
42280
42281
42299
42300
42305
42310
42320
42325
42326
42330
42335
42340
42400
42405
42408
42409
42410
42415
42420
42425
42426
42440
42450
42500
42505
42507
42508
42509
42510
42550
42600
42650
42660
42665
42699
42700
42720
42725
42800
42802
42804
42806
42808
42809
42810
42815
42820
42821
42825
42826
42830
42831
42835
42836
42842
42844
42845
42860
42870
42890
42892
42894
42900
42950
42953
42955
42960
42961
42962
42970
42971
42972
42999
43020
43030
43045
43100
43101
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
43130
43135
43200
43201
43202
43204
43205
43215
43216
43217
43219
43220
43226
43227
43228
43231
43232
43234
43235
43236
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
43250
43251
43255
43256
43258
43259
43260
43261
43262
43263
43264
43265
43267
43268
43269
43271
43272
43280
43289
43300
43305
43310
43312
43313
43314
43320
43324
43325
43326
43330
43331
43340
43341
43350
43351
43352
43360
43361
43400
43401
43405
43410
43415
43420
43425
43450
43453
43456
43458
43460
43496
43499
43500
43501
43502
43510
43520
43600
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43635
43638
43639
43640
43641
43651
43652
43653
43659
43750
43752
43760
43761
43800
43810
43820
43825
43830
43831
43832
43840
43842
43843
43846
43847
43848
43850
43855
43860
43865
43870
43880
43999
44005
44010
44015
44020
44021
44025
44050
44055
44100
44110
44111
44120
44121
44125
44126
44127
44128
44130
44132
44133
44135
44136
44139
44140
44141
44143
44144
44145
44146
44147
44150
44151
44152
44153
44155
44156
44160
44200
44201
44202
44203
44204
44205
44206
44207
44208
44210
44211
44212
44238
44239
44300
44310
44312
44314
44316
44320
44322
44340
44345
44346
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380
44382
44383
44385
44386
44388
44389
44390
44391
44392
44393
44394
44397
44500
44602
44603
44604
44605
44615
44620
44625
44626
44640
44650
44660
44661
44680
44700
44701
44799
44800
44820
44850
44899
44900
44901
44950
44955
44960
44970
44979
45000
45005
45020
45100
45108
45110
45111
45112
45113
45114
45116
45119
45120
45121
45123
45126
45130
45135
45136
45150
45160
45170
45190
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
45342
45345
45355
45378
45379
45380
45381
45382
45383
45384
45385
45386
45387
45500
45505
45520
45540
45541
45550
45560
45562
45563
45800
45805
45820
45825
45900
45905
45910
45915
45999
46020
46030
46040
46045
46050
46060
46070
46080
46083
46200
46210
46211
46220
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46285
46288
46320
46500
46600
46604
46606
46608
46610
46611
46612
46614
46615
46700
46705
46706
46715
46716
46730
46735
46740
46742
46744
46746
46748
46750
46751
46753
46754
46760
46761
46762
46900
46910
46916
46917
46922
46924
46934
46935
46936
46937
46938
46940
46942
46945
46946
46999
47000
47001
47010
47011
47015
47100
47120
47122
47125
47130
47133
47134
47135
47136
47300
47350
47360
47361
47362
47370
47371
47379
47380
47381
47382
47399
47400
47420
47425
47460
47480
47490
47500
47505
47510
47511
47525
47530
47550
47552
47553
47554
47555
47556
47560
47561
47562
47563
47564
47570
47579
47600
47605
47610
47612
47620
47630
47700
47701
47711
47712
47715
47716
47720
47721
47740
47741
47760
47765
47780
47785
47800
47801
47802
47900
47999
48000
48001
48005
48020
48100
48102
48120
48140
48145
48146
48148
48150
48152
48153
48154
48155
48160
48180
48400
48500
48510
48511
48520
48540
48545
48547
48550
48554
48556
48999
49000
49002
49010
49020
49021
49040
49041
49060
49061
49062
49080
49081
49085
49180
49200
49201
49215
49220
49250
49255
49320
49321
49322
49323
49329
49400
49419
49420
49421
49422
49423
49424
49425
49426
49427
49428
49429
49491
49492
49495
49496
49500
49501
49505
49507
49520
49521
49525
49540
49550
49553
49555
49557
49560
49561
49565
49566
49568
49570
49572
49580
49582
49585
49587
49590
49600
49605
49606
49610
49611
49650
49651
49659
49900
49904
49905
49906
49999
50010
50020
50021
50040
50045
50060
50065
50070
50075
50080
50081
50100
50120
50125
50130
50135
50200
50205
50220
50225
50230
50234
50236
50240
50280
50290
50300
50320
50340
50360
50365
50370
50380
50390
50392
50393
50394
50395
50396
50398
50400
50405
50500
50520
50525
50526
50540
50541
50542
50543
50544
50545
50546
50547
50548
50549
50551
50553
50555
50557
50559
50561
50562
50570
50572
50574
50575
50576
50578
50580
50590
50600
50605
50610
50620
50630
50650
50660
50684
50686
50688
50690
50700
50715
50722
50725
50727
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
50930
50940
50945
50947
50948
50949
50951
50953
50955
50957
50959
50961
50970
50972
50974
50976
50978
50980
51000
51005
51010
51020
51030
51040
51045
51050
51060
51065
51080
51500
51520
51525
51530
51535
51550
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51600
51605
51610
51700
51701
51702
51703
51705
51710
51715
51720
51725
51726
51736
51741
51772
51784
51785
51792
51795
51797
51798
51800
51820
51840
51841
51845
51860
51865
51880
51900
51920
51925
51940
51960
51980
51990
51992
52000
52001
52005
52007
52010
52204
52214
52224
52234
52235
52240
52250
52260
52265
52270
52275
52276
52277
52281
52282
52283
52285
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52347
52351
52352
52353
52354
52355
52400
52450
52500
52510
52601
52606
52612
52614
52620
52630
52640
52647
52648
52700
53000
53010
53020
53025
53040
53060
53080
53085
53200
53210
53215
53220
53230
53235
53240
53250
53260
53265
53270
53275
53400
53405
53410
53415
53420
53425
53430
53431
53440
53442
53444
53445
53446
53447
53448
53449
53450
53460
53502
53505
53510
53515
53520
53600
53601
53605
53620
53621
53660
53661
53665
53850
53852
53853
53899
54000
54001
54015
54050
54055
54056
54057
54060
54065
54100
54105
54110
54111
54112
54115
54120
54125
54130
54135
54150
54152
54160
54161
54162
54163
54164
54200
54205
54220
54230
54231
54235
54240
54250
54300
54304
54308
54312
54316
54318
54322
54324
54326
54328
54332
54336
54340
54344
54348
54352
54360
54380
54385
54390
54400
54401
54405
54406
54408
54410
54411
54415
54416
54417
54420
54430
54435
54440
54450
54500
54505
54512
54520
54522
54530
54535
54550
54560
54600
54620
54640
54650
54660
54670
54680
54690
54692
54699
54700
54800
54820
54830
54840
54860
54861
54900
54901
55000
55040
55041
55060
55100
55110
55120
55150
55175
55180
55200
55250
55300
55400
55450
55500
55520
55530
55535
55540
55550
55559
55600
55605
55650
55680
55700
55705
55720
55725
55801
55810
55812
55815
55821
55831
55840
55842
55845
55859
55860
55862
55865
55866
55870
55873
55899
55970
55980
56405
56420
56440
56441
56501
56515
56605
56606
56620
56625
56630
56631
56632
56633
56634
56637
56640
56700
56720
56740
56800
56805
56810
56820
56821
57000
57010
57020
57022
57023
57061
57065
57100
57105
57106
57107
57109
57110
57111
57112
57120
57130
57135
57150
57155
57160
57170
57180
57200
57210
57220
57230
57240
57250
57260
57265
57268
57270
57280
57282
57284
57287
57288
57289
57291
57292
57300
57305
57307
57308
57310
57311
57320
57330
57335
57400
57410
57415
57420
57421
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57520
57522
57530
57531
57540
57545
57550
57555
57556
57700
57720
57800
57820
58100
58120
58140
58145
58146
58150
58152
58180
58200
58210
58240
58260
58262
58263
58267
58270
58275
58280
58285
58290
58291
58292
58293
58294
58300
58301
58321
58322
58323
58340
58345
58346
58350
58353
58400
58410
58520
58540
58545
58546
58550
58552
58553
58554
58555
58558
58559
58560
58561
58562
58563
58578
58579
58600
58605
58611
58615
58660
58661
58662
58670
58671
58672
58673
58679
58700
58720
58740
58750
58752
58760
58770
58800
58805
58820
58822
58823
58825
58900
58920
58925
58940
58943
58950
58951
58952
58953
58954
58960
58970
58974
58976
58999
59000
59001
59012
59015
59020
59025
59030
59050
59051
59100
59120
59121
59130
59135
59136
59140
59150
59151
59160
59200
59300
59320
59325
59350
59400
59409
59410
59412
59414
59425
59426
59430
59510
59514
59515
59525
59610
59612
59614
59618
59620
59622
59812
59820
59821
59830
59840
59841
59850
59851
59852
59855
59856
59857
59866
59870
59871
59898
59899
60000
60001
60100
60200
60210
60212
60220
60225
60240
60252
60254
60260
60270
60271
60280
60281
60500
60502
60505
60512
60520
60521
60522
60540
60545
60600
60605
60650
60659
60699
61000
61001
61020
61026
61050
61055
61070
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61215
61250
61253
61304
61305
61312
61313
61314
61315
61316
61320
61321
61322
61323
61330
61332
61333
61334
61340
61343
61345
61440
61450
61458
61460
61470
61480
61490
61500
61501
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61538
61539
61541
61542
61543
61544
61545
61546
61548
61550
61552
61556
61557
61558
61559
61563
61564
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61609
61610
61611
61612
61613
61615
61616
61618
61619
61623
61624
61626
61680
61682
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710
61711
61720
61735
61750
61751
61760
61770
61790
61791
61793
61795
61850
61860
61862
61870
61875
61880
61885
61886
61888
62000
62005
62010
62100
62115
62116
62117
62120
62121
62140
62141
62142
62143
62145
62146
62147
62148
62160
62161
62162
62163
62164
62165
62180
62190
62192
62194
62200
62201
62220
62223
62225
62230
62252
62256
62258
62263
62264
62268
62269
62270
62272
62273
62280
62281
62282
62284
62287
62290
62291
62292
62294
62310
62311
62318
62319
62350
62351
62355
62360
62361
62362
62365
62367
62368
63001
63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
63042
63043
63044
63045
63046
63047
63048
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
63085
63086
63087
63088
63090
63091
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278
63280
63281
63282
63283
63285
63286
63287
63290
63300
63301
63302
63303
63304
63305
63306
63307
63308
63600
63610
63615
63650
63655
63660
63685
63688
63700
63702
63704
63706
63707
63709
63710
63740
63741
63744
63746
64400
64402
64405
64408
64410
64412
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447
64448
64450
64470
64472
64475
64476
64479
64480
64483
64484
64505
64508
64510
64520
64530
64550
64553
64555
64560
64561
64565
64573
64575
64577
64580
64581
64585
64590
64595
64600
64605
64610
64612
64613
64614
64620
64622
64623
64626
64627
64630
64640
64680
64702
64704
64708
64712
64713
64714
64716
64718
64719
64721
64722
64726
64727
64732
64734
64736
64738
64740
64742
64744
64746
64752
64755
64760
64761
64763
64766
64771
64772
64774
64776
64778
64782
64783
64784
64786
64787
64788
64790
64792
64795
64802
64804
64809
64818
64820
64821
64822
64823
64831
64832
64834
64835
64836
64837
64840
64856
64857
64858
64859
64861
64862
64864
64865
64866
64868
64870
64872
64874
64876
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
64901
64902
64905
64907
64999
65091
65093
65101
65103
65105
65110
65112
65114
65125
65130
65135
65140
65150
65155
65175
65205
65210
65220
65222
65235
65260
65265
65270
65272
65273
65275
65280
65285
65286
65290
65400
65410
65420
65426
65430
65435
65436
65450
65600
65710
65730
65750
65755
65760
65765
65767
65770
65771
65772
65775
65800
65805
65810
65815
65820
65850
65855
65860
65865
65870
65875
65880
65900
65920
65930
66020
66030
66130
66150
66155
66160
66165
66170
66172
66180
66185
66220
66225
66250
66500
66505
66600
66605
66625
66630
66635
66680
66682
66700
66710
66720
66740
66761
66762
66770
66820
66821
66825
66830
66840
66850
66852
66920
66930
66940
66982
66983
66984
66985
66986
66990
66999
67005
67010
67015
67025
67027
67028
67030
67031
67036
67038
67039
67040
67101
67105
67107
67108
67110
67112
67115
67120
67121
67141
67145
67208
67210
67218
67220
67221
67225
67227
67228
67250
67255
67299
67311
67312
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67350
67399
67400
67405
67412
67413
67414
67415
67420
67430
67440
67445
67450
67500
67505
67515
67550
67560
67570
67599
67700
67710
67715
67800
67801
67805
67808
67810
67820
67825
67830
67835
67840
67850
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67909
67911
67914
67915
67916
67917
67921
67922
67923
67924
67930
67935
67938
67950
67961
67966
67971
67973
67974
67975
67999
68020
68040
68100
68110
68115
68130
68135
68200
68320
68325
68326
68328
68330
68335
68340
68360
68362
68399
68400
68420
68440
68500
68505
68510
68520
68525
68530
68540
68550
68700
68705
68720
68745
68750
68760
68761
68770
68801
68810
68811
68815
68840
68850
68899
69000
69005
69020
69090
69100
69105
69110
69120
69140
69145
69150
69155
69200
69205
69210
69220
69222
69300
69310
69320
69399
69400
69401
69405
69410
69420
69421
69424
69433
69436
69440
69450
69501
69502
69505
69511
69530
69535
69540
69550
69552
69554
69601
69602
69603
69604
69605
69610
69620
69631
69632
69633
69635
69636
69637
69641
69642
69643
69644
69645
69646
69650
69660
69661
69662
69666
69667
69670
69676
69700
69710
69711
69714
69715
69717
69718
69720
69725
69740
69745
69799
69801
69802
69805
69806
69820
69840
69905
69910
69915
69930
69949
69950
69955
69960
69970
69979
69990
70010
70015
70030
70100
70110
70120
70130
70134
70140
70150
70160
70170
70190
70200
70210
70220
70240
70250
70260
70300
70310
70320
70328
70330
70332
70336
70350
70355
70360
70370
70371
70373
70380
70390
70450
70460
70470
70480
70481
70482
70486
70487
70488
70490
70491
70492
70496
70498
70540
70542
70543
70544
70545
70546
70547
70548
70549
70551
70552
70553
71010
71015
71020
71021
71022
71023
71030
71034
71035
71040
71060
71090
71100
71101
71110
71111
71120
71130
71250
71260
71270
71275
71550
71551
71552
71555
72010
72020
72040
72050
72052
72069
72070
72072
72074
72080
72090
72100
72110
72114
72120
72125
72126
72127
72128
72129
72130
72131
72132
72133
72141
72142
72146
72147
72148
72149
72156
72157
72158
72159
72170
72190
72191
72192
72193
72194
72195
72196
72197
72198
72200
72202
72220
72240
72255
72265
72270
72275
72285
72295
73000
73010
73020
73030
73040
73050
73060
73070
73080
73085
73090
73092
73100
73110
73115
73120
73130
73140
73200
73201
73202
73206
73218
73219
73220
73221
73222
73223
73225
73500
73510
73520
73525
73530
73540
73542
73550
73560
73562
73564
73565
73580
73590
73592
73600
73610
73615
73620
73630
73650
73660
73700
73701
73702
73706
73718
73719
73720
73721
73722
73723
73725
74000
74010
74020
74022
74150
74160
74170
74175
74181
74182
74183
74185
74190
74210
74220
74230
74235
74240
74241
74245
74246
74247
74249
74250
74251
74260
74270
74280
74283
74290
74291
74300
74301
74305
74320
74327
74328
74329
74330
74340
74350
74355
74360
74363
74400
74410
74415
74420
74425
74430
74440
74445
74450
74455
74470
74475
74480
74485
74710
74740
74742
74775
75552
75553
75554
75555
75556
75600
75605
75625
75630
75635
75650
75658
75660
75662
75665
75671
75676
75680
75685
75705
75710
75716
75722
75724
75726
75731
75733
75736
75741
75743
75746
75756
75774
75790
75801
75803
75805
75807
75809
75810
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
75880
75885
75887
75889
75891
75893
75894
75896
75898
75900
75901
75902
75940
75945
75946
75952
75953
75954
75960
75961
75962
75964
75966
75968
75970
75978
75980
75982
75984
75989
75992
75993
75994
75995
75996
76000
76001
76003
76005
76006
76010
76012
76013
76020
76040
76061
76062
76065
76066
76070
76071
76075
76076
76078
76080
76085
76086
76088
76090
76091
76092
76093
76094
76095
76096
76098
76100
76101
76102
76120
76125
76140
76150
76350
76355
76360
76362
76370
76375
76380
76390
76393
76394
76400
76490
76496
76497
76498
76499
76506
76511
76512
76513
76516
76519
76529
76536
76604
76645
76700
76705
76770
76775
76778
76800
76801
76802
76805
76810
76811
76812
76815
76816
76817
76818
76819
76825
76826
76827
76828
76830
76831
76856
76857
76870
76872
76873
76880
76885
76886
76930
76932
76936
76941
76942
76945
76946
76948
76950
76965
76970
76975
76977
76986
76999
77261
77262
77263
77280
77285
77290
77295
77299
77300
77301
77305
77310
77315
77321
77326
77327
77328
77331
77332
77333
77334
77336
77370
77399
77401
77402
77403
77404
77406
77407
77408
77409
77411
77412
77413
77414
77416
77417
77418
77427
77431
77432
77470
77499
77520
77522
77523
77525
77600
77605
77610
77615
77620
77750
77761
77762
77763
77776
77777
77778
77781
77782
77783
77784
77789
77790
77799
78000
78001
78003
78006
78007
78010
78011
78015
78016
78018
78020
78070
78075
78099
78102
78103
78104
78110
78111
78120
78121
78122
78130
78135
78140
78160
78162
78170
78172
78185
78190
78191
78195
78199
78201
78202
78205
78206
78215
78216
78220
78223
78230
78231
78232
78258
78261
78262
78264
78267
78268
78270
78271
78272
78278
78282
78290
78291
78299
78300
78305
78306
78315
78320
78350
78351
78399
78414
78428
78445
78455
78456
78457
78458
78459
78460
78461
78464
78465
78466
78468
78469
78472
78473
78478
78480
78481
78483
78491
78492
78494
78496
78499
78580
78584
78585
78586
78587
78588
78591
78593
78594
78596
78599
78600
78601
78605
78606
78607
78608
78609
78610
78615
78630
78635
78645
78647
78650
78660
78699
78700
78701
78704
78707
78708
78709
78710
78715
78725
78730
78740
78760
78761
78799
78800
78801
78802
78803
78805
78806
78807
78810
78890
78891
78990
78999
79000
79001
79020
79030
79035
79100
79200
79300
79400
79420
79440
79900
79999
80048
80050
80051
80053
80055
80061
80069
80074
80076
80100
80101
80102
80103
80150
80152
80154
80156
80157
80158
80160
80162
80164
80166
80168
80170
80172
80173
80174
80176
80178
80182
80184
80185
80186
80188
80190
80192
80194
80196
80197
80198
80200
80201
80202
80299
80400
80402
80406
80408
80410
80412
80414
80415
80416
80417
80418
80420
80422
80424
80426
80428
80430
80432
80434
80435
80436
80438
80439
80440
80500
80502
81000
81001
81002
81003
81005
81007
81015
81020
81025
81050
81099
82000
82003
82009
82010
82013
82016
82017
82024
82030
82040
82042
82043
82044
82055
82075
82085
82088
82101
82103
82104
82105
82106
82108
82120
82127
82128
82131
82135
82136
82139
82140
82143
82145
82150
82154
82157
82160
82163
82164
82172
82175
82180
82190
82205
82232
82239
82240
82247
82248
82252
82261
82270
82273
82274
82286
82300
82306
82307
82308
82310
82330
82331
82340
82355
82360
82365
82370
82373
82374
82375
82376
82378
82379
82380
82382
82383
82384
82387
82390
82397
82415
82435
82436
82438
82441
82465
82480
82482
82485
82486
82487
82488
82489
82491
82492
82495
82507
82520
82523
82525
82528
82530
82533
82540
82541
82542
82543
82544
82550
82552
82553
82554
82565
82570
82575
82585
82595
82600
82607
82608
82615
82626
82627
82633
82634
82638
82646
82649
82651
82652
82654
82657
82658
82664
82666
82668
82670
82671
82672
82677
82679
82690
82693
82696
82705
82710
82715
82725
82726
82728
82731
82735
82742
82746
82747
82757
82759
82760
82775
82776
82784
82785
82787
82800
82803
82805
82810
82820
82926
82928
82938
82941
82943
82945
82946
82947
82948
82950
82951
82952
82953
82955
82960
82962
82963
82965
82975
82977
82978
82979
82980
82985
83001
83002
83003
83008
83010
83012
83013
83014
83015
83018
83020
83021
83026
83030
83033
83036
83045
83050
83051
83055
83060
83065
83068
83069
83070
83071
83080
83088
83090
83150
83491
83497
83498
83499
83500
83505
83516
83518
83519
83520
83525
83527
83528
83540
83550
83570
83582
83586
83593
83605
83615
83625
83632
83633
83634
83655
83661
83662
83663
83664
83670
83690
83715
83716
83718
83719
83721
83727
83735
83775
83785
83788
83789
83805
83825
83835
83840
83857
83858
83864
83866
83872
83873
83874
83880
83883
83885
83887
83890
83891
83892
83893
83894
83896
83897
83898
83901
83902
83903
83904
83905
83906
83912
83915
83916
83918
83919
83921
83925
83930
83935
83937
83945
83950
83970
83986
83992
84022
84030
84035
84060
84061
84066
84075
84078
84080
84081
84085
84087
84100
84105
84106
84110
84119
84120
84126
84127
84132
84133
84134
84135
84138
84140
84143
84144
84146
84150
84152
84153
84154
84155
84160
84165
84181
84182
84202
84203
84206
84207
84210
84220
84228
84233
84234
84235
84238
84244
84252
84255
84260
84270
84275
84285
84295
84300
84302
84305
84307
84311
84315
84375
84376
84377
84378
84379
84392
84402
84403
84425
84430
84432
84436
84437
84439
84442
84443
84445
84446
84449
84450
84460
84466
84478
84479
84480
84481
84482
84484
84485
84488
84490
84510
84512
84520
84525
84540
84545
84550
84560
84577
84578
84580
84583
84585
84586
84588
84590
84591
84597
84600
84620
84630
84681
84702
84703
84830
84999
85002
85004
85007
85008
85009
85013
85014
85018
85025
85027
85032
85041
85044
85045
85046
85048
85049
85060
85097
85130
85170
85175
85210
85220
85230
85240
85244
85245
85246
85247
85250
85260
85270
85280
85290
85291
85292
85293
85300
85301
85302
85303
85305
85306
85307
85335
85337
85345
85347
85348
85360
85362
85366
85370
85378
85379
85380
85384
85385
85390
85400
85410
85415
85420
85421
85441
85445
85460
85461
85475
85520
85525
85530
85536
85540
85547
85549
85555
85557
85576
85597
85610
85611
85612
85613
85635
85651
85652
85660
85670
85675
85705
85730
85732
85810
85999
86000
86001
86003
86005
86021
86022
86023
86038
86039
86060
86063
86077
86078
86079
86140
86141
86146
86147
86148
86155
86156
86157
86160
86161
86162
86171
86185
86215
86225
86226
86235
86243
86255
86256
86277
86280
86294
86300
86301
86304
86308
86309
86310
86316
86317
86318
86320
86325
86327
86329
86331
86332
86334
86336
86337
86340
86341
86343
86344
86353
86359
86360
86361
86376
86378
86382
86384
86403
86406
86430
86431
86485
86490
86510
86580
86585
86586
86590
86592
86593
86602
86603
86606
86609
86611
86612
86615
86617
86618
86619
86622
86625
86628
86631
86632
86635
86638
86641
86644
86645
86648
86651
86652
86653
86654
86658
86663
86664
86665
86666
86668
86671
86674
86677
86682
86684
86687
86688
86689
86692
86694
86695
86696
86698
86701
86702
86703
86704
86705
86706
86707
86708
86709
86710
86713
86717
86720
86723
86727
86729
86732
86735
86738
86741
86744
86747
86750
86753
86756
86757
86759
86762
86765
86768
86771
86774
86777
86778
86781
86784
86787
86790
86793
86800
86803
86804
86805
86806
86807
86808
86812
86813
86816
86817
86821
86822
86849
86850
86860
86870
86880
86885
86886
86890
86891
86900
86901
86903
86904
86905
86906
86910
86911
86920
86921
86922
86927
86930
86931
86932
86940
86941
86945
86950
86965
86970
86971
86972
86975
86976
86977
86978
86985
86999
87001
87003
87015
87040
87045
87046
87070
87071
87073
87075
87076
87077
87081
87084
87086
87088
87101
87102
87103
87106
87107
87109
87110
87116
87118
87140
87143
87147
87149
87152
87158
87164
87166
87168
87169
87172
87176
87177
87181
87184
87185
87186
87187
87188
87190
87197
87205
87206
87207
87210
87220
87230
87250
87252
87253
87254
87255
87260
87265
87267
87270
87271
87272
87273
87274
87275
87276
87277
87278
87279
87280
87281
87283
87285
87290
87299
87300
87301
87320
87324
87327
87328
87332
87335
87336
87337
87338
87339
87340
87341
87350
87380
87385
87390
87391
87400
87420
87425
87427
87430
87449
87450
87451
87470
87471
87472
87475
87476
87477
87480
87481
87482
87485
87486
87487
87490
87491
87492
87495
87496
87497
87510
87511
87512
87515
87516
87517
87520
87521
87522
87525
87526
87527
87528
87529
87530
87531
87532
87533
87534
87535
87536
87537
87538
87539
87540
87541
87542
87550
87551
87552
87555
87556
87557
87560
87561
87562
87580
87581
87582
87590
87591
87592
87620
87621
87622
87650
87651
87652
87797
87798
87799
87800
87801
87802
87803
87804
87810
87850
87880
87899
87901
87902
87903
87904
87999
88000
88005
88007
88012
88014
88016
88020
88025
88027
88028
88029
88036
88037
88040
88045
88099
88104
88106
88107
88108
88125
88130
88140
88141
88142
88143
88147
88148
88150
88152
88153
88154
88155
88160
88161
88162
88164
88165
88166
88167
88172
88173
88174
88175
88180
88182
88199
88230
88233
88235
88237
88239
88240
88241
88245
88248
88249
88261
88262
88263
88264
88267
88269
88271
88272
88273
88274
88275
88280
88283
88285
88289
88291
88299
88300
88302
88304
88305
88307
88309
88311
88312
88313
88314
88318
88319
88321
88323
88325
88329
88331
88332
88342
88346
88347
88348
88349
88355
88356
88358
88362
88365
88371
88372
88380
88399
88400
89050
89051
89055
89060
89100
89105
89125
89130
89132
89135
89136
89140
89141
89160
89190
89250
89251
89252
89253
89254
89255
89256
89257
89258
89259
89260
89261
89264
89300
89310
89320
89321
89325
89329
89330
89350
89355
89360
89365
89399
90281
90283
90287
90288
90291
90296
90371
90375
90376
90378
90379
90384
90385
90386
90389
90393
90396
90399
90471
90472
90473
90474
90476
90477
90581
90585
90586
90632
90633
90634
90636
90645
90646
90647
90648
90657
90658
90659
90660
90665
90669
90675
90676
90680
90690
90691
90692
90693
90700
90701
90702
90703
90704
90705
90706
90707
90708
90710
90712
90713
90716
90717
90718
90719
90720
90721
90723
90725
90727
90732
90733
90735
90740
90743
90744
90746
90747
90748
90749
90780
90781
90782
90783
90784
90788
90799
90801
90802
90804
90805
90806
90807
90808
90809
90810
90811
90812
90813
90814
90815
90816
90817
90818
90819
90821
90822
90823
90824
90826
90827
90828
90829
90845
90846
90847
90849
90853
90857
90862
90865
90870
90871
90875
90876
90880
90882
90885
90887
90889
90899
90901
90911
90918
90919
90920
90921
90922
90923
90924
90925
90935
90937
90939
90940
90945
90947
90989
90993
90997
90999
91000
91010
91011
91012
91020
91030
91032
91033
91052
91055
91060
91065
91100
91105
91122
91123
91132
91133
91299
92002
92004
92012
92014
92015
92018
92019
92020
92060
92065
92070
92081
92082
92083
92100
92120
92130
92135
92136
92140
92225
92226
92230
92235
92240
92250
92260
92265
92270
92275
92283
92284
92285
92286
92287
92310
92311
92312
92313
92314
92315
92316
92317
92325
92326
92330
92335
92340
92341
92342
92352
92353
92354
92355
92358
92370
92371
92390
92391
92392
92393
92395
92396
92499
92502
92504
92506
92507
92508
92510
92511
92512
92516
92520
92526
92531
92532
92533
92534
92541
92542
92543
92544
92545
92546
92547
92548
92551
92552
92553
92555
92556
92557
92559
92560
92561
92562
92563
92564
92565
92567
92568
92569
92571
92572
92573
92575
92576
92577
92579
92582
92583
92584
92585
92586
92587
92588
92589
92590
92591
92592
92593
92594
92595
92596
92597
92601
92602
92603
92604
92605
92606
92607
92608
92609
92610
92611
92612
92613
92614
92615
92616
92617
92700
92950
92953
92960
92961
92970
92971
92973
92974
92975
92977
92978
92979
92980
92981
92982
92984
92986
92987
92990
92992
92993
92995
92996
92997
92998
93000
93005
93010
93012
93014
93015
93016
93017
93018
93024
93025
93040
93041
93042
93224
93225
93226
93227
93230
93231
93232
93233
93235
93236
93237
93268
93270
93271
93272
93278
93303
93304
93307
93308
93312
93313
93314
93315
93316
93317
93318
93320
93321
93325
93350
93501
93503
93505
93508
93510
93511
93514
93524
93526
93527
93528
93529
93530
93531
93532
93533
93539
93540
93541
93542
93543
93544
93545
93555
93556
93561
93562
93571
93572
93580
93581
93600
93602
93603
93609
93610
93612
93613
93615
93616
93618
93619
93620
93621
93622
93623
93624
93631
93640
93641
93642
93650
93651
93652
93660
93662
93668
93701
93720
93721
93722
93724
93727
93731
93732
93733
93734
93735
93736
93740
93741
93742
93743
93744
93760
93762
93770
93784
93786
93788
93790
93797
93798
93799
93875
93880
93882
93886
93888
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
93975
93976
93978
93979
93980
93981
93990
94010
94014
94015
94016
94060
94070
94150
94200
94240
94250
94260
94350
94360
94370
94375
94400
94450
94620
94621
94640
94642
94656
94657
94660
94662
94664
94667
94668
94680
94681
94690
94720
94725
94750
94760
94761
94762
94770
94772
94799
95004
95010
95015
95024
95027
95028
95044
95052
95056
95060
95065
95070
95071
95075
95078
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
95180
95199
95250
95805
95806
95807
95808
95810
95811
95812
95813
95816
95819
95822
95824
95827
95829
95830
95831
95832
95833
95834
95851
95852
95857
95858
95860
95861
95863
95864
95867
95868
95869
95870
95872
95875
95900
95903
95904
95920
95921
95922
95923
95925
95926
95927
95930
95933
95934
95936
95937
95950
95951
95953
95954
95955
95956
95957
95958
95961
95962
95965
95966
95967
95970
95971
95972
95973
95974
95975
95990
95999
96000
96001
96002
96003
96004
96100
96105
96110
96111
96115
96117
96150
96151
96152
96153
96154
96155
96400
96405
96406
96408
96410
96412
96414
96420
96422
96423
96425
96440
96445
96450
96520
96530
96542
96545
96549
96567
96570
96571
96900
96902
96910
96912
96913
96920
96921
96922
96999
97001
97002
97003
97004
97005
97006
97010
97012
97014
97016
97018
97020
97022
97024
97026
97028
97032
97033
97034
97035
97036
97039
97110
97112
97113
97116
97124
97139
97140
97150
97504
97520
97530
97532
97533
97535
97537
97542
97545
97546
97601
97602
97703
97750
97780
97781
97799
97802
97803
97804
98925
98926
98927
98928
98929
98940
98941
98942
98943
99000
99001
99002
99024
99025
99026
99027
99050
99052
99054
99056
99058
99070
99071
99075
99078
99080
99082
99090
99091
99100
99116
99135
99140
99141
99142
99170
99172
99173
99175
99183
99185
99186
99190
99191
99192
99195
99199
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99217
99218
99219
99220
99221
99222
99223
99231
99232
99233
99234
99235
99236
99238
99239
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99261
99262
99263
99271
99272
99273
99274
99275
99281
99282
99283
99284
99285
99288
99289
99290
99291
99292
99293
99294
99295
99296
99298
99299
99301
99302
99303
99311
99312
99313
99315
99316
99321
99322
99323
99331
99332
99333
99341
99342
99343
99344
99345
99347
99348
99349
99350
99354
99355
99356
99357
99358
99359
99360
99361
99362
99371
99372
99373
99374
99375
99377
99378
99379
99380
99381
99382
99383
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99411
99412
99420
99429
99431
99432
99433
99435
99436
99440
99450
99455
99456
99499
99500
99501
99502
99503
99504
99505
99506
99507
99509
99510
99511
99512
99551
99552
99553
99554
99555
99556
99557
99558
99559
99560
99561
99562
99563
99564
99565
99566
99567
99568
99569
99600
0001T
0002T
0003T
0005T
0006T
0007T
0008T
0009T
00100
00102
00103
00104
0010T
00120
00124
00126
0012T
0013T
00140
00142
00144
00145
00147
00148
0014T
00160
00162
00164
0016T
00170
00172
00174
00176
0017T
0018T
00190
00192
0019T
0020T
00210
00212
00214
00215
00216
00218
0021T
00220
00222
0023T
0024T
0025T
0026T
0027T
0028T
0029T
00300
0030T
0031T
00320
00322
00326
0032T
0033T
0034T
00350
00352
0035T
0036T
0037T
0038T
0039T
00400
00402
00404
00406
0040T
00410
0041T
0042T
0043T
0044T
00450
00452
00454
00470
00472
00474
00500
00520
00522
00524
00528
00530
00532
00534
00537
00539
00540
00541
00542
00544
00546
00548
00550
00560
00562
00563
00566
00580
00600
00604
00620
00622
00630
00632
00634
00635
00640
00670
00700
00702
00730
00740
00750
00752
00754
00756
00770
00790
00792
00794
00796
00797
00800
00802
00810
00820
00830
00832
00834
00836
00840
00842
00844
00846
00848
00851
00860
00862
00864
00865
00866
00868
00870
00872
00873
00880
00882
00902
00904
00906
00908
00910
00912
00914
00916
00918
00920
00921
00922
00924
00926
00928
00930
00932
00934
00936
00938
00940
00942
00944
00948
00950
00952
01112
01120
01130
01140
01150
01160
01170
01180
01190
01200
01202
01210
01212
01214
01215
01220
01230
01232
01234
01250
01260
01270
01272
01274
01320
01340
01360
01380
01382
01390
01392
01400
01402
01404
01420
01430
01432
01440
01442
01444
01462
01464
01470
01472
01474
01480
01482
01484
01486
01490
01500
01502
01520
01522
01610
01620
01622
01630
01632
01634
01636
01638
01650
01652
01654
01656
01670
01680
01682
01710
01712
01714
01716
01730
01732
01740
01742
01744
01756
01758
01760
01770
01772
01780
01782
01810
01820
01829
01830
01832
01840
01842
01844
01850
01852
01860
01905
01916
01920
01922
01924
01925
01926
01930
01931
01932
01933
01951
01952
01953
01960
01961
01962
01963
01964
01967
01968
01969
01990
01991
01992
01995
01996
01999
A0021
A0080
A0090
A0100
A0110
A0120
A0130
A0140
A0160
A0170
A0180
A0190
A0200
A0210
A0225
A0380
A0382
A0384
A0390
A0392
A0394
A0396
A0398
A0420
A0422
A0424
A0425
A0426
A0427
A0428
A0429
A0430
A0431
A0432
A0433
A0434
A0435
A0436
A0888
A0999
A4206
A4207
A4208
A4209
A4210
A4211
A4212
A4213
A4214
A4215
A4220
A4221
A4222
A4230
A4231
A4232
A4244
A4245
A4246
A4247
A4250
A4253
A4254
A4255
A4256
A4257
A4258
A4259
A4260
A4261
A4262
A4263
A4265
A4266
A4267
A4268
A4269
A4270
A4280
A4281
A4282
A4283
A4284
A4285
A4286
A4290
A4300
A4301
A4305
A4306
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4319
A4320
A4321
A4322
A4323
A4324
A4325
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4338
A4340
A4344
A4346
A4347
A4348
A4351
A4352
A4353
A4354
A4355
A4356
A4357
A4358
A4359
A4361
A4362
A4364
A4365
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4400
A4402
A4404
A4405
A4406
A4407
A4408
A4409
A4410
A4413
A4414
A4415
A4421
A4422
A4450
A4452
A4455
A4458
A4462
A4465
A4470
A4480
A4481
A4483
A4490
A4495
A4500
A4510
A4521
A4522
A4523
A4524
A4525
A4526
A4527
A4528
A4529
A4530
A4531
A4532
A4533
A4534
A4535
A4536
A4537
A4538
A4550
A4554
A4556
A4557
A4558
A4561
A4562
A4565
A4570
A4575
A4580
A4590
A4595
A4606
A4608
A4609
A4610
A4611
A4612
A4613
A4614
A4615
A4616
A4617
A4618
A4619
A4620
A4621
A4622
A4623
A4624
A4625
A4626
A4627
A4628
A4629
A4630
A4631
A4632
A4633
A4634
A4635
A4636
A4637
A4639
A4640
A4641
A4642
A4643
A4644
A4645
A4646
A4647
A4649
A4651
A4652
A4653
A4656
A4657
A4660
A4663
A4670
A4680
A4690
A4706
A4707
A4708
A4709
A4712
A4714
A4719
A4720
A4721
A4722
A4723
A4724
A4725
A4726
A4730
A4736
A4737
A4740
A4750
A4755
A4760
A4765
A4766
A4770
A4771
A4772
A4773
A4774
A4802
A4860
A4870
A4890
A4911
A4913
A4918
A4927
A4928
A4929
A4930
A4931
A4932
A5051
A5052
A5053
A5054
A5055
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5093
A5102
A5105
A5112
A5113
A5114
A5119
A5121
A5122
A5126
A5131
A5200
A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
A5509
A5510
A5511
A6000
A6010
A6011
A6021
A6022
A6023
A6024
A6025
A6154
A6196
A6197
A6198
A6199
A6200
A6201
A6202
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220
A6221
A6222
A6223
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
A6248
A6250
A6251
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6260
A6261
A6262
A6266
A6402
A6403
A6404
A6410
A6411
A6412
A6421
A6422
A6424
A6426
A6428
A6430
A6432
A6434
A6436
A6438
A6440
A6501
A6502
A6503
A6504
A6505
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A7000
A7001
A7002
A7003
A7004
A7005
A7006
A7007
A7008
A7009
A7010
A7011
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7019
A7020
A7025
A7026
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7042
A7043
A7044
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A9150
A9270
A9300
A9500
A9502
A9503
A9504
A9505
A9507
A9508
A9510
A9511
A9512
A9513
A9514
A9515
A9516
A9517
A9518
A9519
A9520
A9521
A9522
A9523
A9524
A9600
A9603
A9605
A9699
A9700
A9900
A9901
B4034
B4035
B4036
B4081
B4082
B4083
B4086
B4100
B4150
B4151
B4152
B4153
B4154
B4155
B4156
B4164
B4168
B4172
B4176
B4178
B4180
B4184
B4186
B4189
B4193
B4197
B4199
B4216
B4220
B4222
B4224
B5000
B5100
B5200
B9000
B9002
B9004
B9006
B9998
B9999
C1010
C1011
C1015
C1016
C1017
C1018
C1020
C1021
C1022
C1031
C1079
C1088
C1091
C1092
C1122
C1146
C1166
C1167
C1170
C1177
C1178
C1200
C1201
C1300
C1305
C1321
C1322
C1323
C1324
C1329
C1368
C1713
C1716
C1718
C1719
C1720
C1765
C1774
C1775
C1783
C1888
C1900
C2600
C2614
C2616
C2618
C2632
C8900
C8901
C8902
C8903
C8904
C8905
C8906
C8907
C8908
C8909
C8910
C8911
C8912
C8913
C8914
C9000
C9003
C9007
C9008
C9009
C9010
C9013
C9102
C9103
C9105
C9109
C9111
C9112
C9113
C9116
C9119
C9120
C9121
C9200
C9201
C9503
C9701
C9703
C9711
D0120
D0140
D0150
D0160
D0170
D0180
D0210
D0220
D0230
D0240
D0250
D0260
D0270
D0272
D0274
D0277
D0290
D0310
D0320
D0321
D0322
D0330
D0340
D0350
D0415
D0425
D0460
D0470
D0472
D0473
D0474
D0480
D0502
D0999
D1110
D1120
D1201
D1203
D1204
D1205
D1310
D1320
D1330
D1351
D1510
D1515
D1520
D1525
D1550
D2140
D2150
D2160
D2161
D2330
D2331
D2332
D2335
D2390
D2391
D2392
D2393
D2394
D2410
D2420
D2430
D2510
D2520
D2530
D2542
D2543
D2544
D2610
D2620
D2630
D2642
D2643
D2644
D2650
D2651
D2652
D2662
D2663
D2664
D2710
D2720
D2721
D2722
D2740
D2750
D2751
D2752
D2780
D2781
D2782
D2783
D2790
D2791
D2792
D2799
D2910
D2920
D2930
D2931
D2932
D2933
D2940
D2950
D2951
D2952
D2953
D2954
D2955
D2957
D2960
D2961
D2962
D2970
D2980
D2999
D3110
D3120
D3220
D3221
D3230
D3240
D3310
D3320
D3330
D3331
D3332
D3333
D3346
D3347
D3348
D3351
D3352
D3353
D3410
D3421
D3425
D3426
D3430
D3450
D3460
D3470
D3910
D3920
D3950
D3999
D4210
D4211
D4240
D4241
D4245
D4249
D4260
D4261
D4263
D4264
D4265
D4266
D4267
D4268
D4270
D4271
D4273
D4274
D4275
D4276
D4320
D4321
D4341
D4342
D4355
D4381
D4910
D4920
D4999
D5110
D5120
D5130
D5140
D5211
D5212
D5213
D5214
D5281
D5410
D5411
D5421
D5422
D5510
D5520
D5610
D5620
D5630
D5640
D5650
D5660
D5670
D5671
D5710
D5711
D5720
D5721
D5730
D5731
D5740
D5741
D5750
D5751
D5760
D5761
D5810
D5811
D5820
D5821
D5850
D5851
D5860
D5861
D5862
D5867
D5875
D5899
D5911
D5912
D5913
D5914
D5915
D5916
D5919
D5922
D5923
D5924
D5925
D5926
D5927
D5928
D5929
D5931
D5932
D5933
D5934
D5935
D5936
D5937
D5951
D5952
D5953
D5954
D5955
D5958
D5959
D5960
D5982
D5983
D5984
D5985
D5986
D5987
D5988
D5999
D6010
D6020
D6040
D6050
D6053
D6054
D6055
D6056
D6057
D6058
D6059
D6060
D6061
D6062
D6063
D6064
D6065
D6066
D6067
D6068
D6069
D6070
D6071
D6072
D6073
D6074
D6075
D6076
D6077
D6078
D6079
D6080
D6090
D6095
D6100
D6199
D6210
D6211
D6212
D6240
D6241
D6242
D6245
D6250
D6251
D6252
D6253
D6545
D6548
D6600
D6601
D6602
D6603
D6604
D6605
D6606
D6607
D6608
D6609
D6610
D6611
D6612
D6613
D6614
D6615
D6720
D6721
D6722
D6740
D6750
D6751
D6752
D6780
D6781
D6782
D6783
D6790
D6791
D6792
D6793
D6920
D6930
D6940
D6950
D6970
D6971
D6972
D6973
D6975
D6976
D6977
D6980
D6985
D6999
D7111
D7140
D7210
D7220
D7230
D7240
D7241
D7250
D7260
D7261
D7270
D7272
D7280
D7281
D7282
D7285
D7286
D7287
D7290
D7291
D7310
D7320
D7340
D7350
D7410
D7411
D7412
D7413
D7414
D7415
D7440
D7441
D7450
D7451
D7460
D7461
D7465
D7471
D7472
D7473
D7485
D7490
D7510
D7520
D7530
D7540
D7550
D7560
D7610
D7620
D7630
D7640
D7650
D7660
D7670
D7671
D7680
D7710
D7720
D7730
D7740
D7750
D7760
D7770
D7771
D7780
D7810
D7820
D7830
D7840
D7850
D7852
D7854
D7856
D7858
D7860
D7865
D7870
D7871
D7872
D7873
D7874
D7875
D7876
D7877
D7880
D7899
D7910
D7911
D7912
D7920
D7940
D7941
D7943
D7944
D7945
D7946
D7947
D7948
D7949
D7950
D7955
D7960
D7970
D7971
D7972
D7980
D7981
D7982
D7983
D7990
D7991
D7995
D7996
D7997
D7999
D8010
D8020
D8030
D8040
D8050
D8060
D8070
D8080
D8090
D8210
D8220
D8660
D8670
D8680
D8690
D8691
D8692
D8999
D9110
D9210
D9211
D9212
D9215
D9220
D9221
D9230
D9241
D9242
D9248
D9310
D9410
D9420
D9430
D9440
D9450
D9610
D9630
D9910
D9911
D9920
D9930
D9940
D9941
D9950
D9951
D9952
D9970
D9971
D9972
D9973
D9974
D9999
E0100
E0105
E0110
E0111
E0112
E0113
E0114
E0116
E0117
E0130
E0135
E0141
E0142
E0143
E0144
E0145
E0146
E0147
E0148
E0149
E0153
E0154
E0155
E0156
E0157
E0158
E0159
E0160
E0161
E0162
E0163
E0164
E0165
E0166
E0167
E0168
E0169
E0175
E0176
E0177
E0178
E0179
E0180
E0181
E0182
E0184
E0185
E0186
E0187
E0188
E0189
E0191
E0192
E0193
E0194
E0196
E0197
E0198
E0199
E0200
E0202
E0203
E0205
E0210
E0215
E0217
E0218
E0220
E0221
E0225
E0230
E0231
E0232
E0235
E0236
E0238
E0239
E0241
E0242
E0243
E0244
E0245
E0246
E0249
E0250
E0251
E0255
E0256
E0260
E0261
E0265
E0266
E0270
E0271
E0272
E0273
E0274
E0275
E0276
E0277
E0280
E0290
E0291
E0292
E0293
E0294
E0295
E0296
E0297
E0305
E0310
E0315
E0316
E0325
E0326
E0350
E0352
E0370
E0371
E0372
E0373
E0424
E0425
E0430
E0431
E0434
E0435
E0439
E0440
E0441
E0442
E0443
E0444
E0445
E0450
E0454
E0455
E0457
E0459
E0460
E0461
E0462
E0480
E0481
E0482
E0483
E0484
E0500
E0550
E0555
E0560
E0565
E0570
E0571
E0572
E0574
E0575
E0580
E0585
E0590
E0600
E0601
E0602
E0603
E0604
E0605
E0606
E0607
E0610
E0615
E0616
E0617
E0618
E0619
E0620
E0621
E0625
E0627
E0628
E0629
E0630
E0635
E0636
E0650
E0651
E0652
E0655
E0660
E0665
E0666
E0667
E0668
E0669
E0671
E0672
E0673
E0691
E0692
E0693
E0694
E0700
E0701
E0710
E0720
E0730
E0731
E0740
E0744
E0745
E0746
E0747
E0748
E0749
E0752
E0754
E0755
E0756
E0757
E0758
E0759
E0760
E0761
E0765
E0776
E0779
E0780
E0781
E0782
E0783
E0784
E0785
E0786
E0791
E0830
E0840
E0850
E0855
E0860
E0870
E0880
E0890
E0900
E0910
E0920
E0930
E0935
E0940
E0941
E0942
E0943
E0944
E0945
E0946
E0947
E0948
E0950
E0951
E0952
E0953
E0954
E0958
E0959
E0961
E0962
E0963
E0964
E0965
E0966
E0967
E0968
E0969
E0970
E0971
E0972
E0973
E0974
E0975
E0976
E0977
E0978
E0979
E0980
E0990
E0991
E0992
E0993
E0994
E0995
E0996
E0997
E0998
E0999
E1000
E1001
E1011
E1012
E1013
E1014
E1015
E1016
E1017
E1018
E1020
E1025
E1026
E1027
E1031
E1035
E1037
E1038
E1050
E1060
E1065
E1066
E1069
E1070
E1083
E1084
E1085
E1086
E1087
E1088
E1089
E1090
E1092
E1093
E1100
E1110
E1130
E1140
E1150
E1160
E1161
E1170
E1171
E1172
E1180
E1190
E1195
E1200
E1210
E1211
E1212
E1213
E1220
E1221
E1222
E1223
E1224
E1225
E1226
E1227
E1228
E1230
E1231
E1232
E1233
E1234
E1235
E1236
E1237
E1238
E1240
E1250
E1260
E1270
E1280
E1285
E1290
E1295
E1296
E1297
E1298
E1300
E1310
E1340
E1353
E1355
E1372
E1390
E1399
E1405
E1406
E1500
E1510
E1520
E1530
E1540
E1550
E1560
E1570
E1575
E1580
E1590
E1592
E1594
E1600
E1610
E1615
E1620
E1625
E1630
E1632
E1635
E1636
E1637
E1639
E1699
E1700
E1701
E1702
E1800
E1801
E1802
E1805
E1806
E1810
E1811
E1815
E1816
E1818
E1820
E1821
E1825
E1830
E1840
E1902
E2000
E2100
E2101
G0001
G0008
G0009
G0010
G0025
G0030
G0031
G0032
G0033
G0034
G0035
G0036
G0037
G0038
G0039
G0040
G0041
G0042
G0043
G0044
G0045
G0046
G0047
G0101
G0102
G0103
G0104
G0105
G0106
G0107
G0108
G0109
G0110
G0111
G0112
G0113
G0114
G0115
G0116
G0117
G0118
G0120
G0121
G0122
G0123
G0124
G0125
G0127
G0128
G0129
G0130
G0141
G0143
G0144
G0145
G0147
G0148
G0151
G0152
G0153
G0154
G0155
G0156
G0166
G0167
G0168
G0173
G0175
G0176
G0177
G0179
G0180
G0181
G0182
G0186
G0202
G0204
G0206
G0210
G0211
G0212
G0213
G0214
G0215
G0216
G0217
G0218
G0219
G0220
G0221
G0222
G0223
G0224
G0225
G0226
G0227
G0228
G0229
G0230
G0231
G0232
G0233
G0234
G0236
G0237
G0238
G0239
G0242
G0243
G0244
G0245
G0246
G0247
G0248
G0249
G0250
G0251
G0252
G0253
G0254
G0255
G0256
G0257
G0258
G0259
G0260
G0261
G0262
G0263
G0264
G0265
G0266
G0267
G0268
G0269
G0270
G0271
G0272
G0273
G0274
G0275
G0278
G0279
G0280
G0281
G0282
G0283
G0288
G0289
G0290
G0291
G0292
G0293
G0294
G0295
G9001
G9002
G9003
G9004
G9005
G9006
G9007
G9008
G9009
G9010
G9011
G9012
G9016
H0001
H0002
H0003
H0004
H0005
H0006
H0007
H0008
H0009
H0010
H0011
H0012
H0013
H0014
H0015
H0016
H0017
H0018
H0019
H0020
H0021
H0022
H0023
H0024
H0025
H0026
H0027
H0028
H0029
H0030
H0031
H0032
H0033
H0034
H0035
H0036
H0037
H0038
H0039
H0040
H0041
H0042
H0043
H0044
H0045
H0046
H0047
H0048
H1000
H1001
H1002
H1003
H1004
H1005
H1010
H1011
H2000
H2001
J0120
J0130
J0150
J0151
J0170
J0190
J0200
J0205
J0207
J0210
J0256
J0270
J0275
J0280
J0282
J0285
J0287
J0288
J0289
J0290
J0295
J0300
J0330
J0350
J0360
J0380
J0390
J0395
J0456
J0460
J0470
J0475
J0476
J0500
J0515
J0520
J0530
J0540
J0550
J0560
J0570
J0580
J0585
J0587
J0592
J0600
J0610
J0620
J0630
J0636
J0637
J0640
J0670
J0690
J0692
J0694
J0696
J0697
J0698
J0702
J0704
J0706
J0710
J0713
J0715
J0720
J0725
J0735
J0740
J0743
J0744
J0745
J0760
J0770
J0780
J0800
J0835
J0850
J0880
J0895
J0900
J0945
J0970
J1000
J1020
J1030
J1040
J1051
J1055
J1056
J1060
J1070
J1080
J1094
J1100
J1110
J1120
J1160
J1165
J1170
J1180
J1190
J1200
J1205
J1212
J1230
J1240
J1245
J1250
J1260
J1270
J1320
J1325
J1327
J1330
J1364
J1380
J1390
J1410
J1435
J1436
J1438
J1440
J1441
J1450
J1452
J1455
J1460
J1470
J1480
J1490
J1500
J1510
J1520
J1530
J1540
J1550
J1560
J1563
J1564
J1565
J1570
J1580
J1590
J1600
J1610
J1620
J1626
J1630
J1631
J1642
J1644
J1645
J1650
J1652
J1655
J1670
J1700
J1710
J1720
J1730
J1742
J1745
J1750
J1756
J1785
J1790
J1800
J1810
J1815
J1817
J1825
J1830
J1835
J1840
J1850
J1885
J1890
J1910
J1940
J1950
J1955
J1956
J1960
J1990
J2000
J2010
J2020
J2060
J2150
J2175
J2180
J2210
J2250
J2260
J2270
J2271
J2275
J2300
J2310
J2320
J2321
J2322
J2324
J2352
J2355
J2360
J2370
J2400
J2405
J2410
J2430
J2440
J2460
J2501
J2510
J2515
J2540
J2543
J2545
J2550
J2560
J2590
J2597
J2650
J2670
J2675
J2680
J2690
J2700
J2710
J2720
J2725
J2730
J2760
J2765
J2770
J2780
J2788
J2790
J2792
J2795
J2800
J2810
J2820
J2910
J2912
J2916
J2920
J2930
J2940
J2941
J2950
J2993
J2995
J2997
J3000
J3010
J3030
J3070
J3100
J3105
J3120
J3130
J3140
J3150
J3230
J3240
J3245
J3250
J3260
J3265
J3280
J3301
J3302
J3303
J3305
J3310
J3315
J3320
J3350
J3360
J3364
J3365
J3370
J3395
J3400
J3410
J3420
J3430
J3470
J3475
J3480
J3485
J3487
J3490
J3520
J3530
J3535
J3570
J3590
J7030
J7040
J7042
J7050
J7051
J7060
J7070
J7100
J7110
J7120
J7130
J7190
J7191
J7192
J7193
J7194
J7195
J7197
J7198
J7199
J7300
J7302
J7308
J7310
J7317
J7320
J7330
J7340
J7342
J7350
J7500
J7501
J7502
J7504
J7505
J7506
J7507
J7508
J7509
J7510
J7511
J7513
J7515
J7516
J7517
J7520
J7525
J7599
J7608
J7618
J7619
J7622
J7624
J7626
J7628
J7629
J7631
J7633
J7635
J7636
J7637
J7638
J7639
J7641
J7642
J7643
J7644
J7648
J7649
J7658
J7659
J7668
J7669
J7680
J7681
J7682
J7683
J7684
J7699
J7799
J8499
J8510
J8520
J8521
J8530
J8560
J8600
J8610
J8700
J8999
J9000
J9001
J9010
J9015
J9017
J9020
J9031
J9040
J9045
J9050
J9060
J9062
J9065
J9070
J9080
J9090
J9091
J9092
J9093
J9094
J9095
J9096
J9097
J9100
J9110
J9120
J9130
J9140
J9150
J9151
J9160
J9165
J9170
J9180
J9181
J9182
J9185
J9190
J9200
J9201
J9202
J9206
J9208
J9209
J9211
J9212
J9213
J9214
J9215
J9216
J9217
J9218
J9219
J9230
J9245
J9250
J9260
J9265
J9266
J9268
J9270
J9280
J9290
J9291
J9293
J9300
J9310
J9320
J9340
J9350
J9355
J9357
J9360
J9370
J9375
J9380
J9390
J9600
J9999
K0001
K0002
K0003
K0004
K0005
K0006
K0007
K0009
K0010
K0011
K0012
K0014
K0015
K0016
K0017
K0018
K0019
K0020
K0022
K0023
K0024
K0025
K0026
K0027
K0028
K0029
K0030
K0031
K0032
K0033
K0035
K0036
K0037
K0038
K0039
K0040
K0041
K0042
K0043
K0044
K0045
K0046
K0047
K0048
K0049
K0050
K0051
K0052
K0053
K0054
K0055
K0056
K0057
K0058
K0059
K0060
K0061
K0062
K0063
K0064
K0065
K0066
K0067
K0068
K0069
K0070
K0071
K0072
K0073
K0074
K0075
K0076
K0077
K0078
K0079
K0080
K0081
K0082
K0083
K0084
K0085
K0086
K0087
K0088
K0089
K0090
K0091
K0092
K0093
K0094
K0095
K0096
K0097
K0098
K0099
K0100
K0102
K0103
K0104
K0105
K0106
K0107
K0108
K0112
K0113
K0114
K0115
K0116
K0195
K0268
K0415
K0416
K0452
K0455
K0460
K0461
K0462
K0531
K0532
K0533
K0534
K0538
K0539
K0540
K0541
K0542
K0543
K0544
K0545
K0546
K0547
K0549
K0550
K0556
K0557
K0558
K0559
K0581
K0582
K0583
K0584
K0585
K0586
K0587
K0588
K0589
K0590
K0591
K0592
K0593
K0594
K0595
K0596
K0597
L0100
L0110
L0120
L0130
L0140
L0150
L0160
L0170
L0172
L0174
L0180
L0190
L0200
L0210
L0220
L0450
L0452
L0454
L0456
L0458
L0460
L0462
L0464
L0466
L0468
L0470
L0472
L0474
L0476
L0478
L0480
L0482
L0484
L0486
L0488
L0490
L0500
L0510
L0515
L0520
L0530
L0540
L0550
L0560
L0561
L0565
L0600
L0610
L0620
L0700
L0710
L0810
L0820
L0830
L0860
L0960
L0970
L0972
L0974
L0976
L0978
L0980
L0982
L0984
L0999
L1000
L1005
L1010
L1020
L1025
L1030
L1040
L1050
L1060
L1070
L1080
L1085
L1090
L1100
L1110
L1120
L1200
L1210
L1220
L1230
L1240
L1250
L1260
L1270
L1280
L1290
L1300
L1310
L1499
L1500
L1510
L1520
L1600
L1610
L1620
L1630
L1640
L1650
L1652
L1660
L1680
L1685
L1686
L1690
L1700
L1710
L1720
L1730
L1750
L1755
L1800
L1810
L1815
L1820
L1825
L1830
L1832
L1834
L1836
L1840
L1843
L1844
L1845
L1846
L1847
L1850
L1855
L1858
L1860
L1870
L1880
L1885
L1900
L1901
L1902
L1904
L1906
L1910
L1920
L1930
L1940
L1945
L1950
L1960
L1970
L1980
L1990
L2000
L2010
L2020
L2030
L2035
L2036
L2037
L2038
L2039
L2040
L2050
L2060
L2070
L2080
L2090
L2102
L2104
L2106
L2108
L2112
L2114
L2116
L2122
L2124
L2126
L2128
L2132
L2134
L2136
L2180
L2182
L2184
L2186
L2188
L2190
L2192
L2200
L2210
L2220
L2230
L2240
L2250
L2260
L2265
L2270
L2275
L2280
L2300
L2310
L2320
L2330
L2335
L2340
L2350
L2360
L2370
L2375
L2380
L2385
L2390
L2395
L2397
L2405
L2415
L2425
L2430
L2435
L2492
L2500
L2510
L2520
L2525
L2526
L2530
L2540
L2550
L2570
L2580
L2600
L2610
L2620
L2622
L2624
L2627
L2628
L2630
L2640
L2650
L2660
L2670
L2680
L2750
L2755
L2760
L2768
L2770
L2780
L2785
L2795
L2800
L2810
L2820
L2830
L2840
L2850
L2860
L2999
L3000
L3001
L3002
L3003
L3010
L3020
L3030
L3040
L3050
L3060
L3070
L3080
L3090
L3100
L3140
L3150
L3160
L3170
L3201
L3202
L3203
L3204
L3206
L3207
L3208
L3209
L3211
L3212
L3213
L3214
L3215
L3216
L3217
L3219
L3221
L3222
L3224
L3225
L3230
L3250
L3251
L3252
L3253
L3254
L3255
L3257
L3260
L3265
L3300
L3310
L3320
L3330
L3332
L3334
L3340
L3350
L3360
L3370
L3380
L3390
L3400
L3410
L3420
L3430
L3440
L3450
L3455
L3460
L3465
L3470
L3480
L3485
L3500
L3510
L3520
L3530
L3540
L3550
L3560
L3570
L3580
L3590
L3595
L3600
L3610
L3620
L3630
L3640
L3649
L3650
L3651
L3652
L3660
L3670
L3675
L3677
L3700
L3701
L3710
L3720
L3730
L3740
L3760
L3762
L3800
L3805
L3807
L3810
L3815
L3820
L3825
L3830
L3835
L3840
L3845
L3850
L3855
L3860
L3890
L3900
L3901
L3902
L3904
L3906
L3907
L3908
L3909
L3910
L3911
L3912
L3914
L3916
L3918
L3920
L3922
L3923
L3924
L3926
L3928
L3930
L3932
L3934
L3936
L3938
L3940
L3942
L3944
L3946
L3948
L3950
L3952
L3954
L3956
L3960
L3962
L3963
L3964
L3965
L3966
L3968
L3969
L3970
L3972
L3974
L3980
L3982
L3984
L3985
L3986
L3995
L3999
L4000
L4010
L4020
L4030
L4040
L4045
L4050
L4055
L4060
L4070
L4080
L4090
L4100
L4110
L4130
L4205
L4210
L4350
L4360
L4370
L4380
L4386
L4392
L4394
L4396
L4398
L5000
L5010
L5020
L5050
L5060
L5100
L5105
L5150
L5160
L5200
L5210
L5220
L5230
L5250
L5270
L5280
L5301
L5311
L5321
L5331
L5341
L5400
L5410
L5420
L5430
L5450
L5460
L5500
L5505
L5510
L5520
L5530
L5535
L5540
L5560
L5570
L5580
L5585
L5590
L5595
L5600
L5610
L5611
L5613
L5614
L5616
L5617
L5618
L5620
L5622
L5624
L5626
L5628
L5629
L5630
L5631
L5632
L5634
L5636
L5637
L5638
L5639
L5640
L5642
L5643
L5644
L5645
L5646
L5647
L5648
L5649
L5650
L5651
L5652
L5653
L5654
L5655
L5656
L5658
L5661
L5665
L5666
L5668
L5670
L5671
L5672
L5674
L5675
L5676
L5677
L5678
L5680
L5682
L5684
L5686
L5688
L5690
L5692
L5694
L5695
L5696
L5697
L5698
L5699
L5700
L5701
L5702
L5704
L5705
L5706
L5707
L5710
L5711
L5712
L5714
L5716
L5718
L5722
L5724
L5726
L5728
L5780
L5781
L5782
L5785
L5790
L5795
L5810
L5811
L5812
L5814
L5816
L5818
L5822
L5824
L5826
L5828
L5830
L5840
L5845
L5846
L5847
L5848
L5850
L5855
L5910
L5920
L5925
L5930
L5940
L5950
L5960
L5962
L5964
L5966
L5968
L5970
L5972
L5974
L5975
L5976
L5978
L5979
L5980
L5981
L5982
L5984
L5985
L5986
L5987
L5988
L5989
L5990
L5995
L5999
L6000
L6010
L6020
L6025
L6050
L6055
L6100
L6110
L6120
L6130
L6200
L6205
L6250
L6300
L6310
L6320
L6350
L6360
L6370
L6380
L6382
L6384
L6386
L6388
L6400
L6450
L6500
L6550
L6570
L6580
L6582
L6584
L6586
L6588
L6590
L6600
L6605
L6610
L6615
L6616
L6620
L6623
L6625
L6628
L6629
L6630
L6632
L6635
L6637
L6638
L6640
L6641
L6642
L6645
L6646
L6647
L6648
L6650
L6655
L6660
L6665
L6670
L6672
L6675
L6676
L6680
L6682
L6684
L6686
L6687
L6688
L6689
L6690
L6691
L6692
L6693
L6700
L6705
L6710
L6715
L6720
L6725
L6730
L6735
L6740
L6745
L6750
L6755
L6765
L6770
L6775
L6780
L6790
L6795
L6800
L6805
L6806
L6807
L6808
L6809
L6810
L6825
L6830
L6835
L6840
L6845
L6850
L6855
L6860
L6865
L6867
L6868
L6870
L6872
L6873
L6875
L6880
L6881
L6882
L6890
L6895
L6900
L6905
L6910
L6915
L6920
L6925
L6930
L6935
L6940
L6945
L6950
L6955
L6960
L6965
L6970
L6975
L7010
L7015
L7020
L7025
L7030
L7035
L7040
L7045
L7170
L7180
L7185
L7186
L7190
L7191
L7260
L7261
L7266
L7272
L7274
L7360
L7362
L7364
L7366
L7367
L7368
L7499
L7500
L7510
L7520
L7900
L8000
L8001
L8002
L8010
L8015
L8020
L8030
L8035
L8039
L8040
L8041
L8042
L8043
L8044
L8045
L8046
L8047
L8048
L8049
L8100
L8110
L8120
L8130
L8140
L8150
L8160
L8170
L8180
L8190
L8195
L8200
L8210
L8220
L8230
L8239
L8300
L8310
L8320
L8330
L8400
L8410
L8415
L8417
L8420
L8430
L8435
L8440
L8460
L8465
L8470
L8480
L8485
L8490
L8499
L8500
L8501
L8505
L8507
L8509
L8510
L8600
L8603
L8606
L8610
L8612
L8613
L8614
L8619
L8630
L8641
L8642
L8658
L8670
L8699
L9900
M0064
M0075
M0076
M0100
M0300
M0301
P2028
P2029
P2031
P2033
P2038
P3000
P3001
P7001
P9010
P9011
P9012
P9016
P9017
P9019
P9020
P9021
P9022
P9023
P9031
P9032
P9033
P9034
P9035
P9036
P9037
P9038
P9039
P9040
P9041
P9043
P9044
P9045
P9046
P9047
P9048
P9050
P9603
P9604
P9612
P9615
Q0035
Q0081
Q0083
Q0084
Q0085
Q0086
Q0091
Q0092
Q0111
Q0112
Q0113
Q0114
Q0115
Q0136
Q0144
Q0163
Q0164
Q0165
Q0166
Q0167
Q0168
Q0169
Q0170
Q0171
Q0172
Q0173
Q0174
Q0175
Q0176
Q0177
Q0178
Q0179
Q0180
Q0181
Q0183
Q0184
Q0187
Q1001
Q1002
Q1003
Q1004
Q1005
Q2001
Q2002
Q2003
Q2004
Q2005
Q2006
Q2007
Q2008
Q2009
Q2010
Q2011
Q2012
Q2013
Q2014
Q2017
Q2018
Q2019
Q2020
Q2021
Q2022
Q3000
Q3001
Q3002
Q3003
Q3004
Q3005
Q3006
Q3007
Q3008
Q3009
Q3010
Q3011
Q3012
Q3014
Q3019
Q3020
Q3021
Q3022
Q3023
Q3025
Q3026
Q4001
Q4002
Q4003
Q4004
Q4005
Q4006
Q4007
Q4008
Q4009
Q4010
Q4011
Q4012
Q4013
Q4014
Q4015
Q4016
Q4017
Q4018
Q4019
Q4020
Q4021
Q4022
Q4023
Q4024
Q4025
Q4026
Q4027
Q4028
Q4029
Q4030
Q4031
Q4032
Q4033
Q4034
Q4035
Q4036
Q4037
Q4038
Q4039
Q4040
Q4041
Q4042
Q4043
Q4044
Q4045
Q4046
Q4047
Q4048
Q4049
Q4050
Q4051
Q9920
Q9921
Q9922
Q9923
Q9924
Q9925
Q9926
Q9927
Q9928
Q9929
Q9930
Q9931
Q9932
Q9933
Q9934
Q9935
Q9936
Q9937
Q9938
Q9939
Q9940
R0070
R0075
R0076
S0009
S0012
S0014
S0016
S0017
S0020
S0021
S0023
S0028
S0030
S0032
S0034
S0039
S0040
S0071
S0072
S0073
S0074
S0077
S0078
S0079
S0080
S0081
S0088
S0090
S0091
S0092
S0093
S0104
S0106
S0108
S0114
S0122
S0124
S0126
S0128
S0130
S0132
S0135
S0155
S0156
S0157
S0170
S0171
S0172
S0173
S0174
S0175
S0176
S0177
S0178
S0179
S0181
S0182
S0183
S0187
S0189
S0190
S0191
S0195
S0199
S0201
S0207
S0208
S0209
S0215
S0220
S0221
S0250
S0255
S0260
S0302
S0310
S0315
S0316
S0320
S0340
S0341
S0342
S0390
S0395
S0400
S0500
S0504
S0506
S0508
S0510
S0512
S0514
S0516
S0518
S0580
S0581
S0590
S0592
S0601
S0605
S0610
S0612
S0620
S0621
S0622
S0630
S0800
S0810
S0812
S0820
S0830
S1001
S1002
S1015
S1016
S1025
S1030
S1031
S1040
S2053
S2054
S2055
S2060
S2061
S2065
S2080
S2102
S2103
S2107
S2112
S2115
S2120
S2130
S2140
S2142
S2150
S2202
S2205
S2206
S2207
S2208
S2209
S2211
S2250
S2260
S2262
S2265
S2266
S2267
S2300
S2340
S2341
S2342
S2350
S2351
S2360
S2361
S2370
S2371
S2400
S2401
S2402
S2403
S2404
S2405
S2409
S2411
S3600
S3601
S3620
S3630
S3645
S3650
S3652
S3655
S3701
S3708
S3818
S3819
S3830
S3831
S3835
S3837
S3900
S3902
S3904
S4005
S4011
S4013
S4014
S4015
S4016
S4017
S4018
S4020
S4021
S4022
S4023
S4025
S4026
S4027
S4028
S4030
S4031
S4035
S4036
S4037
S4040
S4981
S4989
S4990
S4991
S4993
S4995
S5000
S5001
S5010
S5011
S5012
S5013
S5014
S5035
S5036
S5100
S5101
S5102
S5105
S5110
S5111
S5115
S5116
S5120
S5121
S5125
S5126
S5130
S5131
S5135
S5136
S5140
S5141
S5145
S5146
S5150
S5151
S5160
S5161
S5162
S5165
S5170
S5175
S5180
S5181
S5185
S5190
S5199
S5497
S5498
S5501
S5502
S5517
S5518
S5520
S5521
S5522
S5523
S8004
S8030
S8035
S8037
S8040
S8042
S8049
S8055
S8080
S8085
S8092
S8095
S8096
S8097
S8100
S8101
S8110
S8180
S8181
S8182
S8183
S8185
S8186
S8189
S8190
S8210
S8260
S8262
S8265
S8415
S8420
S8421
S8422
S8423
S8424
S8425
S8426
S8427
S8428
S8429
S8430
S8431
S8450
S8451
S8452
S8490
S8945
S8950
S8999
S9001
S9007
S9015
S9022
S9024
S9025
S9034
S9055
S9056
S9061
S9075
S9083
S9088
S9090
S9092
S9098
S9109
S9117
S9122
S9123
S9124
S9125
S9126
S9127
S9128
S9129
S9131
S9140
S9141
S9145
S9150
S9208
S9209
S9211
S9212
S9213
S9214
S9325
S9326
S9327
S9328
S9329
S9330
S9331
S9336
S9338
S9339
S9340
S9341
S9342
S9343
S9345
S9346
S9347
S9348
S9349
S9351
S9353
S9355
S9357
S9359
S9361
S9363
S9364
S9365
S9366
S9367
S9368
S9370
S9372
S9373
S9374
S9375
S9376
S9377
S9379
S9381
S9401
S9430
S9435
S9436
S9437
S9438
S9439
S9441
S9442
S9443
S9444
S9445
S9446
S9447
S9449
S9451
S9452
S9453
S9454
S9455
S9460
S9465
S9470
S9472
S9473
S9474
S9475
S9480
S9484
S9485
S9490
S9494
S9497
S9500
S9501
S9502
S9503
S9504
S9524
S9529
S9537
S9538
S9542
S9546
S9558
S9559
S9560
S9562
S9590
S9802
S9803
S9806
S9810
S9900
S9970
S9975
S9981
S9982
S9986
S9989
S9990
S9991
S9992
S9994
S9996
S9999
T1000
T1001
T1002
T1003
T1004
T1005
T1006
T1007
T1008
T1009
T1010
T1011
T1012
T1013
T1014
T1015
T1016
T1017
T1018
T1019
T1020
T1021
T1022
T1023
T1024
T1025
T1026
T1027
T1028
T1029
T1030
T1031
T1500
T1502
T1999
T2001
T2002
T2003
T2004
T2005
T2006
T2007
V2020
V2025
V2100
V2101
V2102
V2103
V2104
V2105
V2106
V2107
V2108
V2109
V2110
V2111
V2112
V2113
V2114
V2115
V2116
V2117
V2118
V2199
V2200
V2201
V2202
V2203
V2204
V2205
V2206
V2207
V2208
V2209
V2210
V2211
V2212
V2213
V2214
V2215
V2216
V2217
V2218
V2219
V2220
V2299
V2300
V2301
V2302
V2303
V2304
V2305
V2306
V2307
V2308
V2309
V2310
V2311
V2312
V2313
V2314
V2315
V2316
V2317
V2318
V2319
V2320
V2399
V2410
V2430
V2499
V2500
V2501
V2502
V2503
V2510
V2511
V2512
V2513
V2520
V2521
V2522
V2523
V2530
V2531
V2599
V2600
V2610
V2615
V2623
V2624
V2625
V2626
V2627
V2628
V2629
V2630
V2631
V2632
V2700
V2710
V2715
V2718
V2730
V2740
V2741
V2742
V2743
V2744
V2750
V2755
V2760
V2770
V2780
V2781
V2785
V2790
V2799
V5008
V5010
V5011
V5014
V5020
V5030
V5040
V5050
V5060
V5070
V5080
V5090
V5095
V5100
V5110
V5120
V5130
V5140
V5150
V5160
V5170
V5180
V5190
V5200
V5210
V5220
V5230
V5240
V5241
V5242
V5243
V5244
V5245
V5246
V5247
V5248
V5249
V5250
V5251
V5252
V5253
V5254
V5255
V5256
V5257
V5258
V5259
V5260
V5261
V5262
V5263
V5264
V5265
V5266
V5267
V5268
V5269
V5270
V5271
V5272
V5273
V5274
V5275
V5298
V5299
V5336
V5362
V5363
V5364
CPT_LONG_DESCRIPTION
FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE
FINE NEEDLE ASPIRATION; WITH IMAGING GUIDANCE
ACNE SURGERY (EG, MARSUPIALIZATION, OPENING OR REMOVAL OF MULTIPLE MILIA, COMEDONES, CYSTS, PUST
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTA
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTA
INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE
INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED
INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISL
DEBRIDEMENT; SKIN, PARTIAL THICKNESS
DEBRIDEMENT; SKIN, FULL THICKNESS
DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE
DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE
DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); TWO TO FOUR LESIONS
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE THAN FOUR LESIONS
BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS
BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE),UNLESS
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL TEN LESIONS (LIST SE
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DI
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMB
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK
EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NO
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE R
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLEX REPAIR
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE OR INTERMEDIATE
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH COMPLEX REPAIR
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS;EXCISED DIAMETER 0.5 CM OR LES
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS;EXCISED DIAMETER 0.6 TO 1.0 CM
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS;EXCISED DIAMETER OVER 4.0 CM
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE,LIPS; EXCISED DIAMETER 0.5 C
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE,LIPS; EXCISED DIAMETER 0.6 T
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE,LIPS; EXCISED DIAMETER OVE
TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN A
EVACUATION OF SUBUNGUAL HEMATOMA
EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANE
EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANE
BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL NAIL FOLDS) (SEPARATE
REPAIR OF NAIL BED
RECONSTRUCTION OF NAIL BED WITH GRAFT
WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL)
EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED

INJECTION, INTRALESIONAL; UP TO AND INCLUDING SEVEN LESIONS
INJECTION, INTRALESIONAL; MORE THAN SEVEN LESIONS
TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS O
INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST, INCLUDING SUBSEQUENT EXPANSION
REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS
REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OF PROSTHESIS
INSERTION, IMPLANTABLE CONTRACEPTIVE CAPSULES
REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
REMOVAL WITH REINSERTION, IMPLANTABLE CONTRACEPTIVE CAPSULES
SUBCUTANEOUS HORMONE PELLET IMPLANTATION (IMPLANTATION OF ESTRADIOL AND/OR TESTOSTERONE PELL
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTR
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS
LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM
LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; OVER 30.0 CM
LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LE
LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.
LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.
LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12
LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; OVER 30.0 C
REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; EACH A
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM OR LESS
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN AD
SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITA
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITA
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR L
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, MORE THAN 30 SQ CM, UNUSUAL OR COMPLICATED, ANY AR
FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR
PINCH GRAFT, SINGLE OR MULTIPLE, TO COVER SMALL ULCER, TIP OF DIGIT, OR OTHER MINIMAL OPEN AREA (EXC
SPLIT GRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTS AND
SPLIT GRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL ONE PERCENT OF BODY
SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE D
SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE D
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20 SQ CM OR LESS
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH ADDITIONAL 20 SQ C
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS; 20 SQ
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS; EACH
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUT
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUT
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIP
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIP
APPLICATION OF BILAMINATE SKIN SUBSTITUTE/NEODERMIS; 25 SQ CM
APPLICATION OF BILAMINATE SKIN SUBSTITUTE/NEODERMIS; EACH ADDITIONAL 25 SQ CM (LIST SEPARATELY IN A
APPLICATION OF ALLOGRAFT, SKIN; 100 SQ CM OR LESS
APPLICATION OF ALLOGRAFT, SKIN; EACH ADDITIONAL 100 SQ CM (LIST SEPARATELY IN ADDITION TO CODE FOR P
APPLICATION OF XENOGRAFT, SKIN; 100 SQ CM OR LESS
APPLICATION OF XENOGRAFT, SKIN; EACH ADDITIONAL 100 SQ CM (LIST SEPARATELY IN ADDITION TO CODE FOR
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; TRUNK
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; SCALP, ARMS, OR LEGS
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; FOREHEAD, CHEEKS, CHIN, MOUTH,
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS, OR INTR
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT TRUNK
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT SCALP, ARMS, OR LEGS
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS, CHIN, NECK, AXILLAE, G
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG, ABDOMEN TO WRIST, "WALKING" TUBE), ANY LOCATION
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK (EG, TEMPORALIS, MASSETER MUSCL
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; UPPER EXTREMITY
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY
FLAP; ISLAND PEDICLE
FLAP; NEUROVASCULAR PEDICLE
FREE MUSCLE OR MYOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS
FREE SKIN FLAP WITH MICROVASCULAR ANASTOMOSIS
FREE FASCIAL FLAP WITH MICROVASCULAR ANASTOMOSIS
GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR OR NASAL ALA), INCLUDING PRIMARY CLOSURE, DO
GRAFT; DERMA-FAT-FASCIA
PUNCH GRAFT FOR HAIR TRANSPLANT; 1 TO 15 PUNCH GRAFTS
PUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN 15 PUNCH GRAFTS
DERMABRASION; TOTAL FACE (EG, FOR ACNE SCARRING, FINE WRINKLING, RHYTIDS, GENERAL KERATOSIS)
DERMABRASION; SEGMENTAL, FACE
DERMABRASION; REGIONAL, OTHER THAN FACE
DERMABRASION; SUPERFICIAL, ANY SITE, (EG, TATTOO REMOVAL)
ABRASION; SINGLE LESION (EG, KERATOSIS, SCAR)
ABRASION; EACH ADDITIONAL FOUR LESIONS OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PR
CHEMICAL PEEL, FACIAL; EPIDERMAL
CHEMICAL PEEL, FACIAL; DERMAL
CHEMICAL PEEL, NONFACIAL; EPIDERMAL
CHEMICAL PEEL, NONFACIAL; DERMAL
SALABRASION; 20 SQ CM OR LESS
SALABRASION; OVER 20 SQ CM
CERVICOPLASTY
BLEPHAROPLASTY, LOWER EYELID;
BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD
BLEPHAROPLASTY, UPPER EYELID;
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
RHYTIDECTOMY; FOREHEAD
RHYTIDECTOMY; NECK WITH PLATYSMAL TIGHTENING (PLATYSMAL FLAP, "P-FLAP")
RHYTIDECTOMY; GLABELLAR FROWN LINES
RHYTIDECTOMY; CHEEK, CHIN, AND NECK
RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS) FLAP
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ABDOMEN (ABDOMINOPLAST
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); THIGH
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); LEG
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); HIP
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); BUTTOCK

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ARM
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); FOREARM OR HAND
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); SUBMENTAL FAT PAD
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); OTHER AREA
GRAFT FOR FACIAL NERVE PARALYSIS; FREE FASCIA GRAFT (INCLUDING OBTAINING FASCIA)
GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT (INCLUDING OBTAINING GRAFT)
GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE FLAP BY MICROSURGICAL TECHNIQUE
GRAFT FOR FACIAL NERVE PARALYSIS; REGIONAL MUSCLE TRANSFER
REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), SAME SURGEON
REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON
DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL)
INTRAVENOUS INJECTION OF AGENT TO TEST VASCULAR FLOW IN FLAP OR GRAFT
SUCTION ASSISTED LIPECTOMY; HEAD AND NECK
SUCTION ASSISTED LIPECTOMY; TRUNK
SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY
SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY
EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH PRIMARY SUTURE
EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH FLAP CLOSURE
EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE;
EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR SKIN GRAFT
EXCISION, SACRAL PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE; WITH OSTECTOMY
EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE;
EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY (ISCHIECTOMY)
EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FL
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE;
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE;
EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
EXCISION, TROCHANTERIC PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR SKIN
EXCISION, TROCHANTERIC PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR SKIN
UNLISTED PROCEDURE, EXCISION PRESSURE ULCER
INITIAL TREATMENT, FIRST DEGREE BURN, WHEN NO MORE THAN LOCAL TREATMENT IS REQUIRED
DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; UNDER ANESTHESIA, SMALL
DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; UNDER ANESTHESIA, MEDIUM OR LARGE, OR WITH
DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, OFFICE OR HOSPITAL, SMA
DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, MEDIUM (EG, WHOLE FACE
DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, LARGE (EG, MORE THAN O
ESCHAROTOMY; INITIAL INCISION
ESCHAROTOMY; EACH ADDITIONAL INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE
DESTRUCTION, ALL BENIGN OR PREMALIGNANT LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PR
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 10.0 - 50.0 SQ CM
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); OVER 50.0 SQ CM
DESTRUCTION, OF FLAT WARTS, MOLLUSCUM CONTAGIOSUM, OR MILIA; UP TO 14 LESIONS
DESTRUCTION, OF FLAT WARTS, MOLLUSCUM CONTAGIOSUM, OR MILIA; UP TO 15 LESIONS
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA)
DESTRUCTION, MALIGNANT LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS
DESTRUCTION, MALIGNANT LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM
DESTRUCTION, MALIGNANT LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 4.0 CM
DESTRUCTION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS
DESTRUCTION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM
DESTRUCTION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 4.0 CM
DESTRUCTION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER
CHEMOSURGERY,INCLUD REMVAL GROSS TUMOR,SURG EXCIS TISSUE SPEC, MAPPING,MICROSCOPIC EXAM SPE
CHEMO, INCLUD REMOVAL GROSS TUMOR,SURG EXCIS TISSUE SPECIMENS, MICROSCOPIC EXAM SPECIMENS SU
CHEMO,INCLUD REMOVAL GROS TUMOR,SURG EXCIS TISSUE SPECI,MAPPING, MICROSCOPIC EXAM OF SPECIME
CHEMO, INCLUD REMOV GROSS TUMOR, SURG EXCIS TISSUE SPECI,MAPPING, MICROSCO EXAMIN SPECIMENS S
CHEMO,INCLUD REMOV ALL GROSS TUMOR,SURG EXCIS TISSUE SPECI,MAPG MICROSCOP EXAM SPECI SURG,& H
CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
CHEMICAL EXFOLIATION FOR ACNE (EG, ACNE PASTE, ACID)
ELECTROLYSIS EPILATION, EACH 1/2 HOUR
UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
PUNCTURE ASPIRATION OF CYST OF BREAST;
PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE F
MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM OR GALACTOGRAM
BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, NOT USING IMAGING GUIDANCE (SEPARATE PROCEDURE)
BIOPSY OF BREAST; OPEN, INCISIONAL
BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, USING IMAGING GUIDANCE
BIOPSY OF BREAST; PERCUTANEOUS, AUTOMATED VACUUM ASSISTED OR ROTATING BIOPSY DEVICE, USING IMA
NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPILLOMA LACTIF
EXCISION OF LACTIFEROUS DUCT FISTULA
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR ABERRANT BREAST TISSUE, DUC
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, OPEN; SIN
EXCISION OF BREAST LESION IDENTIFIED BY PREOP PLACEMENT OF RADIOLOGICAL MARKER, OPEN; EA ADDTL L
MASTECTOMY FOR GYNECOMASTIA
MASTECTOMY, PARTIAL;
MASTECTOMY, PARTIAL; WITH AXILLARY LYMPHADENECTOMY
MASTECTOMY, SIMPLE, COMPLETE
MASTECTOMY, SUBCUTANEOUS
MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY LYMPH NODES
MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY AND INTERNAL MAMMARY LYMPH NODES (U
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR
EXCISION OF CHEST WALL TUMOR INCLUDING RIBS
EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC RECONSTRUCTION; WITHOUT MEDIASTINAL LY
EXCISION OF CHEST WALL TUMOR INVOLVING RIBS, WITH PLASTIC RECONSTRUCTION; WITH MEDIASTINAL LYMP
PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST;
PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; EACH ADDITIONAL LESION (LIST SEPARAT
IMAGE GUIDED PLACEMENT, METALLIC LOCALIZATION CLIP, PERCUTANEOUS, DURING BREAST BIOPSY (LIST SEPA
MASTOPEXY
REDUCTION MAMMAPLASTY
MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT
MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT
REMOVAL OF INTACT MAMMARY IMPLANT
REMOVAL OF MAMMARY IMPLANT MATERIAL
IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTIO
DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION
NIPPLE/AREOLA RECONSTRUCTION
CORRECTION OF INVERTED NIPPLES
BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING SUBSEQUENT EXPAN
BREAST RECONSTRUCTION WITH LATISSIMUS DORSI FLAP, WITH OR WITHOUT PROSTHETIC IMPLANT
BREAST RECONSTRUCTION WITH FREE FLAP
BREAST RECONSTRUCTION WITH OTHER TECHNIQUE
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP (TRAM), SINGLE PED
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP (TRAM), SINGLE PED
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP (TRAM), DOUBLE PED
OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
PERIPROSTHETIC CAPSULECTOMY, BREAST
REVISION OF RECONSTRUCTED BREAST
PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT
UNLISTED PROCEDURE, BREAST
INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); SUPERFICIAL
INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); DEEP OR COMPLICATED
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); NECK
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); CHEST
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY
EXCISION OF EPIPHYSEAL BAR, WITH OR WITHOUT AUTOGEOUS SOFT TISSUE GRAFT OBTAINED THROUGH SAME
BIOPSY, MUSCLE; SUPERFICIAL
BIOPSY, MUSCLE; DEEP
BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS)
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP
BIOPSY, BONE, EXCISIONAL; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS, TROCHANTER OF FEM
BIOPSY, EXCISIONAL; DEEP (EG, HUMERUS, ISCHIUM, FEMUR)
BIOPSY, VERTEBRAL BODY, OPEN; THORACIC
BIOPSY, VERTEBRAL BODY, OPEN; LUMBAR OR CERVICAL
INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE)
INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM)

REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
INJECTION(S); TENDON SHEATH, LIGAMENT
INJECTION(S); TENDON ORIGIN/INSERTION
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), ONE OR TWO MUSCLE(S)
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), THREE OR MORE MUSCLE(S)
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG,FINGERS, TOES)
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE JOINT, S
ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION
ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST
INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL (SEPARATE PROC
APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL (SEPARATE PROCE
APPLICATION OF HALO, INCLUDING REMOVAL; CRANIAL
APPLICATION OF HALO, INCLUDING REMOVAL; PELVIC
APPLICATION OF HALO, INCLUDING REMOVAL; FEMORAL
APPLICATION OF HALO, INCLUDING REMOVAL, CRANIAL, 6 OR MORE PINS PLACED, FOR THIN SKULL OSTEOLOGY
REMOVAL OF TONGS OR HALO APPLIED BY ANOTHER PHYSICIAN
REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
APPLICATION OF A UNIPLANE (PINS OR WIRES IN ONE PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM
APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION S
ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN(S) OR WIRE(
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
REPLANTATION, ARM (INCLUDES SURGICAL NECK OF HUMERUS THROUGH ELBOW JOINT); COMPLETE AMPUTATIO
REPLANTATION, FOREARM (INCLUDES RADIUS AND ULNA TO RADIAL CARPAL JOINT); COMPLETE AMPUTATION
REPLANTATION, HAND (INCLUDES HAND THROUGH METACARPOPHALANGEAL JOINTS); COMPLETE AMPUTATION
REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES METACARPOPHALANGEAL JOINT TO INSERTION OF FLEXOR
REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TO SUBLIMIS TENDON INSERTION); COMPLETE A
REPLANTATION, THUMB (INCLUDES CARPOMETACARPAL JOINT TO MP JOINT); COMPLETE AMPUTATION
REPLANTATION, THUMB (INCLUDES DISTAL TIP TO MP JOINT); COMPLETE AMPUTATION
REPLANTATION, FOOT; COMPLETE AMPUTATION
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
CARTILAGE GRAFT; COSTOCHONDRAL
CARTILAGE GRAFT; NASAL SEPTUM
FASCIA LATA GRAFT; BY STRIPPER
FASCIA LATA GRAFT; BY INCISION AND AREA EXPOSURE, COMPLEX OR SHEET
TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, PLANTARIS)
TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS)
ALLOGRAFT FOR SPINE SURGERY ONLY; MORSELIZED
ALLOGRAFT FOR SPINE SURGERY ONLY; STRUCTURAL
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCE
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (THROUGH SEPARAT
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); STRUCTURAL, BICORTICAL OR TR
MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WICK CATHETER TECHN
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; FIBULA
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST

BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; METATARSAL
BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN FIBULA, ILIAC CREST OR METATARSAL
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN THE ILIAC CREST, METATARS
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; METATARSAL
FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE WITH WEB SPACE
ELECTRICAL STIMULATION TO AID BONE HEALING; NONINVASIVE (NONOPERATIVE)
ELECTRICAL STIMULATION TO AID BONE HEALING; INVASIVE (OPERATIVE)
LOW INTENSITY ULTRASOUND STIMULATION TO AID BONE HEALING, NONINVASIVE (NONOPERATIVE)
UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL
ARTHROTOMY, TEMPOROMANDIBULAR JOINT
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP
EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); MANDIBLE
EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); FACIAL BONE(S)
REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA OR ZYGOMA BY ENUCLEATION AND CURETTAGE
EXCISION OF TORUS MANDIBULARIS
EXCISION OF MAXILLARY TORUS PALATINUS
EXCISION OF MALIGNANT TUMOR OF MAXILLA OR ZYGOMA
EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE, BY ENUCLEATION AND/OR CURETTAGE
EXCISION OF MALIGNANT TUMOR OF MANDIBLE;
EXCISION OF MALIGNANT TUMOR OF MANDIBLE; RADICAL RESECTION
EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE; REQUIRING INTRA-ORAL OSTEOTOMY (EG, LOCALLY AGGR
EXCISION OF BENIGN TUMOR OR CYST OF MANDIBLE; REQUIRING EXTRA-ORAL OSTEOTOMY&PARTIAL MANDIBUL
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING INTRA-ORAL OSTEOTOMY (EG, LOCALLY AGGRES
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING EXTRA-ORAL OSTEOTOMY AND PARTIAL MAXILLE
CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
CORONOIDECTOMY (SEPARATE PROCEDURE)
IMPRESSION AND CUSTOM PREPARATION; SURGICAL OBTURATOR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; ORBITAL PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; INTERIM OBTURATOR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; DEFINITIVE OBTURATOR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; MANDIBULAR RESECTION PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; PALATAL AUGMENTATION PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; PALATAL LIFT PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; SPEECH AID PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINT
IMPRESSION AND CUSTOM PREPARATION; AURICULAR PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; NASAL PROSTHESIS
IMPRESSION AND CUSTOM PREPARATION; FACIAL PROSTHESIS
UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE
APPLICATION OF HALO TYPE APPLIANCE FOR MAXILLOFACIAL FIXATION, INCLUDES REMOVAL (SEPARATE PROCED
APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE OR DISLOCATION, IN
INJECTION PROCEDURE FOR TEMPOROMANDIBULAR JOINT ARTHROGRAPHY
GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL)
GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE OSTEOTOMIES (EG, WEDGE EXCISION OR BONE WEDGE R
GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE GRAFTS (INCLUDES OBTAINING AUTOGRA
AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL
AUGMENTATION, MANDIBULAR BODY OR ANGLE; WITH BONE GRAFT, ONLAY OR INTERPOSITIONAL (INCLUDES OB
REDUCTION FOREHEAD; CONTOURING ONLY
REDUCTION FOREHEAD; CONTOURING AND APPLICATION OF PROSTHETIC MATERIAL OR BONE GRAFT (INCLUDES
REDUCTION FOREHEAD; CONTOURING AND SETBACK OF ANTERIOR FRONTAL SINUS WALL
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG
RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE G
RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITH
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING BON
RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING BON
RECONSTRUCTION MIDFACE, LEFORT I; 3 OR MORE PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRIN
RECONSTRUCTION MIDFACE, LEFORT II; ANTERIOR INTRUSION (EG, TREACHER-COLLINS SYNDROME)
RECONSTRUCTION MIDFACE, LEFORT II; ANY DIRECTION, REQUIRING BONE GRAFTS (INCLUDES OBTAINING AUTO
RECONSTRUCTION MIDFACE, LEFORT III (EXTRACRANIAL), ANY TYPE, REQUIRING BONE GRAFTS (INCLUDES OBTA
RECONSTRUCTION MIDFACE, LEFORT III (EXTRACRANIAL), ANY TYPE, REQUIRING BONE GRAFTS (INCLUDES OBTA
RECONSTRUCTION MIDFACE, LEFORT III (EXTRA AND INTRACRANIAL) WITH FOREHEAD ADVANCEMENT (EG, MONO
RECONSTRUCTION MIDFACE, LEFORT III (EXTRA AND INTRACRANIAL) WITH FOREHEAD ADVANCEMENT (EG, MONO
RECONSTRUCTION SUPERIOR-LATERAL ORBITAL RIM AND LOWER FOREHEAD, ADVANCEMENT OR ALTERATION, W
RECONSTRUCTION, BIFRONTAL, SUPERIOR-LATERAL ORBITAL RIMS AND LOWER FOREHEAD, ADVANCEMENT OR A
RECONSTRUCTION, ENTIRE OR MAJORITY OF FOREHEAD AND/OR SUPRAORBITAL RIMS; WITH GRAFTS (ALLOGRA
RECONSTRUCTION, ENTIRE OR MAJORITY OF FOREHEAD AND/OR SUPRAORBITAL RIMS; WITH AUTOGRAFT (INCLU
RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF CRANIAL BONES (EG, FIBROUS DYSPLASIA), EXTRAC
RECONSTRUCTION, ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING INTRA-&EXTRACR
RECONSTRUCTION, ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLL INTRA-&EXTRACRANIAL E
RECONSTRUCTION, ORBITAL WALLS, RIMS, FOREHEAD, NASOETHMOID COMPLEX FOLLOWING INTRA-&EXTRACR
RECONSTRUCTION MIDFACE, OSTEOTOMIES (OTHER THAN LEFORT TYPE) AND BONE GRAFTS (INCLUDES OBTAIN
RECONSTRUCTION OF MANDIBULAR RAMI, HORIZONTAL, VERTICAL, "C", OR "L" OSTEOTOMY; WITHOUT BONE GRA
RECONSTRUCTION OF MANDIBULAR RAMUS, HORIZONTAL, VERTICAL, "C", OR "L" OSTEOTOMY; WITH BONE GRAF
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITHOUT INTERNAL RIGID FIXATION
RECONSTRUCTION OF MANDIBULAR RAMUS AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL RIGID FIXATION
OSTEOTOMY, MANDIBLE, SEGMENTAL
OSTEOTOMY, MANDIBLE, SEGMENTAL; WITH GENIOGLOSSUS ADVANCEMENT
OSTEOTOMY, MAXILLA, SEGMENTAL (EG, WASSMUND OR SCHUCHARD)
OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, OR PROSTHETIC IMPLANT)
OSTEOPLASTY, FACIAL BONES; REDUCTION
GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)
GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE OR EAR (INCLUDES OBTAINING GRAFT)
GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUT AUTOGRAFT (INCLUDES OBTAINING GRAFT)
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH ALLOGRAFT
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH PROSTHETIC JOINT REPLACEMENT
RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRANSOSTEAL BONE PLATE (EG, MANDIBULAR STAPLE BON
RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL
RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; COMPLETE
RECONSTRUCTION OF MANDIBULAR CONDYLE WITH BONE AND CARTILAGE AUTOGRAFTS (INCLUDES OBTAINING
RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); PARTIAL
RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); COMPLETE
RECONSTRUCTION OF ZYGOMATIC ARCH AND GLENOID FOSSA WITH BONE AND CARTILAGE (INCLUDES OBTAININ
RECONSTRUCTION OF ORBIT WITH OSTEOTOMIES (EXTRACRANIAL) AND WITH BONE GRAFTS (INCLUDES OBTAIN
PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; EXTRACRANIAL APPROACH
PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; COMBINED INTRA- AND EXTRA
PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; WITH FOREHEAD ADVANCEME
ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS; EXTRACRANIAL APPRO
ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS; COMBINED INTRA- AND
MALAR AUGMENTATION, PROSTHETIC MATERIAL
SECONDARY REVISION OF ORBITOCRANIOFACIAL RECONSTRUCTION
MEDIAL CANTHOPEXY (SEPARATE PROCEDURE)
LATERAL CANTHOPEXY
REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY);
REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY);
UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE
CLOSED TREATMENT OF SKULL FRACTURE WITHOUT OPERATION
CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION
CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION
CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION
OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED
OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL AND/OR EXTERNAL SKELETAL FIXATION
OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT OPEN TREATMENT OF FRACTURED SEPTUM
OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
OPEN TREATMENT OF NASOETHMOID FRACTURE; WITHOUT EXTERNAL FIXATION
OPEN TREATMENT OF NASOETHMOID FRACTURE; WITH EXTERNAL FIXATION
PERCUTANEOUS TREATMENT OF NASOETHMOID COMPLEX FRACTURE, WITH SPLINT, WIRE OR HEADCAP FIXATIO
OPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTURE
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING POSTERIOR WALL) FRONTAL SINUS FRAC
CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE), WITH INTERDENTAL WIRE FIXA
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH WIRING AND/OR LOCAL FIX
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); REQUIRING MULTIPLE OPEN APP
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH BONE GRAFTING (INCLUDE
PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD
OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLES APPROACH)
OPEN TREATMENT OF DEPRESSED MALAR FRACTURE, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE FORAMINA) FRACTURE(S
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE FORAMINA) FRACTURE(S
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; TRANSANTRAL APPROACH (CALDWELL-LUC TYPE
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; PERIORBITAL APPROACH
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; COMBINED APPROACH
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; PERIORBITAL APPROACH, WITH ALLOPLASTIC OR
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; PERIORBITAL APPROACH WITH BONE GRAFT (INC
CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT "BLOWOUT"; WITHOUT MANIPULATION
CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT "BLOWOUT"; WITH MANIPULATION
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT "BLOWOUT"; WITHOUT IMPLANT
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT "BLOWOUT"; WITH IMPLANT
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT "BLOWOUT"; WITH BONE GRAFTING (INCLUDES OBTAINING G
CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE), WITH INTERDENTAL WIRE FIXATION
OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE);
OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE); COMPLICATED (COMMINUTED OR INV
CLOSED TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE) USING INTERDENTAL WIRE FIXATION OF D
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); WITH WIRING AND/OR INTERNAL FIXATION
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED (EG, COMMINUTED OR INVOL
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED, UTILIZING INTERNAL AND/OR
OPEN TREATMENT OF CRANIOFACIAL SEPARATION (LEFORT III TYPE); COMPLICATED, MULTIPLE SURGICAL APPRO
CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)
OPEN TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)
CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION
PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE, WITH EXTERNAL FIXATION
CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION
OPEN TREATMENT OF MANDIBULAR FRACTURE WITH EXTERNAL FIXATION
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTAL FIXATION
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL FIXATION
OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE
OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE BY MULTIPLE SURGICAL APPROACHES INCLUDING
CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT
CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; COMPLICATED (EG, RECURRENT REQUIRING INTE
OPEN TREATMENT OF TEMPOROMANDIBULAR DISLOCATION
CLOSED TREATMENT OF HYOID FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF HYOID FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF HYOID FRACTURE
INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE
UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX; WITH PARTIAL RI
INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), THORAX
BIOPSY, SOFT TISSUE OF NECK OR THORAX
EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; SUBCUTANEOUS
EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; DEEP, SUBFASCIAL, INTRAMUSCULAR
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR THORAX
EXCISION OF RIB, PARTIAL
COSTOTRANSVERSECTOMY (SEPARATE PROCEDURE)
EXCISION FIRST AND/OR CERVICAL RIB;
EXCISION FIRST AND/OR CERVICAL RIB; WITH SYMPATHECTOMY
OSTECTOMY OF STERNUM, PARTIAL
STERNAL DEBRIDEMENT
RADICAL RESECTION OF STERNUM;
RADICAL RESECTION OF STERNUM; WITH MEDIASTINAL LYMPHADENECTOMY
DIVISION OF SCALENUS ANTICUS; WITHOUT RESECTION OF CERVICAL RIB
DIVISION OF SCALENUS ANTICUS; WITH RESECTION OF CERVICAL RIB
DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITHOUT CAST APPLICATION
DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITH CAST APPLICATION
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; OPEN
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE APPROACH (NUSS PRO
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE APPROACH (NUSS PRO
CLOSURE OF MEDIAN STERNOTOMY SEPARATION WITH OR WITHOUT DEBRIDEMENT
CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACH
OPEN TREATMENT OF RIB FRACTURE WITHOUT FIXATION, EACH

TREATMENT OF RIB FRACTURE REQUIRING EXTERNAL FIXATION ("FLAIL CHEST")
CLOSED TREATMENT OF STERNUM FRACTURE
OPEN TREATMENT OF STERNUM FRACTURE WITH OR WITHOUT SKELETAL FIXATION
UNLISTED PROCEDURE, NECK OR THORAX
BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL
BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLANK
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR IN
PARTIAL RESECTION OF VERTEBRAL COMPONENT, SPINOUS PROCESSES; THORACIC
PARTIAL RESECTION OF VERTEBRAL COMPONENT, SPINOUS PROCESSES; LUMBAR
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR IN
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT DECOMPRESSION OF SPINAL C
PARTIAL EXCISION OF VERTEBRAE (EG, FOR OSTEOMYELITIS); THORACIC
PARTIAL EXCISION OF VERTEBRAE (EG, FOR OSTEOMYELITIS); LUMBAR
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, W/O DECOMPRESSION OF SPINAL CORD
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT; CERVICAL
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT; THORACIC
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT; LUMBAR
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL APPROACH, ONE VERTEBRAL SEGMENT; EACH ADDITI
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL SEGMENT; CERVICA
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL SEGMENT; THORAC
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL SEGMENT; LUMBAR
OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL SEGMENT; EACH AD
CLOSED TREATMENT OF VERTEBRAL PROCESS FRACTURE(S)
CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING AND INCLUDING
CLOSED TREATMENT OF VERTEBRAL FRACTURE(S) AND/OR DISLOCATION(S) REQUIRING CASTING OR BRACING, W
OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS OD
OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS OD
OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/OR DISLOCATION(S), POSTERIOR APPR
OPEN TX &/OR REDUCTION OF VERTEBRAL FRACTURE(S) &/OR DISLOCATION(S), POSTERIOR APPROACH, ONE FR
MANIPULATION OF SPINE REQUIRING ANESTHESIA, ANY REGION
PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; THORACIC
PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; LUMBAR
PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH ADDIT
ARTHRODESIS, ANTERIOR TRANSORAL OR EXTRAORAL TECHNIQUE, CLIVUS-C1-C2 (ATLAS-AXIS), WITH OR WITHO
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO PREPARE INTERSPACE
ARTHRODESIS, POSTERIOR TECHNIQUE, CRANIOCERVICAL (OCCIPUT-C2)
ARTHRODESIS, POSTERIOR TECHNIQUE, ATLAS-AXIS (C1-C2)
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; CERVICAL BELOW C2 SEGMENT
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; THORACIC (WITH OR WITHOUT LA
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR (WITH OR WITHOUT LATE
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; EACH ADDITIONAL VERTEBRAL SE
ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISKECTOMY TO PREPA

ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, SINGLE INTERSPACE; EACH ADDITIONAL INTERSPACE (LIST
ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; UP TO 6 VERTEBRAL SEGMENTS
ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 7 TO 12 VERTEBRAL SEGMENTS
ARTHRODESIS, POSTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 13 OR MORE VERTEBRAL SEGME
ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 2 TO 3 VERTEBRAL SEGMENTS
ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 4 TO 7 VERTEBRAL SEGMENTS
ARTHRODESIS, ANTERIOR, FOR SPINAL DEFORMITY, WITH OR WITHOUT CAST; 8 OR MORE VERTEBRAL SEGMENT
KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE OF SPINE AND RESECTION OF VERTEBRAL SEGMENT(S) (INCLUDIN
KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE OF SPINE AND RESECTION OF VERTEBRAL SEGMENT(S) (INCLUDIN
EXPLORATION OF SPINAL FUSION
POSTERIOR NON-SEGMENTAL INSTRUMENTATION
INTERNAL SPINAL FIXATION BY WIRING OF SPINOUS PROCESSES
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SU
ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS
ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENTS
ANTERIOR INSTRUMENTATION; 8 OR MORE VERTEBRAL SEGMENTS
PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER T
REINSERTION OF SPINAL FIXATION DEVICE
REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD)
APPLICATION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE(S), THREADED BONE DOW
REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION
REMOVAL OF ANTERIOR INSTRUMENTATION
UNLISTED PROCEDURE, SPINE
EXCISION, ABDOMINAL WALL TUMOR, SUBFASCIAL (EG, DESMOID)
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS, OPEN
CAPSULAR CONTRACTURE RELEASE (EG, SEVER TYPE PROCEDURE)
INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, SHOULDER AREA; INFECTED BURSA
INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), SHOULDER AREA
ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REM
BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF SHOULDER AREA; DEEP
EXCISION, SOFT TISSUE TUMOR, SHOULDER AREA; SUBCUTANEOUS
EXCISION, TUMOR, SHOULDER AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER AREA
ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING BIOPSY
ARTHROTOMY, ACROMIOCLAVICULAR JOINT OR STERNOCLAVICULAR JOINT, INCLUDING BIOPSY AND/OR EXCISION
ARTHROTOMY; GLENOHUMERAL JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY
ARTHROTOMY; STERNOCLAVICULAR JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY
ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL OF LOOSE OR F
CLAVICULECTOMY; PARTIAL
CLAVICULECTOMY; TOTAL
ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL LIGAMENT RELEASE
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH AUTOGRAFT (INC
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH ALLOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH AUTOGRAFT (INCLU
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH ALLOGRAFT
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), CLAVICLE
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SCAPULA
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERAL HEAD TO SURGICAL NECK
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), CLAVIC
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), SCAPU
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), PROXIM
OSTECTOMY OF SCAPULA, PARTIAL (EG, SUPERIOR MEDIAL ANGLE)
RESECTION HUMERAL HEAD
RADICAL RESECTION FOR TUMOR; CLAVICLE
RADICAL RESECTION FOR TUMOR; SCAPULA
RADICAL RESECTION OF BONE TUMOR, PROXIMAL HUMERUS
RADICAL RESECTION FOR TUMOR, PROXIMAL HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
RADICAL RESECTION FOR TUMOR, PROXIMAL HUMERUS; WITH PROSTHETIC REPLACEMENT
REMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUS
REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG, NEER HEMIARTHROPLASTY REMOVAL)
REMOVAL OF FOREIGN BODY, SHOULDER; COMPLICATED (EG, TOTAL SHOULDER)
INJECTION PROCEDURE FOR SHOULDER ARTHROGRAPHY OR ENHANCED CT/MRI SHOULDER ARTHROGRAPHY
MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; SINGLE
MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; MULTIPLE
SCAPULOPEXY (EG, SPRENGEL'S DEFORMITY OR FOR PARALYSIS)
TENOTOMY, SHOULDER AREA; SINGLE TENDON
TENOTOMY, SHOULDER AREA; MULTIPLE TENDONS THROUGH SAME INCISION
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUT ACROMIOPLASTY
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLAST
TENODESIS OF LONG TENDON OF BICEPS
RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS
CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION
CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, WITH OR WITHOUT BONE BLOCK
CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTI-DIRECTIONAL INSTABILITY
ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR NONUNION OR MALUNIO
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLAT
CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF CLAVICULAR FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION

OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES
CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDE
CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF SCAPULAR FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION (W
OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) WITH OR WITHOUT INTERNAL FIXA
CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITHOUT MANIPUL
CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITH MANIPULATIO
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, WITH OR WITHOUT IN
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, WITH OR W/O INTERN
CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF GREATER TUBEROSITY FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROSITY, WITH
OPEN TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROSITY, WITH OR
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, WITH MAN
OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, WITH OR WI
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLO
ARTHRODESIS, GLENOHUMERAL JOINT
ARTHRODESIS, GLENOHUMERAL JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
INTERTHORACOSCAPULAR AMPUTATION (FOREQUARTER)
DISARTICULATION OF SHOULDER;
DISARTICULATION OF SHOULDER; SECONDARY CLOSURE OR SCAR REVISION
UNLISTED PROCEDURE, SHOULDER
INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA
INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERUS OR
ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE (SEPARATE PROCEDURE)
BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR ELBOW AREA
ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY
ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF L
ARTHROTOMY, ELBOW; WITH SYNOVECTOMY
EXCISION, OLECRANON BURSA
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAININ
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH ALLOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON PR
EXCISION, RADIAL HEAD
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SHAFT OR DISTAL HUMERUS
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), RADIAL HEAD OR NECK
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), OLECRANON PROCESS
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), HUMER
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), RADIAL
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), OLECR
RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH CONTRACTURE RELEA
RADICAL RESECTION FOR TUMOR, SHAFT OR DISTAL HUMERUS;
RADICAL RESECTION FOR TUMOR, SHAFT OR DISTAL HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT
RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK;
RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
RESECTION OF ELBOW JOINT (ARTHRECTOMY)
IMPLANT REMOVAL; ELBOW JOINT
IMPLANT REMOVAL; RADIAL HEAD
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
MANIPULATION, ELBOW, UNDER ANESTHESIA
MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE (EXCLUDING 24320-24331)
TENDON LENGTHENING, UPPER ARM OR ELBOW, EACH TENDON
TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON
TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT FREE GRAFT, ELBOW TO SHOULDER, SINGLE (SEDDO
FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT);
FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT); WITH EXTENSOR ADVANCEMENT
TENOLYSIS, TRICEPS
TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EX
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF
REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF G
FASCIOTOMY, LATERAL OR MEDIAL (EG, "TENNIS ELBOW" OR EPICONDYLITIS);
FASCIOTOMY, LATERAL OR MEDIAL (EG, "TENNIS ELBOW" OR EPICONDYLITIS); WITH EXTENSOR ORIGIN DETACHM
FASCIOTOMY, LATERAL OR MEDIAL (EG, "TENNIS ELBOW" OR EPICONDYLITIS); WITH ANNULAR LIGAMENT RESECT
FASCIOTOMY, LATERAL OR MEDIAL (EG, "TENNIS ELBOW" OR EPICONDYLITIS); WITH STRIPPING
FASCIOTOMY, LATERAL OR MEDIAL (EG, "TENNIS ELBOW" OR EPICONDYLITIS); WITH PARTIAL OSTECTOMY
ARTHROPLASTY, ELBOW; WITH MEMBRANE (EG, FASCIAL)
ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT
ARTHROPLASTY, ELBOW; WITH IMPLANT AND FASCIA LATA LIGAMENT RECONSTRUCTION
ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC REPLACEMENT (EG, TOTAL
ARTHROPLASTY, RADIAL HEAD;
ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION
MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON INTRAMEDULLARY ROD, HUMERAL SHAFT (SOFIELD TYPE PRO
OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876)
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)

REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRA
HEMIEPIPHYSEAL ARREST (EG, FOR CUBITUS VARUS OR VALGUS, DISTAL HUMERUS)
DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL ARTERY EXPLORATION
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING), WITH OR WITHOUT METHYLMETHACRYLAT
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACT
OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOU
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTE
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTE
PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR
OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHOUT INTERN
OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHOUT INTERN
CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION
CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH MANIPU
OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH OR WITHOUT INTERNAL O
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION
OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH OR WITHOUT INTERNAL OR E
PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH MANIPULA
OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL HUM
OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL HUM
TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA
TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION
CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL END O
OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL END OF U
CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, "NURSEMAID ELBOW", WITH MANIPULATION
CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, WITH OR WITHOUT INTERNAL FIXATION OR RADIAL HEA
OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, WITH OR WITHOUT INTERNAL FIXATION OR RADIAL HEA
CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (OLECRANON PROCESS); WITHOUT MANIPULATION
CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (OLECRANON PROCESS); WITH MANIPULATION
OPEN TREATMENT OF ULNAR FRACTURE PROXIMAL END (OLECRANON PROCESS), WITH OR WITHOUT INTERNAL
ARTHRODESIS, ELBOW JOINT; LOCAL
ARTHRODESIS, ELBOW JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
AMPUTATION, ARM THROUGH HUMERUS; WITH PRIMARY CLOSURE
AMPUTATION, ARM THROUGH HUMERUS; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, ARM THROUGH HUMERUS; SECONDARY CLOSURE OR SCAR REVISION
AMPUTATION, ARM THROUGH HUMERUS; RE-AMPUTATION
AMPUTATION, ARM THROUGH HUMERUS; WITH IMPLANT
STUMP ELONGATION, UPPER EXTREMITY
CINEPLASTY, UPPER EXTREMITY, COMPLETE PROCEDURE
UNLISTED PROCEDURE, HUMERUS OR ELBOW
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAIN'S DISEASE)
INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI RADIALIS)
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT; WITHOUT DE

DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT; WITHOUT DE
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT; WITH DEBRI
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; BURSA
INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST (EG, OSTEOMYELITIS OR BONE ABSCESS)
ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN B
BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; SUPERFICIAL
BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA; SUBCUTANEOUS
EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA; DEEP
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/OR WRIST AREA
CAPSULOTOMY, WRIST (EG, CONTRACTURE)
ARTHROTOMY, WRIST JOINT; WITH BIOPSY
ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVA
ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY
ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OF TRIANGULAR CARTILAGE, COMPLEX
EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNG
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNG
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; WITH RESECTION OF DISTAL ULNA
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK O
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH AUTOGRAFT (INCLUDES O
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH ALLOGRAFT
SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR WRIST
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS);
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS);
RADICAL RESECTION FOR TUMOR, RADIUS OR ULNA
CARPECTOMY; ONE BONE
CARPECTOMY; ALL BONES OF PROXIMAL ROW
RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)
INJECTION PROCEDURE FOR WRIST ARTHROGRAPHY
EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST
REMOVAL OF WRIST PROSTHESIS; (SEPARATE PROCEDURE)
REMOVAL OF WRIST PROSTHESIS; COMPLICATED, INCLUDING "TOTAL WRIST"
MANIPULATION, WRIST, UNDER ANESTHESIA
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH TENDON OR MUSC
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE GRAFT (INCLUDES OB
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSC
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH TENDON OR MU
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE GRAFT, EACH TEN
REPAIR, TENDON SHEATH, EXTENSOR, FOREARM AND/OR WRIST, WITH FREE GRAFT (INCLUDES OBTAINING GRAF
LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TE
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
TENODESIS AT WRIST; FLEXORS OF FINGERS
TENODESIS AT WRIST; EXTENSORS OF FINGERS
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TE
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; WITH TE
FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST;
FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST; WITH
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS,LIGAMENT REPAIR, TENDON TRAN
ARTHOPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION, WITH OR WITHOUT EXTERNAL OR INTERNAL FIXATION
CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND)
RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY B
OSTEOTOMY, RADIUS; DISTAL THIRD
OSTEOTOMY, RADIUS; MIDDLE OR PROXIMAL THIRD
OSTEOTOMY; ULNA
OSTEOTOMY; RADIUS AND ULNA
MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE PROCEDURE); RADIUS
MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE PROCEDURE); RADIUS
OSTEOPLASTY, RADIUS OR ULNA; SHORTENING
OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH AUTOGRAFT
OSTEOPLASTY, RADIUS AND ULNA; SHORTENING (EXCLUDING 64876)
OSTEOPLASTY, RADIUS AND ULNA; LENGTHENING WITH AUTOGRAFT
OSTEOPLASTY, CARPAL BONE, SHORTENING
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH AUTOGRAFT
REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITH AUTOGRAFT
REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA
REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS AND ULNA
INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HORI PROCEDURE)
REPAIR OF NONUNION OF CARPAL BONE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)) (INCLUDES OBTAINING GR
REPAIR OF NONUNION, SCAPHOID CARPALBONE, WITH OR WITHOUT RADIAL STYLOIDECTOMY
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL ULNA
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; SCAPHOID CARPAL
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; LUNATE
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS AND PARTIAL OR ENTIRE CARPUS ("TOTAL WR
ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS
REVISION OF ARTHROPLASTY, INCLUDING REMOVAL OF IMPLANT, WRIST JOINT
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS OR ULNA
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS AND ULNA
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION

OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION OF DISTAL RADIO
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH INTERNAL AND/ OR EXTERNAL FIXATION AND CLOSED TRE
OPEN TREATMENT, RADIAL SHAFT FRACTURE, W INTERNAL &/ EXTERNAL FIXATION&OPEN TREATMENT, WWO INT
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF RADI
OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF RADI
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION,
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION,
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEA
OPEN TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, WI
CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL F
CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)); WITHOUT MAN
CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)); WITH MANIPUL
OPEN TREATMENT OF CARPAL BONE FRACTURE, EACH BONE
CLOSED TREATMENT OF ULNAR STYLOID FRACTURE
PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES, WITH MANIPULAT
OPEN TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR DISLOCATION
CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION
OPEN TREATMENT OF DISTAL RADIOULNAR DISLOCATION, ACUTE OR CHRONIC
CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION
CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF LUNATE DISLOCATION
ARTHRODESIS, WRIST; COMPLETE, WITHOUT BONE GRAFT (INCLUDES RADIOCARPAL AND/OR INTERCARPAL AND
ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITH SLIDING GRAFT
ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITH ILIAC OR OTHER AU
ARTHRODESIS, WRIST; LIMITED, WITHOUT BONE GRAFT (EG, INTERCARPAL OR RADIOCARPAL)
INTERCARPAL FUSION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
ARTHRODESIS, DISTAL RADIOULNAR JOINT WITH SEGMENTAL RESECTION OF ULNA, WITH OR WITHOUT BONE GR
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA;
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECONDARY CLOSURE OR SCAR REVISION
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; RE-AMPUTATION
KRUKENBERG PROCEDURE
DISARTICULATION THROUGH WRIST;
DISARTICULATION THROUGH WRIST; SECONDARY CLOSURE OR SCAR REVISION
DISARTICULATION THROUGH WRIST; RE-AMPUTATION
TRANSMETACARPAL AMPUTATION;
TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE OR SCAR REVISION

TRANSMETACARPAL AMPUTATION; RE-AMPUTATION
UNLISTED PROCEDURE, FOREARM OR WRIST
DRAINAGE OF FINGER ABSCESS; SIMPLE
DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
DRAINAGE OF PALMAR BURSA; SINGLE, BURSA
DRAINAGE OF PALMAR BURSA; MULTIPLE BURSA
INCISION, BONE CORTEX, HAND OR FINGER (EG, OSTEOMYELITIS OR BONE ABSCESS)
DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY (EG, GREASE GUN)
DECOMPRESSIVE FASCIOTOMY, HAND (EXCLUDES 26035)
FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); PERCUTANEOUS
FASCIOTOMY, PALMAR, FOR DUPUYTREN'S CONTRACTURE; OPEN, PARTIAL
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
TENOTOMY, PERCUTANEOUS, SINGLE, EACH DIGIT
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; CARPOMETACARPAL
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; METACARPOPHALAN
ARTHROTOMY, FOR INFECTION, WITH EXPLORATION, DRAINAGE OR REMOVAL OF FOREIGN BODY; INTERPHALANG
ARTHROTOMY WITH BIOPSY; CARPOMETACARPAL JOINT, EACH
ARTHROTOMY WITH BIOPSY; METACARPOPHALANGEAL JOINT, EACH
ARTHROTOMY WITH SYNOVIAL BIOPSY; INTERPHALANGEAL JOINT, EACH
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER; SUBCUTANEOUS
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER; DEEP
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER
FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRA
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCL.PROXIMAL INTERPHALANGEAL JOINT, W/ O
FASCIECTMY, PRTL PALMAR W/REL.OF SNGL DGT INCL. PROX. INTPHALNGL JOINT, W/,W/O Z-PLASTY, OTHR LCL TI
SYNOVECTOMY, CARPOMETACARPAL JOINT
SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR HOOD RECONS
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION, EACH INTERPH
SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM AND/OR FINGER, EAC
EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE, HAND OR FINGER
EXCISION OF TENDON, PALM, FLEXOR, SINGLE (SEPARATE PROCEDURE), EACH
EXCISION OF TENDON, FINGER, FLEXOR (SEPARATE PROCEDURE), EACH TENDON
SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE PROCEDURE)
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL; WITH AUTOGRAFT (INCLUDES OB
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE OR DISTAL PHALANX OF FIN
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE OR DISTAL PHALANX OF FIN
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); METAC
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS)
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS)
RADICAL RESECTION, METACARPAL;
RADICAL RESECTION, METACARPAL; WITH AUTOGRAFT
RADICAL RESECTION, PROXIMAL OR MIDDLE PHALANX OF FINGER (EG, TUMOR)
RADICAL RESECTION (OSTECTOMY) FOR TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER; WITH AUTOGRAFT
RADICAL RESECTION, DISTAL PHALANX OF FINGER (EG, TUMOR)
REMOVAL OF IMPLANT FROM FINGER OR HAND
MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT
REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH; PRIMARY OR SEC
REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH; SECONDARY WIT
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH; PRIMARY OR SECOND
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH; SECONDARY, EACH T
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH; SECONDARY WITH FR
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON; PRIMARY, EACH TEN
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON; SECONDARY WITH F
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON; SECONDARY WITHO
EXCISION FLEXOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED TENDON GRAFT, HAND OR F
REMOVAL OF SYNTHETIC ROD AND INSERTION OF FLEXOR TENDON GRAFT, HAND OR FINGER, EACH ROD
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDE
EXCISION OF EXTENSOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED TENDON GRAFT, HAND
REMOVAL OF SYNTHETIC ROD AND INSERTION OF EXTENSOR TENDON GRAFT, HAND OR FINGER, EACH ROD
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLU
REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY; USING LOCAL TISSUE(S), INCLUDING LATERAL BAND
REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY; WITH FREE GRAFT, EACH FINGER
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT PERCUTANEOUS PINNING (E
REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITHOUT GRAFT (EG, MALLET FIN
EXTENSOR TENDON REPAIR, DISTAL INSERTION ("MALLET FINGER"), OPEN, PRIMARY OR SECONDARY REPAIR; WI
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
TENOLYSIS, FLEXOR TENDON; PALM OR FINGER; EACH TENDON
TENOLYSIS, SIMPLE, FLEXOR TENDON; PALM AND FINGER, EACH TENDON
TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER; EACH TENDON
TENOLYSIS, COMPLEX, EXTENSOR TENDON, FINGER, INCLUDING FOREARM, EACH TENDON
TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON
TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
TENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH TENDON
TENODESIS; OF PROXIMAL INTERPHALANGEAL JOINT, EACH JOINT
TENODESIS; OF DISTAL JOINT, EACH JOINT
LENGTHENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON
SHORTENING OF TENDON, EXTENSOR, HAND OR FINGER, EACH TENDON
LENGTHENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
SHORTENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND; WITHOUT FREE GRA
TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL AREA OR DORSUM OF HAND, SINGLE; WITH FREE TEN
TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITHOUT FREE TENDON GRAFT, EACH TENDON
TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, EACH TENDON; WITH FREE TENDON GRAFT (INCLUDES O
OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE, EACH TENDON
OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON
OPPONENSPLASTY; HYPOTHENAR MUSCLE TRANSFER
OPPONENSPLASTY; OTHER METHODS
TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION; RING AND SMALL FINGER
TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION; ALL FOUR FINGERS
CORRECTION CLAW FINGER, OTHER METHODS
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH LOCAL TISSUES (SEPARATE PROCEDURE)
TENDON PULLEY RECONSTRUCTION; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) (SEPARAT
TENDON PULLEY RECONSTRUCTION; WITH TENDON PROSTHESIS (SEPARATE PROCEDURE)
RELEASE OF THENAR MUSCLE(S) (EG, THUMB CONTRACTURE)

CROSS INTRINSIC TRANSFER, EACH TENDON
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
CAPSULODESIS FOR M-P JOINT STABILIZATION; TWO DIGITS
CAPSULODESIS FOR M-P JOINT STABILIZATION; THREE OR FOUR DIGITS
CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACH JOINT
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT
ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT
ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE, WITH TENDON OR FASCIAL GRAFT
PRIMARY REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT; WITH LOCAL TISSUE (EG, ADDUCT
RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING GRAFT, EACH JOINT
REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAINING BONE GRAFT WITH OR WITHOUT EXTERN
REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT
POLLICIZATION OF A DIGIT
TRANSFER, TOE-TO-HAND WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE "WRAP-AROUND" WITH BONE GRAF
TOE-TO-HAND TRANSFER WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN GREAT TOE, SINGLE
TOE-TO-HAND TRANSFER WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN GREAT TOE, DOUBLE
TRANSFER, FINGER TO ANOTHER POSITION WITHOUT MICROVASCULAR ANASTOMOSIS
TRANSFER, FREE TOE JOINT, WITH MICROVASCULAR ANASTOMOSIS
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS AND GRAFTS
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; COMPLEX (EG, INVOLVING BONE, NAILS)
OSTEOTOMY; METACARPAL, EACH
OSTEOTOMY; PHALANX OF FINGER, EACH
OSTEOPLASTY, LENGTHENING, METACARPAL OR PHALANX
REPAIR CLEFT HAND
RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
REPAIR MACRODACTYLIA, EACH DIGIT
REPAIR, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
RELEASE, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
EXCISION OF CONSTRICTING RING OF FINGER, WITH MULTIPLE Z-PLASTIES
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE
CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH EXTERNAL FIXATION, EACH BONE
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, E
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION
CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MA
PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACT
OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH OR WI
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULATION, EACH JO
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULATION, EACH JO
PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPU
OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; WITH OR WITHOUT INTERNAL OR
OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; COMPLEX, MULTIPLE OR DELAYE
CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANEST

CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING ANE
PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION
OPEN TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH OR WITHOUT INTERNAL OR EXTER
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; W
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; W
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHAL
OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WIT
CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JO
CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JO
OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOIN
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT MANIPULATION, EACH
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH MANIPULATION, EACH
PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, EACH
OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, WITH OR WITHOUT INTERNAL OR EXT
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANEST
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING ANE
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION
OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXA
FUSION IN OPPOSITION, THUMB, WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (IN
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER THAN THUMB, EACH;
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER THAN THUMB, EACH; WITH AUTOGRAFT
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCL
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH ADDITIONAL INTERPHAL
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSE
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURE
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURE
UNLISTED PROCEDURE, HANDS OR FINGERS
INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; INFECTED BURSA
INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT (EG, OSTEOMYELITIS OR BONE ABSCESS)
TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE)
TENOTOMY, ADDUCTOR OF HIP, OPEN
TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, WITH OBTURATOR NEURECTOMY
TENOTOMY, HIP FLEXOR(S), OPEN (SEPARATE PROCEDURE)
TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN (SEPARATE PROCEDURE)
FASCIOTOMY, HIP OR THIGH, ANY TYPE
ARTHROTOMY, HIP, WITH DRAINAGE (EG, INFECTION)
ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY
DENERVATION, HIP JOINT, INTRAPELVIC OR EXTRAPELVIC INTRA-ARTICULAR BRANCHES OF SCIATIC, FEMORAL, O
CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT EXCISION OF HETEROTOPIC BONE, WITH RELEASE O
BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
EXCISION, TUMOR, PELVIS AND HIP AREA; SUBCUTANEOUS TISSUE

EXCISION, TUMOR, PELVIS AND HIP AREA; DEEP, SUBFASCIAL, INTRAMUSCULAR
RADICAL RESECTION OF TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA (EG, MALIGNANT NEOPLASM)
ARTHROTOMY, WITH BIOPSY; SACROILIAC JOINT
ARTHROTOMY, WITH BIOPSY; HIP JOINT
ARTHROTOMY WITH SYNOVECTOMY, HIP JOINT
EXCISION; ISCHIAL BURSA
EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
EXCISION OF BONE CYST OR BENIGN TUMOR; SUPERFICIAL (WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATER TR
EXCISION OF BONE CYST OR BENIGN TUMOR; DEEP, WITH OR WITHOUT AUTOGRAFT
EXCISION OF BONE CYST OR BENIGN TUMOR; WITH AUTOGRAFT REQUIRING SEPARATE INCISION
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) (EG, OSTEOMYELITIS OR BONE ABSCESS); SUPERFICIAL (E
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) (EG, OSTEOMYELITIS OR BONE ABSCESS); DEEP (SUBFASC
RADICAL RESECTION OF TUMOR OR INFECTION; WING OF ILIUM, ONE PUBIC OR ISCHIAL RAMUS OR SYMPHYSIS P
RADICAL RESECTION OF TUMOR OR INFECTION; ILIUM, INCLUDING ACETABULUM, BOTH PUBIC RAMI, OR ISCHIUM
RADICAL RESECTION OF TUMOR OR INFECTION; INNOMINATE BONE, TOTAL
RADICAL RESECTION OF TUMOR OR INFECTION; ISCHIAL TUBEROSITY AND GREATER TROCHANTER OF FEMUR
RADICAL RESECTION OF TUMOR OR INFECTION; ISCHIAL TUBEROSITY AND GREATER TROCHANTER OF FEMUR, W
COCCYGECTOMY, PRIMARY
REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE
REMOVAL OF FOREIGN BODY, PELVIS OR HIP; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
REMOVAL OF HIP PROSTHESIS; (SEPARATE PROCEDURE)
REMOVAL OF HIP PROSTHESIS; COMPLICATED, INCLUDING TOTAL HIP PROSTHESIS, METHYLMETHACRYLATE WIT
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITHOUT ANESTHESIA
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA
INJECTION PROCEDURE FOR SACROILIAC JOINT, ARTHROGRAPHY AND/OR ANESTHETIC/STEROID
RELEASE OR RECESSION, HAMSTRING, PROXIMAL
TRANSFER, ADDUCTOR TO ISCHIUM
TRANSFER EXTERNAL OBLIQUE MUSCLE TO GREATER TROCHANTER INCLUDING FASCIAL OR TENDON EXTENSIO
TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES FASCIAL OR TENDON EXTENSION GRAFT)
TRANSFER ILIOPSOAS; TO GREATER TROCHANTER OF FEMUR
TRANSFER ILIOPSOAS; TO FEMORAL NECK
ACETABULOPLASTY; (EG, WHITMAN, COLONNA, HAYGROVES, OR CUP TYPE)
ACETABULOPLASTY; RESECTION, FEMORAL HEAD (EG, GIRDLESTONE PROCEDURE)
HEMIARTHROPLASTY, HIP, PARTIAL (EG, FEMORAL STEM PROSTHESIS, BIPOLAR ARTHROPLASTY)
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT, WITH OR WITHOUT AUTOG
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALL
REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
REVISION OF TOTAL HIP ARTHROPLASTY; ACETABULAR COMPONENT ONLY, WITH OR WITHOUT AUTOGRAFT OR AL
REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT ALLOGRAFT
OSTEOTOMY AND TRANSFER OF GREATER TROCHANTER OF FEMUR
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE;
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH OPEN REDUCTION OF HIP
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY AND WITH OPEN REDUCTI
OSTEOTOMY, PELVIS, BILATERAL (EG, CONGENITAL MALFORMATION)
OSTEOTOMY, FEMORAL NECK (SEPARATE PROCEDURE)
OSTEOTOMY, INTERTROCHANTERIC OR SUBTROCHANTERIC INCLUDING INTERNAL OR EXTERNAL FIXATION AND/O
BONE GRAFT, FEMORAL HEAD, NECK, INTERTROCHANTERIC OR SUBTROCHANTERIC AREA (INCLUDES OBTAINING
TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY TRACTION, WITHOUT REDUCTION

TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; SINGLE OR MULTIPLE PINNING OR BONE GRAFT (INCLUDES
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; CLOSED MANIPULATION WITH SINGLE OR MULTIPLE PINNIN
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; OSTEOPLASTY OF FEMORAL NECK (HEYMAN TYPE PROCED
OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; OSTEOTOMY AND INTERNAL FIXATION
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, GREATER TROCHANTER OF FEMUR
CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; WITHOUT MANIPU
CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; WITH MANIPULATI
CLOSED TREATMENT OF COCCYGEAL FRACTURE
OPEN TREATMENT OF COCCYGEAL FRACTURE
OPEN TREATMENT OF ILIAC SPINE(S), TUBEROSITY AVULSION, OR ILIAC WING FRACTURE(S) (EG, PELVIC FRACTU
PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC RING FRACTURE AND/OR DISLOCATION (INCLUDES I
OPEN TREATMENT OF ANTERIOR RING FRACTURE AND/OR DISLOCATION WITH INTERNAL FIXATION, (INCLUDES PU
OPEN TREATMENT OF POSTERIOR RING FRACTURE AND/OR DISLOCATION WITH INTERNAL FIXATION (INCLUDES I
CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION
CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITH MANIPULATION, WITH OR WITHOUT SKE
OPEN TREATMENT OF POSTERIOR OR ANTERIOR ACETABULAR WALL FRACTURE, WITH INTERNAL FIXATION
OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANTERIOR OR POSTERIOR (ONE) COLUMN, OR A FR
OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANT & POST (TWO) COLUMNS, INC T-FRACTURE AND
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITHOUT MANIPULATION
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITH MANIPULATION, WITH OR WITHOUT S
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK
OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR PROSTHETIC REPLAC
CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTU
CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTU
TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH
TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH
CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION
OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATIO
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA
OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITHOUT INTERNAL FIXATION
OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITH ACETABULAR WALL AND FEMORAL HEAD FRACTURE,
TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICA
TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICA
OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLO
OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLO
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHE
MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA
ARTHRODESIS, SACROILIAC JOINT (INCLUDING OBTAINING GRAFT)
ARTHRODESIS, SYMPHYSIS PUBIS (INCLUDING OBTAINING GRAFT)
ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT)
ARTHRODESIS, HIP JOINT (INCLUDES OBTAINING GRAFT); WITH SUBTROCHANTERIC OSTEOTOMY
INTERPELVIABDOMINAL AMPUTATION (HINDQUARTER AMPUTATION)
DISARTICULATION OF HIP
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION
INCISION, DEEP, WITH OPENING OF BONE CORTEX, FEMUR OR KNEE (EG, OSTEOMYELITIS OR BONE ABSCESS)
FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN
TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; SINGLE TENDON (SEPARATE PROCEDURE)
TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; MULTIPLE TENDONS
ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG, INFECTION)
NEURECTOMY, HAMSTRING MUSCLE
NEURECTOMY, POPLITEAL (GASTROCNEMIUS)
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
EXCISION, TUMOR, THIGH OR KNEE AREA; SUBCUTANEOUS
EXCISION, TUMOR, THIGH OR KNEE AREA; DEEP, SUBFASCIAL, OR INTRAMUSCULAR
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF THIGH OR KNEE AREA
ARTHROTOMY, KNEE; WITH SYNOVIAL BIOPSY ONLY
ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR REMOVAL OF LOOSE OR FOREIGN BODIES
ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL OR LATERAL
ARTHROTOMY, KNEE, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY); MEDIAL AND LATERAL
ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR
ARTHROTOMY, KNEE, WITH SYNOVECTOMY; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL AREA
EXCISION, PREPATELLAR BURSA
EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG, BAKER'S CYST)
EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE
PATELLECTOMY OR HEMIPATELLECTOMY
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH AUTOGRAFT (INCLUDES OBTAININ
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL FIXATION (LIST IN ADDI
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE, FEMUR, PROXIMAL TIBIA AND/
RADICAL RESECTION OF TUMOR, BONE, FEMUR OR KNEE
INJECTION PROCEDURE FOR KNEE ARTHROGRAPHY
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASC
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE TENDON
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, ONE LEG
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, BILATERAL
LENGTHENING OF HAMSTRING TENDON; SINGLE TENDON
LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS, ONE LEG
LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS, BILATERAL
TRANSPLANT, HAMSTRING TENDON TO PATELLA; SINGLE TENDON
TRANSPLANT, HAMSTRING TENDON TO PATELLA; MULTIPLE TENDONS
TRANSFER, TENDON OR MUSCLE, HAMSTRINGS TO FEMUR (EG, EGGER'S TYPE PROCEDURE)
ARTHROTOMY WITH MENISCUS REPAIR, KNEE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL AND CRUCIATE LIGAMENTS
ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)
RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)

RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT
RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; WITH PATELLECTOMY
LATERAL RETINACULAR RELEASE OPEN
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN)
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN) AND EXTRA-ARTICULAR
QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE)
CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE
ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS
ARTHROPLASTY, PATELLA; WITH PROSTHESIS
ARTHROPLASTY, KNEE, TIBIAL PLATEAU;
ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY
ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE
ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS; WITH DEBRIDEMENT AND PARTIAL SYNOVECT
ARTHROPLASTY, KNEE, HINGE PROSTHESIS (EG, WALLDIUS TYPE)
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATE
OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITHOUT FIXATION
OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITH FIXATION
OSTEOTOMY, MULTIPLE, WITH REALIGNMENT ON INTRAMEDULLARY ROD, FEMORAL SHAFT (EG, SOFIELD TYPE PR
OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES CORRECTION OF GENU
OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES CORRECTION OF GENU
OSTEOPLASTY, FEMUR; SHORTENING (EXCLUDING 64876)
OSTEOPLASTY, FEMUR; LENGTHENING
OSTEOPLASTY, FEMUR; COMBINED, LENGTHENING AND SHORTENING WITH FEMORAL SEGMENT TRANSFER
REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITHOUT GRAFT (EG, COMPRESSION TE
REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITH ILIAC OR OTHER AUTOGENOUS BO
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
ARREST, EPIPHYSEAL, ANY METHOD; TIBIA AND FIBULA, PROXIMAL
ARREST, EPIPHYSEAL, ANY METHOD; COMBINED DISTAL FEMUR, PROXIMAL TIBIA AND FIBULA
ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA OR FIBULA (EG, GENU VARUS OR VALGUS)
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; ONE COMPONENT
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPO
REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH OR WITHOUT IN
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR OR ADDUCTO
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR OR ADDUCTO
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS;
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; WITH DEBRIDEMENT OF NONV
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITHOUT INTER
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELET
CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITHOUT INTER
OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUT EXTERNAL FIXATION, WITH INSERTION OF
OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULAT
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, SUPR
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITH MANIPULATION
OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERCONDYLAR

OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCONDYLAR EXT
OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITH OR WITHOUT INTE
CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION
CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITH MANIPULATION, WITH OR WITHOUT S
OPEN TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION, WITH OR WITHOUT INTERNAL OR EXTERNAL F
CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION
OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE PATELLEC
CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION
CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT MANIPULATION, WITH SKEL
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, WITH OR WITHOUT INTERNAL OR
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHOUT INTERNAL FIXAT
CLOSED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF KNEE, WITH OR WITH
OPEN TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, WITH OR WIT
CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF KNEE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITHOUT PRIM
OPEN TREATMENT OF KNEE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITH PRIMARY
OPEN TREATMENT OF KNEE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITH PRIMARY
CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL PATELLECTOMY
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER
ARTHRODESIS, KNEE, ANY TECHNIQUE
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL;
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; IMMEDIATE FITTING TECHNIQUE INCLUDING FIRST CAST
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECONDARY CLOSURE OR SCAR REVISION
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; RE-AMPUTATION
DISARTICULATION AT KNEE
UNLISTED PROCEDURE, FEMUR OR KNEE
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S)
INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA
INCISION AND DRAINAGE, LEG OR ANKLE; INFECTED BURSA
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); LOCAL ANESTHESIA
TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE PROCEDURE); GENERAL ANESTHESIA
INCISION (EG, OSTEOMYELITIS OR BONE ABSCESS), LEG OR ANKLE
ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON LENGTHENING
BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; SUPERFICIAL
BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE AREA
EXCISION, TUMOR, LEG OR ANKLE AREA; SUBCUTANEOUS TISSUE
EXCISION, TUMOR, LEG OR ANKLE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF L
ARTHROTOMY, ANKLE, WITH SYNOVECTOMY;
ARTHROTOMY, ANKLE, WITH SYNOVECTOMY; INCLUDING TENOSYNOVECTOMY
EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH AUTOGRAFT (INCLUDES OB
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH ALLOGRAFT
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR EXOS
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS
RADICAL RESECTION OF TUMOR, BONE; TIBIA
RADICAL RESECTION OF TUMOR, BONE; FIBULA
RADICAL RESECTION OF TUMOR, BONE; TALUS OR CALCANEUS
INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
REPAIR, FASCIAL DEFECT OF LEG
REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
REPAIR, DISLOCATING PERONEAL TENDON; WITHOUT FIBULAR OSTEOTOMY
REPAIR FOR DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; MULTIPLE TENDONS (THROUGH SEPARATE INC
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE TENDONS (THROUGH SAME INCISION), EA
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); SUPERFICIAL (E
TRANSFER/TRANSPLANT SINGLE TENDON (W/MUSCLE REDIRECTION/REROUTING); DEEP (EG, ANT/POST TIBIAL TH
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); EACH ADDITION
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
REPAIR, SECONDARY DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)
ARTHROPLASTY, ANKLE;
ARTHROPLASTY, ANKLE; WITH IMPLANT ("TOTAL ANKLE")
ARTHROPLASTY, ANKLE; REVISION, TOTAL ANKLE
REMOVAL OF ANKLE IMPLANT
OSTEOTOMY; TIBIA
OSTEOTOMY; FIBULA
OSTEOTOMY; TIBIA AND FIBULA
OSTEOTOMY; MULTIPLE, WITH REALIGNMENT ON INTRAMEDULLARY ROD (EG, SOFIELD TYPE PROCEDURE)
OSTEOPLASTY, TIBIA AND FIBULA, LENGTHENING OR SHORTENING
REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT, (EG, COMPRESSION TECHNIQUE)
REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT
REPAIR OF NONUNION OR MALUNION, TIBIA; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
REPAIR OF NONUNION OR MALUNION, TIBIA; BY SYNOSTOSIS, WITH FIBULA, ANY METHOD
REPAIR OF CONGENITAL PSEUDARTHROSIS, TIBIA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL FIBULA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA AND FIBULA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD, COMBINED, PROXIMAL AND DISTAL TIBIA AND FIBULA
EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, COMBINED, PROXIMAL AND DISTAL TIBIA AND FIBULA; AN
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT MANIPULA
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) (EG,
OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR WITHOUT FIBULAR FRACTURE) WITH PLATE/SCREWS,
TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLAN
CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKEL
OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXA
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), WITH OR WITHOUT INTERNAL OR EXTE
CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); WITHOUT MANIPULATION
CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); WITH MANIPULATION
OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION,
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION,
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR T
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR T
OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA (EG, PILO
OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, WITH OR WITHOUT INTERNAL O
CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; REQUIRING ANESTHESIA
OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL
CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT PERCUTANEOUS SKE
OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION; WITHOUT R
OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION; WITH REPA
MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXAT
ARTHRODESIS, ANKLE, OPEN
ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA;
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; WITH IMMEDIATE FITTING TECHNIQUE INCLUDING APPLICATION O
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; OPEN, CIRCULAR (GUILLOTINE)
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION
AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND FIBULA (EG, SYME, PIROGOFF TYPE PROCEDURES), WIT
ANKLE DISARTICULATION
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH DEBRIDEMENT O
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT OF NONVIABLE M
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S), WITH DEB
UNLISTED PROCEDURE, LEG OR ANKLE

INCISION AND DRAINAGE, BURSA, FOOT
INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; SINGLE BUR
DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, WITH OR WITHOUT TENDON SHEATH INVOLVE
INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), FOOT
FASCIOTOMY, FOOT AND/OR TOE
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERTARSAL
ARTHROTOMY, WITH EXPLORATION, DRAINAGE OR REMOVAL OF LOOSE OR FOREIGN BODY; METATARSOPHALAN
ARTHROTOMY, WITH EXPLORATION, DRAINAGE OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL J
NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
EXCISION, TUMOR, FOOT; SUBCUTANEOUS TISSUE
EXCISION, TUMOR, FOOT; DEEP, SUBFASCIAL, INTRAMUSCULAR
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT
ARTHROTOMY WITH BIOPSY; INTERTARSAL OR TARSOMETATARSAL JOINT
ARTHROTOMY FOR SYNOVIAL BIOPSY; METATARSOPHALANGEAL JOINT
ARTHROTOMY FOR SYNOVIAL BIOPSY; INTERPHALANGEAL JOINT
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
FASCIECTOMY, EXCISION OF PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)
SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT, EACH
SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH
EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR
EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANG
EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANG
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ILIAC OR OTHER AUT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ALLOGRAFT
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALC
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT
OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)
OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD
OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL PHALANGECTOMY, EXCLU
OSTECTOMY, EXCISION OF TARSAL COALITION
OSTECTOMY, CALCANEUS;
OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTE
RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE
TALECTOMY (ASTRAGALECTOMY)
METATARSECTOMY
PHALANGECTOMY, TOE, EACH TOE

RESECTION, CONDYLE(S), DISTAL END OF PHALANX, EACH TOE
HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EACH
RADICAL RESECTION OF TUMOR, BONE; TARSAL (EXCEPT TALUS OR CALCANEUS)
RADICAL RESECTION OF TUMOR, BONE; METATARSAL
RADICAL RESECTION OF TUMOR, BONE; PHALANX OF TOE
REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
REMOVAL OF FOREIGN BODY, FOOT; DEEP
REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON
REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE; SECONDARY WITH FREE GRAFT, EACH TENDON (INCLU
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE; SECONDARY WITH FREE GRAFT, EACH TENDON (INC
TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
TENOLYSIS, FLEXOR, FOOT; MULTIPLE TENDONS
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
TENOLYSIS, EXTENSOR, FOOT; MULTIPLE TENDONS
TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLE TENDON(S) (SEPARATE PROCEDURE)
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
RECONSTRUCTION, POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE
TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE
DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLER STRIPPING) (SEPARATE PROCEDURE)
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND TENDON(S) LENG
CAPSULOTOMY, MIDTARSAL (EG, HEYMAN TYPE PROCEDURE)
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PRO
CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT (SEPARATE PROCEDURE)
SYNDACTYLIZATION, TOES (EG, WEBBING OR KELIKIAN TYPE PROCEDURE)
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE (EG, RUIZ-MORA TYPE PROCEDURE)
OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSAL HEAD
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST MET
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; SIMPLE EXOSTECTOMY (EG, SI
HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; KELLER, MCBRIDE OR MAYO TY
HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; RESECTION OF JOINT WITH IMP
CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH TENDON TRANSPLANTS (
HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY
HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; LAPIDUS TYPE PROCEDURE
HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX OSTEOTOMY
CORRECTION, HALLUX VALGUS, WITH OR WITHOUT SESAMOIDECTOMY; BY DOUBLE OSTEOTOMY
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATIO
OSTEOTOMY; TALUS
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT (INCLUDES OBTAINING GR
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; FIRST M
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; FIRST M
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; MULTIP

OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE (SEPARATE
OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY TOE
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECON
SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
REPAIR, NONUNION OR MALUNION; TARSAL BONES
REPAIR OF NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRA
RECONSTRUCTION, TOE, MACRODACTYLY; SOFT TISSUE RESECTION
RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE RESECTION
RECONSTRUCTION, TOE(S); POLYDACTYLY
RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB
RECONSTRUCTION, CLEFT FOOT
CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION
OPEN TREATMENT OF CALCANEAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION;
OPEN TREATMENT OF CALCANEAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITH PRIM
CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION
CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF TALUS FRACTURE, WITH MANIPULATION
OPEN TREATMENT OF TALUS FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT MANIPULATION, EACH
TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITH MANIPULATION, EACH
PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH MAN
OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH OR WITHOUT INTERNAL
CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH
CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
OPEN TREATMENT OF METATARSAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH
CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITHOUT MANIPULATION
CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH MANIPULATION
OPEN TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH OR WITHOUT INTERNAL OR EXTE
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOUT MANIPULATI
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH MANIPULATION,
OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, WITH OR WITHOUT INTER
CLOSED TREATMENT OF SESAMOID FRACTURE
OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION
CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; WITHOUT ANESTHESIA
CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL, WITH MANIPUL
OPEN TREATMENT OF TARSAL BONE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF TALOTARSAL JOINT DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXA
CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNA
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXA
ARTHRODESIS; PANTALAR
ARTHRODESIS; TRIPLE
ARTHRODESIS; SUBTALAR
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY (EG, FLATFO
ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL NAVICULAR-CUNEIFORM
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST METATARSAL NECK, GREAT TOE, INTER
AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE PROCEDURE)
AMPUTATION, FOOT; TRANSMETATARSAL
AMPUTATION, METATARSAL, WITH TOE, SINGLE
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
AMPUTATION, TOE; INTERPHALANGEAL JOINT
UNLISTED PROCEDURE, FOOT OR TOES
APPLICATION OF HALO TYPE BODY CAST (SEE 20661-20663 FOR INSERTION)
APPLICATION OF RISSER JACKET, LOCALIZER, BODY; ONLY
APPLICATION OF RISSER JACKET, LOCALIZER, BODY; INCLUDING HEAD
APPLICATION OF TURNBUCKLE JACKET, BODY; ONLY
APPLICATION OF TURNBUCKLE JACKET, BODY; INCLUDING HEAD
APPLICATION OF BODY CAST, SHOULDER TO HIPS;
APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING HEAD, MINERVA TYPE
APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING ONE THIGH
APPLICATION OF BODY CAST, SHOULDER TO HIPS; INCLUDING BOTH THIGHS
APPLICATION, CAST; FIGURE-OF-EIGHT
APPLICATION, CAST; SHOULDER SPICA
APPLICATION, CAST; PLASTER VELPEAU
APPLICATION, CAST; SHOULDER TO HAND
APPLICATION, CAST; ELBOW TO FINGER
APPLICATION, CAST; HAND AND LOWER FOREARM
APPLICATION, CAST; FINGER (EG, CONTRACTURE)
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC
APPLICATION OF FINGER SPLINT; STATIC
APPLICATION OF FINGER SPLINT; DYNAMIC
STRAPPING; THORAX
STRAPPING; LOW BACK
STRAPPING; SHOULDER (EG, VELPEAU)
STRAPPING; ELBOW OR WRIST

STRAPPING; HAND OR FINGER
APPLICATION OF HIP SPICA CAST; ONE LEG
APPLICATION OF HIP SPICA CAST; ONE AND ONE-HALF SPICA OR BOTH LEGS
APPLICATION OF LONG LEG CAST (THIGH TO TOES);
APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER OR AMBULATORY TYPE
APPLICATION OF LONG LEG CAST BRACE
APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)
APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);
APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING OR AMBULATORY TYPE
APPLICATION OF PATELLAR TENDON BEARING (PTB) CAST
ADDING WALKER TO PREVIOUSLY APPLIED CAST
APPLICATION OF RIGID TOTAL CONTACT LEG CAST
APPLICATION OF CLUBFOOT CAST WITH MOLDING OR MANIPULATION, LONG OR SHORT LEG
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
STRAPPING; HIP
STRAPPING; KNEE
STRAPPING; ANKLE AND/OR FOOT
STRAPPING; TOES
STRAPPING; UNNA BOOT
DENIS-BROWNE SPLINT STRAPPING
REMOVAL OR BIVALVING; GAUNTLET, BOOT OR BODY CAST
REMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST
REMOVAL OR BIVALVING; SHOULDER OR HIP SPICA, MINERVA, OR RISSER JACKET, ETC.
REMOVAL OR BIVALVING; TURNBUCKLE JACKET
REPAIR OF SPICA, BODY CAST OR JACKET
WINDOWING OF CAST
WEDGING OF CAST (EXCEPT CLUBFOOT CASTS)
WEDGING OF CLUBFOOT CAST
UNLISTED PROCEDURE, CASTING OR STRAPPING
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PR
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL
ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY
ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION
ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE
ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUM
ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOUT MANIPU
ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLA
ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED

ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE
ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE
ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR FIBROCARTILAGE AND/OR JOINT D
ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTURE OR INSTABILITY
ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT
ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF TH
ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF TH
ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, WITH OR W
ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WIT
ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), AB
ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY
ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE
ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHONDRITIS D
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCE
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, TWO OR MORE COMPARTMENTS (EG, MEDIAL OR LATE
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)
ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAV
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVI
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)
ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT MANIPULATION (SEPARATE PR
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE GRAFTING, WITH O
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION
ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION
ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING
ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR DOME FRACTURE
ENDOSCOPIC PLANTAR FASCIOTOMY
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH ANKLE ARTHRODESIS
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, DIAGNOSTIC, INCLUDES SYNOVIAL BIOPSY
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH DEBRIDEMENT
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH REDUCTION OF DISPLACED ULNAR COLLATER
UNLISTED PROCEDURE, ARTHROSCOPY
DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH
DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
BIOPSY, INTRANASAL
EXCISION, NASAL POLYP(S), SIMPLE
EXCISION, NASAL POLYP(S), EXTENSIVE
EXCISION OR DESTRUCTION, INTRANASAL LESION; INTERNAL APPROACH
EXCISION OR DESTRUCTION, INTRANASAL LESION; EXTERNAL APPROACH
EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA
EXCISION DERMOID CYST, NOSE; SIMPLE, SKIN, SUBCUTANEOUS
EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE OR CARTILAGE
EXCISION TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
SUBMUCOUS RESECTION TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
RHINECTOMY; PARTIAL
RHINECTOMY; TOTAL
INJECTION INTO TURBINATE(S), THERAPEUTIC
DISPLACEMENT THERAPY (PROETZ TYPE)
INSERTION, NASAL SEPTAL PROSTHESIS (BUTTON)
REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
REMOVAL FOREIGN BODY, INTRANASAL; BY LATERAL RHINOTOMY
RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP
RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL AND ALAR CARTILA
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)
RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING COL
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING COL
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLAC
REPAIR CHOANAL ATRESIA; INTRANASAL
REPAIR CHOANAL ATRESIA; TRANSPALATINE
LYSIS INTRANASAL SYNECHIA
REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030 IF ANTROTOMY IS INCLUDED)
REPAIR FISTULA; ORONASAL
SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES NOT INCLUDE OBTAINING GRAFT)
REPAIR NASAL SEPTAL PERFORATIONS
CAUTERY AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD,; SUPERFICIAL
CAUTERY AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD; INTRAMURAL
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; I
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; S
LIGATION ARTERIES; ETHMOIDAL
LIGATION ARTERIES; INTERNAL MAXILLARY ARTERY, TRANSANTRAL
FRACTURE NASAL TURBINATE(S), THERAPEUTIC
UNLISTED PROCEDURE, NOSE
LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM PUNCTURE OR NATURAL OSTIUM)
LAVAGE BY CANNULATION; SPHENOID SINUS
SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITHOUT REMOVAL OF ANTROCHOANAL POL
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITH REMOVAL OF ANTROCHOANAL POLYPS

PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH
SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;
SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITH MUCOSAL STRIPPING OR REMOVAL OF POLYP(S)
SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION)
SINUSOTOMY FRONTAL; TRANSORBITAL, UNILATERAL (FOR MUCOCELE OR OSTEOMA, LYNCH TYPE)
SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, BROW INCISION (INCLUDES ABLATION)
SINUSOTOMY FRONTAL; OBLITERATIVE, WITHOUT OSTEOPLASTIC FLAP, CORONAL INCISION (INCLUDES ABLATION
SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
SINUSOTOMY, UNILATERAL, THREE OR MORE PARANASAL SINUSES (FRONTAL, MAXILLARY, ETHMOID, SPHENOID)
ETHMOIDECTOMY; INTRANASAL, ANTERIOR
ETHMOIDECTOMY; INTRANASAL, TOTAL
ETHMOIDECTOMY; EXTRANASAL, TOTAL
MAXILLECTOMY; WITHOUT ORBITAL EXENTERATION
MAXILLECTOMY; WITH ORBITAL EXENTERATION (EN BLOC)
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR MEATUS OR CANINE FOS
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SPHENOIDAL FACE O
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL (ANTERIOR)
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND POSTERIOR)
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILL
NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT REMOVAL OF TIS
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; ETHMOID REGION
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; SPHENOID REGION
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL DECOMPRESSION
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL ORBITAL WALL AND INFERIOR ORBITAL WALL DECOMPRESSI
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH OPTIC NERVE DECOMPRESSION
UNLISTED PROCEDURE, ACCESSORY SINUSES
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH REMOVAL OF TUMOR OR LARYNGOCELE, CORDECTOMY
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); DIAGNOSTIC
LARYNGECTOMY; TOTAL, WITHOUT RADICAL NECK DISSECTION
LARYNGECTOMY; TOTAL, WITH RADICAL NECK DISSECTION
LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, WITHOUT RADICAL NECK DISSECTION
LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, WITH RADICAL NECK DISSECTION
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); HORIZONTAL
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); LATEROVERTICAL
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTEROVERTICAL
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTERO-LATERO-VERTICAL
PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITHOUT RECONSTRUCTION
PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITH RECONSTRUCTION

ARYTENOIDECTOMY OR ARYTENOIDOPEXY, EXTERNAL APPROACH
EPIGLOTTIDECTOMY
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT
LARYNGOSCOPY, INDIRECT; DIAGNOSTIC (SEPARATE PROCEDURE)
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH BIOPSY
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF FOREIGN BODY
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF LESION
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH VOCAL CORD INJECTION
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, NEWBORN
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH INSERTION OF OBTURATOR
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, SUBSEQUENT
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICROSCOPE
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIG
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIG
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY;
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC;
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF FOREIGN BODY
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION
LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY
LARYNGOPLASTY; FOR LARYNGEAL WEB, TWO STAGE, WITH KEEL INSERTION AND REMOVAL
LARYNGOPLASTY; FOR LARYNGEAL STENOSIS, WITH GRAFT OR CORE MOLD, INCLUDING TRACHEOTOMY
LARYNGOPLASTY; WITH OPEN REDUCTION OF FRACTURE
TREATMENT OF CLOSED LARYNGEAL FRACTURE; WITHOUT MANIPULATION
TREATMENT OF CLOSED LARYNGEAL FRACTURE; WITH CLOSED MANIPULATIVE REDUCTION
LARYNGOPLASTY, CRICOID SPLIT
LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS, RECONSTRUCTION AFTER PARTIAL LARYNGECT
LARYNGEAL REINNERVATION BY NEUROMUSCULAR PEDICLE
SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE PROCEDURE), UNILATERAL
UNLISTED PROCEDURE, LARYNX
TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE);
TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE); UNDER TWO YEARS
TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL
TRACHEOSTOMY, EMERGENCY PROCEDURE; CRICOTHYROID MEMBRANE
TRACHEOSTOMY, FENESTRATION PROCEDURE WITH SKIN FLAPS
CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENT INSERTION OF AN ALARYNGEAL SPEECH
TRACHEAL PUNCTURE, PERCUTANEOUS WITH TRANSTRACHEAL ASPIRATION AND/OR INJECTION
TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION

TRACHEOSTOMA REVISION; COMPLEX, WITH FLAP ROTATION
TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION
BRONCHOSCOPY, (RIGID OR FLEXIBLE); DIAGNOSTIC, WITH OR WITHOUT CELL WASHING (SEPARATE PROCEDURE
BRONCHOSCOPY; WITH BRUSHING OR PROTECTED BRUSHINGS
BRONCHOSCOPY; WITH BRONCHIAL ALVEOLAR LAVAGE
BRONCHOSCOPY; WITH BIOPSY
BRONCHOSCOPY; WITH TRANSBRONCHIAL LUNG BIOPSY, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE
BRONCHOSCOPY; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY
BRONCHOSCOPY; WITH TRACHEAL OR BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE
BRONCHOSCOPY; WITH TRACHEAL DILATION AND PLACEMENT OF TRACHEAL STENT
BRONCHOSCOPY; WITH REMOVAL OF FOREIGN BODY
BRONCHOSCOPY; WITH EXCISION OF TUMOR
BRONCHOSCOPY,; WITH DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY METHOD OTHER THAN EXCIS
BRONCHOSCOPY; WITH PLACEMENT OF CATHETER(S) FOR INTRACAVITARY RADIOELEMENT APPLICATION
BRONCHOSCOPY; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL
BRONCHOSCOPY; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, SUBSEQUENT
BRONCHOSCOPY; WITH INJECTION OF CONTRAST MATERIAL FOR SEGMENTAL BRONCHOGRAPHY
CATHETERIZATION, TRANSGLOTTIC (SEPARATE PROCEDURE)
INSTILLATION OF CONTRAST MATERIAL FOR LARYNGOGRAPHY OR BRONCHOGRAPHY, WITHOUT CATHETERIZATIO
CATHETERIZATION FOR BRONCHOGRAPHY, WITH OR WITHOUT INSTILLATION OF CONTRAST MATERIAL
TRANSTRACHEAL INJECTION FOR BRONCHOGRAPHY
CATHETERIZATION WITH BRONCHIAL BRUSH BIOPSY
CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL
CATHETER ASPIRATION (SEPARATE PROCEDURE); TRACHEOBRONCHIAL WITH FIBERSCOPE, BEDSIDE
TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/STENT OR INDWELLING TUBE FO
TRACHEOPLASTY; CERVICAL
TRACHEOPLASTY; TRACHEOPHARYNGEAL FISTULIZATION, EACH STAGE
TRACHEOPLASTY; INTRATHORACIC
CARINAL RECONSTRUCTION
BRONCHOPLASTY; GRAFT REPAIR
BRONCHOPLASTY; EXCISION STENOSIS AND ANASTOMOSIS
EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVICAL
EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVICOTHORACIC
EXCISION OF TRACHEAL TUMOR OR CARCINOMA; CERVICAL
EXCISION OF TRACHEAL TUMOR OR CARCINOMA; THORACIC
SUTURE OF TRACHEAL WOUND OR INJURY; CERVICAL
SUTURE OF TRACHEAL WOUND OR INJURY; INTRATHORACIC
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR
REVISION OF TRACHEOSTOMY SCAR
UNLISTED PROCEDURE, TRACHEA, BRONCHI
THORACENTESIS, PUNCTURE OF PLEURAL CAVITY FOR ASPIRATION, INITIAL OR SUBSEQUENT
THORACENTESIS WITH INSERTION OF TUBE WITH OR WITHOUT WATER SEAL (EG, FOR PNEUMOTHORAX) (SEPAR
CHEMICAL PLEURODESIS (EG, FOR RECURRENT OR PERSISTENT PNEUMOTHORAX)
TUBE THORACOSTOMY WITH OR WITHOUT WATER SEAL (EG, FOR ABSCESS, HEMOTHORAX, EMPYEMA) (SEPARAT
THORACOSTOMY; WITH RIB RESECTION FOR EMPYEMA
THORACOSTOMY; WITH OPEN FLAP DRAINAGE FOR EMPYEMA
THORACOTOMY, LIMITED, FOR BIOPSY OF LUNG OR PLEURA
THORACOTOMY, MAJOR; WITH EXPLORATION AND BIOPSY

THORACOTOMY, MAJOR; WITH CONTROL OF TRAUMATIC HEMORRHAGE AND/OR REPAIR OF LUNG TEAR
THORACOTOMY, MAJOR; FOR POSTOPERATIVE COMPLICATIONS
THORACOTOMY, MAJOR; WITH OPEN INTRAPLEURAL PNEUMONOLYSIS
THORACOTOMY, MAJOR; WITH CYST(S) REMOVAL, WITH OR WITHOUT A PLEURAL PROCEDURE
THORACOTOMY, MAJOR; WITH EXCISION-PLICATION OF BULLAE, WITH OR WITHOUT ANY PLEURAL PROCEDURE
THORACOTOMY, MAJOR; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPOSIT
THORACOTOMY, MAJOR; WITH REMOVAL OF INTRAPULMONARY FOREIGN BODY
THORACOTOMY, MAJOR; WITH CARDIAC MASSAGE
PNEUMONOSTOMY, WITH OPEN DRAINAGE OF ABSCESS OR CYST
PNEUMONOSTOMY; WITH PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST
PLEURAL SCARIFICATION FOR REPEAT PNEUMOTHORAX
DECORTICATION, PULMONARY, (SEPARATE PROCEDURE); TOTAL
DECORTICATION, PULMONARY, (SEPARATE PROCEDURE); PARTIAL
PLEURECTOMY, PARIETAL (SEPARATE PROCEDURE)
DECORTICATION AND PARIETAL PLEURECTOMY
BIOPSY, PLEURA; PERCUTANEOUS NEEDLE
BIOPSY, PLEURA; OPEN
BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE
PNEUMOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION
REMOVAL OF LUNG, TOTAL PNEUMONECTOMY;
REMOVAL OF LUNG, TOTAL PNEUMONECTOMY; WITH RESECTION OF SEGMENT OF TRACHEA FOLLOWED BY BRON
REMOVAL OF LUNG, TOTAL PNEUMONECTOMY; EXTRAPLEURAL
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; SINGLE LOBE (LOBECTOMY)
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; TWO LOBES (BILOBECTOMY)
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; SINGLE SEGMENT (SEGMENTECTOMY)
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; WITH CIRCUMFERENTIAL RESECTION OF SEGMENT
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; ALL REMAINING LUNG FOLLOWING PREVIOUS REMO
RMVL OF LUNG, OTHR THN TOTAL PNEUMONECTOMY; EXCISION-PLICATION OF EMPHYSEMATOUS LUNG(S) (BULLO
REMOVAL OF LUNG, OTHER THAN TOTAL PNEUMONECTOMY; WEDGE RESECTION, SINGLE OR MULTIPLE
RESECTION AND REPAIR OF PORTION OF BRONCHUS (BRONCHOPLASTY) WHEN PERFORMED AT TIME OF LOBECT
RESECTION OF LUNG; WITH RESECTION OF CHEST WALL
RESECTION OF LUNG; WITH RECONSTRUCTION OF CHEST WALL, WITHOUT PROSTHESIS
RESECTION OF LUNG; WITH MAJOR RECONSTRUCTION OF CHEST WALL, WITH PROSTHESIS
EXTRAPLEURAL ENUCLEATION OF EMPYEMA (EMPYEMECTOMY)
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITHOUT BIOPSY
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITH BIOPSY
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); PERICARDIAL SAC, WITHOUT BIOPSY
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); PERICARDIAL SAC, WITH BIOPSY
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITHOUT BIOPSY
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY
THORACOSCOPY, SURGICAL; WITH PLEURODESIS
THORACOSCOPY, SURGICAL; WITH PARTIAL PULMONARY DECORTICATION
THORACOSCOPY, SURGICAL; WITH TOTAL PULMONARY DECORTICATION, INCLUDING INTRAPLEURAL PNEUMONO
THORACOSCOPY, SURGICAL; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPOSIT
THORACOSCOPY, SURGICAL; WITH CONTROL OF TRAUMATIC HEMORRHAGE
THORACOSCOPY, SURGICAL; WITH EXCISION-PLICATION OF BULLAE, INCLUDING ANY PLEURAL PROCEDURE
THORACOSCOPY, SURGICAL; WITH PARIETAL PLEURECTOMY
THORACOSCOPY, SURGICAL; WITH WEDGE RESECTION OF LUNG, SINGLE OR MULTIPLE
THORACOSCOPY, SURGICAL; WITH REMOVAL OF CLOT OR FOREIGN BODY FROM PERICARDIAL SAC
THORACOSCOPY, SURGICAL; WITH CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION OF PERICARDIA
THORACOSCOPY, SURGICAL; WITH TOTAL PERICARDIECTOMY
THORACOSCOPY, SURGICAL; WITH EXCISION OF PERICARDIAL CYST, TUMOR, OR MASS
THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR, OR MASS
THORACOSCOPY, SURGICAL; WITH LOBECTOMY, TOTAL OR SEGMENTAL
THORACOSCOPY, SURGICAL; WITH THORACIC SYMPATHECTOMY
THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYOTOMY
REPAIR LUNG HERNIA THROUGH CHEST WALL
CLOSURE OF CHEST WALL FOLLOWING OPEN FLAP DRAINAGE FOR EMPYEMA (CLAGETT TYPE PROCEDURE)
OPEN CLOSURE OF MAJOR BRONCHIAL FISTULA
MAJOR RECONSTRUCTION, CHEST WALL (POST-TRAUMATIC)
DONOR PNEUMONECTOMY(IES) WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT (CADAVER)
LUNG TRANSPLANT, SINGLE; WITHOUT CARDIOPULMONARY BYPASS
LUNG TRANSPLANT, SINGLE; WITH CARDIOPULMONARY BYPASS
LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITHOUT CARDIOPULMONARY BYPASS
LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUENTIAL OR EN BLOC); WITH CARDIOPULMONARY BYPASS
RESECTION OF RIBS, EXTRAPLEURAL, ALL STAGES
THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES);
THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEURAL (ALL STAGES); WITH CLOSURE OF BRONCHOPLEURAL FISTU
PNEUMONOLYSIS, EXTRAPERIOSTEAL, INCLUDING FILLING OR PACKING PROCEDURES
PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION OF AIR
TOTAL LUNG LAVAGE (UNILATERAL)
UNLISTED PROCEDURE, LUNGS AND PLEURA
PERICARDIOCENTESIS; INITIAL
PERICARDIOCENTESIS; SUBSEQUENT
TUBE PERICARDIOSTOMY
PERICARDIOTOMY FOR REMOVAL OF CLOT OR FOREIGN BODY (PRIMARY PROCEDURE)
CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION FOR DRAINAGE
PERICARDIECTOMY, SUBTOTAL OR COMPLETE; WITHOUT CARDIOPULMONARY BYPASS
PERICARDIECTOMY, SUBTOTAL OR COMPLETE; WITH CARDIOPULMONARY BYPASS
EXCISION OF PERICARDIAL CYST OR TUMOR
EXCISION OF INTRACARDIAC TUMOR, RESECTION WITH CARDIOPULMONARY BYPASS
RESECTION OF EXTERNAL CARDIAC TUMOR
TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY (SEPARATE PROCEDURE)
TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORACOTOMY; PERFORMED AT THE TIME OF OTHER OPEN
INSERTION OF PERMANENT PACEMAKER WITH EPICARDIAL ELECTRODE(S); BY THORACOTOMY
INSERTION OF PERMANENT PACEMAKER WITH EPICARDIAL ELECTRODE(S); BY XIPHOID APPROACH
INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL
INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR
INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VE
INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC ELECTRODE OR PACE
INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPARATE
INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; SINGLE CHAMBER, ATRIAL OR VENTRIC
INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER
UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION SINGLE CHAMBER SYS TO DUAL SYS (INC REMOVA
REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR PACING CARDIOVERTER-DEFIBRILL
INSERTION OF A TRANSVENOUS ELECTRODE; SINGLE CHAMBER (ONE ELECTRODE) PERMANENT PACEMAKER OR
INSERTION OF A TRANSVENOUS ELECTRODE; DUAL CHAMBER (TWO ELECTRODES) PERMANENT PACEMAKER OR
REPAIR OF SINGLE TRANSVENOUS ELECTRODE FOR A SINGLE CHAMBER, PERMANENT PACEMAKER OR SINGLE C
REPAIR OF TWO TRANSVENOUS ELECTRODES FOR A DUAL CHAMBER PERMANENT PACEMAKER OR DUAL CHAMB
REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER
REVISION OF SKIN POCKET FOR SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR
INSRT, PACING ELECTRDE, CARD VEN SYST, LEFT VENTRICULAR PACING, W ATTACH PREVIOUSLY PLACED PACEM
INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INS
REPOSITIONING OF PREVIOUSLY IMPLANTED CARDIAC VENOUS SYSTEM (LEFT VENTRICULAR) ELECTRODE (INCL
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); SINGLE LEAD SYSTEM, ATRIAL OR VENTRICULAR
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL LEAD SYSTEM
REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; SINGLE LEAD SYSTEM
REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; DUAL LEAD SYSTEM
REMOVAL OF PERMANENT TRANSVENOUS ELECTRODE(S) BY THORACOTOMY
INSERTION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR
SUBCUTANEOUS REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENE
REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR ELECTRODE(S); BY THORACOT
REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR ELECTRODE(S); BY TRANSVEN
INSERTION OF EPICARDIAL SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR ELECTRODES BY
INSERTION OF EPICARDIAL SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR ELECTRODES BY
INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR SINGLE OR DUAL CHAMBER PACING CARDIOVERTER
OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR PATHWAY, TRACT(S) AND/OR FOCU
OPERATIVE ABLATION OF SUPRAVENTRICULAR ARRHYTHMOGENIC FOCUS OR PATHWAY, TRACT(S) AND/OR FOCU
OPERATIVE INCISIONS AND RECONSTRUCTION OF ATRIA FOR TREATMENT OF ATRIAL FIBRILLATION OR ATRIAL FLU
OPERATIVE ABLATION OF VENTRICULAR ARRHYTHMOGENIC FOCUS WITH CARDIOPULMONARY BYPASS
IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER
REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER
REPAIR OF CARDIAC WOUND; WITHOUT BYPASS
REPAIR OF CARDIAC WOUND; WITH CARDIOPULMONARY BYPASS
CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN BODY); WITHOUT BYPASS
CARDIOTOMY, EXPLORATORY (INCLUDES REMOVAL OF FOREIGN BODY); WITH CARDIOPULMONARY BYPASS
SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITHOUT SHUNT OR CARDIOPULMONARY BYPASS
SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH SHUNT BYPASS
SUTURE REPAIR OF AORTA OR GREAT VESSELS; WITH CARDIOPULMONARY BYPASS
INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITHOUT SHUNT, OR CARDIOPULMONARY BYPASS
INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH SHUNT BYPASS
INSERTION OF GRAFT, AORTA OR GREAT VESSELS; WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, AORTIC VALVE; OPEN, WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, AORTIC VALVE; OPEN, WITH INFLOW OCCLUSION
VALVULOPLASTY, AORTIC VALVE; USING TRANSVENTRICULAR DILATION, WITH CARDIOPULMONARY BYPASS
CONSTRUCTION OF APICAL-AORTIC CONDUIT
REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH PROSTHETIC VALVE OTHER THAN HOMO
REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH ALLOGRAFT VALVE
REPLACEMENT, AORTIC VALVE, WITH CARDIOPULMONARY BYPASS; WITH STENTLESS TISSUE VALVE
REPLACEMENT, AORTIC VALVE; WITH AORTIC ANNULUS ENLARGEMENT, NONCORONARY CUSP
REPLACEMENT, AORTIC VALVE; WITH TRANSVENTRICULAR AORTIC ANNULUS ENLARGEMENT (KONNO PROCEDUR
REPLACEMENT, AORTIC VALVE; BY TRANSLOCATION OF AUTOLOGOUS PULMONARY VALVE WITH ALLOGRAFT REP
REPAIR OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION BY PATCH ENLARGEMENT OF THE OUTFLOW TR
RESECTION OR INCISION OF SUBVALVULAR TISSUE FOR DISCRETE SUBVALVULAR AORTIC STENOSIS
VENTRICULOMYOTOMY (-MYECTOMY) FOR IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS (EG, ASYMMETRIC
AORTOPLASTY (GUSSET) FOR SUPRAVALVULAR STENOSIS

VALVOTOMY, MITRAL VALVE; CLOSED HEART
VALVOTOMY, MITRAL VALVE; OPEN HEART, WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS;
VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS; WITH PROSTHETIC RING
VALVULOPLASTY, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS; RADICAL RECONSTRUCTION, WITH OR WITH
REPLACEMENT, MITRAL VALVE, WITH CARDIOPULMONARY BYPASS
VALVECTOMY, TRICUSPID VALVE, WITH CARDIOPULMONARY BYPASS
VALVULOPLASTY, TRICUSPID VALVE; WITHOUT RING INSERTION
VALVULOPLASTY, TRICUSPID VALVE; WITH RING INSERTION
REPLACEMENT, TRICUSPID VALVE, WITH CARDIOPULMONARY BYPASS
TRICUSPID VALVE REPOSITIONING AND PLICATION FOR EBSTEIN ANOMALY
VALVOTOMY, PULMONARY VALVE, CLOSED HEART; TRANSVENTRICULAR
VALVOTOMY, PULMONARY VALVE, CLOSED HEART; VIA PULMONARY ARTERY
VALVOTOMY, PULMONARY VALVE, OPEN HEART; WITH INFLOW OCCLUSION
VALVOTOMY, PULMONARY VALVE, OPEN HEART; WITH CARDIOPULMONARY BYPASS
REPLACEMENT, PULMONARY VALVE
RIGHT VENTRICULAR RESECTION FOR INFUNDIBULAR STENOSIS, WITH OR WITHOUT COMMISSUROTOMY
OUTFLOW TRACT AUGMENTATION (GUSSET), WITH OR WITHOUT COMMISSUROTOMY OR INFUNDIBULAR RESECT
REPAIR OF NON-STRUCTURAL PROSTHETIC VALVE DYSFUNCTION WITH CARDIOPULMONARY BYPASS (SEPARATE
REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITH CARDIOPULMONARY BY
REPAIR OF CORONARY ARTERIOVENOUS OR ARTERIOCARDIAC CHAMBER FISTULA; WITHOUT CARDIOPULMONAR
REPAIR OF ANOMALOUS CORONARY ARTERY; BY LIGATION
REPAIR OF ANOMALOUS CORONARY ARTERY; BY GRAFT, WITHOUT CARDIOPULMONARY BYPASS
REPAIR OF ANOMALOUS CORONARY ARTERY; BY GRAFT, WITH CARDIOPULMONARY BYPASS
REPAIR OF ANOMALOUS CORONARY ARTERY; WITH CONSTRUCTION OF INTRAPULMONARY ARTERY TUNNEL (TAK
REPAIR OF ANOMALOUS CORONARY ARTERY; BY TRANSLOCATION FROM PULMONARY ARTERY TO AORTA
ENDOSCOPY, SURGICAL, INCLUDING VIDEO-ASSISTED HARVEST OF VEIN(S) FOR CORONARY ARTERY BYPASS PR
CORONARY ARTERY BYPASS, VEIN ONLY; SINGLE CORONARY VENOUS GRAFT
CORONARY ARTERY BYPASS, VEIN ONLY; TWO CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; THREE CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; FOUR CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; FIVE CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, VEIN ONLY; SIX OR MORE CORONARY VENOUS GRAFTS
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SINGLE VEIN GRAFT (LIST SEPA
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); TWO VENOUS GRAFTS (LIST SE
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); THREE VENOUS GRAFTS (LIST S
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FOUR VENOUS GRAFTS (LIST S
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FIVE VENOUS GRAFTS (LIST SE
CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SIX OR MORE VENOUS GRAFTS
REOPERATION, CORONARY ARTERY BYPASS PROCEDURE OR VALVE PROCEDURE, MORE THAN ONE MONTH AFTE
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); SINGLE ARTERIAL GRAFT
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); TWO CORONARY ARTERIAL GRAFTS
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); THREE CORONARY ARTERIAL GRAFTS
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); FOUR OR MORE CORONARY ARTERIAL GRAFTS
MYOCARDIAL RESECTION (EG, VENTRICULAR ANEURYSMECTOMY)
REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT MYOCARDIAL RESECTION
CORONARY ENDARTERECTOMY, OPEN, ANY METHOD, OF LEFT ANTERIOR DESCENDING, CIRCUMFLEX, OR RIGHT
CLOSURE OF ATRIOVENTRICULAR VALVE (MITRAL OR TRICUSPID) BY SUTURE OR PATCH
CLOSURE OF SEMILUNAR VALVE (AORTIC OR PULMONARY) BY SUTURE OR PATCH

ANASTOMOSIS OF PULMONARY ARTERY TO AORTA (DAMUS-KAYE-STANSEL PROCEDURE)
REPAIR OF COMPLEX CARDIAC ANOMALY OTHER THAN PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFEC
REPAIR OF COMPLEX CARDIAC ANOMALIES BY SURGICAL ENLARGEMENT OF VENTRICULAR SEPTAL DEFECT
REPAIR OF DOUBLE OUTLET RIGHT VENTRICLE WITH INTRAVENTRICULAR TUNNEL REPAIR;
REPAIR OF DOUBLE OUTLET RIGHT VENTRICLE WITH INTRAVENTRICULAR TUNNEL REPAIR; WITH REPAIR OF RIGH
REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, TRICUSPID ATRESIA) BY CLOSURE OF ATRIAL SEPTAL DEFECT AN
REPAIR OF COMPLEX CARDIAC ANOMALIES (EG, SINGLE VENTRICLE) BY MODIFIED FONTAN PROCEDURE
REPAIR OF SINGLE VENTRICLE WITH AORTIC OUTFLOW OBSTRUCTION AND AORTIC ARCH HYPOPLASIA (HYPOPLA
REPAIR ATRIAL SEPTAL DEFECT, SECUNDUM, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT PATCH
DIRECT OR PATCH CLOSURE, SINUS VENOSUS, WITH OR WITHOUT ANOMALOUS PULMONARY VENOUS DRAINAGE
REPAIR OF ATRIAL SEPTAL DEFECT AND VENTRICULAR SEPTAL DEFECT, WITH DIRECT OR PATCH CLOSURE
REPAIR OF INCOMPLETE OR PARTIAL ATRIOVENTRICULAR CANAL (OSTIUM PRIMUM ATRIAL SEPTAL DEFECT), WITH
REPAIR OF INTERMEDIATE OR TRANSITIONAL ATRIOVENTRICULAR CANAL, WITH OR WITHOUT ATRIOVENTRICULA
REPAIR OF COMPLETE ATRIOVENTRICULAR CANAL, WITH OR WITHOUT PROSTHETIC VALVE
CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH
CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH WITH PULMONARY VALVOTOMY OR INFU
CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH OR WITHOUT PATCH WITH REMOVAL OF PULMONARY ARTERY
BANDING OF PULMONARY ARTERY
COMPLETE REPAIR TETRALOGY OF FALLOT WITHOUT PULMONARY ATRESIA;
COMPLETE REPAIR TETRALOGY OF FALLOT WITHOUT PULMONARY ATRESIA; WITH TRANSANNULAR PATCH
COMPLETE REPAIR TETRALOGY OF FALLOT WITH PULMONARY ATRESIA INCLUDING CONSTRUCTION OF CONDUIT
REPAIR SINUS OF VALSALVA FISTULA, WITH CARDIOPULMONARY BYPASS;
REPAIR SINUS OF VALSALVA FISTULA, WITH CARDIOPULMONARY BYPASS; WITH REPAIR OF VENTRICULAR SEPTAL
REPAIR SINUS OF VALSALVA ANEURYSM, WITH CARDIOPULMONARY BYPASS
CLOSURE OF AORTICO-LEFT VENTRICULAR TUNNEL
COMPLETE REPAIR OF ANOMALOUS VENOUS RETURN (SUPRACARDIAC, INTRACARDIAC, OR INFRACARDIAC TYPE
REPAIR OF COR TRIATRIATUM OR SUPRAVALVULAR MITRAL RING BY RESECTION OF LEFT ATRIAL MEMBRANE
ATRIAL SEPTECTOMY OR SEPTOSTOMY; CLOSED HEART (BLALOCK-HANLON TYPE OPERATION)
ATRIAL SEPTECTOMY OR SEPTOSTOMY; OPEN HEART WITH CARDIOPULMONARY BYPASS
ATRIAL SEPTECTOMY OR SEPTOSTOMY; OPEN HEART, WITH INFLOW OCCLUSION
SHUNT; SUBCLAVIAN TO PULMONARY ARTERY (BLALOCK-TAUSSIG TYPE OPERATION)
SHUNT; ASCENDING AORTA TO PULMONARY ARTERY (WATERSTON TYPE OPERATION)
SHUNT; DESCENDING AORTA TO PULMONARY ARTERY (POTTS-SMITH TYPE OPERATION)
SHUNT; CENTRAL, WITH PROSTHETIC GRAFT
SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY FOR FLOW TO ONE LUNG (CLASSICAL GLENN PROCEDUR
SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY FOR FLOW TO BOTH LUNGS (BIDIRECTIONAL GLENN PRO
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES WITH VENTRICULAR SEPTAL DEFECT AND SUBPULMONARY
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES WITH VENTRICULAR SEPTAL DEFECT AND SUBPULMONARY
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, ATRIAL BAFFLE PROCEDURE (EG, MUSTARD OR SENNING T
REPAIR OF TRANSPOSITION OF THE GREAT ARTERIES, AORTIC PULMONARY ARTERY RECONSTRUCTION (EG, JAT
TOTAL REPAIR, TRUNCUS ARTERIOSUS (RASTELLI TYPE OPERATION)
REIMPLANTATION OF AN ANOMALOUS PULMONARY ARTERY
AORTIC SUSPENSION (AORTOPEXY) FOR TRACHEAL DECOMPRESSION (EG, FOR TRACHEOMALACIA) (SEPARATE P
DIVISION OF ABERRANT VESSEL (VASCULAR RING);
DIVISION OF ABERRANT VESSEL (VASCULAR RING); WITH REANASTOMOSIS
OBLITERATION OF AORTOPULMONARY SEPTAL DEFECT; WITHOUT CARDIOPULMONARY BYPASS
OBLITERATION OF AORTOPULMONARY SEPTAL DEFECT; WITH CARDIOPULMONARY BYPASS
REPAIR OF PATENT DUCTUS ARTERIOSUS; BY LIGATION
REPAIR OF PATENT DUCTUS ARTERIOSUS; BY DIVISION, UNDER 18 YEARS
REPAIR OF PATENT DUCTUS ARTERIOSUS; BY DIVISION, 18 YEARS AND OLDER
EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS ARTERIOSUS; WITH DIR
EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS ARTERIOSUS; WITH GR
EXCISION OF COARCTATION OF AORTA, WITH OR WITHOUT ASSOCIATED PATENT DUCTUS ARTERIOSUS; REPAIR U
REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC MATERIAL; WIT
REPAIR OF HYPOPLASTIC OR INTERRUPTED AORTIC ARCH USING AUTOGENOUS OR PROSTHETIC MATERIAL; WIT
ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE SUSPENSION;
ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE SUSPENSION; WITH CO
ASCENDING AORTA GRAFT, WITH CARDIOPULMONARY BYPASS, WITH OR WITHOUT VALVE SUSPENSION; WITH AO
TRANSVERSE ARCH GRAFT, WITH CARDIOPULMONARY BYPASS
DESCENDING THORACIC AORTA GRAFT, WITH OR WITHOUT BYPASS
REPAIR OF THORACOABDOMINAL AORTIC ANEURYSM WITH GRAFT, WITH OR WITHOUT CARDIOPULMONARY BYPA
PULMONARY ARTERY EMBOLECTOMY; WITH CARDIOPULMONARY BYPASS
PULMONARY ARTERY EMBOLECTOMY; WITHOUT CARDIOPULMONARY BYPASS
PULMONARY ENDARTERECTOMY, WITH OR WITHOUT EMBOLECTOMY, WITH CARDIOPULMONARY BYPASS
REPAIR OF PULMONARY ARTERY STENOSIS BY RECONSTRUCTION WITH PATCH OR GRAFT
REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY UNIFOCALIZATION OF PULMONARY ART
REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY UNIFOCALIZATION OF PULMONARY ART
REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT, BY CONSTRUCTION OR REPLACEMENT OF
TRANSECTION OF PULMONARY ARTERY WITH CARDIOPULMONARY BYPASS
LIGATION AND TAKEDOWN OF A SYSTEMIC-TO-PULMONARY ARTERY SHUNT, PERFORMED IN CONJUNCTION WITH
DONOR CARDIECTOMY-PNEUMONECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT
HEART-LUNG TRANSPLANT WITH RECIPIENT CARDIECTOMY-PNEUMONECTOMY
DONOR CARDIECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT
HEART TRANSPLANT, WITH OR WITHOUT RECIPIENT CARDIECTOMY
PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; INITIAL 24 HOURS
PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; EACH ADDITIONAL 24 H
INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS
REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS
INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE FEMORAL ARTERY, OPEN APPROACH
REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE INCLUDING REPAIR OF FEMORAL ARTERY, WITH OR WITHO
INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE ASCENDING AORTA
REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE FROM THE ASCENDING AORTA, INCLUDING REPAIR OF THE
INSERTION OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, SINGLE VENTRICLE
INSERTION OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, BIVENTRICULAR
REMOVAL OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, SINGLE VENTRICLE
REMOVAL OF VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL, BIVENTRICULAR
INSERTION OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE
REMOVAL OF VENTRICULAR ASSIST DEVICE, IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE
UNLISTED PROCEDURE, CARDIAC SURGERY
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; CAROTID, SUBCLAVIAN OR INNOMINATE ART
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; INNOMINATE, SUBCLAVIAN ARTERY, BY THO
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLA

EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RADIAL OR ULNAR ARTERY, BY ARM INCISIO
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RENAL, CELIAC, MESENTERY, AORTOILIAC A
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL, AORTOILIAC ARTERY, B
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; POPLITEAL-TIBIO-PERONEAL ARTERY, BY LE
THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC VEIN, BY ABDOMINAL INCISION
THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC, FEMOROPOPLITEAL VEIN, BY LEG INCISION
THROMBECTOMY, DIRECT OR WITH CATHETER; VENA CAVA, ILIAC, FEMOROPOPLITEAL VEIN, BY ABDOMINAL AND
THROMBECTOMY, DIRECT OR WITH CATHETER; SUBCLAVIAN VEIN, BY NECK INCISION
THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM INCISION
VALVULOPLASTY, FEMORAL VEIN
RECONSTRUCTION OF VENA CAVA, ANY METHOD
VENOUS VALVE TRANSPOSITION, ANY VEIN DONOR
CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM
SAPHENOPOPLITEAL VEIN ANASTOMOSIS
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; USING AORTO-AORTIC
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; USING MODULAR BIFU
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; USING UNIBODY BIFUR
ENDOVASCULAR PLACEMENT OF ILIAC ARTERY OCCLUSION DEVICE (LIST SEPARATELY IN ADDITION TO CODE FOR
OPEN FEMORAL ARTERY EXPOSURE FOR DELIVERY OF ENDOVASCULAR PROSTHESIS, BY GROIN INCISION, UNILA
PLACEMENT OF FEMORAL-FEMORAL PROSTHETIC GRAFT DURING ENDOVASCULAR AORTIC ANEURYSM REPAIR (L
OPEN ILIAC ARTERY EXPOSURE FOR DELIVERY OF ENDOVASCULAR PROSTHESIS OR ILIAC OCCLUSION DURING E
PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF INFRARENAL AB
PLACEMENT, PROXIMAL/DISTAL EXTEN PROSTHESIS, ENDOVASCULAR REPAIR, INFRARENAL ABDOMINAL AORTIC/
OPEN REPAIR OF INFRARENAL AORTIC ANEURYSM OR DISSECTION, PLUS REPAIR OF ASSOCIATED ARTERIAL TRA
OPEN ILIAC ARTERY EXPOSURE WITH CREATION, CONDUIT FOR DELIVERY, INFRARENAL AORTIC OR ILIAC ENDOV
OPEN BRACHIAL ARTERY EXPOSURE TO ASSIST IN THE DEPLOYMENT OF INFRARENAL AORTIC OR ILIAC ENDOVAS
ENDOVASCULAR GRAFT REPLACEMENT FOR REPAIR OF ILIAC ARTERY (EG, ANEURYSM,PSEUDOANEURYSM, ARTE
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION AND GRAFT INSERTION, WITH OR WITHOUT PA
DIRECT REPAIR,ANEURYSM,PSEUDOANEURYSM, OR EXCISION&GRAFT INSERTION, WITH/WITHOUT PATCH GRAFT
DIRECT REPAIR, ANEURYSM, PSEUDOANEURYSM/EXCISION&GRAFT INSERTION, WITH/WITHOUT PATCH GRAFT; FO
DIRECT REPAIR, ANEURYSM, PSEUDOANEURYSM, OR EXCISION&GRAFT INSERTION, WITH OR WITHOUT PATCH GR
DIRECT REPAIR, ANEURYSM, PSEUDOANEURYSM/EXCISION&GRAFT INSERTION, WITH/WITHOUT PATCH GRAFT; FO
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; HEAD AND NECK
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; THORAX AND ABDOMEN
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; EXTREMITIES
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; HEAD AND NECK
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; THORAX AND ABDOMEN
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; EXTREMITIES
REPAIR BLOOD VESSEL, DIRECT; NECK
REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER
REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITH BYPASS
REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITHOUT BYPASS
REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY
REPAIR BLOOD VESSEL WITH VEIN GRAFT; NECK
REPAIR BLOOD VESSEL WITH VEIN GRAFT; UPPER EXTREMITY
REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRATHORACIC, WITH BYPASS
REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRATHORACIC, WITHOUT BYPASS
REPAIR BLOOD VESSEL WITH VEIN GRAFT; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL WITH VEIN GRAFT; LOWER EXTREMITY
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; NECK
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; UPPER EXTREMITY
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRATHORACIC, WITH BYPASS
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRATHORACIC, WITHOUT BYPASS
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN; LOWER EXTREMITY
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; CAROTID, VERTEBRAL, SUBCLAVIAN, BY NECK I
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; SUBCLAVIAN, INNOMINATE, BY THORACIC INCIS
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; AXILLARY-BRACHIAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ABDOMINAL AORTA
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; MESENTERIC, CELIAC, OR RENAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ILIAC
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; ILIOFEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMBINED AORTOILIAC
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMBINED AORTOILIOFEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; COMMON FEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; DEEP (PROFUNDA) FEMORAL
THROMBOENDARTERECTOMY, WITH OR WITHOUT PATCH GRAFT; FEMORAL AND/OR POPLITEAL, AND/OR TIBIOPER
REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE THAN ONE MONTH AFTER ORIGINAL OPERATION (
ANGIOSCOPY (NON-CORONARY VESSELS OR GRAFTS) DURING THERAPEUTIC INTERVENTION (LIST SEPARATELY
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; RENAL OR OTHER VISCERAL ARTERY
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; AORTIC
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; ILIAC
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; FEMORAL-POPLITEAL

TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; TIBIOPERONEAL TRUNK AND BRANCHES
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; VENOUS
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; TIBIOPERONEAL TRUNK OR BRANCHES, EACH VESSEL
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; RENAL OR VISCERAL ARTERY
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; AORTIC
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; ILIAC
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; FEMORAL-POPLITEAL
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VES
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; VENOUS
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; RENAL OR OTHER VISCERAL ARTERY
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; AORTIC
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; ILIAC
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; FEMORAL-POPLITEAL
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; TIBIOPERONEAL TRUNK AND BRANCHES
TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; RENAL OR OTHER VISCERAL ARTERY
TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; AORTIC
TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; ILIAC
TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; FEMORAL-POPLITEAL
TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH
TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; TIBIOPERONEAL TRUNK AND BRANCHES
HARVEST OF UPPER EXTREMITY VEIN, ONE SEGMENT, FOR LOWER EXTREMITY OR CORONARY ARTERY BYPASS
BYPASS GRAFT, WITH VEIN; CAROTID
BYPASS GRAFT, WITH VEIN; CAROTID-SUBCLAVIAN
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-CAROTID
BYPASS GRAFT, WITH VEIN; CAROTID-VERTEBRAL
BYPASS GRAFT, WITH VEIN; CAROTID-CAROTID
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-SUBCLAVIAN
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-VERTEBRAL
BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-AXILLARY
BYPASS GRAFT, WITH VEIN; AXILLARY-AXILLARY
BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL
BYPASS GRAFT, WITH VEIN; AORTOSUBCLAVIAN OR CAROTID
BYPASS GRAFT, WITH VEIN; AORTOCELIAC OR AORTOMESENTERIC
BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL-FEMORAL
BYPASS GRAFT, WITH VEIN; SPLENORENAL
BYPASS GRAFT, WITH VEIN; AORTOILIAC OR BI-ILIAC
BYPASS GRAFT, WITH VEIN; AORTOFEMORAL OR BIFEMORAL
BYPASS GRAFT, WITH VEIN; AORTOILIOFEMORAL, UNILATERAL
BYPASS GRAFT, WITH VEIN; AORTOILIOFEMORAL, BILATERAL
BYPASS GRAFT, WITH VEIN; AORTOFEMORAL-POPLITEAL
BYPASS GRAFT, WITH VEIN; FEMORAL-POPLITEAL
BYPASS GRAFT, WITH VEIN; FEMORAL-FEMORAL
BYPASS GRAFT, WITH VEIN; AORTORENAL
BYPASS GRAFT, WITH VEIN; ILIOILIAC
BYPASS GRAFT, WITH VEIN; ILIOFEMORAL
BYPASS GRAFT, WITH VEIN; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, PERONEAL ARTERY OR OTHER DISTA
BYPASS GRAFT, WITH VEIN; POPLITEAL-TIBIAL, -PERONEAL ARTERY OR OTHER DISTAL VESSELS
HARVEST OF FEMOROPOPLITEAL VEIN, ONE SEGMENT, FOR VASCULAR RECONSTRUCTION PROCEDURE (EG, AOR
IN-SITU VEIN BYPASS; AORTOFEMORAL-POPLITEAL (ONLY FEMORAL-POPLITEAL PORTION IN-SITU)
IN-SITU VEIN BYPASS; FEMORAL-POPLITEAL
IN-SITU VEIN BYPASS; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, OR PERONEAL ARTERY
IN-SITU VEIN BYPASS; POPLITEAL-TIBIAL, PERONEAL
HARVEST OF UPPER EXTREMITY ARTERY, ONE SEGMENT, FOR CORONARY ARTERY BYPASS PROCEDURE
BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID
BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID-SUBCLAVIAN
BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-SUBCLAVIAN
BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-AXILLARY
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-FEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-POPLITEAL OR -TIBIAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOSUBCLAVIAN OR CAROTID
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOCELIAC, AORTOMESENTERIC, AORTORENAL
BYPASS GRAFT, WITH OTHER THAN VEIN; SPLENORENAL (SPLENIC TO RENAL ARTERIAL ANASTOMOSIS)
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOILIAC OR BI-ILIAC
BYPASS GRAFT, WITH OTHER THAN VEIN; CAROTID-VERTEBRAL
BYPASS GRAFT, WITH OTHER THAN VEIN; SUBCLAVIAN-VERTEBRAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOBIFEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOFEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-AXILLARY
BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOFEMORAL-POPLITEAL
BYPASS GRAFT, WITH OTHER THAN VEIN; AXILLARY-FEMORAL-FEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-POPLITEAL
BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-FEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; ILIOILIAC
BYPASS GRAFT, WITH OTHER THAN VEIN; ILIOFEMORAL
BYPASS GRAFT, WITH OTHER THAN VEIN; FEMORAL-ANTERIOR TIBIAL, POSTERIOR TIBIAL, OR PERONEAL ARTERY
BYPASS GRAFT, WITH OTHER THAN VEIN; POPLITEAL-TIBIAL OR -PERONEAL ARTERY
BYPASS GRAFT; COMPOSITE, PROSTHETIC AND VEIN (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO
BYPASS GRAFT; AUTOGENOUS COMPOSITE, TWO SEGMENTS OF VEINS FROM TWO LOCATIONS (LIST SEPARATEL
BYPASS GRAFT; AUTOGENOUS COMPOSITE, THREE OR MORE SEGMENTS OF VEIN FROM TWO OR MORE LOCATIO
PLACEMENT OF VEIN PATCH OR CUFF AT DISTAL ANASTOMOSIS OF BYPASS GRAFT, SYNTHETIC CONDUIT (LIST SE
CREATION OF DISTAL ARTERIOVENOUS FISTULA DURING LOWER EXTREMITY BYPASS SURGERY (NON-HEMODIALY
TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO CAROTID ARTERY
TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO SUBCLAVIAN ARTERY
TRANSPOSITION AND/OR REIMPLANTATION; SUBCLAVIAN TO CAROTID ARTERY
TRANSPOSITION AND/OR REIMPLANTATION; CAROTID TO SUBCLAVIAN ARTERY
REOPERATION, FEMORAL-POPLITEAL OR FEMORAL (POPLITEAL) -ANTERIOR TIBIAL, POSTERIOR TIBIAL, PERONEA
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY; CAROTID ARTERY
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY; FEMORAL ARTERY
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY; POPLITEAL ARTERY
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH OR WITHOUT LYSIS OF ARTERY; OTHER VESSELS
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; NECK
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; CHEST
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; ABDOMEN
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; EXTREMITY
REPAIR OF GRAFT-ENTERIC FISTULA
THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA)

THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GRAFT
REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH VEIN PATCH ANGIOPL
REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH SEGMENTAL VEIN INT
EXCISION OF INFECTED GRAFT; NECK
EXCISION OF INFECTED GRAFT; EXTREMITY
EXCISION OF INFECTED GRAFT; THORAX
EXCISION OF INFECTED GRAFT; ABDOMEN
INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN
INJECTION PROCEDURES (EG, THROMBIN) FOR PERCUTANEOUS TREATMENT OF EXTREMITY PSEUDOANEURYSM
INJECTION PROCEDURE FOR EXTREMITY VENOGRAPHY
INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL VEIN, JUGULAR VEIN)
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE, BRANCH (EG, LEF
INTRODUCTION OF CATHETER, RIGHT HEART OR MAIN PULMONARY ARTERY
SELECTIVE CATHETER PLACEMENT, LEFT OR RIGHT PULMONARY ARTERY
SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR SUBSEGMENTAL PULMONARY ARTERY
INTRODUCTION OF NEEDLE OR INTRACATHETER, CAROTID OR VERTEBRAL ARTERY
INTRODUCTION OF NEEDLE OR INTRACATHETER; RETROGRADE BRACHIAL ARTERY
INTRODUCTION OF NEEDLE OR INTRACATHETER; EXTREMITY ARTERY
INTRODUCTION OF NEEDLE OR INTRACATHETER; ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (CANNULA, FI
INTRODUCTION OF NEEDLE OR INTRACATHETER, AORTIC, TRANSLUMBAR
INTRODUCTION OF CATHETER, AORTA
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR BRACHIOCEPHALIC BR
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER THORACIC OR BRACHIOCEPHAL
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE THORACIC O
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADD SECOND ORDER, THIRD ORDER, & BEYOND, THORAC
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER ABDOMINAL, PELVIC, OR LOWER EXT
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL, PELVIC, OR LOWER
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL,
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADD 2ND, 3RD ORDER, & BEYOND, ABDOM, PELVIC/LOWE
INSERTION OF IMPLANTABLE INTRA-ARTERIAL INFUSION PUMP (EG, FOR CHEMOTHERAPY OF LIVER)
REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
UNLISTED PROCEDURE, VASCULAR INJECTION
VENIPUNCTURE, UNDER AGE 3 YEARS; FEMORAL OR JUGULAR
VENIPUNCTURE, UNDER AGE 3 YEARS; SCALP VEIN
VENIPUNCTURE, UNDER AGE 3 YEARS; OTHER VEIN
VENIPUNCTURE, CHILD OVER AGE 3 YEARS OR ADULT, NECESSITATING PHYSICIAN'S SKILL (SEPARATE PROCEDUR
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
COLLECTION OF CAPILLARY BLOOD SPECIMEN (EG, FINGER, HEEL, EAR STICK)
VENIPUNCTURE, CUTDOWN; UNDER AGE 1 YEAR
VENIPUNCTURE, CUTDOWN; AGE 1 OR OVER
TRANSFUSION, BLOOD OR BLOOD COMPONENTS
PUSH TRANSFUSION, BLOOD, 2 YEARS OR UNDER
EXCHANGE TRANSFUSION, BLOOD; NEWBORN
EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN
TRANSFUSION, INTRAUTERINE, FETAL
SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS (TELANGIECTASIA); LIMB OR TRUN
SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS (TELANGIECTASIA); FACE

INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN
INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG
PERCUTANEOUS PORTAL VEIN CATHETERIZATION BY ANY METHOD
PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL VEN
REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE
VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING
CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN
THERAPEUTIC APHERESIS; FOR WHITE BLOOD CELLS
THERAPEUTIC APHERESIS; FOR RED BLOOD CELLS
THERAPEUTIC APHERESIS; FOR PLATELETS
THERAPEUTIC APHERESIS; FOR PLASMA PHERESIS
THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL IMMUNOADSORPTION AND PLASMA REINFUSION
THERAPEUTIC APHERESIS; WITH EXTRACORPOREAL SELECTIVE ADSORPTION OR SELECTIVE FILTRATION AND PL
PHOTOPHERESIS, EXTRACORPOREAL
INSERTION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP
REVISION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP
REMOVAL OF IMPLANTABLE INTRAVENOUS INFUSION PUMP
INSERTION OF IMPLANTABLE VENOUS ACCESS DEVICE, WITH OR WITHOUT SUBCUTANEOUS RESERVOIR
REVISION OF IMPLANTABLE VENOUS ACCESS DEVICE, AND/OR SUBCUTANEOUS RESERVOIR
REMOVAL OF IMPLANTABLE VENOUS ACCESS DEVICE, AND/OR SUBCUTANEOUS RESERVOIR
MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM CENTRAL VENOU
MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM CENTRAL VENOUS D
COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE
DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER
ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS
ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PRO
ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PRO
ARTERIAL CATHETERIZATION FOR PROLONGED INFUSION THERAPY (CHEMOTHERAPY), CUTDOWN
CATHETERIZATION, UMBILICAL ARTERY, NEWBORN, FOR DIAGNOSIS OR THERAPY
PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXT
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXT
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE
INSERTION OF CANNULA(S) FOR PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFF
INSERTION, ARTERIAL&VENOUS CANNULA(S), ISOLATED EXTRACORPOREAL CIRCULATION INCL REGIONAL CHEMO
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PR
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PR
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DI
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS D
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALY
PLASTIC REPAIR OF ARTERIOVENOUS ANEURYSM (SEPARATE PROCEDURE)
INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE)
EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER

CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER
THROMBECTOMY, PERCUTANEOUS, ARTERIOVENOUS FISTULA, AUTOGENOUS OR NONAUTOGENOUS GRAFT (INC
VENOUS ANASTOMOSIS, OPEN; PORTOCAVAL
VENOUS ANASTOMOSIS, OPEN; RENOPORTAL
VENOUS ANASTOMOSIS, OPEN; CAVAL-MESENTERIC
VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, PROXIMAL
VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, DISTAL (SELECTIVE DECOMPRESSION OF ESOPHAGOGASTRIC VA
INS, TRANSVEN INTRAHEP PORTOSYSTIC SHNT(S) (TIPS) (INCL VEN ACCSS, HEP&PORTAL VEIN CATHIZATION,POR
REVISION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S)
THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
TRANSCATHETER BIOPSY
TRANSCATHETER THERAPY, INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY
TRANSCATHETER THERAPY, INFUSION OTHER THAN FOR THROMBOLYSIS, ANY TYPE (EG, SPASMOLYTIC, VASOCO
TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY (EG, FRACTURED VENOUS O
TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE HEMOSTASIS, TO
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), PERCUTANEOUS; IN
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), PERCUTANEOUS; EA
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), OPEN; INITIAL VESS
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), OPEN; EACH ADDITI
EXCHANGE OF A PREVIOUSLY PLACED ARTERIAL CATHETER DURING THROMBOLYTIC THERAPY
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEU
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL) DURING THERAPEUTIC INTERVENTION; EACH ADDITIO
VASCULAR ENDOSCOPY, SURGICAL, WITH LIGATION OF PERFORATOR VEINS, SUBFASCIAL (SEPS)
UNLISTED VASCULAR ENDOSCOPY PROCEDURE
LIGATION, INTERNAL JUGULAR VEIN
LIGATION; EXTERNAL CAROTID ARTERY
LIGATION; INTERNAL OR COMMON CAROTID ARTERY
LIGATION; INTERNAL OR COMMON CAROTID ARTERY, WITH GRADUAL OCCLUSION, AS WITH SELVERSTONE OR CR
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
LIGATION OR BIOPSY, TEMPORAL ARTERY
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); NECK
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); CHEST
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); ABDOMEN
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY
INTERRUPTION, PARTIAL OR COMPLETE, OF INFERIOR VENA CAVA BY SUTURE, LIGATION, PLICATION, CLIP, EXTRA
LIGATION OF FEMORAL VEIN
LIGATION OF COMMON ILIAC VEIN
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTION
LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS
LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG AND SHORT SAPHENOUS VEINS
LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS WITH RADICAL EXCI
LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), WITH OR WITHOUT SKIN GRAFT, OPEN
LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPARATE PROCEDURE
LIGATION, DIVISION, AND/OR EXCISION OF RECURRENT OR SECONDARY VARICOSE VEINS (CLUSTERS), ONE LEG
PENILE REVASCULARIZATION, ARTERY, WITH OR WITHOUT VEIN GRAFT
PENILE VENOUS OCCLUSIVE PROCEDURE
UNLISTED PROCEDURE, VASCULAR SURGERY
SPLENECTOMY; TOTAL (SEPARATE PROCEDURE)
SPLENECTOMY; PARTIAL(SEPARATE PROCEDURE)

SPLENECTOMY; TOTAL, EN BLOC FOR EXTENSIVE DISEASE, IN CONJUNCTION WITH OTHER PROCEDURE (LIST IN
REPAIR OF RUPTURED SPLEEN (SPLENORRHAPHY) WITH OR WITHOUT PARTIAL SPLENECTOMY
LAPAROSCOPY, SURGICAL, SPLENECTOMY
UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN
INJECTION PROCEDURE FOR SPLENOPORTOGRAPHY
MANAGEMENT OF RECIPIENT HEMATOPOIETIC PROGENITOR CELL DONOR SEARCH AND CELL ACQUISITION
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER COLLECTION; A
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER COLLECTION; A
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS;CRYOPRESERVATION AND STORAGE
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; THAWING OF PREVIOUSLY FROZEN HARVE
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; WASHING OF HARVEST
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; SPECIFIC CELL DEPLETION WITHIN HARVE
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; TUMOR CELL DEPLETION
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; RED BLOOD CELL REMOVAL
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; PLATELET DEPLETION
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; PLASMA (VOLUME) DEPLETION
TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITOR CELLS; CELL CONCENTRATION IN PLASMA, MONO
BONE MARROW; ASPIRATION ONLY
BONE MARROW; BIOPSY, NEEDLE OR TROCAR
BONE MARROW HARVESTING FOR TRANSPLANTATION
BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENIC
BONE MARROW TRANSPLANTATION; AUTOLOGOUS
BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENEIC DONOR LYMPHO
DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE
DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; EXTENSIVE
LYMPHANGIOTOMY OR OTHER OPERATIONS ON LYMPHATIC CHANNELS
SUTURE AND/OR LIGATION OF THORACIC DUCT; CERVICAL APPROACH
SUTURE AND/OR LIGATION OF THORACIC DUCT; THORACIC APPROACH
SUTURE AND/OR LIGATION OF THORACIC DUCT; ABDOMINAL APPROACH
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY)
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S) WITH EXCISION SCALENE FAT PAD
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INTERNAL MAMMARY NODE(S)
DISSECTION, DEEP JUGULAR NODE(S)
EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITHOUT DEEP NEUROVASCULAR DISSECTION
EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITH DEEP NEUROVASCULAR DISSECTION
LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE); PELVIC AND PARA-AORTIC
LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE); RETROPERITONEAL (AORTIC AND/OR SPLE
LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE
UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM
SUPRAHYOID LYMPHADENECTOMY
CERVICAL LYMPHADENECTOMY (COMPLETE)
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
AXILLARY LYMPHADENECTOMY; COMPLETE

THORACIC LYMPHADENECTOMY, REGIONAL, INCLUDING MEDIASTINAL AND PERITRACHEAL NODES (LIST IN ADDIT
ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL, PERIPANCREATIC, WITH OR
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, INCLUDING CLOQUET'S NODE (SEPARATE PROCEDURE)
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, IN CONTINUITY WITH PELVIC LYMPHADENECTOMY, INCLUD
PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE P
RETROPERITONEAL TRANSABDOMINAL LYMPHADENECTOMY, EXTENSIVE, INCLUDING PELVIC, AORTIC, AND RENA
INJECTION PROCEDURE; LYMPHANGIOGRAPHY
INJECTION PROCEDURE; FOR IDENTIFICATION OF SENTINEL NODE
CANNULATION, THORACIC DUCT
UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM
MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY; CERVICAL APPROA
MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY; TRANSTHORACIC A
EXCISION OF MEDIASTINAL CYST
EXCISION OF MEDIASTINAL TUMOR
MEDIASTINOSCOPY, WITH OR WITHOUT BIOPSY
UNLISTED PROCEDURE, MEDIASTINUM
REPAIR, LACERATION OF DIAPHRAGM, ANY APPROACH
REPAIR, PARAESOPHAGEAL HIATUS HERNIA, TRANSABDOMINAL, WITH OR WITHOUT FUNDOPLASTY, VAGOTOMY, A
REPAIR, NEONATAL DIAPHRAGMATIC HERNIA, WITH OR WITHOUT CHEST TUBE INSERTION AND WITH OR WITHOU
REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL); TRANSTHORACIC
REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL); COMBINED, THORACOABDOMINAL
REPAIR, DIAPHRAGMATIC HERNIA (ESOPHAGEAL HIATAL); COMBINED, THORACOABDOMINAL, WITH DILATION OF S
REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; ACUTE
REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; CHRONIC
IMBRICATION OF DIAPHRAGM FOR EVENTRATION, TRANSTHORACIC OR TRANSABDOMINAL, PARALYTIC OR NONPA
RESECTION, DIAPHRAGM; WITH SIMPLE REPAIR (EG, PRIMARY SUTURE)
RESECTION, DIAPHRAGM; WITH COMPLEX REPAIR (EG, PROSTHETIC MATERIAL, LOCAL MUSCLE FLAP)
UNLISTED PROCEDURE, DIAPHRAGM
BIOPSY OF LIP
VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT
EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARY CLOSURE
EXCISION OF LIP; V-EXCISION WITH PRIMARY DIRECT LINEAR CLOSURE
EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER OR FAN)
EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP (ABBE-ESTLANDER)
RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION
REPAIR LIP, FULL THICKNESS; VERMILION ONLY
REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT
REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE, UNILATERAL
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE STAGE PROCEDURE
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE OF TWO STAGES
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY, BY RECREATION OF DEFECT AND RECLOSURE
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; WITH CROSS LIP PEDICLE FLAP (ABBE-ESTLANDER TYPE), INC
UNLISTED PROCEDURE, LIPS
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
INCISION OF LABIAL FRENUM (FRENOTOMY)

BIOPSY, VESTIBULE OF MOUTH
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITHOUT REPAIR
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE REPAIR
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH COMPLEX REPAIR
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; COMPLEX, WITH EXCISION OF UNDE
EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT
EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)
DESTRUCTION OF LESION OR SCAR OF VESTIBULE OF MOUTH BY PHYSICAL METHODS (EG, LASER, THERMAL, CR
CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS
CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM OR COMPLEX
VESTIBULOPLASTY; ANTERIOR
VESTIBULOPLASTY; POSTERIOR, UNILATERAL
VESTIBULOPLASTY; POSTERIOR, BILATERAL
VESTIBULOPLASTY; ENTIRE ARCH
VESTIBULOPLASTY; COMPLEX (INCLUDING RIDGE EXTENSION, MUSCLE REPOSITIONING)
UNLISTED PROCEDURE, VESTIBULE OF MOUTH
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; LING
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUB
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; MAS
INCISION OF LINGUAL FRENUM (FRENOTOMY)
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBLINGUAL
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMENTAL
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULA
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; MASTICATOR SP
BIOPSY OF TONGUE; ANTERIOR TWO-THIRDS
BIOPSY OF TONGUE; POSTERIOR ONE-THIRD
BIOPSY OF FLOOR OF MOUTH
EXCISION OF LESION OF TONGUE WITHOUT CLOSURE
EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS
EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD
EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP
EXCISION OF LINGUAL FRENUM (FRENECTOMY)
EXCISION, LESION OF FLOOR OF MOUTH
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
GLOSSECTOMY; HEMIGLOSSECTOMY
GLOSSECTOMY; PARTIAL, WITH UNILATERAL RADICAL NECK DISSECTION
GLOSSECTOMY; COMPLETE OR TOTAL, WITH OR WITHOUT TRACHEOSTOMY, WITHOUT RADICAL NECK DISSECTIO
GLOSSECTOMY; COMPLETE OR TOTAL, WITH OR WITHOUT TRACHEOSTOMY, WITH UNILATERAL RADICAL NECK DI
GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH AND MANDIBULAR RESECTION, W
GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH, WITH SUPRAHYOID NECK DISSE
GLOSSECTOMY; COMPOSITE PROCEDURE WITH RESECTION FLOOR OF MOUTH, MANDIBULAR RESECTION, AND R
REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONGUE
REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OF TONGUE
REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX
FIXATION OF TONGUE, MECHANICAL, OTHER THAN SUTURE (EG, K-WIRE)
SUTURE OF TONGUE TO LIP FOR MICROGNATHIA (DOUGLAS TYPE PROCEDURE)

FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH
DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES
REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; BONE
GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
OPERCULECTOMY, EXCISION PERICORONAL TISSUES
EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITHOUT REPAIR
EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR
EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH COMPLEX REPA
EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH QUADRANT (SPECIFY)
ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY
DESTRUCTION OF LESION (EXCEPT EXCISION), DENTOALVEOLAR STRUCTURES
PERIODONTAL MUCOSAL GRAFTING
GINGIVOPLASTY, EACH QUADRANT (SPECIFY)
ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES
DRAINAGE OF ABSCESS OF PALATE, UVULA
BIOPSY OF PALATE, UVULA
EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE
EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE
RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION
UVULECTOMY, EXCISION OF UVULA
PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
REPAIR, LACERATION OF PALATE; UP TO 2 CM
REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR RIDG
PALATOPLASTY FOR CLEFT PALATE; MAJOR REVISION
PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
LENGTHENING OF PALATE, AND PHARYNGEAL FLAP
LENGTHENING OF PALATE, WITH ISLAND FLAP
REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP
REPAIR OF NASOLABIAL FISTULA
MAXILLARY IMPRESSION FOR PALATAL PROSTHESIS
INSERTION OF PIN-RETAINED PALATAL PROSTHESIS
UNLISTED PROCEDURE, PALATE, UVULA
DRAINAGE OF ABSCESS; PAROTID, SIMPLE
DRAINAGE OF ABSCESS; PAROTID, COMPLICATED
DRAINAGE OF ABSCESS; SUBMAXILLARY OR SUBLINGUAL, INTRAORAL
DRAINAGE OF ABSCESS; SUBMAXILLARY, EXTERNAL
FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA);
FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA); WITH PROSTHESIS

SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL
BIOPSY OF SALIVARY GLAND; NEEDLE
BIOPSY OF SALIVARY GLAND; INCISIONAL
EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA)
MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITHOUT NERVE DISSECTION
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND PRESERVATION OF FA
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH DISSECTION AND PRESERVATION OF FACIAL NE
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, EN BLOC REMOVAL WITH SACRIFICE OF FACIAL NERV
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH UNILATERAL RADICAL NECK DISSECTION
EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND
EXCISION OF SUBLINGUAL GLAND
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; SECONDARY OR COMPLICATED
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE);
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE SUBMANDIBULAR GLA
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH SUBMANDIBULAR GL
PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH SUBMANDIBULAR (W
INJECTION PROCEDURE FOR SIALOGRAPHY
CLOSURE SALIVARY FISTULA
DILATION SALIVARY DUCT
DILATION AND CATHETERIZATION OF SALIVARY DUCT, WITH OR WITHOUT INJECTION
LIGATION SALIVARY DUCT, INTRAORAL
UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS
INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, INTRAORAL APPROACH
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, EXTERNAL APPROACH
BIOPSY; OROPHARYNX
BIOPSY; HYPOPHARYNX
BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE
BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION
EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD
REMOVAL OF FOREIGN BODY FROM PHARYNX
EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS TISSUES
EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTENDING BENEATH SUBCUTANEOUS TISSUES AND/O
TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12
TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12
TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
ADENOIDECTOMY, PRIMARY; UNDER AGE 12
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
ADENOIDECTOMY, SECONDARY; UNDER AGE 12
ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; WITHOUT CLOSURE
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSURE WITH LOCAL F
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSURE WITH OTHER F
EXCISION OF TONSIL TAGS

EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)
LIMITED PHARYNGECTOMY
RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM SINUS, DIRECT CLOSURE BY ADVANCEMENT OF LATE
RESECTION OF PHARYNGEAL WALL REQUIRING CLOSURE WITH MYOCUTANEOUS FLAP
SUTURE PHARYNX FOR WOUND OR INJURY
PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION ON PHARYNX)
PHARYNGOESOPHAGEAL REPAIR
PHARYNGOSTOMY (FISTULIZATION OF PHARYNX, EXTERNAL FOR FEEDING)
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTTONSILLECTOMY); SIMPLE
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTTONSILLECTOMY); COMPLICATE
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTTONSILLECTOMY); WITH SECON
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY; SIMPLE, WITH POSTERIOR NASAL PA
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY; COMPLICATED, REQUIRING HOSPITA
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY; WITH SECONDARY SURGICAL INTER
UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
ESOPHAGOTOMY, CERVICAL APPROACH, WITH REMOVAL OF FOREIGN BODY
CRICOPHARYNGEAL MYOTOMY
CRICOPHARYNGEAL MYOTOMY ESOPHAGOTOMY, THORACIC APPROACH, WITH REMOVAL OF FOREIGN BODY
EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; CERVICAL APPROACH
EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; THORACIC OR ABDOMINAL APPROACH
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITHOUT THORACOTOMY; WITH PHARYNGOGASTROSTOMY OR CERV
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITHOUT THORACOTOMY; WITH COLON INTERPOSITION OR SMALL IN
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITH THORACOTOMY; WITH PHARYNGOGASTROSTOMY OR CERVICAL
TOTAL OR NEAR TOTAL ESOPHAGECTOMY, WITH THORACOTOMY; WITH COLON INTERPOSITION OR SMALL INTEST
PARTIAL ESOPHAGECTOMY, CERVICAL, WITH FREE INTESTINAL GRAFT, INCLUDING MICROVASCULAR ANASTOMOS
PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY AND SEPARATE ABDOMINAL INCISION, W
PARTIAL ESOPHAGECTOMY, DISTAL 2-3RDS, W THORACOTOMY&SEPARATE ABDOMINAL INCIS, WWO PROX GASTR
PARTIAL ESOPHAGECTOMY, DISTAL TWO-THIRDS, WITH THORACOTOMY ONLY, WITH OR WITHOUT PROXIMAL GAS
PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL OR ABDOMINAL APPROACH, WITH OR WITHOUT PROXIMAL GAS
PARTIAL ESOPHAGECTOMY, THORACOABDOMINAL/ABDOMINAL APPROACH, WWO PROXIMAL GASTRECTOMY; W C
TOTAL OR PARTIAL ESOPHAGECTOMY, WITHOUT RECONSTRUCTION (ANY APPROACH), WITH CERVICAL ESOPHAG
DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; CERVICAL APPROACH
DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITH OR WITHOUT MYOTOMY; THORACIC APPROACH
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUS
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S),ANY SUBSTANCE
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARICES
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BAND LIGATION OF ESOPHAGEAL VARICES
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BI
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF PLASTIC TUBE OR STENT
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER)
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OVER GUIDE W
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPO
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S), NOT AME
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANS
UPPER GASTROINTESTINAL ENDOSCOPY, SIMPLE PRIMARY EXAM (EG, WITH SMALL DIAMETER FLEXIBLE ENDOSC
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND
UPPER GI ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS A
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR WITHOUT COLLECT
ERCP; WITH BIOPSY, SINGLE OR MULTIPLE
ERCP; WITH SPHINCTEROTOMY/PAPILLOTOMY
ERCP; WITH PRESSURE MEASUREMENT OF SPHINCTER OF ODDI
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOV
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE DESTRU
ERCP; WITH ENDOSCOPIC RETROGRADE INSERTION OF NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE
ERCP; WITH ENDOSCOPIC RETROGRADE INSERTION OF TUBE OR STENT INTO BILE OR PANCREATIC DUCT
ERCP; WITH ENDOSCOPIC RETROGRADE REMOVAL OF FOREIGN BODY AND/OR CHANGE OF TUBE OR STENT
ERCP; WITH ENDOSCOPIC RETROGRADE BALLOON DILATION OF AMPULLA, BILIARY AND/OR PANCREATIC DUCT(S
ERCP; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOP
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)
UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS
ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITHOUT REPAIR OF TRACH
ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITH REPAIR OF TRACHEOE
ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH; WITHOUT REPAIR OF TRAC
ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH; WITH REPAIR OF TRACHEO
ESOPHAGOPLASTY FOR CONGENITAL DEFECT, (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH;
ESOPHAGOPLASTY FOR CONGENITAL DEFECT, (PLASTIC REPAIR OR RECONSTRUCTION), THORACIC APPROACH;
ESOPHAGOGASTROSTOMY (CARDIOPLASTY), WITH OR WITHOUT VAGOTOMY AND PYLOROPLASTY, TRANSABDOM
ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, BELSEY IV, HILL PROCEDURES)
ESOPHAGOGASTRIC FUNDOPLASTY; WITH FUNDIC PATCH (THAL-NISSEN PROCEDURE)
ESOPHAGOGASTRIC FUNDOPLASTY; WITH GASTROPLASTY (EG, COLLIS)
ESOPHAGOMYOTOMY (HELLER TYPE); ABDOMINAL APPROACH
ESOPHAGOMYOTOMY (HELLER TYPE); THORACIC APPROACH
ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); ABDOMINAL APPROACH
ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); THORACIC APPROACH
ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; ABDOMINAL APPROACH
ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; THORACIC APPROACH
ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; CERVICAL APPROACH

GASTROINTESTINAL RECONSTRUCTION FOR PREVIOUS ESOPHAGECTOMY, FOR OBSTRUCTING ESOPHAGEAL LE
GASTROINTSTINAL RECONS, PREVIOUS ESOPHAGECTOMY, OBSTRUCTING ESOPHAG LES/FIST,/FOR PREVIOUS E
LIGATION, DIRECT, ESOPHAGEAL VARICES
TRANSECTION OF ESOPHAGUS WITH REPAIR, FOR ESOPHAGEAL VARICES
LIGATION OR STAPLING AT GASTROESOPHAGEAL JUNCTION FOR PRE-EXISTING ESOPHAGEAL PERFORATION
SUTURE OF ESOPHAGEAL WOUND OR INJURY; CERVICAL APPROACH
SUTURE OF ESOPHAGEAL WOUND OR INJURY; TRANSTHORACIC OR TRANSABDOMINAL APPROACH
CLOSURE OF ESOPHAGOSTOMY OR FISTULA; CERVICAL APPROACH
CLOSURE OF ESOPHAGOSTOMY OR FISTULA; TRANSTHORACIC OR TRANSABDOMINAL APPROACH
DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES
DILATION OF ESOPHAGUS, OVER GUIDE WIRE
DILATION OF ESOPHAGUS, BY BALLOON OR DILATOR, RETROGRADE
DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) FOR ACHALASIA
ESOPHAGOGASTRIC TAMPONADE, WITH BALLOON (SENGSTAAKEN TYPE)
FREE JEJUNUM TRANSFER WITH MICROVASCULAR ANASTOMOSIS
UNLISTED PROCEDURE, ESOPHAGUS
GASTROTOMY; WITH EXPLORATION OR FOREIGN BODY REMOVAL
GASTROTOMY; WITH SUTURE REPAIR OF BLEEDING ULCER
GASTROTOMY; WITH SUTURE REPAIR OF PRE-EXISTING ESOPHAGOGASTRIC LACERATION (EG, MALLORY-WEISS)
GASTROTOMY; WITH ESOPHAGEAL DILATION AND INSERTION OF PERMANENT INTRALUMINAL TUBE (EG, CELESTI
PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDET-RAMSTEDT TYPE OPERATION)
BIOPSY OF STOMACH; BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)
BIOPSY OF STOMACH; BY LAPAROTOMY
EXCISION, LOCAL; ULCER OR BENIGN TUMOR OF STOMACH
EXCISION, LOCAL; MALIGNANT TUMOR OF STOMACH
GASTRECTOMY, TOTAL; WITH ESOPHAGOENTEROSTOMY
GASTRECTOMY, TOTAL; WITH ROUX-EN-Y RECONSTRUCTION
GASTRECTOMY, TOTAL; WITH FORMATION OF INTESTINAL POUCH, ANY TYPE
GASTRECTOMY, PARTIAL, DISTAL; WITH GASTRODUODENOSTOMY
GASTRECTOMY, PARTIAL, DISTAL; WITH GASTROJEJUNOSTOMY
GASTRECTOMY, PARTIAL, DISTAL; WITH ROUX-EN-Y RECONSTRUCTION
GASTRECTOMY, PARTIAL, DISTAL; WITH FORMATION OF INTESTINAL POUCH
VAGOTOMY WHEN PERFORMED WITH PARTIAL DISTAL GASTRECTOMY (LIST SEPARATELY IN ADDITION TO CODE(S
GASTRECTOMY, PARTIAL, PROXIMAL, THORACIC OR ABDOMINAL APPROACH INCLUDING ESOPHAGOGASTROSTOM
GASTRECTOMY, PARTIAL, PROXIMAL, THORACIC OR ABDOMINAL APPROACH INCLUDING ESOPHAGOGASTROSTOM
VAGOTOMY INCLUDING PYLOROPLASTY, WITH OR WITHOUT GASTROSTOMY; TRUNCAL OR SELECTIVE
VAGOTOMY INCLUDING PYLOROPLASTY, WITH OR WITHOUT GASTROSTOMY; PARIETAL CELL (HIGHLY SELECTIVE)
LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, TRUNCAL
LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, SELECTIVE OR HIGHLY SELECTIVE
LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDUR
UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE
NASO- OR ORO-GASTRIC TUBE PLACEMENT, NECESSITATING PHYSICIAN'S SKILL
CHANGE OF GASTROSTOMY TUBE
REPOSITIONING OF THE GASTRIC FEEDING TUBE, ANY METHOD, THROUGH THE DUODENUM FOR ENTERIC NUTRI
PYLOROPLASTY
GASTRODUODENOSTOMY
GASTROJEJUNOSTOMY; WITHOUT VAGOTOMY
GASTROJEJUNOSTOMY; WITH VAGOTOMY, ANY TYPE

GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROC
GASTROSTOMY, TEMPORARY (TUBE, RUBBER OR PLASTIC) (SEPARATE PROCEDURE); NEONATAL, FOR FEEDING
GASTROSTOMY, OPEN; WITH CONSTRUCTION OF GASTRIC TUBE (EG, JANEWAY PROCEDURE)
GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY
GASTRIC RESTRICTIVE PROCEDURE, WITHOUT GASTRIC BYPASS, FOR MORBID OBESITY; VERTICAL-BANDED GAS
GASTRIC RESTRICTIVE PROCEDURE, WITHOUT GASTRIC BYPASS, FOR MORBID OBESITY; OTHER THAN VERTICAL
GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH SHORT LIMB (LESS TH
GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH SMALL INTESTINE REC
REVISION OF GASTRIC RESTRICTIVE PROCEDURE FOR MORBID OBESITY (SEPARATE PROCEDURE)
REVISION OF GASTRODUODENAL ANASTOMOSIS (GASTRODUODENOSTOMY) WITH RECONSTRUCTION; WITHOUT
REVISION OF GASTRODUODENAL ANASTOMOSIS (GASTRODUODENOSTOMY) WITH RECONSTRUCTION; WITH VAG
REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION, WITH OR WITH
REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION, WITH OR WITH
CLOSURE OF GASTROSTOMY, SURGICAL
CLOSURE OF GASTROCOLIC FISTULA
UNLISTED PROCEDURE, STOMACH
ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
DUODENOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL
TUBE OR NEEDLE CATHETER JEJUNOSTOMY FOR ENTERAL ALIMENTATION, INTRAOPERATIVE, ANY METHOD (LIST
ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY R
ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR DECOMPRESSION (EG, BAKER TUBE)
COLOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL
REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY
CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT VOLVULUS (EG,
BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)
EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING ANASTOMOSIS, EXTERIOR
EXCISION OF ONE OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING ANASTOMOSIS, EXTERIOR
ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS
ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND ANASTOMOSIS (LIST SEPA
ENTERECTOMY, RESECTION OF SMALL INTESTINE; WITH ENTEROSTOMY
ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE RESECTION AND ANASTOM
ENTERECTOMY, RESECTION OF SMALL INTESTINE FOR CONGENITAL ATRESIA, SINGLE RESECTION AND ANASTOM
ENTERECTOMY, RESECTION, SMALL INTESTINE, CONGENITAL ATRESIA, 1 RESECTION&ANASTOMOSIS, PROXIMAL
ENTEROENTEROSTOMY, ANASTOMOSIS OF INTESTINE, WITH OR WITHOUT CUTANEOUS ENTEROSTOMY (SEPARA
DONOR ENTERECTOMY, OPEN, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT; FROM CADAVER DONOR
DONOR ENTERECTOMY, OPEN, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT; PARTIAL, FROM LIVING D
INTESTINAL ALLOTRANSPLANTATION; FROM CADAVER DONOR
INTESTINAL ALLOTRANSPLANTATION; FROM LIVING DONOR
MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LI
COLECTOMY, PARTIAL; WITH ANASTOMOSIS
COLECTOMY, PARTIAL; WITH SKIN LEVEL CECOSTOMY OR COLOSTOMY
COLECTOMY, PARTIAL; WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (HARTMANN TYPE PROCEDUR
COLECTOMY, PARTIAL; WITH RESECTION, WITH COLOSTOMY OR ILEOSTOMY AND CREATION OF MUCOFISTULA
COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS)
COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS), WITH COLOSTOMY
COLECTOMY, PARTIAL; ABDOMINAL AND TRANSANAL APPROACH
COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH ILEOSTOMY OR ILEOPROCTOSTOMY
COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH CONTINENT ILEOSTOMY
COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH RECTAL MUCOSECTOMY, ILEOANAL ANASTOMO
COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY; WITH RECTAL MUCOSECTOMY, ILEOANAL ANASTOMO
COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH ILEOSTOMY
COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY; WITH CONTINENT ILEOSTOMY
COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY
LAPAROSCOPY, SURGICAL; ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)
LAPAROSCOPY, SURGICAL; ENTERECTOMY, RESECTION OF SMALL INTESTINE, SINGLE RESECTION AND ANASTOM
LAPAROSCOPY, SURGICAL; EACH ADDITIONAL SMALL INTESTINE RESECTION AND ANASTOMOSIS (LIST SEPARATE
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (H
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW PELVIC
LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOANAL ANASTOMOS
LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOSTOMY
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
ENTEROSTOMY OR CECOSTOMY, TUBE (EG, FOR DECOMPRESSION OR FEEDING) (SEPARATE PROCEDURE)
ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE (SEPARATE PROCEDURE)
REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
REVISION OF ILEOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE PROCEDURE)
CONTINENT ILEOSTOMY (KOCK PROCEDURE) (SEPARATE PROCEDURE)
COLOSTOMY OR SKIN LEVEL CECOSTOMY; (SEPARATE PROCEDURE)
COLOSTOMY OR SKIN LEVEL CECOSTOMY; WITH MULTIPLE BIOPSIES (EG, FOR CONGENITAL MEGACOLON) (SEPA
REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
REVISION OF COLOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE PROCEDURE)
REVISION OF COLOSTOMY; WITH REPAIR OF PARACOLOSTOMY HERNIA (SEPARATE PROCEDURE)
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILE
SM INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND 2ND PORTN, DUODENUM, NO INCL ILEUM; W CONTROL, BL
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM;
SM INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND 2ND PORTION, DUODENUM, INCL ILEUM; W CONTROL, BLE
ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR
ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILATION)
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; DIAGNOSTIC, WITH OR WITHO
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; WITH BIOPSY, SINGLE OR MUL
COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING
COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE

COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF FOREIGN BODY
COLONOSCOPY THROUGH STOMA; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPS
COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABL
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TEC
COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILATION)
INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT) (SEPARATE PROCEDURE)
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY O
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY O
SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY OR R
SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY OR R
INTESTINAL STRICTUROPLASTY (ENTEROTOMY AND ENTERORRHAPHY) WITH OR WITHOUT DILATION, FOR INTES
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE;
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND ANASTOMOSIS OTHER THAN C
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND COLORECTAL ANASTOMOSIS (
CLOSURE OF INTESTINAL CUTANEOUS FISTULA
CLOSURE OF ENTEROENTERIC OR ENTEROCOLIC FISTULA
CLOSURE OF ENTEROVESICAL FISTULA; WITHOUT INTESTINAL OR BLADDER RESECTION
CLOSURE OF ENTEROVESICAL FISTULA; WITH INTESTINE AND/OR BLADDER RESECTION
INTESTINAL PLICATION (SEPARATE PROCEDURE)
EXCLUSION OF SMALL INTESTINE FROM PELVIS BY MESH OR OTHER PROSTHESIS, OR NATIVE TISSUE (EG, BLADD
INTRAOPERATIVE COLONIC LAVAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
UNLISTED PROCEDURE, INTESTINE
EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR OMPHALOMESENTERIC DUCT
EXCISION OF LESION OF MESENTERY (SEPARATE PROCEDURE)
SUTURE OF MESENTERY (SEPARATE PROCEDURE)
UNLISTED PROCEDURE, MECKEL'S DIVERTICULUM AND THE MESENTERY
INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; OPEN
INCISION AND DRAINAGE OF APPENDICEAL ABSCESS; PERCUTANEOUS
APPENDECTOMY
APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (NOT AS SEPAR
APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS
LAPAROSCOPY, SURGICAL, APPENDECTOMY
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM
INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS
BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
ANORECTAL MYOMECTOMY
PROCTECTOMY; COMPLETE, COMBINED ABDOMINOPERINEAL, WITH COLOSTOMY
PROCTECTOMY; PARTIAL RESECTION OF RECTUM, TRANSABDOMINAL APPROACH
PROCTECTOMY, COMBINED ABDOMINOPERINEAL, PULL-THROUGH PROCEDURE (EG, COLO-ANAL ANASTOMOSIS)
PROCTECTOMY, PARTIAL, WITH RECTAL MUCOSECTOMY, ILEOANAL ANASTOMOSIS, CREATION OF ILEAL RESERVO
PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS; ABDOMINAL AND TRANSSACRAL APPROACH
PROCTECTOMY, PARTIAL, WITH ANASTOMOSIS; TRANSACRAL APPROACH ONLY (KRASKE TYPE)
PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUGH PROCEDURE (EG, COLO-ANAL ANASTOMOSIS),
PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL APPROACH; WITH PULL
PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL APPROACH; WITH SUBT
PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH

PELVIC EXENTERATION FOR COLORECTAL MALIG, W PROCTECTOMY (WWO COLOSTOMY), W REMOVAL OF BLADD
EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; PERINEAL APPROACH
EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; ABDOMINAL AND PERINEAL APPROACH
EXCISION OF ILEOANAL RESERVOIR WITH ILEOSTOMY
DIVISION OF STRICTURE OF RECTUM
EXCISION OF RECTAL TUMOR BY PROCTOTOMY, TRANSACRAL OR TRANSCOCCYGEAL APPROACH
EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH
DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESSICATION, ELECTROSURGERY, LASER ABLATION, LASER RES
PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING O
PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY F
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECH
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT BI
PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR C
PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE
PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS
PROCTOSIGMOIDOSCOPY, RIGID; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILATION)
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR W
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORC
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTE
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION OF VOLVULUS, ANY METHOD
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQU
SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO R
SIGMOIDOSCOPY, FLEXIBLE; WITH DILATION BY BALLOON, 1 OR MORE STRICTURES
SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FIN
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILATION)
COLONOSCOPY, RIGID OR FLEXIBLE, TRANSABDOMINAL VIA COLOTOMY, SINGLE OR MULTIPLE
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF S
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF FOREIGN BODY
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH BIOPSY, SINGLE OR MULTIPLE
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY S
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPO
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH DILATION BY BALLOON, 1 OR MORE STRICTUR
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCL
PROCTOPLASTY; FOR STENOSIS
PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
PERIRECTAL INJECTION OF SCLEROSING SOLUTION FOR PROLAPSE
PROCTOPEXY FOR PROLAPSE; ABDOMINAL APPROACH
PROCTOPEXY FOR PROLAPSE; PERINEAL APPROACH
PROCTOPEXY COMBINED WITH SIGMOID RESECTION, ABDOMINAL APPROACH

REPAIR OF RECTOCELE (SEPARATE PROCEDURE)
EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY;
EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE FOR RECTAL INJURY; WITH COLOSTOMY
CLOSURE OF RECTOVESICAL FISTULA;
CLOSURE OF RECTOVESICAL FISTULA; WITH COLOSTOMY
CLOSURE OF RECTOURETHRAL FISTULA;
CLOSURE OF RECTOURETHRAL FISTULA; WITH COLOSTOMY
REDUCTION OF PROCIDENTIA (SEPARATE PROCEDURE) UNDER ANESTHESIA
DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL
DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
UNLISTED PROCEDURE, RECTUM
PLACEMENT OF SETON
REMOVAL OF ANAL SETON, OTHER MARKER
INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE)
INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR OR SUBMUCOSAL ABSCESS, TRANSANAL, UNDER AN
INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL
INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY OR FISTULOTOMY,
INCISION, ANAL SEPTUM (INFANT)
SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
INCISION OF THROMBOSED HEMORRHOID, EXTERNAL
FISSURECTOMY, WITH OR WITHOUT SPHINCTEROTOMY
CRYPTECTOMY; SINGLE
CRYPTECTOMY; MULTIPLE (SEPARATE PROCEDURE)
PAPILLECTOMY OR EXCISION OF SINGLE TAG, ANUS (SEPARATE PROCEDURE)
HEMORRHOIDECTOMY, BY SIMPLE LIGATURE (EG, RUBBER BAND)
EXCISION OF EXTERNAL HEMORRHOID TAGS AND/OR MULTIPLE PAPILLAE
HEMORRHOIDECTOMY, EXTERNAL, COMPLETE
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE;
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISSURECTOMY
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISTULECTOMY, WITH OR WITHOUT FISSURECTO
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE;
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISSURECTOMY
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISTULECTOMY, WITH OR WIT
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBMUSCULAR
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); COMPLEX OR MULTIPLE, WITH OR WIT
SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE
CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP
ENUCLEATION OR EXCISION OF EXTERNAL THROMBOTIC HEMORRHOID
INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS
ANOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARA
ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE
ANOSCOPY; WITH REMOVAL OF FOREIGN BODY
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FORCEPS OR BIPOLAR
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECHNIQUE
ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT BIOPSY FORCEPS, BIPO
ANOSCOPY; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEAT
ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT
ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT
ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; INFANT
REPAIR OF ANAL FISTULA WITH FIBRIN GLUE
REPAIR OF LOW IMPERFORATE ANUS; WITH ANOPERINEAL FISTULA ("CUT-BACK" PROCEDURE)
REPAIR OF LOW IMPERFORATE ANUS; WITH TRANSPOSITION OF ANOPERINEAL OR ANOVESTIBULAR FISTULA
REPAIR OF HIGH IMPERFORATE ANUS WITHOUT FISTULA; PERINEAL OR SACROPERINEAL APPROACH
REPAIR OF HIGH IMPERFORATE ANUS WITHOUT FISTULA; COMBINED TRANSABDOMINAL AND SACROPERINEAL AP
REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA; PERINEAL OR SACRO
REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA; COMBINED TRANSAB
REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, SACROPERINEAL APPROAC
REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, COMBINED ABDOMINAL AND
REPAIR OF CLOACAL ANOMALY BY ANORECTOVAGINOPLASTY AND URETHROPLASTY, COMBINED ABDOMINAL AND
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; CHILD
GRAFT (THIERSCH OPERATION) FOR RECTAL INCONTINENCE AND/OR PROLAPSE
REMOVAL OF THIERSCH WIRE OR SUTURE, ANAL CANAL
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; MUSCLE TRANSPLANT
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; LEVATOR MUSCLE IMBRICATION (PARK POSTERIOR ANAL
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; IMPLANTATION ARTIFICIAL SPHINCTER
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESIC
DESTRUCTION OF HEMORRHOIDS, ANY METHOD; INTERNAL
DESTRUCTION OF HEMORRHOIDS, ANY METHOD; EXTERNAL
DESTRUCTION OF HEMORRHOIDS, ANY METHOD; INTERNAL AND EXTERNAL
CRYOSURGERY OF RECTAL TUMOR; BENIGN
CRYOSURGERY OF RECTAL TUMOR; MALIGNANT
CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE
CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE
LIGATION OF INTERNAL HEMORRHOIDS; SINGLE PROCEDURE
LIGATION OF INTERNAL HEMORRHOIDS; MULTIPLE PROCEDURES
UNLISTED PROCEDURE, ANUS
BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS
BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (LIST
HEPATOTOMY; FOR OPEN DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES
HEPATOTOMY; FOR PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST, ONE OR TWO STAGES
LAPAROTOMY, WITH ASPIRATION AND/OR INJECTION OF HEPATIC PARASITIC (EG, AMOEBIC OR ECHINOCOCCAL) C
BIOPSY OF LIVER, WEDGE
HEPATECTOMY, RESECTION OF LIVER; PARTIAL LOBECTOMY
HEPATECTOMY, RESECTION OF LIVER; TRISEGMENTECTOMY
HEPATECTOMY, RESECTION OF LIVER; TOTAL LEFT LOBECTOMY
HEPATECTOMY, RESECTION OF LIVER; TOTAL RIGHT LOBECTOMY
DONOR HEPATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT; FROM CADAVER DONOR
DONOR HEPATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT; PARTIAL, FROM LIVING DONOR
LIVER ALLOTRANSPLANTATION; ORTHOTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR LIVING DONOR, ANY AGE
LIVER ALLOTRANSPLANTATION; HETEROTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR LIVING DONOR, ANY AGE
MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER
MANAGEMENT OF LIVER HEMORRHAGE; SIMPLE SUTURE OF LIVER WOUND OR INJURY
MANAGEMENT OF LIVER HEMORRHAGE; COMPLEX SUTURE OF LIVER WOUND OR INJURY, WITH OR WITHOUT HEP
MANAGEMENT OF LIVER HEMORRHAGE; EXPLORATION OF HEPATIC WOUND, EXTENSIVE DEBRIDEMENT, COAGUL
MANAGEMENT OF LIVER HEMORRHAGE; RE-EXPLORATION OF HEPATIC WOUND FOR REMOVAL OF PACKING
LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY
LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY
ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL
ABLATION, ONE OR MORE LIVER TUMOR(S), PERCUTANEOUS, RADIOFREQUENCY
UNLISTED PROCEDURE, LIVER
HEPATICOTOMY OR HEPATICOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CALCULUS
CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CALCULUS, WITH
CHOLEDOCHOTOMY OR CHOLEDOCHOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CALCULUS, WITH
TRANSDUODENAL SPHINCTEROTOMY OR SPHINCTEROPLASTY, WITH OR WITHOUT TRANSDUODENAL EXTRACTIO
CHOLECYSTOTOMY OR CHOLECYSTOSTOMY WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CALCULUS (SEPA
PERCUTANEOUS CHOLECYSTOSTOMY
INJECTION PROCEDURE FOR PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY
INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH AN EXISTING CATHETER (EG, PERCUTANEOUS TRAN
INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETER FOR BILIARY DRAINAGE
INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNAL AND EXTERNAL BILIARY DRAINAGE
CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER
REVISION AND/OR REINSERTION OF TRANSHEPATIC TUBE
BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LIST SEPARATELY IN ADDITION TO CODE FOR PR
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; DIAGNOSTIC, WITH OR WITHOUT COLLECTI
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH BIOPSY, SINGLE OR MULTIPLE
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH REMOVAL OF CALCULUS/CALCULI
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF BILIARY DUCT STRICTUR
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF BILIARY DUCT STRICTUR
LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY, WITHOUT BIOPSY
LAPAROSCOPY, SURGICAL; WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY WITH BIOPSY
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY
UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
CHOLECYSTECTOMY;
CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH TRANSDUODENAL SPHINCTEROTOMY OR SPH
BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBE TRACT, BASKET OR SNARE (EG, BURHENNE TEC
EXPLORATION FOR CONGENITAL ATRESIA OF BILE DUCTS, WITHOUT REPAIR, WITH OR WITHOUT LIVER BIOPSY, W
PORTOENTEROSTOMY (EG, KASAI PROCEDURE)
EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT; EXTRAHEPATIC
EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT; INTRAHEPATIC
EXCISION OF CHOLEDOCHAL CYST

ANASTOMOSIS, CHOLEDOCHAL CYST, WITHOUT EXCISION
CHOLECYSTOENTEROSTOMY; DIRECT
CHOLECYSTOENTEROSTOMY; WITH GASTROENTEROSTOMY
CHOLECYSTOENTEROSTOMY; ROUX-EN-Y
CHOLECYSTOENTEROSTOMY; ROUX-EN-Y WITH GASTROENTEROSTOMY
ANASTOMOSIS, OF EXTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
ANASTOMOSIS, OF INTRAHEPATIC DUCTS AND GASTROINTESTINAL TRACT
ANASTOMOSIS, ROUX-EN-Y, OF EXTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
ANASTOMOSIS, ROUX-EN-Y, OF INTRAHEPATIC BILIARY DUCTS AND GASTROINTESTINAL TRACT
RECONSTRUCTION, PLASTIC, OF EXTRAHEPATIC BILIARY DUCTS WITH END-TO-END ANASTOMOSIS
PLACEMENT OF CHOLEDOCHAL STENT
U-TUBE HEPATICOENTEROSTOMY
SUTURE OF EXTRAHEPATIC BILIARY DUCT FOR PRE-EXISTING INJURY (SEPARATE PROCEDURE)
UNLISTED PROCEDURE, BILIARY TRACT
PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS;
PLACEMENT OF DRAINS, PERIPANCREATIC, FOR ACUTE PANCREATITIS; WITH CHOLECYSTOSTOMY, GASTROSTOM
RESECTION OR DEBRIDEMENT OF PANCREAS AND PERIPANCREATIC TISSUE FOR ACUTE NECROTIZING PANCREA
REMOVAL OF PANCREATIC CALCULUS
BIOPSY OF PANCREAS, OPEN (EG, FINE NEEDLE ASPIRATION, NEEDLE CORE BIOPSY, WEDGE BIOPSY)
BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE
EXCISION OF LESION OF PANCREAS (EG, CYST, ADENOMA)
PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY; WITHOUT PANCREATICOJEJUNOSTOM
PANCREATECTOMY, DISTAL SUBTOTAL, WITH OR WITHOUT SPLENECTOMY; WITH PANCREATICOJEJUNOSTOMY
PANCREATECTOMY, DISTAL, NEAR-TOTAL WITH PRESERVATION OF DUODENUM (CHILD-TYPE PROCEDURE)
EXCISION OF AMPULLA OF VATER
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY, CHOLEDOCHO
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH TOTAL DUODENECTOMY, PARTIAL GASTRECTOMY, CHOLEDOCHO
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY, CHOLEDOCHOENTEROSTOMY AN
PANCREATECTOMY, PROXIMAL SUBTOTAL WITH NEAR-TOTAL DUODENECTOMY, CHOLEDOCHOENTEROSTOMY AN
PANCREATECTOMY, TOTAL
PANCREATECTOMY, TOTAL OR SUBTOTAL, WITH AUTOLOGOUS TRANSPLANTATION OF PANCREAS OR PANCREATIC
PANCREATICOJEJUNOSTOMY, SIDE-TO-SIDE ANASTOMOSIS (PUESTOW-TYPE OPERATION)
INJECTION PROCEDURE FOR INTRAOPERATIVE PANCREATOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FO
MARSUPIALIZATION OF PANCREATIC CYST
EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS
EXTERNAL DRAINAGE, PSEUDOCYST OF PANCREAS;PERCUTANEOUS
INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT; DIRECT
INTERNAL ANASTOMOSIS OF PANCREATIC CYST TO GASTROINTESTINAL TRACT; ROUX-EN-Y
PANCREATORRHAPHY FOR INJURY
DUODENAL EXCLUSION WITH GASTROJEJUNOSTOMY FOR PANCREATIC INJURY
DONOR PANCREATECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT FROM CADAVER DONOR, WI
TRANSPLANTATION OF PANCREATIC ALLOGRAFT
REMOVAL OF TRANSPLANTED PANCREATIC ALLOGRAFT
UNLISTED PROCEDURE, PANCREAS
EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE
REOPENING OF RECENT LAPAROTOMY
EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE)
DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF APPENDICEAL ABSCESS; OPEN
DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF APPENDICEAL ABSCESS; PERC

DRAINAGE OF SUBDIAPHRAGMATIC OR SUBPHRENIC ABSCESS
DRAINAGE OF SUBDIAPHRAGMATICOR SUBPHRENIC ABSCESS;PERCUTANEOUS
DRAINAGE OF RETROPERITONEAL ABSCESS
DRAINAGE OF RETROPERITONEAL ABSCESS;PERCUTANEOUS
DRAINAGE OF EXTRAPERITONEAL LYMPHOCELE TO PERITONEAL CAVITY, OPEN
PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR THERAPEUTIC); IN
PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR THERAPEUTIC); SU
REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY
BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS NEEDLE
EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL OR RETROPERITONEAL TUMORS OR CYSTS OR ENDOMET
EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL OR RETROPERITONEAL TUMORS OR CYSTS OR ENDOMET
EXCISION OF PRESACRAL OR SACROCOCCYGEAL TUMOR
STAGING LAPAROTOMY, HODGKINS DISEASE/LYMPHOMA (INCL SPLENECTOMY, NEEDLE/OPN BIOPSIES, BOTH LIVE
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE PROCEDURE)
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPEC
LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)
LAPAROSCOPY, SURGICAL; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
INJECTION OF AIR OR CONTRAST INTO PERITONEAL CAVITY (SEPARATE PROCEDURE)
INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER, WITH SUBCUTANEOUS RESERVOIR, PERMANENT (IE,
INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; TEMPORARY
INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; PERMANENT
REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER
EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER RADIOLOGICAL GUIDANCE
CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIA PREVIOUSLY PLACED DRAINAGE CATHETER
INSERTION OF PERITONEAL-VENOUS SHUNT
REVISION OF PERITONEAL-VENOUS SHUNT
INJECTION PROCEDURE (EG, CONTRAST MEDIA) FOR EVALUATION OF PREVIOUSLY PLACED PERITONEAL-VENOU
LIGATION OF PERITONEAL-VENOUS SHUNT
REMOVAL OF PERITONEAL-VENOUS SHUNT
REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED F
REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED,B
REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT UNDER AGE 6 MONTHS,/PRETERM INFANT OVER 50 WEEKS
REPR, INT INGUIN HERNIA, FULL TERM INFANT UNDER AGE 6 MONTHS,/PRETERM INFANT OVER 50 WEEKS PSTCO
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY; RE
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY; IN
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
REPAIR LUMBAR HERNIA
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE
REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE; INCARCERATED OR STRANGULATED
REPAIR RECURRENT FEMORAL HERNIA; REDUCIBLE
REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED
REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE

REPAIR INITIAL INCISIONAL HERNIA; INCARCERATED OR STRANGULATED
REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
REPAIR RECURRENT INCISIONAL HERNIA; INCARCERATED OR STRANGULATED
IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL OR VENTRAL HERNIA REPAIR (LIST SEPARATEL
REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE)
REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED
REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE
REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED
REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED
REPAIR SPIGELIAN HERNIA
REPAIR OF SMALL OMPHALOCELE, WITH PRIMARY CLOSURE
REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH OR WITHOUT PROSTHESIS
REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH REMOVAL OF PROSTHESIS, FINAL REDUCTION AND
REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); FIRST STAGE
REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); SECOND STAGE
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION OR DEHISCENCE
OMENTAL FLAP, EXTRA-ABDOMINAL (EG, FOR RECONSTRUCTION OF STERNAL AND CHEST WALL DEFECTS)
OMENTAL FLAP, INTRA-ABDOMINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
FREE OMENTAL FLAP WITH MICROVASCULAR ANASTOMOSIS
UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
RENAL EXPLORATION, NOT NECESSITATING OTHER SPECIFIC PROCEDURES
DRAINAGE OF PERIRENAL OR RENAL ABSCESS (SEPARATE PROCEDURE)
DRAINAGE OF PERIRENAL OR RENAL ABSCESS; PERCUTANEOUS
NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE
NEPHROTOMY, WITH EXPLORATION
NEPHROLITHOTOMY; REMOVAL OF CALCULUS
NEPHROLITHOTOMY; SECONDARY SURGICAL OPERATION FOR CALCULUS
NEPHROLITHOTOMY; COMPLICATED BY CONGENITAL KIDNEY ABNORMALITY
NEPHROLITHOTOMY; REMOVAL OF LARGE STAGHORN CALCULUS FILLING RENAL PELVIS AND CALYCES (INCLUDIN
PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION, ENDOSCOPY,
PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION, ENDOSCOPY,
TRANSECTION OR REPOSITIONING OF ABERRANT RENAL VESSELS (SEPARATE PROCEDURE)
PYELOTOMY; WITH EXPLORATION
PYELOTOMY; WITH DRAINAGE, PYELOSTOMY
PYELOTOMY; WITH REMOVAL OF CALCULUS (PYELOLITHOTOMY, PELVIOLITHOTOMY, INCLUDING COAGULUM PYEL
PYELOTOMY; COMPLICATED (EG, SECONDARY OPERATION, CONGENITAL KIDNEY ABNORMALITY)
RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE
RENAL BIOPSY; BY SURGICAL EXPOSURE OF KIDNEY
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB RESECTION;
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB RESECTION; COMPL
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY OPEN APPROACH INCLUDING RIB RESECTION; RADICA
NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF; THROUGH SAME INCISION
NEPHRECTOMY WITH TOTAL URETERECTOMY AND BLADDER CUFF; THROUGH SEPARATE INCISION
NEPHRECTOMY, PARTIAL
EXCISION OR UNROOFING OF CYST(S) OF KIDNEY

EXCISION OF PERINEPHRIC CYST
DONOR NEPHRECTOMY, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFT, FROM CADAVER DONOR, UNILA
DONOR NEPHRECTOMY, OPEN FROM LIVING DONOR (EXCLUDING PREPARATION AND MAINTENANCE OF ALLOGRA
RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE)
RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; EXCLUDING DONOR AND RECIPIENT NEPHRECTOMY
RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; WITH RECIPIENT NEPHRECTOMY
REMOVAL OF TRANSPLANTED RENAL ALLOGRAFT
RENAL AUTOTRANSPLANTATION, REIMPLANTATION OF KIDNEY
ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS
INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERC
INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND
INJECTION PROCEDURE FOR PYELOGRAPHY (AS NEPHROSTOGRAM, PYELOSTOGRAM, ANTEGRADE PYELOURET
INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITH DILATION TO ESTABLISH NEPHROSTOMY TR
MANOMETRIC STUDIES THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING URETERAL CATHETE
CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE
PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, W W/O PLASTIC OPERATION ON
PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, W W/O PLASTIC OPERATION ON
NEPHRORRHAPHY, SUTURE OF KIDNEY WOUND OR INJURY
CLOSURE OF NEPHROCUTANEOUS OR PYELOCUTANEOUS FISTULA
CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING VISCERAL REPAIR; ABDOMINAL APPROAC
CLOSURE OF NEPHROVISCERAL FISTULA (EG, RENOCOLIC), INCLUDING VISCERAL REPAIR; THORACIC APPROACH
SYMPHYSIOTOMY FOR HORSESHOE KIDNEY WITH OR WITHOUT PYELOPLASTY AND/OR OTHER PLASTIC PROCED
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL CYSTS
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S)
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
LAPAROSCOPY, SURGICAL; PYELOPLASTY
LAPAROSCOPY, SURGICAL; RADICAL NEPHRECTOMY (INCLUDES REMOVAL OF GEROTA'S FASCIA AND SURROUND
LAPAROSCOPY, SURGICAL; NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY
LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY FROM LIVING DONOR (EXCLUDING PREPARATION AND MAINTE
LAPAROSCOPY, SURGICAL; NEPHRECTOMY WITH TOTAL URETERECTOMY
UNLISTED LAPAROSCOPY PROCEDURE, RENAL
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, W W/O IRRIGATION, INSTILLATIO
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, W W/O IRRIGATION, INSTILLATION, OR URETEROP
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR
LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATE PROCEDURE)
URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALL TYPES
URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER

URETEROLITHOTOMY; MIDDLE ONE-THIRD OF URETER
URETEROLITHOTOMY; LOWER ONE-THIRD OF URETER
URETERECTOMY, WITH BLADDER CUFF (SEPARATE PROCEDURE)
URETERECTOMY, TOTAL, ECTOPIC URETER, COMBINATION ABDOMINAL, VAGINAL AND/OR PERINEAL APPROACH
INJECTION PROCEDURE FOR URETEROGRAPHY OR URETEROPYELOGRAPHY THROUGH URETEROSTOMY OR IND
MANOMETRIC STUDIES THROUGH URETEROSTOMY OR INDWELLING URETERAL CATHETER
CHANGE OF URETEROSTOMY TUBE
INJECTION PROCEDURE FOR VISUALIZATION OF ILEAL CONDUIT AND/OR URETEROPYELOGRAPHY, EXCLUSIVE OF
URETEROPLASTY, PLASTIC OPERATION ON URETER (EG, STRICTURE)
URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR RETROPERITONEAL FIBROSIS
URETEROLYSIS FOR OVARIAN VEIN SYNDROME
URETEROLYSIS FOR RETROCAVAL URETER, WITH REANASTOMOSIS OF UPPER URINARY TRACT OR VENA CAVA
REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY);
REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE UROSTOMY); WITH REPAIR OF FASCIAL DEFECT AN
URETEROPYELOSTOMY, ANASTOMOSIS OF URETER AND RENAL PELVIS
URETEROCALYCOSTOMY, ANASTOMOSIS OF URETER TO RENAL CALYX
URETEROURETEROSTOMY
TRANSURETEROURETEROSTOMY, ANASTOMOSIS OF URETER TO CONTRALATERAL URETER
URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETER TO BLADDER
URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED URETER TO BLADDER
URETERONEOCYSTOSTOMY; WITH EXTENSIVE URETERAL TAILORING
URETERONEOCYSTOSTOMY; WITH VESICO-PSOAS HITCH OR BLADDER FLAP
URETEROENTEROSTOMY, DIRECT ANASTOMOSIS OF URETER TO INTESTINE
URETEROSIGMOIDOSTOMY, WITH CREATION OF SIGMOID BLADDER AND ESTABLISHMENT OF ABDOMINAL OR PER
URETEROCOLON CONDUIT, INCLUDING INTESTINE ANASTOMOSIS
URETEROILEAL CONDUIT (ILEAL BLADDER), INCLUDING INTESTINE ANASTOMOSIS (BRICKER OPERATION)
CONTINENT DIVERSION, INCLUDING INTESTINE ANASTOMOSIS USING ANY SEGMENT OF SMALL AND/OR LARGE IN
URINARY UNDIVERSION (EG, TAKING DOWN OF URETEROILEAL CONDUIT, URETEROSIGMOIDOSTOMY OR URETER
REPLACEMENT OF ALL OR PART OF URETER BY INTESTINE SEGMENT, INCLUDING INTESTINE ANASTOMOSIS
CUTANEOUS APPENDICO-VESICOSTOMY
URETEROSTOMY, TRANSPLANTATION OF URETER TO SKIN
URETERORRHAPHY, SUTURE OF URETER (SEPARATE PROCEDURE)
CLOSURE OF URETEROCUTANEOUS FISTULA
CLOSURE OF URETEROVISCERAL FISTULA (INCLUDING VISCERAL REPAIR)
DELIGATION OF URETER
LAPAROSCOPY, SURGICAL; URETEROLITHOTOMY
LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT PLACEMENT
LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITHOUT CYSTOSCOPY AND URETERAL STENT PLACEM
UNLISTED LAPAROSCOPY PROCEDURE, URETER
URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION
URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETERO

ASPIRATION OF BLADDER BY NEEDLE
ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE MATERIAL
CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION
CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE PROCEDURE)
CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION
TRANSVESICAL URETEROLITHOTOMY
CYSTOTOMY, WITH CALCULUS BASKET EXTRACTION AND/OR ULTRASONIC OR ELECTROHYDRAULIC FRAGMENTA
DRAINAGE OF PERIVESICAL OR PREVESICAL SPACE ABSCESS
EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR
CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATE PROCEDURE)
CYSTOTOMY; FOR EXCISION OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE (SEPARATE PROCEDURE)
CYSTOTOMY; FOR EXCISION OF BLADDER TUMOR
CYSTOTOMY FOR EXCISION, INCISION, OR REPAIR OF URETEROCELE
CYSTECTOMY, PARTIAL; SIMPLE
CYSTECTOMY, PARTIAL; COMPLICATED (EG, POSTRADIATION, PREVIOUS SURGERY, DIFFICULT LOCATION)
CYSTECTOMY, PARTIAL, WITH REIMPLANTATION OF URETER(S) INTO BLADDER (URETERONEOCYSTOSTOMY)
CYSTECTOMY, COMPLETE; (SEPARATE PROCEDURE)
CYSTECTOMY, COMPLETE; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGAS
CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS TRANSPLANTATIONS;
CYSTECTOMY, COMPLETE, WITH URETEROSIGMOIDOSTOMY OR URETEROCUTANEOUS TRANSPLANTATIONS; WIT
CYSTECTOMY, COMPLETE, WITH URETEROILEAL CONDUIT OR SIGMOID BLADDER, INCLUDING INTESTINE ANASTO
CYSTECTOMY, COMPLETE, WITH URETEROILEAL CONDUIT OR SIGMOID BLADDER, INCLUDING INTESTINE ANASTO
CYSTECTOMY, COMPLETE, WITH CONTINENT DIVERSION, ANY OPEN TECHNIQUE, USING ANY SEGMENT OF SMALL
PELVIC EXENTERATION, COMPLETE, VESICAL, PROSTATIC OR URETHRAL MALIGNANCY, WITH REMOVAL BLADDER
INJECTION PROCEDURE FOR CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY
INJECTION PROCEDURE AND PLACEMENT OF CHAIN FOR CONTRAST AND/OR CHAIN URETHROCYSTOGRAPHY
INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR RESIDUAL URINE)
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG, ALTERED ANATOMY, FRACTUR
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLA
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING DETENTION TIME)
SIMPLE CYSTOMETROGRAM (CMG) (EG, SPINAL MANOMETER)
COMPLEX CYSTOMETROGRAM (EG, CALIBRATED ELECTRONIC EQUIPMENT)
SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE, MECHANICAL UROFLOWMETER)
COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT)
URETHRAL PRESSURE PROFILE STUDIES (UPP) (URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE
ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, OTHER THAN NEEDLE, ANY TECHNIQ
NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, ANY TECHNIQUE
STIMULUS EVOKED RESPONSE (EG, MEASUREMENT OF BULBOCAVERNOSUS REFLEX LATENCY TIME)
VOIDING PRESSURE STUDIES (VP); BLADDER VOIDING PRESSURE, ANY TECHNIQUE

VOIDING PRESSURE STUDIES (VP); INTRA-ABDOMINAL VOIDING PRESSURE (AP) (RECTAL, GASTRIC, INTRAPERITO
MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING
CYSTOPLASTY OR CYSTOURETHROPLASTY, PLASTIC OPERATION ON BLADDER AND/OR VESICAL NECK (ANTERIO
CYSTOURETHROPLASTY WITH UNILATERAL OR BILATERAL URETERONEOCYSTOSTOMY
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, MARSHALL-MARCHETTI-KRANTZ, BURCH); SIMPLE
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (MARSHALL-MARCHETTI-KRANTZ TYPE); COMPLICATED (EG
ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR WITHOUT ENDOSCOPIC CONTROL (EG, STAMEY, RAZ,
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; SIMPLE
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; COMPLICATED
CLOSURE OF CYSTOSTOMY (SEPARATE PROCEDURE)
CLOSURE OF VESICOVAGINAL FISTULA, ABDOMINAL APPROACH
CLOSURE OF VESICOUTERINE FISTULA;
CLOSURE OF VESICOUTERINE FISTULA; WITH HYSTERECTOMY
CLOSURE, EXSTROPHY OF BLADDER
ENTEROCYSTOPLASTY, INCLUDING INTESTINAL ANASTOMOSIS
CUTANEOUS VESICOSTOMY
LAPAROSCOPY, SURGICAL; URETHRAL SUSPENSION FOR STRESS INCONTINENCE
LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
CYSTOURETHROSCOPY WITH IRRIGATION AND EVACUATION OF MULTIPLE OBSTRUCTING CLOTS
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR U
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, W W/O IRRIGATION, INSTILLATION, OR URETEROPY
CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLA
CYSTOURETHROSCOPY, WITH BIOPSY
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGONE, BLA
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECT
CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT BIOPSY OR FULGURA
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION (S
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANESTHESIA
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE
CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY
CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)
CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR
CYSTOURETHROSCOPY, WITH INSERTION OF URETHRAL STENT
CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE
CYSTOURETHROSCOPY FOR TREATMENT OF FEMALE URETHRAL SYNDROME: URETHRAL MEATOTOMY, URETHRA
CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL O
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR BIL
CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR MU
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA O
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA O
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRA
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRA
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS

CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF URETERAL CALCU
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTION OF IMPLANT
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL O
CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABLISH A PERCUT
CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTRO
CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLOON DILATION,
CYSTOURETHROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON DILATION, LASER, ELECT
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILA
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (E
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON D
CYSTOURETHROSCOPY WITH TRANSURETHRAL RESECTION OR INCISION OF EJACULATORY DUCTS
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OF CA
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CATHETER
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION OF U
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF URETERAL OR RENA
CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERIOR URETHRAL
TRANSURETHRAL INCISION OF PROSTATE
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA
TRANSURETHRAL ELECTROSURGICAL RESECTION PROSTATE, INC CONTROL OF POSTOPERATIVE BLEEDING, CO
TRANSURETHRAL FULGURATION FOR POSTOPERATIVE BLEEDING OCCURRING AFTER THE USUAL FOLLOW-UP TI
TRANSURETHRAL RESECTION OF PROSTATE; FIRST STAGE OF TWO-STAGE RESECTION (PARTIAL RESECTION)
TRANSURETHRAL RESECTION OF PROSTATE; SECOND STAGE OF TWO-STAGE RESECTION (RESECTION COMPLET
TRANSURETHRAL RESECTION; OF RESIDUAL OBSTRUCTIVE TISSUE AFTER 90 DAYS POSTOPERATIVE
TRANSURETHRAL RESECTION; OF REGROWTH OF OBSTRUCTIVE TISSUE LONGER THAN ONE YEAR POSTOPERAT
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
NON-CONTACT LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMP
CONTACT LASER VAPORIZATION W W/O TRANSURETHRAL RESECTION PROSTATE, INC CONTROL POSTOPERATIVE
TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS
URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PENDULOUS URETHRA
URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA, EXTERNAL
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT
DRAINAGE OF DEEP PERIURETHRAL ABSCESS
DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST
DRAINAGE OF PERINEAL URINARY EXTRAVASATION; UNCOMPLICATED (SEPARATE PROCEDURE)
DRAINAGE OF PERINEAL URINARY EXTRAVASATION; COMPLICATED
BIOPSY OF URETHRA
URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE
URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; MALE
EXCISION OR FULGURATION OF CARCINOMA OF URETHRA
EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE
EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); MALE
MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE
EXCISION OF BULBOURETHRAL GLAND (COWPER'S GLAND)
EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTAL URETHRA
EXCISION OR FULGURATION; URETHRAL CARUNCLE

EXCISION OR FULGURATION; SKENE'S GLANDS
EXCISION OR FULGURATION; URETHRAL PROLAPSE
URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE)
URETHROPLASTY; SECOND STAGE (FORMATION OF URETHRA), INCLUDING URINARY DIVERSION
URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA
URETHROPLASTY, TRANSPUBIC OR PERINEAL, ONE STAGE, FOR RECONSTRUCTION OR REPAIR OF PROSTATIC O
URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; FIRST
URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; SECO
URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA
URETHROPLASTY WITH TUBULARIZATION OF POSTERIOR URETHRA AND/OR LOWER BLADDER FOR INCONTINENC
SLING OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)
REMOVAL OR REVISION OF SLING FOR MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)
INSERTION OF TANDEM CUFF (DUAL CUFF)
INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP, RESERVO
REMOVAL OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP, RESERVOIR, AND CUFF
REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING PUMP, RESERV
REMOVAL&REPLACEMENT, INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING PUMP, RESERVOIR,&C
REPAIR OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP, RESERVOIR, AND CUFF
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT (RICHARDSON TYPE PROCED
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PERINEAL
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PROSTATOMEMBRANOUS
CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE)
DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; INITIAL
DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; SUBSEQUENT
DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE, G
DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; INITIAL
DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; SUBSEQUENT
DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; INITIAL
DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT
DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY WATER-INDUCED THERMOTHERAPY
UNLISTED PROCEDURE, URINARY SYSTEM
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); NEWBORN
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
INCISION AND DRAINAGE OF PENIS, DEEP
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESI
BIOPSY OF PENIS (SEPARATE PROCEDURE)
BIOPSY OF PENIS; DEEP STRUCTURES
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);

EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN LENGTH
REMOVAL FOREIGN BODY FROM DEEP PENILE TISSUE (EG, PLASTIC IMPLANT)
AMPUTATION OF PENIS; PARTIAL
AMPUTATION OF PENIS; COMPLETE
AMPUTATION OF PENIS, RADICAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
AMPUTATION OF PENIS, RADICAL; IN CONTINUITY WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTE
CIRCUMCISION, USING CLAMP OR OTHER DEVICE; NEWBORN
CIRCUMCISION, USING CLAMP OR OTHER DEVICE; EXCEPT NEWBORN
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; NEWBORN
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; EXCEPT NEWBORN
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
REPAIR INCOMPLETE CIRCUMCISION
FRENULOTOMY OF PENIS
INJECTION PROCEDURE FOR PEYRONIE DISEASE;
INJECTION PROCEDURE FOR PEYRONIE DISEASE; WITH SURGICAL EXPOSURE OF PLAQUE
IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM
INJECTION PROCEDURE FOR CORPORA CAVERNOSOGRAPHY
DYNAMIC CAVERNOSOMETRY, INCLUDING INTRACAVERNOSAL INJECTION OF VASOACTIVE DRUGS (EG, PAPAVERI
INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S) (EG, PAPAVERINE, PHENTOLAMINE)
PENILE PLETHYSMOGRAPHY
NOCTURNAL PENILE TUMESCENCE AND/OR RIGIDITY TEST
PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH OR WITHOUT MOB
PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE HYPOSPADIAS REPAIR WIT
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); LESS THAN 3 CM
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); GREATER THAN
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION) WITH FREE SKIN
URETHROPLASTY FOR THIRD STAGE HYPOSPADIAS REPAIR TO RELEASE PENIS FROM SCROTUM (EG, THIRD STAG
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE MEAT
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLA
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLA
ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH EXTENSIVE D
ONE STAGE PROXIMAL PENILE OR PENOSCROTAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE DISSECTION TO
ONE STAGE PERINEAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE DISSECTION TO CORRECT CHORDEE AND U
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); BY CLOSURE, INCISION, OR E
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING MOBILIZATION O
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING EXTENSIVE DISS
REPAIR OF HYPOSPADIAS CRIPPLE REQUIRING EXTENSIVE DISSECTION & EXCISION OF PREVIOUSLY CONSTRUC
PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER;
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH INCONTINENCE
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH EXSTROPHY OF BLADD
INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)
INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF-CONTAINED)
INSERTION OF MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP, CYLINDE
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS WITHOUT REPLACEM
REPAIR OF COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS
REMOVAL AND REPLACEMENT OF ALL COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS
REMOVAL&REPLACEMENT OF ALL COMPONENTS OF MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS THROU

REMOVAL OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS, WITHOUT R
REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROS
REMOVAL&REPLACEMENT, NON-INFLATABLE (SEMI-RIGID)/INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS TH
CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL
CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL
CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER PROCEDURE, RONGEUR, OR
PLASTIC OPERATION OF PENIS FOR INJURY
FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING
BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE)
BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE)
EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR
ORCHIECTOMY, PARTIAL
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
ORCHIECTOMY, RADICAL, FOR TUMOR; WITH ABDOMINAL EXPLORATION
EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA)
EXPLORATION FOR UNDESCENDED TESTIS WITH ABDOMINAL EXPLORATION
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)
ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR
ORCHIOPEXY, ABDOMINAL APPROACH, FOR INTRA-ABDOMINAL TESTIS (EG, FOWLER-STEPHENS)
INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
SUTURE OR REPAIR OF TESTICULAR INJURY
TRANSPLANTATION OF TESTIS(ES) TO THIGH (BECAUSE OF SCROTAL DESTRUCTION)
LAPAROSCOPY, SURGICAL; ORCHIECTOMY
LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS
UNLISTED LAPAROSCOPY PROCEDURE, TESTIS
INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA)
BIOPSY OF EPIDIDYMIS, NEEDLE
EXPLORATION OF EPIDIDYMIS, WITH OR WITHOUT BIOPSY
EXCISION OF LOCAL LESION OF EPIDIDYMIS
EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY
EPIDIDYMECTOMY; UNILATERAL
EPIDIDYMECTOMY; BILATERAL
EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; UNILATERAL
EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; BILATERAL
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
EXCISION OF HYDROCELE; UNILATERAL
EXCISION OF HYDROCELE; BILATERAL
REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)
DRAINAGE OF SCROTAL WALL ABSCESS
SCROTAL EXPLORATION
REMOVAL OF FOREIGN BODY IN SCROTUM
RESECTION OF SCROTUM
SCROTOPLASTY; SIMPLE
SCROTOPLASTY; COMPLICATED
VASOTOMY, CANNULIZATION WITH OR WITHOUT INCISION OF VAS, UNILATERAL OR BILATERAL (SEPARATE PROCE
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAM(S)
VASOTOMY FOR VASOGRAMS, SEMINAL VESICULOGRAMS, OR EPIDIDYMOGRAMS, UNILATERAL OR BILATERAL

VASOVASOSTOMY, VASOVASORRHAPHY
LIGATION (PERCUTANEOUS) OF VAS DEFERENS, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)
EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE)
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE)
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL APPROACH
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH HERNIA REPAIR
LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE
UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
VESICULOTOMY;
VESICULOTOMY; COMPLICATED
VESICULECTOMY, ANY APPROACH
EXCISION OF MULLERIAN DUCT CYST
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH
PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; SIMPLE
PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; COMPLICATED
PROSTATECTOMY, PERINEAL, SUBTOTAL (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEA
PROSTATECTOMY, PERINEAL RADICAL;
PROSTATECTOMY, PERINEAL RADICAL; WITH LYMPH NODE BIOPSY(S) (LIMITED PELVIC LYMPHADENECTOMY)
PROSTATECTOMY, PERINEAL RADICAL; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC
PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URETHRAL C
PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URETHRAL C
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING;
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH LYMPH NODE BIOPSY(S) (LIM
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH BILATERAL PELVIC LYMPHAD
TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL RADIOELEMENT A
EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;
EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE; WITH LYMPH NODE BI
EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE; WITH BILATERAL PELV
LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING
ELECTROEJACULATION
CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES ULTRASONIC GUIDANCE FOR INTERSTITIAL CRYOSURG
UNLISTED PROCEDURE, MALE GENITAL SYSTEM
INTERSEX SURGERY; MALE TO FEMALE
INTERSEX SURGERY; FEMALE TO MALE
INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS
INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
LYSIS OF LABIAL ADHESIONS
DESTRUCTION OF LESION(S), VULVA; SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMO
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHE
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIST SEPARATE
VULVECTOMY SIMPLE; PARTIAL
VULVECTOMY SIMPLE; COMPLETE
VULVECTOMY, RADICAL, PARTIAL;
VULVECTOMY, RADICAL, PARTIAL; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, PARTIAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY

VULVECTOMY, RADICAL, COMPLETE;
VULVECTOMY, RADICAL, COMPLETE; WITH UNILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, COMPLETE; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY
VULVECTOMY, RADICAL, COMPLETE, WITH INGUINOFEMORAL, ILIAC, AND PELVIC LYMPHADENECTOMY
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
HYMENOTOMY, SIMPLE INCISION
EXCISION OF BARTHOLIN'S GLAND OR CYST
PLASTIC REPAIR OF INTROITUS
CLITOROPLASTY FOR INTERSEX STATE
PERINEOPLASTY, REPAIR OF PERINEUM, NON-OBSTETRICAL (SEPARATE PROCEDURE)
COLPOSCOPY OF THE VULVA
COLPOSCOPY OF THE VULVA; WITH BIOPSY(S)
COLPOTOMY; WITH EXPLORATION
COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS
COLPOCENTESIS (SEPARATE PROCEDURE)
INCISION AND DRAINAGE OF VAGINAL HEMATOMA; OBSTETRICAL/POSTPARTUM
INCISION AND DRAINAGE OF VAGINAL HEMATOMA; NON-OBSTETRICAL (EG, POST-TRAUMA, SPONTANEOUS BLEED
DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEM
DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CH
BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE)
BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS)
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL TISSUE (RADICAL VAGINE
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL TISSUE (RADICAL VAGINE
VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL
VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL TISSUE (RADICAL VAGI
VAGINECTOMY, COMPLETE REMOVAL OF VAGINAL WALL; WITH REMOVAL OF PARAVAGINAL TISSUE (RADICAL VAGI
COLPOCLEISIS (LE FORT TYPE)
EXCISION OF VAGINAL SEPTUM
EXCISION OF VAGINAL CYST OR TUMOR
IRRIGATION OF VAGINA AND/OR APPLICATION OF MEDICAMENT FOR TREATMENT OF BACTERIAL, PARASITIC, OR F
INSERTION OF UTERINE TANDEMS AND/OR VAGINAL OVOIDS FOR CLINICAL BRACHYTHERAPY
FITTING AND INSERTION OF PESSARY OR OTHER INTRAVAGINAL SUPPORT DEVICE
DIAPHRAGM OR CERVICAL CAP FITTING WITH INSTRUCTIONS
INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR SPONTANEOUS OR TRAUMATIC NONOBSTETRICAL VA
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)
PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL PLICATION)
PLASTIC REPAIR OF URETHROCELE
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
COMBINED ANTEROPOSTERIOR COLPORRHAPHY;
COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR
REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)
REPAIR OF ENTEROCELE, ABDOMINAL APPROACH (SEPARATE PROCEDURE)
COLPOPEXY, ABDOMINAL APPROACH
SACROSPINOUS LIGAMENT FIXATION FOR PROLAPSE OF VAGINA
PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, STRESS URINARY INCONTINENCE, AND/OR IN
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY
CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT
CONSTRUCTION OF ARTIFICIAL VAGINA; WITH GRAFT
CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH
CLOSURE OF RECTOVAGINAL FISTULA; ABDOMINAL APPROACH
CLOSURE OF RECTOVAGINAL FISTULA; ABDOMINAL APPROACH, WITH CONCOMITANT COLOSTOMY
CLOSURE OF RECTOVAGINAL FISTULA; TRANSPERINEAL APPROACH, WITH PERINEAL BODY RECONSTRUCTION, W
CLOSURE OF URETHROVAGINAL FISTULA;
CLOSURE OF URETHROVAGINAL FISTULA; WITH BULBOCAVERNOSUS TRANSPLANT
CLOSURE OF VESICOVAGINAL FISTULA; VAGINAL APPROACH
CLOSURE OF VESICOVAGINAL FISTULA; TRANSVESICAL AND VAGINAL APPROACH
VAGINOPLASTY FOR INTERSEX STATE
DILATION OF VAGINA UNDER ANESTHESIA
PELVIC EXAMINATION UNDER ANESTHESIA
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT;
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT; WITH BIOPSY(S)
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDO
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF TH
BIOPSY, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PR
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
CAUTERY OF CERVIX; ELECTRO OR THERMAL
CAUTERY OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT
CAUTERY OF CERVIX; LASER ABLATION
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH
TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)
RADICAL TRACHELECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE
EXCISION OF CERVICAL STUMP, ABDOMINAL APPROACH;
EXCISION OF CERVICAL STUMP, ABDOMINAL APPROACH; WITH PELVIC FLOOR REPAIR
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH ANTERIOR AND/OR POSTERIOR REPAIR
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE
CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL
TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH
DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE)
DILATION AND CURETTAGE OF CERVICAL STUMP
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAM
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR W
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR W
SUPRACERVICAL ABDOMINAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR WITHOUT REMOVAL OF TU
TOTAL ABDOMINAL HYSTERECTOMY, INCLUDING PARTIAL VAGINECTOMY, WITH PARA-AORTIC AND PELVIC LYMPH
RADICAL ABDOMINAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PARA-AORTIC LY
PELVIC EXENTERATION FOR GYNECOLOGIC MALIGNANCY, WITH TOTAL ABDOMINAL HYSTERECTOMY OR CERVICE
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S), WI
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH COLPO-URETHROCYSTOPEXY (MARSHALL-M
VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REPAIR OF ENTEROCELE
VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY;
VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY; WITH REPAIR OF ENTEROCELE
VAGINAL HYSTERECTOMY, RADICAL (SCHAUTA TYPE OPERATION)
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS;
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF TUBE(S) AND/OR OVARY
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF TUBE(S) AND/OR OVARY
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH COLPO-URETHROCYSTOPEXY (MARSH
VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REPAIR OF ENTEROCELE
INSERTION OF INTRAUTERINE DEVICE (IUD)
REMOVAL OF INTRAUTERINE DEVICE (IUD)
ARTIFICIAL INSEMINATION; INTRA-CERVICAL
ARTIFICIAL INSEMINATION; INTRA-UTERINE
SPERM WASHING FOR ARTIFICIAL INSEMINATION
INJECTION PROCEDURE FOR HYSTEROSALPINGOGRAPHY
TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE CATHETER FOR DIAGNOSIS AND/OR RE-ESTABLISHING PAT
INSERTION OF HEYMAN CAPSULES FOR CLINICAL BRACHYTHERAPY
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR WITHOUT SHORTENIN
UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR WITHOUT SHORTENIN
HYSTERORRHAPHY, REPAIR OF RUPTURED UTERUS (NONOBSTETRICAL)
HYSTEROPLASTY, REPAIR OF UTERINE ANOMALY (STRASSMAN TYPE)
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL M
LAPAROSCOPY SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS;
LAPAROSCOPY SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 GRAMS OR LESS; WITH REMOVAL O
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS;
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REM
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITH
HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY METHOD)
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL
UNLISTED LAPAROSCOPY PROCEDURE, UTERUS
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNILATERAL OR BILATE
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, POSTPARTUM, UNILATE
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN DELIVERY OR INTRA
OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP, FALOPE RING) VAGINAL OR SUPRAPUBIC APPROA
LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR P
LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)
LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)
LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY
LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY)
UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS)
TUBOTUBAL ANASTOMOSIS
TUBOUTERINE IMPLANTATION
FIMBRIOPLASTY
SALPINGOSTOMY (SALPINGONEOSTOMY)
DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); VAGINAL APPROACH
DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); ABDOMINAL APPROACH
DRAINAGE OF OVARIAN ABSCESS; VAGINAL APPROACH
DRAINAGE OF OVARIAN ABSCESS; ABDOMINAL APPROACH
DRAINAGE OF PELVIC ABSCESS, TRANSVAGINAL OR TRANSRECTAL APPROACH, PERCUTANEOUS (EG, OVARIAN, P
TRANSPOSITION, OVARY(S)
BIOPSY OF OVARY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
WEDGE RESECTION OR BISECTION OF OVARY, UNILATERAL OR BILATERAL
OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL;
OOPHORECT, PRTL OR TTL, UNILAT OR BIL; FOR OVAR, TUBAL OR PRIM PERITON MALIG, W PARA-AORT & PELV LY
RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL SALPINGO-OOPHOREC
RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BILATERAL SALPINGO-OOPHOREC
RESECTION OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY WITH BSO AND OMENTECT; WITH RADIC
BILATERAL SALPINGO-OOPHORECTOMY WITH OMENTECTOMY, TOTAL ABDOMINAL HYSTERECTOMY AND RADICAL
BILATERAL SALPINGO-OOPHORECTOMY WITH OMENTECTOMY, TOTAL ABDOMINAL HYSTERECTOMY AND RADICAL
LAPAROT, FOR STAGING/RESTAG OF OVARIAN, TUBAL/PRIMARY PERITON MALIG (SECOND LOOK), W/W/O OMENTC
FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD
EMBRYO TRANSFER, INTRAUTERINE
GAMETE, ZYGOTE, OR EMBRYO INTRAFALLOPIAN TRANSFER, ANY METHOD
UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)
AMNIOCENTESIS; DIAGNOSTIC
AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTION (INCLUDES ULTRASOUND GUIDANCE)
CORDOCENTESIS (INTRAUTERINE), ANY METHOD
CHORIONIC VILLUS SAMPLING, ANY METHOD
FETAL CONTRACTION STRESS TEST
FETAL NON-STRESS TEST
FETAL SCALP BLOOD SAMPLING
FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WITH WRITTEN
FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WITH WRITTEN
HYSTEROTOMY, ABDOMINAL (EG, FOR HYDATIDIFORM MOLE, ABORTION)
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, REQUIRING SALPINGECTOMY AND/OR OOP
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, WITHOUT SALPINGECTOMY AND/OR OOPH
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; ABDOMINAL PREGNANCY
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; INTERSTITIAL, UTERINE PREGNANCY REQUIRING TOTAL HYSTE
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; INTERSTITIAL, UTERINE PREGNANCY WITH PARTIAL RESECTIO
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; CERVICAL, WITH EVACUATION
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
CURRETTAGE, POSTPARTUM
INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)
EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING PHYSICIAN
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
CERCLAGE OF CERVIX, DURING PREGNANCY; ABDOMINAL
HYSTERORRHAPHY OF RUPTURED UTERUS
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY
VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS);
VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); INCLUDING POSTPARTUM CARE
EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS
DELIVERY OF PLACENTA (SEPARATE PROCEDURE)
ANTEPARTUM CARE ONLY; 4-6 VISITS
ANTEPARTUM CARE ONLY; 7 OR MORE VISITS
POSTPARTUM CARE ONLY (SEPARATE PROCEDURE)
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CARE
CESAREAN DELIVERY ONLY;
CESAREAN DELIVERY ONLY; INCLUDING POSTPARTUM CARE
SUBTOTAL OR TOTAL HYSTERECTOMY AFTER CESAREAN DELIVERY (LIST SEPARATELY IN ADDITION TO CODE FOR
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY
VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORC
VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORC
ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CARE, FOL
CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS CESAREAN DELIVERY
CESAREAN DELIVERY ONLY, FOLLOWING ATTEMPTED VAGINAL DELIVERY AFTER PREVIOUS CESAREAN DELIVERY
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
TREATMENT OF SEPTIC ABORTION, COMPLETED SURGICALLY
INDUCED ABORTION, BY DILATION AND CURETTAGE
INDUCED ABORTION, BY DILATION AND EVACUATION
INDUCED ABORTION, BY ONE OR MORE INTRA-AMNIOTIC INJECTIONS (AMNIOCENTESIS-INJECTIONS), INC HOSP A
INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) W W/O CERVICAL DILAT
MULTIFETAL PREGNANCY REDUCTION(S) (MPR)
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL)
UNLISTED LAPAROSCOPY PROCEDURE, MATERNITY CARE AND DELIVERY
UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
INCISION AND DRAINAGE OF THYROGLOSSAL DUCT CYST, INFECTED
ASPIRATION AND/OR INJECTION, THYROID CYST

BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE
EXCISION OF CYST OR ADENOMA OF THYROID, OR TRANSECTION OF ISTHMUS
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMU
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUS
THYROIDECTOMY, TOTAL OR COMPLETE
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH RADICAL NECK DISSECTION
THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS REMOVAL OF A PORTIO
THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; STERNAL SPLIT OR TRANSTHORACIC APPROACH
THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; CERVICAL APPROACH
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; RECURRENT
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); RE-EXPLORATION
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); WITH MEDIASTINAL EXPLORATION, STERNAL SPLI
PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
THYMECTOMY, PARTIAL OR TOTAL; TRANSCERVICAL APPROACH (SEPARATE PROCEDURE)
THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACIC APPROACH, WITHOUT RADICAL MEDIAST
THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACIC APPROACH, WITH RADICAL MEDIASTINAL
ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TR
ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TR
EXCISION OF CAROTID BODY TUMOR; WITHOUT EXCISION OF CAROTID ARTERY
EXCISION OF CAROTID BODY TUMOR; WITH EXCISION OF CAROTID ARTERY
LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLA
UNLISTED LAPAROSCOPY PROCEDURE, ENDOCRINE SYSTEM
UNLISTED PROCEDURE, ENDOCRINE SYSTEM
SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INITIAL
SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; SUBSEQUENT TAPS
VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULA
VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULA
CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE PROCEDURE)
CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITH INJECTION OF MEDICATION OR OTHER SUBSTANCE
PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE
TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE
TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE; FOR IMPLANTING VENTRICULAR CATHETER OR
TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE; FOR EVACUATION AND/OR DRAINAGE OF SUBD
BURR HOLE(S) FOR VENTRICULAR PUNCTURE (INCLUDING INJECTION OF GAS, CONTRAST MEDIA, DYE, OR RADIO
BURR HOLE(S) OR TREPHINE; WITH BIOPSY OF BRAIN OR INTRACRANIAL LESION
BURR HOLE(S) OR TREPHINE; WITH DRAINAGE OF BRAIN ABSCESS OR CYST
BURR HOLE(S) OR TREPHINE; WITH SUBSEQUENT TAPPING (ASPIRATION) OF INTRACRANIAL ABSCESS OR CYST
BURR HOLE(S) WITH EVACUATION AND/OR DRAINAGE OF HEMATOMA, EXTRADURAL OR SUBDURAL
BURR HOLE(S); WITH ASPIRATION OF HEMATOMA OR CYST, INTRACEREBRAL
BURR HOLE(S); FOR IMPLANTING VENTRICULAR CATHETER, RESERVOIR, EEG ELECTRODE(S) OR PRESSURE REC
INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR CONNECTION TO VE
BURR HOLE(S) OR TREPHINE, SUPRATENTORIAL, EXPLORATORY, NOT FOLLOWED BY OTHER SURGERY
BURR HOLE(S) OR TREPHINE, INFRATENTORIAL, UNILATERAL OR BILATERAL
CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; SUPRATENTORIAL

CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; INFRATENTORIAL (POSTERIOR FOSSA)
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, SUPRATENTORIAL; EXTRADURAL OR SUBDUR
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, SUPRATENTORIAL; INTRACEREBRAL
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, INFRATENTORIAL; EXTRADURAL OR SUBDURA
CRANIECTOMY OR CRANIOTOMY FOR EVACUATION OF HEMATOMA, INFRATENTORIAL; INTRACEREBELLAR
INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL BONE GRAFT (LIST SEPARATELY IN ADDITION TO CODE F
CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL ABSCESS; SUPRATENTORIAL
CRANIECTOMY OR CRANIOTOMY, DRAINAGE OF INTRACRANIAL ABSCESS; INFRATENTORIAL
CRANIECTOMY/CRANIOTOMY, DECOMPRESSIVE, WITH/WITHOUT DURAPLASTY, FOR TREATMENT, INTRACRANIAL H
CRANIECTOMY OR CRANIOTOMY, DECOMPRESSIVE, WITH OR WITHOUT DURAPLASTY, FOR TREATMENT OF INTRA
DECOMPRESSION OF ORBIT ONLY, TRANSCRANIAL APPROACH
EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH BIOPSY
EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF LESION
EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF FOREIGN BODY
SUBTEMPORAL CRANIAL DECOMPRESSION (PSEUDOTUMOR CEREBRI, SLIT VENTRICLE SYNDROME)
CRANIECTOMY, SUBOCCIPITAL WITH CERVICAL LAMINECTOMY FOR DECOMPRESSION OF MEDULLA AND SPINAL C
OTHER CRANIAL DECOMPRESSION, POSTERIOR FOSSA
CRANIOTOMY FOR SECTION OF TENTORIUM CEREBELLI (SEPARATE PROCEDURE)
CRANIECTOMY, SUBTEMPORAL, FOR SECTION, COMPRESSION, OR DECOMPRESSION OF SENSORY ROOT OF GAS
CRANIECTOMY, SUBOCCIPITAL; FOR EXPLORATION OR DECOMPRESSION OF CRANIAL NERVES
CRANIECTOMY, SUBOCCIPITAL; FOR SECTION OF ONE OR MORE CRANIAL NERVES
CRANIECTOMY, SUBOCCIPITAL; FOR MEDULLARY TRACTOTOMY
CRANIECTOMY, SUBOCCIPITAL; FOR MESENCEPHALIC TRACTOTOMY OR PEDUNCULOTOMY
CRANIOTOMY FOR LOBOTOMY, INCLUDING CINGULOTOMY
CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE LESION OF SKULL
CRANIECTOMY; FOR OSTEOMYELITIS
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF BRAIN TUMOR, SUPRATENTORIAL, E
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF MENINGIOMA, SUPRATENTORIAL
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OF BRAIN ABSCESS, SUPRATENTORIAL
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; FOR EXCISION OR FENESTRATION OF CYST, SUPRATEN
IMPLANTATION OF BRAIN INTRACAVITARY CHEMOTHERAPY AGENT (LIST SEPARATELY IN ADDITION TO CODE FOR
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA; EXCEPT MENINGIOMA
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA; MENINGIOMA
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA; CEREBELLOPONTINE
CRANIECTOMY FOR EXCISION OF BRAIN TUMOR, INFRATENTORIAL OR POSTERIOR FOSSA; MIDLINE TUMOR AT BA
CRANIECTOMY, INFRATENTORIAL OR POSTERIOR FOSSA; FOR EXCISION OF BRAIN ABSCESS
CRANIECTOMY, INFRATENTORIAL OR POSTERIOR FOSSA; FOR EXCISION OR FENESTRATION OF CYST
CRANIECTOMY, BONE FLAP CRANIOTOMY, TRANSTEMPORAL (MASTOID) FOR EXCISION OF CEREBELLOPONTINE A
CRANIECTOMY, BONE FLAP CRANIOTOMY, TRANSTEMPORAL (MASTOID) FOR EXCISION OF CEREBELLOPONTINE A
SUBDURAL IMPLANTATION OF STRIP ELECTRODES THROUGH ONE OR MORE BURR OR TREPHINE HOLE(S) FOR LO
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR SUBDURAL IMPLANTATION OF AN ELECTRODE ARRAY, FOR LO
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF EPILEPTOGENIC FOCUS WITHOUT ELECTROCO
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR REMOVAL OF EPIDURAL OR SUBDURAL ELECTRODE ARRAY, W
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF CEREBRAL EPILEPTOGENIC FOCUS, WITH ELEC
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY WITH ELECTROCORTICOGRAPHY DURING SURG
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR LOBECTOMY WITH ELECTROCORTICOGRAPHY DURING SURG
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR TRANSECTION OF CORPUS CALLOSUM
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR TOTAL HEMISPHERECTOMY
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR PARTIAL OR SUBTOTAL HEMISPHERECTOMY

CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OR COAGULATION OF CHOROID PLEXUS
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OF CRANIOPHARYNGIOMA
CRANIOTOMY FOR HYPOPHYSECTOMY OR EXCISION OF PITUITARY TUMOR, INTRACRANIAL APPROACH
HYPOPHYSECTOMY OR EXCISION OF PITUITARY TUMOR, TRANSNASAL OR TRANSSEPTAL APPROACH, NONSTERE
CRANIECTOMY FOR CRANIOSYNOSTOSIS; SINGLE CRANIAL SUTURE
CRANIECTOMY FOR CRANIOSYNOSTOSIS; MULTIPLE CRANIAL SUTURES
CRANIOTOMY FOR CRANIOSYNOSTOSIS; FRONTAL OR PARIETAL BONE FLAP
CRANIOTOMY FOR CRANIOSYNOSTOSIS; BIFRONTAL BONE FLAP
EXTENSIVE CRANIECTOMY FOR MULTIPLE CRANIAL SUTURE CRANIOSYNOSTOSIS (EG, CLOVERLEAF SKULL); NOT
EXTENSIVE CRANIECTOMY FOR MULTIPLE CRANIAL SUTURE CRANIOSYNOSTOSIS (EG, CLOVERLEAF SKULL); REC
EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF CRANIAL BONE (EG, FIBROUS DYSPLASIA); WITHOUT O
EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF CRANIAL BONE (EG, FIBROUS DYSPLASIA); WITH OPTIC
CRANIECTOMY OR CRANIOTOMY; WITH EXCISION OF FOREIGN BODY FROM BRAIN
CRANIECTOMY OR CRANIOTOMY; WITH TREATMENT OF PENETRATING WOUND OF BRAIN
TRANSORAL APPROACH TO SKULL BASE, BRAIN STEM OR UPPER SPINAL CORD FOR BIOPSY, DECOMPRESSION O
TRANSORAL APPROACH TO SKULL BASE, BRAIN STEM OR UPPER SPINAL CORD FOR BIOPSY, DECOMPRESSION O
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL RHINOTOMY, ETHM
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL RHINOTOMY, ORBI
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING UNILATERAL OR BIFRONTAL
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; INTRADURAL, INCLUDING UNILATERAL OR BIFRONTAL
ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA, EXTRADURAL, INCLUDING SUPRAORBITAL RIDGE OS
ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA, EXTRADURAL, INCLUDING SUPRAORBITAL RIDGE OS
BICORONAL, TRANSZYGOMATIC AND/OR LEFORT I OSTEOTOMY APPROACH TO ANTERIOR CRANIAL FOSSA WITH O
INFRATEMPORAL PRE-AURICULAR APPROACH TO MID CRANIAL FOSSA (PARAPHARYNGEAL SPACE, INFRATEMPOR
INFRATEMPORAL POST-AURICULAR APPROACH TO MID CRANIAL FOSSA (INTERNAL AUDITORY MEATUS, PETROUS
ORBITOCRANIAL ZYGOMATIC APPROACH TO MIDDLE CRANIAL FOSSA (CAVERNOUS SINUS & CAROTID ARTERY, BA
TRANSTEMPORAL APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE SKULL BASE, INC
TRANSCOCHLEAR APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE SKULL BASE, INC
TRANSCONDYLAR (FAR LATERAL) APPROACH TO POSTERIOR CRANIAL FOSSA, JUGULAR FORAMEN OR MIDLINE S
TRANSPETROSAL APPROACH TO POSTERIOR CRANIAL FOSSA, CLIVUS OR FORAMEN MAGNUM, INCLUDING LIGAT
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF ANTERIOR CRANIAL F
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF BASE OF ANTERIOR CRANIAL F
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF INFRATEMPORAL FOSSA, PARA
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF INFRATEMPORAL FOSSA, PARA
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF PARASELLAR AREA, CAVERNO
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF PARASELLAR AREA, CAVERNO
TRANSECTION OR LIGATION, CAROTID ARTERY IN CAVERNOUS SINUS; WITHOUT REPAIR (LIST SEPARATELY IN AD
TRANSECTION OR LIGATION, CAROTID ARTERY IN CAVERNOUS SINUS; WITH REPAIR BY ANASTOMOSIS OR GRAFT
TRANSECTION OR LIGATION, CAROTID ARTERY IN PETROUS CANAL; WITHOUT REPAIR (LIST SEPARATELY IN ADDIT
TRANSECTION OR LIGATION, CAROTID ARTERY IN PETROUS CANAL; WITH REPAIR BY ANASTOMOSIS OR GRAFT (L
OBLITERATION OF CAROTID ANEURYSM, ARTERIOVENOUS MALFORMATION, OR CAROTID-CAVERNOUS FISTULA B
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR/INFECTIOUS LESION BASE OF POSTERIOR CRANIAL FOSSA
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR/INFECTIOUS LESION BASE OF POSTERIOR CRANIAL FOSSA
SECONDARY REPAIR,DURA,CEREBROSPINAL FLD LEAK,ANT,MIDDLE/POST CRANIAL FOSSA FOLL SURG,THE SKULL
SECONDARY REPR,A,CEREBROSPINAL FLD LEAK,ANT,MIDDLE/PST CRANIAL FOSSA FOLL SURG,THE SKULL BASE;L
ENDO TEMP BALOON ART OCLSIN,HED/NCK INCLUD SLCT CATH VESEL OCLDED,POSIT & INFLT OCLSIN,CNCMIT NE
TRANSCATHETER PERMANENT OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE HEM
TRANSCATH PERM OCCLUSION/EMBOLIZATION (EG,, TUMR DESTRUCT, ACHIEVE HEMOSTA, OCCLUDEVASCMALFO
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, SIMPLE

SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, COMPLEX
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; INFRATENTORIAL, SIMPLE
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; INFRATENTORIAL, COMPLEX
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; DURAL, SIMPLE
SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; DURAL, COMPLEX
SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID CIRCULATION
SURGERY OF COMPLEX INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; VERTEBROBASILAR CIRCULATION
SURGERY OF SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; CAROTID CIRCULATION
SURGERY OF SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIAL APPROACH; VERTEBROBASILAR CIRCULATION
SURGERY OF INTRACRANIAL ANEURYSM, CERVICAL APPROACH BY APPLICATION OF OCCLUDING CLAMP TO CERV
SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY INTRACRANIAL AND
SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY INTRACRANIAL ELE
SURGERY OF ANEURYSM, VASCULAR MALFORMATION OR CAROTID-CAVERNOUS FISTULA; BY INTRA-ARTERIAL EM
ANASTOMOSIS, ARTERIAL, EXTRACRANIAL-INTRACRANIAL (EG, MIDDLE CEREBRAL/CORTICAL) ARTERIES
CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) AND LOCALIZING AND RECORDING
CREATION OF LESION BY STEREOTACTIC METHOD, INCLUDING BURR HOLE(S) AND LOCALIZING AND RECORDING
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR INTRACRANIAL LESION;
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR INTRACRANIAL LESION; WITH
STEREOTACTIC IMPLANTATION OF DEPTH ELECTRODES INTO THE CEREBRUM FOR LONG TERM SEIZURE MONITO
STEREOTACTIC LOCALIZATION, INCLUDING BURR HOLE(S), WITH INSERTION OF CATHETER(S) OR PROBE(S) FOR
CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT (EG, ALCOHOL, THE
CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT (EG, ALCOHOL, THE
STEREOTACTIC RADIOSURGERY (PARTICLE BEAM, GAMMA RAY OR LINEAR ACCELERATOR), ONE OR MORE SESSI
STEREOTACTIC COMPUTER ASSISTED VOLUMETRIC (NAVIGATIONAL) PROCEDURE, INTRACRANIAL, EXTRACRANIA
TWIST DRILL OR BURR HOLE(S) FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CORTICAL
CRANIECTOMY OR CRANIOTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBRAL, CORTICA
TWIST DRILL, BURR HOLE, CRANIOTOMY/CRANIECTOMY FOR STEREOTACTIC IMPLANTATION OF 1 NEUROSTIMULA
CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR; CORTICAL
CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR; SUBCORTICAL
REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR ELECTRODES
INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
ELEVATION OF DEPRESSED SKULL FRACTURE; SIMPLE, EXTRADURAL
ELEVATION OF DEPRESSED SKULL FRACTURE; COMPOUND OR COMMINUTED, EXTRADURAL
ELEVATION OF DEPRESSED SKULL FRACTURE; WITH REPAIR OF DURA AND/OR DEBRIDEMENT OF BRAIN
CRANIOTOMY FOR REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, INCLUDING SURGERY FOR RHINORRHEA/OTO
REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); NOT REQUIRING BONE GRAFTS OR CR
REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); WITH SIMPLE CRANIOPLASTY
REDUCTION OF CRANIOMEGALIC SKULL (EG, TREATED HYDROCEPHALUS); REQUIRING CRANIOTOMY AND RECON
REPAIR OF ENCEPHALOCELE, SKULL VAULT, INCLUDING CRANIOPLASTY
CRANIOTOMY FOR REPAIR OF ENCEPHALOCELE, SKULL BASE
CRANIOPLASTY FOR SKULL DEFECT; UP TO 5 CM DIAMETER
CRANIOPLASTY FOR SKULL DEFECT; LARGER THAN 5 CM DIAMETER
REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
REPLACEMENT OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN SURGERY
CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); UP TO 5 CM DIAMETER
CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONE GRAFTS); LARGER THAN 5 CM DIAMETER
INCISION AND RETRIEVAL OF SUBCUTANEOUS CRANIAL BONE GRAFT FOR CRANIOPLASTY (LIST SEPARATELY IN A
NEUROENDOSCOPY, INTRACRANIAL, FOR PLACEMENT OR REPLACEMENT OF VENTRICULAR CATHETER AND ATTA
NEUROENDOSCOPY, INTRACRANIAL; WITH DISSECTION OF ADHESIONS, FENESTRATION OF SEPTUM PELLUCIDUM
NEUROENDOSCOPY, INTRACRANIAL; WITH FENESTRATION OR EXCISION OF COLLOID CYST, INCLUDING PLACEME
NEUROENDOSCOPY, INTRACRANIAL; WITH RETRIEVAL OF FOREIGN BODY
NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF BRAIN TUMOR, INCLUDING PLACEMENT OF EXTERNAL VE
NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF PITUITARY TUMOR,TRANSNASAL OR TRANS-SPHENOIDAL
VENTRICULOCISTERNOSTOMY (TORKILDSEN TYPE OPERATION)
CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-ATRIAL, -JUGULAR, -AURICULAR
CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-PERITONEAL, -PLEURAL, OTHER TERMINUS
REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER
VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE;
VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE; STEREOTACTIC, NEUROENDOSCOPIC METHOD
CREATION OF SHUNT; VENTRICULO-ATRIAL, -JUGULAR, -AURICULAR
CREATION OF SHUNT; VENTRICULO-PERITONEAL, -PLEURAL, OTHER TERMINUS
REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER
REPLACEMENT OR REVISION OF CEREBROSPINAL FLUID SHUNT, OBSTRUCTED VALVE, OR DISTAL CATHETER IN S
REPROGRAMMING OF PROGRAMMABLE CEREBROSPINAL SHUNT
REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITHOUT REPLACEMENT
REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITH REPLACEMENT BY SIMILAR OR OTHER SH
PERCUTANEOUS LYSIS, EPIDUR ADHES USING SOL INJECT (EG, HYPERTONIC SAL, ENZYME)/MECH MEANS (EG, CA
PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (EG, HYPERTONIC SALINE, ENZYM
PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX
BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER)
INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH
INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR W
INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL, CERVICA
INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR W
INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTED TOMOGRAPHY, SPINAL (OTHER THAN C1-C2 AN
ASPIRATION OR DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL
INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; LUMBAR
INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; CERVICAL OR THORACIC
INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, INTERVERTEBRAL DISK, SINGLE O
INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF ARTERIOVENOUS MALFORMATION, SPINAL
INJECTION, SING (NOT INDWELL CATH),NOT INCL NEUROLYT SUBST,WWO CONTRAST (FOR EITHER LOCAL/EPIDUR
INJECTION, SING (NOT INDWELL CATH),NOT INCL NEUROLYT SUBST,WWO CONTRAST (FOR EITHER LOCAL/EPIDUR
INJECT,INCL CATH PLACE,CONTIN INFUS/INTERMIT BOLUS,NOT INCL NEUROLYT SUB, WWO CONTRAST (EITHER LO
INJECT,INCL CATH PLACE,CONTIN INFUS/INTERMIT BOLUS,NOT INCL NEUROLYT SUB, WWO CONTRAST (EITHER LO
IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL/EPIDURAL CATHETER, FOR LONG-TER
IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OR EPIDURAL CATHETER, FOR IMPLANTABLE RES
REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; SUBCUTANEOUS
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; NON-PROGRAMM
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABL
REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL OR EPIDURAL
ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION
ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOU
LAMINECTOMY WITH EXPLORATION AND/OR DECOMP OF SPINAL CORD AND/OR CAUDA EQUINA, W/O FACETECTO
LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH DECOMPRESSION
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTO
LAMINOTOMY (HEMILAMINECTOMY), W DECOMPRESSION OF NERVE ROOT(S), INCL PARTIAL FACETECTOMY, FORA
LAMINOTOMY (HEMILAMINECTOMY), W DECOMPRESS OF NERVE ROOT(S), INCL PART FACETECT, FORAMINOT &/ E
LAMINOTOMY (HEMILAMINECTOMY), W/DECOMPRESSION OF NERVE ROOT(S), INCLDG PARTIAL FACETECTOMY, FO
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTO
LAMINOTOMY (HEMILAMINECTOMY), W/ DECOMPRESS NERVE ROOT(S), INCL PART FACETECTOMY, FORAMINOTOM
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESS NERVE ROOT(S), INCL PART FACETECTOMY, FORAMINOT
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNI OR BILATERAL W DECOMP OF SPINAL CORD, CAUDA EQ
LAMINECT,FACETECT & FORAMINOT (UNI/BILAT W DECOMP OF SPINAL CORD,CAUDA EQUINA &/ NERVE ROOT(S),(E
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, H
TRANSPEDICULAR APPR W DECOMPRESSION OF SPINAL CORD, EQUINA &/ NERVE ROOT(S) (EG,HERNIATED INTER
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, H
COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S), (EG, HERNIATED IN
COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S), (EG, HERNIATED IN
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S), INCLUDING OSTEOP
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S), INCLUDING OSTEO
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S), INCLUDING OSTEO
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANSTHORACIC APPROAC
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANSTHORACIC APPROAC
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED THORACOLUMBA
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED THORACOLUMBA
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANS/RETROPERITONEAL
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PART/COMP, TRANSPERITONEAL/RETROPERITONEAL
LAMINECTOMY WITH MYELOTOMY (EG, BISCHOF OR DREZ TYPE), CERVICAL, THORACIC OR THORACOLUMBAR
LAMINECTOMY WITH DRAINAGE OF INTRAMEDULLARY CYST/SYRINX; TO SUBARACHNOID SPACE
LAMINECTOMY WITH DRAINAGE OF INTRAMEDULLARY CYST/SYRINX; TO PERITONEAL SPACE
LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT, CERVICAL; ONE OR TW
LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT, CERVICAL; MORE THAN
LAMINECTOMY WITH RHIZOTOMY; ONE OR TWO SEGMENTS
LAMINECTOMY WITH RHIZOTOMY; MORE THAN TWO SEGMENTS
LAMINECTOMY WITH SECTION OF SPINAL ACCESSORY NERVE
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF ONE SPINOTHALAMIC TRACT, ONE STAGE; CERVICAL
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF ONE SPINOTHALAMIC TRACT, ONE STAGE; THORACIC
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, ONE STAGE; CERVICAL
LAMINECTOMY WITH CORDOTOMY, WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, ONE STAGE; THORACIC
LAMINECTOMY WITH CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, TWO STAGES WITHIN 14 DA
LAMINECTOMY WITH CORDOTOMY WITH SECTION OF BOTH SPINOTHALAMIC TRACTS, TWO STAGES WITHIN 14 DA
LAMINECTOMY WITH RELEASE OF TETHERED SPINAL CORD, LUMBAR
LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL CORD; CERVICAL
LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL CORD; THORACIC
LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS MALFORMATION OF SPINAL CORD; THORACO
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN NEOPLASM, EXTRADURAL;
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL; CERVICAL
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL; THORACIC
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL; LUMBAR
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THAN NEOPLASM, INTRADURAL; SACRAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, CERVICAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, THORACIC
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, LUMBAR
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; EXTRADURAL, SACRAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, CERVICAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, THORACIC
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, LUMBAR
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, SACRAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, INTRAMEDULLARY, CERVICAL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, INTRAMEDULLARY, THORACIC
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, INTRAMEDULLARY, THORACOL
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; COMBINED EXTRADURAL-INTRADURAL LESIO
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR EXCISION OF INTRASPI
CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODALITY (INCLUDIN
STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT FOLLOWED BY OT
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, SPINAL CORD
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL
REVISION OR REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S) OR PLATE/PADDL
INCISION AND SUBCUTANEOUS PLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, D
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
REPAIR OF MENINGOCELE; LESS THAN 5 CM DIAMETER
REPAIR OF MENINGOCELE; LARGER THAN 5 CM DIAMETER
REPAIR OF MYELOMENINGOCELE; LESS THAN 5 CM DIAMETER
REPAIR OF MYELOMENINGOCELE; LARGER THAN 5 CM DIAMETER
REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, NOT REQUIRING LAMINECTOMY
REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK OR PSEUDOMENINGOCELE, WITH LAMINECTOMY
DURAL GRAFT, SPINAL

CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; INCLUDING LAMINECTOMY
CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; PERCUTANEOUS, NOT REQU
REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT
REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT
INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH
INJECTION, ANESTHETIC AGENT; FACIAL NERVE
INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE
INJECTION, ANESTHETIC AGENT; VAGUS NERVE
INJECTION, ANESTHETIC AGENT; PHRENIC NERVE
INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE
INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS
INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, SINGLE
INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETE
INJECTION, ANESTHETIC AGENT; AXILLARY NERVE
INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE
INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK
INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES
INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE
INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE) NERVE
INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER, (INCLUDING CATHETER
INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER
INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; CERV
INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; CERV
INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; LUMB
INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; LUMB
INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR THORACIC, SINGL
INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR THORACIC, EACH
INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR SACRAL, SINGLE LE
INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; LUMBAR OR SACRAL, EACH ADD
INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE)
INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING
APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLUDES SACRAL
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORAMINAL PLAC
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLUDES SACRAL NE
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORAMINAL PLACEM

REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES
INCISION AND SUBCUTANEOUS PLACEMENT OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIV
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SUPRAORBITAL, INFRAORBITAL, MENTAL, OR INFERIO
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT FORAM
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT FORAM
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE (EG, FOR BLEPHAROSPASM, HE
CHEMODENERVATION OF MUSCLE(S); CERVICAL SPINAL MUSCLE(S) (EG, FOR SPASMODIC TORTICOLLIS)
CHEMODENERVATION OF MUSCLE(S); EXTREMITY(S) AND/OR TRUNK MUSCLE(S) (EG, FOR DYSTONIA, CEREBRAL
DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; LUMBAR OR SACRAL, SINGLE LEV
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; LUMBAR OR SACRAL, EACH ADDIT
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; CERVICAL OR THORACIC, SINGLE
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; CERVICAL OR THORACIC, EACH AD
DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
DESTRUCTION BY NEUROLYTIC AGENT, CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING
NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT
NEUROPLASTY; NERVE OF HAND OR FOOT
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; OTHER THAN SPECIFIED
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; SCIATIC NERVE
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; BRACHIAL PLEXUS
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS
NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)
DECOMPRESSION; PLANTAR DIGITAL NERVE
INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE
TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE
TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE
TRANSECTION OR AVULSION OF; MENTAL NERVE
TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY
TRANSECTION OR AVULSION OF; LINGUAL NERVE
TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE
TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE
TRANSECTION OR AVULSION OF; PHRENIC NERVE
TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), TRANSTHORACIC
TRANSECTION OR AVULSION OF; VAGUS NERVES LIMITED TO PROXIMAL STOMACH (SELECTIVE PROXIMAL VAGOT
TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), ABDOMINAL
TRANSECTION OR AVULSION OF; PUDENDAL NERVE
TRANSECTION OR AVULSION OF OBTURATOR NERVE, EXTRAPELVIC, WITH OR WITHOUT ADDUCTOR TENOTOMY
TRANSECTION OR AVULSION OF OBTURATOR NERVE, INTRAPELVIC, WITH OR WITHOUT ADDUCTOR TENOTOMY
TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL
TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL
EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE
EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT
EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR P
EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE
EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT (LIST SEPARATELY IN AD
EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC
EXCISION OF NEUROMA; SCIATIC NERVE
IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION)
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL NERVE
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; EXTENSIVE (INCLUDING MALIGNANT TYPE)
BIOPSY OF NERVE
SYMPATHECTOMY, CERVICAL
SYMPATHECTOMY, CERVICOTHORACIC
SYMPATHECTOMY, THORACOLUMBAR
SYMPATHECTOMY, LUMBAR
SYMPATHECTOMY; DIGITAL ARTERIES, EACH DIGIT
SYMPATHECTOMY; RADIAL ARTERY
SYMPATHECTOMY; ULNAR ARTERY
SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH
SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE
SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST SEPARATELY IN ADDITION TO
SUTURE OF ONE NERVE, HAND OR FOOT; COMMON SENSORY NERVE
SUTURE OF ONE NERVE, HAND OR FOOT; MEDIAN MOTOR THENAR
SUTURE OF ONE NERVE, HAND OR FOOT; ULNAR MOTOR
SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PR
SUTURE OF POSTERIOR TIBIAL NERVE
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; INCLUDING TRANSPOSITION
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT TRANSPOSITION
SUTURE OF SCIATIC NERVE
SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMAR
SUTURE OF; BRACHIAL PLEXUS
SUTURE OF; LUMBAR PLEXUS
SUTURE OF FACIAL NERVE; EXTRACRANIAL
SUTURE OF FACIAL NERVE; INFRATEMPORAL, WITH OR WITHOUT GRAFTING
ANASTOMOSIS; FACIAL-SPINAL ACCESSORY
ANASTOMOSIS; FACIAL-HYPOGLOSSAL
ANASTOMOSIS; FACIAL-PHRENIC
SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN ADDITION TO CODE FOR
SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE (LIST SEPARATELY IN A
SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN ADDITION TO CODE
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM IN LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; MORE THAN 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; UP TO 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; MORE THAN 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; UP TO 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; MORE THAN 4 CM LE
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; UP TO 4 CM LENGTH
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; MORE THAN 4 CM LENG
NERVE GRAFT, EACH ADDITIONAL NERVE; SINGLE STRAND (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMAR
NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE) (LIST SEPARATELY IN ADDITION TO CODE F
NERVE PEDICLE TRANSFER; FIRST STAGE
NERVE PEDICLE TRANSFER; SECOND STAGE
UNLISTED PROCEDURE, NERVOUS SYSTEM
EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT
EVISCERATION OF OCULAR CONTENTS; WITH IMPLANT
ENUCLEATION OF EYE; WITHOUT IMPLANT
ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES NOT ATTACHED TO IMPLANT
ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHED TO IMPLANT
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL CONTENTS; ONLY
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL CONTENTS; WITH THERAPEU
EXENTERATION OF ORBIT (DOES NOT INCLUDE SKIN GRAFT), REMOVAL OF ORBITAL CONTENTS; WITH MUSCLE O
MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLING RECEPTACLE
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER EVISCERATION, IN SCLERAL SHELL
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES NOT ATTACHED TO IMPLANT
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT
REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT
REINSERTION OF OCULAR IMPLANT; WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT AND/OR ATTACHME
REMOVAL OF OCULAR IMPLANT
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES CONCRETIONS), SUBCONJU
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OF EYE OR LENS
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC EXTRACTION, ANTERIOR O
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC EXTRACTION
REPAIR OF LACERATION; CONJUNCTIVA, WITH OR WITHOUT NONPERFORATING LACERATION SCLERA, DIRECT CL
REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT HOSPITALIZATION
REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITH HOSPITALIZATION
REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN BODY
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR RESECTION OF UVEAL
REPAIR OF LACERATION; APPLICATION OF TISSUE GLUE, WOUNDS OF CORNEA AND/OR SCLERA
REPAIR OF WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR TENON'S CAPSULE
EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR, PARTIAL), EXCEPT PTERYGIUM
BIOPSY OF CORNEA
EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT
EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT
SCRAPING OF CORNEA, DIAGNOSTIC, FOR SMEAR AND/OR CULTURE
REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION (ABRASION, CURETTAGE)
REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)
DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY, PHOTOCOAGULATION OR THERMOCAUTERIZATION
MULTIPLE PUNCTURES OF ANTERIOR CORNEA (EG, FOR CORNEAL EROSION, TATTOO)
KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA)
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN APHAKIA)
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA)
KERATOMILEUSIS
KERATOPHAKIA
EPIKERATOPLASTY
KERATOPROSTHESIS
RADIAL KERATOTOMY
CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH DIAGNOSTIC ASPIRATION OF AQ
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH THERAPEUTIC RELEASE OF AQU
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF VITREOUS AND/OR
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF BLOOD, WITH OR
GONIOTOMY
TRABECULOTOMY AB EXTERNO
TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT SERIES)
SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE)
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION
REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER OF EYE
REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT OF EYE
REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT OF EYE
INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); AIR OR LIQUID
INJECTION, ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); MEDICATION
EXCISION OF LESION, SCLERA
FISTULIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION WITH IRIDECTOMY
FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY
FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY
FISTULIZATION OF SCLERA FOR GLAUCOMA; IRIDENCLEISIS OR IRIDOTASIS
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGE
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO WITH SCARRING FROM PREVIOUS
AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR (EG, MOLTENO, SCHOCKET, DENVER-KRUPIN)
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR
REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT
REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT
REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR MIN
IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPT TRANSFIXION
IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); WITH TRANSFIXION AS FOR IRIS BOMBE
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; WITH CYCLECTOMY
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCED
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA (SEPARATE PROCEDURE)
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; "OPTICAL" (SEPARATE PROCEDURE)
REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS)
SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE THROUGH SMALL INCISIO
CILIARY BODY DESTRUCTION; DIATHERMY
CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION
CILIARY BODY DESTRUCTION; CRYOTHERAPY
CILIARY BODY DESTRUCTION; CYCLODIALYSIS
IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (EG, FOR GLAUCOMA) (ONE OR MORE SESSIONS)
IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF VISION, FOR WIDE
DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY (NONEXCISIONAL PROCEDURE)
DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIO
DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIO
REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE)
REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR
REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES
REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOE
REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY
REMOVAL OF LENS MATERIAL; INTRACAPSULAR
REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS
REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)
XCAPSULAR CTRCT REM W INS, IOL PRSTH,MAN/MECH TECHN,CMPLX,REQ S/TECHNS NO GENLY USED ROUTINE
INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PR
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROC
INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT
EXCHANGE OF INTRAOCULAR LENS
USE OF OPHTHALMIC ENDOSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVA
ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDAL FLUID, PARS PLANA APPROACH (POSTERIO
INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBAL APPROACH, (FLUID-GAS EXCHANGE), WITH OR W
IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG, GANCICLOVIR IMPLANT), INCLUDES CONCOMITAN
INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)
DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA APPROACH
SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR OPACITIES, LASER S
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH EPIRETINAL MEMBRANE STRIPPING
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER PHOTOCOAGULATION
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL PHOTOCOAGULATION
REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; CRYOTHERAPY OR DIATHERMY, WITH OR WITHOUT
REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC, ONE
REPAIR RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL DISSECTION, IMBRICATION OR
REPAIR RETINAL DETACHMENT; W/VITRECTOMY, ANY METHOD, W W/O AIR OR GAS TAMPONADE, FOCAL ENDOLAS
REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; BY INJECTION OF AIR OR OTHER GAS (EG, PNEUMA
REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING PREVIOUS IPSIL
RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT)
REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; EXTRAOCULAR
REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE, O
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE, O
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR MORE SESSIONS; CR
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAR EDEMA, TUMORS), ONE OR MORE SESSIONS; PH
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE O
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); PHOTOCOAGULATI
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); PHOTODYNAMIC TH
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); PHOTODYNAMIC TH
DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SE
DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SE

SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT
SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT
UNLISTED PROCEDURE, POSTERIOR SEGMENT
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE HORIZONTAL MUSCLE
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TW
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ON
STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TW
STRABISMUS SURGERY, ANY PROCEDURE, SUPERIOR OBLIQUE MUSCLE
TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIF
STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE EXTR
STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR OCULAR INJURY, S
STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCLE RECESSION
PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING POSTOPERATIVE ADJUSTM
STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR MUSCLE(S) (LIS
RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE PROCEDURE)
CHEMODENERVATION OF EXTRAOCULAR MUSCLE
BIOPSY OF EXTRAOCULAR MUSCLE
UNLISTED PROCEDURE, OCULAR MUSCLE
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLORATION, WITH O
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH DRAINAGE ONLY
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF FOREIG
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF BONE F
FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF LESION
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF FOREIGN
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH DRAINAGE
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF BONE FO
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); FOR EXPLORATION, WITH OR
RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION)
RETROBULBAR INJECTION; ALCOHOL
INJECTION OF MEDICATION OR OTHER SUBSTANCE INTO TENON'S CAPSULE
ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION
ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL OR REVISION
OPTIC NERVE DECOMPRESSION (EG, INCISION OR FENESTRATION OF OPTIC NERVE SHEATH)
UNLISTED PROCEDURE, ORBIT
BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
SEVERING OF TARSORRHAPHY
CANTHOTOMY (SEPARATE PROCEDURE)
EXCISION OF CHALAZION; SINGLE
EXCISION OF CHALAZION; MULTIPLE, SAME LID
EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS
EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING HOSPITALIZATION, SINGLE OR MULT
BIOPSY OF EYELID
CORRECTION OF TRICHIASIS; EPILATION, BY FORCEPS ONLY
CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY ELECTROSURGERY, CRYOTHERAPY,
CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN
CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE GRAFT
EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE DIRECT CLOSURE
DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY; WITH TRANSP
REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH)
REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL
REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING FASC
REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, INTERNAL APPROACH
REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH
REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING FASC
REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'S MUSCLE-LEVATOR RESECTION (EG, FASANELLA-S
REDUCTION OF OVERCORRECTION OF PTOSIS
CORRECTION OF LID RETRACTION
REPAIR OF ECTROPION; SUTURE
REPAIR OF ECTROPION; THERMOCAUTERIZATION
REPAIR OF ECTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE
REPAIR OF ECTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, KUHNT-SZYMANOWSKI OR TARSAL STRIP OPERATIO
REPAIR OF ENTROPION; SUTURE
REPAIR OF ENTROPION; THERMOCAUTERIZATION
REPAIR OF ENTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE
REPAIR OF ENTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, WHEELER OPERATION)
SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIREC
SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIREC
REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
CANTHOPLASTY (RECONSTRUCTION OF CANTHUS)
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNES
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNES
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING
UNLISTED PROCEDURE, EYELIDS
INCISION OF CONJUNCTIVA, DRAINAGE OF CYST
EXPRESSION OF CONJUNCTIVAL FOLLICLES, EG, FOR TRACHOMA
BIOPSY OF CONJUNCTIVA
EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM
EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA
DESTRUCTION OF LESION, CONJUNCTIVA
SUBCONJUNCTIVAL INJECTION
CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT
CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT)
CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANG
CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES O
REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT
REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE (INCLUDES OBT
REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OR C
CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE)
CONJUNCTIVAL FLAP; TOTAL (SUCH AS GUNDERSON THIN FLAP OR PURSE STRING FLAP)
UNLISTED PROCEDURE, CONJUNCTIVA
INCISION, DRAINAGE OF LACRIMAL GLAND
INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR DACRYOCYSTOSTOMY)
SNIP INCISION OF LACRIMAL PUNCTUM
EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; TOTAL
EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; PARTIAL
BIOPSY OF LACRIMAL GLAND
EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY)
BIOPSY OF LACRIMAL SAC
REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES
EXCISION OF LACRIMAL GLAND TUMOR; FRONTAL APPROACH
EXCISION OF LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOMY
PLASTIC REPAIR OF CANALICULI
CORRECTION OF EVERTED PUNCTUM, CAUTERY
DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY)
CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITHOUT TUBE
CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITH INSERTION OF TUBE OR
CLOSURE OF THE LACRIMAL PUNCTUM; BY THERMOCAUTERIZATION, LIGATION, OR LASER SURGERY
CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH
CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)
DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL ANESTHESIA
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT
PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION
INJECTION OF CONTRAST MEDIUM FOR DACRYOCYSTOGRAPHY
UNLISTED PROCEDURE, LACRIMAL SYSTEM
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED
DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
EAR PIERCING
BIOPSY EXTERNAL EAR
BIOPSY EXTERNAL AUDITORY CANAL
EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
EXCISION EXTERNAL EAR; COMPLETE AMPUTATION
EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL
EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL
RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITHOUT NECK DISSECTION
RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITH NECK DISSECTION
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS
DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE CLEANING)
DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN ROUTINE CLEANING)
OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECT
RECONSTRUCTION EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA, SINGLE STAGE
UNLISTED PROCEDURE, EXTERNAL EAR
EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITH CATHETERIZATION

EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITHOUT CATHETERIZATION
EUSTACHIAN TUBE CATHETERIZATION, TRANSTYMPANIC
FOCAL APPLICATION OF PHASE CONTROL SUBSTANCE, MIDDLE EAR (BAFFLE TECHNIQUE)
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESI
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR TOPICAL ANESTHESIA
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION
TYMPANOLYSIS, TRANSCANAL
TRANSMASTOID ANTROTOMY ("SIMPLE" MASTOIDECTOMY)
MASTOIDECTOMY; COMPLETE
MASTOIDECTOMY; MODIFIED RADICAL
MASTOIDECTOMY; RADICAL
PETROUS APICECTOMY INCLUDING RADICAL MASTOIDECTOMY
RESECTION TEMPORAL BONE, EXTERNAL APPROACH
EXCISION AURAL POLYP
EXCISION AURAL GLOMUS TUMOR; TRANSCANAL
EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID
EXCISION AURAL GLOMUS TUMOR; EXTENDED (EXTRATEMPORAL)
REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MASTOIDECTOMY
REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADICAL MASTOIDECTOMY
REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTOIDECTOMY
REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY
REVISION MASTOIDECTOMY; WITH APICECTOMY
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OR PERFORATION FOR CLOSURE, WITH O
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
TYMPANOPLASTY W/O MASTOIDECTOMY (INC CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIA
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR S
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRA
STAPES MOBILIZATION
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT US
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT US
REVISION OF STAPEDECTOMY OR STAPEDOTOMY
REPAIR OVAL WINDOW FISTULA
REPAIR ROUND WINDOW FISTULA
MASTOID OBLITERATION (SEPARATE PROCEDURE)
TYMPANIC NEURECTOMY
CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE)
IMPLANTATION OR REPLACEMENT OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL B

REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHMENT TO EXTERN
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHMENT TO EXTERN
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WIT
REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WIT
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL TO GENICULATE GANGLION
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; INCLUDING MEDIAL TO GENICULATE GANGLION
SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION; LATERAL TO GENICU
SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION; INCLUDING MEDIAL T
UNLISTED PROCEDURE, MIDDLE EAR
LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE PROC
LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY OR OTHER NONEXCISIONAL DESTRUCTIVE PROCEDURES
ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT
ENDOLYMPHATIC SAC OPERATION; WITH SHUNT
FENESTRATION SEMICIRCULAR CANAL
REVISION FENESTRATION OPERATION
LABYRINTHECTOMY; TRANSCANAL
LABYRINTHECTOMY; WITH MASTOIDECTOMY
VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH
COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY
UNLISTED PROCEDURE, INNER EAR
VESTIBULAR NERVE SECTION, TRANSCRANIAL APPROACH
TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT)
DECOMPRESSION INTERNAL AUDITORY CANAL
REMOVAL OF TUMOR, TEMPORAL BONE
UNLISTED PROCEDURE, TEMPORAL BONE, MIDDLE FOSSA APPROACH
MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO
MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION
CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY
RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS
RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE
RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE
RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE
RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS
RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF THREE VIEWS
DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION; OPTIC FORAMINA
RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS
RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, SELLA TURCICA
RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS, WITH OR WITHOUT STEREO
RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS, WITH OR WITHOUT STEREO
RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW
RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS THAN FULL MOUTH
RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH

RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; UNILATERAL
RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; BILATERAL
TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULAR JOINT(S)
CEPHALOGRAM, ORTHODONTIC
ORTHOPANTOGRAM
RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE
RADIOLOGIC EXAMINATION; PHARYNX OR LARYNX, INCLUDING FLUOROSCOPY AND/OR MAGNIFICATION TECHNIQ
COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY CINE OR VIDEO RECORDING
LARYNGOGRAPHY, CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS
SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIA
COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT C
COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITH CONT
COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT C
COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL,FOLLOWED BY CONTRAST MAT
COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL FOLLOWED BY CONTRAST MATE
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK; WITHOUT CONTRAST MATERIAL(S), FOL
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MA
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MA
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIA
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIA
RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL
RADIOLOGIC EXAMINATION, CHEST; STEREO, FRONTAL
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL;
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE PROJECTIONS
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH FLUOROSCOPY
RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS;
RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; WITH FLUOROSCOPY
RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES)
BRONCHOGRAPHY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
BRONCHOGRAPHY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION

INSERTION PACEMAKER, FLUOROSCOPY AND RADIOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS
RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF THREE VIEW
RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS
RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS, MINIMUM OF THREE VIEWS
COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AN
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST
MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMP
MAGNETIC RESONANCE ANGIOGRAPHY, CHEST (EXCLUDING MYOCARDIUM), WITH OR WITHOUT CONTRAST MATE
RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL
RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; TWO OR THREE VIEWS
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSIO
RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS)
RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS
RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS
RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR, TWO VIEWS
RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT STUDIES
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; MINIMUM OF FOUR VIEWS
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS
COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERI
COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATER
COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITH CONTRAST MA
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAS
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITH CONTRAST MA
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST M
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITH CONTRAST MATE
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL
MAGNETIC RESONANCE ANGIOGRAPHY, SPINAL CANAL AND CONTENTS, WITH OR WITHOUT CONTRAST MATERIAL
RADIOLOGIC EXAMINATION, PELVIS; ONE OR TWO VIEWS
RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAS
COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CON
MAGNETIC RESONANCE ANGIOGRAPHY, PELVIS, WITH OR WITHOUT CONTRAST MATERIAL(S)
RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS
RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS
RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS
MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MYELOGRAPHY, ENTIRE SPINAL CANAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
DISKOGRAPHY, CERVICAL OR THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE
RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE
RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW
RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED DISTRACTI
RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, ELBOW; TWO VIEWS
RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION; FOREARM, TWO VIEWS
RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, WRIST; TWO VIEWS
RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, HAND; TWO VIEWS
RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS
COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL,FOLLOWED BY CONTRAST MATER
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED B
MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST M
MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATE
MAGNETIC RESONANCE IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S), FO
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERI
MAGNETIC RESONANCE IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOW
MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY, WITH OR WITHOUT CONTRAST MATERIAL(S)

RADIOLOGIC EXAMINATION, HIP UNILATERAL; ONE VIEW
RADIOLOGIC EXAMINATION, HIP UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF TWO VIEWS OF EACH HIP, INCLUDING ANTEROPOSTER
RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE
RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT OR CHILD, MINIMUM OF TWO VIEWS
RADIOLOGICAL EXAMINATION, SACROILIAC JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRE
RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS
RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS
RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS
RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE VIEWS
RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR
RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS
RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION, ANKLE; TWO VIEWS
RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, FOOT; TWO VIEWS
RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF THREE VIEWS
RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS
RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS
COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL,FOLLOWED BY CONTRAST MATE
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED B
MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST M
MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH CONTRAST MATE
MAGNETIC RESONANCE IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S), FO
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATER
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATER
MAGNETIC RESONANCE ANGIOGRAPHY, LOWER EXTREMITY, WITH OR WITHOUT CONTRAST MATERIAL(S)
RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW
RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR AND ADDITIONAL OBLIQUE AND CONE VIEWS
RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDING DECUBITUS AND/OR ERECT VIEWS
RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/OR
COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL
COMPUTED TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S)
COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) A
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTR
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITH CONTRAST MATERIAL(S)
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY W
MAGNETIC RESONANCE ANGIOGRAPHY, ABDOMEN, WITH OR WITHOUT CONTRAST MATERIAL(S)
PERITONEOGRAM (EG, AFTER INJECTION OF AIR OR CONTRAST), RADIOLOGICAL SUPERVISION AND INTERPRETA
RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS
RADIOLOGIC EXAMINATION; ESOPHAGUS
SWALLOWING FUNCTION, WITH CINERADIOGRAPHY/VIDEORADIOGRAPHY

REMOVAL OF FOREIGN BODY(S), ESOPHAGEAL, WITH USE OF BALLOON CATHETER, RADIOLOGICAL SUPERVISION
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITHOUT K
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITH KUB
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL INTESTINE, INCLUDES MULTIPLE SE
RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY
RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS;
RADIOLOGIC EXAMINATION, SMALL INTESTINE, INCLUDES MULTIPLE SERIAL FILMS; VIA ENTEROCLYSIS TUBE
DUODENOGRAPHY, HYPOTONIC
RADIOLOGIC EXAMINATION, COLON; BARIUM ENEMA, WITH OR WITHOUT KUB
RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFIC HIGH DENSITY BARIUM, WITH OR WITHOUT G
BARIUM ENEMA, THERAPEUTIC, FOR REDUCTION OF INTUSSUSCEPTION
CHOLECYSTOGRAPHY, ORAL CONTRAST;
CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE DAY EXAMINATION
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPR
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONAL SET INTRAOPERATIVE, RADIOLOGICAL SUPERVIS
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; THROUGH EXISTING CATHETER, RADIOLOGICAL SUPERVISION
CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
POSTOPERATIVE BILIARY DUCT CALCULUS REMOVAL, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE (E
ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRET
ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTER
COMBINED ENDOSCOPIC CATHETERIZATION OF THE BILIARY AND PANCREATIC DUCTAL SYSTEMS, RADIOLOGICAL
INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT), INCLUDING MULTIPLE FLUOROSCOPIE
PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL SUPERVISI
PERCUTANEOUS TRANSHEPATIC DILATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF STE
UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOGRAPHY;
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE;
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH NEPHROTOMOGRAPHY
UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB
UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM, NEPHROSTOGRAM, LOOPOGRAM), RADIOLOGICAL SUPERVISION A
CYSTOGRAPHY, MINIMUM OF THREE VIEWS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VASOGRAPHY, VESICULOGRAPHY, OR EPIDIDYMOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION AND INTERPRETATION
RADIOLOGIC EXAMINATION, RENAL CYST STUDY, TRANSLUMBAR, CONTRAST VISUALIZATION, RADIOLOGICAL SUP
INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERC
INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND
DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION
PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION
HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATION OR EXTENT OF ANOMALIES)
CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITHOUT CONTRAST MATERIAL
CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITH CONTRAST MATERIAL
CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; COMPLETE STUD
CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY;LIMITED STUDY
CARDIAC MAGNETIC RESONANCE IMAGING FOR VELOCITY FLOW MAPPING
AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY
COMPUTD TOMOGRAPH ANGIOGRAPHY,ABDOMIN AORTA & BILATRL ILIOFEMORAL LOW EXTREMITY RUNOFF,RADL
ANGIOGRAPHY, CERVICOCEREBRAL, CATHETER, INCLUDING VESSEL ORIGIN, RADIOLOGICAL SUPERVISION AND I
ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, EXTERNAL CAROTID, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATIO
ANGIOGRAPHY, EXTERNAL CAROTID, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, CAROTID, CEREBRAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, CAROTID, CEREBRAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, CAROTID, CERVICAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, CAROTID, CERVICAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, VERTEBRAL, CERVICAL, AND/OR INTRACRANIAL, RADIOLOGICAL SUPERVISION AND INTERPRETAT
ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, RENAL, UNILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION
ANGIOGRAPHY, RENAL, BILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION A
ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE, (WITH OR WITHOUT FLUSH AORTOGRAM), RADIOLO
ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, PULMONARY, BY NONSELECTIVE CATHETER OR VENOUS INJECTION, RADIOLOGICAL SUPERVISIO
ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED AFTER BASIC EXAMINATION, RADIOLOGICAL SUP
ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETA
LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN S
SPLENOPORTOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, SINUS OR JUGULAR, CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, EPIDURAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION

PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISIO
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERV
HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND
HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION
VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR PARATHYROID HORMONE
TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, RADIOLOGICAL SUPERVISION AND INTERPRETATION
TRANSCATHETER THERAPY, INFUSION, ANY METHOD (EG, THROMBOLYSIS OTHER THAN CORONARY), RADIOLOGI
ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOL
EXCHANGE OF A PREVIOUSLY PLACED ARTERIAL CATHETER DURING THROMBOLYTIC THERAPY WITH CONTRAST
MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM CENTRAL VENOU
MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM CENTRAL VENOUS D
PERCUTANEOUS PLACEMENT OF IVC FILTER, RADIOLOGICAL SUPERVISION AND INTERPRETATION
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND INTERPRETATION;
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICAL SUPERVISION AND INTERPRETATION;
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION, RADIOLOGICAL SUPER
PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF INFRARENAL AO
ENDOVASCULAR REPAIR OF ILIAC ARTERY ANEURYSM, PSEUDOANEURYSM, ARTERIOVENOUS MALFORMATION, O
TRANSCATHETER INTRODUCTION OF INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), PERCUTANEOUS AN
TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY (EG, FRACTURED VENOUS O
TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATI
TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION A
TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND
TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND
TRANSCATHETER BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIAN STENOSIS), RADIOLOGICAL SUPERVISION AN
PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE WITH CONTRAST MONITORING, RADIOLOGICAL SUPERVISION
PERCUTANEOUS PLACEMENT OF DRAINAGE CATH FOR COMBINED INT/EXTERNAL BILIARY DRAINAGE FOR INTERN
CHANGE OF PERCUTANEOUS TUBE OR DRAINAGE CATHETER WITH CONTRAST MONITORING (EG, GASTROINTEST
RADIOLOGICAL GUIDANCE (IE, FLUOROSCOPY, ULTRASOUND,/COMPUTED TOMOGRAPHY),, PERCUTANEOUS DRA
TRANSLUMINAL ATHERECTOMY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTER
TRANSLUMINAL ATHERECTOMY, RENAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
TRANSLUMINAL ATHERECTOMY, VISCERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPR
FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHER THAN 71023 OR 71034 (EG, C
FLUOROSCOPY, PHYSICIAN TIME MORE THAN ONE HOUR, ASSISTING A NON-RADIOLOGIC PHYSICIAN (EG, NEPHR
FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVIC
FLUOROSCOPIC GUIDE & LOCAL OF NEEDLE/CATH TIP FOR SPINE/PARASPINOUS DIAG/THERAP INJ PROC (EPIDUR
MANUAL APPLICATION OF STRESS PERFORMED BY PHYSICIAN FOR JOINT RADIOGRAPHY, INCLUDING CONTRALAT
RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY, SINGLE VIEW, CHILD
RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, PER VERTEBRAL BODY
RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, PER VERTEBRAL BODY
BONE AGE STUDIES
BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM)
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES)
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON)
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT
JOINT SURVEY, SINGLE VIEW, TWO OR MORE JOINTS (SPECIFY)
COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, ONE OR MORE SITES; AXIAL SKELETON (EG, HIPS, PE
COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR SKELETON (PE
DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY
DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY, ONE OR MORE SITES;APPENDICULAR SK
RADIOGRAPHIC ABSORPTIOMETRY (EG, PHOTODENSITOMETRY, RADIOGRAMMETRY), ONE OR MORE SITES
RADIOLOGIC EXAMINATION, FISTULA OR SINUS TRACT STUDY, RADIOLOGICAL SUPERVISION AND INTERPRETATIO
DIGITIZATION OF FILM RADIOGRAPHIC IMAGES WITH COMPUTER ANALYSIS FOR LESION DETECTION&FURTHER P
MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION
MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND INTERPRETATI
MAMMOGRAPHY; UNILATERAL
MAMMOGRAPHY; BILATERAL
SCREENING MAMMOGRAPHY, BILATERAL (TWO VIEW FILM STUDY OF EACH BREAST)
MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UNILATERAL
MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BILATERAL
STEREOTACTIC LOCALIZATION GUIDANCE FOR BREAST BIOPSY OR NEEDLE PLACEMENT (EG, FOR WIRE LOCALIZ
MAMMOGRAPHIC GUIDANCE FOR NEEDLE PLACEMENT, BREAST (EG, FOR WIRE LOCALIZATION OR FOR INJECTIO
RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN
RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), OTHER THAN WITH UROGRAPHY
RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID POLYTOMOG
RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID POLYTOMOG
CINERADIOGRAPHY/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED
CINERADIOGRAPHY/VIDEORADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION (LIST SEPARATELY IN ADDITIO
CONSULTATION ON X-RAY EXAMINATION MADE ELSEWHERE, WRITTEN REPORT
XERORADIOGRAPHY
SUBTRACTION IN CONJUNCTION WITH CONTRAST STUDIES
COMPUTED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION
COMPUTED TOMOGRAPHY GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZA
COMPUTERIZED AXIAL TOMOGRAPHIC GUIDANCE FOR, AND MONITORING OF, TISSUE ABLATION
COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS
CORONAL, SAGITTAL, MULTIPLANAR, OBLIQUE, 3-DIMENSIONAL AND/OR HOLOGRAPHIC RECONSTRUCTION OF CO
COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY
MAGNETIC RESONANCE SPECTROSCOPY
MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRATION, INJECTION
MAGNETIC RESONANCE GUIDANCE FOR, AND MONITORING OF, TISSUE ABLATION
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW BLOOD SUPPLY
ULTRASOUND GUIDANCE FOR, AND MONITORING OF, TISSUE ABLATION
UNLISTED FLUOROSCOPIC PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
UNLISTED COMPUTED TOMOGRAPHY PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
UNLISTED MAGNETIC RESONANCE PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE
ECHOENCEPHALOGRAPHY, B-SCAN AND/OR REAL TIME W IMAGE DOC (GRAY SCALE) (FOR VENTRICULAR SIZE, DE
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; A-SCAN ONLY, WITH AMPLITUDE QUANTIFICATION
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; CONTACT B-SCAN (WITH OR WITHOUT SIMULTANEOUS A
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; ANTERIOR SEGMENT ULTRASOUND, IMMERSION (WATE
OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN;
OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATIO
OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), B-SCAN AND/OR REAL
ULTRASOUND, CHEST, B-SCAN (INCLUDES MEDIASTINUM) AND/OR REAL TIME WITH IMAGE DOCUMENTATION
ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATIO
ULTRASOUND, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
ULTRASOUND, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORG
ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUM
ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUM
ULTRASOUND, TRANSPLANTED KIDNEY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION, WITH OR WIT
ULTRASOUND, SPINAL CANAL AND CONTENTS
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL&MATERNAL EVALUATION, F
ULTRASOUND, PREGNANT UTERUS, REAL TIME W IMAGE DOCUMENTATION, FETAL&MATERNAL EVAL, 1ST TRIMES
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATIO
ULTRASOUND, PREGNANT UTERUS, REAL TME W IMAGE DOCUMENT, FETAL&MATERNAL EVAL, AFTER 1ST TRIMES
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATIO
ULTRASOUND, PREGNANT UTERUS, REAL TIME W IMAGE DOCUMENT, FETAL&MATERNAL EVAL+DETAILED FETAL A
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (EG, FETAL HEART BEAT, P
US, PRGNANT UTERUS, REAL TME W IMG DOCUMENTATION, F/U (EG, RE-EVAL, ORGAN SYST(S) SUSPECTED/CONF
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION,TRANSVAGINAL
FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS TESTING
FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D) WITH O
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D) WITH O
DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, PULSED WAVE AND/OR CONTINUOUS WAVE
DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, PULSED WAVE AND/OR CONTINUOUS WAVE
ULTRASOUND, TRANSVAGINAL
HYSTEROSONOGRAPHY, WITH OR WITHOUT COLOR FLOW DOPPLER
ULTRASOUND, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
ULTRASOUND, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED OR
ULTRASOUND, SCROTUM AND CONTENTS
ECHOGRAPHY, TRANSRECTAL
ECHOGRAPHY, TRANSRECTAL; PROSTATE VOLUME STUDY FOR BRACHYTHERAPY TREATMENT PLANNING (SEPAR
ULTRASOUND, EXTREMITY, NON-VASCULAR, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION
ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC (REQUIRING PHYSICIAN MANI
ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC (NOT REQUIRING PHYS
ULTRASONIC GUIDANCE FOR PERICARDIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION
ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY, IMAGING SUPERVISION AND INTERPRETATION
ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDOANEURYSM OR ARTERIOVENOUS FISTULAE (
ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL TRANSFUSION OR CORDOCENTESIS, IMAGING SUPERVISION
ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE),
ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, IMAGING SUPERVISION AND INTERPRETATION
ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION
ULTRASONIC GUIDANCE FOR ASPIRATION OF OVA, IMAGING SUPERVISION AND INTERPRETATION
ULTRASONIC GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS
ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENT APPLICATION
ULTRASOUND STUDY FOLLOW-UP (SPECIFY)
GASTROINTESTINAL ENDOSCOPIC ULTRASOUND, SUPERVISION AND INTERPRETATION
ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY METHOD
ULTRASONIC GUIDANCE, INTRAOPERATIVE
UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX

THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; INTERMEDIATE
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; COMPLEX
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; BY THREE-DIMENSIONAL RECONSTRUCTION OF T
UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY CLINICAL TREATMENT PLANNING
BASIC RAD DOSIMETRY CALC,CENTRL AXIS DPTH DOS CALC,TDF,NSD,GAP CALC,OFF AXIS FACTOR,TISS INHOMOG
INTENSITY MODULATED RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS FOR TARGET AND CRITIC
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); SIMPLE (ONE OR TWO PARALLEL
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); INTERMEDIATE (THREE OR MORE
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); COMPLEX (MANTLE OR INVERTED
SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMI-BODY, TOTAL BODY
BRACHYTHERAPY ISODOSE PLAN; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR SOURCES/R
BRACHYTHERAPY ISODOSE PLAN; INTERMEDIATE (MULTIPLANE DOSAGE CALCULATIONS, APPLICATION INVOLVIN
BRACHYTHERAPY ISODOSE PLAN; COMPLEX (MULTIPLANE ISODOSE PLAN, VOL IMPLANT CALCULATIONS, OVER 1
SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING PHYS
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE (SIMPLE BLOCK, SIMPLE BOLUS)
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE (MULTIPLE BLOCKS, STENTS, BITE BLOCKS,
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL SHIELDS, COMPEN
CONTINUING MEDICAL PHYSICS CONSULT, INCL ASSESSMENT OF TREAT PARAMETERS, QUALITY ASSURANCE OF
SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION
UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS, DOSIMETRY AND TREATMENT DEVICES, AND SPECIAL SER
RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE
RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIM
RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TR
RADIATION TREATMENT DELIVERY, >=3 SEPARATE TREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS,
THERAPEUTIC RADIOLOGY PORT FILM(S)
INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND
RADIATION TREATMENT MANAGEMENT, FIVE TREATMENTS
RADIATION THERAPY MANAGEMENT WITH COMPLETE COURSE OF THERAPY CONSISTING OF ONE OR TWO FRAC
STEREOTACTIC RADIATION TREATMENT MANAGEMENT OF CEREBRAL LESION(S) (COMPLETE COURSE OF TREATM
SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODY RADIATION, PER ORAL, ENDOCAVIT
UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY TREATMENT MANAGEMENT
PROTON TREATMENT DELIVERY; SIMPLE, WITHOUT COMPENSATION
PROTON TREATMENT DELIVERY; SIMPLE, WITH COMPENSATION
PROTON TREATMENT DELIVERY; INTERMEDIATE
PROTON TREATMENT DELIVERY; COMPLEX
HYPERTHERMIA, EXTERNALLY GENERATED; SUPERFICIAL (IE, HEATING TO A DEPTH OF 4 CM OR LESS)
HYPERTHERMIA, EXTERNALLY GENERATED; DEEP (IE, HEATING TO DEPTHS GREATER THAN 4 CM)
HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); 5 OR FEWER INTERSTITIAL APPLICATORS
HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN 5 INTERSTITIAL APPLICATORS

HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S)
INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION
INTRACAVITARY RADIATION SOURCE APPLICATION; SIMPLE
INTRACAVITARY RADIATION SOURCE APPLICATION; INTERMEDIATE
INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLEX
INTERSTITIAL RADIATION SOURCE APPLICATION; SIMPLE
INTERSTITIAL RADIATION SOURCE APPLICATION; INTERMEDIATE
INTERSTITIAL RADIATION SOURCE APPLICATION; COMPLEX
REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 1-4 SOURCE POSITIONS OR CATHETERS
REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; OVER 12 SOURCE POSITIONS OR CATHETERS
SURFACE APPLICATION OF RADIATION SOURCE
SUPERVISION, HANDLING, LOADING OF RADIATION SOURCE
UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY
THYROID UPTAKE; SINGLE DETERMINATION
THYROID UPTAKE; MULTIPLE DETERMINATIONS
THYROID UPTAKE; STIMULATION, SUPPRESSION OR DISCHARGE (NOT INCLUDING INITIAL UPTAKE STUDIES)
THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION
THYROID IMAGING, WITH UPTAKE; MULTIPLE DETERMINATIONS
THYROID IMAGING; ONLY
THYROID IMAGING; WITH VASCULAR FLOW
THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA (EG, NECK AND CHEST ONLY)
THYROID CARCINOMA METASTASES IMAGING; WITH ADDITIONAL STUDIES (EG, URINARY RECOVERY)
THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY
THYROID CARCINOMA METASTASES UPTAKE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE
PARATHYROID IMAGING
ADRENAL IMAGING, CORTEX AND/OR MEDULLA
UNLISTED ENDOCRINE PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
BONE MARROW IMAGING; LIMITED AREA
BONE MARROW IMAGING; MULTIPLE AREAS
BONE MARROW IMAGING; WHOLE BODY
PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); SINGLE SA
PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); MULTIPLE S
RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING
RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS
WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA VOLUME AND RED C
RED CELL SURVIVAL STUDY;
RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC AND/OR HEPATIC SEQUESTRA
LABELED RED CELL SEQUESTRATION, DIFFERENTIAL ORGAN/TISSUE, (EG, SPLENIC AND/OR HEPATIC)
PLASMA RADIOIRON DISAPPEARANCE (TURNOVER) RATE
RADIOIRON ORAL ABSORPTION
RADIOIRON RED CELL UTILIZATION
CHELATABLE IRON FOR ESTIMATION OF TOTAL BODY IRON
SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW
KINETICS, STUDY OF PLATELET SURVIVAL, WITH OR WITHOUT DIFFERENTIAL ORGAN/TISSUE LOCALIZATION
PLATELET SURVIVAL STUDY
LYMPHATICS AND LYMPH NODES IMAGING
UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE, DIAGNOSTIC NUCLEAR MEDIC

LIVER IMAGING; STATIC ONLY
LIVER IMAGING; WITH VASCULAR FLOW
LIVER IMAGING (SPECT)
LIVER IMAGING (SPECT); WITH VASCULAR FLOW
LIVER AND SPLEEN IMAGING; STATIC ONLY
LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW
LIVER FUNCTION STUDY WITH HEPATOBILIARY AGENTS, WITH SERIAL IMAGES
HEPATOBILIARY DUCTAL SYSTEM IMAGING, INCLUDING GALLBLADDER, WITH OR WITHOUT PHARMACOLOGIC INTE
SALIVARY GLAND IMAGING;
SALIVARY GLAND IMAGING; WITH SERIAL IMAGES
SALIVARY GLAND FUNCTION STUDY
ESOPHAGEAL MOTILITY
GASTRIC MUCOSA IMAGING
GASTROESOPHAGEAL REFLUX STUDY
GASTRIC EMPTYING STUDY
UREA BREATH TEST, C-14; ACQUISITION FOR ANALYSIS
UREA BREATH TEST, C-14; ANALYSIS
VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR
VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR
VITAMIN B-12 ABSORPTION STUDIES COMBINED, WITH AND WITHOUT INTRINSIC FACTOR
ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
GASTROINTESTINAL PROTEIN LOSS
INTESTINE IMAGING (EG, ECTOPIC GASTRIC MUCOSA, MECKELS LOCALIZATION, VOLVULUS)
PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT)
UNLISTED GASTROINTESTINAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
BONE AND/OR JOINT IMAGING; LIMITED AREA
BONE AND/OR JOINT IMAGING; MULTIPLE AREAS
BONE AND/OR JOINT IMAGING; WHOLE BODY
BONE AND/OR JOINT IMAGING; THREE PHASE STUDY
BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT)
BONE DENSITY (BONE MINERAL CONTENT) STUDY; SINGLE PHOTON ABSORPTIOMETRY
BONE DENSITY (BONE MINERAL CONTENT) STUDY; DUAL PHOTON ABSORPTIOMETRY
UNLISTED MUSCULOSKELETAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NON-IMAGING) (EG, EJECTION FRACTION WITH PROBE TECH
CARDIAC SHUNT DETECTION
NON-CARDIAC VASCULAR FLOW IMAGING (IE, ANGIOGRAPHY, VENOGRAPHY)
VENOUS THROMBOSIS STUDY (EG, RADIOACTIVE FIBRINOGEN)
ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE
VENOUS THROMBOSIS IMAGING, VENOGRAM; UNILATERAL
VENOUS THROMBOSIS IMAGING (EG, VENOGRAM); BILATERAL
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION
MYOCARDIAL PERFUSION IMAGING; (PLANAR) SINGLE STUDY, AT REST OR STRESS (EXERCISE AND/OR PHARMAC
MYOCARDIAL PERFUSION IMAGING; MULTIPLE STUDIES, (PLANAR) AT REST AND/OR STRESS (EXERCISE AND/OR P
MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), SINGLE STUDY AT REST OR STRESS (EXERCISE AND
MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), MULT. STUDIES AT REST AND/OR STRESS (EXERCISE
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; WITH EJECTION FRACTION BY FIRST PASS TECHNIQUE
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; TOMOGRAPHIC SPECT WITH OR WITHOUT QUANTIFICATION
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; PLANAR, SINGLE STUDY AT REST OR STRESS (EXERCISE A
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; MULTIPLE STUDIES, WALL MOTION STUDY PLUS EJECTION
MYOCARDIAL PERFUSION STUDY WITH WALL MOTION, QUALITATIVE OR QUANTITATIVE STUDY (LIST SEPARATELY
MYOCARDIAL PERFUSION STUDY WITH EJECTION FRACTION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA
CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT REST OR W/ STRESS (EXE
CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECH.; MULT. STUDIES, AT REST & W/ STRESS (EXERCISE
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION;SINGLE STUDY AT REST OR STRES
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE STUDIES AT REST AND/
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT, AT REST, WALL MOTION STUDY PLUS EJECTION FR
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SINGLE STUDY, AT REST, WITH RIGHT VENTRICULAR EJEC
UNLISTED CARDIOVASCULAR PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
PULMONARY PERFUSION IMAGING, PARTICULATE
PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; SINGLE BREATH
PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; REBREATHING AND WASHOUT, WITH OR W
PULMONARY VENTILATION IMAGING, AEROSOL; SINGLE PROJECTION
PULMONARY VENTILATION IMAGING, AEROSOL; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL V
PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION IMAGING, AEROSOL, ONE OR MULTIPLE PRO
PULMONARY VENTILATION IMAGING, GASEOUS, SINGLE BREATH, SINGLE PROJECTION
PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE B
PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE B
PULMONARY QUANTITATIVE DIFFERENTIAL FUNCTION (VENTILATION/PERFUSION) STUDY
UNLISTED RESPIRATORY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
BRAIN IMAGING, LIMITED PROCEDURE; STATIC
BRAIN IMAGING, LIMITED PROCEDURE; WITH VASCULAR FLOW
BRAIN IMAGING, COMPLETE STUDY; STATIC
BRAIN IMAGING, COMPLETE STUDY; WITH VASCULAR FLOW
BRAIN IMAGING, COMPLETE STUDY; TOMOGRAPHIC (SPECT)
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); METABOLIC EVALUATION
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); PERFUSION EVALUATION
BRAIN IMAGING, VASCULAR FLOW ONLY
CEREBRAL VASCULAR FLOW
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); CISTERNOGRAPHY
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); VENTRICULOGRAPHY
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); SHUNT EVALUATION
CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); TOMOGRAPHIC (SPECT)
CEREBROSPINAL FLUID LEAKAGE DETECTION AND LOCALIZATION
RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
UNLISTED NERVOUS SYSTEM PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
KIDNEY IMAGING; STATIC ONLY
KIDNEY IMAGING; WITH VASCULAR FLOW
KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM)
KIDNEY IMAGING; WITH VASCULAR FLOW AND FUNCTION STUDY
KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY WITH PHARMACOLOGICAL INTERVENTIO
KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; MULTIPLE STUDIES, WITH AND WITHOUT PHARMACOLO
KIDNEY IMAGING; TOMOGRAPHIC (SPECT)
KIDNEY VASCULAR FLOW ONLY
KIDNEY FUNCTION STUDY, NON-IMAGING RADIOISOTOPIC STUDY
URINARY BLADDER RESIDUAL STUDY
URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM)
TESTICULAR IMAGING;
TESTICULAR IMAGING; WITH VASCULAR FLOW
UNLISTED GENITOURINARY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; LIMITED AREA
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; MULTIPLE AREAS
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; WHOLE BODY
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; TOMOGRAPHIC (SPECT)
RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; LIMITED AREA
RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY
RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; TOMOGRAPHIC (SPECT)
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION
GENERATION OF AUTOMATED DATA: INTERACTIVE PROCESS INVOLVING NUCLEAR PHYSICIAN AND/OR ALLIED HE
GENERATION OF AUTOMATED DATA: INTERACTIVE PROCESS INVOLVING NUCLEAR PHYSICIAN AND/OR ALLIED HE
PROVISION OF DIAGNOSTIC RADIOPHARMACEUTICAL(S)
UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
RADIOPHARMACEUTICAL THERAPY, HYPERTHYROIDISM; INITIAL, INCLUDING EVALUATION OF PATIENT
RADIOPHARMACEUTICAL THERAPY, HYPERTHYROIDISM; SUBSEQUENT, EACH THERAPY
RADIOPHARMACEUTICAL THERAPY, THYROID SUPPRESSION (EUTHYROID CARDIAC DISEASE), INCLUDING EVALUA
RADIOPHARMACEUTICAL ABLATION OF GLAND FOR THYROID CARCINOMA
RADIOPHARMACEUTICAL THERAPY FOR METASTASES OF THYROID CARCINOMA
RADIOPHARMACEUTICAL THERAPY, POLYCYTHEMIA VERA, CHRONIC LEUKEMIA, EACH TREATMENT
INTRACAVITARY RADIOACTIVE COLLOID THERAPY
INTERSTITIAL RADIOACTIVE COLLOID THERAPY
RADIOPHARMACEUTICAL THERAPY, NONTHYROID, NONHEMATOLOGIC
INTRAVASCULAR RADIOPHARMACEUTICAL THERAPY, PARTICULATE
INTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPY
PROVISION OF THERAPEUTIC RADIOPHARMACEUTICAL(S)
UNLISTED RADIOPHARMACEUTICAL THERAPEUTIC PROCEDURE
BASIC METABOLIC PANEL
GENERAL HEALTH PANEL
ELECTROLYTES PANEL
COMPREHENSIVE METABOLIC PANEL
OBSTETRIC PANEL
LIPID PANEL
RENAL FUNCTION PANEL
ACUTE HEPATITIS PANEL
HEPATIC FUNCTION PANEL
DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES CHROMATOGRAPHIC METHOD, EACH PROCEDURE
DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (EG, IMMUNOASSAY, ENZYME ASSAY), EACH DRUG C
DRUG, CONFIRMATION, EACH PROCEDURE
TISSUE PREPARATION FOR DRUG ANALYSIS
AMIKACIN
AMITRIPTYLINE
BENZODIAZEPINES
CARBAMAZEPINE; TOTAL
CARBAMAZEPINE; FREE
CYCLOSPORINE
DESIPRAMINE
DIGOXIN
DIPROPYLACETIC ACID (VALPROIC ACID)

DOXEPIN
ETHOSUXIMIDE
GENTAMICIN
GOLD
HALOPERIDOL
IMIPRAMINE
LIDOCAINE
LITHIUM
NORTRIPTYLINE
PHENOBARBITAL
PHENYTOIN; TOTAL
PHENYTOIN; FREE
PRIMIDONE
PROCAINAMIDE;
PROCAINAMIDE; WITH METABOLITES (EG, N-ACETYL PROCAINAMIDE)
QUINIDINE
SALICYLATE
QUANT DRUG TACROLIMUS
THEOPHYLLINE
TOBRAMYCIN
TOPIRAMATE
VANCOMYCIN
QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED
ACTH STIMULATION PANEL; FOR ADRENAL INSUFFICIENCY THIS PANEL MUST INCLUDE THE FOLLOWING: CORTISO
ACTH STIMULATION PANEL; FOR 21 HYDROXYLASE DEFICIENCY THIS PANEL MUST INCLUDE THE FOLLOWING: CO
ACTH STIMULATION PANEL; FOR 3 BETA-HYDROXYDEHYDROGENASE DEFICIENCY THIS PANEL MUST INCLUDE THE
ALDOSTERONE SUPPRESSION EVALUATION PANEL (EG, SALINE INFUSION) THIS PANEL MUST INCLUDE THE FOLLO
CALCIUM-PENTAGASTRIN STIMULATION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CALCITONIN (82308 X
CORTICOTROPIC RELEASING HORMONE (CRH) STIMULATION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING
CHORIONIC GONADOTROPIN STIMULATION PANEL; TESTOSTERONE RESPONSE THIS PANEL MUST INCLUDE THE F
CHORIONIC GONADOTROPIN STIMULATION PANEL; ESTRADIOL RESPONSE THIS PANEL MUST INCLUDE THE FOLLO
RENAL VEIN RENIN STIMULATION PANEL (EG, CAPTOPRIL)
PERIPHERAL VEIN RENIN STIMULATION PANEL (EG, CAPTOPRIL)
COMBINED RAPID ANT PITUITARY EVAL PANEL MUST INCLUDE: (ACTH) (82024 X 4) (LH) (83002 X 4) (FSH) (83001 X 4)
DEXAMETHASONE SUPPRESSION PANEL, 48 HOUR MUST INCLUDE: FREE CORTISOL, URINE (82530 X 2) CORTISOL
GLUCAGON TOLERANCE PANEL; FOR INSULINOMA MUST INCLUDE: GLUCOSE (82947 X 3) INSULIN (83525 X 3)
GLUCAGON TOLERANCE PANEL; FOR PHEOCHROMOCYTOMA MUST INCLUDE: CATECHOLAMINES, FRACTIONATED
GONADOTROPIN RELEASING HORMONE STIMULATION PANEL MUST INCLUDE: FOLLICLE STIMULATING HORMONE
GROWTH HORMONE STIMULATION PANEL (EG, ARGININE INFUSION, L-DOPA ADMINISTRATION) THIS PANEL MUST I
GROWTH HORMONE SUPPRESSION PANEL (GLUCOSE ADMINISTRATION) THIS PANEL MUST INCLUDE THE FOLLOW
INSULIN-INDUCED C-PEPTIDE SUPPRESSION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: INSULIN (83525
INSULIN TOLERANCE PANEL; FOR ACTH INSUFFICIENCY THIS PANEL MUST INCLUDE THE FOLLOWING: CORTISOL (
INSULIN TOLERANCE PANEL; FOR GROWTH HORMONE DEFICIENCY THIS PANEL MUST INCLUDE THE FOLLOWING:
METYRAPONE PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CORTISOL (82533 X 2) 11 DEOXYCORTISOL (82
THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; ONE HOUR THIS PANEL MUST INCLUDE THE FO
THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; TWO HOUR THIS PANEL MUST INCLUDE THE FO
THYROTROPIN RELEASING HORMONE (TRH) STIMULATION PANEL; FOR HYPERPROLACTINEMIA THIS PANEL MUST
CLINICAL PATHOLOGY CONSULTATION; LIMITED, WITHOUT REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORD
CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTIC PROBLEM, WITH REVIEW
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTE
URINALYSIS, BY DIP STICK/TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, N
URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS
URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK
URINALYSIS; MICROSCOPIC ONLY
URINALYSIS; TWO OR THREE GLASS TEST
URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS
VOLUME MEASUREMENT FOR TIMED COLLECTION, EACH
UNLISTED URINALYSIS PROCEDURE
ACETALDEHYDE, BLOOD
ACETAMINOPHEN
ACETONE OR OTHER KETONE BODIES, SERUM; QUALITATIVE
ACETONE OR OTHER KETONE BODIES, SERUM; QUANTITATIVE
ACETYLCHOLINESTERASE
ACYLCARNITINES; QUALITATIVE
ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN
ADRENOCORTICOTROPIC HORMONE (ACTH)
ADENOSINE, 5'-MONOPHOSPHATE, CYCLIC (CYCLIC AMP)
ALBUMIN; SERUM
ALBUMIN; URINE OR OTHER SOURCE, QUANTITATIVE, EACH SPECIMEN
ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE
ALBUMIN; URINE, MICROALBUMIN, SEMIQUANTITATIVE (EG, REAGENT STRIP ASSAY)
ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT BREATH
ALCOHOL (ETHANOL); BREATH
ALDOLASE
ALDOSTERONE
ALKALOIDS, URINE, QUANTITATIVE
ALPHA-1-ANTITRYPSIN; TOTAL
ALPHA-1-ANTITRYPSIN; PHENOTYPE
ALPHA-FETOPROTEIN; SERUM
ALPHA-FETOPROTEIN; AMNIOTIC FLUID
ALUMINUM
AMINES, VAGINAL FLUID, QUALITATIVE
AMINO ACIDS, SINGLE, QUALITATIVE
AMINO ACIDS, QUALITATIVE
AMINO ACIDS, QUANTITATION, EACH
AMINOLEVULINIC ACID, DELTA (ALA)
AMINO ACIDS, 2-5 AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN
AMINO ACIDS, 6 OR MORE, QUANTITATIVE
AMMONIA
AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC)
AMPHETAMINE OR METHAMPHETAMINE
AMYLASE
ANDROSTANEDIOL GLUCURONIDE
ANDROSTENEDIONE
ANDROSTERONE
ANGIOTENSIN II
ANGIOTENSIN I - CONVERTING ENZYME (ACE)
APOLIPOPROTEIN, EACH
ARSENIC
ASCORBIC ACID (VITAMIN C), BLOOD
ATOMIC ABSORPTION SPECTROSCOPY, EACH ANALYTE
BARBITURATES, NOT ELSEWHERE SPECIFIED
BETA-2 MICROGLOBULIN
BILE ACIDS; TOTAL
BILE ACIDS; CHOLYLGLYCINE
BILIRUBIN; TOTAL
BILIRUBIN;DIRECT
BILIRUBIN; FECES, QUALITATIVE
BIOTINIDASE
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, 1-3 SIMULTANEOUS DETERMINAT
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES
BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTAN
BRADYKININ
CADMIUM
CALCIFEDIOL (25-OH VITAMIN D-3)
CALCIFEROL (VITAMIN D)
CALCITONIN
CALCIUM; TOTAL
CALCIUM; IONIZED
CALCIUM; AFTER CALCIUM INFUSION TEST
CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN
CALCULUS; QUALITATIVE ANALYSIS
CALCULUS; QUANTITATIVE ANALYSIS, CHEMICAL
CALCULUS; INFRARED SPECTROSCOPY
CALCULUS; X-RAY DIFFRACTION
CARBOHYDRATE DEFICIENT TRANSFERRIN
CARBON DIOXIDE (BICARBONATE)
CARBON MONOXIDE, (CARBOXYHEMOGLOBIN); QUANTITATIVE
CARBON MONOXIDE, (CARBOXYHEMOGLOBIN); QUALITATIVE
CARCINOEMBRYONIC ANTIGEN (CEA)
CARNITINE (TOTAL & FREE), QUANTITATIVE
CAROTENE
CATECHOLAMINES; TOTAL URINE
CATECHOLAMINES; BLOOD
CATECHOLAMINES; FRACTIONATED
CATHEPSIN-D
CERULOPLASMIN
CHEMILUMINESCENT ASSAY
CHLORAMPHENICOL
CHLORIDE; BLOOD
CHLORIDE; URINE
OTHER SOURCE
CHLORINATED HYDROCARBONS, SCREEN
CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL
CHOLINESTERASE; SERUM
CHOLINESTERASE; RBC
CHONDROITIN B SULFATE, QUANTITATIVE
CHROMATOGRAPHY, QUALITATIVE; COLUMN (EG, GAS LIQUID OR HIGH PERFORMANCE LIQUID CHROMATOGRAPH
CHROMATOGRAPHY, QUALITATIVE; PAPER, 1-DIMENSIONAL, ANALYTE NOT ELSEWHERE SPECIFIED
CHROMATOGRAPHY, QUALITATIVE; PAPER, 2-DIMENSIONAL, ANALYTE NOT ELSEWHERE SPECIFIED
CHROMATOGRAPHY, QUALITATIVE; THIN LAYER, ANALYTE NOT ELSEWHERE SPECIFIED
CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID OR HIGH PERFORMANCE LIQUID CHROMATOGRAP
CHROMAT,QUANT,GLC/HPLC;MULTI,SINGLE,STATIONARY,MOBILE
CHROMIUM
CITRATE
COCAINE OR METABOLITE
COLLAGEN CROSS LINKS, ANY METHOD
COPPER
CORTICOSTERONE
CORTISOL; FREE
CORTISOL; TOTAL
CREATINE
COLUMN CHROMAT/MS,ANALYTE NOS;QUAL,SINGLE,STATIONARY,MOBILE
COLUMN CHROMAT/MS,ANALYTE NOS;QUANT,SINGLE,STATIONARY,MOBILE
COLUMN CHROMAT/MS,ANALYTE NOS;STABLE ISOTOPE,SINGLE,QUANT
COLUMN CHROMAT/MS,ANALYTE NOS;STABLE ISOTOPE,MULTI,QUANT
CREATINE KINASE (CK), (CPK); TOTAL
CREATINE KINASE (CK), (CPK); ISOENZYMES
CREATINE KINASE (CK), (CPK); MB FRACTION ONLY
CREATINE KINASE (CK), (CPK); ISOFORMS
CREATININE; BLOOD
CREATININE; OTHER SOURCE
CREATININE; CLEARANCE
CRYOFIBRINOGEN
CRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE (EG, CRYOCRIT)
CYANIDE
CYANOCOBALAMIN (VITAMIN B-12);
CYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING CAPACITY
CYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE
DEHYDROEPIANDROSTERONE (DHEA)
DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)
DESOXYCORTICOSTERONE, 11DEOXYCORTISOL, 11DIBUCAINE NUMBER
DIHYDROCODEINONE
DIHYDROMORPHINONE
DIHYDROTESTOSTERONE (DHT)
DIHYDROXYVITAMIN D, 1,25DIMETHADIONE
ENZYME ACTIVITY,CULTURED CELLS OR TISSUE,NOS;NON-RADIOACTIVE
ENZYME ACTIVITY,CULTURED CELLS OR TISSUE,NOS;RADIOACTIVE
ELECTROPHORETIC TECHNIQUE, NOT ELSEWHERE SPECIFIED
EPIANDROSTERONE
ERYTHROPOIETIN
ESTRADIOL
ESTROGENS; FRACTIONATED
ESTROGENS; TOTAL
ESTRIOL
ESTRONE
ETHCHLORVYNOL
ETHYLENE GLYCOL
ETIOCHOLANOLONE
FAT OR LIPIDS, FECES; QUALITATIVE
FAT OR LIPIDS, FECES; QUANTITATIVE
FAT DIFFERENTIAL, FECES, QUANTITATIVE
FATTY ACIDS, NONESTERIFIED
VERY LONG CHAIN FATTY ACIDS
FERRITIN
FETAL FIBRONECTIN, CERVICO VAGINAL SECRETIONS, SEMI-QUANT
FLUORIDE
FLURAZEPAM
FOLIC ACID; SERUM
FOLIC ACID; RBC
FRUCTOSE, SEMEN
GALACTOKINASE, RBC
GALACTOSE
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITATIVE
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; SCREEN
GAMMAGLOBULIN; IGA, IGD, IGG, IGM, EACH
GAMMAGLOBULIN; IGE
GAMMAGLOBULIN; IMMUNOGLOBULIN SUBCLASSES, (IGG1, 2, 3, OR 4), EACH
GASES, BLOOD, PH ONLY
GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO2 (INCLUDING CALCULATED O2 SATURATION)
GASES, BLOOD, ANY COMBINATION OF PH, PCO2, PO2, CO2, HCO2 (INCLUDING CALCULATED O2 SATURATION); WI
GASES, BLOOD, O2 SATURATION ONLY, BY DIRECT MEASUREMENT, EXCEPT PULSE OXIMETRY
HEMOGLOBIN-OXYGEN AFFINITY (PO2 FOR 50% HEMOGLOBIN SATURATION WITH OXYGEN)
GASTRIC ACID, FREE AND TOTAL, EACH SPECIMEN
GASTRIC ACID, FREE OR TOTAL; EACH SPECIMEN
GASTRIN AFTER SECRETIN STIMULATION
GASTRIN
GLUCAGON
GLUCOSE, BODY FLUID, OTHER THAN BLOOD
GLUCAGON TOLERANCE TEST
GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)
GLUCOSE; BLOOD, REAGENT STRIP
GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)
GLUCOSE; TOLERANCE TEST (GTT), THREE SPECIMENS (INCLUDES GLUCOSE)
GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND THREE SPECIMENS
GLUCOSE; TOLBUTAMIDE TOLERANCE TEST
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN
GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE
GLUCOSIDASE, BETA
GLUTAMATE DEHYDROGENASE
GLUTAMINE (GLUTAMIC ACID AMIDE)
GLUTAMYLTRANSFERASE, GAMMA (GGT)
GLUTATHIONE
GLUTATHIONE REDUCTASE, RBC
GLUTETHIMIDE
GLYCATED PROTEIN
GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)
GONADOTROPIN; LUTEINIZING HORMONE (LH)
GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN)
GUANOSINE MONOPHOSPHATE (GMP), CYCLIC
HAPTOGLOBIN; QUANTITATIVE
HAPTOGLOBIN; PHENOTYPES
HELICOBACTER PYLORI; ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE
HELICOBACTER PYLORI; DRUG ADMINISTRATION AND SAMPLE COLLECTION
HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); SCREEN
HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH, ANTIMONY, MERCURY); QUANTITATIVE, EACH
HEMOGLOBIN, ELECTROPHORESIS (EG, A2, S, C)
HEMOGLOBIN FRACTIONATION & QUANTITATION; CHROMATOGRAPHY
HEMOGLOBIN; BY COPPER SULFATE METHOD, NON-AUTOMATED
HEMOGLOBIN; F(FETAL), CHEMICAL
HEMOGLOBIN; F (FETAL), QUALITATIVE
HEMOGLOBIN; GLYCATED
HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE
HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE
HEMOGLOBIN; PLASMA
HEMOGLOBIN; SULFHEMOGLOBIN, QUALITATIVE
HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE
HEMOGLOBIN; THERMOLABILE
HEMOGLOBIN; UNSTABLE, SCREEN
HEMOGLOBIN; URINE
HEMOSIDERIN; QUALITATIVE
HEMOSIDERIN; QUANTITATIVE
B-HEXOSAMINIDASE, EACH ASSAY
HISTAMINE
HOMOCYSTINE
HOMOVANILLIC ACID (HVA)
HYDROXYCORTICOSTEROIDS, 17- (17-OHCS)
HYDROXYINDOLACETIC ACID, 5-(HIAA)
HYDROXYPROGESTERONE, 17-D
HYDROXYPROGESTERONE, 20HYDROXYPROLINE; FREE
HYDROXYPROLINE; TOTAL
IMMUNOASSAY FOR ANALYTE OTHER THAN ANTIBODY OR INFECTIOUS AGENT ANTIGEN, QUALITATIVE OR SEMIQU
IMMUNOASSAY FOR ANALYTE OTHER THAN ANTIBODY OR INFECTIOUS AGENT ANTIGEN, QUALITATIVE OR SEMIQU
IMMUNOASSAY, ANALYTE, QUANTITATIVE; BY RADIOPHARMACEUTICAL TECHNIQUE (EG, RIA)
IMMUNOASSAY, ANALYTE, QUANTITATIVE; NOT OTHERWISE SPECIFIED
INSULIN; TOTAL
INSULIN; FREE
INTRINSIC FACTOR
IRON
IRON BINDING CAPACITY
ISOCITRIC DEHYDROGENASE (IDH)
KETOGENIC STEROIDS, FRACTIONATION
KETOSTEROIDS, 17- (17-KS); TOTAL
KETOSTEROIDS, 17- (17-KS); FRACTIONATION
LACTATE (LACTIC ACID)
LACTATE DEHYDROGENASE (LD), (LDH);
LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION AND QUANTITATION
LACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SOMATOMAMMOTROPIN
LACTOSE, URINE; QUALITATIVE
LACTOSE, URINE; QUANTITATIVE
LEAD
FETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMYELIN (L/S) RATIO
FETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TEST
FETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLARIZATION
FETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENSITY
LEUCINE AMINOPEPTIDASE (LAP)
LIPASE
LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION
LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION & QUANT
LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)
LIPOPROTEIN, DIRECT MEASUREMENT; VLDL CHOLESTEROL
LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL
LUTEINIZING RELEASING FACTOR (LRH)
MAGNESIUM
MALATE DEHYDROGENASE
MANGANESE
MASS SPEC & TANDEM MASS SPEC (MS,MS/MS), NOS, QUAL
MASS SPEC & TANDEM MASS SPEC (MS,MS/MS), NOS, QUANT
MEPROBAMATE
MERCURY, QUANTITATIVE
METANEPHRINES
METHADONE
METHEMALBUMIN
METHSUXIMIDE
MUCOPOLYSACCHARIDES, ACID; QUANTITATIVE
MUCOPOLYSACCHARIDES, ACID; SCREEN
MUCIN, SYNOVIAL FLUID (ROPES TEST)
MYELIN BASIC PROTEIN, CEREBROSPINAL FLUID
MYOGLOBIN
NATRIURETIC PEPTIDE
NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED
NICKEL
NICOTINE
MOLECULAR DIAGNOSTICS; MOLECULAR ISOLATION OR EXTRACTION
MOLECULAR DIAGNOSTICS;ISOLATION/EXTRACTION HIGHLY PURIFIED
NUCLEAR MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION

MOLECULAR DIAGNOSTICS;DOT/SLOT BLOT PRODUCTION
NUCLEAR MOLECULAR DIAGNOSTICS; SEPARATION (EG, DOT BLOT, ELECTROPHORESIS)
NUCLEAR MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH
MOLECULAR DIAGNOSTICS; NUCLEIC ACID TRANSFER
MOLECULAR DIAGNOSTICS; AMPLIFICATION OF PATIENT NUCLEIC ACID (EG, PCR, LCR), SINGLE PRIMER PAIR, EAC
MOLECULAR DIAGNOSTICS;AMPLI NUCLEIC ACID,MULTIPLEX,EA
MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION
MOLECULAR DIAGNOSTICS;MUT SCANNING PHYSICAL PROPS,SINGLE,EA
MOLECULAR DIAGNOSTICS;MUTATION ID SEQUENCING,SINGLE SEG,EA
MOLECULAR DIAGNOSTICS;MUT ID ALLELE TRANSCR,SINGLE SEG,EA
MOLECULAR DIAGNOSTICS;MUT ID ALLELETRANSL,SINGLE SEG,EA
NUCLEAR MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT
NUCLEOTIDASE 5'OLIGOCLONAL IMMUNE (OLIGOCLONAL BANDS)
ORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN
ORGANIC ACIDS, QUAL
ORGANIC ACID, SINGLE, QUANTITATIVE
OPIATES, (EG, MORPHINE, MEPERIDINE)
OSMOLALITY; BLOOD
OSMOLALITY; URINE
OSTEOCALCIN (BONE G1A PROTEIN)
OXALATE
ONCOPROTEIN, HER-2/NEU
PARATHORMONE (PARATHYROID HORMONE)
PH, BODY FLUID, EXCEPT BLOOD
PHENCYCLIDINE (PCP)
PHENOTHIAZINE
PHENYLALANINE (PKU), BLOOD
PHENYLKETONES, QUALITATIVE
PHOSPHATASE, ACID; TOTAL
PHOSPHATASE, ACID; FORENSIC EXAMINATION
PHOSPHATASE, ACID; PROSTATIC
PHOSPHATASE, ALKALINE;
PHOSPHATASE, ALKALINE; HEAT STABLE (TOTAL NOT INCLUDED)
PHOSPHATASE, ALKALINE; ISOENZYMES
PHOSPHATIDYLGLYCEROL
PHOSPHOGLUCONATE, 6-, DEHYDROGENASE, RBC
PHOSPHOHEXOSE ISOMERASE
PHOSPHORUS INORGANIC (PHOSPHATE);
PHOSPHORUS INORGANIC (PHOSPHATE); URINE
PORPHOBILINOGEN, URINE; QUALITATIVE
PORPHOBILINOGEN, URINE; QUANTITATIVE
PORPHYRINS, URINE; QUALITATIVE
PORPHYRINS, URINE; QUANTITATION AND FRACTIONATION
PORPHYRINS, FECES; QUANTITATIVE
PORPHYRINS, FECES; QUALITATIVE
POTASSIUM; SERUM
POTASSIUM; URINE
PREALBUMIN
PREGNANEDIOL
PREGNANETRIOL
PREGNENOLONE
17-HYDROXYPREGNENOLONE
PROGESTERONE
PROLACTIN
PROSTAGLANDIN, EACH
PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT)
PROSTATE SPECIFIC ANTIGEN (PSA)
PROSTRATE SPECIFIC ANTIGEN (PSA); FREE
PROTEIN; TOTAL, EXCEPT REFRACTOMETRY
PROTEIN; REFRACTOMETRIC
PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION
PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID
PROTEIN; WESTERN BLOT, WITH INTERPRETATION AND REPORT, BLOOD OR OTHER BODY FLUID, IMMUNOLOGICA
PROTOPORPHYRIN, RBC; QUANTITATIVE
PROTOPORPHYRIN, RBC; SCREEN
PROINSULIN
PYRIDOXAL PHOSPHATE (VITAMIN B-6)
PYRUVATE
PYRUVATE KINASE
QUININE
RECEPTOR ASSAY; ESTROGEN
RECEPTOR ASSAY; PROGESTERONE
RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN OR PROGESTERONE (SPECIFY HORMONE)
RECEPTOR ASSAY; NON-ENDOCRINE (EG, ACETYLCHOLINE) (SPECIFY RECEPTOR)
RENIN
RIBOFLAVIN (VITAMIN B-2)
SELENIUM
SEROTONIN
SEX HORMONE BINDING GLOBULIN (SHBG)
SIALIC ACID
SILICA
SODIUM; SERUM
SODIUM; URINE
SODIUM; OTHER SOURCE
SOMATOMEDIN
SOMATOSTATIN
SPECTROPHOTOMETRY, ANALYTE NOT ELSEWHERE SPECIFIED
SPECIFIC GRAVITY (EXCEPT URINE)
SUGARS, CHROMATOGRAPHIC, TLC OR PAPER CHROMATOGRAPHY
SUGARS; (MONO-,DI-,& OLIGOSACCHARIDES);SINGLE QUALITATIVE, EACH SPECIMEN
SUGARS; (MONO-,DI-,& OLIGOSACCHARIDES);MULTIPLE QUALITATIVE, EACH SPECIMEN
SUGARS; SINGLE QUANTITATIVE, EACH SPECIMEN
SUGARS; MULTIPLE QUANTITATIVE, EACH SPECIMEN
SULFATE, URINE
TESTOSTERONE; FREE
TESTOSTERONE; TOTAL
THIAMINE (VITAMIN B-1)

THIOCYANATE
THYROGLOBULIN
THYROXINE; TOTAL
THYROXINE; REQUIRING ELUTION (EG, NEONATAL)
THYROXINE; FREE
THYROXINE BINDING GLOBULIN (TBG)
THYROID STIMULATING HORMONE (TSH)
THYROID STIMULATING IMMUNE GLOBULINS (TSI)
TOCOPHEROL ALPHA (VITAMIN E)
TRANSCORTIN (CORTISOL BINDING GLOBULIN)
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
TRANSFERRIN
TRIGLYCERIDES
THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)
TRIIODOTHYRONINE T3; TOTAL (TT-3)
TRIIODOTHYRONINE (T-3); FREE
TRIIODOTHYRONINE (T-3); REVERSE
TROPONIN
TRYPSIN; DUODENAL FLUID
TRYPSIN; FECES, QUALITATIVE
TRYPSIN; FECES, QUANTITATIVE, 24-HOUR COLLECTION
TYROSINE
TROPONIN, QUALITATIVE
UREA NITROGEN; QUANTITATIVE
UREA NITROGEN; SEMIQUANTITATIVE (EG, REAGENT STRIP TEST)
UREA NITROGEN, URINE
UREA NITROGEN, CLEARANCE
URIC ACID; BLOOD
URIC ACID; OTHER SOURCE
UROBILINOGEN, FECES, QUANTITATIVE
UROBILINOGEN, URINE; QUALITATIVE
UROBILINOGEN, URINE; QUANTITATIVE, TIMED SPECIMEN
UROBILINOGEN, URINE; SEMIQUANTITATIVE
VANILLYLMANDELIC ACID (VMA), URINE
VASOACTIVE INTESTINAL PEPTIDE (VIP)
VASOPRESSIN (ANTIDIURETIC HORMONE, ADH)
VITAMIN A
VITAMIN, NOT OTHERWISE SPECIFIED
VITAMIN K
VOLATILES (EG, ACETIC ANHYDRIDE, CARBON TETRACHLORIDE, DICHLOROETHANE, DICHLOROMETHANE, DIETHY
XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE
ZINC
C-PEPTIDE
GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE
GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE
OVULATION TESTS, BY VISUAL COLOR COMPARISON METHODS FOR HUMAN LUTEINIZING HORMONE
UNLISTED CHEMISTRY PROCEDURE
BLEEDING TIME
BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT
BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT
BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITHOUT MANUAL DIFFERENTIAL WBC COUNT
BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY COAT
BLOOD COUNT; SPUN MICROHEMATOCRIT
BLOOD COUNT; HEMATOCRIT (HCT)
BLOOD COUNT; HEMOGLOBIN (HGB)
BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DI
BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)
BLOOD COUNT; MANUAL CELL COUNT (ERYTHROCYTE, LEUKOCYTE, OR PLATELET) EACH
BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED
BLOOD COUNT; RETICULOCYTE, MANUAL
BLOOD COUNT; RETICULOCYTE, AUTOMATED
BLOOD COUNT; RETIC, HGB CONCENTRATION
BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED
BLOOD COUNT; PLATELET, AUTOMATED
BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT
BONE MARROW, SMEAR INTERPRETATION
CHROMOGENIC SUBSTRATE ASSAY
CLOT RETRACTION
CLOT LYSIS TIME, WHOLE BLOOD DILUTION
CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC
CLOTTING; FACTOR V (ACG OR PROACCELERIN), LABILE FACTOR
CLOTTING; FACTOR VII (PROCONVERTIN, STABLE FACTOR)
CLOTTING; FACTOR VIII (AHG), ONE STAGE
CLOTTING; FACTOR VIII RELATED ANTIGEN
CLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFACTOR
CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN
CLOTTING; FACTOR VIII, VON WILLEBRAND'S FACTOR, MULTIMETRIC ANALYSIS
CLOTTING; FACTOR IX (PTC OR CHRISTMAS)
CLOTTING; FACTOR X (STUART-PROWER)
CLOTTING; FACTOR XI (PTA)
CLOTTING; FACTOR XII (HAGEMAN)
CLOTTING; FACTOR XIII (FIBRIN STABILIZING)
CLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN SOLUBILITY
CLOTTING; PREKALLIKREIN ASSAY (FLETCHER FACTOR ASSAY)
CLOTTING; HIGH MOLECULAR WEIGHT KININOGEN ASSAY (FITZGERALD FACTOR ASSAY)
CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ACTIVITY
CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III, ANTIGEN ASSAY
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ANTIGEN
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, TOTAL
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN S, FREE
ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY
FACTOR INHIBITOR TEST
THROMBOMODULIN
COAGULATION TIME; LEE AND WHITE
COAGULATION TIME; ACTIVATED
COAGULATION TIME; OTHER METHODS

EUGLOBULIN LYSIS
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); AGGLUTINATION SLIDE, SEMIQUANTITATIVE
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); PARACOAGULATION
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FSP); QUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE OR SEMIQUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITIVE (EG, FOR EVALUATION FOR VENOUS THROMBOEMB
FIBRINOGEN; ACTIVITY
FIBRINOGEN; ANTIGEN
FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN
FIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIPLASMIN
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN ACTIVATOR
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, EXCEPT ANTIGENIC ASSAY
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN, ANTIGENIC ASSAY
HEINZ BODIES; DIRECT
HEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE
HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; DIFFERENTIAL LYSIS (KLEIHAUER-BETKE)
HEMOGLOBIN OR RBCS, FETAL, FOR FETOMATERNAL HEMORRHAGE; ROSETTE
HEMOLYSIN, ACID
HEPARIN ASSAY
HEPARIN NEUTRALIZATION
HEPARIN-PROTAMINE TOLERANCE TEST
IRON STAIN, PERIPHERAL BLOOD
LEUKOCYTE ALKALINE PHOSPHATASE WITH COUNT
MECHANICAL FRAGILITY, RBC
MURAMIDASE
OSMOTIC FRAGILITY, RBC; UNINCUBATED
OSMOTIC FRAGILITY, RBC; INCUBATED
PLATELET; AGGREGATION (IN VITRO), EACH AGENT
PLATELET NEUTRALIZATION
PROTHROMBIN TIME;
PROTHROMBIN TIME; SUBSTITUTION, PLASMA FRACTIONS, EACH
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUTED
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED
REPTILASE TEST
SEDIMENTATION RATE, ERYTHROCYTE, NON-AUTOMATED
SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
SICKLING OF RBC, REDUCTION
THROMBIN TIME; PLASMA
THROMBIN TIME; TITER
THROMBOPLASTIN INHIBITION; TISSUE
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD
THROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION, PLASMA FRACTIONS, EACH
VISCOSITY
UNLISTED HEMATOLOGY AND COAGULATION PROCEDURE
AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED F
ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
ALLERGEN SPECIFIC IGE; QUANTITATIVE, EACH PANEL OF UP TO 12 ALLERGENS

ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (DIPSTICK OR DISK)
ANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES
ANTIBODY IDENTIFICATION; PLATELET ANTIBODIES
ANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUNOGLOBULIN ASSAY
ANTINUCLEAR ANTIBODIES (ANA);
ANTINUCLEAR ANTIBODIES (ANA); TITER
ANTISTREPTOLYSIN 0; TITER
ANTISTREPTOLYSIN 0; SCREEN
BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF IRREGULAR ANTIBODY(S)
BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING SUSPICION OF TRA
BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD BANKING PROCED
C-REACTIVE PROTEIN;
C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)
BETA 2 GLYCOPROTEIN I ANTIBODY, EACH
CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS
ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIPID) ANTIBODY
CHEMOTAXIS ASSAY, SPECIFY METHOD
COLD AGGLUTININ; SCREEN
COLD AGGLUTININ; TITER
COMPLEMENT; ANTIGEN, EACH COMPONENT
COMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT
COMPLEMENT; TOTAL HEMOLYTIC (CH50)
COMPLEMENT FIXATION TESTS, EACH ANTIGEN
COUNTERIMMUNOELECTROPHORESIS, EACH ANTIGEN
DEOXYRIBONUCLEASE, ANTIBODY
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRANDED
EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EAC
FC RECEPTOR
FLUORESCENT ANTIBODY; SCREEN, EACH ANTIBODY
FLUORESCENT ANTIBODY; TITER, EACH ANTIBODY
GROWTH HORMONE, HUMAN (HGH), ANTIBODY
HEMAGGLUTINATION INHIBITION TEST (HAI)
IMMUNOASSAY FOR TUMOR ANTIGEN, QUALITATIVE OR SEMIQUANTITATIVE (EG, BLADDER TUMOR ANTIGEN)
IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)
IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9
IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125
HETEROPHILE ANTIBODIES; SCREENING
HETEROPHILE ANTIBODIES; TITER
HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION WITH BEEF CELLS AND GUINEA PIG KIDNEY
IMMUNOASSAY FOR TUMOR ANTIGEN; OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH
IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT ELSEWHERE SPECIFIED
IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUALITATIVE OR SEMIQUANTITATIVE, SINGLE STEP METHOD (
IMMUNOELECTROPHORESIS; SERUM
IMMUNOELECTROPHORESIS; OTHER FLUIDS (EG, URINE, CEREBROSPINAL FLUID) WITH CONCENTRATION
IMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSAY)
IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED
IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY), EACH ANTIGEN OR ANTIBODY
IMMUNE COMPLEX ASSAY

IMMUNOFIXATION ELECTROPHORESIS
INHIBIN A
INSULIN ANTIBODIES
INTRINSIC FACTOR ANTIBODIES
ISLET CELL ANTIBODY
LEUKOCYTE HISTAMINE RELEASE TEST (LHR)
LEUKOCYTE PHAGOCYTOSIS
LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN) OR ANTIGEN INDUCED BLASTOGENESIS
T CELLS; TOTAL COUNT
T CELLS; T4 AND T8, INCLUDING RATIO
T CELLS; CD4 ABSOLUTE COUNT
MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH
MIGRATION INHIBITORY FACTOR TEST (MIF)
NEUTRALIZATION TEST, VIRAL
NITROBLUE TETRAZOLIUM DYE TEST (NTD)
PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY
PARTICLE AGGLUTINATION; TITER, EACH ANTIBODY
RHEUMATOID FACTOR; QUALITATIVE
RHEUMATOID FACTOR; QUANTITATIVE
SKIN TEST; CANDIDA
SKIN TEST; COCCIDIOIDOMYCOSIS
SKIN TEST; HISTOPLASMOSIS
SKIN TEST; TUBERCULOSIS, INTRADERMAL
SKIN TEST; TUBERCULOSIS, TINE TEST
SKIN TEST; UNLISTED ANTIGEN, EACH
STREPTOKINASE, ANTIBODY
SYPHILIS TEST; QUALITATIVE (EG, VDRL, RPR, ART)
SYPHILIS TEST; QUANTITATIVE
ANTIBODY; ACTINOMYCES
ANTIBODY; ADENOVIRUS
ANTIBODY; ASPERGILLUS
ANTIBODY; BACTERIUM, NOT ELSEWHERE SPECIFIED
ANTIBODY; BARTONELLA
ANTIBODY; BLASTOMYCES
ANTIBODY; BORDETELLA
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN BLOT OR IMMUNOBLO
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)
ANTIBODY; BORRELIA (RELAPSING FEVER)
ANTIBODY; BRUCELLA
ANTIBODY; CAMPYLOBACTER
ANTIBODY; CANDIDA
ANTIBODY; CHLAMYDIA
ANTIBODY; CHLAMYDIA, IGM
ANTIBODY; COCCIDIOIDES
ANTIBODY; COXIELLA BRUNETII (Q FEVER)
ANTIBODY; CRYPTOCOCCUS
ANTIBODY; CYTOMEGALOVIRUS (CMV)
ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM
ANTIBODY; DIPHTHERIA
ANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE)
ANTIBODY; ENCEPHALITIS, EASTERN EQUINE
ANTIBODY; ENCEPHALITIS, ST. LOUIS
ANTIBODY; ENCEPHALITIS, WESTERN EQUINE
ANTIBODY; ENTEROVIRUS (EG, COXSACKIE, ECHO, POLIO)
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)
ANTIBODY; EHRLICHIA
ANTIBODY; FRANCISELLA TULARENSIS
ANTIBODY; FUNGUS, NOT ELSEWHERE SPECIFIED
ANTIBODY; GIARDIA LAMBLIA
ANTIBODY; HELICOBACTER PYLORI
ANTIBODY; HELMINTH, NOT ELSEWHERE SPECIFIED
ANTIBODY; HEMOPHILUS INFLUENZA
ANTIBODY; HTLV I
ANTIBODY; HTLV-II
ANTIBODY; HTLV OR HIV ANTIBODY, CONFIRMATORY TEST (EG, WESTERN BLOT)
ANTIBODY; HEPATITIS, DELTA AGENT
ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST
ANTIBODY; HERPES SIMPLEX, TYPE 1
ANTIBODY; HERPES SIMPLEX, TYPE 2
ANTIBODY; HISTOPLASMA
ANTIBODY; HIV-1
ANTIBODY; HIV-2
ANTIBODY; HIV-1 AND HIV-2, SINGLE ASSAY
HEPATITIS B CORE ANTIBODY (HBCAB), TOTAL
IGM ANTIBODY
HEPATITIS B SURFACE AB (HBSAB)
HEPATITIS BE ANTIBODY (HBEAB)
HEPATITIS A ANTIBODY (HAAB), TOTAL
HEPATITIS A ANTIBODY (HAAB), IGM ANTIBODY
ANTIBODY; INFLUENZA VIRUS
ANTIBODY; LEGIONELLA
ANTIBODY; LEISHMANIA
ANTIBODY; LEPTOSPIRA
ANTIBODY; LISTERIA MONOCYTOGENES
ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS
ANTIBODY; LYMPHOGRANULOMA VENEREUM
ANTIBODY; MUCORMYCOSIS
ANTIBODY; MUMPS
ANTIBODY; MYCOPLASMA
ANTIBODY; NEISSERIA MENINGITIDIS
ANTIBODY; NOCARDIA
ANTIBODY; PARVOVIRUS
ANTIBODY; PLASMODIUM (MALARIA)
ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED
ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
ANTIBODY; RICKETTSIA
ANTIBODY; ROTAVIRUS
ANTIBODY; RUBELLA
ANTIBODY; RUBEOLA
ANTIBODY; SALMONELLA
ANTIBODY; SHIGELLA
ANTIBODY; TETANUS
ANTIBODY; TOXOPLASMA
ANTIBODY; TOXOPLASMA, IGM
ANTIBODY; TREPONEMA PALLIDUM, CONFIRMATORY TEST (EG, FTA-ABS)
ANTIBODY; TRICHINELLA
ANTIBODY; VARICELLA-ZOSTER
ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED
ANTIBODY; YERSINIA
THYROGLOBULIN ANTIBODY
HEPATITIS C ANTIBODY
HEPATITIS C ANTIBODY, CONFIRM
LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITH TITRATION
LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; WITHOUT TITRATION
SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); STANDARD METHOD
SERUM SCREENING FOR CYTOTOXIC PERCENT REACTIVE ANTIBODY (PRA); QUICK METHOD
HLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN
HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS
HLA TYPING; DR/DQ, SINGLE ANTIGEN
HLA TYPING; DR/DQ, MULTIPLE ANTIGENS
HLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC)
HLA TYPING; LYMPHOCYTE CULTURE, PRIMED (PLC)
UNLISTED IMMUNOLOGY PROCEDURE
ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE
ANTIBODY ELUTION (RBC), EACH ELUTION
ANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQUE
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EACH ANTISERUM
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, QUALITATIVE, EACH ANTISERUM
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, TITER, EACH ANTISERUM
AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESSING AND STORAGE; PREDEPOSITED
AUTOLOGOUS BLOOD OR COMPONENT, COLLECTION PROCESSING AND STORAGE; INTRA- OR POSTOPERATIVE S
BLOOD TYPING; ABO
BLOOD TYPING; RH (D)
BLOOD TYPING; ANTIGEN SCREENING FOR COMPATIBLE BLOOD UNIT USING REAGENT SERUM, PER UNIT SCREEN
BLOOD TYPING; ANTIGEN SCREENING FOR COMPATIBLE UNIT USING PATIENT SERUM, PER UNIT SCREENED
BLOOD TYPING; RBC ANTIGENS, OTHER THAN ABO OR RH (D), EACH
BLOOD TYPING; RH PHENOTYPING, COMPLETE
BLOOD TYPING, FOR PATERNITY TESTING, PER INDIVIDUAL; ABO, RH AND MN
BLOOD TYPING, FOR PATERNITY TESTING, PER INDIVIDUAL, ABO, RH AND MN; EACH ADDITIONAL ANTIGEN SYSTEM
COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE
COMPATIBILITY TEST EACH UNIT; INCUBATION TECHNIQUE
COMPATIBILITY TEST EACH UNIT; ANTIGLOBULIN TECHNIQUE
FRESH FROZEN PLASMA, THAWING, EACH UNIT
FROZEN BLOOD, EACH UNIT; FREEZING (INCLUDES PREPARATION)
FROZEN BLOOD, EACH UNIT; THAWING

FROZEN BLOOD, EACH UNIT; FREEZING (INCLUDES PREPARATION) AND THAWING
HEMOLYSINS AND AGGLUTININS; AUTO, SCREEN, EACH
HEMOLYSINS AND AGGLUTININS, AUTO, SCREEN, EACH; INCUBATED
IRRADIATION OF BLOOD PRODUCT, EACH UNIT
LEUKOCYTE TRANSFUSION
POOLING OF PLATELETS OR OTHER BLOOD PRODUCTS
PRETREATMENT OF RBC'S FOR USE IN RBC ANTIBODY DETECTION, IDENTIFICATION, AND/OR COMPATIBILITY TEST
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; INCUBATION WITH DRUGS, EACH
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; BY DILUTION
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; INCUBATION WITH INHIBITORS, EACH
PRETREATMENT OF SERUM FOR USE IN RBC ANTIBODY IDENTIFICATION; BY DIFFERENTIAL RED CELL ABSORPTIO
SPLITTING OF BLOOD OR BLOOD PRODUCTS, EACH UNIT
UNLISTED TRANSFUSION MEDICINE PROCEDURE
ANIMAL INOCULATION, SMALL ANIMAL; WITH OBSERVATION
ANIMAL INOCULATION, SMALL ANIMAL; WITH OBSERVATION AND DISSECTION
CONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS
CULTURE, BACTERIAL; BLOOD, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES (INCLUDES ANA
CULTURE, BACTERIAL; FECES, WITH ISOLATION AND PRELIMINARY EXAMINATION (EG, KIA, LIA), SALMONELLA AND
CULTURE, BACTERIAL; STOOL, ADDITIONAL PATHOGENS, ISOLATION AND PRELIMINARY EXAMINATION (EG, CAMPY
CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, WITH ISOLATION AND PRESUMPT
CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATE
CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLA
CULTURE, BACTERIAL; ANY SOURCE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLAT
CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION,
CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EA
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY, BY COMMERCIAL KIT (SPECIFY TYPE); WI
CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE
CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, URINE
CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; SKIN, HAIR, O
CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; OTHER SOUR
CULTURE, FUNGI (MOLD OR YEAST) ISOLATION, WITH PRESUMPTIVE IDENTIFICATION OF ISOLATES; BLOOD
CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; YEAST
CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD
CULTURE, MYCOPLASMA, ANY SOURCE
CULTURE, CHLAMYDIA, ANY SOURCE
CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY SOURCE, WITH ISOLATION
CULTURE, MYCOBACTERIAL, DEFINITIVE IDENTIFICATION, EACH ISOLATE
CULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EACH ANTISERUM
CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC) OR HIGH PRESSURE LIQUID CHROMATOGRAPHY (HPLC
CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESCENCE (EG, AGGLUTINATION GROUP
CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID PROBE
CULTURE, TYPING; IDENTIFICATION BY PULSE FIELD GEL TYPING
CULTURE, TYPING; OTHER METHODS
DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); INCLUDES SPECIMEN COLLECTION
DARK FIELD EXAMINATION, ANY SOURCE (EG, PENILE, VAGINAL, ORAL, SKIN); WITHOUT COLLECTION
MACROSCOPIC EXAMINATION; ARTHROPOD

MACROSCOPIC EXAMINATION; PARASITE
PINWORM EXAM (EG, CELLOPHANE TAPE PREP)
HOMOGENIZATION, TISSUE, FOR CULTURE
OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR DILUTION METHOD, PER AGENT (EG, ANTIBIOTIC GRADIE
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR FEWER AGENTS)
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA LACTAMASE), PER ENZYME
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CO
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION, MINIMUM LETHAL CONCE
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MACROBROTH DILUTION METHOD, EACH AGENT
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MYCOBACTERIA, PROPORTION METHOD, EACH AGENT
SERUM BACTERICIDAL TITER (SCHLICTER TEST)
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYP
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; FLUORESCENT AND/OR ACID FAST STAIN FOR BACTERIA, FUN
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; SPECIAL STAIN FOR INCLUSION BODIES OR PARASITES (EG, M
SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG, SALINE, INDIA INK
TISSUE EXAMINATION BY KOH SLIDE OF SAMPLES FROM SKIN, HAIR, OR NAILS FOR FUNGI OR ECTOPARASITE OV
TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUM DIFFICILE TOXIN)
VIRUS ISOLATION; INOCULATION OF EMBRYONATED EGGS, OR SMALL ANIMAL, INCLUDES OBSERVATION AND DISS
VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSERVATION, AND PRESUMPTIVE IDENTIFICATION BY CYTOP
VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION (EG, HEMABSORPTION
VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL) TECHNIQUE, INCLUDES IDENTIFICATION WITH IMMUNOF
VIRUS ISOLATION; INCLUDING IDENTIFICATION BY NON-IMMUNOLOGIC METHOD,OTHER THAN BY CYTOPATHIC EF
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; ADENOVIRUS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; BORDETELLA PERTUSSIS/PARA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE;ENTEROVIRUS, DIRECT FLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CHLAMYDIA TRACHOMATIS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CYTOMEGALOVIRUS, DIRECT F
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; CRYPTOSPORIDIUM/GIARDIA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA A VIRUS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA MICDADEI
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; LEGIONELLA PNEUMOPHILA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PARAINFLUENZA VIRUS, EACH
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RESPIRATORY SYNCYTIAL VIRU
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS CARINII
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; RUBEOLA
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; TREPONEMA PALLIDUM
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; VARICELLA ZOSTER VIRUS
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; NOT OTHERWISE SPECIFIED, E
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FOR MULTIPLE OR
INFECTIOUS AGENT AG DETECT BY EI, MULTI;ADENOVIRUS TYPE 40/4
INFECTIOUS AGENT AG DETECT BY EI, MULTI;CHLAMYDIA
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTIT
INFECTIOUS AGENT AG DETECT BY EI, MULTI;CRYPTOSPORIDUM
INFECTIOUS AGENT AG DETECT BY EI, MULTI;CYTOMEGALOVIRUS

INFECTIOUS AGENT AG DETECT BY EI, MULTI;ESCHERICHIA COLI
INFECTIOUS AGENT AG DETECT BY EI, MULTI; HBSAG
INFECTIOUS AGENT AG DETECT BY EI, MULTI; HBEAG
INFECTIOUS AGENT AG DETECT BY EI, MULTI;HEPATITIS, DELTA
INFECTIOUS AGENT AG DETECT BY EI, MULTI;HISTOPLASMA CAPSULAT
INFECTIOUS AGENT AG DETECT BY EI, MULTI; HIV-1
INFECTIOUS AGENT AG DETECT BY EI, MULTI; HIV-2
INFECTIOUS AGENT AG DETECT BY EI, MULTI; RSV
INFECTIOUS AGENT AG DETECT BY EI, MULTI; ROTAVIRUS
INFECTIOUS AGENT AG DETECT BY EI, MULTI;STREP, GRP A
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQUANTIT
INFECTIOUS AGENT DETECT BY DNA/RNA; BARTONELLA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; BARTONELLA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; BARTONELLA, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; BORRELIA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; BORRELIA AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; BORRELIA QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; CANDIDA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; CANDIDA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; CANDIDA, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA P, DIRECT PROB
INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA P, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA P, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA T, DIRECT PROB
INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA T, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA T, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; CYTOMEGALO, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; CYTOMEGALO, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; CYTOMEGALO, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA;GARDNERELLA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA;GARDNERELLA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA;GARDNERELLA, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP B, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP B, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP B, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP C, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP C, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP C, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP G, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HEP G, AMP PROBE

INFECTIOUS AGENT DETECT BY DNA/RNA; HEP G, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HERPES SIMP, DIRECT PROB
INFECTIOUS AGENT DETECT BY DNA/RNA; HERPES SIMP, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HERPES SIMP, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HERPES -6, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HERPES -6, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HERPES -6, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HIV-1, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HIV-1, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HIV-1, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; HIV-2, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HIV-2, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; HIV-2, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; LEGIONELLA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; LEGIONELLA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; LEGIONELLA, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOBACT, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOBACT, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOBACT, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOBACA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOBACA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOBACA, QUANT
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA AVIUM-INTRACELLULARE, DIRE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA AVIUM-INTRACELLULARE, AMPL
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA AVIUM-INTRACELLULARE, QUAN
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOPLASMA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOPLASMA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; MYCOPLASMA, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; NEISSERIA G, DIRECT PROB
INFECTIOUS AGENT DETECT BY DNA/RNA; NEISSERIA G, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; NEISSERIA G, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; PAPILLOMA, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; PAPILLOMA, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; PAPILLOMA, QUANT
INFECTIOUS AGENT DETECT BY DNA/RNA; STREP A, DIRECT PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; STREP A, AMP PROBE
INFECTIOUS AGENT DETECT BY DNA/RNA; STREP A, QUANT
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; DIRECT PROBE TE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; QUANTIFICATION,
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; DIRECT PROBE(S) TECH
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOC
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; CLOSTRIDIUM
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA
INFECTIOUS AGENT DETECT BY IMMUNOASSAY, DIRECT OPT, CHLAMYDI
INFECTIOUS AGENT DETECT BY IMMUNOASSAY, DIRECT OPT, NEISSERI
INFECTIOUS AGENT DETECT BY IMMUNOASSAY, DIRECT OPT, STREP A
INFECTIOUS AGENT DETECT BY IMMUNOASSAY, DIRECT OPT, NOS

INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HIV 1, REVERSE TRANSCRIPTASE AND
INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C VIRUS
INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESISTANCE TISSUE CUL
INFECTIOUS AGENT PHENOTYPE ANALYSIS NUCLEIC ACID (DNA/RNA) WITH DRUG RESISTANCE TISSUE CULTURE
UNLISTED MICROBIOLOGY PROCEDURE
NECROPSY (AUTOPSY), GROSS EXAMINATION ONLY; WITHOUT CNS
NECROPSY (AUTOPSY), GROSS EXAMINATION ONLY; WITH BRAIN
NECROPSY (AUTOPSY), GROSS EXAMINATION ONLY; WITH BRAIN AND SPINAL CORD
NECROPSY (AUTOPSY), GROSS EXAMINATION ONLY; INFANT WITH BRAIN
NECROPSY (AUTOPSY), GROSS EXAMINATION ONLY; STILLBORN OR NEWBORN WITH BRAIN
NECROPSY (AUTOPSY), GROSS EXAMINATION ONLY; MACERATED STILLBORN
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; WITHOUT CNS
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; WITH BRAIN
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; WITH BRAIN AND SPINAL CORD
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; INFANT WITH BRAIN
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; STILLBORN OR NEWBORN WITH BRAIN
NECROPSY (AUTOPSY), LIMITED, GROSS AND/OR MICROSCOPIC; REGIONAL
NECROPSY (AUTOPSY), LIMITED, GROSS AND/OR MICROSCOPIC; SINGLE ORGAN
NECROPSY (AUTOPSY); FORENSIC EXAMINATION
NECROPSY (AUTOPSY); CORONER'S CALL
UNLISTED NECROPSY (AUTOPSY) PROCEDURE
CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH INTERPRE
CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; FILTER METHOD ONLY W
CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS AND FILTER PRE
CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; CONCENTRATION TECHN
CYTOPATHOLOGY, FORENSIC (EG, SPERM)
SEX CHROMATIN IDENTIFICATION; BARR BODIES
SEX CHROMATIN IDENTIFICATION; PERIPHERAL BLOOD SMEAR, POLYMORPHONUCLEAR "DRUMSTICKS"
CYTOPATHOLOGY INTERPRETATION BY PHYSICIAN
CYTOPATHOLOGY; PAP SMEAR, PRESERVED, AUTO THIN LAYER, MAX 3
CYTPATH C/VAG T/LAYER REDO
CYTPATH C/VAG AUTOMATED
CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL; SCREENING BY AUTOMATED SYSTEM WITH MANUAL RESCRE
CYTOPATHOLOGY, SMEARS, CERVICAL OR VAGINAL, UP TO THREE SMEARS; SCREENING BY TECHNICIAN UNDER
CYTOPATHOLOGY; PAP SMEAR, WITH PHYSICIAN RESCREEN
CYTPATH C/VAG REDO
CYTPATH C/VAG SELECT
CYTOPATHOLOGY, SMEARS, CERVICAL OR VAGINAL, UP TO THREE SMEARS; WITH DEFINITIVE HORMONAL EVALUA
CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION
CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION
CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES AND/OR MULTIPL
CYTPATH TBS C/VAG MANUAL
CYTPATHOLOGY, SLIDES, CERVICAL OR VAGINAL (THE BETHESDA SYSTEM); WITH MANUAL SCREENING AND RESC
CYTPATH TBS C/VAG AUTO REDO
CYTPATH TBS C/VAG SELECT
CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC STUDY TO DETERMINE
CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; INTERPRETATION AND REPORT
CYTOPATHOLOGY, CERVICAL/VAGINAL (ANY RPTING SYSTEM), COLLECTED PRESERVATIVE FLUID, AUTOMATED TH
CYTOPATHOLOGY, CERVICAL/VAGINAL (ANY REPORTING SYSTEM), COLLECTED PRESERVATIVE FLUID, AUTOMATE

FLOW CYTOMETRY; EACH CELL SURFACE, CYTOPLASMIC OR NUCLEAR MARKER
FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS
UNLISTED CYTOPATHOLOGY PROCEDURE
TISSUE CULTURE FOR CHROMOSOME ANALYSIS; LYMPHOCYTE
TISSUE CULTURE FOR CHROMOSOME ANALYSIS; SKIN OR OTHER SOLID TISSUE BIOPSY
TISSUE CULTURE FOR CHROMOSOME ANALYSIS; AMNIOTIC FLUID OR CHORIONIC VILLUS CELLS
TISSUE CULTURE FOR CHROMOSOME ANALYSIS; BONE MARROW (MYELOID) CELLS
TISSUE CULTURE FOR CHROMOSOME ANALYSIS; OTHER TISSUE
CRYOPRESERVATION,FREEZING,& STORAGE OF CELLS,EA CELL LINE
THAWING & EXPANSION OF FROZEN CELLS, EA ALIQUOT
CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 25 CELLS (SCE STUDY), COUNT 5 CELLS, 1 KARYO
CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, COUNT 20 CELLS, 2 KARYOTYPES, W
CHROMO ANALYSIS BREAKAGE SYNDS;100 CELLS,CLASTROGEN STRESS
CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING
CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING
CHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDING
CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1 KARYOTYPE, WITH BANDIN
CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-12 COLONIES, 1 KARYOTYP
CYTOGENETICS, DNA PROBE
CYTOGENETICS, 3-5
CYTOGENETICS, 10-30
CYTOGENETICS, 25-99
CYTOGENETICS, 100-300
CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY
CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR, C-BANDING)
CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY
CHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY
CYTOGENETICS & MOLECULAR CYTOGENETICS,INTERP & REPORT
UNLISTED CYTOGENETIC STUDY
LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY
LEVEL II - SURGICAL PATH, GROSS & MICRO EXAM APPENDIX, FALLOPIAN TUBE, STERILIZATION FINGERS/TOES, AM
LVL III-SX PATHOLGY,GROSS&MICROSCOP X ABORT,IND ABSCESS ANRYM-ARTRL/VENTRIC ANUS,OTH THAN INCID
LVL IV-SX PATHOLOGY,GROSS&MICROSCOPIC X ABORT-SPON/MISSED ART,BX BN MARRW, BX BN XOSTOSIS BRAIN
LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
LEVEL VI - SURGICAL PATH, GROSS & MICRO EXAM BONE RESECTION BREAST, MASTECTOMY - WITH REGIONAL LY
DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATI
SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); GROUP I FO
SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); GROUP II, A
SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); HISTOCHE
DETERMINATIVE HISTOCHEMISTRY TO IDENTIFY CHEMICAL COMPONENTS (EG, COPPER, ZINC)
DETERMINATIVE HISTOCHEMISTRY OR CYTOCHEMISTRY TO IDENTIFY ENZYME CONSTITUENTS, EACH
CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE
CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES
CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REPORT ON REFERRED M
PATHOLOGY CONSULTATION DURING SURGERY;
PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN SECTION(S), SINGLE SPECIM
PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S)
IMMUNOCYTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY

IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD
ELECTRON MICROSCOPY; DIAGNOSTIC
ELECTRON MICROSCOPY; SCANNING
MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE
MORPHOMETRIC ANALYSIS; NERVE
MORPHOMETRIC ANALYSIS; TUMOR
NERVE TEASING PREPARATIONS
TISSUE IN SITU HYBRIDIZATION, INTERPRETATION AND REPORT
PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT;
PROTEIN ANALYSIS OF TISSUE BY WESTERN BLOT, WITH INTERPRETATION AND REPORT; IMMUNOLOGICAL PROBE
MICRODISSECTION (EG, MECHANICAL, LASER CAPTURE)
UNLISTED SURGICAL PATHOLOGY PROCEDURE
BILIRUBIN, TOTAL, TRANSCUTANEOUS
CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD;
CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINT FLUID), EXCEPT BLOOD; WITH D
LEUKOCYTE COUNT, FECAL
CRYSTAL IDENTIFICATION BY LIGHT MICROSCOPY WITH OR WITHOUT POLARIZING LENS ANALYSIS, ANY BODY FLU
DUODENAL INTUBATION AND ASPIRATION; SINGLE SPECIMEN (EG, SIMPLE BILE STUDY OR AFFERENT LOOP CULTU
DUODENAL INTUBATION AND ASPIRATION; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH PANCREATIC
FAT STAIN, FECES, URINE, OR RESPIRATORY SECRETIONS
GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, FOR CHEMICAL ANALYSES OR CYTOPATH
GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, FOR CHEMICAL ANALYSES OR CYTOPATH
GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); ONE HO
GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); TWO HO
GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); TWO HO
GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); THREE H
MEAT FIBERS, FECES
NASAL SMEAR FOR EOSINOPHILS
CULTURE AND FERTILIZATION OF OOCYTE(S)
CULTURE AND FERTILIZATION OF OOCYTE(S); WITH CO-CULTURE OF EMBRYOS
ASSISTED OOCYTE FERTILIZATION, MICROTECHNIQUE (ANY METHOD)
ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY METHOD)
OOCYTE IDENTIFICATION FROM FOLLICULAR FLUID
PREPARATION OF EMBRYO FOR TRANSFER (ANY METHOD)
PREPARATION OF CRYOPRESERVED EMBRYOS FOR TRANSFER (INCLUDES THAW)
SPERM IDENTIFICATION FROM ASPIRATION (OTHER THAN SEMINAL FLUID)
CRYOPRESERVATION; EMBRYO
CRYOPRESERVATION; SPERM
SPERM ISOLATION; SIMPLE PREP (EG, SPERM WASH AND SWIM-UP) FOR INSEMINATION OR DIAGNOSIS WITH SEM
SPERM ISOLATION; COMPLEX PREP (EG, PER COL GRADIENT, ALBUMIN GRADIENT) FOR INSEMINATION OR DIAGN
SPERM IDENTIFICATION FROM TESTIS TISSUE, FRESH OR CRYOPRESERVED
SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM INCLUDING HUHNER TEST
SEMEN ANALYSIS; MOTILITY AND COUNT (NOT INCLUDING HUHNER TEST)
SEMEN ANALYSIS; COMPLETE (VOLUME, COUNT, MOTILITY AND DIFFERENTIAL)
SEMEN ANALYSIS, PRESENCE AND/OR MOTILITY OF SPERM
SPERM ANTIBODIES
SPERM EVALUATION; HAMSTER PENETRATION TEST
SPERM EVALUATION; CERVICAL MUCUS PENETRATION TEST, WITH OR WITHOUT SPINNBARKEIT TEST
SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE)
STARCH GRANULES, FECES
SWEAT COLLECTION BY IONTOPHORESIS
WATER LOAD TEST
UNLISTED MISCELLANEOUS PATHOLOGY TEST
IMMUNE GLOBULIN (IG), HUMAN, FOR INTRAMUSCULAR USE
IMMUNE GLOBULIN (IGIV), HUMAN, FOR INTRAVENOUS USE
BOTULINUM ANTITOXIN, EQUINE, ANY ROUTE
BOTULISM IMMUNE GLOBULIN, HUMAN, FOR INTRAVENOUS USE
CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGIV), HUMAN, FOR INTRAVENOUS USE
DIPHTHERIA ANTITOXIN, EQUINE, ANY ROUTE
HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, FOR INTRAMUSCULAR USE
RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR INTRAMUSCULAR AND/OR SUBCUTANEOUS USE
RABIES IMMUNE GLOBULIN, HEAT-TREATED (RIG-HT), HUMAN, FOR INTRAMUSCULAR AND/OR SUBCUTANEOUS US
RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN (RSV-IGIM), FOR INTRAMUSCULAR USE, 50 MG, EACH
RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN (RSV-IGIV), HUMAN, FOR INTRAVENOUS USE
RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FULL-DOSE, FOR INTRAMUSCULAR USE
RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, MINI-DOSE, FOR INTRAMUSCULAR USE
RHO(D) IMMUNE GLOBULIN (RHIGIV), HUMAN, FOR INTRAVENOUS USE
TETANUS IMMUNE GLOBULIN (TIG), HUMAN, FOR INTRAMUSCULAR USE
VACCINIA IMMUNE GLOBULIN, HUMAN, FOR INTRAMUSCULAR USE
VARICELLA-ZOSTER IMMUNE GLOBULIN, HUMAN, FOR INTRAMUSCULAR USE
UNLISTED IMMUNE GLOBULIN
IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, INTRAMUSCULAR
IMMUNIZATION ADMINISTRATION (INCL PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, INTRAMUSCULAR&JET
IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; ONE VACCINE (SINGLE OR COMBINATION VACC
IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; EACH ADDITIONAL VACCINE (SINGLE OR COMB
ADENOVIRUS VACCINE, TYPE 4, LIVE, FOR ORAL USE
ADENOVIRUS VACCINE, TYPE 7, LIVE, FOR ORAL USE
ANTHRAX VACCINE, FOR SUBCUTANEOUS USE
BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR TUBERCULOSIS, LIVE, FOR PERCUTANEOUS USE
BACILLUS CALMETTE-GUERIN VACCINE (BCG) FOR BLADDER CANCER, LIVE, FOR INTRAVESICAL USE
HEPATITIS A VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-2 DOSE SCHEDULE, FOR INTRAMUSCULAR USE
HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-3 DOSE SCHEDULE, FOR INTRAMUSCULAR USE
HEPATITIS A AND HEPATITIS B VACCINE (HEPA-HEPB), ADULT DOSAGE, FOR INTRAMUSCULAR USE
HEMOPHILUS INFLUENZA B VACCINE (HIB), HBOC CONJUGATE (4 DOSE SCHEDULE), FOR INTRAMUSCULAR USE
HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-D CONJUGATE, FOR BOOSTER USE ONLY, INTRAMUSCULAR USE
HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-OMP CONJUGATE (3 DOSE SCHEDULE), FOR INTRAMUSCULAR US
HEMOPHILUS INFLUENZA B VACCINE (HIB),PRP-T CONJUGATE (4 DOSE SCHEDULE), FOR INTRAMUSCULAR USE
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, 6-35 MONTHS DOSAGE, FOR INTRAMUSCULAR OR JET INJECTION USE
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, 3 YEARS AND ABOVE DOSAGE, FOR INTRAMUSCULAR OR JET INJECTIO
INFLUENZA VIRUS VACCINE, WHOLE VIRUS, FOR INTRAMUSCULAR OR JET INJECTION USE
INFLUENZA VIRUS VACCINE, LIVE, FOR INTRANASAL USE
LYME DISEASE VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
PNEUMOCOCCAL CONJUGATE VACCINE, POLYVALENT, FOR CHILDREN UNDER FIVE YEARS, FOR INTRAMUSCULAR
RABIES VACCINE, FOR INTRAMUSCULAR USE
RABIES VACCINE, FOR INTRADERMAL USE
ROTAVIRUS VACCINE, TETRAVALENT, LIVE, FOR ORAL USE

TYPHOID VACCINE, LIVE, ORAL
TYPHOID VACCINE, VI CAPSULAR POLYSACCHARIDE (VICPS), FOR INTRAMUSCULAR USE
TYPHOID VACCINE, HEAT- AND PHENOL-INACTIVATED (H-P), FOR SUBCUTANEOUS OR INTRADERMAL USE
TYPHOID VACCINE, ACETONE-KILLED, DRIED (AKD), FOR SUBCUTANEOUS OR JET INJECTION USE (U.S. MILITARY)
DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP), FOR INTRAMUSCULAR USE
DIPHTHERIA, TETANUS TOXOIDS, AND WHOLE CELL PERTUSSIS VACCINE (DTP), FOR INTRAMUSCULAR USE
DIPHTHERIA AND TETANUS TOXOIDS (DT) ADSORBED FOR USE IN INDIVIDUALS YOUNGER THAN SEVEN YEARS, FO
TETANUS TOXOID ADSORBED, FOR INTRAMUSCULAR OR JET INJECTION USE
MUMPS VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS OR JET INJECTION USE
MEASLES VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS OR JET INJECTION USE
RUBELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS OR JET INJECTION USE
MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS OR JET INJECTION USE
MEASLES AND RUBELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS OR JET INJECTION USE
MEASLES, MUMPS, RUBELLA, AND VARICELLA VACCINE (MMRV), LIVE, FOR SUBCUTANEOUS USE
POLIOVIRUS VACCINE, (ANY TYPE(S)) (OPV), LIVE, FOR ORAL USE
POLIOVIRUS VACCINE, INACTIVATED, (IPV), FOR SUBCUTANEOUS USE
VARICELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE
YELLOW FEVER VACCINE, LIVE, FOR SUBCUTANEOUS USE
TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED FOR USE IN INDIVIDUALS SEVEN YEARS OR OLDER, FOR INT
DIPHTHERIA TOXOID, FOR INTRAMUSCULAR USE
DIPHTHERIA, TETANUS TOXOIDS, AND WHOLE CELL PERTUSSIS VACCINE AND HEMOPHILUS INFLUENZA B VACCIN
DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE AND HEMOPHILUS INFLUENZA B VACCINE
DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HEPATITIS B, AND POLIOVIRUS VACCINE, INAC
CHOLERA VACCINE FOR INJECTABLE USE
PLAGUE VACCINE, FOR INTRAMUSCULAR OR JET INJECTION USE
PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT, ADULT OR IMMUNOSUPPRESSED PATIENT DOSAGE, FO
MENINGOCOCOCCAL POLYSACCHARIDE VACCINE (ANY GROUP(S)), FOR SUBCUTANEOUS OR JET INJECTION USE
JAPANESE ENCEPHALITIS VIRUS VACCINE, FOR SUBCUTANEOUS USE
HEPATITIS B VACCINE, DIALYSIS OR IMMUNOSUPPRESSED PATIENT DOSAGE (3 DOSE SCHEDULE), FOR INTRAMUS
HEPATITIS B VACCINE, ADOLESCENT (2 DOSE SCHEDULE), FOR INTRAMUSCULAR USE
HEPATITIS B VACCINE, PEDIATRIC/ADOLESCENT DOSAGE (3 DOSE SCHEDULE), FOR INTRAMUSCULAR USE
HEPATITIS B VACCINE, ADULT DOSAGE, FOR INTRAMUSCULAR USE
HEPATITIS B VACCINE, DIALYSIS OR IMMUNOSUPPRESSED PATIENT DOSAGE (4 DOSE SCHEDULE), FOR INTRAMUS
HEPATITIS B AND HEMOPHILUS INFLUENZA B VACCINE (HEPB-HIB), FOR INTRAMUSCULAR USE
UNLISTED VACCINE/TOXOID
INTRAVENOUS INFUSION FOR THERAPY/DIAGNOSIS, ADMINISTERED BY PHYSICIAN OR UNDER DIRECT SUPERVIS
INTRAVENOUS INFUSION, THERAPY/DIAGNOSIS, ADMINISTERED PHYSICIAN/UNDER DIRECT SUPERVISION, PHYSIC
THERAPEUTIC, PROPHYLACTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); SUBCUTANEOUS OR
THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); INTRA-ARTERIAL
THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); INTRAVENOUS
INTRAMUSCULAR INJECTION OF ANTIBIOTIC (SPECIFY)
UNLISTED THERAPEUTIC, PROPHYLACTIC OR DIAGNOSTIC INJECTION
PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION
INTERACTIVE PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION USING PLAY EQUIPMENT, PHYSICAL DEVICES,
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR

INDIVIDUAL PSYCHOTHERAPY,INTERACTIVE,USING PLAY EQUIP, PHYSICAL DEVICES, LANG INTERPRETER/OTH ME
INDIVIDUAL PSYCHOTHER,INTERACT,PLAY EQUIP,PHYS DEVICES,LANG INTERPRETER/OTH MECHANISMS OF NON
INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIP, PHYSICAL DEVICES, LANG INTERPRETER/OTH M
INDIVIDUAL PSYCHOTHERAPY,INTERACTIVE,USING PLAY EQUIP,PHYSICAL DEVICES, LANGUAGE INTERPRETER/OT
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN INPATIENT
INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAV MODIFY &/ SUPPORTIVE, IN AN INPATIENT HOSPITAL, PA
INDIVIDUAL PSYCHOTHER,INTERACT,PLAY EQUIP,PHYS DEVICES,LANG INTERPRETER/OTH MECH OF NON-VERBAL
INDIVIDUAL PSYCHOTHER, INTERACT, PLAY EQUIP, PHYS DEVICES, LANG INTERPRETER/OTH MECH OF NON-VERB
INDIVIDUAL PSYCHOTHER, INTERACTIVE, PLAY EQUIP, PHYS DEVICES, LANG INTERPRETER/OTH MECH OF NON-V
INDIVIDUAL PSYCHOTHER,INTERACT,PLAY EQUIP,PHYS DEVICE,LANG INTERPRETER/OTH MECH OF NON-VERBAL
INDIVIDUAL PSYCHOTHERAPY,INTERACTIVE, PLAY EQUIP,PHYS DEVICES,LANG INTERPRETER/OTH MECH OF NON
INDIVIDUAL PSYCHOTHER,INTERACT,PLAY EQUIP,PHYS DEVICE,LANG INTERPRETER/OTH MECH OF NON-VERBAL
PSYCHOANALYSIS
FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT)
FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT)
MULTIPLE-FAMILY GROUP PSYCHOTHERAPY
GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)
INTERACTIVE GROUP PSYCHOTHERAPY
PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION, USE, AND REVIEW OF MEDICATION WITH NO MORE
NARCOSYNTHESIS FOR PSYCHIATRIC DIAGNOSTIC AND THERAPEUTIC PURPOSES (EG, SODIUM AMOBARBITAL (A
ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); SINGLE SEIZURE
ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); MULTIPLE SEIZURES, PER DAY
INDIV. PSYCHOPHYSIOLOGICAL THRPY INCORP. BIOFEEDBACK TRNG BY ANY MODALITY FACE/FACE W/ PT.(EG, INS
INDIV. PSYCHOPHYSIOLOGICAL THRPY INCORP. BIOFEEDBACK TRNG BY ANY MODALITY FACE/FACE W/ PT.(EG, INS
HYPNOTHERAPY
ENVIRONMENTAL INTERVENTION FOR MEDICAL MGMT PURPOSES ON A PSYCHIATRIC PATIENT'S BEHALF WITH AG
PSYCHIATRIC EVALUATION OF HOSPITAL RECORDS, OTHER PSYCHIATRIC REPORTS, PSYCHOMETRIC AND/OR PR
INTERPRETATION OR EXPLANATION OF RESULTS OF PSYCHIATRIC, OTH MEDICAL EXAMS/PROCEDURES, OR OTH
PREPARATION OF REPORT OF PATIENT'S PSYCHIATRIC STATUS, HISTORY, TREATMENT, OR PROGRESS (OTHER TH
UNLISTED PSYCHIATRIC SERVICE OR PROCEDURE
BIOFEEDBACK TRAINING BY ANY MODALITY
BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES PER FULL MONTH; <2 YEARS OF AGE TO INC MONITORIN
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES PER FULL MONTH; FOR PATIENTS 2-11 YEARS OLD TO INC
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES PER FULL MONTH; FOR PATIENTS 12-19 YEARS OLD TO IN
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES PER FULL MONTH; 20 YEARS OF AGE AND OVER
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS UND
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS BET
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS BET
END STAGE RENAL DISEASE (ESRD) RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS TWE
HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION
HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT SUBSTANTIAL REVISION O

HEMODIALYSIS ACCESS FLOW STUDY TO DETERMINE BLOOD FLOW IN GRAFTS AND ARTERIOVENOUS FISTULAE
HEMODIALYSIS ACCESS FLOW STUDY TO DETERMINE BLOOD FLOW IN GRAFTS AND ARTERIOVENOUS FISTULAE
DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS, HEMOFILTRATION, OR OTHER CO
DIALYSIS PROC OTHER THAN HEMODIALY (EG, PERITONEAL DIALYSIS, HEMOFILTRATION,/OTHER CONT RENAL RE
DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COMPLETED COURSE
DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COURSE NOT COMPLETED, PE
HEMOPERFUSION (EG, WITH ACTIVATED CHARCOAL OR RESIN)
UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT
ESOPHAGEAL INTUBATION AND COLLECTION OF WASHINGS FOR CYTOLOGY, INCLUDING PREPARATION OF SPECI
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) ST
ESOPHAGEAL MOTILITY STUDY; WITH MECHOLYL OR SIMILAR STIMULANT
ESOPHAGEAL MOTILITY STUDY; WITH ACID PERFUSION STUDIES
GASTRIC MOTILITY (MANOMETRIC) STUDIES
ESOPHAGUS, ACID PERFUSION (BERNSTEIN) TEST FOR ESOPHAGITIS
ESOPHAGUS, ACID REFLUX TEST, WITH INTRALUMINAL PH ELECTRODE FOR DETECTION OF GASTROESOPHAGEA
ESOPHAGUS, ACID REFLUX TEST, WITH INTRALUMINAL PH ELECTRODE FOR DETECTION OF GASTROESOPHAGEA
GASTRIC ANALYSIS TEST WITH INJECTION OF STIMULANT OF GASTRIC SECRETION (EG, HISTAMINE, INSULIN, PEN
GASTRIC INTUBATION, WASHINGS, AND PREPARING SLIDES FOR CYTOLOGY (SEPARATE PROCEDURE)
GASTRIC SALINE LOAD TEST
BREATH HYDROGEN TEST (EG, FOR DETECTION OF LACTASE DEFICIENCY)
INTESTINAL BLEEDING TUBE, PASSAGE, POSITIONING AND MONITORING
GASTRIC INTUBATION, AND ASPIRATION OR LAVAGE FOR TREATMENT (EG, FOR INGESTED POISONS)
ANORECTAL MANOMETRY
PULSED IRRIGATION OF FECAL IMPACTION
ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS
ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS; WITH PROVOCATIVE TESTING
UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATION OF DIAGNOSTIC AND
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATION OF DIAGNOSTIC AND
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIATION OR CONTINUATION O
OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIATION OR CONTINUATION O
DETERMINATION OF REFRACTIVE STATE
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT MANIP
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT MANIP
GONIOSCOPY (SEPARATE PROCEDURE)
SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR P
ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND EVALUATION
FITTING OF CONTACT LENS FOR TREATMENT OF DISEASE, INCLUDING SUPPLY OF LENS
VISUAL FIELD EXAMINATION, UNI OR BILATERAL, WITH MEDICAL DIAGNOSTIC EVAL; LIMITED EXAM (EG, TANGENT
VISUAL FIELD EXAMINATION, UNI OR BILATERAL, WITH MEDICAL DIAGNOSTIC EVAL; INTERMEDIATE EXAM (EG, AT
VISUAL FIELD EXAMINATION, UNI OR BILATERAL, WITH MEDICAL DIAGNOSTIC EVAL; EXTENDED EXAM (EG, GOLDM
SERIAL TONOMETRY (SEP PROC) WITH MULT MEAS OF INTRAOCULAR PRESSURE OVER EXTENDED TIME PERIOD
TONOGRAPHY WITH INTERPRETATION AND REPORT, RECORDING INDENTATION TONOMETER METHOD OR PERILIM
TONOGRAPHY WITH WATER PROVOCATION
SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING (EG, SCANNING LASER) WITH INTERPRETATION A
OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH INTRAOCULAR LENS POWER CALCUL
PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION AND REPORT, WITHOUT TONOGRAPHY
OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH IN
OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH ME
FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT
FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT
INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT
FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT
OPHTHALMODYNAMOMETRY
NEEDLE OCULOELECTROMYOGRAPHY, ONE OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH EYES, WITH MED
ELECTRO-OCULOGRAPHY, WITH MEDICAL DIAGNOSTIC EVALUATION
ELECTRORETINOGRAPHY, WITH MEDICAL DIAGNOSTIC EVALUATION
COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT
DARK ADAPTATION EXAMINATION, WITH MEDICAL DIAGNOSTIC EVALUATION
EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PR
SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH SPECULAR ENDOTHEL
SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH MEDICAL DIAGNOSTIC EVALUATION; WITH FLUORESCEIN ANG
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH MEDICA
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION
MODIFICATION OF CONTACT LENS (SEPARATE PROCEDURE), WITH MEDICAL SUPERVISION OF ADAPTATION
REPLACEMENT OF CONTACT LENS
PRESCRIPTION, FITTING, AND SUPPLY OF OCULAR PROSTHESIS (ARTIFICIAL EYE), WITH MEDICAL SUPERVISION O
PRESCRIPTION OF OCULAR PROSTHESIS (ARTIFICIAL EYE) AND DIRECTION OF FITTING AND SUPPLY BY INDEPEN
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MONOFOCAL
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; BIFOCAL
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MULTIFOCAL, OTHER THAN BIFOCAL
FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MONOFOCAL
FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MULTIFOCAL
FITTING OF SPECTACLE MOUNTED LOW VISION AID; SINGLE ELEMENT SYSTEM
FITTING OF SPECTACLE MOUNTED LOW VISION AID; TELESCOPIC OR OTHER COMPOUND LENS SYSTEM
PROSTHESIS SERVICE FOR APHAKIA, TEMPORARY (DISPOSABLE OR LOAN, INCLUDING MATERIALS)
REPAIR AND REFITTING SPECTACLES; EXCEPT FOR APHAKIA
REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHESIS FOR APHAKIA
SUPPLY OF SPECTACLES, EXCEPT PROSTHESIS FOR APHAKIA AND LOW VISION AIDS
SUPPLY OF CONTACT LENSES, EXCEPT PROSTHESIS FOR APHAKIA
SUPPLY OF LOW VISION AIDS (ANY LENS OR DEVICE USED TO AID OR IMPROVE VISUAL FUNCTION IN PERSON WH
SUPPLY OF OCULAR PROSTHESIS (ARTIFICIAL EYE)
SUPPLY OF PERMANENT PROSTHESIS FOR APHAKIA; SPECTACLES
SUPPLY OF PERMANENT PROSTHESIS FOR APHAKIA; CONTACT LENSES
UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
BINOCULAR MICROSCOPY (SEPARATE DIAGNOSTIC PROCEDURE)
EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AUDITORY PROCESSING, AND/OR AURAL REHABI
TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER (INCL
TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER (INCL
AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT (INCLUDES EVALUATION OF AURAL REHABILITATION ST
NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE)

NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY)
FACIAL NERVE FUNCTION STUDIES (EG, ELECTRONEURONOGRAPHY)
LARYNGEAL FUNCTION STUDIES
TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING
SPONTANEOUS NYSTAGMUS, INCLUDING GAZE
POSITIONAL NYSTAGMUS TEST
CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION CONSTITUTES FOUR TESTS
OPTOKINETIC NYSTAGMUS TEST
SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH RECORDING
POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING
CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION CONSTITUTES FOUR TESTS
OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION, WITH RECORDING
OSCILLATING TRACKING TEST, WITH RECORDING
SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
COMPUTERIZED DYNAMIC POSTUROGRAPHY
SCREENING TEST, PURE TONE, AIR ONLY
PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
SPEECH AUDIOMETRY THRESHOLD;
SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION
COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND 92556 COMBIN
AUDIOMETRIC TESTING OF GROUPS
BEKESY AUDIOMETRY; SCREENING
BEKESY AUDIOMETRY; DIAGNOSTIC
LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL
TONE DECAY TEST
SHORT INCREMENT SENSITIVITY INDEX (SISI)
STENGER TEST, PURE TONE
TYMPANOMETRY (IMPEDANCE TESTING)
ACOUSTIC REFLEX TESTING
ACOUSTIC REFLEX DECAY TEST
FILTERED SPEECH TEST
STAGGERED SPONDAIC WORD TEST
LOMBARD TEST
SENSORINEURAL ACUITY LEVEL TEST
SYNTHETIC SENTENCE IDENTIFICATION TEST
STENGER TEST, SPEECH
VISUAL REINFORCEMENT AUDIOMETRY (VRA)
CONDITIONING PLAY AUDIOMETRY
SELECT PICTURE AUDIOMETRY
ELECTROCOCHLEOGRAPHY
AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERV
AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERV
EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT OR DISTORTION PRO
EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON OF TRANSIEN
CENTRAL AUDITORY FUNCTION TEST(S) (SPECIFY)
HEARING AID EXAMINATION AND SELECTION; MONAURAL
HEARING AID EXAMINATION AND SELECTION; BINAURAL

HEARING AID CHECK; MONAURAL
HEARING AID CHECK; BINAURAL
ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL
ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL
EAR PROTECTOR ATTENUATION MEASUREMENTS
EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC DEVICE TO SUPPLEMENT ORAL SPEECH
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; WITH PROGRAMMING
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; SUBSEQUENT REPROGRAMMI
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAMMING
DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT REPROGRAMMING
EVALUATION FOR PRESCRIPTION OF NON-SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE COMMUNICAT
THERAPEUTIC SERVICE(S) FOR THE USE OF NON-SPEECH-GENERATING DEVICE, INCLUDING PROGRAMMING AND
EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
EVAL, RX, SPEECH-GENERATING AUGMENTATIVE&ALTERNATIVE COMM, FCE-TO-FCE W THE PT; EA ADD 30 MIN
THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING PROGRAMMING AND MODI
EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION
MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RECORDING
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RECORDING; PHYSICIAN I
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR VIDEO RECORDIN
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR VIDEO RECORDIN
FLEX FIBEROPTIC ENDOSCOPIC EVAL, SWALLOW&LARYNGEAL SENSRY TSTING CINE/VIDEO REC;
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY TESTING BY CINE
UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE
CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)
TEMPORARY TRANSCUTANEOUS PACING
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; EXTERNAL
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; INTERNAL (SEPARATE PROCEDURE)
CARDIOASSIST-METHOD OF CIRCULATORY ASSIST; INTERNAL
CARDIOASSIST-METHOD OF CIRCULATORY ASSIST; EXTERNAL
PERCUTANEOUS TRANSLUMINAL CORONARY THROMBECTOMY (LIST SEPARATELY IN ADDITION TO CODE FOR PRI
TRANSCATHETER PLACEMENT OF RADIATION DELIVERY DEVICE FOR SUBSEQUENT CORONARY INTRAVASCULAR
THROMBOLYSIS, CORONARY; BY INTRACORONARY INFUSION, INCLUDING SELECTIVE CORONARY ANGIOGRAPHY
THROMBOLYSIS, CORONARY; BY INTRAVENOUS INFUSION
INTRAVASCULAR ULTRASOUND (CORONARY VESSEL/GRAFT) DURING DIAG EVALUATION &/ THERAPEUTIC INTERV
INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURING THERAPEUTIC INTERVENTION INCLUDIN
TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER T
TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER T
PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; SINGLE VESSEL
PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST SEPARAT
PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE
PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE
PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALVE
ATRIAL SEPTECTOMY OR SEPTOSTOMY; TRANSVENOUS METHOD, BALLOON (EG, RASHKIND TYPE) (INCLUDES CA
ATRIAL SEPTECTOMY OR SEPTOSTOMY; BLADE METHOD (PARK SEPTOSTOMY) (INCLUDES CARDIAC CATHETERIZ
PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD, WITH OR WIT
PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD, WITH OR WIT
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; SINGLE VESSEL
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY
TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S), 24-HOUR ATTENDED
TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S), 24-HOUR ATTENDED
CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINO
ERGONOVINE PROVOCATION TEST
MICROVOLT T-WAVE ALTERNANS FOR ASSESSMENT OF VENTRICULAR ARRHYTHMIAS
RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION AND REPORT
RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT
RHYTHM ECG, ONE TO THREE LEADS; INTERPRETATION AND REPORT ONLY
ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORD &
ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS COMPUTER MONITOR & NON-CONTINUO
PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, 24-HOUR ATTEN
SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENTIAL CARDIAC ANOMALIES; COMPLETE
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENTIAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MO
ECHOCARDIOGRAPHY, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; F
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M
ECHOCARDIOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING),
ECHOCARDIOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING),
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENTIAL CARDIAC ANOMALIES; INCLUDING PROBE PLACEM
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENTIAL CARDIAC ANOMALIES; PLACEMENT OF TRANSESOP
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENTIAL CARDIAC ANOMALIES; IMAGE ACQUISITION, INTERP
ECHOCARDIOGRAPHY,TRANSESOPHAGEAL MONITOR PRPOSES,INCL PROBE PLCEMNT,REAL TIME 2 DIMENZIONA
DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEP
DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE &/ CONTINUOUS WAVE W SPEC DISP (LIST SEP IN ADD TO CODES
DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODES FO
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMAGE DOC (2D, WWO M-MODE RCRDNG), DURING REST &
RIGHT HEART CATHETERIZATION
INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR MONITORING PURPOSES
ENDOMYOCARDIAL BIOPSY
CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL CORONARY CONDUIT(S), AND/OR VENOUS CORONA
LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTERY OR FEMORAL AR
LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTERY OR FEMORAL AR
LEFT HEART CATHETERIZATION BY LEFT VENTRICULAR PUNCTURE
COMBINED TRANSSEPTAL AND RETROGRADE LEFT HEART CATHETERIZATION
COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION
COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTAC
COMBINED RIGHT HEART CATHETERIZATION WITH LEFT VENTRICULAR PUNCTURE (WITH OR WITHOUT RETROGR
COMBINED RIGHT HEART CATHETERIZATION AND LEFT HEART CATHETERIZATION THROUGH EXISTING SEPTAL OP
RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES
COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITA
COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTAC
COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH EXIST
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE OPACIFICATION OF ARTERIAL CON
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE OPACIFICATION OF AORTOCORON
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR PULMONARY ANGIOGRAPHY
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE RIGHT VENTRICULAR OR RIGHT AT
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE LEFT VENTRICULAR OR LEFT ATRI
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR AORTOGRAPHY
INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE CORONARY ANGIOGRAPHY (INJEC
IMAGING SUPERVISION, INTERPRETATION AND REPORT FOR INJECTION PROCEDURE(S) DURING CARDIAC CATHE
IMAGING SUPERVISION, INTERPRETATION AND REPORT FOR INJECTION PROCEDURE(S) DURING CARDIAC CATH;
INDICATOR DILUTION STUDIES SUCH AS DYE OR THERMAL DILUTION, INCLUDING ARTERIAL AND/OR VENOUS CAT
INDICATOR DILUTION STUDIES SUCH AS DYE OR THERMAL DILUTION, INCLUDING ARTERIAL AND/OR VENOUS CAT
INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RESERVE MEASUREMENT
INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RESERVE MEASUREMENT
PERCUTANEOUS TRANSCATHETER CLOSURE OF CONGENITAL INTERATRIAL COMMUNICATION (IE, FONTAN FENES
PERCUTANEOUS TRANSCATHETER CLOSURE OF A CONGENITAL VENTRICULAR SEPTAL DEFECT WITH IMPLANT
BUNDLE OF HIS RECORDING
INTRA-ATRIAL RECORDING
RIGHT VENTRICULAR RECORDING
INTRAVENTRICULAR &/ INTRA-ATRIAL MAPPING, TACHYCARDIA SITE(S) WITH CATHETER MANIPULATION TO RECOR
INTRA-ATRIAL PACING
INTRAVENTRICULAR PACING
INTRACARDIAC ELECTROPHYSIOLOGIC 3-DIMENSIONAL MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR P
ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR ELECTROGRAM(S);
ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR ELECTROGRAM(S); WITH
INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING
COMPR ELECTROPHYSIOLOGIC EVAL W RIGHT ATRIAL PACING&REC, RIGHT VENTRICULAR PACING&REC, HIS BUN
COMPR ELECTROPHYSIOLOGIC EVAL INCL INSERTION&REPOSITION, MULTI ELECTRODE CATHETERS W INDUCTIO
COMPREHENSIVE ELECTROPHYSIOLOGIC EVAL INCLUD INSERTION & REPOS OF MULT ELECTRODE CATH W INDU
COMPREHENSIVE ELECTROPHYSIOLOGIC EVAL INCLUDING INSERTION & REPOSITIONING OF MULTIPLE ELECTRO
PROGRAMMED STIMULATION AND PACING AFTER INTRAVENOUS DRUG INFUSION (LIST SEPARATELY IN ADDITION
ELECTROPHYSIOLOGIC FOLLOW-UP STUDY WITH PACING AND RECORDING TO TEST EFFECTIVENESS OF THERAP
INTRA-OPERATIVE EPICARDIAL AND ENDOCARDIAL PACING AND MAPPING TO LOCALIZE THE SITE OF TACHYCARD
ELECTROPHYSIOLOGIC EVAL,1/2 CHAMB PAC CARDIOVERT-DEFIBRILL LEADS INCL DEFIBRILL THRESH EVAL (INDU
ELECTROPHYSIOLOGIC EVAL,1/2 CHAMB PAC CARDIOVERT-DEFIBRILL LEADS INCL DEFIBRILL THRESH EVAL (INDU
ELECTROPHYSIOLOGIC EVAL, 1/2 CHAMB PAC CARDIOVERT-DEFIBRILL (INCL DEFIBRILL THRESH EVAL, INDUCT OF
INTRACARDIAC CATHETER ABLATION OF ATRIOVENTRICULAR NODE FUNCTION, ATRIOVENTRICULAR CONDUCTIO
INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TX OF SUPRAVENTRICULAR TACHYCAR

INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF VENTRICULAR TACHYC
EVALUATION OF CARDIOVASCULAR FUNCTION WITH TILT TABLE EVALUATION, WITH CONTINUOUS ECG MONITORI
INTRACARDIAC ECHOCARDIOGRAPHY DURING THERAPEUTIC/DIAGNOSTIC INTERVENTION, INCLUDING IMAGING S
PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION, PER SESSION
BIOIMPEDANCE, THORACIC, ELECTRICAL
PLETHYSMOGRAPHY, TOTAL BODY; WITH INTERPRETATION AND REPORT
PLETHYSMOGRAPHY, TOTAL BODY; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT
PLETHYSMOGRAPHY, TOTAL BODY; INTERPRETATION AND REPORT ONLY
ELECTRONIC ANALYSIS OF ANTITACHYCARDIA PACEMAKER (INC ELECTROCARDIOGRAPHIC RECORDING, PROGRA
ELECTRONIC ANALYSIS OF IMPLANTABLE LOOP RECORDER (ILR) SYSTEM (INCLUDES RETRIEVAL OF RECORDED A
ELECTRONIC ANALYSIS OF DUAL-CHAMBER PACEMAKER, RECORDING AND INTERPRETATION AT REST AND EXERC
ELECTRONIC ANALYSIS OF DUAL-CHAMBER PACEMAKER, RECORDING & INTERPRET AT REST AND DURING EXERC
ELECTRONIC ANALYSIS OF DUAL-CHAMBER INTERNAL PACEMAKE (MAY INCLUDE RATE, PULSE AMPLITUDE AND D
ELECTRONIC ANALYSIS OF SINGLE CHAMBER PACEMAKER SYSTEM (INC EVAL OF PROGRAMMABLE PARAMETERS
ELECTRONIC ANALYSIS OF SINGLE CHAMBER PACEMAKER SYSTEM (INC EVAL OF PROGRAMMABLE PARAMETERS
ELECTRONIC ANALYSIS OF SINGLE CHAMBER INTERNAL PACEMAKER (RATE, PULSE AMPLITUDE & DURATION, CON
TEMPERATURE GRADIENT STUDIES
ELECTRONIC ANALYSIS OF PACING CARDIOVERTER-DEFIBRILLATOR (INTERROG,EVAL PULSE GENERATOR,PROG
THERMOGRAM; CEPHALIC
THERMOGRAM; PERIPHERAL
DETERMINATION OF VENOUS PRESSURE
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEM SUCH AS MAGNETIC TAPE AND/OR COMPUTE
PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG MONITORING (PE
PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITH CONTINUOUS ECG MONITORING (PER S
UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE
NONINVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, COMPLETE BILATERAL STUDY (EG, PERIORB
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY
NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER/LOWER EXTREMITY ARTERIES, SINGLE LEVEL, BILATERAL (EG, A
NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER/LOWER EXTREMITY ARTERIES, MULT LEVEL OR W/ PROVOCATIV
NONINVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWING TREADMILL ST
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY
DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY
DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY
NONINVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (EG, DOPPLER WAVEF
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMP
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILA
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/O
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, AND/OR RETROPERITONEA
DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY
DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; UNILATERAL OR LIMIT
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP OR LIMITED STUD
DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFL
SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASU
PATIENT-INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; INCL REINFORCED EDUC, TRANSMIS
PATIENT INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; RECORDING (INCLUDES HOOK-UP, R
PATIENT INITIATED SPIROMETRIC RECORDING PER 30-DAY PERIOD OF TIME; PHYSICIAN REVIEW AND INTERPRET
BRONCHOSPASM EVALUATION: SPIROMETRY AS IN 94010, BEFORE AND AFTER BRONCHODILATOR (AEROSOL OR
PROLONGED POSTEXPOSURE EVALUATION OF BRONCHOSPASM WITH MULTIPLE SPIROMETRIC DETERMINATION
VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)
MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION
FUNCTIONAL RESIDUAL CAPACITY OR RESIDUAL VOLUME: HELIUM METHOD, NITROGEN OPEN CIRCUIT METHOD,
EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE)
THORACIC GAS VOLUME
DETERMINATION OF MALDISTRIBUTION OF INSPIRED GAS: MULTIPLE BREATH NITROGEN WASHOUT CURVE INCLU
DETERMINATION OF RESISTANCE TO AIRFLOW, OSCILLATORY OR PLETHYSMOGRAPHIC METHODS
DETERMINATION OF AIRWAY CLOSING VOLUME, SINGLE BREATH TESTS
RESPIRATORY FLOW VOLUME LOOP
BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE)
BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE)
PULMONARY STRESS TESTING; SIMPLE (EG, PROLONGED EXERCISE TEST FOR BRONCHOSPASM WITH PRE- AND
PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2 UPTAKE, AND E
PRESSURIZED/NONPRESSURIZED INHAL TREATMENT, ACT AIRWAY OBSTRUC/FOR SPUTUM INDUCTION, DIAG PUR
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT OR PROPHYLAXIS
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSI
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSI
CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND MANAGEMENT
CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION AND MANAGEMENT
DEMONSTRATION AND/OR EVALUATION OF PATIENT UTILIZATION OF AN AEROSOL GENERATOR, NEBULIZER, METE
MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO FACILITATE LUNG FUNCTION;
MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO FACILITATE LUNG FUNCTION;
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE, DIRECT, SIMPLE
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; INCLUDING CO2 OUTPUT, PERCENTAGE OXYGEN EXTRACTED
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT (SEPARATE PROCEDURE)
CARBON MONOXIDE DIFFUSING CAPACITY (EG, SINGLE BREATH, STEADY STATE)
MEMBRANE DIFFUSION CAPACITY
PULMONARY COMPLIANCE STUDY (EG, PLETHYSMOGRAPHY, VOLUME AND PRESSURE MEASUREMENTS)
NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; SINGLE DETERMINATION
NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; MULTIPLE DETERMINATIONS (EG, DURING EX
NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS OVERNIGHT MONITORING (
CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED ANALYZER
CIRCADIAN RESPIRATORY PATTERN RECORDING (PEDIATRIC PNEUMOGRAM), 12 TO 24 HOUR CONTINUOUS RECO
UNLISTED PULMONARY SERVICE OR PROCEDURE
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTIO
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOLOGIC
INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOLOGICALS, OR VEN
INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, SPECIFY N
INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH ALLERGENIC EXTRACTS FOR
INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE REACTION, INCLUDING
PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)
PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS)
PHOTO TESTS
OPHTHALMIC MUCOUS MEMBRANE TESTS
DIRECT NASAL MUCOUS MEMBRANE TEST
INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WIT
INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WIT
INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR
PROVOCATIVE TESTING (EG, RINKEL TEST)
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRA
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRA
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY IN PRESCRIBING PHYSICIAN'S OFFICE OR INSTITUT
PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGE
RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, PENICILLIN, EQUINE SERUM)
UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE OR PROCEDURE
GLUC MON, UP 72 HRS CONT REC&STORAGE, GLUC VALUES,INTERSTITIAL TISSUE FLUID VIA SUBCUTANEOUS SE
MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESS TESTING, RECORDING, ANALYSIS AND INTERPRE
SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND O
SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND O
POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLO
POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TE
POLYSOMNOGRAPHY; OF SLEEP,ATTEND BY A TECHNOLOGIST SLEEP STAGING W 4/+ ADD PARAMETERS OF SLEE
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; 41-60 MINUTES
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THAN ONE HOUR
ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND DROWSY
ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND ASLEEP
ELECTROENCEPHALOGRAM (EEG); RECORDING IN COMA OR SLEEP ONLY
ELECTROENCEPHALOGRAM (EEG); CEREBRAL DEATH EVALUATION ONLY
ELECTROENCEPHALOGRAM (EEG); ALL NIGHT RECORDING
ELECTROCORTICOGRAM AT SURGERY (SEPARATE PROCEDURE)
INSERTION BY PHYSICIAN OF SPHENOIDAL ELECTRODES FOR ELECTROENCEPHALOGRAPHIC (EEG) RECORDING
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; EXTREMITY (EXCLUDING HAND) OR TRUNK
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); HAND (WITH OR WITHOUT COMPARISON WITH NORMAL SID
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION OF BODY, EXCLUDING HANDS
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION OF BODY, INCLUDING HANDS
RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); EACH EXTREMITY (EXCLUDING HAN
RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); HAND, WITH OR WITHOUT COMPAR
TENSILON TEST FOR MYASTHENIA GRAVIS;
TENSILON TEST FOR MYASTHENIA GRAVIS; WITH ELECTROMYOGRAPHIC RECORDING
NEEDLE ELECTROMYOGRAPHY, ONE EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS
NEEDLE ELECTROMYOGRAPHY, TWO EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
NEEDLE ELECTROMYOGRAPHY, THREE EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
NEEDLE ELECTROMYOGRAPHY, FOUR EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLE(S), UNILATERAL
NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL
NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES (EXCLUDING T1 OR T12)
NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN ONE EXTREMITY OR NON-LIMB (AXIAL) MUSCLES
NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE MEASUREMENT OF JITTE
ISCHEMIC LIMB EXERCISE TEST WITH SERIAL SPECIMEN(S) ACQUISITION FOR MUSCLE(S) METABOLITE(S)
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCTIY STUDY, EACH NERVE; MOTOR, WITHOUT F-WAVE STUD
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE NE
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE; SENSORY
INTRAOPERATIVE NEUROPHYSIOLOGY TESTING, PER HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA
TSTNG AUTONOMIC NRVOUS SYST. FNCTN; CARDIOVAGAL INNERVATION (PARASYMPATHETIC FNCTN), INCL. 2+ OF
TSTNG AUTONOMIC NRVOUS SYST. FUNCT.; VASOMOTOR ADRENERGIC (AD.) INNERVATION (SYMP. AD. FUNCT.), IN
TSTNG AUTONOMIC NRVOUS SYST. FUNCT.;SUDOMOTOR, INCL. 1+ OF FOLLOWING: QUANT. SUDOMOTOR AXON R
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES
VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUS SYSTEM, CHECKERBOARD OR FLASH
ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING
H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE
H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN GASTROCNEMIUS/SOLEUS MUSCLE
NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY ONE MET
MONITORING FOR IDENTIFICATION AND LATERALIZATION OF CEREBRAL SEIZURE FOCUS, ELECTROENCEPHALOG
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR MORE CHANNEL TE
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY COMPUTERIZED PORTABLE 16 OR MORE CHA
PHARMACOLOGICAL OR PHYSICAL ACTIVATION REQUIRING PHYSICIAN ATTENDANCE DURING EEG RECORDING O
ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL SURGERY (EG, CAROTID SURGERY)
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR MORE CHANNEL TE
DIGITAL ANALYSIS OF ELECTROENCEPHALOGRAM (EEG) (EG, FOR EPILEPTIC SPIKE ANALYSIS)
WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING ELECTROENCEPHALOGRAPHIC (EEG) MONITO
FUNCTIONAL CORTICAL AND SUBCORTICAL MAPPING BY STIMULATION &/ RECORDING OF ELECTRODES ON BRAIN
FUNCTIONAL CORTICAL MAPPING BY STIMULATION OF ELECTRODES ON BRAIN SURFACE, OR OF DEPTH ELECTRO
MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR SPONTANEOUS BRAIN MAGNETIC ACTIVIT
MAGNETOENCEPHALOGRAPHY (MEG), RECORDING AND ANALYSIS; FOR EVOKED MAGNETIC FIELDS, SINGLE MOD
MAGNETOENCEPHALOGRAPHY (MEG), RECORDING&ANALYSIS;EVOKED MAGNETIC FIELDS, EA ADDITION MODALIT
ELECTRONIC ANAL OF IMPLANT NEUROSTIM PULSE GEN SYS; SIMPLE/COMPLEX BRAIN, SPINAL CORD/PERIPHERA
ELECTRONIC ANAL OF IMPLANT NEUROSTIM PULSE GEN SYS; SIMPLE BRAIN, SPINAL CORD, OR PERIPHERAL (IE,
ELECTRONIC ANAL OF IMPLANT NEUROSTIM PULSE GEN SYS; COMPLEX BRAIN, SPINAL CORD, OR PERIPHERAL (E
ELECTRONIC ANAL OF IMPLANT NEUROSTIM PULSE GEN SYS;COMPLEX BRAIN,SPINAL CORD/PERIPHERAL (EXCEP
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPL
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPL
REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SPINAL (INTRATHEC
UNLISTED NEUROLOGICAL OR NEUROMUSCULAR DIAGNOSTIC PROCEDURE
COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO-TAPING AND 3-D KINEMATICS;
COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VIDEO-TAPING AND 3-D KINEMATICS; WITH DYNAMIC
DYNAMIC SURFACE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL ACTIVITIES, 1-12 MUSCLES
DYNAMIC FINE WIRE ELECTROMYOGRAPHY, DURING WALKING OR OTHER FUNCTIONAL ACTIVITIES, 1 MUSCLE
PHYSICIAN REV&INTERPRET, COMPR COMPUTER BASED MOTION ANAL, DYNAM PLANTAR PRESS MEASURES, DYN
PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF PERSONALITY PSYCHOPATHOLOGY
ASSESSMENT OF APHASIA (INCLUDES ASSESS EXPRESS & RECEPT SPEECH & LANG FNC, LANG COMPR, SPEECH
DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE SC
DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE &/OR
NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESS OF THINKING, REASON & JUDGMENT, EG, ACQUIRED KNOW
NEUROPSYCHOLOGICAL TESTING BATTERY (EG, HALSTEAD-REITAN, LURIA, WAIS-R) WITH INTERPRETATION AND
HEALTH&BEHAV ASSESSMENT (EG, HEALTH-FOC CLINICAL INTERVIEW, BEHAVIORAL OBSERVATIONS, PSYCHOPHY
HEALTH AND BEHAVIOR ASSESS (EG, HEALTH-FOC CLIN INTERVIEW, BEHAVIORAL OBSERVATIONS, PSYCHOPHYSI
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; INDIVIDUAL
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; GROUP (2 OR MORE PATIENTS)
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; FAMILY (WITH THE PATIENT PRESENT)
HEALTH AND BEHAVIOR INTERVENTION, EACH 15 MINUTES, FACE-TO-FACE; FAMILY (WITHOUT THE PATIENT PRESE
CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR, WITH OR WITHOUT LOCAL ANESTHES
CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; UP TO AND INCLUDING 7 LESIONS
CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; MORE THAN 7 LESIONS
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; PUSH TECHNIQUE
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, UP TO ONE HOUR
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, ONE TO 8 HOURS, EACH ADDITIONAL H
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, INITIATION OF PROLONGED INFUSION
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, UP TO ONE HOUR
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, ONE TO 8 HOURS, EACH ADDITIONAL
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, INITIATION OF PROLONGED INFUSIO
CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, REQUIRING AND INCLUDING THORACENTESIS
CHEMOTHERAPY ADMINISTRATION INTO PERITONEAL CAVITY, REQUIRING AND INCLUDING PERITONEOCENTESIS
CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL), REQUIRING AND INCLUDING SPINAL PUNCTURE
REFILLING AND MAINTENANCE OF PORTABLE PUMP
REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SYSTEMIC (EG, INTR
CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS RESERVOIR, SINGLE
PROVISION OF CHEMOTHERAPY AGENT
UNLISTED CHEMOTHERAPY PROCEDURE
PHOTODYNAMIC THERAPY EXTERNAL APPLICATION, LIGHT TO DESTROY PREMALIGNANT &/ MALIGNANT LESIONS
PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPL OF LIGHT TO ABLATE ABNORMAL TISS VIA ACTIVAT OF PHOTOSE
PHOTODYNAMIC THERAPY BY ENDOSCOPIC APPL OF LIGHT TO ABLATE ABNORMAL TISS VIA ACTIVAT OF PHOTOSE
ACTINOTHERAPY (ULTRAVIOLET LIGHT)
MICROSCOPIC EXAMINATION OF HAIRS PLUCKED OR CLIPPED BY THE EXAMINER (EXCLUDING HAIR COLLECTED
PHOTOCHEMOTHERAPY; TAR AND ULTRAVIOLET B (GOECKERMAN TREATMENT) OR PETROLATUM AND ULTRAVIOL
PHOTOCHEMOTHERAPY; PSORALENS AND ULTRAVIOLET A (PUVA)
PHOTOCHEMOTHERAPY (GOECKERMAN AND/OR PUVA) FOR SEVERE PHOTORESPONSIVE DERMATOSES REQUIRI
LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); TOTAL AREA LESS THAN 250 SQ CM
LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); 250 SQ CM TO 500 SQ CM
LASER TREATMENT FOR INFLAMMATORY SKIN DISEASE (PSORIASIS); OVER 500 SQ CM
UNLISTED SPECIAL DERMATOLOGICAL SERVICE OR PROCEDURE

PHYSICAL THERAPY EVALUATION
PHYSICAL THERAPY RE-EVALUATION
OCCUPATIONAL THERAPY EVALUATION
OCCUPATIONAL THERAPY RE-EVALUATION
ATHLETIC TRAINING EVALUATION
ATHLETIC TRAINING RE-EVALUATION
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD PACKS
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; MICROWAVE
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES
APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES
UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT ATTENDANCE)
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP S
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EA 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEM
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC E
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBIN
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PET
UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRA
THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)
ORTHOTIC(S) FITTING AND TRAINING, UPPER EXTREMITY(IES), LOWER EXTREMITY(IES), AND/OR TRUNK, EACH 15
PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15 MINUTES
THERAPEUTIC ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT BY THE PROVIDER (USE OF DYNAMIC ACTIVI
DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING, (INCLUDES COMPE
SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSE
SELF-CARE/HOME MGT TRAIN (EG, ACTIVITIES, DAILY LIVNG (ADL)&COMPENSAT TRAIN, MEAL PREP, SAFETY PROC
COMMUNITY/WORK REINTEGRATION TRAIN (EG, SHOP, TRANSPORT, MONEY MGMT, AVOCATIONAL ACTIVITIES &/O
WHEELCHAIR MANAGEMENT/PROPULSION TRAINING, EACH 15 MINUTES
WORK HARDENING/CONDITIONING; INITIAL 2 HOURS
WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA
REM,DEVITAL TISS,WND(S);SEL DEBRIDE,WO ANES(EG,HI PRESS WATER JET,SHRP SEL DEBRIDE W SCISSORS, SC
REM, DEVITAL TISSUE,WOUND(S); NON-SELECT DEBRIDEMENT, WO ANES (EG, WET-TO-MOIST DRESSINGS, ENZYM
CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES
PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG, MUSCULOSKELETAL, FUNCTIONAL CAPACITY), WITH WR
ACUPUNCTURE, ONE OR MORE NEEDLES; WITHOUT ELECTRICAL STIMULATION
ACUPUNCTURE, ONE OR MORE NEEDLES; WITH ELECTRICAL STIMULATION
UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR PROCEDURE
MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE P
MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE PATI
MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE INDIVIDUAL(S)), EACH 30 MINUTES
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); ONE TO TWO BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TO FOUR BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); FIVE TO SIX BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); SEVEN TO EIGHT BODY REGIONS INVOLVED
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODY REGIONS INVOLVED
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, ONE TO TWO REGIONS
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, THREE TO FOUR REGIONS
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, FIVE REGIONS
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, ONE OR MORE REGIONS
HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PHYSICIAN'S OFFICE TO A LABORATO
HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE PATIENT IN OTHER THAN A PHYSICIAN
HANDLING, CONVEYANCE, ANY OTHER SERVICE IN CONNECTION WITH DEVICES (EG, DESIGNING, FITTING, PACKA
POSTOPERATIVE FOLLOW-UP VISIT, INCLUDED IN GLOBAL SERVICE
INITIAL (NEW PATIENT) VISIT WHEN STARRED ( ) SURGICAL PROCEDURE CONSTITUTES MAJOR SERVICE AT THAT
HOSPITAL MANDATED ON CALL SERVICE; IN-HOSPITAL, EACH HOUR
HOSPITAL MANDATED ON CALL SERVICE; OUT-OF-HOSPITAL, EACH HOUR
SERVICES REQUESTED AFTER OFFICE HOURS IN ADDITION TO BASIC SERVICE
SERVICES REQUESTED BETWEEN 10:00 PM AND 8:00 AM IN ADDITION TO BASIC SERVICE
SERVICES REQUESTED ON SUNDAYS AND HOLIDAYS IN ADDITION TO BASIC SERVICE
SERVICES PROVIDED AT REQUEST OF PATIENT IN A LOCATION OTHER THAN PHYSICIAN'S OFFICE WHICH ARE NOR
OFFICE SERVICES PROVIDED ON AN EMERGENCY BASIS
SUPPLIES & MATERIALS (EXCEPT SPECTACLES), PROVIDED BY PHYSICIAN OVER AND ABOVE THOSE USUALLY INC
EDUCATIONAL SUPPLIES, SUCH AS BOOKS, TAPES, AND PAMPHLETS, PROVIDED BY THE PHYSICIAN FOR THE PAT
MEDICAL TESTIMONY
PHYSICIAN EDUCATIONAL SERVICES RENDERED TO PATIENTS IN A GROUP SETTING (EG, PRENATAL, OBESITY, OR
SPECIAL REPORTS SUCH AS INSURANCE FORMS, MORE THAN THE INFORMATION CONVEYED IN THE USUAL MEDI
UNUSUAL TRAVEL (EG, TRANSPORTATION AND ESCORT OF PATIENT)
ANALYSIS OF CLINICAL DATA STORED IN COMPUTERS (EG, ECGS, BLOOD PRESSURES, HEMATOLOGIC DATA)
COLLECT&INTERPRET, PHYSIOLOGIC DATA (EG, ECG, BLOOD PRESS, GLUC MON) DIGITALLY STORED &/ TRANSMIT
ANESTHESIA FOR PATIENT OF EXTREME AGE, UNDER ONE YEAR AND OVER SEVENTY (LIST SEPARATELY IN ADDIT
ANESTHESIA COMPLICATED BY UTILIZATION OF TOTAL BODY HYPOTHERMIA (LIST SEPARATELY IN ADDITION TO CO
ANESTHESIA COMPLICATED BY UTILIZATION OF CONTROLLED HYPOTENSION (LIST SEPARATELY IN ADDITION TO C
ANESTHESIA COMPLICATED BY EMERGENCY CONDITIONS (SPECIFY) (LIST SEPARATELY IN ADDITION TO CODE FO
SEDATION WITH OR WITHOUT ANALGESIA (CONSCIOUS SEDATION); INTRAVENOUS, INTRAMUSCULAR OR INHALAT
SEDATION WITH OR WITHOUT ANALGESIA (CONSCIOUS SEDATION); ORAL, RECTAL AND/OR INTRANASAL
ANOGENITAL EXAMINATION WITH COLPOSCOPIC MAGNIFICATION IN CHILDHOOD FOR SUSPECTED TRAUMA
VISUAL FUNCTION SCREENING, AUTOMATED OR SEMI-AUTOMATED BILATERAL QUANTITATIVE DETERMINATION OF
SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE, BILATERAL
IPECAC OR SIMILAR ADMINISTRATION FOR INDIVIDUAL EMESIS AND CONTINUED OBSERVATION UNTIL STOMACH A
PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION
HYPOTHERMIA; REGIONAL
HYPOTHERMIA; TOTAL BODY
ASSEMBLY AND OPERATION OF PUMP WITH OXYGENATOR OR HEAT EXCHANGER (WITH OR WITHOUT ECG AND/O
PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)
UNLISTED SPECIAL SERVICE, PROCEDURE OR REPORT
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF NEW PATIENT, REQUIRES: PROBLEM FOCUSED HISTO
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF NEW PATIENT, REQUIRES: EXPANDED PROBLEM FOC
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF NEW PATIENT, REQUIRES: DETAILED HISTORY; EXAM
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF NEW PATIENT, REQUIRES: COMPREHENSIVE HISTORY
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF NEW PATIENT, REQUIRES: COMPREHENSIVE HISTORY
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT, MAY NOT REQUIRE PHYSICIA
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT, REQUIRES 2 OF 3: PROBLEM
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT, REQUIRES 2 OF 3: EXPANDED
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT, REQUIRES 2 OF 3: DETAILED
OFFICE OR OTHER OUTPATIENT VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT, REQUIRES 2 OF 3: COMPREH
OBSERVATION CARE DISCHARGE DAY MANAGEMENT
INITIAL OBSERVATION CARE, PER DAY FOR EVAL & MGMT OF PATIENT, REQUIRES: COMPREHENSIVE HISTORY; EXA
INITIAL HOSPITAL CARE, PER DAY, FOR EVAL & MGMT OF PATIENT REQUIRES: COMPREHENSIVE HISTORY; EXAM; M
INITIAL HOSPITAL CARE, PER DAY, FOR EVAL & MGMT OF PATIENT, REQUIRES: COMPREHENSIVE HISTORY; EXAM; M
INITIAL HOSPITAL CARE, PER DAY, FOR EVAL & MGMT OF PATIENT, REQUIRES: COMPREHENSIVE HISTORY; EXAM; M
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR EVAL & MGMT, REQUIRES 2 OF: PROBLEM FOCUSED INTERVAL HIST
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR EVAL & MGMT, REQUIRES 2 OF: EXPANDED INTERVAL HISTORY; EXA
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR EVAL & MGMT, REQUIRES 2 OF: DETAILED INTERVAL HISTORY; EXAM
OBSER/INPAT HOSP CARE,INC ADMIS & DISCH ON SAME DATE,REQ:DETAIL/COMP HX,EXAM;MED DEC MAKING THA
OBSER/INPAT HOSP CARE,INC ADMIS & DISCH ON SAME DATE,REQ:COMP HX,EXAM;MED DEC MAKING OF MOD CO
OBSER/INPAT HOSP CARE,INC ADMIS & DISCH ON SAME DATE,REQ:COMP HX,EXAM;MED DEC MAKING OF HIGH CO
HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS
HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES
OFFICE CONSULTATION FOR NEW OR ESTABLISHED PATIENT, REQUIRES: PROBLEM FOCUSED HISTORY; EXAM; ST
OFFICE CONSULTATION FOR A NEW/EST PATIENT,REQUIRES THESE 3 KEY COMP:AN EXPAND PROB FOC HX;AN EX
OFFICE CONSULTATION FOR NEW OR ESTABLISHED PATIENT, REQUIRES: DETAILED HISTORY; DETAILED EXAM; ME
OFFICE CONSULTATION FOR NEW OR ESTABLISHED PATIENT, REQUIRES: COMPREHENSIVE HISTORY; EXAM; MED
OFFICE CONSULTATION FOR NEW OR ESTABLISHED PATIENT, REQUIRES: COMPREHENSIVE HISTORY; EXAM; MED
INITIAL INPATIENT CONSULT FOR NEW OR ESTABLISHED PATIENT, REQUIRES: PROBLEM FOCUSED HISTORY; EXAM
INITIAL INPATIENT CONSULT FOR NEW OR ESTABLISHED PATIENT, REQUIRES: EXPANDED PROBLEM FOCUSED HIS
INITIAL INPATIENT CONSULT FOR NEW OR ESTABLISHED PATIENT, REQUIRES: DETAILED HISTORY; EXAM; MEDICAL
INITIAL INPATIENT CONSULT FOR NEW OR ESTABLISHED PATIENT, REQUIRES: COMPREHENSIVE HISTORY; EXAM; D
INITIAL INPATIENT CONSULT FOR NEW OR ESTABLISHED PATIENT, REQUIRES: A COMPREHENSIVE HISTORY; A COM
FOLLOW-UP INPATIENT CONSULT FOR ESTABLISHED PATIENT REQUIRES 2 OF: PROBLEM FOCUSED INTERVAL HIS
FOLLOW-UP INPATIENT CONSULT FOR ESTABLISHED PATIENT REQUIRES 2 OF: EXPANDED PROBLEM FOCUSED HI
FOLLOW-UP INPATIENT CONSULT FOR ESTABLISHED PATIENT REQUIRES 2 OF: DETAILED INTERVAL HISTORY; EXA
CONFIRMATORY CONSULT, REQUIRES: PROBLEM FOCUSED HISTORY; EXAM; STRAIGHTFORWARD MEDICAL DECIS
CONFIRMATORY CONSULT, REQUIRES: EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUS
CONFIRMATORY CONSULT, REQUIRES: DETAILED HISTORY; EXAM; MEDICAL DECISION MAKING OF LOW COMPLEX
CONFIRMATORY CONSULT, REQUIRES: COMPREHENSIVE HISTORY; COMPREHENSIVE EXAM; MEDICAL DECISION M
CONFIRMATORY CONSULT, REQUIRES: COMPREHENSIVE HISTORY; COMPREHENSIVE EXAM; MEDICAL DECISION M
EMERGENCY DEPARTMENT VISIT FOR EVAL & MGMT, REQUIRES: PROBLEM FOCUSED HISTORY; EXAM; AND STRAI
EMERGENCY DEPARTMENT VISIT FOR EVAL & MGMT, REQUIRES: EXPANDED PROBLEM FOCUSED HISTORY; EXAM
EMERGENCY DEPARTMENT VISIT FOR EVAL & MGMT, REQUIRES: EXPANDED PROBLEM FOCUSED HISTORY; EXAM
EMERGENCY DEPARTMENT VISIT FOR EVAL & MGMT, REQUIRES: DETAILED HISTORY; EXAM; MEDICAL DECISION M
EMERGENCY DEPART VISIT FOR THE EVAL & MGT OF A PATIENT,REQUIRES THESE 3 KEY COMP:COMP HX; COMP E
PHYSICIAN DIRECTION OF EMERGENCY MEDICAL SYSTEMS (EMS) EMERGENCY CARE, ADVANCED LIFE SUPPORT
CRITICAL CARE SVCS DELIVERED PHYSICIAN, FACE-TO-FACE, DUR AN INTERFACIL TRANSPORT, CRITICALLY ILL/CR
CRITICAL CARE SVCS DELIVER PHYSICIAN, FCE-TO-FCE, DUR ANINTERFACIL TRNSPORT, CRITICALLY ILL/CRITICAL
CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST
CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE UNSTABLE CRITICALLY ILL OR UNSTABLE CRITICALLY IN
INITIAL PEDIATRIC CRITICAL CARE, 31 DAYS UP THROUGH 24 MONTHS OF AGE, PER DAY, FOR THE EVALUATION AN
SUBSEQUENT PEDIATRIC CRITICAL CARE, 31 DAYS UP THROUGH 24 MONTHS OF AGE,PER DAY, FOR THE EVALUAT
INIT NEO CRIT CARE,PER DAY,EVAL & MANAG CRIT ILL NEO,30 DAYS OLD/<THIS CDE IS RSRD DATE ADMIS NEO CR
SUBSEQUENT NEO CRITICAL CARE,PER DAY, FOR THE EVALU &MANAGEMENT CRITI ILL NEONATE,30 DAYS OLD\< A
SUBSEQUENT INTENSIVE CARE, PER DAY, EVALUATION & MANAGEMENT RECOVERING VERY LOW BIRTH WT INFAN
SUBSEQUENT INTENSIVE CARE,PER DAY,FOR EVAL&MANAGEMENT OF RECOVR LOW BIRTH WT;INFNT W BODY W
EVAL&MGT,NEW/EST PT AN ANNUAL NURSE FAC ASSESS,REQS 3 COMPTS:DET INTRVL HX;COMPR X;&MED DECISN
EVALUATION & MGMT OF NEW/ESTABLISHED PATIENT INVOLVING NURSING FACILITY ASSESSMENT; MODERATE TO
EVALUATION & MGMT OF NEW/ESTABLISHED PATIENT INVOLVING NURSING FACILITY ASSESSMENT; INITIAL ADMIS
SUBSQNT NURSE FAC CARE,EVAL&MGT,NEW/EST PT,REQS AT LST TWO,3 KEY COMPTS:PROB FOC INTERVAL HX; P
SUBSEQUENT NURSING FACILITY CARE, PER DAY, EVAL & MGMT OF NEW/ESTABLISHED PATIENT, REQUIRES 2 OF:
SUBSEQUENT NURSING FACILITY CARE, PER DAY, EVAL & MGMT OF NEW/ESTABLISHED PATIENT, REQUIRES 2 OF:
NURSING FACILITY DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS
NURSING FACILITY DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES
DOMICILIARY OR REST HOME VISIT FOR EVAL & MGMT OF NEW PATIENT REQUIRES: PROBLEM FOCUSED HISTORY
DOMICILIARY OR REST HOME VISIT FOR EVAL & MGMT OF NEW PATIENT REQUIRES: EXPANDED PROBLEM FOCUS
DOMICILIARY OR REST HOME VISIT FOR EVAL & MGMT OF NEW PATIENT REQUIRES: DETAILED HISTORY; EXAM; ME
DOMICILIARY OR REST HOME VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT REQUIRES 2 OF: PROBLEM FOCU
DOMICILIARY OR REST HOME VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT REQUIRES 2 OF: EXPANDED PRO
DOMICILIARY OR REST HOME VISIT FOR EVAL & MGMT OF ESTABLISHED PATIENT REQUIRES 2 OF: DETAILED HIST
HOME VISIT FOR E&M OF NEW PAT,REQ 3: PROB FOCUSED HX,EXAM;STRAIGHTFORWARD MED DEC MAKING;CARE
HOME VISIT FOR E&M OF NEW PAT,REQ 3:EXPAND PROB FOC HX,EXAM;MED DEC MAKING OF LOW COMPLX;CARE
HOME VISIT FOR E&M OF NEW PAT,REQ 3:DETAILED HX,EXAM;MED DEC MAKING OF MOD COMPLX;CARE CONSIST
HOME VISIT FOR E&M OF NEW PAT,REQ: COMP HX,EXAM;MED DEC MAKING OF MOD COMPLX;CARE CONSIST W PR
HME VIS FOR E&M OF NEW PAT,REQ:COMP HX,EXAM;MED DEC MAKING OF HIGH COMPLX;CARE CONSIST W PROB
HME VIS FOR E&M OF ESTAB PAT,REQ AT LEAST 2:PROB FOCUSED INTERVAL HX,EXAM;STRAIGHTFOR MEDICAL DE
HME VIS FOR E&M OF ESTAB PAT,REQ AT LEAST 2:EXPAND PROB FOC INTERVAL HX,EXAM;LOW COMPLX MED DEC
HME VIS FOR E&M OF ESTAB PAT,REQ AT LEAST 2:DETAIL INTERVAL HX,EXAM; MED DEC MAKING OF MOD COMPLX
HM VIS FOR E&M OF ESTAB PAT,REQ AT LEAST 2:COMP INTER HX,EXAM;MED DEC MAKING MOD-HIGH COMPLX;CAR
PROLONGED PHYSICIAN SERVICE IN THE OFFICE OR OTHER OUTPATIENT SETTING REQUIRING DIRECT (FACE-TO
PROLONGED PHYSICIAN SERVICE IN THE OFFICE OR OTHER OUTPATIENT SETTING REQUIRING DIRECT (FACE-TO
PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING DIRECT (FACE-TO-FACE) PATIENT CONT
PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING DIRECT (FACE-TO-FACE) PATIENT CONT
PROLONGED EVALUATION AND MANAGEMENT SERVICE BEFORE AND/OR AFTER DIRECT (FACE-TO-FACE) PATIENT
PROLONGED EVALUATION AND MANAGEMENT SERVICE BEFORE AND/OR AFTER DIRECT (FACE-TO-FACE) PATIENT
PHYSICIAN STANDBY SERVICE, REQUIRING PROLONGED PHYSICIAN ATTENDANCE, EACH 30 MINUTES (EG, OPERA
MEDICAL CONFERENCE BY PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH PROFESSIONALS OR REPRES
MEDICAL CONFERENCE BY PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH PROFESSIONALS OR REPRES
TELEPHONE CALL BY PHYSICIAN TO PATIENT OR CONSULT OR MEDICAL MGMT OR FOR COORDINATING W/ OTH H
PHYS SUPRVSN,PT UNDER CARE,HHA HM,DOMICIL/EQUIV ENV REQ CMPLX&MULTDISC CARE MODAL DR DEV &/CA
PHYS SUPRVSN,PT UNDER CARE,HHA HOME,CARE PLANS, REV, SUBSQNT RPTS, PT STATUS, REV, RELATED LAB&
PHYS SUPRVSN,HOSPICE PT REQ CMPLX&MULTDISC CARE MODAL &/CARE PLANS,SUBSQNT RPTS,PT STATUS,RE
PHYS SUPRVSN,HOSPICE PT REQ CMPLX&MULTDISCIPL CARE MODAL&/CARE PLANS,PT STATUS,REV,RELATED LA
PHYS SUPRVSN,NURSE FAC PT REQ CMPLX&MULTDIS CARE MODAL&/CARE PLANS,REV,SUBSQNT RPTS,PT STATU
PHYS SUPRVSN,NURSE FAC PT REQ CMPLX&MULTDISCIPL CARE MODAL&/CARE PLANSPT STATUS,REV,RELATED L
INT COMPR PREVENTIVE MEDICINE EVAL&MGT, AN INDIV AN AGE&GENDER HX, EX, COUNS/ANTICIPATORY/RSK FA
INT COMPR PREVENTIVE MEDICINE EVAL&MGT, AN INDIV AN AGE&GENDER HX, X, COUNS/ANTICIPATORY/RSK FAC
INIT COMPR PREVENTIVE MEDICINE EVAL&MGT, AN INDIV AN AGE&GENDER APPROP HX, EX,COUNS/ANTICIPATORY
PDIC COMPR PREVENTIVE MEDICINE REEVAL&MGT, AN INDIV AN AGE&GENDER HX, X, COUNS/ANTICIPATORY/RSK
PDIC COMPR PREVENTIVE MEDICINE REEVAL&MGT, AN INDIV AN AGE&GENDER HX, EX, COUNS/ANTICIPATORY/RS
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO AN INDI
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO INDIVID
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO INDIVID
ADMINISTRATION AND INTERPRETATION OF HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPR
UNLISTED PREVENTIVE MEDICINE SERVICE
HISTORY AND EXAM OF THE NORMAL NEWBORN INFANT, INITIATION OF DIAGNOSTIC AND TREATMENT PROGRAMS
NORMAL NEWBORN CARE IN OTHER THAN HOSPITAL OR BIRTHING ROOM SETTING, INCLUDING PHYSICAL EXAM O
SUBSEQUENT HOSPITAL CARE, FOR EVAL & MGMT OF A NORMAL NEWBORN, PER DAY
HISTORY AND EXAM OF NORMAL NEWBORN INFANT, INCLUDING PREP OF MEDICAL RECORDS (THIS CODE SHOUL
ATTENDANCE AT DELIVERY (WHEN REQUESTED BY DELIVERING PHYSICIAN) AND INITIAL STABILIZATION OF NEWB
NEWBORN RESUSCITATION: PROVISION OF POSITIVE PRESSURE VENTILATION AND/OR CHEST COMPRESSIONS IN
BASIC LIFE AND/OR DISABILITY EXAM THAT INCLUDES: HEIGHT, WEIGHT & BLOOD PRESSURE; COMPLETION OF M
WORK RELATED OR MEDICAL DISABILITY EXAM BY TREATING PHYSICIAN INC: MEDICAL HISTORY; EXAM; DIAGNOS
WORK RELATED OR MEDICAL DISABILITY EXAM BY OTHER THAN TREATING PHYSICIAN INC: MEDICAL HX; EXAM; D
UNLISTED EVALUATION & MANAGEMENT SERVICE
HOME VISIT FOR PRENATAL MONITORING AND ASSESSMENT TO INCLUDE FETAL HEART RATE, NON-STRESS TEST
HOME VISIT FOR POSTNATAL ASSESSMENT AND FOLLOW-UP CARE
HOME VISIT FOR NEWBORN CARE AND ASSESSMENT
HOME VISIT FOR RESPIRATORY THERAPY CARE (EG, BRONCHODILATOR, OXYGEN THERAPY, RESPIRATORY ASSE
HOME VISIT FOR MECHANICAL VENTILATION CARE
HOME VISIT FOR STOMA CARE AND MAINTENANCE INCLUDING COLOSTOMY AND CYSTOSTOMY
HOME VISIT FOR INTRAMUSCULAR INJECTIONS
HOME VISIT FOR CARE AND MAINTENANCE OF CATHETER(S) (EG, URINARY, DRAINAGE, AND ENTERAL)
HOME VISIT FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING AND PERSONAL CARE
HOME VISIT FOR INDIVIDUAL, FAMILY, OR MARRIAGE COUNSELING
HOME VISIT FOR FECAL IMPACTION MANAGEMENT AND ENEMA ADMINISTRATION
HOME VISIT FOR HEMODIALYSIS
HOME INFUSION FOR PAIN MANAGEMENT (INTRAVENOUS OR SUBCUTANEOUS), PER VISIT
HOME INFUSION FOR PAIN MANAGEMENT (EPIDURAL OR INTRATHECAL), PER VISIT
HOME INFUSION FOR TOCOLYTIC THERAPY, PER VISIT
HOME INFUSION FOR HEMATOPOIETIC HORMONES (EG, ERYTHROPOIETIN, G-CSF, CM-CSF) OR PLATELETS, PER V
HOME INFUSION FOR CHEMOTHERAPY, PER VISIT
HOME INFUSION FOR ANTIBIOTICS/ANTIFUNGALS/ANTIVIRALS, PER VISIT
HOME INFUSION OF CONTINUOUS ANTICOAGULANT THERAPY (EG, HEPARIN), PER VISIT
HOME INFUSION OF IMMUNOTHERAPY, PER VISIT
HOME INFUSION OF PERITONEAL DIALYSIS, PER VISIT
HOME INFUSION OF ENTERAL NUTRITION, PER VISIT
HOME INFUSION OF HYDRATION THERAPY, PER VISIT
HOME INFUSION OF TOTAL PARENTERAL NUTRITION, PER VISIT
HOME ADMINISTRATION OF AEROSOLIZED PENTAMIDINE, PER VISIT
HOME INFUSION FOR ANTI-HEMOPHILIC AGENTS (EG, FACTOR VIII), PER VISIT
HOME INFUSION OF ALPHA-1-PROTEINASE INHIBITOR (EG, PROLASTIN), PER VISIT
HOME INFUSION FOR UNINTERRUPTED, LONG-TERM INTRAVENOUS TREATMENT (EG,EPOPROSTENOL), PER VISIT
HOME INFUSION OF SYMPATHOMIMETIC AGENTS (EG, DOBUTAMINE), PER VISIT
HOME INFUSION OF MISCELLANEOUS DRUGS, PER VISIT
HOME INFUSION, EACH ADDITIONAL THERAPY GIVEN ON SAME DAY (LIST SEPARATELY IN ADDITION TO CODE FOR
UNLISTED HOME VISIT SERVICE OR PROCEDURE
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; MODULAR BIFURCATE
ENDOVASCULAR REPAIR OF INFRARENAL ABDOMINAL AORTIC ANEURYSM OR DISSECTION; AORTO-UNI-ILIAC OR A
CERVICOGRAPHY
TRANSCATHETER PLACEMENT OF EXTRACRANIAL CEREBROVASCULAR ARTERY STENT(S), PERCUTANEOUS; INIT
TRANSCATHETER PLACEMENT OF EXTRACRANIAL CEREBROVASCULAR ARTERY STENT(S), PERCUTANEOUS; EAC
TRANSCATHETER PLACEMENT OF EXTRACRANIAL CEREBROVASCULAR ARTERY STENT(S), PERCUTANEOUS, RAD
ENDOMETRIAL CRYOABLATION WITH ULTRASONIC GUIDANCE
ANESTHESIA FOR PROCEDURES ON SALIVARY GLANDS, INCLUDING BIOPSY
ANESTHESIA FOR PROCEDURES ON PLASTIC REPAIR OF CLEFT LIP
ANESTHESIA FOR RECONSTRUCTIVE PROCEDURES OF EYELID (EG, BLEPHAROPLASTY, PTOSIS SURGERY)
ANESTHESIA FOR ELECTROCONVULSIVE THERAPY
TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY MEASUREMENT OF GAMMA INTERFERON ANTIGEN RESPONSE
ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY; NOT OTHERWISE S
ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY; OTOSCOPY
ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY; TYMPANOTOMY
ARTHROSCOPY, KNEE, SURGICAL, IMPLANTATION OF OSTEOCHONDRAL GRAFT(S) FOR TREATMENT OF ARTICULA
ARTHROSCOPY, KNEE, SURGICAL, IMPLANTATION OF OSTEOCHONDRAL GRAFT(S) FOR TREATMENT OF ARTICULA
ANESTHESIA FOR PROCEDURES ON EYE; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY
ANESTHESIA FOR PROCEDURES ON EYE; CORNEAL TRANSPLANT
ANESTHESIA FOR PROCEDURES ON EYE; VITREORETINAL SURGERY
ANESTHESIA FOR PROCEDURES ON EYE; IRIDECTOMY
ANESTHESIA FOR PROCEDURES ON EYE; OPHTHALMOSCOPY
MENISCAL TRANSPLANTATION, MEDIAL OR LATERAL, KNEE (ANY METHOD)
ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; RADICAL SURGERY
ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; BIOPSY, SOFT TISSUE
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION), TRANSPUPILLARY T
ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; REPAIR OF CLEFT PALATE
ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; EXCISION OF RETROPHARYNGEAL TUMOR
ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; RADICAL SURGERY

DESTRUCTION OF MACULAR DRUSEN, PHOTOCOAGULATION
DELIVERY OF HIGH POWER, FOCAL MAGNETIC PULSES FOR DIRECT STIMULATION TO CORTICAL NEURONS
ANESTHESIA FOR PROCEDURES ON FACIAL BONES OR SKULL; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON FACIAL BONES OR SKULL; RADICAL SURGERY (INCLUDING PROGNATHISM)
EXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING MUSCULOSKELETAL SYSTEM
EXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING PLANTAR FASCIA
ANESTHESIA FOR INTRACRANIAL PROCEDURES; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR INTRACRANIAL PROCEDURES; SUBDURAL TAPS
ANESTHESIA FOR INTRACRANIAL PROCEDURES; BURR HOLES, INCLUDING VENTRICULOGRAPHY
ANESTHESIA FOR INTRACRANIAL PROCEDURES; CRANIOPLASTY OR ELEVATION OF DEPRESSED SKULL FRACTUR
ANESTHESIA FOR INTRACRANIAL PROCEDURES; VASCULAR PROCEDURES
ANESTHESIA FOR INTRACRANIAL PROCEDURES; PROCEDURES IN SITTING POSITION
INSERTION OF TRANSCERVICAL OR TRANSVAGINAL FETAL OXIMETRY SENSOR
ANESTHESIA FOR INTRACRANIAL PROCEDURES; CEREBROSPINAL FLUID SHUNTING PROCEDURES
ANESTHESIA FOR INTRACRANIAL PROCEDURES; ELECTROCOAGULATION OF INTRACRANIAL NERVE
INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING GENOTYPIC COMPARISON TO KNOW
NON-SURGICAL SEPTAL REDUCTION THERAPY (EG, ALCOHOL ABLATION), FOR HYPERTROPHIC OBSTRUCTIVE CAR
DETERMINATION OF CORNEAL THICKNESS (EG, PACHYMETRY) WITH INTERPRETATIONAND REPORT, BILATERAL
LIPOPROTEIN, DIRECT MEASUREMENT, INTERMEDIATE DENSITY LIPOPROTEINS (IDL)(REMNANT LIPOPROTEINS)
ENDOSCOPIC LYSIS OF EPIDURAL ADHESIONS W DIRECT VISUALIZATION USING MECHANICAL MEANS (EG, SPINAL
DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA) BODY COMPOSITION STUDY, ONE OR MORE SITES
TREATMENT(S) FOR INCONTINENCE, PULSED MAGNETIC NEUROMODULATION, PER DAY
ANESTHESIA FOR ALL PROCEDURES ON THE INTEGUMENTARY SYSTEM, MUSCLES AND NERVES OF HEAD, NECK,
ANTIPROTHROMBIN (PHOSPHOLIPID COFACTOR) ANTIBODY, EACH IG CLASS
SPECULOSCOPY
ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS, THYROID, LARYNX, TRACHEA AND LYMPHATIC SYSTEM OF
ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS, THYROID, LARYNX, TRACHEA AND LYMPHATIC SYSTEM OF
ANESTHESIA FOR ALL PROCEDURES ON THE LARYNX AND TRACHEA IN CHILDREN LESS THAN 1 YEAR OF AGE
SPECULOSCOPY; WITH DIRECTED SAMPLING
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTIC ANEURYSM, PSEUDOANEURYSM OR DISSECTION; IN
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTIC ANEURYSM, PSEUDOANEURYSM OR DISSECTION; N
ANESTHESIA FOR PROCEDURES ON MAJOR VESSELS OF NECK; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON MAJOR VESSELS OF NECK; SIMPLE LIGATION
PLACEMENT OF PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING T
PLACEMENT OF PROXIMAL/ DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF DESCENDING THO
OPEN SUBCLAVIAN TO CAROTID ARTERY TRANSPOSITION PERFORMED IN CONJUNCTION WITH ENDOVASCULAR T
ENDOVASCULAR REPAIR, DESCENDING THORACIC AORTIC ANEURYSM, PSEUDOANEURYSM/DISSECTION INVOLVI
ENDOVASCULAR REPAIR, DESCENDING THORACIC AORTIC ANEURYSM, PSEUDOANEURYSM/DISSECTION NO INVO
ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES, ANTERIOR TRUNK AND
ANESTHESIA FOR PROCEDURES ON ANTERIOR INTEGUMENTARY SYSTEM OF CHEST, INCLUDING SUBCUTANEOUS
PLACEMENT, PROXIMAL OR DISTAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR, DESCENDING THORA
URINALYSIS INFECTIOUS AGENT DETECTION, SEMI-QUANTITATIVE ANALYSIS OF VOLATILE COMPOUNDS
CEREBRAL PERFUSION ANAL USING COMPUTED TOMOGRAPHY W CONTRAST ADMIN, INCLUDING POST-PROCESS
CARBON MONOXIDE, EXPIRED GAS ANALYSIS (EG, ETCOC/HEMOLYSIS BREATH TEST)
WHOLE BODY INTEGUMENTARY PHOTOGRAPHY, AT REQUEST OF A PHYSICIAN, FOR MONITORING OF HIGH-RISK P
ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; NOT OTHERWISE SPECIFIED

ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; RADICAL SURGERY
ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; BIOPSY OF CLAVICLE
ANESTHESIA FOR PARTIAL RIB RESECTION; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PARTIAL RIB RESECTION; THORACOPLASTY (ANY TYPE)
ANESTHESIA FOR PARTIAL RIB RESECTION; RADICAL PROCEDURES (EG, PECTUS EXCAVATUM)
ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS
ANESTHESIA FOR CLOSED CHEST PROCEDURES; (INCLUDING BRONCHOSCOPY) NOT OTHERWISE SPECIFIED
ANESTHESIA FOR CLOSED CHEST PROCEDURES (INCLUDING ESOPHAGOSCOPY, BRONCHOSCOPY, THORACOSCO
ANESTHESIA FOR CLOSED CHEST PROCEDURES (INCLUDING ESOPHAGOSCOPY, BRONCHOSCOPY, THORACOSCO
ANESTHESIA FOR CLOSED CHEST PROCEDURES; MEDIASTINOSCOPY AND DIAGNOSTIC THORACOSCOPY
ANESTHESIA FOR PERMANENT TRANSVENOUS PACEMAKER INSERTION
ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION
ANESTHESIA FOR TRANSVENOUS INSERTION OR REPLACEMENT OF PACING CARDIOVERTER-DEFIBRILLATOR
ANESTHESIA FOR CARDIAC ELECTROPHYSIOLOGIC PROCEDURES INCLUDING RADIOFREQUENCY ABLATION
ANESTHESIA FOR TRACHEOBRONCHIAL RECONSTRUCTION
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND MEDIASTINUM (IN
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND MEDIASTINUM; D
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND MEDIASTINUM; P
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND MEDIASTINUM; P
ANESTHESIA FOR STERNAL DEBRIDEMENT
ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF CHEST; WITHOUT PUMP
ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF CHEST; WITH PUMP OXY
ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF CHEST; WITH PUMP OXY
ANESTHESIA FOR DIRECT CORONARY ARTERY BYPASS GRAFTING WITHOUT PUMP OXYGENATOR
ANESTHESIA FOR HEART TRANSPLANT OR HEART/LUNG TRANSPLANT
ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND CORD; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND CORD; PROCEDURES WITH PATIENT IN THE SITTING PO
ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND CORD; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND CORD; THORACOLUMBAR SYMPATHECTOMY
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; LUMBAR SYMPATHECTOMY
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; CHEMONUCLEOLYSIS
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; DIAGNOSTIC OR THERAPEUTIC LUMBAR PUNCTURE
ANESTHESIA FOR MANIPULATION OF THE SPINE OR FOR CLOSED PROCEDURES ON THE CERVICAL, THORACIC O
ANESTHESIA FOR EXTENSIVE SPINE AND SPINAL CORD PROCEDURES (EG, SPINAL INSTRUMENTATION OR VASCU
ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR ABDOMINAL WALL; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR ABDOMINAL WALL; PERCUTANEOUS LIVER BIOPSY
ANESTHESIA FOR PROCEDURES ON UPPER POSTERIOR ABDOMINAL WALL
ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMA
ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; LUMBAR AND VENTRAL (INCISIONAL) HERNIAS AND/OR W
ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; OMPHALOCELE
ANESTHESIA FOR HERNIA REPAIRS IN UPPER ABDOMEN; TRANSABDOMINAL REPAIR OF DIAPHRAGMATIC HERNIA
ANESTHESIA FOR ALL PROCEDURES ON MAJOR ABDOMINAL BLOOD VESSELS
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; NOT OTHER
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; PARTIAL HE
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; PANCREATE

ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; LIVER TRAN
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; GASTRIC RE
ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR ABDOMINAL WALL; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR ABDOMINAL WALL; PANNICULECTOMY
ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODE
ANESTHESIA FOR PROCEDURES ON LOWER POSTERIOR ABDOMINAL WALL
ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN; VENTRAL AND INCISIONAL HERNIAS
ANESTHESIA FOR HERNIA REPAIRS IN THE LOWER ABDOMEN NOT OTHERWISE SPECIFIED, UNDER 1 YEAR OF AG
ANESTHESIA FOR HERNIA REPAIRS IN THE LOWER ABDOMEN NOT OTHERWISE SPECIFIED, INFANTS LESS THAN 3
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; NOT OTHER
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; AMNIOCENT
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; ABDOMINOP
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; RADICAL HY
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; PELVIC EXE
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; TUBAL LIGA
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; NOT OTH
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; RENAL PR
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; TOTAL CY
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; RADICAL
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; ADRENAL
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; RENAL TR
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN, INCLUDING URINARY TRACT; CYSTOLIT
ANESTHESIA FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE; WITH WATER BATH
ANESTHESIA FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE; WITHOUT WATER BATH
ANESTHESIA FOR PROCEDURES ON MAJOR LOWER ABDOMINAL VESSELS; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON MAJOR LOWER ABDOMINAL VESSELS; INFERIOR VENA CAVA LIGATION
ANESTHESIA FOR; ANORECTAL PROCEDURE
ANESTHESIA FOR; RADICAL PERINEAL PROCEDURE
ANESTHESIA FOR; VULVECTOMY
ANESTHESIA FOR; PERINEAL PROSTATECTOMY
ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); NOT OTHERWISE SPEC
ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); TRANSURETHRAL RESE
ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); TRANSURETHRAL RESE
ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); POST-TRANSURETHRAL
ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDING URETHROCYSTOSCOPY); WITH FRAGMENTATION,
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); NOT OTHERW
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); VASECTOMY,
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); SEMINAL VES
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); UNDESCENDE
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); RADICAL ORC
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); RADICAL ORC
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); ORCHIOPEXY
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); COMPLETE A
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); RADICAL AMP
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); RADICAL AMP
ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); INSERTION O
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); NO
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); CO
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); VA
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); CE
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); CU
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); HY
ANESTHESIA FOR BONE MARROW ASPIRATION AND/OR BIOPSY, ANTERIOR OR POSTERIOR ILIAC CREST
ANESTHESIA FOR PROCEDURES ON BONY PELVIS
ANESTHESIA FOR BODY CAST APPLICATION OR REVISION
ANESTHESIA FOR INTERPELVIABDOMINAL (HINDQUARTER) AMPUTATION
ANESTHESIA FOR RADICAL PROCEDURES FOR TUMOR OF PELVIS, EXCEPT HINDQUARTER AMPUTATION
ANESTHESIA FOR CLOSED PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT
ANESTHESIA FOR OPEN PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT
ANESTHESIA FOR OBTURATOR NEURECTOMY; EXTRAPELVIC
ANESTHESIA FOR OBTURATOR NEURECTOMY; INTRAPELVIC
ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING HIP JOINT
ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF HIP JOINT
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; HIP DISARTICULATION
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; TOTAL HIP ARTHROPLASTY
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; REVISION OF TOTAL HIP ARTHROPLASTY
ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING UPPER 2/3 OF FEMUR
ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; AMPUTATION
ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; RADICAL RESECTION
ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSA OF UPPER LEG
ANESTHESIA FOR ALL PROCEDURES INVOLVING VEINS OF UPPER LEG, INCLUDING EXPLORATION
ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAFT; NOT OTHERW
ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAFT; FEMORAL ART
ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAFT; FEMORAL ART
ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSA OF KNEE AND/OR PO
ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER 1/3 OF FEMUR
ANESTHESIA FOR ALL OPEN PROCEDURES ON LOWER 1/3 OF FEMUR
ANESTHESIA FOR ALL CLOSED PROCEDURES ON KNEE JOINT
ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF KNEE JOINT
ANESTHESIA FOR ALL CLOSED PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR PATELLA
ANESTHESIA FOR ALL OPEN PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR PATELLA
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT;NOT OTHERWISE SPECIFIE
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT;TOTAL KNEE ARTHROPLAS
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON KNEE JOINT;DISARTICULATION AT KNEE
ANESTHESIA FOR ALL CAST APPLICATIONS, REMOVAL, OR REPAIR INVOLVING KNEE JOINT
ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; ARTERIOVENOUS FISTULA
ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL THROMBOENDARTERE
ANESTHESIA FOR PROCEDURES ON ARTERIES OF KNEE AND POPLITEAL AREA; POPLITEAL EXCISION AND GRAFT
ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER LEG, ANKLE, AND FOOT
ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ANKLE AND/OR FOOT
ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, ANKLE, AND FOO
ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; NOT OTHERWISE SPECIFIE
ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; RADICAL RESECTION (INCL
ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; OSTEOTOMY OR OSTEOPL
ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWER LEG, ANKLE, AND FOOT; TOTAL ANKLE REPLACEMEN
ANESTHESIA FOR LOWER LEG CAST APPLICATION, REMOVAL, OR REPAIR
ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER LEG, INCLUDING BYPASS GRAFT; NOT OTHERWISE SPE
ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER LEG, INCLUDING BYPASS GRAFT; EMBOLECTOMY, DIRE
ANESTHESIA FOR PROCEDURES ON VEINS OF LOWER LEG; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON VEINS OF LOWER LEG; VENOUS THROMBECTOMY, DIRECT OR CATHETER
ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSA OF SHOULDER AND A
ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERAL HEAD AND NECK, STERNOCLAVICULAR JOINT, ACROM
ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF SHOULDER JOINT
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES ON HUMERAL HEAD AND NECK, STERNOCL
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; AXILLARY-BRACHIAL ANEURYSM
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; BYPASS GRAFT
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; AXILLARY-FEMORAL BYPASS GRAFT
ANESTHESIA FOR ALL PROCEDURES ON VEINS OF SHOULDER AND AXILLA
ANESTHESIA FOR SHOULDER CAST APPLICATION, REMOVAL OR REPAIR; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR SHOULDER CAST APPLICATION, REMOVAL OR REPAIR; SHOULDER SPICA
ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSA OF UPPER ARM AND ELB
ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERUS AND ELBOW
ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES OF ELBOW JOINT
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW;NOT OTHERWISE SPECIFIE
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW;OSTEOTOMY OF HUMERUS
ANESTHESIA FOR OPEN/SURGICAL ARTHROSCOPIC PROCEDURES, THE ELBOW;REPAIR, NONUNION/MALUNION, H
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW;RADICAL PROCEDURES
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW;EXCISION OF CYST OR TUM
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC PROCEDURES OF THE ELBOW;TOTAL ELBOW REPLACEME
ANESTHESIA FOR PROCEDURES ON ARTERIES OF UPPER ARM AND ELBOW; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON ARTERIES OF UPPER ARM AND ELBOW; EMBOLECTOMY
ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND ELBOW; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND ELBOW; PHLEBORRHAPHY
ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSA OF FOREARM, WRIST
ANESTHESIA FOR ALL CLOSED PROCEDURES ON RADIUS, ULNA, WRIST, OR HAND BONES
ANESTHESIA FOR DIAGNOSTIC ARTHROSCOPIC PROCEDURES ON THE WRIST
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC/ENDOSCOPIC PROCEDURES ON DISTAL RADIUS, DISTAL U
ANESTHESIA FOR OPEN OR SURGICAL ARTHROSCOPIC/ENDOSCOPIC PROCEDURES ON DISTAL RADIUS, DISTAL U
ANESTHESIA FOR PROCEDURES ON ARTERIES OF FOREARM, WRIST, AND HAND; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON ARTERIES OF FOREARM, WRIST, AND HAND; EMBOLECTOMY
ANESTHESIA FOR VASCULAR SHUNT, OR SHUNT REVISION, ANY TYPE (EG, DIALYSIS)
ANESTHESIA FOR PROCEDURES ON VEINS OF FOREARM, WRIST, AND HAND; NOT OTHERWISE SPECIFIED
ANESTHESIA FOR PROCEDURES ON VEINS OF FOREARM, WRIST, AND HAND; PHLEBORRHAPHY
ANESTHESIA FOR FOREARM, WRIST, OR HAND CAST APPLICATION, REMOVAL, OR REPAIR
ANESTHESIA FOR MYELOGRAPHY, DISKOGRAPHY, VERTEBROPLASTY
ANESTHESIA FOR DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPHY
ANESTHESIA FOR CARDIAC CATHETERIZATION INCLUDING CORONARY ANGIOGRAPHY AND VENTRICULOGRAPHY
ANESTHESIA FOR NON-INVASIVE IMAGING OR RADIATION THERAPY
ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE ARTERIAL SYSTEM
ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL RADIOLOGIC PROCEDURES INVOLVING THE VENOUS/LYMPHAT
ANES, THERAPEUTIC INTERVENEAL RADIOLOGIC PROCS INVOLV THE VENOUS/LYMPHATIC SYST (NOT INCL ACCSS
ANESTHESIA, SECOND&THIRD DEGREE BURN EXCISION/DEBRIDEMENT WWO SKIN GRAFTING, ANY SITE,TOTAL B
ANESTHESIA, SECOND&THIRD DEGREE BURN EXCISION/DEBRIDEMENT WWO SKIN GRAFTING, ANY SITE,TOTAL B
ANESTHESIA, 2ND&3RD DEGREE BURN EXCISION/DEBRIDEMENT WWO SKIN GRAFTING, ANY SITE,TOTAL BODY SU
ANESTHESIA FOR; VAGINAL DELIVERY ONLY
ANESTHESIA FOR CESAREAN DELIVERY ONLY
ANESTHESIA FOR URGENT HYSTERECTOMY FOLLOWING DELIVERY
ANESTHESIA FOR CESAREAN HYSTERECTOMY WITHOUT ANY LABOR ANALGESIA/ANESTHESIA CARE
ANESTHESIA FOR ABORTION PROCEDURES
NEURAXIAL LABOR ANALGESIA/ANESTHESIA FOR PLANNED VAGINAL DELIVERY (THIS INCLUDES ANY REPEAT SUB
ANESTHESIA FOR CESAREAN DELIVERY FOLLOWING NEURAXIAL LABOR ANALGESIA/ANESTHESIA (LIST SEPARATE
ANESTHESIA FOR CESAREAN HYSTERECTOMY FOLLOWING NEURAXIAL LABOR ANALGESIA/ANESTHESIA (LIST SE
PHYSIOLOGICAL SUPPORT FOR HARVESTING OF ORGAN(S) FROM BRAIN-DEAD PATIENT
ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE BLOCKS AND INJECTIONS (WHEN BLOCK OR INJECTION
ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE BLOCKS AND INJECTIONS (WHEN BLOCK OR INJECTION
REGIONAL INTRAVENOUS ADMINISTRATION OF LOCAL ANESTHETIC AGENT OR OTHER MEDICATION
DAILY HOSPITAL MANAGEMENT OF EPIDURAL OR SUBARACHNOID CONTINUOUS DRUG ADMINISTRATION
UNLISTED ANESTHESIA PROCEDURE(S)
AMBULANCE SERVICE, OUTSIDE STATE PER MILE, TRANSPORT (MEDICAID ONLY)
NON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY VOLUNTEER (INDIVIDUAL OR ORGANIZAT
NON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY INDIVIDUAL (FAMILY MEMBER, SELF, NEIG
NON-EMERGENCY TRANSPORTATION; TAXI
NONEMERGENCY TRANSPORTATION AND BUS, INTRA- OR INTER STATE CARRIER
NON-EMERGENCY TRANSPORTATION: MINI-BUS, MOUNTAIN AREA TRANSPORTS, OR OTHER TRANSPORTATION SY
NONEMERGENCY TRANSPORTATION: WHEELCHAIR VAN
NONEMERGENCY TRANSPORTATION AND AIR TRAVEL (PRIVATE OR COMMERCIAL) INTRA OR INTER STATE
NONEMERGENCY TRANSPORTATION: PER MILE - CASE WORKER OR SOCIAL WORKER
TRANSPORTATION ANCILLARY: PARKING FEES, TOLLS, OTHER
NONEMERGENCY TRANSPORTATION: ANCILLARY: LODGING-RECIPIENT
NONEMERGENCY TRANSPORTATION: ANCILLARY: MEALS-RECIPIENT
NONEMERGENCY TRANSPORTATION: ANCILLARY: LODGING ESCORT
NONEMERGENCY TRANSPORTATION: ANCILLARY: MEALS-ESCORT
AMBULANCE SERVICE, NEONATAL TRANSPORT, BASE RATE, EMERGENCY TRANSPORT, ONE WAY
BLS MILEAGE (PER MILE)
BLS ROUTINE DISPOSABLE SUPPLIES
BLS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; DEFIBRILLATION (USED BY ALS AMBULANCES AND BLS AMBUL
ALS MILEAGE (PER MILE)

ALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; DEFIBRILLATION (TO BE USED ONLY IN JURISDICTIONS WHER
ALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; IV DRUG THERAPY
ALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; ESOPHAGEAL INTUBATION
ALS ROUTINE DISPOSABLE SUPPLIES
AMBULANCE WAITING TIME (ALS OR BLS), ONE HALF (1/2) HOUR INCREMENTS
AMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN SUPPLIES, LIFE SUSTAINING SITUATION
EXTRA AMBULANCE ATTENDANT, GROUND (ALS OR BLS) OR AIR (FIXED OR ROTARY WINGED); (REQUIRES MEDICA
GROUND MILEAGE, PER STATUTE MILE
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS 1)
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS1-EMERGENCY)
AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT (BLS)
AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)
AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING)
AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING)
PARAMEDIC INTERCEPT (PI), RURAL AREA, TRANSPORT FURNISHED BY A VOLUNTEER AMBULANCE COMPANY WH
ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)
SPECIALTY CARE TRANSPORT (SCT)
FIXED WING AIR MILEAGE, PER STATUTE MILE
ROTARY WING AIR MILEAGE, PER STATUTE MILE
NONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR MILES TRAVELED BEYOND CLOSEST APPROPRIATE FA
UNLISTED AMBULANCE SERVICE
SYRINGE WITH NEEDLE, STERILE 1CC, EACH
SYRINGE WITH NEEDLE, STERILE 5CC OR GREATER, EACH
NEEDLE-FREE INJECTION DEVICE, EACH
SUPPLIES FOR SELF-ADMINISTERED INJECTIONS
NON CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER
SYRINGE, STERILE, 20 CC OR GREATER, EACH
STERILE SALINE OR WATER, 30 CC VIAL
NEEDLES ONLY, STERILE, ANY SIZE, EACH
REFILL KIT FOR IMPLANTABLE INFUSION PUMP
SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG SEPARATELY)
SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUG SEPARATELY)
INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE
INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE
SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC
ALCOHOL OR PEROXIDE, PER PINT
ALCOHOL WIPES, PER BOX
BETADINE OR PHISOHEX SOLUTION, PER PINT
BETADINE OR IODINE SWABS/WIPES, PER BOX
URINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLETS OR STRIPS)
BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50 STRIPS
REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR O
PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER BOX
NORMAL, LOW AND HIGH CALIBRATOR SOLUTION/CHIPS
REPLACEMENT LENS SHIELD CARTRIDGE FOR USE WITH LASER SKIN PIERCING DEVICE, EACH
SPRING-POWERED DEVICE FOR LANCET, EACH
LANCETS, PER BOX OF 100

LEVONORGESTREL (CONTRACEPTIVE) IMPLANTS SYSTEM, INCLUDING IMPLANTS AND SUPPLIES
CERVICAL CAP FOR CONTRACEPTIVE USE
TEMPORARY, ABSORBABLE LACRIMAL DUCT IMPLANT, EACH
PERMANENT, LONG-TERM, NONDISSOLVABLE LACRIMAL DUCT IMPLANT, EACH
PARAFFIN, PER POUND
DIAPHRAGM FOR CONTRACEPTIVE USE
CONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH
CONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH
CONTRACEPTIVE SUPPLY, SPERMICIDE (E.G., FOAM, GEL), EACH
DISPOSABLE ENDOSCOPE SHEATH, EACH
ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH
TUBING FOR BREAST PUMP, REPLACEMENT
ADAPTER FOR BREAST PUMP, REPLACEMENT
CAP FOR BREAST PUMP BOTTLE, REPLACEMENT
BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT
POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT
LOCKING RING FOR BREAST PUMP, REPLACEMENT
SACRAL NERVE STIMULATION TEST LEAD, EACH
IMPLANTABLE ACCESS CATHETER,(E.G., VENOUS, ARTERIAL, EPIDURAL SUBARACHNOID, OR PERITONEAL, ETC.) E
IMPLANTABLE ACCESS TOTAL CATHETER, PORT/RESERVOIR (E.G., VENOUS, ARTERIAL, EPIDURAL, SUBARACHNO
DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR
DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 5 ML OR LESS PER HOUR
INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY)
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH CO
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, THREE-WAY, FOR CONTIN
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATI
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, THREE-WAY, FOR CONTINUOU
STERILE WATER IRRIGATION SOLUTION, 1000 ML
IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE
THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION
IRRIGATION SYRINGE, BULB OR PISTON, EACH
STERILE SALINE IRRIGATION SOLUTION, 1000 ML
MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH
MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH
MALE EXTERNAL CATHETER SPECIALTY TYPE (E.G., INFLATABLE, FACEPLATE, ETC.), EACH
FEMALE EXTERNAL URINARY COLLECTION DEVICE; METAL CUP, EACH
FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH
PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH
EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR USE WITH URINARY L
LUBRICANT, INDIVIDUAL STERILE PACKET, FOR INSERTION OF URINARY CATHETER, EACH
URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH
URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH
INCONTINENCE SUPPLY; MISCELLANEOUS
INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOME
INDWELLING CATHETER; SPECIALTY TYPE, (E.G., COUDE, MUSHROOM, WING, ETC.), EACH
INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH
INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH
MALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX DEVICE; PER DOZEN
MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR, EACH (E.G., 2 PER M
INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING(TEFLON, SILICONE, SILICONE EL
INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING(TEFLON, SILICONE. SILIC
INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES
INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER
IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY INDWELLING FOLEY C
EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER CLAMP), EACH
BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR WITHOUT TUBE, EAC
URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS, EACH
URINARY SUSPENSORY WITHOUT LEG BAG, EACH
OSTOMY FACEPLATE, EACH
SKIN BARRIER; SOLID, FOUR BY FOUR OR EQUIVALENT; EACH
ADHESIVE, LIQUID OR EQUAL, ANY TYPE
ADHESIVE REMOVER WIPES, ANY TYPE, PER 50
OSTOMY BELT, EACH
OSTOMY FILTER, ANY TYPE, EACH
OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ
OSTOMY SKIN BARRIER, POWDER, PER OZ
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, WITH BUILT-IN CONVEXITY, EACH
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN), WITH BUILT-IN CONVEXITY, ANY SIZE, E
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLASTIC, EACH
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH
OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN CONVEXITY, EACH
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE),
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE), EA
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE), EA
OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, LIQUID, PER FLUID OUNCE
OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, PER TABLET
OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT
IRRIGATION SUPPLY; SLEEVE, EACH
OSTOMY IRRIGATION SUPPLY; BAG, EACH
OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, INCLUDING BRUSH
OSTOMY IRRIGATION SET
LUBRICANT, PER OUNCE
OSTOMY RING, EACH
OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE

OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED WEAR, WITH BUILT-IN CON
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, WITH BUILT-IN CON
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, WITHOUT BUILT-IN
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, WITHOUT BUILT-IN C
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE SYSTEM), WITH FILT
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT BUILT-IN CONVEXITY, 4 X 4 IN
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT BUILT-IN CONVEXITY, LARGE
OSTOMY SUPPLY; MISCELLANEOUS
OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH TO THICKEN LIQUID
TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
TAPE, WATERPROOF, PER 18 SQUARE INCHES
ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE
ENEMA BAG WITH TUBING, REUSABLE
ABDOMINAL DRESSING HOLDER, EACH
NONELASTIC BINDER FOR EXTREMITY
GRAVLEE JET WASHER
VABRA ASPIRATOR
TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH
MOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVASIVE MECHANICAL VENTILATION
SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH
SURGICAL STOCKINGS THIGH LENGTH, EACH
SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH
SURGICAL STOCKINGS FULL-LENGTH, EACH
ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, MEDIUM SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, EXTRA LARGE SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, MEDIUM SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH
ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, EXTRA-LARGE SIZE, EACH
CHILD-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL/MEDIUM SIZE, EACH
CHILD-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH
CHILD-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL/MEDIUM SIZE, EACH
CHILD-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH
YOUTH-SIZED INCONTINENCE PRODUCT, DIAPER, EACH
YOUTH-SIZED INCONTINENCE PRODUCT, BRIEF, EACH
DISPOSABLE LINER/SHIELD FOR INCONTINENCE, EACH
PROTECTIVE UNDERWEAR, WASHABLE, ANY SIZE, EACH
UNDER PAD, REUSABLE/WASHABLE, ANY SIZE, EACH
DIAPER SERVICE, REUSABLE DIAPER, EACH DIAPER
SURGICAL TRAYS
DISPOSABLE UNDERPADS, ALL SIZES, (E.G., CHUX'S)
ELECTRODES (E.G., APNEA MONITOR), PER PAIR
LEAD WIRES (E.G., APNEA MONITOR), PER PAIR
CONDUCTIVE PASTE OR GEL
PESSARY, RUBBER, ANY TYPE
PESSARY, NON RUBBER, ANY TYPE

SLINGS
SPLINT
TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE
CAST SUPPLIES (E.G. PLASTER)
SPECIAL CASTING MATERIAL (E.G. FIBERGLASS)
ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)
OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACEMENT
TRANSTRACHEAL OXYGEN CATHETER, EACH
TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR LESS THAN 72 HOURS OF USE, EACH
TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR 72 OR MORE HOURS OF USE, EACH
BATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED VENTILATOR
BATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
BATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
PEAK EXPIRATORY FLOW RATE METER, HAND HELD
CANNULA, NASAL
TUBING (OXYGEN), PER FOOT
MOUTH PIECE
BREATHING CIRCUITS
FACE TENT
VARIABLE CONCENTRATION MASK
TRACHEOSTOMY MASK OR COLLAR
TRACHEOSTOMY OR LARYNGECTOMY TUBE
TRACHEOSTOMY, INNER CANNULA (REPLACEMENT ONLY)
TRACHEAL SUCTION CATHETER, ANY TYPE OTHER THAN CLOSED SYSTEM, EACH
TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY
TRACHEOSTOMY CLEANING BRUSH, EACH
SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE INHALER
OROPHARYNGEAL SUCTION CATHETER, EACH
TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY
REPLACEMENT BATTERIES FOR MEDICALLY NECESSARY TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (T
REPLACEMENT BATTERIES FOR MEDICALLY NECESSARY ELECTRONIC WHEEL CHAIR OWNED BY PATIENT
REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH
REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH
REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL
UNDERARM PAD, CRUTCH, REPLACEMENT, EACH
REPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EACH
REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH
REPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, EACH
REPLACEMENT PAD FOR USE WITH MEDICALLY NECESSARY ALTERNATING PRESSURE PAD OWNED BY PATIENT
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, NOT OTHERWISE CLASSIFIED
SUPPLY OF SATUMOMAB PENDETIDE, RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, PER DOSE
SUPPLY OF ADDITIONAL HIGH DOSE CONTRAST MATERIAL(S) DURING MAGNETIC RESONANCE IMAGING, E.G., GAD
SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (100-199 MG OF IODINE)
SUPPLY OF PARAMAGNETIC CONTRAST MATERIAL (E.G., GADOLINIUM)
SURGICAL SUPPLY; MISCELLANEOUS
CALIBRATED MICROCAPILLARY TUBE, EACH
MICROCAPILLARY TUBE SEALANT

PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH
NEEDLE, ANY SIZE, EACH
SYRINGE, WITH OR WITHOUT NEEDLE, EACH
SPHYGMOMANOMETER/BLOOD PRESSURE APPARATUS WITH CUFF AND STETHOSCOPE
BLOOD PRESSURE CUFF ONLY
AUTOMATIC BLOOD PRESSURE MONITOR
ACTIVATED CARBON FILTER FOR HEMODIALYSIS, EACH
DIALYZER (ARTIFICIAL KIDNEYS), ALL TYPES, ALL SIZES, FOR HEMODIALYSIS, EACH
BICARBONATE CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON
BICARBONATE CONCENTRATE, POWDER, FOR HEMODIALYSIS, PER PACKET
ACETATE CONCENTRATE SOLUTION, FOR HEMODIALYSIS, PER GALLON
ACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON
WATER, STERILE, FOR INJECTION, PER 10 ML
TREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OSMOSIS) FOR PERITONEALDIALYSIS, PER GALLON
Y SET TUBING FOR PERITONEAL DIALYSIS
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 249CC, BUT LESS TH
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 999CC, BUT LESS TH
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 1999CC, BUT LESS T
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 5999CC, FOR PERITO
FISTULA CANNULATION SET FOR HEMODIALYSIS, EACH
TOPICAL ANESTHETIC, FOR DIALYSIS, PER GRAM
INJECTABLE ANESTHETIC, FOR DIALYSIS, PER 10 ML
SHUNT ACCESSORY, FOR HEMODIALYSIS, ANY TYPE, EACH
BLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS, EACH
BLOOD TUBING, ARTERIAL AND VENOUS COMBINED, FOR HEMODIALYSIS, EACH
DIALYSATE SOLUTION TEST KIT, FOR PERITONEAL DIALYSIS, ANY TYPE, EACH
DIALYSATE CONCENTRATE, POWDER, ADDITIVE FOR PERITONEAL DIALYSIS, PER PACKET
DIALYSATE CONCENTRATE, SOLUTION, ADDITIVE FOR PERITONEAL DIALYSIS, PER 10 ML
BLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 50
SERUM CLOTTING TIME TUBE, FOR DIALYSIS, PER 50
BLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50
OCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50
AMMONIA TEST STRIPS, FOR DIALYSIS, PER 50
PROTAMINE SULFATE, FOR HEMODIALYSIS, PER 50 MG
DISPOSABLE CATHETER TIPS FOR PERITONEAL DIALYSIS, PER 10
PLUMBING AND/OR ELECTRICAL WORK FOR HOME HEMODIALYSIS EQUIPMENT
CONTRACTS, REPAIR AND MAINTENANCE, FOR HEMODIALYSIS EQUIPMENT
DRAIN BAG/BOTTLE, FOR DIALYSIS, EACH
MISCELLANEOUS DIALYSIS SUPPLIES, NOT OTHERWISE SPECIFIED
VENOUS PRESSURE CLAMP, FOR HEMODIALYSIS, EACH
GLOVES, NON-STERILE, PER 100
SURGICAL MASK, PER 20
TOURNIQUET FOR DIALYSIS, EACH
GLOVES, STERILE, PER PAIR
ORAL THERMOMETER, REUSABLE, ANY TYPE, EACH
RECTAL THERMOMETER, REUSABLE, ANY TYPE, EACH

OSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH
STOMA CAP
OSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE (2 PIECE SYSTEM), EACH
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH
CONTINENT DEVICE; PLUG FOR CONTINENT STOMA
CONTINENT DEVICE; CATHETER FOR CONTINENT STOMA
OSTOMY ACCESSORY; CONVEX INSERT
BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE, EACH
URINARY SUSPENSORY; WITH LEG BAG, WITH OR WITHOUT TUBE
URINARY LEG BAG; LATEX
LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET
LEG STRAP; FOAM OR FABRIC, REPLACEMENT ONLY, PER SET
SKIN BARRIER; WIPES, BOX PER 50
SKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH
SKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH
ADHESIVE OR NON-ADHESIVE; DISK OR FOAM PAD
APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ.
PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY OF OFF-THE-SHELF
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY OF SHOE MOLDED
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM M
FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF DEPT
FOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM MOLDED SHOE, PER
FOR DIABETICS ONLY, DIRECT FORMED, MOLDED TO FOOT WITH EXTERNAL HEAT SOURCE (I.E. HEAT GUN) MULTI
FOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOLDED TO PATIENT'S FOOT WITHOUT EXTERNAL HEAT S
FOR DIABETICS ONLY, CUSTOM-MOLDED FROM MODEL OF PATIENT'S FOOT, MULTIPLE DENSITY INSERT(S), CUSTO
NON-CONTACT WOUND WARMING WOUND COVER FOR USE WITH THE NON-CONTACT WOUND WARMING DEVICE
COLLAGEN BASED WOUND FILLER, DRY FORM, PER GRAM OF COLLAGEN
COLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN
COLLAGEN DRESSING, PAD SIZE 16 SQ. IN. OR LESS, EACH
COLLAGEN DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH
COLLAGEN DRESSING, PAD SIZE MORE THAN 48 SQ. IN., EACH
COLLAGEN DRESSING WOUND FILLER, PER 6 INCHES
SILICONE GEL SHEET, EACH
WOUND POUCH, EACH
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSING
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THA
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., EACH DRESSI
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, PER 6 INCHES

COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
COMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHE
COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
COMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE
COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
CONTACT LAYER, 16 SQ. IN. OR LESS, EACH DRESSING
CONTACT LAYER, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
CONTACT LAYER, MORE THAN 48 SQ. IN., EACH DRESSING
FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSIN
FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESS
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DR
FOAM DRESSING, WOUND FILLER, PER GRAM
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DR
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH
GAUZE, NON-IMPREGNATED, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
GAUZE, NON-IMPREGNATED, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY
GAUZE, NON-IMPREGNATED, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSIN
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, PAD SIZE 16 SQ. IN. OR LESS
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, PAD SIZE MORE THAN 16 SQ
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, PAD SIZE MORE THAN 48 SQ
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER,
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL T
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDE
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSIN
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, PAD SIZE GREATER THAN 16 SQ. IN., BUT LES
GAUZE, IMPREGNATED, HYDROGEL FOR DIRECT WOUND CONTACT, PAD SIZE MORE THAN 48 SQ. IN., EACH DRESS
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH D
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EAC
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EA
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER
HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, PER FLUID OUNCE
HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, PER GRAM
HYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESS
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN.
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DR
HYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH D
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN.
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EAC
HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE
SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANY TYPE, ANY SIZE
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORD
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BOR
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE
TRANSPARENT FILM, 16 SQ. IN. OR LESS, EACH DRESSING
TRANSPARENT FILM, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
TRANSPARENT FILM, MORE THAN 48 SQ. IN., EACH DRESSING
WOUND CLEANSERS, ANY TYPE, ANY SIZE
WOUND FILLER, GEL/PASTE, PER FLUID OUNCE, NOT ELSEWHERE CLASSIFIED
WOUND FILLER, DRY FORM, PER GRAM, NOT ELSEWHERE CLASSIFIED
GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, ANY WIDTH, PER LINEAR YARD
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSI
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., W
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRE
EYE PAD, STERILE, EACH
EYE PAD, NON-STERILE, EACH
EYE PATCH, OCCLUSIVE, EACH
PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR EQUAL TO 3 INCHES A
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN OR EQUAL TO 3
ONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN OR EQUAL TO 5 IN
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE WIDTH GREATER THAN OR EQUAL TO 3 INCHE
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR EQUAL TO 5 INCH
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE < 1.25 FOOT POUNDS AT 50% MA
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE < 1.25 FT LBS AT 50% MAX STRET
MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25 - 1.34 FOOT POUND
HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE >/= 1.35 FOOT POUNDS AT 50% MA
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE >/= 0.55 FOOT POUNDS AT 5
ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO 3 IN
COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED
COMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED
COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST), CUSTOM FABRICAT
COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD), CUSTOM FABRIC
COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM FABRICATED
COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED
CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH
CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH
TUBING, USED WITH SUCTION PUMP, EACH
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE
SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, NON-DISPOSABLE
ADMINISTRATION SET, WITH SMALL VOLUME FILTERED PNEUMATIC NEBULIZER
LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED WITH AEROSOL COMPRESSOR
LARGE VOLUME NEBULIZER, DISPOSABLE, PREFILLED, USED WITH AEROSOL COMPRESSOR

RESERVOIR BOTTLE, NON-DISPOSABLE, USED WITH LARGE VOLUME ULTRASONIC NEBULIZER
CORRUGATED TUBING, DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 100 FEET
CORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 10 FEET
WATER COLLECTION DEVICE, USED WITH LARGE VOLUME NEBULIZER
FILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR
FILTER, NONDISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR
AEROSOL MASK, USED WITH DME NEBULIZER
DOME AND MOUTHPIECE, USED WITH SMALL VOLUME ULTRASONIC NEBULIZER
NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, NOT USED WITH OXYGEN
WATER, DISTILLED, USED WITH LARGE VOLUME NEBULIZER, 1000 ML
SALINE SOLUTION, PER 10 ML, METERED DOSE DISPENSER, FOR USE WITH INHALATION DRUGS
STERILE WATER OR STERILE SALINE, 1000 ML, USED WITH LARGE VOLUME NEBULIZER
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST, REPLACEMENT FOR USE WITH PATIENT OWNED EQU
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE, REPLACEMENT FOR USE WITH PATIENT OWNED EQ
FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH
REPLACEMENT CUSHION FOR NASAL APPLICATION DEVICE, EACH
REPLACEMENT PILLOWS FOR NASAL APPLICATION DEVICE, PAIR
NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHO
HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE
CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE
TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE
FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
IMPLANTED PLEURAL CATHETER, EACH
VACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH IMPLANTED CATHETER
ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH
REPLACEMENT DIAPHRAGM/FACEPLATE FOR TRACHEOSTOMA VALVE, EACH
FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYS
FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH
HOUSING, REUSABLE WITHOUT ADHESIVE, FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH
ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH TRACHEOSTOMA VALVE, A
FILTER HOLDER AND INTEGRATED FILTER WITHOUT ADHESIVE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTU
HOUSING AND INTEGRATED ADHESIVE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM
FILTER HOLDER AND INTEGRATED FILTER HOUSING, AND ADHESIVE, FOR USE AS A TRACHEOSTOMA HEAT AND M
NONPRESCRIPTION DRUG
NONCOVERED ITEM OR SERVICE
EXERCISE EQUIPMENT
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M SESTAMIBI, PER DOSE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M TETROFOSMIN, PER UN
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M, MEDRONATE, UP TO 30
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M APCITIDE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL-201, PER MILLICURIE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM IN 111 CAPROMAB PENDETIDE, PER D
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, IOBENGUANE SULFATE I-131, PER 0.5 MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M DISOFENIN, PER VIAL
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M, DEPREOTIDE, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M PERTECHNETATE, PER M

SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M MEBROFENIN, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M PYROPHOSPHATE, PER
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M PENTETATE, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-123 SODIUM IODIDE CAPSULE, PER 100 UCI
SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE CAPSULE, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE SOLUTION, PER UCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M MACROAGGREGATED A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M SULFUR COLLOID, PER
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M EXAMETAZINE, PER DOS
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB TIUXETAN, PER MC
SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB TIUXETAN, PER M
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, IODINATED I-131 SERUM ALBUMIN, 5 MICROCU
SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, STRONTIUM-89 CHLORIDE, PER MCI
SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, I-131 SODIUM IODIDE CAPSULE, PER MCI
SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, SAMARIUM SM 153 LEXIDRONAMM, 50 MCI
SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, NOT OTHERWISE CLASSIFIED
SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS CODE
DME DELIVERY, SET UP, AND/OR DISPENSING SERVICE COMPONENT OF ANOTHER HCPCS CODE
ENTERAL FEEDING SUPPLY KIT; SYRINGE, PER DAY
ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY
ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY
NASOGASTRIC TUBING WITH STYLET
NASOGASTRIC TUBING WITHOUT STYLET
STOMACH TUBE - LEVINE TYPE
GASTROSTOMY/JEJUNOSTOMY TUBE, ANY MATERIAL, ANY TYPE, (STANDARD OR LOW PROFILE), EACH
FOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE
ENTERAL FORMULAE; CATEGORY I; SEMI-SYNTHETIC INTACT PROTEIN/PROTEIN ISOLATES, ADMINISTERED THROU
ENTERAL FORMULAE; CATEGORY I: NATURAL INTACT PROTEIN/PROTEIN ISOLATES, ADMINISTERED THROUGH AN
ENTERAL FORMULAE; CATEGORY II: INTACT PROTEIN/PROTEIN ISOLATES (CALORICALLY DENSE), ADMINISTERED
ENTERAL FORMULAE; CATEGORY III: HYDROLIZED PROTEIN/AMINO ACIDS, ADMINISTERED THROUGH AN ENTERAL
ENTERAL FORMULAE; CATEGORY IV: DEFINED FORMULA FOR SPECIAL METABOLIC NEED, ADMINISTERED THROUG
ENTERAL FORMULAE; CATEGORY V: MODULAR COMPONENTS, ADMINISTERED THROUGH AN ENTERAL FEEDING T
ENTERAL FORMULAE; CATEGORY VI: STANDARDIZED NUTRIENTS, ADMINISTERED THROUGH AN ENTERAL FEEDIN
PARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXTROSE), 50% OR LESS (500 ML = 1 UNIT) - HOMEMIX
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5%, (500 ML = 1 UNIT) - HOMEMIX
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 5.5% THROUGH 7%, (500 ML = 1 UNIT) - HOMEMIX
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 7% THROUGH 8.5%, (500 ML = 1 UNIT) - HOMEMIX
PARENTERAL NUTRITION SOLUTION; AMINO ACID, GREATER THAN 8.5% (500 ML = 1 UNIT) - HOMEMIX
PARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXTROSE), GREATER THAN 50% (500 ML=1 UNIT) - HOME
PARENTERAL NUTRITION SOLUTION; LIPIDS, 10% WITH ADMINISTRATION SET (500 ML = 1 UNIT)
PARENTERAL NUTRITION SOLUTION, LIPIDS, 20% WITH ADMINISTRATION SET (500 ML = 1 UNIT)
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TR
PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN, ELECTROLYTES) HOMEMIX PER DAY
PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY
PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY

PARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES,TR
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES,TR
ENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM
ENTERAL NUTRITION INFUSION PUMP - WITH ALARM
PARENTERAL NUTRITION INFUSION PUMP, PORTABLE
PARENTERAL NUTRITION INFUSION PUMP, STATIONARY
NOC FOR ENTERAL SUPPLIES
NOC FOR PARENTERAL SUPPLIES
WHOLE BLOOD OR RED BLOOD CELLS, LEUKOREDUCED, CMV NEGATIVE, EACH UNIT
PLATELET, HLA-MATCHED LEUKOREDUCED, APHERESIS/PHERESIS, EACH UNIT
PLATELETS, PHERESIS, LEUKOCYTE-REDUCED, CMV NEGATIVE, IRRADIATED, EACH UNIT
WHOLE BLOOD OR RED BLOOD CELLS, LEUKOREDUCED, FROZEN, DEGLYCEROL, WASHED, EACH UNIT
PLATELET, LEUKOREDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT
WHOLE BLOOD, LEUKOREDUCED, IRRADIATED, EACH UNIT
RED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTE-REDUCED, IRRADIATED, EACH UNIT
RED BLOOD CELLS, LEUKOCYTE-REDUCED, CMV NEGATIVE, IRRADIATED, EACH UNIT
PLASMA, FROZEN WITHIN 24 HOURS OF COLLECTION, EACH UNIT
ELECTRODE, NEEDLE, ABLATION, MR COMPATIBLE LEVEEN, MODIFIED LEVEEN NEEDLE ELECTRODE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN CO 57/58, PER 0.5 MICROC
LASER OPTIC TREATMENT SYSTEM, INDIGO LASEROPTIC TREATMENT SYSTEM
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 OXYQUINOLINE, PER 0.5 MILLICUR
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 PENTETATE, PER 0.5 MILLICURIE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M ARCITUMOMAB, PER VIA
ENDOTRACHEAL TUBE, VETT TRACHEOBRONCHIAL TUBE
INJECTION, CYTARABINE LIPOSOME, PER 10 MG
INJECTION, EPIRUBICIN HYDROCHLORIDE, 2 MG
BIOPSY DEVICE, BREAST, ABBI DEVICE
BIOPSY DEVICE, 11-GAUGE MAMMOTOME PROBE WITH VACUUM CANNISTER
INJECTION, BUSULFAN, PER 6 MG
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M SODIUM GLUCOHEPTON
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M SUCCIMER, PER VIAL
HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL
APLIGRAF, PER 44 SQ CM
ELECTRODE, DISPOSABLE, PALATE SOMNOPLASTY COAGULATING ELECTRODE, BASE OF TONGUE SOMNOPLAST
ELECTRODE, DISPOSABLE, TURBINATE SOMNOPLASTY COAGULATING ELECTRODE
ELECTRODE, DISPOSABLE, VAPR ELECTRODE, VAPR T THERMAL ELECTRODE
ELECTRODE, DISPOSABLE, LIGASURE DISPOSABLE ELECTRODE
ELECTRODE, DISPOSABLE, GYNECARE VERSAPOINT RESECTOSCOPIC SYSTEM BIPOLAR ELECTRODE
INFUSION SYSTEM, ON-Q PAIN MANAGEMENT SYSTEM, ON-Q SOAKER PAIN MANAGEMENT SYSTEM, AND PAINBUS
ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (INPLANTABLE)
BRACHYTHERAPY SEED, GOLD 198
BRACHYTHERAPY SEED, IODINE 125
BRACHYTHERAPY SEED, NON-HIGH DOSE RATE IRIDIUM 192
BRACHYTHERAPY SEED, PALLADIUM 103
ADHESION BARRIER
INJECTION, DARBEPOETIN ALFA (FOR NON ESRD USE), PER 1 MCG
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, FLUORODEOXYGLUCOSE F18 (2-DEOXY-2-[18F

OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE
CATHETER, ABLATION, NON-CARDIAC, ENDOVASCULAR (IMPLANTABLE)
LEAD, LEFT VENTRICULAR CORONARY VENOUS SYSTEM
CATHETER, GOLD PROBE SINGLE-USE ELECTROHEMOSTASIS CATHETER
PROBE, PERCUTANEOUS LUMBAR DISCECTOMY
BRACHYTHERAPY SEED, YTTRIUM-90
PROBE, CRYOABLATION
BRACHYTHERAPY SOLUTION, IODINE-125, PER MCI
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, ABDOMEN
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN
MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; UNILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; UNILATERAL
MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; BILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; BILATERAL
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, CHEST (EXCLUDIN
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWER EXTREMITY
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, LOWER EXTREMITY
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, LOWER EXTREMIT
INJECTION, SODIUM CHROMATE CR51, PER 0.25 MCI
PALIVIZUMAB-RSV-IGM, PER 50 MG
BACLOFEN INTRATHECAL SCREENING KIT (1 AMP)
BACLOFEN INTRATHECAL REFILL KIT, PER 500 MCG
BACLOFEN REFILL KIT, PER 2000 MCG
BACLOFEN INTRATHECAL REFILL KIT, PER 4000 MCG
SUPPLY OF CO 57 COBALTOUS CHLORIDE, RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, 51 SODIUM CHROMATE, PER 50 MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM IOTHALAMATE I-125 INJECTION, PER
INJECTION, HEPATITIS B IMMUNE GLOBULIN, PER 1 ML
INJECTION, TIROFIBAN HYDROCHLORIDE, 6.25 MG
INJECTION, BIVALIRUDIN, 250 MG PER VIAL
INJECTION, PERFLUTREN LIPID MICROSPHERE, PER 2 ML VIAL
INJECTION, PANTOPRAZOLE SODIUM, PER VIAL
INJECTION, ERTAPENEM SODIUM, PER 1 GRAM VIAL
INJECTION, PEGFILGRASTIM, PER 6 MG SINGLE DOSE VIAL
INJECTION, FULVESTRANT, PER 50 MG
INJECTION, ARGATROBAN, PER 5 MG
ORCEL, PER 36 SQUARE CENTIMETERS
DERMAGRAFT, PER 37.5 SQUARE CENTIMETERS
FRESH FROZEN PLASMA, DONOR RETESTED, EACH UNIT
STRETTA SYSTEM
BARD ENDOSCOPIC SUTURING SYSTEM
H.E.L.P. APHERESIS SYSTEM
PERIODIC ORAL EVALUATION
LIMIT ORAL EVAL PROBLM FOCUS

COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT
EXTENSV ORAL EVAL PROB FOCUS
RE-EVALUATION-LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-OPERATIVE VISIT)
COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT
INTRAOR COMPLETE FILM SERIES
INTRAORAL PERIAPICAL FIRST F
INTRAORAL PERIAPICAL EA ADD
INTRAORAL OCCLUSAL FILM
EXTRAORAL FIRST FILM
EXTRAORAL EA ADDITIONAL FILM
DENTAL BITEWING SINGLE FILM
DENTAL BITEWINGS TWO FILMS
DENTAL BITEWINGS FOUR FILMS
VERTICAL BITEWINGS - 7 TO 8 FILMS
DENTAL FILM SKULL/ FACIAL BON
DENTAL SALIOGRAPHY
DENTAL TMJ ARTHROGRAM INCL I
DENTAL OTHER TMJ FILMS
DENTAL TOMOGRAPHIC SURVEY
DENTAL PANORAMIC FILM
DENTAL CEPHALOMETRIC FILM
ORAL/FACIAL IMAGES (INCLUDES INTRA AND EXTRAORAL IMAGES)
BACTERIOLOGIC STUDY
CARIES SUSCEPTIBILITY TEST
PULP VITALITY TEST
DIAGNOSTIC CASTS
ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN REPORT
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTE
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT OF SURGICAL MARG
PROCESSING AND INTERPRETATION OF CYTOLOGIC SMEARS, INCLUDING THE PREPARATION AND TRANSMISSION
OTHER ORAL PATHOLOGY PROCEDU
UNSPECIFIED DIAGNOSTIC PROCE
DENTAL PROPHYLAXIS ADULT
DENTAL PROPHYLAXIS CHILD
TOPICAL FLUOR W/ PROPHY CHILD
TOPICAL FLUOR W/O PROPHY CHI
TOPICAL FLUOR W/O PROPHY ADU
TOPICAL FLUORIDE W/ PROPHY A
NUTRI COUNSEL-CONTROL CARIES
TOBACCO COUNSELING
ORAL HYGIENE INSTRUCTION
DENTAL SEALANT PER TOOTH
SPACE MAINTAINER FXD UNILAT
FIXED BILAT SPACE MAINTAINER
REMOVE UNILAT SPACE MAINTAIN
REMOVE BILAT SPACE MAINTAIN
RECEMENT SPACE MAINTAINER
AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT
AMALGAM-TWO SURFACES, PRIMARY OR PERMANENT

AMALGAM-THREE SURFACES, PRIMARY OR PERMANENT
AMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT
RESIN ONE SURFACE- ANTERIOR
RESIN TWO SURFACES- ANTERIOR
RESIN THREE SURFACES- ANTERIO
RESIN 4/> SURF OR W/ INCIS AN
RESIN-BASED COMPOSITE CROWN, ANTERIOR
RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR
RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR
RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR
DENTAL GOLD FOIL ONE SURFACE
DENTAL GOLD FOIL TWO SURFACE
DENTAL GOLD FOIL THREE SURFA
DENTAL INLAY METALIC 1 SURF
DENTAL INLAY METALLIC 2 SURF
DENTAL INLAY METL 3/ MORE SUR
ONLAY-METALLIC-TWO SURFACES
DENTAL ONLAY METALLIC 3 SURF
DENTAL ONLAY METL 4/ MORE SUR
INLAY PORCELAIN/CERAMIC 1 SU
DENTAL ONLAY PORC 3/ MORE SUR
DENTAL ONLAY PORCELIN 2 SURF
INLAY - RESIN-BASED COMPOSITE - ONE SURFACE
INLAY - RESIN-BASED COMPOSITE - TWO SURFACES
INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES
ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES
ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES
ONLAY - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES
CROWN - RESIN (INDIRECT)
CROWN RESIN W/ HIGH NOBLE ME
CROWN RESIN W/ BASE METAL
CROWN RESIN W/ NOBLE METAL
CROWN PORCELAIN/CERAMIC SUBS
CROWN PORCELAIN W/ H NOBLE M
CROWN PORCELAIN FUSED BASE M
CROWN PORCELAIN W/ NOBLE MET
CROWN - 3/4 CAST HIGH NOBLE METAL
CROWN - 3/4 CAST PREDOMINANTLY BASE METAL
CROWN - 3/4 CAST NOBLE METAL (SINGLE RESTORATION ONLY)
CROWN - 3/4 PORCELAIN/CERAMIC (SINGLE RESTORATION ONLY)
CROWN FULL CAST HIGH NOBLE M
CROWN FULL CAST BASE METAL
CROWN FULL CAST NOBLE METAL
PROVISIONAL CROWN
DENTAL RECEMENT INLAY

DENTAL RECEMENT CROWN
PREFAB STNLSS STEEL CRWN PRI
PREFAB STNLSS STEEL CROWN PE
PREFABRICATED RESIN CROWN
PREFAB STAINLESS STEEL CROWN
DENTAL SEDATIVE FILLING
CORE BUILD-UP INCL ANY PINS
TOOTH PIN RETENTION
POST AND CORE CAST + CROWN
EACH ADDITIONAL CAST POST - SAME TOOTH (OTHER RESTORATIVE SERVICES)
PREFAB POST/CORE + CROWN
POST REMOVAL
EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH (OTHER RESTORATIVE SERVICES)
LAMINATE LABIAL VENEER
LAB LABIAL VENEER RESIN
LAB LABIAL VENEER PORCELAIN
TEMPORARY- FRACTURED TOOTH
CROWN REPAIR
DENTAL UNSPEC RESTORATIVE PR
PULP CAP DIRECT
PULP CAP INDIRECT
THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) REMOVAL OF PULP CORONAL TO THE DENTINOCE
PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH
PULPAL THERAPY ANTERIOR PRIM
PULPAL THERAPY POSTERIOR PRI
ANTERIOR
ROOT CANAL THERAPY 2 CANALS
TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS
INCOMPLETE ENDODONTIC THERAPY; INOPERABLE OR FRACTURED TOOTH
INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
RETREAT ROOT CANAL ANTERIOR
RETREAT ROOT CANAL BICUSPID
RETREAT ROOT CANAL MOLAR
APEXIFICATION/RECALC INITIAL
APEXIFICATION/RECALC INTERIM
APEXIFICATION/RECALC FINAL
APICOECT/PERIRAD SURG ANTER
ROOT SURGERY BICUSPID
ROOT SURGERY MOLAR
ROOT SURGERY EA ADD ROOT
RETROGRADE FILLING
ROOT AMPUTATION
ENDODONTIC ENDOSSEOUS IMPLAN
INTENTIONAL REPLANTATION
ISOLATION-TOOTH W RUBB DAM
TOOTH SPLITTING
CANAL PREP/FITTING OF DOWEL
ENDODONTIC PROCEDURE
GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES, PER Q
GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE TEETH, PER QUADRANT
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TE
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
APICALLY POSITIONED FLAP
CROWN LENGTHEN HARD TISSUE
OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDE
OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE TEETH, PER QUADRANT
BONE REPLCE GRAFT FIRST SITE
BONE REPLCE GRAFT EACH ADD
BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION
GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE
GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE, (INCLUDES MEMBRANE REMOVAL)
SURGICAL REVISION PROCEDURE, PER TOOTH
PEDICLE SOFT TISSUE GRAFT PR
FREE SOFT TISSUE GRAFT PROC
SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES
DISTAL/PROXIMAL WEDGE PROC
SOFT TISSUE ALLOGRAFT
COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT
PROVISION SPLNT INTRACORONAL
PROVISIONAL SPLINT EXTRACORO
PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES
PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT
FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS
LOCALIZED CHEMO DELIVERY
PERIODONTAL MAINTENANCE
UNSCHEDULED DRESSING CHANGE
UNSPECIFIED PERIODONTAL PROC
DENTURES COMPLETE MAXILLARY
DENTURES COMPLETE MANDIBLE
DENTURES IMMEDIAT MAXILLARY
DENTURES IMMEDIAT MANDIBLE
DENTURES MAXILL PART RESIN
DENTURES MAND PART RESIN
DENTURES MAXILL PART METAL
DENTURES MANDIBL PART METAL
REMOVABLE PARTIAL DENTURE
DENTURES ADJUST CMPLT MAXIL
DENTURES ADJUST CMPLT MAND
DENTURES ADJUST PART MAXILL
DENTURES ADJUST PART MANDBL
DENTUR REPR BROKEN COMPL BAS
REPLACE DENTURE TEETH COMPLT
DENTURES REPAIR RESIN BASE
REP PART DENTURE CAST FRAME
REP PARTIAL DENTURE CLASP
REPLACE PART DENTURE TEETH
ADD TOOTH TO PARTIAL DENTURE

ADD CLASP TO PARTIAL DENTURE
REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)
REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)
DENTURES REBASE CMPLT MAXIL
DENTURES REBASE CMPLT MAND
DENTURES REBASE PART MAXILL
DENTURES REBASE PART MANDBL
DENTURE RELN CMPLT MAXIL CH
DENTURE RELN CMPLT MAND CHR
DENTURE RELN PART MAXIL CHR
DENTURE RELN PART MAND CHR
DENTURE RELN CMPLT MAX LAB
DENTURE RELN CMPLT MAND LAB
DENTURE RELN PART MAXIL LAB
DENTURE RELN PART MAND LAB
DENTURE INTERM CMPLT MAXILL
DENTURE INTERM CMPLT MANDBL
DENTURE INTERM PART MAXILL
DENTURE INTERM PART MANDBL
DENTURE TISS CONDITN MAXILL
DENTURE TISS CONDTIN MANDBL
OVERDENTURE COMPLETE
OVERDENTURE PARTIAL
PRECISION ATTACHMENT BY REPORT
REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE OR FEMALE COM
MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY
REMOVABLE PROSTHODONTIC PROC
FACIAL MOULAGE SECTIONAL
FACIAL MOULAGE COMPLETE
NASAL PROSTHESIS
AURICULAR PROSTHESIS
ORBITAL PROSTHESIS
OCULAR PROSTHESIS
FACIAL PROSTHESIS
NASAL SEPTAL PROSTHESIS
OCULAR PROSTHESIS INTERIM
CRANIAL PROSTHESIS
FACIAL AUGMENTATION IMPLANT
REPLACEMENT NASAL PROSTHESIS
AURICULAR REPLACEMENT
ORBITAL REPLACEMENT
FACIAL REPLACEMENT
SURGICAL OBTURATOR
POSTSURGICAL OBTURATOR
REFITTING OF OBTURATOR
MANDIBULAR FLANGE PROSTHESIS
MANDIBULAR DENTURE PROSTH
TEMP OBTURATOR PROSTHESIS
TRISMUS APPLIANCE
FEEDING AID
PEDIATRIC SPEECH AID
ADULT SPEECH AID
SUPERIMPOSED PROSTHESIS
PALATAL LIFT PROSTHESIS
INTRAORAL CON DEF INTER PLT
INTRAORAL CON DEF MOD PALAT
MODIFY SPEECH AID PROSTHESIS
SURGICAL STENT
RADIATION APPLICATOR
RADIATION SHIELD
RADIATION CONE LOCATOR
FLUORIDE APPLICATOR
COMMISSURE SPLINT
SURGICAL SPLINT
MAXILLOFACIAL PROSTHESIS
ODONTICS ENDOSTEAL IMPLANT
ODONTICS ABUTMENT PLACEMENT
ODONTICS EPOSTEAL IMPLANT
ODONTICS TRANSOSTEAL IMPLNT
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS ARCH
IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH
IMPLANT CONNECTING BAR
PREFABRICATED ABUTMENT
CUSTOM ABUTMENT
ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL)
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE METAL)
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL)
ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL)
ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL)
ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL)
IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN
IMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)
IMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE METAL)
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY BASE METAL)
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL)
ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (HIGH NOBLE METAL)
ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (PREDOMINANTLY BASE METAL)
ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (NOBLE METAL)
IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD
IMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH NO
IMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TITANIUM, TITANIUM ALLOY, OR HIGH NOBLE METAL)
IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR COMPLETELY EDENTULOUS ARCH
IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH
IMPLANT MAINTENANCE
REPAIR IMPLANT
ODONTICS REPR ABUTMENT
REMOVAL OF IMPLANT
IMPLANT PROCEDURE
PROSTHODONT HIGH NOBLE METAL
BRIDGE BASE METAL CAST
BRIDGE NOBLE METAL CAST
BRIDGE PORCELAIN HIGH NOBLE
BRIDGE PORCELAIN BASE METAL
BRIDGE PORCELAIN NOBEL METAL
PONTIC - PORCELAIN/CERAMIC
BRIDGE RESIN W/HIGH NOBLE
BRIDGE RESIN BASE METAL
BRIDGE RESIN W/NOBLE METAL
PROVISIONAL PONTIC
DENTAL RETAINR CAST METL
RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS
INLAY-PORCELAIN/CERAMIC, TWO SURFACES
INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
INLAY - CAST HIGH NOBLE METAL, TWO SURFACES
INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
INLAY - CAST NOBLE METAL, TWO SURFACES
INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
ONLAY - PORCELAIN/CERAMIC, TWO SURFACES
ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES
ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES
ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES
ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES
ONLAY - CAST NOBLE METAL, TWO SURFACES
ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
RETAIN CROWN RESIN W HI NBLE
CROWN RESIN W/BASE METAL
CROWN RESIN W/NOBLE METAL
CROWN - PORCELAIN/CERAMIC
CROWN PORCELAIN HIGH NOBLE
CROWN PORCELAIN BASE METAL
CROWN PORCELAIN NOBLE METAL
CROWN \3/4\ HIGH NOBLE METAL
CROWN - 3/4 CAST PREDOMINANTLY BASED METAL
CRWN - 3/4 CAST NOBLE METAL (FIXED PARTIAL DENTURE RETAINERS)
CROWN - 3/4 PORCELAIN/CERAMIC (FIXED PARTIAL DENTURE RETAINERS-CROWNS)
CROWN FULL HIGH NOBLE METAL
CROWN FULL BASE METAL CAST
CROWN FULL NOBLE METAL CAST
PROVISIONAL RETAINER CROWN
DENTAL CONNECTOR BAR
DENTAL RECEMENT BRIDGE

STRESS BREAKER
PRECISION ATTACH
POST & CORE PLUS RETAINER
CAST POST BRIDGE RETAINER
PREFAB POST & CORE PLUS RETA
CORE BUILD UP FOR RETAINER
COPING METAL
EACH ADDITIONAL CAST POST - SAME TOOTH (OTHER FIXED PARTIAL DENTURE SERVICES)
EA ADDITIONAL PREFABRICATED POST - SAME TOOTH (OTHER FIXED PARTIAL DENTURE SERVICES)
BRIDGE REPAIR
PEDIATRIC PARTIAL DENTURE, FIXED
FIXED PROSTHODONTIC PROC
CORONAL REMNANTS - DECIDUOUS TOOTH
EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)
REM IMP TOOTH W MUCOPER FLP
IMPACT TOOTH REMOV SOFT TISS
IMPACT TOOTH REMOV PART BONY
IMPACT TOOTH REMOV COMP BONY
IMPACT TOOTH REM BONY W/ COMP
SURG REMOV TOOTH ROOTS (CUT PROC)
ORAL ANTRAL FISTULA CLOSURE
PRIMARY CLOSURE OF A SINUS PERFORATION
TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED TOOTH
TOOTH TRANSPLANTATION
SURGICAL ACCESS OF AN UNERUPTED TOOTH
EXPOSURE TOOTH AID ERUPTION
MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION
BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH)
BIOPSY OF ORAL TISSUE - SOFT (ALL OTHERS)
CYTOLOGY SAMPLE COLLECTION
REPOSITIONING OF TEETH
TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT
ALVEOPLASTY W/ EXTRACTION
ALVEOPLASTY W/O EXTRACTION
VESTIBULOPLASTY RIDGE EXTENS
VESTIBULOPLASTY EXTEN GRAFT
EXCISION OF BENIGN LESION UP TO 1.25 CM
EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
EXCISION OF BENIGN LESION, COMPLICATED
EXCISION OF MALIGNANT LESION UP TO 1.25 CM
EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
EXCISION OF MALIGNANT LESION, COMPLICATED
MALIG TUMOR EXC TO 125 CM
MALIG TUMOR > 125 CM
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP T0 1.25 CM
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CM
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP TO 1.25 CM
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CM
LESION DESTRUCTION
REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)
REMOVAL OF TORUS PALATINUS
REMOVAL OF TORUS MANDIBULARIS
SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
MANDIBLE RESECTION
I&D ABSC INTRAORAL SOFT TISS
I&D ABSCESS EXTRAORAL
REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE
REMOVAL OF FB REACTION
PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE
MAXILLARY SINUSOTOMY
MAXILLA OPEN REDUCT SIMPLE
CLSD REDUCT SIMPL MAXILLA FX
OPEN RED SIMPL MANDIBLE FX
CLSD RED SIMPL MANDIBLE FX
OPEN RED SIMP MALAR/ ZYGOM FX
CLSD RED SIMP MALAR/ ZYGOM FX
ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH
REDUCT SIMPLE FACIAL BONE FX
MAXILLA OPEN REDUCT COMPOUND
CLSD REDUCT COMPD MAXILLA FX
OPEN REDUCT COMPD MANDBLE FX
CLSD REDUCT COMPD MANDBLE FX
OPEN RED COMP MALAR/ ZYGMA FX
CLSD RED COMP MALAR/ ZYGMA FX
ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH
ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
REDUCT COMPND FACIAL BONE FX
TMJ OPEN REDUCT- DISLOCATION
CLOSED TMP MANIPULATION
TMJ MANIPULATION UNDER ANEST
REMOVAL OF TMJ CONDYLE
TMJ MENISCECTOMY
TMJ REPAIR OF JOINT DISC
TMJ EXCISN OF JOINT MEMBRANE
TMJ CUTTING OF A MUSCLE
TMJ RECONSTRUCTION
TMJ CUTTING INTO JOINT
TMJ RESHAPING COMPONENTS
TMJ ASPIRATION JOINT FLUID
NON-ARTHROSCOPIC LYSIS AND LAVAGE
TMJ DIAGNOSTIC ARTHROSCOPY
TMJ ARTHROSCOPY LYSIS ADHESN
TMJ ARTHROSCOPY DISC REPOSIT
TMJ ARTHROSCOPY SYNOVECTOMY
TMJ ARTHROSCOPY DISCECTOMY
TMJ ARTHROSCOPY DEBRIDEMENT
OCCLUSAL ORTHOTIC APPLIANCE

TMJ UNSPECIFIED THERAPY
DENT SUTURE RECENT WOUND TO 5 CM
DENTAL SUTURE WOUND TO 5 CM
SUTURE COMPLICATE WND > 5 CM
DENTAL SKIN GRAFT
RESHAPING BONE ORTHOGNATHIC
OSTEOTOMY- MANDIBULAR RAMI
OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT
BONE CUTTING SEGMENTED
BONE CUTTING BODY MANDIBLE
RECONSTRUCTION MAXILLA TOTAL
RECONSTRUCT MAXILLA SEGMENT
RECONSTRUCT MIDFACE NO GRAFT
RECONSTRUCT MIDFACE W/ GRAFT
MANDIBLE GRAFT
REPAIR MAXILLOFACIAL DEFECTS
FRENULECTOMY/ FRENULOTOMY
EXCISION HYPERPLASTIC TISSUE
EXCISION PERICORONAL GINGIVA
SURGICAL REDUCTION OF FIBROUS TUBEROSITY
SIALOLITHOTOMY
EXCISION OF SALIVARY GLAND
SIALODOCHOPLASTY
CLOSURE OF SALIVARY FISTULA
EMERGENCY TRACHEOTOMY
DENTAL CORONOIDECTOMY
SYNTHETIC GRAFT FACIAL BONES
IMPLANT MANDIBLE FOR AUGMENT
APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF ARCHBAR
ORAL SURGERY PROCEDURE
LIMITED DENTAL TX PRIMARY
LIMITED DENTAL TX TRANSITION
LIMITED DENTAL TX ADOLESCENT
LIMITED DENTAL TX ADULT
NTERCEP DENTAL TX PRIMARY
INTERCEP DENTAL TX TRANSITION
COMPRE DENTAL TX TRANSITION
COMPRE DENTAL TX ADOLESCENT
COMPRE DENTAL TX ADULT
ORTHODONTIC REM APPLIANCE TX
FIXED APPLIANCE THERAPY HABT
PREORTHODONTIC TX VISIT
PERIODIC ORTHODONTIC TX VISIT
ORTHODONTIC RETENTION
ORTHODONTIC TREATMENT
REPAIR OF ORTHODONTIC APPLIANCE
REPLACEMENT OF LOST OR BROKEN RETAINER
ORTHODONTIC PROCEDURE
TX DENTAL PAIN MINOR PROC

DENT ANESTHESIA W/O SURGERY
REGIONAL BLOCK ANESTHESIA
TRIGEMINAL BLOCK ANESTHESIA
LOCAL ANESTHESIA
DEEP SEDATION/GENERAL ANESTHESIA-FIRST 30 MINUTES
DEEP SEDATION/GENERAL ANESTHESIA-EACH ADDITIONAL 15 MINUTES
ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE
INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - FIRST 30 MINUTES
INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - EACH ADDITIONAL 15 MINUTES
NON-INTRAVENOUS CONSCIOUS SEDATION
DENTAL CONSULTATION
HOUSE/EXTENDED CARE FACILITY CALL
HOSPITAL CALL
OFFICE VISIT DURING HOURS
OFFICE VISIT AFTER HOURS
CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING
DENT THERAPEUTIC DRUG INJECT
OTHER DRUGS/MEDICAMENTS
DENT APPL DESENSITIZING MED
APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH
BEHAVIOR MANAGEMENT
TREATMENT OF COMPLICATIONS
DENTAL OCCLUSAL GUARD
FABRICATION ATHLETIC GUARD
OCCLUSION ANALYSIS
LIMITED OCCLUSAL ADJUSTMENT
COMPLETE OCCLUSAL ADJUSTMENT
ENAMEL MICROABRASION
ODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS
EXTERNAL BLEACHING - PER ARCH
EXTERNAL BLEACHING - PER TOOTH
INTERNAL BLEACHING - PER TOOTH
ADJUNCTIVE PROCEDURE
CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP
CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIPS
CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, PAIR, COMPLETE
CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, EACH, WITH TIP AND
CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND HANDGRIPS
CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP
CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND HANDGRIPS
CRUTCH UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP
CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH
WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT
WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT
RIGID WALKER, WHEELED, WITHOUT SEAT
RIGID WALKER, WHEELED, WITH SEAT
FOLDING WALKER, WHEELED, WITHOUT SEAT
ENCLOSED, FRAMED FOLDING WALKER, WHEELED, WITH POSTERIOR SEAT
WALKER, WHEELED, WITH SEAT AND CRUTCH ATTACHMENTS

FOLDING WALKER, WHEELED, WITH SEAT
HEAVY DUTY, MULTIPLE BREAKING SYSTEM, VARIABLE WHEEL RESISTANCE WALKER
WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH
WALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE, EACH
PLATFORM ATTACHMENT, FOREARM CRUTCH, EACH
PLATFORM ATTACHMENT, WALKER, EACH
WHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR
SEAT ATTACHMENT, WALKER
CRUTCH ATTACHMENT, WALKER, EACH
LEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4)
BRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT, EACH
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE, WITH FAUCET ATTACHMENT/S
SITZ BATH CHAIR
COMMODE CHAIR, STATIONARY, WITH FIXED ARMS
COMMODE CHAIR, MOBILE, WITH FIXED ARMS
COMMODE CHAIR, STATIONARY, WITH DETACHABLE ARMS
COMMODE CHAIR, MOBILE, WITH DETACHABLE ARMS
PAIL OR PAN FOR USE WITH COMMODE CHAIR
COMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATIONARY OR MOBILE, WITH OR WITHOUT ARMS, ANY TY
COMMODE CHAIR WITH SEAT LIFT MECHANISM
FOOT REST, FOR USE WITH COMMODE CHAIR, EACH
AIR PRESSURE PAD OR CUSHION, NONPOSITIONING
WATER PRESSURE PAD OR CUSHION, NONPOSITIONING
GEL OR GEL-LIKE PRESSURE PAD OR CUSHION, NONPOSITIONING
DRY PRESSURE PAD OR CUSHION, NONPOSITIONING
PRESSURE PAD, ALTERNATING WITH PUMP
PRESSURE PAD, ALTERNATING WITH PUMP, HEAVY DUTY
PUMP FOR ALTERNATING PRESSURE PAD
DRY PRESSURE MATTRESS
GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
AIR PRESSURE MATTRESS
WATER PRESSURE MATTRESS
SYNTHETIC SHEEPSKIN PAD
LAMBSWOOL SHEEPSKIN PAD, ANY SIZE
HEEL OR ELBOW PROTECTOR, EACH
LOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR
POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)
AIR FLUIDIZED BED
GEL PRESSURE MATTRESS
AIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
WATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
DRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
HEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES BULB, OR INFRARED ELEMENT
PHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOTOMETER
THERAPEUTIC LIGHTBOX, MINIMUM 10,000 LUX, TABLE TOP MODEL
HEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED ELEMENT
ELECTRIC HEAT PAD, STANDARD
ELECTRIC HEAT PAD, MOIST

WATER CIRCULATING HEAT PAD WITH PUMP
WATER CIRCULATING COLD PAD WITH PUMP
HOT WATER BOTTLE
INFRARED HEATING PAD SYSTEM
HYDROCOLLATOR UNIT, INCLUDES PADS
ICE CAP OR COLLAR
NON-CONTACT WOUND WARMING DEVICE (TEMPERATURE CONTROL UNIT, AC ADAPTER AND POWER CORD) FOR
WARMING CARD FOR USE WITH THE NON CONTACT WOUND WARMING DEVICE AND NON CONTACT WOUND WARM
PARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY CODE A4265 FOR PARAFFIN)
PUMP FOR WATER CIRCULATING PAD
NON-ELECTRIC HEAT PAD, MOIST
HYDROCOLLATOR UNIT, PORTABLE
BATH TUB WALL RAIL, EACH
BATH TUB RAIL, FLOOR BASE
TOILET RAIL, EACH
RAISED TOILET SEAT
TUB STOOL OR BENCH
TRANSFER TUB RAIL ATTACHMENT
PAD FOR WATER CIRCULATING HEAT UNIT
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITH MATTRESS
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITHOUT MATTRES
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE SIDE RAILS, WITH MA
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE SIDE RAILS, WITHOU
HOSPITAL BED, INSTITUTIONAL TYPE INCLUDES: OSCILLATING, CIRCULATING AND STRYKER FRAME, WITH MATTR
MATTRESS, INNERSPRING
MATTRESS, FOAM RUBBER
BED BOARD
OVER-BED TABLE
BED PAN, STANDARD, METAL OR PLASTIC
BED PAN, FRACTURE, METAL OR PLASTIC
POWERED PRESSURE-REDUCING AIR MATTRESS
BED CRADLE, ANY TYPE
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITH MATTRESS
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITHOUT MATTRESS
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE RAILS, WITH MATTRE
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE RAILS, WITHOUT MAT
BED SIDE RAILS, HALF-LENGTH
BED SIDE RAILS, FULL-LENGTH
BED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, ANY TYPE
SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE
URINAL; MALE, JUG-TYPE, ANY MATERIAL

URINAL; FEMALE, JUG-TYPE, ANY MATERIAL
CONTROL UNIT FOR ELECTRONIC BOWEL IRRIGATION/EVACUATION SYSTEM
DISPOSABLE PACK (WATER RESERVOIR BAG, SPECULUM, VALVING MECHANISM AND COLLECTION BAG/BOX) FOR
AIR PRESSURE ELEVATOR FOR HEEL
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND
POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH
NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS
STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS, REGULATO
STATIONARY COMPRESSED GAS SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER, HUMIDIFIER, NEBUL
PORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER, HUMIDIFIER, CANNUL
PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, H
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, SUPPLY RESERVOIR, HUMIDIFIE
PORTABLE LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES PORTABLE CONTAINER, SUPPLY RESERVOIR, FLOWM
STATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS, REGULATOR, FLOWMETER, H
STATIONARY LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES USE OF RESERVOIR, CONTENTS INDICATOR, REGU
OXYGEN CONTENTS, GASEOUS (FOR USE WITH OWNED GASEOUS STATIONARY SYSTEMS OR WHEN BOTH A STAT
OXYGEN CONTENTS, LIQUID (FOR USE WITH OWNED LIQUID STATIONARY SYSTEMS OR WHEN BOTH A STATIONAR
PORTABLE OXYGEN CONTENTS, GASEOUS (FOR USE ONLY WITH PORTABLE GASEOUS SYSTEMS WHEN NO STAT
PORTABLE OXYGEN CONTENTS, LIQUID (FOR USE ONLY WITH PORTABLE LIQUID SYSTEMS WHEN NO STATIONARY
OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY
VOLUME VENTILATOR, STATIONARY OR PORTABLE, WITH BACKUP RATE FEATURE, USED WITH INVASIVE INTERFA
PRESSURE VENTILATOR WITH PRESSURE CONTROL, PRESSURE SUPPORT AND FLOW TRIGGERING FEATURES
OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS
CHEST SHELL (CUIRASS)
CHEST WRAP
NEGATIVE PRESSURE VENTILATOR; PORTABLE OR STATIONARY
VOLUME VENTILATOR, STATIONARY OR PORTABLE, WITH BACKUP RATE FEATURE, USED WITH NON-INVASIVE INTE
ROCKING BED WITH OR WITHOUT SIDE RAILS
PERCUSSOR, ELECTRIC OR PNEUMATIC, HOME MODEL
INTRAPULMONARY PERCUSSIVE VENTILATION SYSTEM AND RELATED ACCESSORIES
COUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE
HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES HOSES AND VEST), EA
OSCILLATORY POSITIVE EXPIRATORY PRESSURE DEVICE, NON-ELECTRIC, ANY TYPE, EACH
IPPB MACHINE, ALL TYPES, WITH BUILT-IN NEBULIZATION; MANUAL OR AUTOMATIC VALVES; INTERNAL OR EXTERN
HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATMENTS OR OXYGEN
HUMIDIFIER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC BOTTLE TYPE, FOR USE WITH REGULATOR OR FLOW
HUMIDIFIER, DURABLE FOR SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATMENT OR OXYGEN DELIVERY
COMPRESSOR, AIR POWER SOURCE FOR EQUIPMENT WHICH IS NOT SELF- CONTAINED OR CYLINDER DRIVEN
NEBULIZER, WITH COMPRESSOR
AEROSOL COMPRESSOR, BATTERY POWERED, FOR USE WITH SMALL VOLUME NEBULIZER
AEROSOL COMPRESSOR, ADJUSTABLE PRESSURE, LIGHT DUTY FOR INTERMITTENT USE
ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER
NEBULIZER, ULTRASONIC, LARGE VOLUME
NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, FOR USE WITH REGULATOR OR FLOW
NEBULIZER, WITH COMPRESSOR AND HEATER
DISPENSING FEE COVERED DRUG ADMINISTERED THROUGH DME NEBULIZER
RESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC
CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE
BREAST PUMP, MANUAL, ANY TYPE

BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE
BREAST PUMP, HEAVY DUTY,HOSPITAL GRADE,PISTON OPERATED,PULSATILE VACUUM SUCTION/RELEASE CYCLE
VAPORIZER, ROOM TYPE
POSTURAL DRAINAGE BOARD
HOME BLOOD GLUCOSE MONITOR
PACEMAKER MONITOR, SELF-CONTAINED, CHECKS BATTERY DEPLETION, INCLUDES AUDIBLE AND VISIBLE CHECK
PACEMAKER MONITOR, SELF-CONTAINED, CHECKS BATTERY DEPLETION AND OTHER PACEMAKER COMPONENTS
IMPLANTABLE CARDIAC EVENT RECORDER WITH MEMORY, ACTIVATOR AND PROGRAMMER
EXTERNAL DEFIBRILLATOR WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS
APNEA MONITOR, WITHOUT RECORDING FEATURE
APNEA MONITOR, WITH RECORDING FEATURE
SKIN PIERCING DEVICE FOR COLLECTION OF CAPILLARY BLOOD, LASER, EACH
SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON
PATIENT LIFT, KARTOP, BATHROOM OR TOILET
SEAT LIFT MECHANISM INCORPORATED INTO A COMBINATION LIFT-CHAIR MECHANISM
SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-ELECTRIC
SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-NON-ELECTRIC
PATIENT LIFT, HYDRAULIC, WITH SEAT OR SLING
PATIENT LIFT, ELECTRIC WITH SEAT OR SLING
MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT ACCESSIBLE CONTROLS
PNEUMATIC COMPRESSOR, NONSEGMENTAL HOME MODEL
PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSURE
PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE
NONSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF ARM
NONSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG
NONSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM
NONSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL LEG
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL ARM
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, HALF LEG
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE PROTECTION; TREATME
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE PROTECTION, 4 FOOT P
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE PROTECTION, 6 FOOT P
ULTRAVIOLET MULTIDIRECTIONAL LIGHT THERAPY SYSTEM IN 6 FOOT CABINET, INCLUDES BULBS/LAMPS, TIMER A
SAFETY EQUIPMENT (E.G., BELT, HARNESS OR VEST)
HELMET WITH FACE GUARD AND SOFT INTERFACE MATERIAL, PREFABRICATED
RESTRAINT, ANY TYPE (BODY, CHEST, WRIST OR ANKLE)
TENS, TWO LEAD, LOCALIZED STIMULATION
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION DEVICE, FOUR OR MORE LEADS, FOR MULTIPLE NERVE ST
FORM-FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TENS OR NMES (WITH CONDUCTIVE FIBERS SEPARATE
INCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMULATOR, MONITOR, SENSOR AND/OR TRAINER
NEUROMUSCULAR STIMULATOR FOR SCOLIOSIS
NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT
ELECTROMYOGRAPHY (EMG), BIOFEEDBACK DEVICE
OSTEOGENESIS STIMULATOR, ELECTRICAL, NONINVASIVE, OTHER THAN SPINAL APPLICATIONS
OSTEOGENESIS STIMULATOR, ELECTRICAL, NONINVASIVE, SPINAL APPLICATIONS

OSTEOGENESIS STIMULATOR, ELECTRICAL, SURGICALLY IMPLANTED
IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH
PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE NEUROSTIMULATOR PULSE
ELECTRONIC SALIVARY REFLEX STIMULATOR (INTRAORAL/NONINVASIVE)
IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR
IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER
RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR RADIOFREQUE
RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT NEUROSTIMULATOR
OSTEOGENESIS STIMULATOR, LOW INTENSITY ULTRASOUND, NON-INVASIVE
NON-THERMAL PULSED HIGH FREQUENCY RADIOWAVES, HIGH PEAK POWER ELECTROMAGNETIC ENERGY TREA
FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF NAUSEA AND VOMITIN
IV POLE
AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION 8 HOURS OR GREATER
AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION LESS THAN 8 HOURS
AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY OPERATED, WITH ADMIN
INFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G., PUMP, CATHETER, CO
INFUSION PUMP SYSTEM, IMPLANTABLE, PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G., PUMP, CATHETER
EXTERNAL AMBULATORY INFUSION PUMP, INSULIN
IMPLANTABLE INTRASPINAL (EPIDURAL/INTRATHECAL) CATHETER USED WITH IMPLANTABLE INFUSION PUMP, REP
IMPLANTABLE PROGRAMMABLE INFUSION PUMP, REPLACEMENT (EXCLUDES IMPLANTABLE INTRASPINAL CATHET
PARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MULTI-CHANNEL
AMBULATORY TRACTION DEVICE, ALL TYPES, EACH
TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION
TRACTION STAND, FREE STANDING, CERVICAL TRACTION
CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME
TRACTION EQUIPMENT, OVERDOOR, CERVICAL
TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G., BUCK'S)
TRACTION STAND, FREE STANDING, EXTREMITY TRACTION, (E.G., BUCK'S)
TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION
TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S)
TRAPEZE BARS, ALSO KNOWN AS PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR
FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS
FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS
PASSIVE MOTION EXERCISE DEVICE
TRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR
GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE
CERVICAL HEAD HARNESS/HALTER
CERVICAL PILLOW
PELVIC BELT/HARNESS/BOOT
EXTREMITY BELT/HARNESS
FRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO BED, (E.G. BALKEN, 4 POSTER)
FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION
FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION
TRAY
LOOP HEEL, EACH
LOOP TOE, EACH
PNEUMATIC TIRE, EACH
SEMI-PNEUMATIC CASTER, EACH
WHEELCHAIR ATTACHMENT TO CONVERT ANY WHEELCHAIR TO ONE ARM DRIVE

AMPUTEE ADAPTER (DEVICE USED TO COMPENSATE FOR TRANSFER OF WEIGHT DUE TO LOST LIMBS TO MAINTA
BRAKE EXTENSION, FOR WHEELCHAIR
ONE-INCH CUSHION, FOR WHEELCHAIR
TWO-INCH CUSHION, FOR WHEELCHAIR
THREE-INCH CUSHION, FOR WHEELCHAIR
FOUR-INCH CUSHION, FOR WHEELCHAIR
HOOK ON HEAD REST EXTENSION
WHEELCHAIR HAND RIMS WITH EIGHT VERTICAL RUBBER TIPPED PROJECTIONS, PAIR
COMMODE SEAT, WHEELCHAIR
NARROWING DEVICE, WHEELCHAIR
NO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST
ANTI-TIPPING DEVICE WHEELCHAIR
TRANSFER BOARD OR DEVICE
ADJUSTABLE HEIGHT DETACHABLE ARMS, DESK OR FULL-LENGTH, WHEELCHAIR
"GRADE-AID" (DEVICE TO PREVENT ROLLING BACK ON AN INCLINE) FOR WHEELCHAIR
REINFORCED SEAT UPHOLSTERY, WHEELCHAIR
REINFORCED BACK, WHEELCHAIR, UPHOLSTERY OR OTHER MATERIAL
WEDGE CUSHION, WHEELCHAIR
BELT, SAFETY WITH AIRPLANE BUCKLE, WHEELCHAIR
BELT, SAFETY WITH VELCRO CLOSURE, WHEELCHAIR
SAFETY VEST, WHEELCHAIR
ELEVATING LEG REST, EACH
UPHOLSTERY SEAT
SOLID SEAT INSERT
BACK, UPHOLSTERY
ARM REST, EACH
CALF REST, EACH
TIRE, SOLID, EACH
CASTER WITH FORK
CASTER WITHOUT FORK
PNEUMATIC TIRE WITH WHEEL
TIRE, PNEUMATIC CASTER
WHEEL, SINGLE
MODIFICATION TO PEDIATRIC WHEELCHAIR, WIDTH ADJUSTMENT PACKAGE (NOT TO BE DISPENSED WITH INITIAL
INTEGRATED SEATING SYSTEM, PLANAR, FOR PEDIATRIC WHEELCHAIR
INTEGRATED SEATING SYSTEM, CONTOURED, FOR PEDIATRIC WHEELCHAIR
RECLINING BACK, ADDITION TO PEDIATRIC WHEELCHAIR
SHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH
SHOCK ABSORBER FOR POWER WHEELCHAIR, EACH
HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY MANUAL WHEELCHAIR, EACH
HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY POWER WHEELCHAIR, EACH
RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR
LATERAL THORACIC SUPPORT, NON-CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)
LATERAL THORACIC SUPPORT, CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)
LATERAL/ANTERIOR SUPPORT, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)
ROLLABOUT CHAIR, ANY AND ALL TYPES WITH CASTERS FIVE INCHES OR GREATER
MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY CARE GIVER
TRANSPORT CHAIR, PEDIATRIC SIZE
TRANSPORT CHAIR, ADULT SIZE

FULLY RECLINING WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
FULLY RECLINING WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEVA
POWER ATTACHMENT (TO CONVERT ANY WHEELCHAIR TO MOTORIZED WHEELCHAIR, E.G., SOLO)
BATTERY CHARGER
DEEP CYCLE BATTERY
FULLY RECLINING WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTR
HEMI-WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
HEMI-WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEVATING LEGRE
HEMI-WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE FOOTRESTS
HEMI-WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTRESTS
HIGH-STRENGTH LIGHTWEIGHT WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATIN
HIGH-STRENGTH LIGHTWEIGHT WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETAC
HIGH-STRENGTH LIGHTWEIGHT WHEELCHAIR; FIXED-LENGTH ARMS, SWING-AWAY, DETACHABLE FOOTRESTS
HIGH-STRENGTH LIGHTWEIGHT WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETAC
WIDE HEAVY-DUTY WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEV
WIDE HEAVY-DUTY WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE
SEMI-RECLINING WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
SEMI-RECLINING WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, ELEVATING LEG REST
STANDARD WHEELCHAIR; FIXED FULL-LENGTH ARMS, FIXED OR SWING-AWAY, DETACHABLE FOOTRESTS
WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTRESTS
WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE
AMPUTEE WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
AMPUTEE WHEELCHAIR; FIXED FULL-LENGTH ARMS, WITHOUT FOOTRESTS OR LEGRESTS
AMPUTEE WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, WITHOUT FOOTRESTS OR LEGRESTS
AMPUTEE WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTRESTS
AMPUTEE WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEVATING LE
HEAVY DUTY WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
AMPUTEE WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE FOOTREST
MOTORIZED WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
MOTORIZED WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEVATING
MOTORIZED WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE FOOTRESTS
MOTORIZED WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTRESTS
WHEELCHAIR; SPECIALLY SIZED OR CONSTRUCTED, (INDICATE BRAND NAME, MODEL NUMBER, IF ANY, AND JUST
WHEELCHAIR WITH FIXED ARM, FOOTRESTS
WHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS
WHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS
WHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGRESTS
SEMI-RECLINING BACK FOR CUSTOMIZED WHEEL CHAIR
FULL RECLINING BACK FOR CUSTOMIZED WHEELCHAIR
SPECIAL HEIGHT ARMS FOR WHEELCHAIR
SPECIAL BACK HEIGHT FOR WHEELCHAIR
POWER OPERATED VEHICLE (THREE- OR FOUR-WHEEL NONHIGHWAY), SPECIFY BRAND NAME AND MODEL NUMB
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITHOUT SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITHOUT SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM

WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITHOUT SEATING SYSTEM
WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITHOUT SEATING SYSTEM
LIGHTWEIGHT WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE, ELEVATIN
LIGHTWEIGHT WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE FOOTRESTS
LIGHTWEIGHT WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTRES
LIGHTWEIGHT WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE, ELEVATING LEGRESTS
HEAVY DUTY WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, ELEVATING LEGRESTS
HEAVY DUTY WHEELCHAIR; FIXED FULL-LENGTH ARMS, SWING-AWAY, DETACHABLE FOOTREST
HEAVY DUTY WHEELCHAIR; DETACHABLE ARMS, DESK OR FULL-LENGTH, SWING-AWAY, DETACHABLE FOOTREST
HEAVY DUTY WHEELCHAIR; FIXED FULL-LENGTH ARMS, ELEVATING LEGREST
SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR
SPECIAL WHEELCHAIR SEAT DEPTH, BY UPHOLSTERY
SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CONSTRUCTION
WHIRLPOOL, PORTABLE (OVERTUB TYPE)
WHIRLPOOL, NONPORTABLE (BUILT-IN TYPE)
REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT REQUIRING THE SKILL OF A TECHNICIAN,
REGULATOR
STAND/RACK
IMMERSION EXTERNAL HEATER FOR NEBULIZER
OXYGEN CONCENTRATOR, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT TH
DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS
OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITH HEATED DELIVERY
OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITHOUT HEATED DELIVERY
CENTRIFUGE, FOR DIALYSIS
KIDNEY, DIALYSATE DELIVERY SYSTEM KIDNEY MACHINE, PUMP RECIRCULATING, AIR REMOVAL SYSTEM, FLOWRA
HEPARIN INFUSION PUMP FOR HEMODIALYSIS
AIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT
PRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT
BATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH
BLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT
ADJUSTABLE CHAIR, FOR ESRD PATIENTS
TRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIALYSIS, ANY SIZE, PER 10
UNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS
HEMODIALYSIS MACHINE
AUTOMATIC INTERMITTENT PERITONEAL DIALYSIS SYSTEM
CYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS
DELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALYSIS EQUIPMENT
REVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS
DEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS
BLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT
WATER SOFTENING SYSTEM, FOR HEMODIALYSIS
RECIPROCATING PERITONEAL DIALYSIS SYSTEM
WEARABLE ARTIFICIAL KIDNEY, EACH
COMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM
SORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10
HEMOSTATS, EACH
SCALE, EACH
DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED

JAW MOTION REHABILITATION SYSTEM
REPLACEMENT CUSHIONS FOR JAW MOTION REHABILITATION SYSTEM, PACKAGE OF SIX
REPLACEMENT MEASURING SCALES FOR JAW MOTION REHABILITATION SYSTEM, PACKAGE OF 200
DYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ELBOW DEVICE WITH RANGE OF MOTION ADJUSTMENT, INCLUD
DYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
DYNAMIC ADJUSTABLE WRIST EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH WRIST DEVICE WITH RANGE OF MOTION ADJUSTMENT, INCLUDE
DYNAMIC ADJUSTABLE KNEE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH KNEE DEVICE WITH RANGE OF MOTION ADJUSTMENT, INCLUDE
DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ANKLE DEVICE WITH RANGE OF MOTION ADJUSTMENT, INCLUDE
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH FOREARM PRONATION/SUPINATION DEVICE WITH RANGE OF MO
REPLACEMENT SOFT INTERFACE MATERIAL, DYNAMIC ADJUSTABLE EXTENSION/FLEXION DEVICE
REPLACEMENT SOFT INTERFACE MATERIAL/CUFFS FOR BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH DEVICE
DYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
DYNAMIC ADJUSTABLE SHOULDER FLEXION/ABDUCTION/ROTATION DEVICE, INCLUDES SOFT INTERFACE MATERIA
COMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE OR ALTERNATIVE COMMUNICATION DEVICE
GASTRIC SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC
BLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHESIZER
BLOOD GLUCOSE MONITOR WITH INTEGRATED LANCING/BLOOD SAMPLE
ROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S)
ADMINISTRATION OF INFLUENZA VIRUS VACCINE WHEN NO PHYSICIAN FEE SCHEDULE SERVICE ON THE SAME DA
ADMINISTRATION OF PNEUMOCOCCAL VACCINE WHEN NO PHYSICIAN FEE SCHEDULE SERVICE ON THE SAME DA
ADMINISTRATION OF HEPATITIS B VACCINE WHEN NO PHYSICIAN FEE SCHEDULE SERVICE ON THE SAME DAY
COLLAGEN SKIN TEST KIT
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); SINGLE STUDY, REST OR STR
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); MULTIPLE STUDIES, REST OR
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); SINGLE STUDY, REST OR STRESS (EXE
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); MULTIPLE STUDIES, REST OR STRESS
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); SINGLE STUDY, REST OR STRESS (E
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); MULTIPLE STUDIES, REST OR STRE
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, 93510-93529); SINGLE STUDY, R
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, 93510-93529); MULTIPLE STUDIE
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PERFUSION, 78460); SINGLE
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PERFUSION, 78460); MULTIP
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); SINGLE STUDY, REST
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); MULTIPLE STUDIES, R
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, 78481 OR 78483); SIN
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, 78481 OR 78483); MU
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); SINGLE STUDY, REST OR STRESS (EXER
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); MULTIPLE STUDIES, REST OR STRESS (E
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); SINGLE STUDY, REST OR STRESS (EX
PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); MULTIPLE STUDIES, REST OR STRESS
CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION
PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION
PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA), TOTAL
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY, BARIUM ENEMA
COLORECTAL CANCER SCREENING; FECAL-OCCULT BLOOD TEST, 1-3 SIMULTANEOUS DETERMINATIONS
DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 MINUTES
DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR MORE), PER 30 MINUTE
NETT PULMONARY REHABILITATION; EDUCATION/SKILLS TRAINING, INDIVIDUAL
NETT PULMONARY REHABILITATION; EDUCATION/SKILLS TRAINING, GROUP
NETT PULMONARY REHABILITATION; NUTRITIONAL GUIDANCE, INITIAL
NETT PULMONARY REHABILITATION; NUTRITIONAL GUIDANCE, SUBSEQUENT
NETT PULMONARY REHABILITATION; PSYCHOSOCIAL CONSULTATION
NETT PULMONARY REHABILITATION; PSYCHOLOGICAL TESTING
NETT PULMONARY REHABILITATION; PSYCHOSOCIAL COUNSELLING
GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR OPHTHALMOLOGIST
GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION OF AN OPTOMET
COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY, BARIUM ENEMA
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
COLORECTAL CANCER SCREENING; BARIUM ENEMA
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE
PET IMAGING REGIONAL OR WHOLE BODY; SINGLE PULMONARY NODULE
TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER
DIRECT (FACE-TO-FACE WITH PATIENT) SKILLED NURSING SERVICES OF A REGISTERED NURSE PROVIDED IN A CO
OCCUPATIONAL THERAPY REQUIRING THE SKILLS OF A QUALIFIED OCCUPATIONAL THERAPIST, FURNISHED AS A C
SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR S
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED SYSTEM, WITH MA
SCREENING CYTOPATHOLOGY, CERVICAL/VAGINAL, COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYE
SCREENING CYTOPATHOLOGY, CERVICAL/VAGINAL (ANY RPTING SYSTEM), COLLECTED PRESERVATIVE FLUID, AU
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED SYSTEM UNDER PH
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED SYSTEM WITH MAN
SERVICES OF PHYSICAL THERAPIST IN HOME HEALTH SETTING, EACH 15 MINUTES
SERVICES OF OCCUPATIONAL THERAPIST IN HOME HEALTH SETTING, EACH 15 MINUTES
SERVICES OF SPEECH AND LANGUAGE PATHOLOGIST IN HOME HEALTH SETTING, EACH 15 MINUTES
SERVICES OF SKILLED NURSE IN HOME HEALTH SETTING, EACH 15 MINUTES
SERVICES OF CLINICAL SOCIAL WORKER IN HOME HEALTH SETTING, EACH 15 MINUTES
SERVICES OF HOME HEALTH AIDE IN HOME HEALTH SETTING, EACH 15 MINUTES
EXTERNAL COUNTERPULSATION, PER TREATMENT SESSION
HYPERBARIC OXYGEN TREATMENT NOT REQUIRING PHYSICIAN ATTENDANCE, PER TREATMENT SESSION
WOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY
STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF THERAPY IN ONE SESSION
SCHEDULED INTERDISCIPLINARY TEAM CONFERENCE (MINIMUM OF THREE EXCLUSIVE OF PATIENT CARE NURSIN
ACTIVITY THERAPY, SUCH AS MUSIC, DANCE, ART OR PLAY THERAPIES NOT FOR RECREATION, RELATED TO THE C
TRAINING AND EDUCATIONAL SERVICES RELATED TO THE CARE AND TREATMENT OF PATIENT'S DISABLING MENT
PHYSICIAN RE-CERTIFICATION MEDICARE-COVERED HOME HEALTH SERVICES,CONTACTS W AGENCY & REVIEW R
PHYS CERT, MEDICARE-CVR HOME HEALTH SVCS UNDER HOME HEALTH PLAN, CARE (PT NO PRES), CONTS W H
PHYS SUPERVSN,PAT RECEIV MEDICARE-COVERD SRV PROV BY PART HHA REQ COMPLX&MULTIDISC CARE MODA
PHYS SUPERVSN,PAT UNDR MEDICARE-APPROVED HOSPICE REQ COMPLX&MULTIDISC CARE MODALITIES INVLV
DESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL NEOVASCULARIZATION); PHOTO
SCREENING MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS

DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS
DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, UNILATERAL, ALL VIEWS
PET IMAGING WHOLE BODY; DIAGNOSIS; LUNG CANCER, NON-SMALL CELL
PET IMAGING WHOLE BODY; INITIAL STAGING; LUNG CANCER; NON-SMALL CELL (REPLACES G0126)
PET IMAGING WHOLE BODY; RESTAGING; LUNG CANCER; NON-SMALL
PET IMAGING WHOLE BODY; DIAGNOSIS; COLORECTAL
PET IMAGING WHOLE BODY; INITIAL STAGING; COLORECTAL
PET IMAGING WHOLE BODY; RESTAGING; COLORECTAL CANCER (REPLACES G0163)
PET IMAGING WHOLE BODY; DIAGNOSIS; MELANOMA
PET IMAGING WHOLE BODY; INITIAL STAGING; MELANOMA
PET IMAGING WHOLE BODY; RESTAGING; MELANOMA (REPLACES G0165)
PET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS
PET IMAGING WHOLE BODY; DIAGNOSIS; LYMPHOMA
PET IMAGING WHOLE BODY; INITIAL STAGING; LYMPHOMA (REPLACES G0164)
PET IMAGING WHOLE BODY; RESTAGING; LYMPHOMA (REPLACES G0164)
PET IMAGING WHOLE BODY OR REGIONAL; DIAGNOSIS; HEAD AND NECK CANCER; EXCLUDING THYROID AND CNS
PET IMAGING WHOLE BODY OR REGIONAL; INITIAL STAGING; HEAD AND NECK CANCER; EXCLUDING THYROID AND
PET IMAGING WHOLE BODY OR REGIONAL; RESTAGING; HEAD AND NECK CANCER, EXCLUDING THYROID AND CN
PET IMAGING WHOLE BODY; DIAGNOSIS; ESOPHAGEAL CANCER
PET IMAGING WHOLE BODY; INITIAL STAGING; ESOPHAGEAL CANCER
PET IMAGING WHOLE BODY; RESTAGING; ESOPHAGEAL CANCER
PET IMAGING; METABOLIC BRAIN IMAGING FOR PRE-SURGICAL EVALUATION OF REFRACTORY SEIZURES
PET IMAGING; METABOLIC ASSESSMENT FOR MYOCARDIAL VIABILITY FOLLOWING INCONCLUSIVE SPECT STUDY
PET, WHOLE BODY, FOR RECURRENCE OF COLORECTAL OR COLORECTAL METASTATIC CANCER; GAMMA CAMERA
PET, WHOLE BODY, FOR STAGING AND CHARACTERIZATION OF LYMPHOMA; GAMMA CAMERAS ONLY
PET, WHOLE BODY, FOR RECURRENCE OF MELANOMA OR MELANOMA METASTATIC CANCER; GAMMA CAMERAS O
PET, REGAL/WHOLE BDY, SOLITARY PULMONARY NODULE FOLL CT/FOR INT STGNG, PATHOLOGICALLY DIAGNOSE
DIGITIZATION, FILM RADIOGRAPHIC IMAG W COMPUTER ANAL, LES DETECT,/COMP ANAL DIG MAMMO &FURTHER P
THERAPEUTIC PROCEDURES TO INCREASE STRENGTH OR ENDURANCE OF RESPIRATORY MUSCLES, FACE TO FA
THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION, OTHER THAN DESCRIBED BY G0237, ONE ON
THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION / INCREASE STRENGTH / ENDURANCE OF RE
MULT-SRC PHOTON STEREOTAC RADSRG PLAN,DOS HISTOGMS,TARGT&CRITICL STRUCTUR TOLERANCES,PLAN O
MULTI-SOURCE PHOTON STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING COLLIMATOR CHANGES AND CUS
OBSERVATION CARE PROVIDED BY A FACILITY TO A PATIENT WITH CHF, CHEST PAIN, OR ASTHMA, MINIMUM EIGHT
INITIAL PHYSICIAN EVALUATION & MANAGEMENT DIABETIC W SENSORY NEUROPATHY LOSS OF PROTECTIVE SEN
FOLLOW-UP PHYSICIAN EVALUATION & MANAGEMENT DIABETIC W SENSORY NEUROPATHY LOSS OF PROTECTIVE
ROUTINE FOOT CARE BY A PHYSICIAN OF A DIABETIC W SENSORY NEUROPATHY LOSS OF PROTECTIVE SENSATIO
DEMONSTRATION,INITIAL USE,HOME INR MONITORING PATIENT W MECHANICAL HEART VALVE MEDICARE COVERA
PROVISION OF TEST MATERIALS & EQUIPMENT HOME INR MONITORING TO PATIENT W MECHANICAL HEART VALVE
PHYSICIAN REVIEW, INTERPRETATION AND PATIENT MANAGEMENT OF HOME INR TESTING FOR A PATIENT WITH M
LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING COLLIMATOR CHANGES & C
PET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY, FOR INITIAL DIAGNOSIS OF BREAST CANCER AND/O
PET IMAGING FOR BREAST CANCER, FULL & PARTIAL-RING PET SCANNERS ONLY, STAGING/RESTAGING OF LOCAL
PET IMAGING FOR BREAST CANCER, FULL AND PARTIAL-RING PET SCANNERS ONLY, EVALUATION OF RESPONSE T
CURRENT PERCEPTION THRESHOLD/SENSORY NERVE CONDUCTION TEST, (SNCT) PER LIMB, ANY NERVE
PROSTATE BRACHYTHERAPY USING PERMANENTLY IMPLANTED PALLADIUM SEEDS, TRANSPERITONEAL PLACEM
UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL OUTPATIENT DEPAR
INTRAVENOUS INFUSION DURING SEPARATELY PAYABLE OBSERVATION STAY, PER OBSERVATION STAY (MUST BE
INJECTION PROCEDURE FOR SACROILIAC JOINT; ARTHROGRAPY

INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPE
PROSTATE BRACHYTHERAPY PERMANENTLY IMPLANTED IODINE SEEDS, INCLUDING TRANSPERINEAL PLACEMEN
SMALL INTESTINAL IMAGING; INTRALUMINAL, FROM LIGAMENT OF TREITZ TO THE ILEO CECAL VALVE, INCLUDES P
DIRECT ADMISSION OF PATIENT WITH DIAGNOSIS OF CONGESTIVE HEART FAILURE, CHEST PAIN OR ASTHMA FOR
INITIAL NURSING ASSESSMENT OF PATIENT DIRECTLY ADMITTED TO OBSERVATION WITH DIAGNOSIS OTHER THAN
CRYOPRESERVATION, FREEZING AND STORAGE OF CELLS FOR THERAPEUTIC USE, EACH CELL LINE
THAWING AND EXPANSION OF FROZEN CELLS FOR THERAPEUTIC USE, EACH ALIQUOT
BONE MARROW OR PERIPHERAL STEM CELL HARVEST, MODIFICATION OR TREATMENT TO ELIMINATE CELL TYPE(
REMOVAL OF IMPACTED CERUMEN (ONE OR BOTH EARS) BY PHYSICIAN ON SAME DATE OF SERVICE AS AUDIOLO
PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE, POST SURGICAL OR INT
MEDICAL NUTRITION THERAPY; REASSESSMENT & SUBSEQUENT INTERVENTION FOLLOWING 2ND REFERRL SAM
MEDICAL NUTRITION THERAPY, REASSESSMENT & SUBSEQUENT INTERVENTION FOLLOWING 2ND REFERRL SAME
NASO/ORO GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND FLUOROSCOPIC GUIDANCE (INCLUDE
RADIOPHARMACEUTICAL BIODISTRIBUTION, SINGLE/MULTIPLE SCANS 1 /+ DAYS, PRE-TREATMENT PLANNING RAD
RADIOPHARMACEUTICAL THERAPY, NON-HODGKIN'S LYMPHOMA, INCLUDES ADMINISTRATION OF RADIOPHARMAC
RENAL ARTERY ANGIOGRAPHY PERFORMED TIME OF CARDIAC CATHETERIZATION, INCLUDES CATHETER PLACEM
ILIAC ARTERY ANGIOGRAPHY PERFORMED AT THE SAME TIME OF CARDIAC CATHETERIZATION, INCLUDES CATHE
EXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING ELBOW EPICONDYLITIS
EXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING OTHER THAN ELBOW EPICONDYLITIS OR PLANTAR FASCI
ELECTRICAL STIMULATION,TO 1/+ AREAS,FOR CHRONIC STAGE III & STAGE IV PRESSURE ULCERS,ARTERIAL ULCE
ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBE
ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CA
RECONSTRUCTION, COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF AORTA FOR SURGICAL PLANNING FOR VASCUL
ARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE BODY, FOREIGN BODY, DEBRIDEMENT/SHAVING OF A
TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS, W/ WO OTHER
TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS,W/WO OTHER T
ADMINISTRATION EXPERIMENTAL DRUG ONLY MEDICARE QUALIFYING CLINICAL TRIAL (INCLUDES ADMINISTRATIO
NONCOVERED SURGICAL PROCEDURE(S) USING CONSCIOUS SEDATION, REGIONAL, GENERAL OR SPINAL ANEST
NONCOVERED PROCEDURE(S) USING EITHER NO ANESTHESIA OR LOCAL ANESTHESIA ONLY, IN A MEDICARE QUA
ELECTROMAGNETIC STIMULATION, TO ONE OR MORE AREAS
COORDINATED CARE FEE, INITIAL RATE
COORDINATED CARE FEE, MAINTENANCE RATE
COORDINATED CARE FEE, RISK ADJUSTED HIGH, INITIAL
COORDINATED CARE FEE, RISK ADJUSTED LOW, INITIAL
COORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE
COORDINATED CARE FEE, HOME MONITORING
COORDINATED CARE FEE, SCHEDULE TEAM CONFERENCE
COORDINATED CARE FEE, PHYSICIAN COORDINATED CARE OVERSIGHT SERVICES
COORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 3
OTHER SPECIFIED CASE MANAGEMENT SERVICE NOT ELSEWHERE CLASSIFIED
SMOKING CESSATION COUNSELING, INDIVIDUAL, IN THE ABSENCE OF OR IN ADDITION TO ANY OTHER EVALUATIO
ALCOHOL AND/OR DRUG ASSESSMENT
BEHAVIORAL HEALTH SCREENING TO DETERMINE ELIGIBILITY FOR ADMISSION TO TREATMENT PROGRAM
ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF ALCOHOL AND/
BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES
ALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN
ALCOHOL AND/OR DRUG SERVICES; CASE MANAGEMENT

ALCOHOL AND/OR DRUG SERVICES; CRISIS INTERVENTION (OUTPATIENT)
ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (HOSPITAL INPATIENT)
ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (HOSPITAL INPATIENT)
ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT
ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)
ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM OUTPATIE
ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM OUTPATIENT)
ALCOHOL AND/OR DRUG SERVICES; AMBULATORY DETOXIFICATION
ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TX PRGM OPERATES >= 3 HRS/DAY & >= 3 DAYS/WK
ALCOHOL AND/OR DRUG SERVICES; MEDICAL/SOMATIC (MEDICAL INTERVENTION IN AMBULATORY SETTING)
BEHAVIORAL HEALTH; RESIDENTIAL (HOSPITAL RESIDENTIAL TREATMENT PROGRAM), WITHOUT ROOM AND BOAR
BEHAVIORAL HEALTH; SHORT-TERM RESIDENTIAL (NON-HOSPITAL RESIDENTIAL TREATMENT PROGRAM), WITHOU
BEHAVIORAL HEALTH; LONG-TERM RESIDENTIAL (NON-MEDIAL, NON-ACUTE CARE IN A RESIDENTIAL TREATMENT
ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG B
ALCOHOL AND/OR DRUG TRAINING SERVICE (FOR STAFF AND PERSONNEL NOT EMPLOYED BY PROVIDERS)
ALCOHOL AND/OR DRUG INTERVENTION SERVICE (PLANNED FACILITATION)
BEHAVIORAL HEALTH OUTREACH SERVICE (PLANNED APPROACH TO REACH A TARGETED POPULATION)
BEHAVIORAL HEALTH PREVENTION INFORMATION DISSEMINATION SERVICE (ONE-WAY DIRECT OR NON-DIRECT C
BEHAVIORAL HEALTH PREVENTION EDUCATION SERVICE (DELIVERY OF SERVICES WITH TARGET POPULATION TO
ALCOHOL AND/OR DRUG PREVENTION PROCESS SERVICE, COMMUNITY-BASED (DELIVERY OF SERVICES TO DEVE
ALCOHOL AND/OR DRUG PREVENTION ENVIRONMENTAL SERVICE (BROAD RANGE OF EXTERNAL ACTIVITIES GEAR
ALCOHOL AND/OR DRUG PREVENTION PROBLEM IDENTIFICATION AND REFERRAL SERVICE (E.G., STUDENT ASSIS
ALCOHOL AND/OR DRUG PREVENTION ALTERNATIVES SERVICE (SERVICES FOR POPULATIONS THAT EXCLUDE AL
BEHAVIORAL HEALTH HOTLINE SERVICE
MENTAL HEALTH ASSESSMENT, BY NON-PHYSICIAN
MENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NON-PHYSICIAN
ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION
MEDICATION TRAINING AND SUPPORT, PER 15 MINUTES
MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS
COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT, FACE-TO-FACE, PER 15 MINUTES
COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT PROGRAM, PER DIEM
SELF-HELP/PEER SERVICES, PER 15 MINUTES
ASSERTIVE COMMUNITY TREATMENT, FACE-TO-FACE, PER 15 MINUTES
ASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM
FOSTER CARE, CHILD, NON-THERAPEUTIC, PER DIEM
FOSTER CARE, CHILD, NON-THERAPEUTIC, PER MONTH
SUPPORTED HOUSING, PER DIEM
SUPPORTED HOUSING, PER MONTH
RESPITE CARE SERVICES, NOT IN THE HOME, PER DIEM
MENTAL HEALTH SERVICES, NOT OTHERWISE SPECIFIED
ALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOT OTHERWISE SPECIFIED
ALCOHOL AND/OR OTHER DRUG TESTING: COLLECTION AND HANDLING ONLY, SPECIMENS OTHER THAN BLOOD
PRENATAL CARE, AT-RISK ASSESSMENT
PRENATAL CARE, AT-RISK ENHANCED SERVICE; ANTEPARTUM MANAGEMENT
PRENATAL CARE, AT RISK ENHANCED SERVICE; CARE COORDINATION
PRENATAL CARE, AT-RISK ENHANCED SERVICE; EDUCATION
PRENATAL CARE, AT-RISK ENHANCED SERVICE; FOLLOW-UP HOME VISIT
PRENATAL CARE, AT-RISK ENHANCED SERVICE PACKAGE (INCLUDES H1001-H1004)
NON-MEDICAL FAMILY PLANNING EDUCATION, PER SESSION

FAMILY ASSESSMENT BY LICENSED BEHAVIORAL HEALTH PROFESSIONAL FOR STATE DEFINED PURPOSES
COMPREHENSIVE MULTIDISCIPLINARY EVALUATION
REHABILITATION PROGRAM, PER 1/2 DAY
INJECTION, TETRACYCLINE, UP TO 250 MG
INJECTION ABCIXIMAB, 10 MG
INJECTION, ADENOSINE, 6 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD
INJECTION, ADENOSINE, 90 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEA
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, BIPERIDEN LACTATE, PER 5 MG
INJECTION, ALATROFLOXACIN MESYLATE, 100 MG
INJECTION, ALGLUCERASE, PER 10 UNITS
INJECTION, AMIFOSTINE, 500 MG
INJECTION, METHYLDOPATE HCL, UP TO 250 MG
INJECTION, ALPHA 1 - PROTEINASE INHIBITOR - HUMAN, 10 MG
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER TH
ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDE
INJECTION, AMINOPHYLLIN, UP TO 250 MG
INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG
INJECTION, AMPHOTERICIN B, 50 MG
INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG
INJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 G
INJECTION, AMOBARBITAL, UP TO 125 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, ANISTREPLASE, PER 30 UNITS
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, METARAMINOL BITARTRATE, PER 10 MG
INJECTION, CHLOROQUINE HCL, UP TO 250 MG
INJECTION, ARBUTAMINE HCL, 1 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, ATROPINE SULFATE, UP TO 0.3 MG
INJECTION, DIMERCAPROL, PER 100 MG
INJECTION, BACLOFEN, 10 MG
INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE, UP TO 5 MG
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000 UNITS
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 1,200,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000 UNITS
BOTULINUM TOXIN TYPE A, PER UNIT
BOTULINUM TOXIN TYPE B, PER 100 UNITS
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG

INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER 10 ML
INJECTION, CALCITONIN-SALMON, UP TO 400 UNITS
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CASPOFUNGIN ACETATE, 5 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, MEPIVACAINE HCL, PER 10 ML
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFOXITIN SODIUM, 1 G
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG
CEFOTAXIME SODIUM, PER G
INJECTION, BETAMETHASONE ACETATE AND BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG
INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CEPHAPIRIN SODIUM, UP TO 1 G
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTIZOXIME SODIUM, PER 500 MG
INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 G
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CIDOFOVIR, 375 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, COLCHICINE, PER 1MG
INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG
INJECTION, PROCHLORPERAZINE, UP TO 10 MG
INJECTION, CORTICOTROPIN, UP TO 40 UNITS
INJECTION, COSYNTROPIN, PER 0.25 MG
INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL
INJECTION, DARBEPOETIN ALFA, 5 MCG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, TESTOSTERONE ENANTHATE AND ESTRADIOL VALERATE, UP TO 1 CC
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG
INJECTION, MEDROXYPROGESTERONE ACETATE/ESTRADIOL CYPIONATE, 5MG/25MG
INJECTION, TESTOSTERONE CYPIONATE AND ESTRADIOL CYPIONATE, UP TO 1 ML
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG

INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG
INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG
INJECTION, DIGOXIN, UP TO 0.5 MG
INJECTION, PHENYTOIN SODIUM, PER 50 MG
INJECTION, HYDROMORPHONE, UP TO 4 MG
INJECTION, DYPHYLLINE, UP TO 500 MG
INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DOBUTAMINE HCL, PER 250 MG
INJECTION, DOLASETRON MESYLATE, 10 MG
INJECTION, DOXERCALCIFEROL, 1 MCG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPTIFIBATIDE, 5 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
INJECTION, ESTROGEN CONJUGATED, PER 25 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ETIDRONATE DISODIUM, PER 300 MG
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE D
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION FLUCONAZOLE, 200 MG
INJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG
INJECTION, FOSCARNET SODIUM, PER 1000 MG
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G
INJECTION, IMMUNE GLOBULIN, 10 MG
INJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG
INJECTION, GANCICLOVIR SODIUM, 500 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GATIFLOXACIN, 10MG

INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, TINZAPARIN SODIUM, 1000 IU
INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, IBUTILIDE FUMARATE, 1 MG
INJECTION INFLIXIMAB, 10 MG
INJECTION, IRON DEXTRAN, 50 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IMIGLUCERASE, PER UNIT
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, PROPRANOLOL HCL, UP TO 1 MG
INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE
INJECTION, INSULIN, PER 5 UNITS
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS
INJECTION, INTERFERON BETA-1A, 33 MCG
INJECTION INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UND
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, KANAMYCIN SULFATE, UP TO 500 MG
INJECTION, KANAMYCIN SULFATE, UP TO 75 MG
INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
INJECTION, CEPHALOTHIN SODIUM, UP TO 1 G
INJECTION, KUTAPRESSIN, UP TO 2 ML
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG
INJECTION, LEVOCARNITINE, PER 1 G
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG
INJECTION, LIDOCAINE HCL, 50 CC
INJECTION, LINCOMYCIN HCL, UP TO 300 MG
INJECTION, LINEZOLID, 200MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MEPERIDINE HCL, PER 100 MG
INJECTION, MEPERIDINE AND PROMETHAZINE HCL, UP TO 50 MG
INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG

INJECTION, MIDAZOLAM HCL, PER 1 MG
INJECTION, MILRINON LACTATE, 5MG
INJECTION, MORPHINE SULFATE, UP TO 10 MG
INJECTION, MORPHINE SULFATE, 100MG
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG
INJECTION, NALBUPHINE HCL, PER 10 MG
INJECTION, NALOXONE HCL, PER 1 MG
INJECTION, NANDROLONE DECANOATE, UP TO 50 MG
INJECTION, NESIRITIDE, 0.5 MG
INJECTION, OCTREOTIDE ACETATE, 1 MG
INJECTION, OPRELVEKIN, 5 MG
INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, CHLOROPROCAINE HCL, PER 30 ML
INJECTION, ONDANSETRON HCL, PER 1 MG
INJECTION, OXYMORPHONE HCL, UP TO 1 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
INJECTION, PARICALCITOL, 1 MCG
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS
INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS)
PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, PER 300 MG, ADMINISTERED THROUGH A DME
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, TOLAZOLINE HCL, UP TO 25 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG
INJECTION, PROCAINAMIDE HCL, UP TO 1 G
INJECTION, OXACILLIN SODIUM, UP TO 250 MG
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTIRELIN, PER 250 MCG
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 G
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MCG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG

INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
INJECTION, AUROTHIOGLUCOSE, UP TO 50 MG
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, SOMATREM, 1 MG
INJECTION, SOMATROPIN, 1 MG
INJECTION, PROMAZINE HCL, UP TO 25 MG
INJECTION, RETEPLASE, 18.1 MG
INJECTION, STREPTOKINASE, PER 250,000 IU
INJECTION, ALTEPLASE RECOMBINANT, 1 MG
INJECTION, STREPTOMYCIN, UP TO 1 G
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED U
INJECTION, PENTAZOCINE, 30 MG
INJECTION, TENECTEPLASE, 50MG
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 100 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE PROPIONATE, UP TO 100 MG
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL
INJECTION, TIROFIBAN HYDROCHLORIDE, 12.5 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TORSEMIDE, 10 MG/ML
INJECTION, THIETHYLPERAZINE MALEATE, UP TO 10 MG
INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJECTION, TRIMETREXATE GLUCORONATE, PER 25 MG
INJECTION, PERPHENAZINE, UP TO 5 MG
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
INJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 G
INJECTION, UREA, UP TO 40 G
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, UROKINASE, 5000 IU VIAL
INJECTION, IV, UROKINASE, 250,000 IU VIAL
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VERTEPORFIN, 15MG
INJECTION, TRIFLUPROMAZINE HCL, UP TO 20 MG
INJECTION, HYDROXYZINE HCL, UP TO 25 MG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, HYALURONIDASE, UP TO 150 UNITS

INJECTION, MAGNESIUM SULPHATE, PER 500 MG
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, ZIDOVUDINE, 10 MG
INJECTION, ZOLEDRONIC ACID, 1 MG
UNCLASSIFIED DRUGS
EDETATE DISODIUM, PER 150 MG
NASAL VACCINE INHALATION
DRUG ADMINISTERED THROUGH A METERED DOSE INHALER
LAETRILE, AMYGDALIN, VITAMIN B-17
UNCLASSIFIED BIOLOGICS
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
INFUSION, NORMAL SALINE SOLUTION , 250 CC
STERILE SALINE OR WATER, UP TO 5 CC
5% DEXTROSE/WATER (500 ML = 1 UNIT)
INFUSION, D5W, 1000 CC
INFUSION, DEXTRAN 40, 500 ML
INFUSION, DEXTRAN 75, 500 ML
RINGERS LACTATE INFUSION, UP TO 1000 CC
HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER IU
FACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER IU
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER IU
FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U.
FACTOR IX, COMPLEX, PER IU
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
ANTITHROMBIN III (HUMAN), PER IU
ANTI-INHIBITOR, PER IU
HEMOPHILIA CLOTTING FACTOR, NOT OTHERWISE CLASSIFIED
INTRAUTERINE COPPER CONTRACEPTIVE
LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG
AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE FORM (354 MG)
GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION
HYLAN G-F 20, 16 MG, FOR INTRA-ARTICULAR INJECTION
AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT
DERMAL AND EPIDERMAL TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT BIOENGINEERED OR PROCESSED ELEM
DERMAL TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, W
DERMAL TISSUE OF HUMAN ORIGIN, INJECTABLE, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED E
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, PARENTERAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE, PARENTERAL, 250 MG
MUROMONAB-CD3, PARENTERAL, 5 MG
PREDNISONE, ORAL, PER 5MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 5 MG
METHYLPREDNISOLONE ORAL, PER 4 MG

PREDNISOLONE ORAL, PER 5 MG
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG
DACLIZUMAB, PARENTERAL, 25 MG
CYCLOSPORINE, PARENTERAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
SIROLIMUS, ORAL, 1 MG
TACROLIMUS, PARENTERAL, 5 MG
IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED
ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAM
ALBUTEROL,ALL FORMULATIONS SEPARATED ISOMERS,INHALATION SOLUTION ADMINISTERED THRU DME,CONCE
ALBUTEROL,ALL FORMULATIONS SEPARATED ISOMERS,INHALATION SOLUTION ADMINISTERED THRU DME,UNIT D
BECLOMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
BETAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
BUDESONIDE INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 0.25 TO 0.50 MG
BITOLTEROL MESYLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MIL
BITOLTEROL MESYLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRA
CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRA
BUDESONIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 0.25 MILLIGRA
ATROPINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM
ATROPINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
DEXAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRA
DEXAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
FLUNISOLIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE, PER MILLIGRAM
GLYCOPYRROLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGR
GLYCOPYRROLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
IPRATROPIUM BROMIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRA
ISOETHARINE HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRA
ISOETHARINE HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
ISOPROTERENOL HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLI
ISOPROTERENOL HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
METAPROTERENOL SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PE
METAPROTERENOL SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 M
TERBUTALINE SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILL
TERBUTALINE SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRA
TOBRAMYCIN, UNIT DOSE FORM, 300 MG, INHALATION SOLUTION, ADMINISTERED THROUGH DME
TRIAMCINOLONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM
TRIAMCINOLONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME
NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME
PRESCRIPTION DRUG, ORAL, NONCHEMOTHERAPEUTIC, NOT OTHERWISE SPECIFIED
BUSULFAN; ORAL, 2 MG
CAPECITABINE, ORAL, 150 MG
CYCLOPHOSPHAMIDE; ORAL, 25 MG
ETOPOSIDE; ORAL, 50 MG
MELPHALAN; ORAL, 2 MG
METHOTREXATE; ORAL, 2.5 MG

TEMOZOLOMIDE, ORAL, 5 MG
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
DOXORUBICIN HCL, 10 MG
DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG
ALEMTUZUMAB, 10 MG
ALDESLEUKIN, PER SINGLE USE VIAL
ARSENIC TRIOXIDE, 1MG
ASPARAGINASE, 10,000 UNITS
BCG LIVE (INTRAVESICAL) PER INSTALLATION
BLEOMYCIN SULFATE, 15 UNITS
CARBOPLATIN, 50 MG
CARMUSTINE, 100 MG
CISPLATIN, POWDER OR SOLUTION, PER 10 MG
CISPLATIN, 50 MG
INJECTION, CLADRIBINE, PER 1 MG
CYCLOPHOSPHAMIDE, 100 MG
CYCLOPHOSPHAMIDE, 1.0 G
CYCLOPHOSPHAMIDE, 2.0 G
CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM
CYTARABINE, 100 MG
CYTARABINE, 500 MG
DACTINOMYCIN, 0.5 MG
DACARBAZINE, 100 MG
DACARBAZINE, 200 MG
DAUNORUBICIN, 10 MG
DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG
DENILEUKIN DIFTITOX, 300 MCG
DIETHYLSTILBESTROL DIPHOSPHATE, 250 MG
DOCETAXEL, 20 MG
EPIRUBICIN HYDROCHLORIDE, 50 MG
ETOPOSIDE, 10 MG
ETOPOSIDE, 100 MG
FLUDARABINE PHOSPHATE, 50 MG
FLUOROURACIL, 500 MG
FLOXURIDINE, 500 MG
GEMCITABINE HCL, 200 MG
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
IRINOTECAN, 20 MG
IFOSFAMIDE, 1 G
MESNA, 200 MG
IDARUBICIN HCL, 5 MG
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MCG
INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS

INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU
INTERFERON, GAMMA 1-B, 3 MILLION UNITS
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE IMPLANT, 65 MG
MECHLORETHAMINE HCL, (NITROGEN MUSTARD), 10 MG
INJECTION, MELPHALAN HCL, 50 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 50 MG
PACLITAXEL, 30 MG
PEGASPARGASE, PER SINGLE DOSE VIAL
PENTOSTATIN, PER 10 MG
PLICAMYCIN, 2.5 MG
MITOMYCIN, 5 MG
MITOMYCIN, 20 MG
MITOMYCIN, 40 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
GEMTUZUMAB OZOGAMICIN, 5MG
RITUXIMAB, 100 MG
STREPTOZOCIN, 1 G
THIOTEPA, 15 MG
TOPOTECAN, 4 MG
TRASTUZUMAB, 10 MG
VALRUBICIN, INTRAVESICAL, 200 MG
VINBLASTINE SULFATE, 1 MG
VINCRISTINE SULFATE, 1 MG
VINORELBINE TARTRATE, PER 10 MG
PORFIMER SODIUM, 75 MG
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUG
STANDARD WHEELCHAIR
STANDARD HEMI (LOW SEAT) WHEELCHAIR
LIGHTWEIGHT WHEELCHAIR
HIGH STRENGTH, LIGHTWEIGHT WHEELCHAIR
ULTRALIGHTWEIGHT WHEELCHAIR
HEAVY DUTY WHEELCHAIR
EXTRA HEAVY DUTY WHEELCHAIR
OTHER MANUAL WHEELCHAIR/BASE
STANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR
STANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR WITH PROGRAMMABLE CONTROL PARAMETERS
LIGHTWEIGHT PORTABLE MOTORIZED/POWER WHEELCHAIR
OTHER MOTORIZED/POWER WHEELCHAIR BASE
DETACHABLE, NONADJUSTABLE HEIGHT ARMREST, EACH
DETACHABLE, ADJUSTABLE HEIGHT ARMREST, COMPLETE ASSEMBLY, EACH
DETACHABLE, ADJUSTABLE HEIGHT ARMREST, BASE, EACH
DETACHABLE, ADJUSTABLE HEIGHT ARMREST, UPPER PORTION, EACH
ARM PAD, EACH

FIXED, ADJUSTABLE HEIGHT ARMREST, PAIR
REINFORCED BACK UPHOLSTERY
SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, ATTACHED WITH STRAPS
SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, WITH ADJUSTABLE HOOK-ON HARDWARE
HOOK-ON HEADREST EXTENSION
BACK UPHOLSTERY FOR ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR
BACK UPHOLSTERY FOR WHEELCHAIR TYPE OTHER THAN ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGH
MANUAL, FULLY RECLINING BACK
REINFORCED SEAT UPHOLSTERY
SOLID SEAT INSERT, PLANAR SEAT, SINGLE DENSITY FOAM
SAFETY BELT/PELVIC STRAP, EACH
SEAT UPHOLSTERY FOR ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR
SEAT UPHOLSTERY FOR WHEELCHAIR TYPE OTHER THAN ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGH
HEEL LOOP WITH ANKLE STRAP, EACH
TOE LOOP, EACH
HIGH MOUNT FLIP-UP FOOTREST, EACH
LEG STRAP, EACH
LEG STRAP, H STYLE, EACH
ADJUSTABLE ANGLE FOOTPLATE, EACH
LARGE SIZE FOOTPLATE, EACH
STANDARD SIZE FOOTPLATE, EACH
FOOTREST, LOWER EXTENSION TUBE, EACH
FOOTREST, UPPER HANGER BRACKET, EACH
FOOTREST, COMPLETE ASSEMBLY
ELEVATING LEGREST, LOWER EXTENSION TUBE, EACH
ELEVATING LEGREST, UPPER HANGER BRACKET, EACH
ELEVATING LEGREST, COMPLETE ASSEMBLY
CALF PAD, EACH
RATCHET ASSEMBLY
CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, EACH
SWINGAWAY, DETACHABLE FOOTRESTS, EACH
ELEVATING FOOTRESTS, ARTICULATING (TELESCOPING), EACH
SEAT WIDTH OF 10, 11, 12, 15, 17, OR 20 INCHES FOR A HIGH STRENGTH, LIGHTWEIGHT OR ULTRALIGHTWEIGHT W
SEAT DEPTH OF 15, 17, OR 18 INCHES FOR A HIGH STRENGTH, LIGHTWEIGHT OR ULTRALIGHTWEIGHT WHEELCHA
SEAT HEIGHT LESS THAN 17 INCHES OR EQUAL TO OR GREATER THAN 21 INCHES FOR A HIGH STRENGTH, LIGHTW
SEAT WIDTH 19 OR 20 INCHES FOR HEAVY DUTY OR EXTRA HEAVY DUTY CHAIR
SEAT DEPTH 17 OR 18 INCHES FOR MOTORIZED/POWER WHEELCHAIR
PLASTIC COATED HANDRIM, EACH
STEEL HANDRIM, EACH
ALUMINUM HANDRIM, EACH
HANDRIM WITH 8 TO 10 VERTICAL OR OBLIQUE PROJECTIONS, EACH
HANDRIM WITH 12 TO 16 VERTICAL OR OBLIQUE PROJECTIONS, EACH
ZERO PRESSURE TUBE (FLAT FREE INSERT), ANY SIZE, EACH
SPOKE PROTECTORS, EACH
SOLID TIRE, ANY SIZE, EACH
PNEUMATIC TIRE, ANY SIZE, EACH
PNEUMATIC TIRE TUBE, EACH
REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, EACH
REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, EACH
FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, EACH
FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, EACH
CASTER PIN LOCK,EACH
PNEUMATIC CASTER TIRE, ANY SIZE, EACH
SEMIPNEUMATIC CASTER TIRE, ANY SIZE, EACH
SOLID CASTER TIRE, ANY SIZE, EACH
FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH
PNEUMATIC CASTER TIRE TUBE, EACH
WHEEL LOCK EXTENSION, PAIR
ANTIROLLBACK DEVICE, PAIR
WHEEL LOCK ASSEMBLY, COMPLETE, EACH
22 NF NON-SEALED LEAD ACID BATTERY, EACH
22 NF SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)
GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH
GROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)
U-1 NON-SEALED LEAD ACID BATTERY, EACH
U-1 SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)
BATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE BATTERY TYPE, SEALED OR NON-SEALED
BATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER BATTERY TYPE, SEALED OR NON-SEALED
REAR WHEEL TIRE FOR POWER WHEELCHAIR, ANY SIZE, EACH
REAR WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR POWER WHEELCHAIR, ANY SIZE, EACH
REAR WHEEL ASSEMBLY FOR POWER WHEELCHAIR, COMPLETE, EACH
REAR WHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER WHEELCHAIR, ANY SIZE, EACH
WHEEL TIRE FOR POWER BASE, ANY SIZE, EACH
WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR EACH BASE, ANY SIZE, EACH
WHEEL ASSEMBLY FOR POWER BASE, COMPLETE, EACH
WHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER BASE, ANY SIZE, EACH
DRIVE BELT FOR POWER WHEELCHAIR
FRONT CASTER FOR POWER WHEELCHAIR
WHEELCHAIR ADAPTER FOR AMPUTEE, PAIR
CRUTCH AND CANE HOLDER, EACH
TRANSFER BOARD, LESS THAN 25 INCHES
CYLINDER TANK CARRIER, EACH
IV HANGER, EACH
ARM TROUGH, EACH
WHEELCHAIR TRAY
OTHER ACCESSORIES
TRUNK SUPPORT DEVICE, VEST TYPE, WITH INNER FRAME, PREFABRICATED
TRUNK SUPPORT DEVICE, VEST TYPE, WITHOUT INNER FRAME, PREFABRICATED
BACK SUPPORT SYSTEM FOR USE WITH A WHEELCHAIR, WITH INNER FRAME, PREFABRICATED
SEATING SYSTEM, BACK MODULE, POSTERIORLATERAL CONTROL, WITH OR WITHOUT LATERAL SUPPORTS, CUST
SEATING SYSTEM, COMBINED BACK AND SEAT MODULE, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHA
ELEVATING LEGRESTS, PAIR (FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE)
HUMIDIFIER, NONHEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
PRESCRIPTION ANTIEMETIC DRUG, ORAL, PER 1 MG, FOR USE IN CONJUNCTION WITH ORAL ANTI-CANCER DRUG
PRESCRIPTION ANTIEMETIC DRUG, RECTAL, PER 1 MG, FOR USE IN CONJUNCTION WITH ORAL ANTI-CANCER DRU
WHEELCHAIR BEARINGS, ANY TYPE
INFUSION PUMP USED FOR UNINTERRUPTED ADMINISTRATION OF EPOPROSTENOL
POWER ADD-ON, TO CONVERT MANUAL WHEELCHAIR TO MOTORIZED WHEELCHAIR, JOYSTICK CONTROL

POWER ADD-ON, TO CONVERT MANUAL WHEELCHAIR TO POWER OPERATED VEHICLE, TILLER CONTROL
TEMPORARY REPLACEMENT FOR PATIENT OWNED EQUIPMENT BEING REPAIRED, ANY TYPE
HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH N
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE FEATURE, USED WITH NONI
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPACITY, WITH BACK UP RATE FEATURE, USED WITH INVASI
NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE
DRESSING SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE, EAC
CANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE, EAC
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS THAN OR EQUAL TO
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, GREATER THAN 8 MINUTE
SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY SPELLING AND A
SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF MESSAGE FORMULA
SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL ASSISTANT
ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM
ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED
HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350 POUNDS, BUT LESS THAN
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 600 POUNDS, WITH AN
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR P
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR P
ADDITION LOWER EXTREMITY,BELOW KNEE/ABOVE KNEE,CUSTOM FABRICATED SOCKET INSERT FOR CONGENITA
ADDITION LOWER EXTREMITY,BELOW KNEE/ABOVE KNEE,CUSTOM FABRICATED SOCKET INSERT NOT CONGENITA
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE, WITH FILTER (2 PIECE), EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2 PIECE), EACH
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE, WITH FILTER (2 PIECE SYSTEM), EACH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE SYSTEM), EACH
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2 PIECE SYSTEM), EA
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE (1 P
OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH FAUCET-TYPE TAP WITH V
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH FAUCE
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE, WITH FAUCET-TYPE TAP WITH VALVE (2 PIECE),
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE TAP WITH VALVE (
CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE, MOLDED TO PATIENT MODEL
CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED
CERVICAL, FLEXIBLE, NONADJUSTABLE (FOAM COLLAR)
CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO PATIENT
CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR)
CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP (PLASTIC COLLAR WITH MANDIBULAR/OCCIPITAL PIECE)
CERVICAL, SEMI-RIGID, WIRE FRAME OCCIPITAL/MANDIBULAR SUPPORT
CERVICAL, COLLAR, MOLDED TO PATIENT MODEL
CERVICAL, COLLAR, SEMI-RIGID THERMOPLASTIC FOAM, TWO PIECE
CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE WITH THORACIC EXTENSION
CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE
CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE CERVICAL BARS (SOMI, G
CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE CERVICAL BARS, AND THO
THORACIC, RIB BELT
THORACIC, RIB BELT, CUSTOM FABRICATED
TLSO,FLEXIBLE,PROVIDES TRUNK SUPPORT,UPPER THORACIC REGION,PRODUCES INTRACAVITARY PRESSURE R
TLSO,FLEXIBLE,PROVIDES TRUNK SUPPORT,UPPER THORACIC REGION,PRODUCES INTRACAVITARY PRESSURE R
TLSO FLEXIBLE,TRUNK SUPPORT,SACROCOCCYGEAL JUNCTION ABOVE T-9 VERTEBRA,RESTRICTS GROSS TRUN
TLSO,FLEXIBLE,TRUNK SUPPORT,THORACIC REGION,RIGID POSTERIOR PANEL & SOFT ANTERIOR APRON,EXTEND
TLSO,TRIPLANAR CONTROL,MODULAR SEGMENTED SPINAL SYSTEM,2 RIGID PLASTIC SHELLS,POSTERIOR EXTEN
TLSO,SAGITTAL CONTROL,RIGID POSTERIOR FRAME & FLEX SOFT ANTERIOR APRON W STRAPS,CLOSURES & PAD
TLSO,SAGITTAL-CORONAL CONTROL,RIGID POSTERIOR FRAME & FLEXIBLE SOFT ANTERIOR APRON W STRAPS,C
TLSO,TRIPLANAR CONTROL,RIGID POSTERIOR FRAME & FLEXIBLE SOFT ANTERIOR APRON W STRAPS, CLOSURE
TLSO,TRIPLANAR CONTROL,HYPEREXTENSION,RIGID ANTERIOR & LATERAL FRAME EXTENDS SYMPHYSIS PUBIS
TLSO,TRIPLANAR CONTROL,RIGID POSTERIOR FRAME W FLEXIBLE SOFT APRON ANTERIOR W MULTIPLE STRAPS
TLSO,SAGITTAL-CORONAL CONTROL,FLEXION COMPRESS JACKET,2 RIGID PLASTIC SHELLS W SOFT LINER,POSTE
TLSO,SAGITTAL-CORONAL CONTROL,FLEXION COMPRESSION JACKET,2 RIGID PLASTIC SHELLS W SOFT LINER,PO
TLSO,TRIPLANAR CONTROL,1 PIECE RIGID PLASTIC SHELL WO INTERFACE LINER,W MULTIPLE STRAPS & CLOSUR
TLSO,TRIPLANAR CONTROL,1 PIECE RIGID PLASTIC SHELL W INTERFACE LINER,MULTIPLE STRAPS & CLOSURES,P
TLSO,TRIPLANAR CONTROL,2 PIECE RIGID PLASTIC SHELL WO INTERFACE LINER,W MULTIPLE STRAPS & CLOSUR
TLSO,SAGITTAL-CORONAL CONTROL,1 PIECE RIGID PLASTIC SHELL,W OVERLAPPING REINFORCED ANTERIOR,W
LUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT)
LSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED
LSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED
LUMBAR-SACRAL ORTHOSIS (LSO), ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH AP
LUMBAR-SACRAL ORTHOSIS (LSO), ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT
LUMBAR-SACRAL ORTHOSIS (LSO), LUMBAR FLEXION (WILLIAMS FLEXION TYPE)
LUMBAR-SACRAL ORTHOSIS (LSO), ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL
LUMBAR-SACRAL ORTHOSIS (LSO), ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WIT
LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED
LUMBAR-SACRAL ORTHOSIS (LSO), ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED
SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT)
SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED
SACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT
CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO), ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED
CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO), ANTERIOR-POSTERIOR-LATERAL-CONTROL, MOLDED
HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO JACKET VEST
HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO PLASTER BODY JACKET
HALO PROCEDURE, CERVICAL HALO INCORPORATED INTO MILWAUKEE TYPE ORTHOSIS
ADDITION TO HALO PROCEDURES, MAGNETIC RESONANCE IMAGE COMPATIBLE SYSTEM
TORSO SUPPORT, POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT
THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), CORSET FRONT
LUMBAR-SACRAL ORTHOSIS (LSO), CORSET FRONT
THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), FULL CORSET

LUMBAR-SACRAL ORTHOSIS (LSO), FULL CORSET
AXILLARY CRUTCH EXTENSION
PERONEAL STRAPS, PAIR
STOCKING SUPPORTER GRIPS, SET OF FOUR (4)
PROTECTIVE BODY SOCK, EACH
ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED
CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) (MILWAUKEE), INCLUSIVE OF FURNISHING INITIAL ORT
TENSION BASED SCOLIOSIS ORTHOSIS AND ACCESSORY PADS, INCLUDES FITTING AND ADJUSTMENT
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, AXILLA SLING
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, KYPHOSIS PA
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, KYPHOSIS PA
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, LUMBAR BOL
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, LUMBAR OR L
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, STERNAL PAD
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, THORACIC PA
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, TRAPEZIUS S
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, OUTRIGGER
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, OUTRIGGER,
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, LUMBAR SLIN
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, RING FLANGE
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS ORTHOSIS, RING FLANGE
ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO), SCOLIOSIS ORTHOSIS, COVER FOR UPR
THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), INCLUSIVE OF FURNISHING INITIAL ORTHOSIS ONLY
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), LATERAL THORACIC EXTENSION
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), ANTERIOR THORACIC EXTENSION
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), MILWAUKEE TYPE SUPERSTRUCTU
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), LUMBAR DEROTATION PAD
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), ANTERIOR ASIS PAD
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), ANTERIOR THORACIC DEROTATION
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), ABDOMINAL PAD
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), RIB GUSSET (ELASTIC), EACH
ADDITION TO THORACIC-LUMBAR-SACRAL ORTHOSIS (TLSO), (LOW PROFILE), LATERAL TROCHANTERIC PAD
OTHER SCOLIOSIS PROCEDURE, BODY JACKET MOLDED TO PATIENT MODEL
OTHER SCOLIOSIS PROCEDURE, POSTOPERATIVE BODY JACKET
SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED
THORACIC-HIP-KNEE-ANKLE ORTHOSIS (THKAO), MOBILITY FRAME (NEWINGTON, PARAPODIUM TYPES)
THKAO, STANDING FRAME, WITH OR WITHOUT TRAY AND ACCESSORIES
THORACIC-HIP-KNEE-ANKLE ORTHOSIS (THKAO), SWIVEL WALKER
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, FREJKA TYPE WITH COVER, PREFABRICATE
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (FREJKA COVER ONLY), PREFABRICATED, IN
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (PAVLIK HARNESS), PREFABRICATED, INCLU
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, SEMI-FLEXIBLE (VON ROSEN TYPE), CUSTOM FABRICA
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, STATIC, PELVIC BAND OR SPREADER BAR, THIGH CUFF
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, STATIC, ADJUSTABLE, (ILFLED TYPE), PREFABRICATED
HIP ORTHOSIS, BILATERAL THIGH CUFFS WITH ADJUSTABLE ABDUCTOR SPREADER BAR, ADULT SIZE, PREFABRIC
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, STATIC, PLASTIC, PREFABRICATED, INCLUDES FITTING
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINTS, DYNAMIC, PELVIC CONTROL, ADJUSTABLE HIP MOTION
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, CUSTOM FABRI
HIP ORTHOSIS (HO), ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, PREFABRICATE
COMBINATION, BILATERAL, LUMBO-SACRAL, HIP, FEMUR ORTHOSIS PROVIDING ADDUCTION AND INTERNAL ROTAT
LEGG PERTHES ORTHOSIS, (TORONTO TYPE), CUSTOM FABRICATED
LEGG PERTHES ORTHOSIS, (NEWINGTON TYPE), CUSTOM FABRICATED
LEGG PERTHES ORTHOSIS, TRILATERAL, (TACHDIJAN TYPE), CUSTOM FABRICATED
LEGG PERTHES ORTHOSIS, (SCOTTISH RITE TYPE), CUSTOM FABRICATED
LEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED, INCLUDES FITTING AND
LEGG PERTHES ORTHOSIS, (PATTEN BOTTOM TYPE), CUSTOM FABRICATED
KNEE ORTHOSIS (KO), ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
KNEE ORTHOSIS (KO), ELASTIC WITH JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
KNEE ORTHOSIS (KO), ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S), PREFABRICATED, IN
KNEE ORTHOSIS (KO), ELASTIC WITH CONDYLAR PADS AND JOINTS, PREFABRICATED, INCLUDES FITTING AND AD
KNEE ORTHOSIS (KO), ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
KNEE ORTHOSIS (KO), IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTM
KNEE ORTHOSIS (KO), ADJUSTABLE KNEE JOINTS, POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED, INC
KNEE ORTHOSIS (KO), WITHOUT KNEE JOINT, RIGID, CUSTOM FABRICATED
KNEE ORTHOSIS, RIGID, WITHOUT JOINT(S), INCLUDES SOFT INTERFACE MATERIAL, PREFABRICATED, INCLUDES
KNEE ORTHOSIS (KO), DEROTATION, MEDIAL-LATERAL, ANTERIOR CRUCIATE LIGAMENT, CUSTOM FABRICATED
KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH&CALF, WITH ADJUSTABLE FLEXION&EXTENSION JOINT, MEDIAL-LATERA
KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT, MEDIAL
KNEE ORTHOSIS (KO), DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT, M
KNEE ORTHOSIS (KO), DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT, M
KNEE ORTHOSIS (KO), DOUBLE UPRIGHT WITH ADJUSTABLE JOINT, WITH INFLATABLE AIR SUPPORT CHAMBER(S),
KNEE ORTHOSIS (KO), SWEDISH TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
KNEE ORTHOSIS (KO), MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT KNEE JOINTS, CUS
KNEE ORTHOSIS (KO), MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS (CTI), CUSTOM FAB
KNEE ORTHOSIS (KO), MODIFICATION OF SUPRACONDYLAR PROSTHETIC SOCKET, CUSTOM FABRICATED (SK)
KNEE ORTHOSIS (KO), DOUBLE UPRIGHT, THIGH AND CALF LACERS, WITH KNEE JOINTS, CUSTOM FABRICATED
KNEE ORTHOSIS (KO), DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE JOINTS, CUS
KNEE ORTHOSIS (KO), SINGLE OR DOUBLE UPRIGHT, THIGH AND CALF, WITH FUNCTIONAL ACTIVE RESISTANCE C
ANKLE-FOOT ORTHOSIS (AFO), SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, CUSTOM FABRICATED
ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)
ANKLE-FOOT ORTHOSIS (AFO), ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
ANKLE-FOOT ORTHOSIS (AFO), MOLDED ANKLE GAUNTLET, CUSTOM FABRICATED
ANKLE-FOOT ORTHOSIS (AFO), MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES FITTING AND AD
ANKLE-FOOT ORTHOSIS (AFO), POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER, PREFABRICAT
ANKLE-FOOT ORTHOSIS (AFO), SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR PERLSTEIN TYP
ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED
ANKLE-FOOT ORTHOSIS (AFO), MOLDED TO PATIENT MODEL, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR R
ANKLE-FOOT ORTHOSIS (AFO), SPIRAL, (IRM TYPE), PLASTIC, CUSTOM FABRICATED
ANKLE-FOOT ORTHOSIS (AFO), POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM FABRICATED
ANKLE-FOOT ORTHOSIS (AFO), PLASTIC, WITH ANKLE JOINT, CUSTOM FABRICATED
ANKLE-FOOT ORTHOSIS (AFO), SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CUF
ANKLE-FOOT ORTHOSIS (AFO), DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CU
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, THIGH AND CA
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/C
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), DOUBLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, THIGH AND C
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/C
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FULL PLASTIC, STATIC, (PEDIATRIC SIZE), PREFABRICATED, INCLUDES FITT
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FULL PLASTIC, DOUBLE UPRIGHT, FREE KNEE, CUSTOM FABRICATED
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FULL PLASTIC, SINGLE UPRIGHT, FREE KNEE, CUSTOM FABRICATED
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FULL PLASTIC, WITHOUT KNEE JOINT, MULTI-AXIS ANKLE, (LIVELY ORTHOS
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE, MEDIAL LATERAL ROT
HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO), TORSION CONTROL, BILATERAL ROTATION STRAPS, PELVIC BAND/BE
HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO), TORSION CONTROL, BILATERAL TORSION CABLES, HIP JOINT, PELVIC
HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO), TORSION CONTROL, BILATERAL TORSION CABLES, BALL BEARING HIP
HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO), TORSION CONTROL, UNILATERAL ROTATION STRAPS, PELVIC BAND/B
HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO), TORSION CONTROL, UNILATERAL TORSION CABLE, HIP JOINT, PELVIC
HIP-KNEE-ANKLE-FOOT ORTHOSIS (HKAFO), TORSION CONTROL, UNILATERAL TORSION CABLE, BALL BEARING HI
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, PLASTER TYPE CASTIN
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, SYNTHETIC TYPE CAST
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, THERMOPLASTIC TYPE
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, CUSTOM FABRICATED
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT, PREFABRICATED, INCL
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID, PREFABRICATED
ANKLE-FOOT ORTHOSIS (AFO), FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID, PREFABRICATED, INCL
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, PLASTER T
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SYNTHETIC
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, THERMOPL
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, CUSTOM FA
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SOFT, PREF
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SEMI-RIGID
KNEE-ANKLE-FOOT ORTHOSIS (KAFO), FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, RIGID, PREF
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, PLASTIC SHOE INSERT WITH ANKLE JOINTS
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, DROP LOCK KNEE JOINT
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, LIMITED MOTION KNEE JOINT
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, ADJUSTABLE MOTION KNEE JOINT, LERMAN TYPE
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, QUADRILATERAL BRIM
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, WAIST BELT
ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, HIP JOINT, PELVIC BAND, THIGH FLANGE, AND PELVIC BE
ADDITION TO LOWER EXTREMITY, LIMITED ANKLE MOTION, EACH JOINT
ADDITION TO LOWER EXTREMITY, DORSIFLEXION ASSIST (PLANTAR FLEXION RESIST), EACH JOINT
ADDITION TO LOWER EXTREMITY, DORSIFLEXION AND PLANTAR FLEXION ASSIST/RESIST, EACH JOINT
ADDITION TO LOWER EXTREMITY, SPLIT FLAT CALIPER STIRRUPS AND PLATE ATTACHMENT
ADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT
ADDITION TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP ATTACHMENT
ADDITION TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE)
ADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP
ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ("T") STRAP, PADDED/LINED OR MALLEOLUS PAD
ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION, PADDED/LINED
ADDITION TO LOWER EXTREMITY, MOLDED INNER BOOT
ADDITION TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT), JOINTED, ADJUSTABLE
ADDITION TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT
ADDITION TO LOWER EXTREMITY, NON-MOLDED LACER
ADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL
ADDITION TO LOWER EXTREMITY, ANTERIOR SWING BAND
ADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL
ADDITION TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT MODEL, (USED FOR 'PTB
ADDITION TO LOWER EXTREMITY, EXTENDED STEEL SHANK
ADDITION TO LOWER EXTREMITY, PATTEN BOTTOM
ADDITION TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID STIRRUP
ADDITION TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT
ADDITION TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT
ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT
ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT
ADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE
ADDITION TO KNEE JOINT, DROP LOCK, EACH JOINT
ADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM (BAIL, CABLE, OR EQUAL), ANY MATERIAL, EA
ADDITION TO KNEE JOINT, DISC OR DIAL LOCK FOR ADJUSTABLE KNEE FLEXION, EACH JOINT
ADDITION TO KNEE JOINT, RATCHET LOCK FOR ACTIVE AND PROGRESSIVE KNEE EXTENSION, EACH JOINT
ADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT
ADDITION TO KNEE JOINT, LIFT LOOP FOR DROP LOCK RING
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, GLUTEAL/ ISCHIAL WEIGHT BEARING, RING
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, MOLDED TO PATIENT MODEL
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, CUSTOM FITTED
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM MOLDED T
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM, CUSTOM
ADDITION TO LOWER EXTREMITY, THIGH-WEIGHT BEARING, LACER, NON-MOLDED
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, LACER, MOLDED TO PATIENT MODEL
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, HIGH ROLL CUFF
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE TWO POSITION JOINT, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PELVIC SLING
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE, OR THRUST BEARING, FREE, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS OR THRUST BEARING, LOCK, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, HEAVY DUTY, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EACH
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EXTENSION, ABDUCTION C
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PLASTIC, MOLDED TO PATIENT MODEL, RECIPROCATING HIP
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, METAL FRAME, RECIPROCATING HIP JOINT AND CABLES
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, UNILATERAL
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, BILATERAL
ADDITION TO LOWER EXTREMITY, PELVIC AND THORACIC CONTROL, GLUTEAL PAD, EACH
ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, THORACIC BAND
ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, PARASPINAL UPRIGHTS
ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, LATERAL SUPPORT UPRIGHTS
ADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR
ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION
ADDITION TO LOWER EXTREMITY ORTHOSIS, EXTENSION, PER EXTENSION, PER BAR (FOR LINEAL ADJUSTMENT F
ORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR
ADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT
ADDITION TO LOWER EXTREMITY ORTHOSIS, NON-CORROSIVE FINISH, PER BAR
ADDITION TO LOWER EXTREMITY ORTHOSIS, DROP LOCK RETAINER, EACH
ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, FULL KNEECAP
ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, KNEE CAP, MEDIAL OR LATERAL PULL
ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, CONDYLAR PAD
ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW KNEE SECTION
ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE KNEE SECTION
ADDITION TO LOWER EXTREMITY ORTHOSIS, TIBIAL LENGTH SOCK, FRACTURE OR EQUAL, EACH
ADDITION TO LOWER EXTREMITY ORTHOSIS, FEMORAL LENGTH SOCK, FRACTURE OR EQUAL, EACH
ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANIS
LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED
FOOT INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, "UCB" TYPE, BERKELEY SHELL, EACH
FOOT INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH
FOOT INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH
FOOT INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH
FOOT INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT, EACH
FOOT INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL SUPPORT, EACH
FOOT INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH
FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH
FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH
FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH
FOOT, ARCH SUPPORT, NONREMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH
FOOT, ARCH SUPPORT, NONREMOVABLE ATTACHED TO SHOE, METATARSAL, EACH
FOOT, ARCH SUPPORT, NONREMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL, EACH
HALLUS-VALGUS NIGHT DYNAMIC SPLINT
FOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES
FOOT, ABDUCTION ROTATION BAR, WITHOUT SHOES
FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE
FOOT, PLASTIC HEEL STABILIZER
ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT
ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD
ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR
SURGICAL BOOT, EACH, INFANT
SURGICAL BOOT, EACH, CHILD
SURGICAL BOOT, EACH, JUNIOR
BENESCH BOOT, PAIR, INFANT
BENESCH BOOT, PAIR, CHILD
BENESCH BOOT, PAIR, JUNIOR
ORTHOPEDIC FOOTWEAR, WOMAN'S SHOES, OXFORD
ORTHOPEDIC FOOTWEAR, WOMAN'S SHOES, DEPTH INLAY
ORTHOPEDIC FOOTWEAR, WOMAN'S SHOES, HIGHTOP, DEPTH INLAY
ORTHOPEDIC FOOTWEAR, MAN'S SHOES, OXFORD
ORTHOPEDIC FOOTWEAR, MAN'S SHOES, DEPTH INLAY
ORTHOPEDIC FOOTWEAR, MAN'S SHOES, HIGHTOP, DEPTH INLAY
ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE (ORTHOSIS)
ORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE (ORTHOSIS)
ORTHOPEDIC FOOTWEAR, CUSTOM SHOES, DEPTH INLAY
ORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE, EACH
FOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH
FOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, EACH
FOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR), CUSTOM FITTED, EACH
NONSTANDARD SIZE OR WIDTH
NONSTANDARD SIZE OR LENGTH

ORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE
SURGICAL BOOT/SHOE, EACH
PLASTAZOTE SANDAL, EACH
LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH
LIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH
LIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH
LIFT, ELEVATION, METAL EXTENSION (SKATE)
LIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH
LIFT, ELEVATION, HEEL, PER INCH
HEEL WEDGE, SACH
HEEL WEDGE
SOLE WEDGE, OUTSIDE SOLE
SOLE WEDGE, BETWEEN SOLE
CLUBFOOT WEDGE
OUTFLARE WEDGE
METATARSAL BAR WEDGE, ROCKER
METATARSAL BAR WEDGE, BETWEEN SOLE
FULL SOLE AND HEEL WEDGE, BETWEEN SOLE
HEEL, COUNTER, PLASTIC REINFORCED
HEEL, COUNTER, LEATHER REINFORCED
HEEL, SACH CUSHION TYPE
HEEL, NEW LEATHER, STANDARD
HEEL, NEW RUBBER, STANDARD
HEEL, THOMAS WITH WEDGE
HEEL, THOMAS EXTENDED TO BALL
HEEL, PAD AND DEPRESSION FOR SPUR
HEEL, PAD, REMOVABLE FOR SPUR
ORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER
ORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER
ORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER
ORTHOPEDIC SHOE ADDITION, SOLE, HALF
ORTHOPEDIC SHOE ADDITION, SOLE, FULL
ORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD
ORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE
ORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS)
ORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE
ORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER
ORTHOPEDIC SHOE ADDITION, MARCH BAR
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT (RIVETON), BOTH SHOES
ORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED
SHOULDER ORTHOSIS (SO), FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, PREFABRICATED, INCLUDES FIT
SHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G
SHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.
SHOULDER ORTHOSIS (SO), FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFAB
SHOULDER ORTHOSIS (SO), ACROMIO/CLAVICULAR, CANVAS AND WEBBING TYPE, PREFABRICATED, INCLUDES FI
SHOULDER ORTHOSIS (SO), VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE, OR EQUAL, PREFABR
SHOULDER ORTHOSIS, HARD PLASTIC, SHOULDER STABILIZER, PRE-FABRICATED, INCLUDES FITTING AND ADJUS
ELBOW ORTHOSIS (EO), ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
ELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)
ELBOW ORTHOSIS (EO), ELASTIC WITH METAL JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
ELBOW ORTHOSIS (EO), DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION, CUSTOM FABRICATED
ELBOW ORTHOSIS (EO), DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION ASSIST, CUSTOM F
ELBOW ORTHOSIS (EO), DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK WITH ACTI
ELBOW ORTHOSIS (EO), WITH ADJUSTABLE POSITION LOCKING JOINT(S), PREFABRICATED, INCLUDES FITTING AN
ELBOW ORTHOSIS, RIGID, WITHOUT JOINTS, INCLUDES SOFT INTERFACE MATERIAL, PREFABRICATED, INCLUDES
WRIST-HAND-FINGER ORTHOSIS (WHFO), SHORT OPPONENS, NO ATTACHMENTS, CUSTOM FABRICATED
WRIST-HAND-FINGER ORTHOSIS (WHFO), LONG OPPONENS, NO ATTACHMENT, CUSTOM FABRICATED
WRIST-HAND-FINGER ORTHOSIS (WHFO), WITHOUT JOINT(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTM
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ("C") B
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION A
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, I.P. EXTENSION ASSIST, WIT
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION A
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASS
WRIST-HAND ORTHOSIS (WHO), ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION
WRIST-HAND-FINGER ORTHOSIS (WHFO), ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION
ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANI
WRIST-HAND-FINGER ORTHOSIS (WHFO), DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/ FLEXION, FI
WRIST-HAND-FINGER ORTHOSIS (WHFO), DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/ FLEXION, FI
WRIST-HAND-FINGER ORTHOSIS (WHFO), EXTERNAL POWERED, COMPRESSED GAS, CUSTOM FABRICATED
WRIST-HAND-FINGER ORTHOSIS (WHFO), EXTERNAL POWERED, ELECTRIC, CUSTOM FABRICATED
WRIST-HAND ORTHOSIS (WHO), WRIST GAUNTLET, MOLDED TO PATIENT MODEL, CUSTOM FABRICATED
WRIST-HAND-FINGER ORTHOSIS (WHFO), WRIST GAUNTLET WITH THUMB SPICA, MOLDED TO PATIENT MODEL, CU
WRIST-HAND ORTHOSIS (WHO), WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, INCLUDE
WRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)
WRIST-HAND-FINGER ORTHOSIS (WHFO), SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTM
WRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRE
HAND-FINGER ORTHOSIS (HFO), FLEXION GLOVE WITH ELASTIC FINGER CONTROL, PREFABRICATED, INCLUDES F
WRIST-HAND ORTHOSIS (WHO), WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES FITTING AND ADJUSTM
WRIST-HAND-FINGER ORTHOSIS (WHFO), WRIST EXTENSION COCK-UP, WITH OUTRIGGER, PREFABRICATED, INCL
HAND-FINGER ORTHOSIS (HFO), KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
HAND-FINGER ORTHOSIS (HFO), KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND
HAND-FINGER ORTHOSIS (HFO), KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS, PREFABRICATED, INCLUDES
HAND-FINGER ORTHOSIS (HFO), WITHOUT JOINT(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENTS, AN
WRIST-HAND-FINGER ORTHOSIS (WHFO), OPPENHEIMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
WRIST-HAND-FINGER ORTHOSIS (WHFO), THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING AND ADJUS
HAND-FINGER ORTHOSIS (HFO), FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED, INCLUDES FITTING
WRIST-HAND-FINGER ORTHOSIS (WHFO), FINGER EXTENSION, WITH WRIST SUPPORT, PREFABRICATED, INCLUDE
FINGER ORTHOSIS (FO), SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
FINGER ORTHOSIS (FO), SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
WRIST-HAND-FINGER ORTHOSIS (WHFO), PALMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

WRIST-HAND-FINGER ORTHOSIS (WHFO), DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
WRIST-HAND-FINGER ORTHOSIS (WHFO), DORSAL WRIST, WITH OUTRIGGER ATTACHMENT, PREFABRICATED, INCL
HAND-FINGER ORTHOSIS (HFO), REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTM
HAND-FINGER ORTHOSIS (HFO), REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED, INCLUDES FIT
HAND-FINGER ORTHOSIS (HFO), COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
FINGER ORTHOSIS (FO), FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
WRIST-HAND-FINGER ORTHOSIS (WHFO), COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND TWO ATTAC
WRIST-HAND-FINGER ORTHOSIS (WHFO), COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND TWO ATTA
HAND-FINGER ORTHOSIS (HFO), SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
ADDITION OF JOINT TO UPPER EXTREMITY ORTHOSIS, ANY MATERIAL; PER JOINT
SHOULDER-ELBOW-WRIST-HAND ORTHOSIS (SEWHO), ABDUCTION POSITIONING, AIRPLANE DESIGN, PREFABRICA
SHOULDER-ELBOW-WRIST-HAND ORTHOSIS (SEWHO), ABDUCTION POSITIONING, ERB'S PALSEY DESIGN, PREFAB
SHOULDER-ELBOW-WRIST-HAND ORTHOSIS (SEWHO), MOLDED SHOULDER, ARM, FOREARM, AND WRIST, WITH AR
SHOULDER-ELBOW ORTHOSIS (SEO), MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTAB
SHOULDER-ELBOW ORTHOSIS (SEO), MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTAB
SHOULDER-ELBOW ORTHOSIS (SEO), MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, RECLINING
SHOULDER-ELBOW ORTHOSIS (SEO), MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, FRICTION A
SHOULDER-ELBOW ORTHOSIS (SEO), MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND HAND SUPPORT, OVE
SHOULDER-ELBOW ORTHOSIS (SEO), ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM
SHOULDER-ELBOW ORTHOSIS (SEO), ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM W
SHOULDER-ELBOW ORTHOSIS (SEO), ADDITION TO MOBILE ARM SUPPORT, SUPINATOR
UPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
UPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR, PREFABRICATED, INCLUDES FITTING AND ADJUSTMEN
UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
UPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE, CUSTOM FABRICATED
UPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST (EXAMPLE: COLLE
ADDITION TO UPPER EXTREMITY ORTHOSIS, SOCK, FRACTURE OR EQUAL, EACH
UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED
REPLACE GIRDLE FOR SPINAL ORTHOSIS
REPLACE TRILATERAL SOCKET BRIM
REPLACE QUADRILATERAL SOCKET BRIM, MOLDED TO PATIENT MODEL
REPLACE QUADRILATERAL SOCKET BRIM, CUSTOM FITTED
REPLACE MOLDED THIGH LACER
REPLACE NONMOLDED THIGH LACER
REPLACE MOLDED CALF LACER
REPLACE NONMOLDED CALF LACER
REPLACE HIGH ROLL CUFF
REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KNEE-ANKLE-FOOT ORTHOSIS (KAFO)
REPLACE METAL BANDS KNEE-ANKLE-FOOT ORTHOSIS (KAFO), PROXIMAL THIGH
REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH
REPLACE LEATHER CUFF KNEE-ANKLE-FOOT ORTHOSIS (KAFO), PROXIMAL THIGH
REPLACE LEATHER CUFF KAFO-AFO, CALF OR DISTAL THIGH
REPLACE PRETIBIAL SHELL
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS
PNEUMATIC ANKLE CONTROL SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
PNEUMATIC ANKLE FOOT ORTHOSIS, WITH OR WITHOUT JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUS
PNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
PNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT

NON-PNEUMATIC WALKING SPLINT, WITH OR WITHOUT JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUST
REPLACEMENT SOFT INTERFACE MATERIAL, STATIC ANKLE-FOOT ORTHOSIS (AFO)
REPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT
STATIC ANKLE FOOT ORTHOSIS, INCL SFT INTERFACE MATL,ADJUST, FIT, POSITIONING, PRESSURE REDUCTION, M
FOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
PARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER
PARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGHT, WITH TOE FILLER
PARTIAL FOOT, MOLDED SOCKET, TIBIAL TUBERCLE HEIGHT, WITH TOE FILLER
ANKLE, SYMES, MOLDED SOCKET, SACH FOOT
ANKLE, SYMES, METAL FRAME, MOLDED LEATHER SOCKET, ARTICULATED ANKLE/FOOT
BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT
BELOW KNEE, PLASTIC SOCKET, JOINTS AND THIGH LACER, SACH FOOT
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS, SHIN, SACH FOOT
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, BENT KNEE CONFIGURATION, EXTERNAL KNEE
ABOVE KNEE, MOLDED SOCKET, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT
ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ("STUBBIES"), WITH FOOT BLOCKS, NO ANKLE JOINTS, EACH
ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ("STUBBIES"), WITH ARTICULATED ANKLE/FOOT, DYNAMICALL
ABOVE KNEE, FOR PROXIMAL FEMORAL FOCAL DEFICIENCY, CONSTANT FRICTION KNEE, SHIN, SACH FOOT
HIP DISARTICULATION, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT FRICTION KNEE, SH
HIP DISARTICULATION, TILT TABLE TYPE; MOLDED SOCKET, LOCKING HIP JOINT, SINGLE AXIS CONSTANT FRICTION
HEMIPELVECTOMY, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN,
BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS, SHIN, SACH FOOT, EN
ABOVE KNEE, MOLDED SOCKET, OPEN END, SACH FOOT, ENDOSKELETAL SYSTEM, SINGLE AXIS KNEE
HIP DISARTICULATION, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT, SINGLE AXIS KNE
HEMIPELVECTOMY, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT, SINGLE AXIS KNEE, S
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING, AL
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NONWEIGHT BEARING RIGID DRESSING, BELOW
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NONWEIGHT BEARING RIGID DRESSING, ABOVE
INITIAL, BELOW KNEE "PTB" TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PLASTER S
INITIAL, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO CO
PREPARATORY, BELOW KNEE "PTB" TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PLA
PREPARATORY, BELOW KNEE "PTB" TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, TH
PREPARATORY, BELOW KNEE "PTB" TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, TH
PREPARATORY, BELOW KNEE "PTB" TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PR
PREPARATORY, BELOW KNEE "PTB" TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, LAM
PREPARATORY, ABOVE KNEE- KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON
PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET, NON-ALIGNABLE SYSTEM, PYLON
PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR E
PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT, LAMINATED SOCKET, M
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, HYDRACADENCE SYSTEM
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE - KNEE DISARTICULATION, 4-BAR LINKAG
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE DISARTICULATION, 4-BAR LINKAG
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE DISARTICULATION, 4-BAR LINKAG
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, UNIVERSAL MULTIPLEX SYSTEM, FRICT
ADDITION TO LOWER EXTREMITY, QUICK CHANGE SELF-ALIGNING UNIT, ABOVE KNEE OR BELOW KNEE, EACH
ADDITION TO LOWER EXTREMITY, TEST SOCKET, SYMES
ADDITION TO LOWER EXTREMITY, TEST SOCKET, BELOW KNEE
ADDITION TO LOWER EXTREMITY, TEST SOCKET, KNEE DISARTICULATION
ADDITION TO LOWER EXTREMITY, TEST SOCKET, ABOVE KNEE
ADDITION TO LOWER EXTREMITY, TEST SOCKET, HIP DISARTICULATION
ADDITION TO LOWER EXTREMITY, TEST SOCKET, HEMIPELVECTOMY
ADDITION TO LOWER EXTREMITY, BELOW KNEE, ACRYLIC SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, EXPANDABLE WALL SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, ACRYLIC SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, "PTB" BRIM DESIGN SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, POSTERIOR OPENING (CANADIAN) SOCKET
ADDITION TO LOWER EXTREMITY, SYMES TYPE, MEDIAL OPENING SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT
ADDITION TO LOWER EXTREMITY, BELOW KNEE, LEATHER SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, WOOD SOCKET
ADDITION TO LOWER EXTREMITY, KNEE DISARTICULATION, LEATHER SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, LEATHER SOCKET
ADDITION TO LOWER EXTREMITY, HIP DISARTICULATION, FLEXIBLE INNER SOCKET, EXTERNAL FRAME
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, WOOD SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME
ADDITION TO LOWER EXTREMITY, BELOW KNEE, AIR CUSHION SOCKET
ADDITION TO LOWER EXTREMITY, BELOW KNEE SUCTION SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, AIR CUSHION SOCKET
ADDITION TO LOWER EXTREMITY, ISCHIAL CONTAINMENT/NARROW M-L SOCKET
ADDITION TO LOWER EXTREMITY, TOTAL CONTACT, ABOVE KNEE OR KNEE DISARTICULATION SOCKET
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME
ADDITION TO LOWER EXTREMITY, SUCTION SUSPENSION, ABOVE KNEE OR KNEE DISARTICULATION SOCKET
ADDITION TO LOWER EXTREMITY, KNEE DISARTICULATION, EXPANDABLE WALL SOCKET
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, SYMES, (KEMBLO, PELITE, ALIPLAST, PLASTAZOTE OR EQUAL)
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE (KEMBLO, PELITE, ALIPLAST, PLASTAZOTE OR E
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION (KEMBLO, PELITE, ALIPLAST, PLASTAZ
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE (KEMBLO, PELITE, ALIPLAST, PLASTAZOTE OR EQ
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER SYMES
ADDITION TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER, BELOW KNEE
ADDITION TO LOWER EXTREMITY, BELOW KNEE, CUFF SUSPENSION
ADDITION TO LOWER EXTREMITY, BELOW KNEE, MOLDED DISTAL CUSHION
ADDITION TO LOWER EXTREMITY, BELOW KNEE, MOLDED SUPRACONDYLAR SUSPENSION ("PTS" OR SIMILAR)
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE SUSPENSION LOCKING MECHANISM (SHUTTLE, LAN
ADDITION TO LOWER EXTREMITY, BELOW KNEE, REMOVABLE MEDIAL BRIM SUSPENSION
ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL, EACH
ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY MATERIAL, EACH
ADDITION TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, SINGLE AXIS, PAIR
ADDITION TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, POLYCENTRIC, PAIR
ADDITION TO LOWER EXTREMITY, BELOW KNEE, JOINT COVERS, PAIR
ADDITION TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, NONMOLDED
ADDITION TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, GLUTEAL/ISCHIAL, MOLDED

ADDITION TO LOWER EXTREMITY, BELOW KNEE, FORK STRAP
ADDITION TO LOWER EXTREMITY, BELOW KNEE, BACK CHECK (EXTENSION CONTROL)
ADDITION TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, WEBBING
ADDITION TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, PADDED AND LINED
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, LIGHT
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, PADDED AND LINED
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL, SLEEVE SUSPENSION, NEOPRENE OR EQUAL,
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC JOINT
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC BAND
ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, SILESIAN BANDAGE
ALL LOWER EXTREMITY PROSTHESES, SHOULDER HARNESS
REPLACEMENT, SOCKET, BELOW KNEE, MOLDED TO PATIENT MODEL
REPLACEMENT, SOCKET, ABOVE KNEE/KNEE DISARTICULATION, INCLUDING ATTACHMENT PLATE, MOLDED TO PAT
REPLACEMENT, SOCKET, HIP DISARTICULATION, INCLUDING HIP JOINT, MOLDED TO PATIENT MODEL
CUSTOM SHAPED PROTECTIVE COVER, BELOW KNEE
CUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE
CUSTOM SHAPED PROTECTIVE COVER, KNEE DISARTICULATION
CUSTOM SHAPED PROTECTIVE COVER, HIP DISARTICULATION
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT MATERIAL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE PHASE CONTROL (SA
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, VARIABLE FRICTION SWING PHASE CONTROL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE LOCK
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING AND STANCE PHASE CONTROL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION STANCE PHASE CONT
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, EXTERNAL JOINTS FLUID SWING PHASE CONTROL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/HYDRA PNEUMATIC SWING PHASE CONT
ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND MOISTURE
ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND MOISTURE
ADDITION, EXOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)
ADDITION, EXOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)
ADDITION, EXOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT MATERIAL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE PHASE CONTROL (S
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, HYDRAULIC SWING PHASE CONTROL, MECHANIC
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE LOCK
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND STANCE PHASE CONTROL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION STANCE PHASE CON
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, HYDRAULIC SWING PHASE CONTROL, WITH MINIAT
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/ SWING PHASE CONTROL
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, 4-BAR LINKAGE OR MULTIAXIAL, PNEUMATIC SWING PHASE CONT
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, STANCE FLEXION FEATURE, ADJUSTABLE
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE

ADDITION TO ENDOSKELETAL, KNEE-SHIN SYSTEM, HYDRAULIC STANCE EXTENSION, DAMPENING FEATURE, ADJU
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, KNEE EXTENSION ASSIST
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, MECHANICAL HIP EXTENSION ASSIST
ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE SYSTEM
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, KNEE DISARTICULATION OR HIP DISARTICULATION, MANUAL LO
ADDITION, ENDOSKELETAL SYSTEM, HIGH ACTIVITY KNEE CONTROL FRAME
ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR
ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING SYSTEM
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING SYSTEM
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING S
ADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE DORSIFLEXION FEATUR
ALL LOWER EXTREMITY PROSTHESES, FOOT, EXTERNAL KEEL, SACH FOOT
ALL LOWER EXTREMITY PROSTHESES, FLEXIBLE KEEL FOOT (SAFE, STEN, BOCK DYNAMIC OR EQUAL)
ALL LOWER EXTREMITY PROSTHESES, FOOT, SINGLE AXIS ANKLE/FOOT
ALL LOWER EXTREMITY PROSTHESIS, COMBINATION SINGLE AXIS ANKLE AND FLEXIBLE KEEL FOOT
ALL LOWER EXTREMITY PROSTHESES, ENERGY STORING FOOT (SEATTLE CARBON COPY II OR EQUAL)
ALL LOWER EXTREMITY PROSTHESES, FOOT, MULTIAXIAL ANKLE/FOOT
ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE PIECE SYSTEM
ALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM
ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL
ALL EXOSKELETAL LOWER EXTREMITY PROSTHESES, AXIAL ROTATION UNIT
ALL ENDOSKELETAL LOWER EXTREMITY PROSTHESES, AXIAL ROTATION UNIT
ALL ENDOSKELETAL LOWER EXTREMITY PROTHESES, DYNAMIC PROSTHETIC PYLON
ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT ("MCP" OR EQUAL)
ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON
ADDITION TO LOWER LIMB PROSTHESIS, VERTICAL SHOCK REDUCING PYLON FEATURE
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH INTEGRATED ELECTRONIC
ADDITION TO LOWER EXTREMITY PROSTHESIS, USER ADJUSTABLE HEEL HEIGHT
ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE (FOR PATIENT WEIGHT > 300 LBS)
LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED
PARTIAL HAND, ROBIN-AIDS, THUMB REMAINING (OR EQUAL)
PARTIAL HAND, ROBIN-AIDS, LITTLE AND/OR RING FINGER REMAINING (OR EQUAL)
PARTIAL HAND, ROBIN-AIDS, NO FINGER REMAINING (OR EQUAL)
TRANSCARPAL/METACARPAL/PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERN POWER,SELF-SUSPENDED
WRIST DISARTICULATION, MOLDED SOCKET, FLEXIBLE ELBOW HINGES, TRICEPS PAD
WRIST DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, FLEXIBLE ELBOW HINGES, TRICEPS
BELOW ELBOW, MOLDED SOCKET, FLEXIBLE ELBOW HINGE, TRICEPS PAD
BELOW ELBOW, MOLDED SOCKET, (MUENSTER OR NORTHWESTERN SUSPENSION TYPES)
BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STEP-UP HINGES, HALF CUFF
BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STUMP ACTIVATED LOCKING HINGE, HALF CUFF
ELBOW DISARTICULATION, MOLDED SOCKET, OUTSIDE LOCKING HINGE, FOREARM
ELBOW DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, OUTSIDE LOCKING HINGES, FOREA
ABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, INTERNAL LOCKING ELBOW, FOREARM
SHOULDER DISARTICULATION, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION, INTERNAL LOCKING
SHOULDER DISARTICULATION, PASSIVE RESTORATION (COMPLETE PROSTHESIS)
SHOULDER DISARTICULATION, PASSIVE RESTORATION (SHOULDER CAP ONLY)

INTERSCAPULAR THORACIC, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION, INTERNAL LOCKING E
INTERSCAPULAR THORACIC, PASSIVE RESTORATION (COMPLETE PROSTHESIS)
INTERSCAPULAR THORACIC, PASSIVE RESTORATION (SHOULDER CAP ONLY)
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING AL
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING INCLUDING FITTING ALI
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING INCLUDING FITTING ALI
IMMEDIATE POST SURGICAL OR EARLY FITTING, EACH ADDITIONAL CAST CHANGE AND REALIGNMENT
IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF RIGID DRESSING ONLY
BELOW ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING
ELBOW DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SH
ABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING
SHOULDER DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSU
INTERSCAPULAR THORACIC, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE
PREPARATORY,WRIST DISARTICULATN/BELOW ELBOW,1 WALL PLASTIC SOCKET, FRICTION WRIST, FLEXIBLE ELBO
PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL SOCKET, FRICTION WRIST, FLEXIBLE E
PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL PLASTIC SOCKET, FRICTION WRIST, L
PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL SOCKET, FRICTION WRIST, LOCKING E
PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL PLASTIC SOCKET,SH
PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL SOCKET, SHOULDER
UPPER EXTREMITY ADDITIONS, POLYCENTRIC HINGE, PAIR
UPPER EXTREMITY ADDITIONS, SINGLE PIVOT HINGE, PAIR
UPPER EXTREMITY ADDITIONS, FLEXIBLE METAL HINGE, PAIR
UPPER EXTREMITY ADDITION, DISCONNECT LOCKING WRIST UNIT
UPPER EXTREMITY ADDITION, ADDITIONAL DISCONNECT INSERT FOR LOCKING WRIST UNIT, EACH
UPPER EXTREMITY ADDITION, FLEXION-FRICTION WRIST UNIT
UPPER EXTREMITY ADDITION, SPRING ASSISTED ROTATIONAL WRIST UNIT WITH LATCH RELEASE
UPPER EXTREMITY ADDITION, ROTATION WRIST UNIT WITH CABLE LOCK
UPPER EXTREMITY ADDITION, QUICK DISCONNECT HOOK ADAPTER, OTTO BOCK OR EQUAL
UPPER EXTREMITY ADDITION, QUICK DISCONNECT LAMINATION COLLAR WITH COUPLING PIECE, OTTO BOCK OR
UPPER EXTREMITY ADDITION, STAINLESS STEEL, ANY WRIST
UPPER EXTREMITY ADDITION, LATEX SUSPENSION SLEEVE, EACH
UPPER EXTREMITY ADDITION, LIFT ASSIST FOR ELBOW
UPPER EXTREMITY ADDITION, NUDGE CONTROL ELBOW LOCK
UPPER EXTREMITY ADDITION TO PROSTHESIS, ELECTRIC LOCKING FEATURE, ONLY FOR USE WITH MANUALLY PO
UPPER EXTREMITY ADDITIONS, SHOULDER ABDUCTION JOINT, PAIR
UPPER EXTREMITY ADDITION, EXCURSION AMPLIFIER, PULLEY TYPE
UPPER EXTREMITY ADDITION, EXCURSION AMPLIFIER, LEVER TYPE
UPPER EXTREMITY ADDITION, SHOULDER FLEXION-ABDUCTION JOINT, EACH
UPPER EXTREMITY ADDITION, SHOULDER JOINT, MULTIPOSITIONAL LOCKING, FLEXION, ADJUSTABLE ABDUCTION
UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, BODY POWERED ACTUATOR
UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, EXTERNAL POWERED ACTUATOR
UPPER EXTREMITY ADDITION, SHOULDER UNIVERSAL JOINT, EACH
UPPER EXTREMITY ADDITION, STANDARD CONTROL CABLE, EXTRA
UPPER EXTREMITY ADDITION, HEAVY DUTY CONTROL CABLE
UPPER EXTREMITY ADDITION, TEFLON, OR EQUAL, CABLE LINING
UPPER EXTREMITY ADDITION, HOOK TO HAND, CABLE ADAPTER
UPPER EXTREMITY ADDITION, HARNESS, CHEST OR SHOULDER, SADDLE TYPE
UPPER EXTREMITY ADDITION, HARNESS, FIGURE OF EIGHT TYPE, FOR SINGLE CONTROL
UPPER EXTREMITY ADDITION, HARNESS, FIGURE OF EIGHT TYPE, FOR DUAL CONTROL
UPPER EXTREMITY ADDITION, TEST SOCKET, WRIST DISARTICULATION OR BELOW ELBOW
UPPER EXTREMITY ADDITION, TEST SOCKET, ELBOW DISARTICULATION OR ABOVE ELBOW
UPPER EXTREMITY ADDITION, TEST SOCKET, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC
UPPER EXTREMITY ADDITION, SUCTION SOCKET
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, BELOW ELBOW OR WRIST DISARTICULATION
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, ABOVE ELBOW OR ELBOW DISARTICULATION
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, SHOULDER DISARTICULATION
UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, INTERSCAPULAR-THORACIC
UPPER EXTREMITY ADDITION, REMOVABLE INSERT, EACH
UPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, EACH
UPPER EXTREMITY ADDITION, LOCKING ELBOW, FOREARM COUNTERBALANCE
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #3
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5X
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5XA
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7LO
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10P
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #12P
TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #SS555
TERMINAL DEVICE, HOOK, ACCU HOOK, OR EQUAL
TERMINAL DEVICE, HOOK, 2 LOAD, OR EQUAL
TERMINAL DEVICE, HOOK, APRL VC, OR EQUAL
TERMINAL DEVICE, MODIFIER WRIST FLEXION UNIT
TERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL
TERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL
TERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL
TERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE
TERMINAL DEVICE, PINCHER TOOL, OTTO BOCK OR EQUAL
TERMINAL DEVICE, HAND, DORRANCE, VO
TERMINAL DEVICE, HAND, APRL, VC
TERMINAL DEVICE, HAND, SIERRA, VO
TERMINAL DEVICE, HAND, BECKER IMPERIAL
TERMINAL DEVICE, HAND, BECKER LOCK GRIP
TERMINAL DEVICE, HAND, BECKER PLYLITE
TERMINAL DEVICE, HAND, ROBIN-AIDS, VO
TERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT
TERMINAL DEVICE, HAND, PASSIVE HAND
TERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL)
TERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL)
TERMINAL DEVICE, HAND, CHILD MITT
TERMINAL DEVICE, HAND, NYU CHILD HAND

TERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL
TERMINAL DEVICE, HAND, BOCK, VC
TERMINAL DEVICE, HAND, BOCK, VO
AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL DEVICE
MICROPROCESSOR CONTROL FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL DEVICE
TERMINAL DEVICE, GLOVE FOR ABOVE HANDS, PRODUCTION GLOVE
TERMINAL DEVICE, GLOVE FOR ABOVE HANDS, CUSTOM GLOVE
HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH GLOVE, THUMB O
HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH GLOVE, MULTIPLE
HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH GLOVE, NO FINGE
HAND RESTORATION (SHADING, AND MEASUREMENTS INCLUDED), REPLACEMENT GLOVE FOR ABOVE
WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL,
WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL,
BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOC
BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOC
ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, OUTSIDE
ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOV HUMERAL SHELL, OUTSIDE LOCK
ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL LOCKING E
ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL LOCKING E
SHLDR DISARTICULTN,EXTERNL POWR,MOLDED INNER SOCKET,REMOV SHLDR SHELL,SHLDR BULKHEAD,HUMRA
SHLDR DISARTICULTN,EXTERN POWR,MOLDED INNER SOCKET,REMOV SHLDR SHELL,SHLDR BULKHEAD,HMERAL
INTERSCAPULAR-THORAC,EXTERN POWR,MOLDED INNR SOCKET,REMOV SHLDR SHELL,SHLDR BULKHEAD,HUME
INTERSCAPULAR-THORACIC, EXTERNAL POWER,MOLDED INNER SOCKET,REMOV SHLDR SHELL,SHLDR BULKHEA
ELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED
ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED
ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED
ELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED
ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED
ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED
PREHENSILE ACTUATOR, HOSMER OR EQUAL, SWITCH CONTROLLED
ELECTRONIC HOOK, CHILD, MICHIGAN OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, BOSTON, UTAH OR EQUAL, MYOELECTRONICALLY CONTROLLED
ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED
ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED
ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED
ELECTRONIC WRIST ROTATOR, OTTO BOCK OR EQUAL
ELECTRONIC WRIST ROTATOR, FOR UTAH ARM
SERVO CONTROL, STEEPER OR EQUAL
ANALOGUE CONTROL, UNB OR EQUAL
PROPORTIONAL CONTROL, 6-12 VOLT, LIBERTY, UTAH OR EQUAL
SIX VOLT BATTERY, OTTO BOCK OR EQUAL, EACH
BATTERY CHARGER, SIX VOLT, OTTO BOCK OR EQUAL
TWELVE VOLT BATTERY, UTAH OR EQUAL, EACH
BATTERY CHARGER, TWELVE VOLT, UTAH OR EQUAL
LITHIUM ION BATTERY, REPLACEMENT
LITHIUM ION BATTERY CHARGER
UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED

REPAIR OF PROSTHETIC DEVICE, HOURLY RATE (EXCLUDES V5335 REPAIR OF ORAL OR LARYNGEAL PROSTHESIS
REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS
REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
VACUUM ERECTION SYSTEM
BREAST PROSTHESIS, MASTECTOMY BRA
BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM, UNILATERAL
BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM, BILATERAL
BREAST PROSTHESIS, MASTECTOMY SLEEVE
EXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM, POST MASTECTOMY
BREAST PROSTHESIS, MASTECTOMY FORM
BREAST PROSTHESIS, SILICONE OR EQUAL
CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL
BREAST PROSTHESIS, NOT OTHERWISE SPECIFIED
NASAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
MIDFACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
ORBITAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
UPPER FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
HEMI-FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
AURICULAR PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
PARTIAL FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
NASAL SEPTAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN
UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT, PROVIDED BY A NON-PHYSICIAN
REPAIR OR MODIFICATION OF MAXILLOFACIAL PROSTHESIS, LABOR COMPONENT, 15 MINUTE INCREMENTS, PROV
GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, FULL-LENGTH/CHAP STYLE, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH
GRADIENT COMPRESSION STOCKING, CUSTOM MADE
GRADIENT COMPRESSION STOCKING, LYMPHEDEMA
GRADIENT COMPRESSION STOCKING, GARTER BELT
GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED
TRUSS, SINGLE WITH STANDARD PAD
TRUSS, DOUBLE WITH STANDARD PADS
TRUSS, ADDITION TO STANDARD PAD, WATER PAD
TRUSS, ADDITION TO STANDARD PAD, SCROTAL PAD
PROSTHETIC SHEATH, BELOW KNEE, EACH
PROSTHETIC SHEATH, ABOVE KNEE, EACH
PROSTHETIC SHEATH, UPPER LIMB, EACH
PROSTHETIC SHEATH/SOCK, INCLUDING A GEL CUSHION LAYER, BELOW KNEE OR ABOVE KNEE, EACH
PROSTHETIC SOCK, MULTIPLE PLY, BELOW KNEE, EACH
PROSTHETIC SOCK, MULTIPLE PLY, ABOVE KNEE, EACH

PROSTHETIC SOCK, MULTIPLE PLY, UPPER LIMB, EACH
PROSTHETIC SHRINKER, BELOW KNEE, EACH
PROSTHETIC SHRINKER, ABOVE KNEE, EACH
PROSTHETIC SHRINKER, UPPER LIMB, EACH
PROSTHETIC SOCK, SINGLE PLY, FITTING, BELOW KNEE, EACH
PROSTHETIC SOCK, SINGLE PLY, FITTING, ABOVE KNEE, EACH
PROSTHETIC SOCK, SINGLE PLY, FITTING, UPPER LIMB, EACH
ADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM
UNLISTED PROCEDURE FOR MISCELLANEOUS PROSTHETIC SERVICES
ARTIFICIAL LARYNX, ANY TYPE
TRACHEOSTOMY SPEAKING VALVE
ARTIFICIAL LARYNX REPLACEMENT BATTERY/ACCESSORY, ANY TYPE
TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, PATIENT INSERTED, ANY TYPE, EACH
TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, INSERTED BY A LICENSED HEALTH CARE PROVIDER, ANY TYPE
VOICE AMPLIFIER
IMPLANTABLE BREAST PROSTHESIS, SILICONE OR EQUAL
INJECTABLE BULKING AGENT, COLLAGEN IMPLANT, URINARY TRACT, 2.5 ML SYRINGE, INCLUDES SHIPPING AND NE
INJECTABLE BULKING AGENT, SYNTHETIC IMPLANT, URINARY TRACT, 1 ML SYRINGE, INCLUDES SHIPPING AND NE
OCULAR IMPLANT
AQUEOUS SHUNT
OSSICULA IMPLANT
COCHLEAR DEVICE/SYSTEM
COCHLEAR IMPLANT EXTERNAL SPEECH PROCESSOR, REPLACEMENT
METACARPOPHALANGEAL JOINT IMPLANT
METATARSAL JOINT IMPLANT
HALLUX IMPLANT
INTERPHALANGEAL JOINT IMPLANT
VASCULAR GRAFT MATERIAL, SYNTHETIC, IMPLANT
PROSTHETIC IMPLANT, NOT OTHERWISE SPECIFIED
ORTHOTIC AND PROSTHETIC SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS L CODE
BRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG PRESCRIPTIONS USED IN TH
CELLULAR THERAPY
PROLOTHERAPY
INTRAGASTRIC HYPOTHERMIA USING GASTRIC FREEZING (MNP)
IV CHELATION THERAPY (CHEMICAL ENDARTERECTOMY)
FABRIC WRAPPING OF ABDOMINAL ANEURYSM (MNP)
CEPHALIN FLOCULATION, BLOOD
CONGO RED, BLOOD
HAIR ANALYSIS (EXCLUDING ARSENIC)
THYMOL TURBIDITY, BLOOD
MUCOPROTEIN, BLOOD (SEROMUCOID) (MEDICAL NECESSITY PROCEDURE)
SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, BY TECHNICIAN UNDER PHY
SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, REQUIRING INTERPRETATIO
CULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY
BLOOD (WHOLE), FOR TRANSFUSION, PER UNIT
BLOOD (SPLIT UNIT), SPECIFY AMOUNT
CRYOPRECIPITATE, EACH UNIT
RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT
FRESH FROZEN PLASMA (SINGLE DONOR), EACH UNIT

PLATELETS, EACH UNIT
PLATELET RICH PLASMA, EACH UNIT
RED BLOOD CELLS, EACH UNIT
RED BLOOD CELLS, WASHED, EACH UNIT
PLASMA, POOLED MULTIPLE DONOR, SOLVENT/DETERGENT TREATED, FROZEN, EACH UNIT
PLATELETS, LEUKOCYTES REDUCED, EACH UNIT
PLATELETS, IRRADIATED, EACH UNIT
PLATELETS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
PLATELETS, PHERESIS, EACH UNIT
PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT
PLATELETS, PHERESIS, IRRADIATED, EACH UNIT
PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
RED BLOOD CELLS, IRRADIATED, EACH UNIT
RED BLOOD CELLS, DEGLYCEROLIZED, EACH UNIT
RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT
INFUSION, ALBUMIN (HUMAN), 5%, 50 ML
INFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 50 ML
PLASMA, CRYOPRECIPITATE REDUCED, EACH UNIT
INFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 250ML
GRANULOCYTES, PHERESIS, EACH UNIT
TRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECT
TRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECT
CATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLE PATIENT, ALL PLACES OF SERVICE
CATHETERIZATION FOR COLLECTION OF SPECIMEN (S) (MULTIPLE PATIENTS)
CARDIOKYMOGRAPHY
INFUSION THERAPY, USING OTHER THAN CHEMOTHERAPEUTIC DRUGS, PER VISIT
CHEMOTHERAPY ADMINISTRATION BY OTHER THAN INFUSION TECHNIQUE ONLY (E.G., SUBCUTANEOUS, INTRAMU
CHEMOTHERAPY ADMINISTRATION BY INFUSION TECHNIQUE ONLY, PER VISIT
CHEMOTHERAPY ADMINISTRATION BY BOTH INFUSION TECHNIQUE AND OTHER TECHNIQUE(S) (E.G., SUBCUTANE
PHYSICAL THERAPY EVALUATION/TREATMENT, PER VISIT
SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVEYANCE OF CERVICAL OR VAGINAL SMEA
SET-UP PORTABLE X-RAY EQUIPMENT
WET MOUNTS, INCLUDING PREPARATIONS OF VAGINAL, CERVICAL OR SKIN SPECIMENS
ALL POTASSIUM HYDROXIDE (KOH) PREPARATIONS
PINWORM EXAMINATION
FERN TEST
POST-COITAL DIRECT, QUALITATIVE EXAMINATIONS OF VAGINAL OR CERVICAL MUCOUS
INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A
PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPL
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMP
GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMP
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUT
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A C
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A CO
CHLORPROMAZINE HYDROCHLORIDE, 10 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A
CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A
TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE A
THIETHYLPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLE
PERPHENZAINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEU
PERPHENZAINE, 8 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEU
HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE T
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE T
ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMP
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE
UNSPECIFIED ORAL DOSAGE FORM, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THE
DERMAL TISSUE, OF HUMAN ORIGIN, WITH AND WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, B
DERMAL TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, W
FACTOR VIIA (COAGULATION FACTOR, RECOMBINANT) PER 1.2 MG
NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 1 AS DEFINED IN FEDERAL REGISTER NOTICE, VOL. 65, DATE
NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 2 AS DEFINED IN FEDERAL REGISTER NOTICE, VOL. 65, DATE
NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 3 AS DEFINED IN FEDERAL REGISTER NOTICE
ORAL, CABERGOLINE, 0.5 MG
INJECTION, ELLIOTTS B SOLUTION, PER ML
INJECTION, APROTININ, 10,000 KIU
IRRIGATION SOLUTION FOR TREATMENT OF BLADDER CALCULI, FOR EXAMPLE RENACIDIN, PER 500 ML
INJECTION, CORTICORELIN OVINE TRIFLUTATE, PER DOSE
INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL
INJECTION, ETHANOLAMINE OLEATE, 100 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOSPHENYTOIN, 50 MG
INJECTION, GLATIRAMER ACETATE, PER DOSE
INJECTION, HEMIN, PER 1 MG
INJECTION, PEGADEMASE BOVINE, 25 IU
INJECTION, PENTASTARCH, 10% SOLUTION, PER 100 ML
INJECTION, SERMORELIN ACETATE, 0.5 MG
INJECTION, TENIPOSIDE, 50 MG
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, BASILIXIMAB, 20 MG
INJECTION, HISTRELIN ACETATE, 10 MG
INJECTION, LEPIRUDIN, 50 MG
VON WILLEBRAND FACTOR COMPLEX, HUMAN, PER IU
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, RUBIDIUM RB-82, PER DOSE
RADIOELEMENTS FOR BRACHYTHERAPY, ANY TYPE, EACH
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, GALLIUM GA 67, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M BICISATE, PER UNIT DOS
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, XENON XE 133, PER 10 MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M MERTIATIDE, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M GLUCEPATATE, PER 5 M
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM PHOSPHATE P32, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111-IN PENTETREOTIDE, PER 3 MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M OXIDRONATE, PER MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M - LABELED RED BLOOD C
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CHROMIC PHOSPHATE P32 SUSPENSION, PER
SUPPLY OF ORAL RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN COBALT CO57, PER
TELEHEALTH ORIGINATING SITE FACILITY FEE
ALS VEHICLE USED, EMERGENCY TRANSPORT, NO ALS LEVEL SERVICES FURNISHED
ALS VEHICLE USED, NON-EMERGENCY TRANSPORT, NO ALS LEVEL SERVICE FURNISHED
INJECTION, HEPATITIS B VACCINE, PEDIATRIC OR ADOLESCENT, PER DOSE
INJECTION, HEPATITIS B VACCINE, ADULT, PER DOSE
INJECTION, HEPATITIS B VACCINE, IMMUNOSUPPRESSED PATIENTS (INCLUDING RENAL DIALYSIS PATIENTS), PER
INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE
INJECTION, INTERFERON BETA-1A, 11 MCG FOR SUBCUTANEOUS USE
CASTING SUPPLIES, BODY CAST ADULT, WITH OR WITHOUT HEAD, PLASTER
CAST SUPPLIES, BODY CAST ADULT, WITH OR WITHOUT HEAD, FIBERGLASS
CAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 YEARS), FIBERGLAS
CAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS
CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), PLASTER
CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS
CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER
CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS
FINGER SPLINT, STATIC
CAST SUPPLIES, FOR UNLISTED TYPES AND MATERIALS OF CASTS
SPLINT SUPPLIES, MISCELLANEOUS (INCLUDES THERMOPLASTICS, STRAPPING, FASTENERS, PADDING AND OTHE
INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 20 OR LESS
INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 21
INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 40 OR ABOVE
TRANSPORTATION OF PORTABLE X-RAY EQUIPMENT AND PERSONNEL TO HOME OR NURSING HOME, PER TRIP TO
TRANSPORTATION OF PORTABLE X-RAY EQUIPMENT AND PERSONNEL TO HOME OR NURSING HOME, PER TRIP TO
TRANSPORTATION OF PORTABLE EKG TO FACILITY OR LOCATION, PER PATIENT
INJECTION, BUTORPHANOL TARTRATE, 1 MG
BUTORPHANOL TARTRATE, NASAL SPRAY, 25 MG
TACRINE HYDROCHLORIDE, 10 MG
INJECTION, AMIKACIN SULFATE, 500 MG
INJECTION, AMINOCAPROIC ACID, 5 GRAMS
INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML
INJECTION, CEFTOPERAZONE SODIUM, 1 GRAM
INJECTION, CIMETIDINE HYDROCHLORIDE, 300 MG
INJECTION, FAMOTIDINE, 20 MG
INJECTION, METRONIDAZOLE, 500 MG
INJECTION, NAFCILLIN SODIUM, 2 GRAMS

INJECTION, OFLOXACIN, 400 MG
INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML
INJECTION, TICARCILLIN DISODIUM AND CLAVULANATE POTASSIUM, 3.1 GRAMS
INJECTION, ACYCLOVIR SODIUM, 50 MG
INJECTION, AMIKACIN SULFATE, 100 MG
INJECTION, AZTREONAM, 500 MG
INJECTION, CEFOTETAN DISODIUM, 500 MG
INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG
INJECTION, FOSPHENYTOIN SODIUM, 750 MG
INJECTION, OCTREOTIDE ACETATE, 100 MCG (FOR DOSES OVER 1 MG USE J2352 OR C1207)
INJECTION, PENTAMIDINE ISETHIONATE, 300 MG
INJECTION, PIPERACILLIN SODIUM, 500 MG
ALEMTUZUMAB INJECTION, 30 MG
SILDENAFIL CITRATE, 25 MG
GRAINSETRON HYDROCHLORIDE, 1MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE STATUE, USE Q01
INJECTION, HYROMORPHONE HYDROCHLORIDE, 250MG (LOADING DOSE FOR INFUSION PUMP)
INJECTION, MORPHINE SULFATE, 500MG (LOADING DOSE FOR INFUSION PUMP)
ZIDOVUDINE, ORAL, 100MG
BUPROPION HCL SUSTAINED RELEASE TABLET, 150 MG, PER BOTTLE OF 60 TABLETS
MERCAPTOPURINE, ORAL, 50 MG
INJECTION, TREPROSTINIL SODIUM, 0.5 MG
INJECTION, MENOTROPINS, 75 IU
INJECTION, UROFOLLITROPIN, PURIFIED, 75 IU
INJECTION, FOLLITROPIN ALFA, 75 IU
INJECTION, FOLLITROPIN BETA, 75 IU
INJECTION, CHORIONIC GONADOTROPIN, 5000 UNITS
INJECTION, GANIRELIX ACETATE, 250 MCG
INJECTION, PEGFILGRASTIM, 6MG
STERILE DILUTANT FOR EPOPROSTENOL, 50ML
EXEMESTANE, 25 MG
BECAPLERMIN GEL 0.01%, 0.5 G
ANASTROZOLE, ORAL, 1MG
INJECTION, BUMETANIDE, 0.5MG
CHLORAMBUCIL, ORAL, 2MG
DEXAMETHASONE, ORAL, 4MG
DOLASETRON MESYLATE, ORAL 50MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE STATUTE, USE Q01
FLUTAMIDE, ORAL, 125MG
HYDROXYUREA, ORAL, 500MG
LEVAMISOLE HYDROCHLORIDE, ORAL, 50MG
LOMUSTINE, ORAL, 10MG
MEGESTROL ACETATE, ORAL, 20MG
ONDANSETRON HYDROCHLORIDE, ORAL, 4MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE STATUTE,
PROCARBAZINE HYDROCHLORIDE, ORAL, 50MG
PROCHLORPERAZINE MALEATE, ORAL, 5MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE STATUTE, US
TAMOXIFEN CITRATE, ORAL, 10MG
TESTOSTERONE PELLET, 75MG
MIFEPRISTONE, ORAL, 200 MG
MISOPROSTOL, ORAL, 200 MCG
PNEUMOCOCCAL CONJUGATE VACCINE, POLYVALENT, INTRAMUSCULAR, FOR CHILDREN FROM FIVE YEARS TO N
MEDICALLY INDUCED ABORTION BY ORAL INGESTION OF MEDICATION INCLUDING ALL ASSOCIATED SERVICES AN
PARTIAL HOSPITALIZATION SERVICES, LESS THAN 24 HOURS, PER DIEM
PARAMEDIC INTERCEPT, NON-HOSPITAL BASED ALS SERVICE (NON-VOLUNTARY), NON-TRANSPORT
PARAMEDIC INTERCEPT, HOSPITAL-BASED ALS SERVICE (NON-VOLUNTARY), NON-TRANSPORT
WHEELCHAIR VAN, MILEAGE, PER MILE
NON-EMERGENCY TRANSPORTATION; MILEAGE, PER MILE
MEDICAL CONFERENCE BY A PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH PROFESSIONALS OR REPRE
MEDICAL CONFERENCE BY A PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH PROFESSIONALS OR REPRE
COMPREHENSIVE GERIATRIC ASSESSMENT AND TREATMENT PLANNING PERFORMED BY ASSESSMENT TEAM
HOSPICE REFERRAL VISIT (ADVISING PATIENT AND FAMILY OF CARE OPTIONS) PERFORMED BY NURSE, SOCIAL W
HISTORY&PHYSICAL (OUTPATIENT/OFFICE) RELATED SURGICAL PROCEDURE (LIST SEPARATELY ADDITION CD, AP
COMPLETED EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) SERVICE (LIST IN ADDITION TO C
HOSPITALIST SERVICES (LIST SEPARATELY IN ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEM
DISEASE MANAGEMENT PROGRAM; INITIAL ASSESSMENT AND INITIATION OF THE PROGRAM
FOLLOW-UP/REASSESSMENT
TELEPHONE CALLS BY A REGISTERED NURSE TO A DISEASE MANAGEMENT PROGRAM MEMBER FOR MONITORING
LIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE, INCLUDING ALL SUPPO
ROUTINE FOOT CARE; REMOVAL AND/OR TRIMMING OF CORNS, CALLUSES AND/OR NAILS AND PREVENTIVE MAIN
IMPRESSION CASTING OF A FOOT PERFORMED BY A PRACTITIONER OTHER THAN THE MANUFACTURER OF THE O
GLOBAL FEE FOR EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY TREATMENT OF KIDNEY STONE(S)
DISPOSABLE CONTACT LENS, PER LENS
SINGLE VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS
BIFOCAL VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS
TRIFOCAL VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS
NON-PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS
DAILY WEAR SPECIALTY CONTACT LENS, PER LENS
COLOR CONTACT LENS, PER LENS
SAFETY EYEGLASS FRAMES
SUNGLASSES FRAMES
POLYCARBONATE LENS (LIST THIS CODE IN ADDITION TO THE BASIC CODE FOR THE LENS)
NONSTANDARD LENS (LIST THIS CODE IN ADDITION TO THE BASIC CODE FOR THE LENS)
INTEGRAL LENS SERVICE, MISCELLANEOUS SERVICES REPORTED SEPARATELY
COMPREHENSIVE CONTACT LENS EVALUATION
SCREENING PROCTOSCOPY
DIGITAL RECTAL EXAMINATION, ANNUAL
ANNUAL GYNECOLOGICAL EXAMINATION, NEW PATIENT
ANNUAL GYNECOLOGICAL EXAMINATION, ESTABLISHED PATIENT
ROUTINE OPHTHALMOLOGICAL EXAMINATION INCLUDING REFRACTION; NEW PATIENT
ROUTINE OPHTHALMOLOGICAL EXAMINATION INCLUDING REFRACTION; ESTABLISHED PATIENT
PHYSICAL EXAM FOR COLLEGE, NEW OR ESTABLISHED PATIENT (LIST SEPARATELY IN ADDITION TO APPROPRIATE
REMOVAL OF SUTURES; BY A PHYSICIAN OTHER THAN THE PHYSICIAN WHO ORIGINALLY CLOSED THE WOUND
LASER IN SITU KERATOMILEUSIS (LASIK)
PHOTOREFRACTIVE KERATECTOMY (PRK)
PHOTOTHERAPEUTIC KERATECTOMY (PTK)
COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL
ULTRASOUND PACHYMETRY TO DETERMINE CORNEAL THICKNESS, WITH INTERPRETATION AND REPORT, UNILATE
DELUXE ITEM, PATIENT AWARE (LIST IN ADDITION TO CODE FOR BASIC ITEM)
CUSTOMIZED ITEM (LIST IN ADDITION TO CODE FOR BASIC ITEM)
IV TUBING EXTENSION SET
NON-PVC (POLYVINYL CHLORIDE) INTRAVENOUS ADMINISTRATION SET, FOR USE WITH DRUGS THAT ARE NOT STA
INHALED NITRIC OXIDE FOR THE TREATMENT OF HYPOXIC RESPIRATORY FAILURE IN THE NEONATE; PER DIEM
CONTINUOUS NONINVASIVE GLUCOSE MONITORING DEVICE, PURCHASE (FOR PHYSICIAN INTERPRETATION OF D
CONT NONINVASIVE GLUCOSE MONITOR DEVICE, RENTAL, INCL SENSR, SENSR REPLCMNT,&DOWNLOAD MONITO
CRAINAL REMOLDING ORTHOSIS, RIGID, WITH SOFT INTERFACE MATERIAL, CUSTOM FABRICATED, INCLUDES FITT
TRANSPLANTATION OF SMALL INTESTINE AND LIVER ALLOGRAFTS
TRANSPLANTATION OF MULTIVISCERAL ORGANS
HARVESTING OF DONOR MULTIVISCERAL ORGANS, WITH PREPARATION AND MAINTENANCE OF ALLOGRAFTS; FR
LOBAR LUNG TRANSPLANTATION
DONOR LOBECTOMY (LUNG) FOR TRANSPLANTATION, LIVING DONOR
SIMULTANEOUS PANCREAS KIDNEY TRANSPLANTATION
LASER-ASSISTED UVULOPALATOPLASTY (LAUP)
ISLET CELL TISSUE TRANSPLANT FROM PANCREAS; ALLOGENEIC
ADRENAL TISSUE TRANSPLANT TO BRAIN
ADOPTIVE IMMUNOTHERAPY I.E. DEVELOPMENT OF SPECIFIC ANTI-TUMOR REACTIVITY (E.G. TUMOR-INFILTRATIN
ARTHROSCOPY, KNEE, SURGICAL FOR HARVESTING OF CARTILAGE (CHONDROCYTE CELLS)
OSTEOTOMY, PERIACETABULAR, WITH INTERNAL FIXATION
LOW DENSITY LIPOPROTEIN (LDL) APHERESIS USING HEPARIN-INDUCED EXTRACORPOREAL LDL PRECIPITATION
ENDOLUMINAL RADIOFREQUENCY ABLATION OF REFLUXING SAPHENOUS VEIN
CORD BLOOD HARVESTING FOR TRANSPLANTATION, ALLOGENEIC
CORD BLOOD-DERIVED STEM-CELL TRANSPLANTATION, ALLOGENEIC
BN MARRW/BLOOD-DERIVED PERIPH STEM CELL HARV&TRANSPLANT, ALLO/AUTOLOGOUS, INCL PHERES, HI-DOS
ECHOSCLEROTHERAPY
MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING MINI-THORACOTOMY OR MINI-ST
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CAROTID ARTERY, PERCUTANEOUS, UNILATERAL (I
UTERINE ARTERY EMBOLIZATION FOR UTERINE FIBROIDS
INDUCED ABORTION, 17 TO 24 WEEKS, ANY SURGICAL METHOD
ABORTION FOR MATERNAL INDICATION, 25 WEEKS OR GREATER
ABORTION FOR FETAL INDICATION, 25-28 WEEKS
ABORTION FOR FETAL INDICATION, 29-31 WEEKS
ABORTION FOR FETAL INDICATION, 32 WEEKS OR GREATER
ARTHROSCOPY, SHOULDER, SURGICAL; WITH THERMALLY-INDUCED CAPSULORRHAPHY
CHEMODENERVATION OF ABDUCTOR MUSCLE(S) OF VOCAL CORD
CHEMODENERVATION OF ADDUCTOR MUSCLE(S) OF VOCAL CORD
NASAL ENDOSCOPY FOR POST-OPERATIVE DEBRIDEMENT FOLLOWING FUNCTIONAL ENDOSCOPIC SINUS SURGE
PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; CERVICAL
EACH ADDITIONAL CERVICAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDU
INTRADISCAL ELECTROTHERMAL THERAPY, SINGLE INTERSPACE
EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
REPAIR, CONGENITAL DIAPHRAGMATIC HERNIA IN THE FETUS USING TEMPORARY TRACHEAL OCCLUSION, PROCE
REPAIR, URINARY TRACT OBSTRUCTION IN THE FETUS, PROCEDURE PERFORMED IN UTERO

REPAIR, CONGENITAL CYSTIC ADENOMATOID MALFORMATION IN THE FETUS, PROCEDURE PERFORMED IN UTERO
REPAIR, EXTRALOBAR PULMONARY SEQUESTRATION IN THE FETUS, PROCEDURE PERFORMED IN UTERO
REPAIR, MYELOMENINGOCELE IN THE FETUS, PROCEDURE PERFORMED IN UTERO
REPAIR OF SACROCOCCYGEAL TERATOMA IN THE FETUS, PROCEDURE PERFORMED IN UTERO
REPAIR, CONGENITAL MALFORMATION OF FETUS, PROCEDURE PERFORMED IN UTERO, NOT OTHERWISE CLASSI
FETOSCOPIC LASER THERAPY FOR TREATMENT OF TWIN-TO-TWIN TRANSFUSION SYNDROME
STAT LABORATORY REQUEST (SITUATIONS OTHER THAN S3601)
EMERGENCY STAT LABORATORY CHARGE FOR PATIENT WHO IS HOMEBOUND OR RESIDING IN A NURSING FACILI
NEWBORN METABOLIC SCREENING PANEL, INCLUDES TEST KIT, POSTAGE AND THE LABORATORY TESTS SPECIFI
EOSINOPHIL COUNT, BLOOD, DIRECT
HIV-1 ANTIBODY TESTING OF ORAL MUCOSAL TRANSUDATE
SALIVA TEST, HORMONE LEVEL; DURING MENOPAUSE
SALIVA TEST, HORMONE LEVEL; TO ASSESS PRETERM LABOR RISK
ANTISPERM ANTIBODIES TEST (IMMUNOBEAD)
IMMUNOASSAY FOR NUCLEAR MATRIX PROTEIN 22 (NMP-22), QUANTITATIVE
GASTROINTESTINAL FAT ABSORPTION STUDY
COMPLETE GENE SEQUENCE ANALYSIS; BRCA1 GENE
COMPLETE GENE SEQUENCE ANALYSIS; BRCA2 GENE
COMPLETE MLH1 AND MLH2 GENE SEQUENCE ANALYSIS FOR HEREDITARY NONPOLYPOSIS COLORECTAL CANCE
1-MUTATION ANAL (IN INDIV W KNOWN MLH1&MLH2 MUTATION THE FAMILY), HEREDITARY NONPOLYPOSIS COLOR
COMPLETE GENE SEQUENCE ANALYSIS FOR CYSTIC FIBROSIS GENETIC TESTING
COMPLETE GENE SEQUENCE ANALYSIS FOR HEMOCHROMATOSIS GENETIC TESTING
SURFACE ELECTROMYOGRAPHY (EMG)
BALLISTOCARDIOGRAM
MASTERS TWO STEP
INTERIM LABOR FACILITY GLOBAL (LABOR OCCURRING BUT NOT RESULTING IN DELIVERY)
IN VITRO FERTILIZATION; INCLUDING BUT NO LIMITED IDENTIFICATION&INCUBATION, MATURE OOCYTES, FERTILIZ
COMPLETE CYCLE, GAMETE INTRAFALLOPIAN TRANSFER (GIFT), CASE RATE
COMPLETE CYCLE, ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT), CASE RATE
COMPLETE IN VITRO FERTILIZATION CYCLE, NOT OTHERWISE SPECIFIED, CASE RATE
FROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE
INCOMPLETE CYCLE, TREATMENT CANCELLED PRIOR TO STIMULATION, CASE RATE
FROZEN EMBRYO TRANSFER PROCEDURE CANCELLED BEFORE TRANSFER, CASE RATE
IN VITRO FERTILIZATION PROCEDURE CANCELLED BEFORE ASPIRATION, CASE RATE
IN VITRO FERTILIZATION PROCEDURE CANCELLED AFTER ASPIRATION, CASE RATE
ASSISTED OOCYTE FERTILIZATION, CASE RATE
DONOR EGG CYCLE, INCOMPLETE, CASE RATE
DONOR SERVICES FOR IN VITRO FERTILIZATION (SPERM OR EMBRYO), CASE RATE
PROCUREMENT OF DONOR SPERM FROM SPERM BANK
STORAGE OF PREVIOUSLY FROZEN EMBRYOS
MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION (MESA)
SPERM PROCUREMENT AND CRYOPRESERVATION SERVICES; INITIAL VISIT
SPERM PROCUREMENT AND CRYOPRESERVATION SERVICES; SUBSEQUENT VISIT
STIMULATED INTRAUTERINE INSEMINATION (IUI), CASE RATE
INTRAVAGINAL CULTURE (IVC), CASE RATE
CRYOPRESERVED EMBRYO TRANSFER, CASE RATE
MONITORING AND STORAGE OF CRYOPRESERVED EMBRYOS, PER 30 DAYS
INSERTION OF LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM
CONTRACEPTIVE INTRAUTERINE DEVICE (E.G. PROGESTACERT IUD), INCLUDING IMPLANTS AND SUPPLIES
NICOTINE PATCHES, LEGEND
NICOTINE PATCHES, NON-LEGEND
CONTRACEPTIVE PILLS FOR BIRTH CONTROL
SMOKING CESSATION GUM
PRESCRIPTION DRUG, GENERIC
PRESCRIPTION DRUG, BRAND NAME
5% DEXTROSE AND 45% NORMAL SALINE, 1000 ML
5% DEXTROSE IN LACTATED RINGER'S, 1000 ML
5% DEXTROSE WITH POTASSIUM CHLORIDE, 1000 ML
5% DEXTROSE/45% NORMAL SALINE WITH POTASSIUM CHLORIDE AND MAGNESIUM SULFATE, 1000 ML
5% DEXTROSE/0.45% NORMAL SALINE WITH POTASSIUM CHLORIDE AND MAGNESIUM SULFATE, 1500 ML
HOME INFUSION THERAPY, ROUTINE SERVICE OF INFUSION DEVICE (E.G. PUMP MAINTENANCE)
HOME INFUSION THERAPY, REPAIR OF INFUSION DEVICE (E.G. PUMP REPAIR)
DAY CARE SERVICES, ADULT;PER 15 MINUTES
DAY CARE SERVICES, ADULT;PER HALF DAY
DAY CARE SERVICES, ADULT;PER DIEM
DAY CARE SERVICES, CENTER-BASED;SERVICES NOT INCLUDED IN PROGRAM FEE, PER DIEM
HOME CARE TRAINING, FAMILY;PER 15 MINUTES
HOME CARE TRAINING, FAMILY;PER SESSION
HOME CARE TRAINING, NON-FAMILY; PER 15 MINUTES
HOME CARE TRAINING, NON-FAMILY; PER SESSION
CHORE SERVICES; PER 15 MINUTES
CHORE SERVICES; PER DIEM
ATTENDANT CARE SERVICES; PER 15 MINUTES
ATTENDANT CARE SERVICES; PER DIEM
HOMEMAKER SERVICES, NOS; PER 15 MINUTES
HOMEMAKER SERVICES, NOS; PER DIEM
COMPAINION CARE, ADULT(E.G. IADL/ADL);PER 15 MINUTES
COMPAINION CARE, ADULT(E.G. IADL/ADL);PER DIEM
FOSTER CARE, ADULT; PER DIEM
FOSTER CARE, ADULT;PER MONTH
FOSTER CARE, THERAPEUTIC, CHILD; PER DIEM
FOSTER CARE, THERAPEUTIC, CHILD; PER MONTH
UNSKILLED RESPITE CARE, NOT HOSPICE; PER 15 MINUTES
UNSKILLED RESPITE CARE, NOT HOSPICE; PER DIEM
EMERGENCY RESPONSE SYSTEM; INSTALLATION AND TESTING
EMERGENCY RESPONSE SYSTEM; SERVICE FEE, PER MONTH(EXCLUDES INSTALLATION AND TESTING)
EMERGENCY RESPONSE SYSTEM; PURCHASE ONLY
HOME MODIFICATIONS; PER SERVICE
HOME DELIVERED MEALS, INCLUDING PREPARATION; PER MEAL
LAUNDRY SERBICE, EXTERNAL,PROFESSIONAL; PER ORDER
HOME HEALTH RESPIRATORY THERAPY, INITIAL EVALUATION
HOME HEALTH RESPIRATORY THERAPY, NOS, PER DIEM
MEDICATION REMINDER SERVICE, NON-FACE-TO-FACE; PER MONTH
WELLNESS ASSESSMENT, PERFORMED BY NON-PHYSICIAN
PERSONAL CARE ITEM, NOS, EACH
HOME INFUS TX, CATH CARE/MAINT, NOT OTHRWISE CLASSFD; ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY
HOME INFUS TX, CATH CARE/MAINT, SIMP (1 LMN), ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE C
HOME INFUS TX, CATH CARE/MAINT, CMPLX (> 1 LMN), ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CA
HOME INFUS TX, CATH CARE/MAINT, IMPLED ACCSS, ADMIN SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDN
HOME INFUSION THERAPY, ALL SUPPLIES NECESSARY FOR RESTORATION OF CATHETER PATENCY OR DECLOTTI
HOME INFUSION THERAPY, ALL SUPPLIES NECESSARY FOR CATHETER REPAIR
HOME INFUSION THERAPY, ALL SUPPLIES (INCLUDING CATHETER) NECESSARY FOR A PERIPHERALLY INSERTED C
HOME INFUSION THERAPY, ALL SUPPLIES (INCLUDING CATHETER) NECESSARY FOR A MIDLINE CATHETER INSERT
HOME INFUSION THERAPY, INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), NURSI
HOME INFUSION THERAPY, INSERTION OF MIDLINE CENTRAL VENOUS CATHETER, NURSING SERVICES ONLY (NO
RADIOIMMUNOPHARMACEUTICAL LOCALIZATION OF TARGETED CELLS; WHOLE BODY
SCLERAL APPLICATION OF TANTALUM RING(S) FOR LOCALIZATION OF LESIONS FOR PROTON BEAM THERAPY
MAGNETIC SOURCE IMAGING
MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)
TOPOGRAPHIC BRAIN MAPPING
MAGNETIC RESONANCE IMAGING (MRI), LOW-FIELD
INTRAOPERATIVE RADIATION THERAPY (SINGLE ADMINISTRATION)
US, MULTFET PRG REDUCTION(S), TECHNICAL COMPONENT (BE USED WHEN THEDRDOING THE REDUCTN PROC
SCINTIMAMMOGRAPHY (RADIOIMMUNOSCINTIGRAPHY OF THE BREAST), UNILATERAL, INCLUDING SUPPLY OF RAD
FLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL-HEAD COINCIDENCE DETECTION SYSTE
ELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINE CT)
WIG (FOR MEDICALLY-INDUCED OR CONGENITAL HAIR LOSS)
PORTABLE PEAK FLOW METER
ASTHMA KIT (INCLUDING BUT NOT LIMITED TO PORTABLE PEAK EXPIRATORY FLOW METER, INSTRUCTIONAL VIDE
HOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITHOUT MASK
HOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITH MASK
PEAK EXPIRATORY FLOW RATE (PHYSICIAN SERVICES)
TRACHEOSTOMY SHOWER PROTECTOR
TRACHEOSTOMY TUBE HOLDER
HUMIDIFIER, HEATED, USED WITH VENTILATOR, NON-SERVO-CONTROLLED
HUMIDIFIER, HEATED, USED WITH VENTILATOR, DUAL SERVO-CONTROLLED WITH TEMPERATURE MONITORING
FLUTTER DEVICE
SWIVEL ADAPTOR
TRACHEOSTOMY SUPPLY, NOT OTHERWISE CLASSIFIED
ELECTRONIC SPIROMETER (OR MICROSPIROMETER)
MUCUS TRAP
ORAL ORTHOTIC FOR TREATMENT OF SLEEP APNEA, INCLUDES FITTING, FABRICATION, AND MATERIALS
MANDIBULAR ORTHOPEDIC REPOSITIONING DEVICE, EACH
HABERMAN FEEDER FOR CLEFT LIP/PALATE
SUPPLIES FOR HOME DELIVERY OF INFANT
GRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), CUSTOM MADE
GRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), READY MADE
GRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, MEDIUM WEIGHT
GRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, HEAVY WEIGHT
GRADIENT PRESSURE AID (SLEEVE), READY MADE
GRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, MEDIUM WEIGHT
GRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, HEAVY WEIGHT
GRADIENT PRESSURE AID (GLOVE), READY MADE
GRADIENT PRESSURE AID (GAUNTLET), READY MADE
GRADIENT PRESSURE EXTERIOR WRAP
PADDING FOR COMPRESSION BANDAGE, ROLL
COMPRESSION BANDAGE, ROLL

SPLINT, PREFABRICATED, DIGIT (SPECIFY DIGIT BY USE OF MODIFIER)
SPLINT, PREFABRICATED, WRIST OR ANKLE
SPLINT, PREFABRICATED, ELBOW
INSULIN SYRINGES (100 SYRINGES, ANY SIZE)
PHYSICAL MEDICINE TREATMENT (CONSTANT ATTENDANCE BY PROVIDER) TO ONE AREA, INITIAL 30 MINUTES, EA
COMPLEX LYMPHEDEMA THERAPY, EACH 15 MINUTES
RESUSCITATION BAG (FOR USE BY PATIENT ON ARTIFICIAL RESPIRATION DURING POWER FAILURE OR OTHER CA
HOME UTERINE MONITOR WITH OR WITHOUT ASSOCIATED NURSING SERVICES
ULTRAFILTRATION MONITOR
AUTOMATED EEG MONITORING
DIGITAL SUBTRACTION ANGIOGRAPHY (USE IN ADDITION TO CPT CODE FOR THE PROCEDURE FOR FURTHER IDE
PARANASAL SINUS ULTRASOUND
OMNICARDIOGRAM/CARDIOINTEGRAM
EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR GALL STONES (IF PERFORMED WITH ERCP, USE 43265)
PROCUREN OR OTHER GROWTH FACTOR PREPARATION TO PROMOTE WOUND HEALING
COMA STIMULATION PER DIEM
HOME ADMINISTRATION, AEROSOLIZED DRUG THERAPY (E.G., PENTAMIDINE); ADMINISTRATIVE SERVICES, PROFE
SMOKING CESSATION TREATMENT
GLOBAL FEE URGENT CARE CENTERS
SERVICES PROVIDED IN AN URGENT CARE CENTER (LIST IN ADDITION TO CODE FOR SERVICE)
VERTEBRAL AXIAL DECOMPRESSION, PER SESSION
CANOLITH REPOSITIONING, PER VISIT
HOME VISIT, PHOTOTHERAPY SERVICES (E.G. BILI-LITE), INCLUDING EQUIPMENT RENTAL, NURSING SERVICES, BL
CONGESTIVE HEART FAILURE TELEMONITORING, EQUIPMENT RENTAL, INCLUDING TELESCALE, COMPUTER SYST
BACK SCHOOL, PER VISIT
HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PROVIDING CARE IN THE HOME; PER HOUR
NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NO
NURSING CARE, IN THE HOME; BY LICENSED PRACTICAL NURSE, PER HOUR
RESPITE CARE, IN THE HOME, PER DIEM
HOSPICE CARE, IN THE HOME, PER DIEM
SOCIAL WORK VISIT, IN THE HOME, PER DIEM
SPEECH THERAPY, IN THE HOME, PER DIEM
OCCUPATIONAL THERAPY, IN THE HOME, PER DIEM
PHYSICAL THERAPY; IN THE HOME, PER DIEM
DIABETIC MANAGEMENT PROGRAM, FOLLOW-UP VISIT TO NON-MD PROVIDER
DIABETIC MANAGEMENT PROGRAM, FOLLOW-UP VISIT TO MD PROVIDER
INSULIN PUMP INITIATION, INSTRUCTION IN INITIAL USE OF PUMP (PUMP NOT INCLUDED)
EVALUATION BY OCULARIST
HOME MGT, PRETERM LABOR, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATION, AND
HOME MGT, PRETERM PREMATURE RUPTURE, MEMBRANES (PPROM), ADMINISTRATIVE SVCS, PROFSIONAL PHAR
HOME MGT, GESTATIONAL HTN, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATION, AN
HOME MGT, PSTPT HTN, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATION, AND SUPP
HOME MGT, PREECLAMPSIA, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATION,SUP&
HOME MGT, GESTATIONAL DIABETES, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATIO
HOME INFUS TX, PAIN MGT INFUS; ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORD,SUP&EQ
HOME INFUSION THERAPY, CONTINUOUS PAIN MGT INFUSION; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMAC
HOME INFUSION THERAPY, INTERMITTENT PAIN MGT INFUSION; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMAC
HOME INFUSION THERAPY, IMPLANTED PUMP PAIN MGT INFUSION; ADMINISTRATIVE SVCS, PROFESSIONAL PHAR
HOME INFUS TX, CHEMOTX INFUS; ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATION
HOME INFUSION THERAPY, CONTINUOUS CHEMOTHERAPY INFUSION; ADMINISTRATIVE SVCS, PROFESSIONAL PH
HOME INFUSION THERAPY, INTERMITTENT CHEMOTHERAPY INFUSION; ADMINISTRATIVE SVCS, PROFESSIONAL P
HOME INFUS TX, CONT ANTICOAGULANT INFUS TX (E.G. HEPARIN), ADMINISTRATIVE SVCS, PROFSIONAL PHARMA
HOME INFUSION THERAPY, IMMUNOTHERAPY THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVC
HOME THERAPY; PERITONEAL DIALYSIS, ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CARE COORD
HOME THERAPY; ENTERAL NUTRITION; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CARE COORDIN
HOME THERAPY; ENTERAL NUTRITION VIA GRAVITY; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CA
HOME THERAPY; ENTERAL NUTRITION VIA PUMP; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CARE
HOME THERAPY; ENTERAL NUTRITION VIA BOLUS; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CAR
HOME INFUS TX, ANTI-HEMOPHILIC AG INFUS TX (E.G. FACTOR VIII); ADMINISTRATIVE SVCS, PROFSIONAL PHARMA
HOME INFUS TX, ALPHA-1-PROTASE INHIBITOR (E.G., PROLASTIN); ADMINISTRATIVE SVCS, PROFSIONAL PHARMAC
HOME INFUS TX, UNINTER, LONG-TERM, CNTRL RATE IV/SUBQ INFUS TX (E.G. EPOPROSTEN); ADMINISTRATIVE SV
HOME INFUS TX, SYMPATHOMIMETIC/INOTROPIC AG INFUS TX (E.G.,DOBUTAMINE); ADMINISTRATIVE SVCS, PROFS
HOME INFUSION THERAPY, TOCOLYTIC INFUSION THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY S
HOME INFUSION THERAPY, CONTINUOUS ANTI-EMETIC INFUSION THERAPY; ADMINISTRATIVE SVCS, PROFESSION
HOME INFUSION THERAPY, CONTINUOUS INSULIN INFUSION THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PH
HOME INFUSION THERAPY, CHELATION THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CAR
HOME INFUS TX, ENZYME REPLCMNT IV TX; (E.G. IMIGLUCERASE); ADMINISTRATIVE SVCS, PROFSIONAL PHARMAC
HOME INFUS TX, ANTI-TUMR NECROSIS FACTOR IV TX; (E.G. INFLIXIMAB); ADMINISTRATIVE SVCS, PROFSIONAL PH
HOME INFUSION THERAPY, DIURETIC INTRAVENOUS THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PHARMAC
HOME INFUSION THERAPY, ANTI-SPASMOTIC INTRAVENOUS THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PH
HOME INFUS TX, TTL PARENTERAL NUTR (TPN);ADMIN SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATIO
HOME INFUS TX,TTL PARENTERAL NUTR;1 LITER/DAY,ADMINISTRATIVE SVCS,PROFSIONAL PHARMACY SVCS,CARE
HOME INFUS TX,TTL PARENTRAL NUTR;>1 LITER BUT NO>2 LITERS/DAY,ADMIN SVCS,PROFSIONAL RX SVCS,CARE
HOME INFUS TX,TTL PARENTERAL NUTR(TPN);>2 LITERS BUT NO>3 LITERS/DAY,ADMIN SVCS,PROF RX SVCS, CAR
HOME INFUS TX,TTL PARENTERAL NUTR(TPN);>3 LITERS/DAY,ADMIN SVCS,PROF RX SVCS,CARE COORDINATION,S
HOME THERAPY, INTERMITTENT ANTI-EMETIC INJECTION THERAPY; ADMINISTRATIVE SVCS, PROFESSIONAL PHAR
HOME TX;INTERMITT ANTICOAGULANT INJ TX(E.G. HEPARIN);ADMIN SVCS,PROFSIONAL RX SVCS,CARE COORDINA
HOME INFUS TX, HYD TX; ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVCS, CARE COORDINATION,SUP&EQU
HOME INFUSION THERAPY, HYDRATION THERAPY; 1 LITER/DAY, ADMINISTRATIVE SVCS, PROFESSIONAL PHARMAC
HOME INFUS TX, HYD TX; > 1 LITER BUT NO > 2 LITERS/DAY, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SVC
HOME INFUS TX, HYD TX; > 2 LITERS BUT NO > 3 LITERS/DAY, ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY SV
HOME INFUSION THERAPY, HYDRATION THERAPY; > 3 LITERS/DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PH
HOME INFUS TX, INFUS TX, NOT OTHRWISE CLASSFD; ADMIN SVCS, PROFSIONAL PHARMACY SVCS, CARE COORD
DELIVERY OR SERVICE TO HIGH RISK AREAS REQUIRING ESCORT OR EXTRA PROTECTION, PER VISIT
ANTICOAGULATION CLINIC, INCLUSIVE OF ALL SERVICES EXCEPT LABORATORY TESTS, PER SESSION
PHARMACY COMPOUNDING AND DISPENSING SERVICES
MEDICAL FOODS FOR INBORN ERRORS OF METABOLISM
CHILDBIRTH PREPARATION/LAMAZE CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
CHILDBIRTH REFRESHER CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
CESAREAN BIRTH CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
VBAC (VAGINAL BIRTH AFTER CESAREAN) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
ASTHMA EDUCATION, NON-PHYSICIAN PROVIDER, PER SESSION
BIRTHING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
PARENTING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION
PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, GROUP, PER SESSION
INFANT SAFETY (INCLUDING CPR) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION

WEIGHT MANAGEMENT CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
EXERCISE CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
NUTRITION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
SMOKING CESSATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
STRESS MANAGEMENT CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION
DIABETIC MANAGEMENT PROGRAM, GROUP SESSION
DIABETIC MANAGEMENT PROGRAM, NURSE VISIT
DIABETIC MANAGEMENT PROGRAM, DIETITIAN VISIT
NUTRITIONAL COUNSELING, DIETITIAN VISIT
CARDIAC REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM
PULMONARY REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM
ENTEROSTOMAL THERAPY BY A REGISTERED NURSE CERTIFIED IN ENTEROSTOMAL THERAPY, PER DIEM
AMBULATORY SETTING SUBSTANCE ABUSE TREATMENT OR DETOXIFICATION SERVICES, PER DIEM
INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM
CRISIS INTERBENTION MENTAL HEALTH SERVICES, PER HOUR
CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM
HOME INFUSION THERAPY, CORTICOSTEROID INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY
HOME INFUS TX,ABX,ANTIVIR,/ANTIFUNGAL TX;ADMIN SVCS,PROFSIONAL PHARMACY SVCS,CARE COORDINATION
HOME INFUS TX, ABX, ANTIVIR,/ANTIFUNGAL TX; ONCE EVERY 3 HRS; ADMINISTRATIVE SVCS, PROFSIONAL PHARM
HOME INFUS TX, ABX, ANTIVIR,/ANTIFUNGAL TX; ONCE EVERY 24 HRS; ADMINISTRATIVE SVCS, PROFSIONAL PHAR
HOME INFUS TX, ABX, ANTIVIR,/ANTIFUNGAL TX; ONCE EVERY 12 HRS; ADMINISTRATIVE SVCS, PROFSIONAL PHAR
HOME INFUS TX, ABX, ANTIVIR,/ANTIFUNGAL TX; ONCE EVERY 8 HRS, ADMINISTRATIVE SVCS, PROFSIONAL PHARM
HOME INFUS TX, ABX, ANTIVIR,/ANTIFUNGAL; ONCE EVERY 6 HRS; ADMINISTRATIVE SVCS, PROFSIONAL PHARMAC
HOME INFUS TX, ABX, ANTIVIR,/ANTIFUNGAL; ONCE EVERY 4 HRS; ADMINISTRATIVE SVCS, PROFSIONAL PHARMAC
NURSING SERVICES RELATED TO HOME IV THERAPY, PER DIEM
ROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S), SINGLE HOME BOUND, NURSING HOME, OR SKILLE
HOME TX; HEMATOP HORME INJ TX (E.G.CRYTHROPOIETIN, G-CSF, GM-CSF); ADMINISTRATIVE SVCS, PROFSIONAL
HOME TRANSFUSION, BLOOD PRODUCT(S); ADMINISTRATIVE SVCS, PROFESSIONAL PHARMACY SVCS, CARE COO
HOME INJABLE TX; NOT OTHRWISE CLASSIFIED, ADMIN SVCS, PROFSIONAL PHARMACY SVCS, COORDINATION, CA
HOME INFUSION OF BLOOD PRODUCTS, NURSING SERVICES, PER VISIT
HOME INJECTABLE THERAPY; GROWTH HORMONE, INCL ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY
HOME INJECTABLE THERAPY; INTERFERON, INCL ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVIC
HOME INJABLE TX; HORMAL TX (E.G., LEUPROLIDE, GOSERELIN),ADMINISTRATIVE SVCS, PROFSIONAL PHARMACY
HOME INJECTABLE THERAPY,PALIVIZUMAB,ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,CA
HOME THERAPY,IRRIGATION THERAPY;ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE
HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, NURSING SERVICES; PER VISIT (UP TO 2 HOURS)
EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE S9802)
RN SERVICES IN THE INFUSION SUITE OF THE IV THERAPY PROVIDER, PER VISIT
HOME THERAPY; PROFESSIONAL PHARMACY SERVICES, PROVISION, INFUSION, SPECIALTY DRUG ADMINISTRATIO
SERVICES BY AUTHORIZED CHRISTIAN SCIENCE PRACTITIONER FOR THE PROCESS OF HEALING, PER DIEM. NOT
HEALTH CLUB MEMBERSHIP, ANNUAL
TRANSPLANT RELATED LODGING, MEALS AND TRANSPORTATION, PER DIEM
MEDICAL RECORDS COPYING FEE, ADMINISTRATIVE
MEDICAL RECORDS COPYING FEE, PER PAGE
NOT MEDICALLY NECESSARY SERVICE (PATIENT IS AWARE THAT SERVICE NOT MEDICALLY NECESSARY)
SERVICES PROVIDED OUTSIDE OF THE UNITED STATES OF AMERICA (LIST IN ADDITION TO CODE(S) FOR SERVICE
SERVICES PROVIDED AS PART OF A PHASE II CLINICAL TRIAL
SERVICES PROVIDED AS PART OF A PHASE III CLINICAL TRIAL
TRANSPORTATION COSTS TO AND FROM TRIAL LOCATION AND LOCAL TRANSPORTATION COSTS (E.G., FARES FOR
LODGING COSTS (E.G., HOTEL CHARGES) FOR CLINICAL TRIAL PARTICIPANT AND ONE CAREGIVER/COMPANION
MEALS FOR CLINICAL TRIAL PARTICIPANT AND ONE CAREGIVER/COMPANION
SALES TAX
PRIVATE DUTY/INDEPENDENT NURSING SERVICE(S) - LICENSED, UP TO 15 MINUTES
NURSING ASSESSMENT/EVALUATION
RN SERVICES, UP TO 15 MINUTES
LPN/LVN SERVICES, UP TO 15 MINUTES
SERVICES OF A QUALIFIED NURSING AIDE, UP TO 15 MINUTES
RESPITE CARE SERVICES, UP TO 15 MINUTES
ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, FAMILY/COUPLE COUNSELING
ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, TREATMENT PLAN DEVELOPMENT AND/OR MODIFICATION
DAY TREATMENT FOR INDIVIDUAL ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES
CHILD SITTING SERVICES FOR CHILDREN OF THE INDIVIDUAL RECEIVING ALCOHOL AND/OR SUBSTANCE ABUSE S
MEALS FOR INDIVIDUALS RECEIVING ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES (WHEN MEALS NOT INCLUD
ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, NOT OTHERWISE CLASSIFIED
ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, SKILLS DEVELOPMENT
SIGN LANGUAGE OR ORAL INTERPRETIVE SERVICES, PER 15 MINUTE
TELEHEALTH TRANSMISSION, PER MINUTE, PROFESSIONAL SERVICES BILL SEPARATELY
CLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE
CASE MANAGEMENT, EACH 15 MINUTES
TARGETED CASE MANAGEMENT, EACH 15 MINUTES
SCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES, BUNDLED
PERSONAL CARE SERVICES,PER 15 MINUTES,NOT FOR AN INPATIENT/RESIDENT OF A HOSPITAL,NURSING FACILIT
PERSONAL CARE SERVICES, PER DIEM, NOT FOR AN INPATIENT OR RESIDENT OF A HOSPITAL, NURSING FACILITY,
HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PER VISIT
CONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT, PER DAY
SCREENING TO DETERMINE THE APPROPRIATENESS OF CONSIDERATION OF AN INDIVIDUAL FOR PARTICIPATION
EVALUATION AND TREATMENT BY AN INTEGRATED, SPECIALTY TEAM CONTRACTED TO PROVIDE COORDINATED C
INTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO CHILDREN WITH COMP
INTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO CHILDREN WITH COMP
FAMILY TRAINING AND COUNSELING FOR CHILD DEVELOPMENT, PER 15 MINUTES
ASSESSMENT OF HOME, PHYSICAL AND FAMILY ENVIRONMENT, TO DETERMINE SUITABILITY TO MEET PATIENT'S M
COMPREHENSIVE ENVIRONMENTAL LEAD INVESTIGATION, NOT INCLUDING LABORATORY ANALYSIS, PER DWELLIN
NURSING CARE, IN THE HOME, BY REGISTERED NURSE, PER DIEM
NURSING CARE, IN THE HOME, BY LICENSED PRACTICAL NURSE, PER DIEM
DIAPER/INCONTINENT PANT, REUSABLE/WASHABLE, ANY SIZE, EACH
ADMINISTRATION OF ORAL, INTRAMUSCULAR AND/OR SUBCUTANEOUS MEDICATION BY HEALTH CARE AGENCY/P
MISCELLANEOUS THERAPEUTIC ITEMS AND SUPPLIES, RETAIL PURCHASES, NOT OTHERWISE CLASSIFIED; IDENT
NON-EMERGENCY TRANSPORTATION; PATIENT ATTENDANT/ESCORT
NON-EMERGENCY TRANSPORTATION; PER DIEM
NON-EMERGENCY TRANSPORTATION; ENCOUNTER/TRIP
NON-EMERGENCY TRANSPORT; COMMERCIAL CARRIER, MULTI-PASS
NON-EMERGENCY TRANSPORTATION; NON-AMBULATORY STRETCHER VAN
AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT
TRANSPORTATION WAITING TIME, AIR AMBULANCE AND NON-EMERGENCY VEHICLE, ONE-HALF (1/2) HOUR INCRE
FRAMES, PURCHASES
DELUXE FRAME
SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00, PER LENS
SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS
SPHERE, SINGLE VISION, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS
SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO 2.00D CYLINDER, PER LENS
SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS
SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00 SPHERE, .12 TO 2.00D CYLINDER
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLIN
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 TO 6.00D CYLIND
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO 7.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, .25 TO 2.25D CYLIND
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 2.25D TO 4.00D CYL
SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 4.25 TO 6.00D CYLIN
SPHEROCYLINDER, SINGLE VISION, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS
LENTICULAR, (MYODISC), PER LENS, SINGLE VISION
LENTICULAR LENS, NONASPHERIC, PER LENS, SINGLE VISION
LENTICULAR, ASPHERIC, PER LENS, SINGLE VISION
ANISEIKONIC LENS, SINGLE VISION
NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS
SPHERE, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS
SPHERE, BIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS
SPHERE, BIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS
SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO 2.00D CYLINDER, PER LENS
SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS
SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,.12 TO 2.00D CYLINDER, PER
SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, P
SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER 6.00D CYLINDER,PER
SPHEROCYLINDER, BIFOCAL, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS
LENTICULAR (MYODISC), PER LENS, BIFOCAL
LENTICULAR, NONASPHERIC, PER LENS, BIFOCAL
LENTICULAR, ASPHERIC LENS, BIFOCAL
ANISEIKONIC, PER LENS, BIFOCAL
BIFOCAL SEG WIDTH OVER 28 MM
BIFOCAL ADD OVER 3.25D
SPECIALTY BIFOCAL (BY REPORT)
SPHERE, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS
SPHERE, TRIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS
SPHERE, TRIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00, PER LENS
SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12-2.00D CYLINDER, PER LENS
SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.25-4.00D CYLINDER, PER LENS
SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00 CYLINDER, PER LENS
SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, .12 TO 2.00D CYLINDER, P
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER,
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 TO 6.00D CYLINDER,
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER 6.00D CYLINDER, PE
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, .25 TO 2.25D CYLINDER,
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 2.25 TO 4.00D CYLINDER
SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 4.25 TO 6.00D CYLINDER
SPHEROCYLINDER, TRIFOCAL, SPHERE OVER PLUS OR MINUS 12 .00D, PER LENS
LENTICULAR, (MYODISC), PER LENS, TRIFOCAL
LENTICULAR NONASPHERIC, PER LENS, TRIFOCAL
LENTICULAR, ASPHERIC LENS, TRIFOCAL
ANISEIKONIC LENS, TRIFOCAL
TRIFOCAL SEG WIDTH OVER 28 MM
TRIFOCAL ADD OVER 3.25D
SPECIALTY TRIFOCAL (BY REPORT)
VARIABLE ASPHERICITY LENS, SINGLE VISION, FULL FIELD, GLASS OR PLASTIC, PER LENS
VARIABLE ASPHERICITY LENS, BIFOCAL, FULL FIELD, GLASS OR PLASTIC, PER LENS
VARIABLE SPHERICITY LENS, OTHER TYPE
CONTACT LENS, PMMA, SPHERICAL, PER LENS
CONTACT LENS, PMMA, TORIC OR PRISM BALLAST, PER LENS
CONTACT LENS, PMMA, BIFOCAL, PER LENS
CONTACT LENS, PMMA, COLOR VISION DEFICIENCY, PER LENS
CONTACT LENS, GAS PERMEABLE, SPHERICAL, PER LENS
CONTACT LENS, GAS PERMEABLE, TORIC, PRISM BALLAST, PER LENS
CONTACT LENS, GAS PERMEABLE, BIFOCAL, PER LENS
CONTACT LENS, GAS PERMEABLE, EXTENDED WEAR, PER LENS
CONTACT LENS, HYDROPHILIC, SPHERICAL, PER LENS
CONTACT LENS, HYDROPHILIC, TORIC, OR PRISM BALLAST, PER LENS
CONTACT LENS, HYDROPHILIC, BIFOCAL, PER LENS
CONTACT LENS, HYDROPHILIC, EXTENDED WEAR, PER LENS
CONTACT LENS, SCLERAL, GAS IMPERMEABLE, PER LENS (FOR CONTACT LENS MODIFICATION, SEE 92325)
CONTACT LENS, SCLERAL, GAS PERMEABLE, PER LENS (FOR CONTACT LENS MODIFICATION, SEE 92325)
CONTACT LENS, OTHER TYPE
HAND HELD LOW VISION AIDS AND OTHER NONSPECTACLE MOUNTED AIDS
SINGLE LENS SPECTACLE MOUNTED LOW VISION AIDS
TELESCOPIC AND OTHER COMPOUND LENS SYSTEM, INCLUDING DISTANCE VISION TELESCOPIC, NEAR VISION TE
PROSTHETIC EYE, PLASTIC, CUSTOM
POLISHING/RESURFACING OF OCULAR PROSTHESIS
ENLARGEMENT OF OCULAR PROSTHESIS
REDUCTION OF OCULAR PROSTHESIS
SCLERAL COVER SHELL
FABRICATION AND FITTING OF OCULAR CONFORMER
PROSTHETIC EYE, OTHER TYPE
ANTERIOR CHAMBER INTRAOCULAR LENS
IRIS SUPPORTED INTRAOCULAR LENS
POSTERIOR CHAMBER INTRAOCULAR LENS
BALANCE LENS, PER LENS
SLAB OFF PRISM, GLASS OR PLASTIC, PER LENS
PRISM, PER LENS
PRESS-ON LENS, FRESNELL PRISM, PER LENS
SPECIAL BASE CURVE, GLASS OR PLASTIC, PER LENS

TINT, PLASTIC, ROSE 1 OR 2 PER LENS
TINT, PLASTIC, OTHER THAN ROSE 1-2, PER LENS
TINT, GLASS ROSE 1 OR 2, PER LENS
TINT, GLASS OTHER THAN ROSE 1 OR 2, PER LENS
TINT, PHOTOCHROMATIC, PER LENS
ANTI-REFLECTIVE COATING, PER LENS
U-V LENS, PER LENS
SCRATCH RESISTANT COATING, PER LENS
OCCLUDER LENS, PER LENS
OVERSIZE LENS, PER LENS
PROGRESSIVE LENS, PER LENS
PROCESSING, PRESERVING AND TRANSPORTING CORNEAL TISSUE
AMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION, PER PROCEDURE
VISION SERVICE, MISCELLANEOUS
HEARING SCREENING
ASSESSMENT FOR HEARING AID
FITTING/ORIENTATION/CHECKING OF HEARING AID
REPAIR/MODIFICATION OF A HEARING AID
CONFORMITY EVALUATION
HEARING AID, MONAURAL, BODY WORN, AIR CONDUCTION
HEARING AID, MONAURAL, BODY WORN, BONE CONDUCTION
HEARING AID, MONAURAL, IN THE EAR
HEARING AID, MONAURAL, BEHIND THE EAR
GLASSES, AIR CONDUCTION
GLASSES, BONE CONDUCTION
DISPENSING FEE, UNSPECIFIED HEARING AID
SEMI-IMPLANTABLE MIDDLE EAR HEARING PROSTHESIS
HEARING AID, BILATERAL, BODY WORN
DISPENSING FEE, BILATERAL
BINAURAL, BODY
BINAURAL, IN THE EAR
BINAURAL, BEHIND THE EAR
BINAURAL, GLASSES
DISPENSING FEE, BINAURAL
HEARING AID, CROS, IN THE EAR
HEARING AID, CROS, BEHIND THE EAR
HEARING AID, CROS, GLASSES
DISPENSING FEE, CROS
HEARING AID, BICROS, IN THE EAR
HEARING AID, BICROS, BEHIND THE EAR
HEARING AID, BICROS, GLASSES
DISPENSING FEE, BICROS
DISPENSING FEE, MONAURAL HEARING AID, ANY TYPE
HEARING AID, ANALOG, MONAURAL, CIC (COMPLETELY IN THE EAR CANAL)
HEARING AID, ANALOG, MONAURAL, ITC (IN THE CANAL)
HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, CIC
HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG, MONAURAL, ITC
HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, ITE (IN THE EAR)
HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, BTE (BEHIND THE EAR)
HEARING AID, ANALOG, BINAURAL, CIC
HEARING AID, ANALOG, BINAURAL, ITC
HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, CIC
HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, ITC
HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, ITE
HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, BTE
HEARING AID, DIGITAL, MONAURAL, CIC
HEARING AID, DIGITAL, MONAURAL, ITC
HEARING AID, DIGITAL, MONAURAL, ITE
HEARING AID, DIGITAL, MONAURAL, BTE
HEARING AID, DIGITAL, BINAURAL, CIC
HEARING AID, DIGITAL, BINAURAL, ITC
HEARING AID, DIGITAL, BINAURAL, ITE
HEARING AID, DIGITAL, BINAURAL, BTE
HEARING AID, DISPOSABLE, ANY TYPE, MONAURAL
HEARING AID, DISPOSABLE, ANY TYPE, BINAURAL
EAR MOLD/INSERT, NOT DISPOSABLE, ANY TYPE
EAR MOLD/INSERT, DISPOSABLE, ANY TYPE
BATTERY FOR USE IN HEARING DEVICE
HEARING AID SUPPLIES/ACCESSORIES
ASSISTIVE LISTENING DEVICE, TELEPHONE AMPLIFIER, ANY TYPE
ASSISTIVE LISTENING DEVICE, ALERTING, ANY TYPE
ASSISTIVE LISTENING DEVICE, TELEVISION AMPLIFIER, ANY TYPE
ASSISTIVE LISTENING DEVICE, TELEVISION CAPTION DECODER
ASSISTIVE LISTENING DEVICE, TDD
ASSISTIVE LISTENING DEVICE, FOR USE WITH COCHLEAR IMPLANT
ASSISTIVE LISTENING DEVICE, NOT OTHERWISE CLASSIFIED
EAR IMPRESSION, EACH
HEARING AID, NOT OTHERWISE CLASSIFIED
HEARING SERVICE, MISCELLANEOUS
REPAIR/MODIFICATION OF AUGMENTATIVE COMMUNICATIVE SYSTEM OR DEVICE (EXCLUDES ADAPTIVE HEARING
SPEECH SCREENING
LANGUAGE SCREENING
DYSPHAGIA SCREENING
IMP
OMP
LE OR SINGLE
LICATED OR MULTIPLE
PRO
CEDURE)
SCI
SCI
A, AND MUSCLE
A, MUSCLE AND BONE
ION
TE/
ADD LESION (LIST SEP IN ADD TO CODE FOR PRIMARY PROC)
EDU
RE)
CM
OR LESS
TO
TO
TO
TO
R4
VER
1.0 CM
2.0 CM
3.0 CM
4.0 CM
.0 CM
CM OR LESS
TO 1.0 CM
TO 2.0 C
TO 3.0 CM
TO 4.0 CM
4.0 CM
PHA
LANX
0.5
0.6
0.1
0.1
0.1
SS
CM
OF
LE
O2
O3
CM
20 .0 SQ CM (LIST SEP IN ADD TO CODE FOR PRIMARY PROC)

"FILLING" MATERIAL (EG, COLLAGEN); 1 CC OR LESS
SS
7 5 CM
12 .5 CM
0.0 CM
0.0 CM
DDI
TION TO CODE FOR PRIMARY PROCEDURE)
0S
Q CM
SQ
TIO
ER
CM OR ONE PERCENT OF BODY AREA OF INFANTS & CHILDREN

NAL 100 SQ CM OR EACH ADDITIONAL ONE PERCENT OF BODY
(L
RCE
CEN
IST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROC)

NT OF BODY AREA OF INFANTS AND CHILDREN (EXC 15050)
T OF BODY AREA OF INFANTS & CHILDREN, OR PART THEREOF
IMA
RY PROCEDURE)
TIO
;2
;E
N TO CODE FOR PRIMARY PROCEDURE)

0 SQ CM OR LESS
ACH ADDITIONAL 20 SQ CM
IN
ADDITION TO CODE FOR PRIMARY PROCEDURE)
CH
NE
AIN
ES
INE
PEC
STAIN;1ST STAGE,FRESH TISSUE TECH,UP TO 5 SPECIMEN

; 2ND STAGE,FIXED / FRESH TISSUE,UP TO 5 SPECIMENS
TAIN;3RD STAGE,FIXED / FRESH TISSUE,UP TO 5 SPECIM
STAIN ADDL STAGE,UP TO 5 SPECIMENS, EACH STAGE
I,AFTER THE 1ST 5 SPECI,FIXED /FRESH TISSUE,ANY STAGE
,O
PEN, MALE OR FEMALE, ONE OR MORE LESIONS
RKE
R (LIST SEP IN ADD TO CODE FOR PRIM PROC)
RE)
CUL
AR ANASTOMOSIS (SUPERCHARGING)
NON
BURSA)
ENE
SIS IMPERFECTA), REQUIRING GENERAL ANESTHESIA
CIS
ION
ION
OF
)
MUSCLE COMPARTMENT SYNDROME
ON(
S))
ION
(S))
RAF
NGR
TED UNILATERAL ALVEOLAR CLEFT)

AFTED BILAT ALVEOLAR CLEFT OR MULT OSTEOTOMIES)
GA
GA
S)
HYC
UTOGRAFTS); WITHOUT LEFORT I

UTOGRAFTS); WITH LEFORT I
LE
RAF
LE
AUTOGRAFTS; TOTAL AREA, BONE GRAFTING < 40 SQ CM

TS; TOTAL AREA, BONE GRAFT > 40 SQ CM BUT < 80 SQ CM
AUTOGRAFTS; TOTAL AREA, BONE GRAFTING > 80 SQ CM
EPHALY), W W/O GRAFTS (INC OBTAINING AUTOGRAFTS)
NA
SOLACRIMAL APPARATUS
RT
RT
RIPOD; WITH INTERNAL FIXATION & MULT SURG APPROACHES

RIPOD; WITH BONE GRAFTING (INCLUDES OBTAINING GRAFT)
HES
LA
HA
INC
PPROACHES
LO DEVICE, AND/OR INTERMAXILLARY FIXATION)
LUDES OBTAINING GRAFT)
ING
OF DENTURES OR SPLINTS
QUE
NT
ERV
ICAL
ACH
CE
ADDITIONAL SEG (LIST SEPARATE FROM PRIMARY PROC)

RVICAL
DED
VERTEBRAL SEG (LIST SEPARATE FROM PRIMARY PROC)
TO
PRIMARY PROCEDURE)
DIT
ION TO PRIMARY PROCEDURE)
RW
TO
TO
NT;
NT;
NT;
TV
ITHOUT ANESTHESIA, BY MANIPULATION OR TRACTION

F INTERNAL FIXATION; WITHOUT GRAFTING
F INTERNAL FIXATION; WITH GRAFTING
LUMBAR
CERVICAL
THORACIC
ERT OR DISLOC SEG (LIST SEPARATE FROM PRIMARY PROC)
ARA
TELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
NTE
RSPACE (LIST SEPARATE FROM PRIMARY PROC)
IMA
RY PROCEDURE)
EI
EDU
NTERSPACE; LUMBAR
RE)
TS
SEGMENTS
RI
NTERSPACE
ATI
ON)
RO
SIT
F TUBEROSITY(-IES);
Y(-IES); W/ PROXIMAL HUMERAL PROSTHETIC REPLACEMENT
RV
ALGUS, DISTAL HUMERUS)
TS
KIN OR SKELETAL TRACTION
ON
R EXTENSION
TH
IMPLANT ARTHROPLASTY
ULA
OUT
TION
INTERNAL OR EXTERNAL FIXATION
ENT
IS)
)E
; FLEXORS
XTENSORS, WITH W/O TRANSPOSITION DORSAL RETINACULUM
INC
LUDES OBTAINING GRAFT)
DON
DO
PEN REDUCTION) FOR CARPAL INSTABILITY
NDO
N GRAFT/WEAVE, OR TENODESIS) W W/O OPEN REDUC
,W
IN
ITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION

CLUDES REPAIR, TRIANGULAR FIBROCARTILAGE COMPLEX
OUT
MA
YLO
RW
MANIPULATION
NIPULATION
ID, REQUIRING MANIPULATION, W W/O EXTERNAL FIXATION
ITHOUT INTERNAL OR EXTERNAL FIXATION
ENT
EA.
, OR SKIN GRAFTING (INCL. OBTAINING GRAFT);

ADDIT. DGT(LIST SEP. IN ADDIT. TO PRIM. PROC.)
IXA
TION
TR
ACTION, EACH
CH
DE
FOR PRIMARY PROCEDURE)
EPA
RATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
D)
MI
NIMUS, TENSOR FASCIA LATAE, RECTUS FEMORIS, SARTORIUS
RT
ROCHANTER OF FEMUR)
WI
TH INTERNAL FIXATION
,W
MEN
ITH INTERNAL FIXATION

T, SINGLE COLUMN OR TRANSVERSE FRACTURE
LT
RACTION
SC
REWS AND/OR CERCLAGE
HES
TIO
(IN
(IN
IA, WITHOUT MANIPULATION

N, REQUIRING ANESTHESIA
CLUDING TENOTOMY, ETC);
CLUDING TENOTOMY, ETC) WITH FEMORAL SHAFT SHORTENING
CERCLAGE
ROCEDURE)
FOR
TER
E EPIPHYSEAL CLOSURE
EPIPHYSEAL CLOSURE
SK
AN
IN OR SKELETAL TRACTION
D/OR LOCKING SCREWS
ENS
ION, OR DISTAL FEMORAL EPIPHYSEAL SEPARATION
N
NAL FIXATION
CTI
ON
CTI
ON
,F
OCE
LX HALLICUS LNG, OR PERONEAL TENDON TO MIDFT/HINDFT)

DURE)
CLA
GE
OF
PO
HOU
HS
FI
FI
FI
POSTERIOR LIP
STERIOR LIP
T MANIPULATION
KELETAL TRACTION AND/OR REQUIRING MANIPULATION
XATION; OF FIBULA ONLY
XATION; OF TIBIA ONLY
XATION; OF BOTH TIBIA AND FIBULA
E,
EXCEPT TALUS OR CALCANEUS
RES
SO
BTAINING GRAFT)
ERN
AL
RTH
THR
AL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)

OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)
ROSCOPY)
OSCOPY)
TO
F BASE OF LESION)
NAL
FIXATION (INCLUDES ARTHROSCOPY)
NECTOMY)
S(
ONECTOMY)
LIT
OC
SLEEVE LOBECTOMY)
/TRANSTHORACIC APPRCH, W/OR W/O PLEURAL PROC.
ODE FOR PRIMARY PROCEDURE)
TO
CODE FOR PRIMARY PROCEDURE)
LEA
D, INSERT NEW LEAD, INSERT NEW PULSE GENERATOR)
IS,
PA
NER
POCKET, REM, INSRT &/ REPLCMNT, GEN)

CEMAKER PULSE GENERATOR
ATOR)
PRI
MARY PROCEDURE)
T)
)
)
LG
COD
RAFT)
E FOR PRIMARY PROCEDURE)
ASS
GRAFT PROCEDURE, EACH VESSEL (LIST SEPARATELY)
GHT
OR LEFT VENTRICLE TO PULMONARY ARTERY
RY
ARTERY (SIMPLE FONTAN PROCEDURE)
RE
OF VENTRICULAR SEPTAL DEFECT;
ULA
RS
R SEPTAL DEFECT
EPTAL DEFECT
OF
OF
FS
PULMONARY BAND
VENTRICULAR SEPTAL DEFECT
UBPULMONIC OBSTRUCTION
ROCEDURE)
ECT
MA
TERIAL AS GUSSET FOR ENLARGEMENT
ND
CORONARY RECONSTRUCTION
AR
TERY
DDI
TION TO CODE FOR PRIMARY PROCEDURE)
RY
PROCEDURE)
DUR
EAL
OR
DIT
TU
AO
AO
LI
E)
INCISION, UNILATERAL
DISSECTION; INITIAL VESSEL
ION VESSEL (LIST SEPARATELY ADDITION CD, 1 PROCEDU
BE PROSTHESIS
RTO-BI-ILIAC PROSTHESIS
RTO-BIFEMORAL PROSTHESIS
NCISION, UNILATERAL
DIS
VIA
CIA
DIS
AL
ASE
CLA
CIA
CIA
EASE, CAROTID, SUBCLAVIAN ARTERY, BY NECK INCISION

N ARTERY, BY NECK INCISION
TED OCCLUSIVE DISEASE, VERTEBRAL ARTERY
EASE, AXILLARY-BRACHIAL ARTERY, BY ARM INCISION
ARTERY, BY ARM INCISION
, INNOMINATE, SUBCLAVIAN ARTERY, THORACIC INCISION
VIAN ARTERY, BY THORACIC INCISION
TED OCCLUSIVE DISEASE, RADIAL OR ULNAR ARTERY
TED OCCLUSIVE DISEASE, ABDOMINAL AORTA
DIS
IN
LUS
IN
CIA
EASE, ABDOMINAL AORTA INVOLVING VISCERAL VESSELS

VOLVING VISCERAL VESSELS
IVE DISEASE, ABDOMINAL AORTA INVOLVING ILIAC VESSELS
VOLVING ILIAC VESSELS
TED OCCLUSIVE DISEASE, SPLENIC ARTERY
ISE
,R
CIA
ASE, HEPATIC, CELIAC, RENAL/MESENTERIC ARTERY

ENAL, OR MESENTERIC ARTERY
TED OCCLUSIVE DISEASE, ILIAC ARTERY
CIA
ART
CIA
Y
CIA
TED OCCLUSIVE DISEASE, COMMON FEMORAL ARTERY

ERY
TED OCCLUSIVE DISEASE, POPLITEAL ARTERY
EDU
RE)
TED OCCLUSIVE DISEASE, OTHER ARTERIES
PRI
MARY PROCEDURE)
SE
PARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
PRO
DUR
ARY
CEDURE)
E)
PROCEDURE)
EM
ONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY)
LY
LIS
T IN ADD TO CODE FOR INIT 2ND/3RD ORDER VESS AS APP)
LY
NA
ST
VASCULAR FAMILY
IN ADD TO CODE FOR INIT 2ND/3RD ORDER VESS AS APP)
TT
O BE USED FOR ROUTINE VENIPUNCTURE.
CH
CH
CH
CH
EMOTHERAPY); PERCUTANEOUS, AGE 2 YEARS OR UNDER

EMOTHERAPY); PERCUTANEOUS, OVER AGE 2
EMOTHERAPY); CUTDOWN, AGE 2 YEARS OR UNDER
EMOTHERAPY); CUTDOWN, OVER AGE 2
REM, CANNULA(S)&REPAIR, ARTERIOTOMY&VENOTOMY SITES
AGE
N, THERMOPLASTIC GRAFT)
HRO
MBOLYSIS)
ION
/DILATATION, STNT PLCMNT&ALL ASSOC IMAG GDNCE&DOCENT
NY
METHOD, NON-CENTRAL NERVOUS SYSTEM, NON-HEAD OR NECK
TO
FOR
PRIMARY PROCEDURE)
AD
DITION TO CODE FOR PRIMARY PROCEDURE)
CO
MMUNICATING VEINS LOWER LEG, WITH EXCIS DEEP FASCIA
SEP
ARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
DES
(SEPARATE PROCEDURE)
ST
ERNOTOMY
R CAUTERY
(TR
ATI
YLOROPLASTY
ON,
TIO
AST
N,
OR
PYL
ING
SMA
AR
ANSHIATAL)
ON, PREPARATION AND ANASTOMOSIS(ES)
PREPARATION, AND ANASTOMOSIS(ES)
N
ROSTOMY, W W/O PYLOROPLASTY (IVOR LEWIS)
INCL INTSTINE MOBILIZATION, PREP,&ANASTOMOSIS(ES)
WITHOUT PYLOROPLASTY
OROPLASTY
INTESTINE MOBILIZATION, PREPARATION,&ANASTOMOSIS(ES)
COAGULATOR)
CAUTERY OR SNARE TECHNIQUE
ION
INJ
LTI
OF
ALU
INT
OF
PHA
OUT
FP
ODY
IRE
ESO
PO
PO
AN
TP
OLY
DE
ROC
OF SPECIMEN(S) BY BRUSHING/WASHING (SEP PROCEDURE)

ECTION(S), ANY SUBSTANCE
PLE
PSEUDOCYST
MINAL TUBE OR CATHETER PLACEMENT
RAMURAL/TRANSMURAL FINE NEEDLE ASPIRATION/BIOPS
ESOPHAGEAL AND/OR GASTRIC VARICES
GEAL AND/OR GASTRIC VARICES
LET FOR OBSTRUCTION (EG, BALLOON, GUIDE WIRE, BOUGIE)
ERCUTANEOUS GASTROSTOMY TUBE
FOLLOWED BY DILATION OF ESOPHAGUS OVER GUIDE WIRE
PHAGUS (LESS THAN 30 MM DIAMETER)
LYP(S), OR OTH LESION(S) HOT BIOPSY FORCEPS CAUTERY
LYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
Y METHOD
LACEMENT (INCLUDES PREDILATION)
P,OR OTH LESION(S) NOT AMENABLE TO TECHNIQUE
XAM
EDURE)
CTS
TUL
A
MAC
ONS
LOROMYOTOMY
H,W W/O PYLOROPLASTY

, INCL INTSTINE MOBILIZATION, PREP,&ANASTOMOSIS(ES)
OUT
VA
VAGOTOMY
GOTOMY
)
PER
ING
TOM
ING
OSIS (LIST SEPARATELY ADDITION CODE, 1 PROCEDURE)
WIT
HOUT LOOP ILEOSTOMY
PI
LEOSTOMY, WITH OR WITHOUT RECTAL MUCOSECTOMY
MEN
(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
SIO
SIO
AUT
ION
PRE
OSTOMY TUBE
ET
S)
N(S) BY SNARE TECHNIQUE

N(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
ERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)
(S) NOT AMENABLE TO BIOPSY FORCEPS, CAUTERY OR SNARE
DILATION)
OPERCUTANEOUS JEJUNOSTOMY TUBE
BYBRUSHING OR WASHING (SEPARATE PROCEDURE)
UTE
ILA
RY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)

TION)
HIN
G(SEPARATE PROCEDURE)
GUL
ATOR)
RY
ORSNARE TECHNIQUE
CO
LOS
LOSTOMY
TOMY
FO
R PRIMARY PROCEDURE)
TH
HAM
ORWITHOUT PROXIMAL DIVERTING OSTOMY

EL, OR SOAVE TYPE OPERATION)
ICE
CTOMY, WWO REM OF TUBE(S), OVARY(S)/ANY COMB THEREOF
AGU
ERY
LATOR)
OR SNARE TECHNIQUE (EG, LASER)
LAT
OR)
OR
SNARE TECHNIQUE
UTC
OLON DECOMPRESSION (SEPARATE PROCEDURE)
ROB
SY
TER
E, STAPLER, PLASMA COAGULATOR)

FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
Y
IQU
IN
TESTINAL GRAFT OR PEDICLE FLAPS
Y,
CRYOSURGERY, CHEMOSURGERY)
EDU
RE)
INC
TER
TEROTOMY OR SPHINCTEROPLASTY
OTOMY OR SPHINCTEROPLASTY
PAR
ATE PROCEDURE)
DUR
DUR
CED
CED
PLANTATION
E); WITH PANCREATOJEJUNOSTOMY

E); WITHOUT PANCREATOJEJUNOSTOMY
URE); WITH PANCREATOJEJUNOSTOMY
URE); WITHOUT PANCREATOJEJUNOSTOMY
OMI
NAL NODE &/ BONE MARROW BIOPSIES, OVARIAN REPOSITION)
E,
TH/
TI
WW
WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE

WITHOUT HYDROCELECTOMY; INCARCERATED/STRANGULATED
ME, SURGERY, WITH/WITHOUT HYDROCELECTOMY; REDUCIBLE
O HYDROCELECTOMY; INCARCERATED/STRANGULATED
TRA
LHERNIA REPAIR)
CM
M
TH
ROMBECTOMY
DWE
LLING URETERAL CATHETER
RU
RU
RETERAL SPLINTING; SIMPLE

RETERAL SPLINTING; COMPLICATED (CONGENITAL)
AND
ADRENALECTOMY)
E;
E;
E;
E;
E;
E;
DIO
WITH URETERAL CATH, W W/O DILATION URETER

WITH BIOPSY
WITH FULGURATION AND/OR INCISION, W W/O BIOPSY
WITH INSERT RADIOACTIVE SUBSTANCE W W/O BIOPSY
WITH REMOVAL OF FOREIGN BODY OR CALCULUS
LOGIC SERVICE; WITH RESECTION OF TUMOR
AL
CATHETERIZATION, WITH OR WITHOUT DILATION OF URETER
(I
CE;
CE;
CE;
NCCYSTO, URETEROSCOPY, DILATION URETER AND URETERAL)

WITH FULGURATION AND/OR INCISION, W W/O BIOPSY
WITH INSERT RAD SUBSTANCE, W W/O BIOPSY
WITH REMOVAL OF FOREIGN BODY OR CALCULUS
CYS
TOSTOMY)
ERV
ERV
ERV
ERV
ERV
ERV
ICE;
ICE; WITH URETERAL CATH, W W/O DILATION OF URETER
ICE; WITH BIOPSY
ICE; WITH FULGURATION AND/OR INCISION, W W/O BIOPSY
ICE; WITH INSERTION OF RAD SUBSTANCE, W W/O BIOPSY
ICE; WITH REMOVAL OF FOREIGN BODY OR CALCULUS
URE
BIO
TERAL CATHETERIZATION, W W/O DILATION OF URETER

PSY
FUL
INS
REM
GURATION AND/OR INCISION, WITH OR WITHOUT BIOPSY

ERTION OF RADIOACTIVE SUBSTANCE, W W/O BIOPSY
OVAL OF FOREIGN BODY OR CALCULUS
IL
IAC, HYPOGASTRIC AND OBTURATOR NODES
LUD
ING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES
CT
OFRECTUM, COLON & COLOSTOMY, OR ANY COMBINATION
E,
WW/O WEDGE RESECT OF POSTERIOR VESICAL NECK
ICE
BRU
CS
;
SHBIOPSY OF URETER AND/OR RENAL PELVIS
ERVICE
LG
BI
LANDS
OPSY
CED
URE FOR CYSTOGRAPHY, MALE OR FEMALE
SEP
TAL FIBROSIS, POLYP(S) URETHRA, BLADDER NECK
TECHNIQUE)
ION
SAL
FOLDS
THR
ALCALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY)
HRA
THR
LCALIBRATION AND/OR DILATION INTERNAL URETHROTOMY)

OSCOPY, URETHRAL CALIBRATION DILATION, URETHROTOMY)
SSI
ON INCLUDING IRRIGATION&DEBRIDEMENT, INFECTED TISSUE
RY,
CRYOSURGERY, CHEMOSURGERY)
IN
FLAPS
FL
RA
ITH
GRA
ND
AP)
PAT
TU
URE
CHGRAFT
BED GRAFT (INCLUDES URINARY DIVERSION)
THRA & PENIS; LOCAL SKIN GRAFTS & ISLAND FLAPS
LOCAL SKIN FLAPS, SKIN GRAFT PATCH, ISLAND FLAP

FTTUBE AND/OR ISLAND FLAP
FLAP
INC
LUDING IRRIGATION&DEBRIDEMENT OF INFECTED TISSUE
SIO
N, INCLUDING IRRIGATION&DEBRIDEMENT, INFECTED TISSUE
IN
TERNAL URETHROTOMY)
Y);
Y);
SUPRAPUBIC, SUBTOTAL, ONE OR TWO STAGES

RETROPUBIC, SUBTOTAL
AND
OBTURATOR NODES
POG
ASTRIC AND OBTURATOR NODES
OMY
AND PARA-AORTIC LYMPH NODE SAMPLING (BIOPSY)
TOM
Y AND PARA-AORTIC LYMPH NODE SAMPLING (BIOPSY)
S),
WITH OR WITHOUT REMOVAL OF OVARY(S)
MY
MY
MS,
OMAS; ABDOMINAL APPROACH

OMAS; VAGINAL APPROACH
ABDOMINAL APPROACH
STO
PEXY (EG, MARSHALL-MARCHETTI-KRANTZ, BURCH)
),
AL
VAL
WITH OR WITHOUT REMOVAL OF OVARY(S)

OFTUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S)
OF BLADDER AND URETERAL TRANSPLANT; ANY COMBINATION
END
OSCOPIC CONTROL
HOU
T ENDOSCOPIC CONTROL
OGR
APHY
ECT
OMY
SEP
ARATE PROCEDURE)
ST
SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
RAG
M ASSESS, W/W/O SALPINGECT, W/W/O OMENTECT
PA
UCT
RA-AORTIC LYMPHADENECTOMY
, INTRA-ABDOMINAL/RETROPERITONEAL TUMORS)
YA
AS
ND LIMITED PARA-AORTIC LYMPHADENECTOMY

SESS W/PELV& LTD PARA-AORT LYMPHADENECTOMY
LY
IOU
SCESAREAN DELIVERY
ESA
REAN DELIVERY
ES;
ES;
ES;
,D
RY
RY
WITH DILATION AND CURETTAGE AND/OR EVACUATION

WITH HYSTEROTOMY (FAILED INTRA-AMNIOTIC INJECTION)
ELIVERY OF FETUS & SECUNDINES;
FETUS & SECUNDINES; WITH D&C &/OR EVAC
FETUS & SECUNDINES; W HYSTEROTOMY (FAILED MED EVAL)
E);
E);
WITH EXCISION OF ADJACENT RETROPERITONEAL TUMOR
OR
DORSAL
OR
OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT
ARE
TED
NCHYMAL HEMATOMA; WITHOUT LOBECTOMY

INTRAPARENCHYMAL HEMATOMA; WITH LOBECTOMY
IM
ALFORMATION)
TB
ASE OF SKULL
RAN
IOTOMY/CRANIECTOMY
EDU
LO
RE)
FELECTRODE ARRAY)
G,
BARREL-STAVE PROCEDURE) (INC OBTAINING GRAFTS)
EA
RO
ND/
OMY
BE,
OBE
OBE
ND/OR MANDIBLE (INCLUDING TRACHEOSTOMY)

RBITAL EXENTERATION
ORMAXILLECTOMY
OF BASE OF ANTERIOR CRANIAL FOSSA
OSTEOTOMY OF BASE OF ANTERIOR CRANIAL FOSSA
(S); WITHOUT ORBITAL EXENTERATION
(S); WITH ORBITAL EXENTERATION
ICU
,I
GOM
US
IZA
MY,
LATION OF MANDIBLE, INC PAROTIDECTOMY, CRANIOTOMY

NFRATEMPORAL FOSSA) INC MASTOIDECTOMY
A,CRANIOTOMY, EXTRA/INTRADURAL ELEV TEMPORAL LOBE
AND/OR FACIAL NERVE, WITH OR WITHOUT MOBILIZATION
TION OF FACIAL NERVE AND/OR PETROUS CAROTID ARTERY
RESECTION OF C1-C3 VERTEBRAL BODY(S)
OR
WITHOUT GRAFT
UDI
L
L,
NGDURAL REPAIR, WITH OR WITHOUT GRAFT
YP
ROCEDURE)
PRO
CEDURE)
EBR
EBR
OR
NEO
OR
TAN
SS
AL BODIES; EXTRADURAL
AL BODIES; INTRADURAL, INC DURAL REPAIR, W W/O GRAFT
FASCIA LATA, ADIPOSE TISS, HOMOLOGOUS/SYNTH GFS)
US FLAP(GALEA,TEMPIS,FRONTALIS/OCCIPITALIS MUSC)
BALOON OCLSIN & EXCLDE VASCU INJRY POST OCLSIN
EOUS, ANY METHOD; CENTRAL NERVOUS SYSTEM
YST, HD/NCK (EXTRACRANIAL,BRACHIOCEPHALIC BRANCH)
INCLUDING DURAL REPAIR, WITH OR WITHOUT GRAFT
ER
LLI
AL
DUS OR THALAMUS
STRUCTURE(S) OTHER THAN GLOBUS PALLIDUS OR THALAMUS
CE
GUIDANCE
LIO
ULL
N
ARY TRACT
FOR
PRIMARY PROCEDURE)
LLI
DUS,SUBTHALAM NUCL,PERIVENTRIC,PERIAQUEDUCTAL GRAY)
SIN
OO
GLE ELECTRODE ARRAY

R MORE ELECTRODE ARRAYS
INI
NG GRAFTS)
PAR
EPL
ATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

ACEMENT, OR REMOVAL OF VENTRICULAR CATHETER)
WH
LIZ
EN ADMINISTERED), MULTI ADHESIOL SESSNS; 2/MORE DA

ATION, MULTIPLE ADHESIOLYSIS SESSIONS; 1 DAY
OID
LU
MBAR, SACRAL (CAUDAL)
(EG
, MAN/AUTO PERCUT DISKECTOMY,PERCUT LASER DISKECTOMY)
SM,
PIO
NTI
SP,
BLE
ECT
OPIOID,STER,OTH SOL), EPIDUR/SUBARACHNOID;CERV/THORAC

ID,STER,OTH SOL),EPIDUR/SUBARACHN;LUMBAR,SACRAL(CAUD)
SP,OPIOID,STER,OTH SOL),EPIDUR/SUBARACH;CERV/THORACIC
OPIOID,STER,OTH SOL),EPIDUR/SUBARACH;LUMB,SACRL(CAUD)
RESERVOIR/INFUSION PUMP; W/O LAMINECTOMY
OMY
OUT
PROGRAMMING
TAT
US, DRUG PRESCRIPTION STATUS); WITHOUT REPROGRAMMING
TAT
NAL
NAL
GME
NAL
SIS
NAL
NAL
NAL
ERV
TER
ISK
ERV
PLO
EXP
REC
REC
REC
DD
RAC
CET
HA
US, DRUG PRESCRIPTION STATUS); WITH REPROGRAMMING

STENOSIS), ONE OR TWO VERTEBRAL SEGMENTS; CERVICAL
STENOSIS), ONE OR TWO VERTEBRAL SEGMENTS; THORACIC
NTS; LUMBAR, EXCEPT SPONDYLOLISTHESIS
STENOSIS), ONE OR TWO VERTEBRAL SEGMENTS; SACRAL
,LUMBAR (GILL TYPE PROCEDURE)
STENOSIS), MORE THAN 2 VERTEBRAL SEGMENTS; CERVICAL
STENOSIS), MORE THAN 2 VERTEBRAL SEGMENTS; THORACIC
STENOSIS), MORE THAN 2 VERTEBRAL SEGMENTS; LUMBAR
ERTEBRAL DISK; ONE INTERSPACE, CERVICAL
1 INTERSPACE, LUMBAR (INCL OPEN/ENDOSCOPIC-ASSIST APPR)
SP, CERV/LUMB (LIST SEP IN ADD TO CODE FOR PRIM PROC)
, REEXPLORATION, SNGL INTERSPACE; CERVICAL
ERTEBRAL DISK, RE-EXPLORATION; LUMBAR
RATION,SINGLE INTERSPACE;EA ADDTL CERVICAL INTE
LORATION,SINGLE INTERSPACE;EA ADDTL LUMBAR INTE
ESS STENOSIS)), SINGLE VERTEBRAL SEGMENT; CERVICAL
ESS STENOSIS)), SINGLE VERTEBRAL SEGMENT; THORACIC
ESS STENOSIS)), SINGLE SEGMENT; LUMBAR
SEG, CERV, THOR/LUMB (LIST SEP,ADD TO CODE,PRIM PROC)
IC
/LAT EXTRAFORAMIN APPR) (EG,FAR LAT HERN INTERV DISK)
DDITIONAL SEGMENT, THORACIC OR LUMBAR
ENT
(LIST SEPARATELY IN ADD TO CODE FOR PRIMARY PROC)
(LI
ST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROC)
(LI
CE
CE
T(S
T(S
NER
EQU
ERV
ER
ST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROC)

RVICAL, SINGLE SEGMENT
RVICAL, EACH ADDITIONAL SEGMENT
);THORACIC, SINGLE SEGMENT
); THORACIC, EACH ADDITIONAL SEGMENT
VEROOT(S), LOWER THORACIC OR LUMBAR; SINGLE SEGMENT
INA OR NERVE ROOT(S), LOWER THORACIC OR LUMBAR; EACH
EROOT(S), LOWER THORACIC, LUMBAR, SACRAL; 1 SEGMENT
OOT(S), LOWER THORACIC, LUMBAR, OR SACRAL; EA ADD SEG
BY
BY
SA
TRANSTHORACIC APPROACH
THORACOLUMBAR APPROACH
CRAL BY TRANSPERITONEAL OR RETROPERITONEAL APPROACH
BY
BY
SA
NT
TRANSTHORACIC APPROACH
THORACOLUMBAR APPROACH
CRAL BY TRANSPERITONEAL OR RETROPERITONEAL APPROACH
(LIST SEP IN ADD TO CODES FOR SINGLE SEGMENT)
STH
ETIC AGENT ADMINISTRATION
THE
TIC AGENT ADMINISTRATION
HET
IC AGENT ADMINISTRATION
EPA
RATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
ATE
LY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
OC
DE
FOR
PRIMARY PROCEDURE)
ODE
NE
UROLYSIS)
OTO
MY, SUPRA- OR HIGHLY SELECTIVE VAGOTOMY)
WIT
HOUT AIR INJECTION
ECH
SY
RS
TRE
IAE
NECHIAE, EXCEPT GONIOSYNECHIAE
YNECHIAE
ALADHESIONS
IFI
BROTIC AGENTS)
ELE
ORE
RKNIFE)
STAGES)
TI
RIDECTOMY (IRIDOCAPSULOTOMY, IRIDOCAPSULECTOMY)
LOR
RHEXIS)/PERF PTS THE AMBLYOGENIC DEVEL STAGE
ION
AND ASPIRATION OR PHACOEMULSIFICATION)
BRE
RAP
,S
TINAL FLUID
Y,PHOTOCOAGULATION, & DRAINAGE OF SUBRETINAL FLUID
CLERAL BUCKLING, &/OR LENS REMOVAL BY SAME TECHNIQUE
RAL
BUCKLING OR VITECTOMY TECHNIQUES
XEN
ONARC)
URC
E(INCLUDES REMOVAL OF SOURCE)
TEL
Y IN ADDITION TO CODE FOR PRIMARY EYE TREATMENT)
IQU
E)
PR
COD
ICT
OCE
CO
DUR
OCEDURE)
IVE MYOPATHY (EG, DYSTHYROID OPHTHALMOPATHY)
DURE)
DE FOR SPECIFIC STRABISMUS SURGERY)
E)
AP
AP
IRS
AGE
AGE
WITH ADJ TISSUE TRF/REARRANGE; <1/4TH OF LID MARGIN

WITH ADJ TISSUE TRF/REARRANGE; >1/4TH OF LID MARGIN
TSTAGE
CTI
OST
NTH
OSS
ICU
ICU
ON
FENESTRATION)
ETIC PROSTHESIS (PORP/TORP)
ICULAR CHAIN RECONSTRUCTION
LAR CHAIN RECONSTRUCTION
LAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS
OUT
,W
CHA
IN
OSSICULAR CHAIN RECONSTRUCTION

ITH OSSICULAR CHAIN RECONSTRUCTION
INRECONSTRUCTION
RECONSTRUCTION
STRUCTION
STO
IDE
CES
CES
IDECTOMY
CTOMY
SOR/COCHLEAR STIMULATOR; WITHOUT MASTOIDECTOMY
SOR/COCHLEAR STIMULATOR; WITH MASTOIDECTOMY
OR
MULTIPLE PERFUSIONS); TRANSCANAL
S)
AND FURTHER SECTIONS
STST-
PROCESSING
PROCESSING
ENC
ES
SEQ
UENCES
OST
#NAME?
LOW
ED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES
UEN
UEN
UEN
CES; CERVICAL
CES; THORACIC
CES; LUMBAR
POS
T-PROCESSING
NG
IMAGE POST-PROCESSING
NCE
NG
IMAGE POST-PROCESSING
CES
ER
SEQUENCES
PO
ST-PROCESSING
LUC
LUC
LUC
AGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB

AGON; WITH OR WITHOUT DELAYED FILMS, WITH KUB
AGON; WITH SMALL INTESTINE FOLLOW-THROUGH
TO
AN
D INTERPRETATION
RET
ATION
ATI
ON
ON
AND INTERPRETATION
LOW
CONTRST MTRIAL & FURTHR SECT,INCL IMGE POST-PROCESS
AD
ON
PUMP), RADIOLOGICAL S AND I
PRETATION
TIO
PER
AN
N
VISION&INTERPRETATION
D INTERPRETATION
LY
IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
DIS
N
ION
INT
SECTION, RADIOLOGICAL SUPERVISION AND INTERPRETATI
OC
COD
LOG
GIC
MEN
ICAL SUPERVISION AND INTERPRETATION

ALSUPERVISION AND INTERPRETATION
T, CATHETER, RADIOLOGICAL SUPERVISION&INTERPRETATN
OR
PRIMARY PROCEDURE)
PR
IMARY PROCEDURE)
LB
IOPSY)
T,P
ARAVERT FACET JT NV/SACROIL JT),INCL NEUROLYT AG DSTR
,EACH VESSEL
ERPRETATION
LIS
T SEPARATELY ADDITION TO CODE FOR PRIMARY PROCEDURE)
LS
RPR
UPERVISION AND INTERPRETATION

ETATION
RET
ATION
MAG
ING, OR OTHER TOMOGRAPHIC MODALITY
AL
SUPERVISION AND INTERPRETATION
UID
MASSES OR INTRACRANIAL ABNORMALITIES), INC A-MODE
APP
AD
TR
AD
DOM
DIT
TAT
FET
ROACH; SINGLE/FIRST GESTATION

DITION GESTATION (LIST SEP ADDITION CD, 1 PROCEDURE)
ANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION
DITION GESTATION (LST SEP ADDITION CD, 1 PROCEDURE)
INAL APPROACH; SINGLE OR FIRST GESTATION
ION GESTATION (LIST SEP ADDITION CD, 1 PROCEDURE)
IVE AMNIOTIC FLUID VOLUME), ONE OR MORE FETUSES
US
TUD
ON
OF LESION AND IMAGING)
DO
S,AS REQD COURSE,TX, WHEN PRESCRIBED TREAT PHYS
OF
EST
COM
INTEREST)
)
PLEX BLOCKING, ROTATIONAL OR SPECIAL BEAM)
PY,
ACH
ON,
1 TO 8 SOURCES)
YTHERAPY, 9 TO 12 SOURCES)
REMOTE AFTERLOADING BRACHYTHERAPY, OVER 12 SRCS)
UPP
OF THE RAD ONCOLOGIST, REPORTED PER WEEK OF THERAPY
REA
ICL
ICL
ICL
ICL
TER
EBEAM (EG, ELECTRON OR NEUTRONS); UP TO 5 MEV
EBEAM (EG, ELECTRON OR NEUTRONS); 6-10 MEV
EBEAM (EG, ELECTRON OR NEUTRONS); 11-19 MEV
EBEAM (EG, ELECTRON OR NEUTRONS); 20 MEV OR GREATER
CM
LC), PER TREATMENT SESSION
NIQ
UE)
TO
F GALLBLADDER FUNCTION
OR
EXERCISE, SINGLE OR MULTIPLE DETERMINATIONS
INJ
ON
RR
ECTION, WITH OR WITHOUT QUANTIFICATION

EST INJECTION, W/WO QUANT.
JEC
PHA
TION FRACTION, WWO ADDITIONAL QUANTITATIVE PROCESSING

RMACOLOGIC), W W/O ADDITIONAL QUANTIFICATION
DY
LUS
PLUS EJECTION FRACTION, W/WOQUANT.

EJECT. FRACTION, W/WO QUANTIFICATION
G
PAR
ATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
OR,
LATERAL VIEWS)
/OR
YME
DIURETIC)
INHIBITOR AND/OR DIURETIC)
AN
SA
DINTERPRETATION, NOT TO EXCEED 30 MINUTES

NDINTERPRETATION, EXCEEDING 30 MINUTES
X
NOL
2)
ONE (84143 X 2)
(A
BLO
SAM
CTH) (82024 X 6)
ODSAMPLES)
PLES)
X4
N(
)CORTISOL (82533 X 4) (TSH) (84443 X 4)

81050 X 2) (SINGLE DOSE DEXAMETHASONE, USE 82533)
4)
H)
(8
(83003 X 4)
3003 X 4)
300 3X 5)
X
X
3)
4)
NOG
AN
NOG
NOG
EN, ANY NUMBER OF CONSTITUENTS; WITH MICROSCOPY

YNUMBER OF CONSTITUENTS; AUTOMATED, W/ MICROSCOPY
EN, ANY NUMBER OF CONSTITUENTS; W/O MICRO, NON-AUTO
EN, ANY NUMBER OF CONSTITUENTS; W/O MICRO, AUTOMATED
PT
PULSE OXIMETRY
EPO
IN
RT
COMPATIBLE UNITS), WITH WRITTEN REPORT
,E
ACH
PE,
EACH ABSORPTION
HP
LATE
ANT
AD
IMICROBIAL, PER PLATE

HER
PES VIRUSES)
EA
LYS
CH ISOLATE
IS; MOTILITY AND COUNT (NOT INCLUDING HUHNER TEST)
ET
ANS
OXIN(S)
AD
AG
ST
ISPAR GROUP
ROUP
OOL
ANT
IGEN (HBSAG) NEUTRALIZATION
ACH
ED,
,E
LE
EACH ORGANISM
ACH ORGANISM
ORGANISMS, EACH POLYVALENT ANTISERUM
STE
STE
D
D (LIST SEPARATELY ADDITION CODE, PRIMARY PROCEDURE)
CHN
IQUE)
ES
TROGENIC INDEX)
UN
DER PHYSICIAN SUPERVISION
DS
YSTEM&MANUAL RESCREENING, UNDER PHYSICIAN SUPERVISIO
MIA
IA
RSA
ROS
SAC, HYDROCELE SAC NERVE SKIN, STERILIZATION

/SYNOVL CYST CRPL TUN TISS CART,INFLM,NASL/SINOIDL SK
COP EVAL,SX MARGINS BRST,REDUCTN MAMMOPLASTY BRONCHS
CO
LON, TOTAL RESECTION ESOPHAGUS
THE
UNO
NAMINE SILVER), EACH

CYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, EACH
MEN
TUBE
,P
ENTAGASTRIN)
ATI
CCI
ON VACCINE/TOXOID)
NE/TOXOID) (LIST SEPARATELY ADDITION CD, 1 PROCEDURE)
ITI
ON TO CODE FOR PRIMARY PROCEDURE)
SE
EOU
S OR INTRAMUSCULAR USE
(LI
ST SEPARATELY ADDITION TO CODE, PRIMARY PROCEDURE)
OMM
INU
INU
INU
INU
UNICATION
TES FACE-TO-FACE WITH THE PATIENT
TES FACE-TO-FACE W THE PATIENT; W MED EVAL & MGT SER
INU
INU
TIE
CA
RE,
IDE
,AP
RES
,AP

NTFACILITY,APPROX 20-30 MIN FACE-TO-FACE W THE PAT
-30 MIN FACE-TO-FACE W THE PAT;W MED EVAL & MGT SER
IENT FACIL,APPROX 45-50 MIN FACE-TO-FACE W THE PAT
TIENT FACIL,APPROX 75-80 MIN FACE-TO-FACE W THE PAT
ETTING, APPROX 20-30 MINUTES FACE-TO-FACE W THE PAT
RESETTING, APPROX 20-30 MIN FACE-TO-FACE W THE PAT
APPROX 20-30 MIN FACE-TO-FACE W PAT; W MED E&M SER
NTSETTING, APPROX 45-50 MIN FACE-TO-FACE W THE PAT
PROX 45-50 MIN FACE-TO-FACE W THE PAT;W MED E&M SER
IDENT CARE, APPROX 75-80 MIN FACE-TO-FACE W THE PAT
PROX 75-80 MIN FACE-TO-FACE W THE PAT;W MED E&M SER
VE
VE
PSYCHOTHRPY); APPROX. 20-30 MINS

PSYCHOTHRPY); APPROX. 45-50 MINS
ICA
SON
RP
LDIAGNOSTIC PURPOSES
S,OR ADVISING THEM HOW TO ASSIST PATIENT
HYSICIANS, AGENCIES, OR INSURANCE CARRIERS
DEV
,A
N,
ELOPMENT, & COUNSELING OF PARENTS

SSESS GROWTH & DEVELOPMENT, & COUNSELING OF PARENTS
ASSESS GROWTH & DEVELOPMENT, & COUNSELING OF PARENTS
20
PAT
45
TPA
75
ES
20
ES
45
ES
75
NEO
NT
GLE
,W
US MEASUREMENT AND DISCONNECTION

AND DISCONNECTION
PHYSICIAN EVALUATION
/WO SUBSTANT REVIS OF DIALYSIS PRESCRIPT
ONE
E,
VE,
OR MORE VISITS
ESTABLISHED PATIENT
ESTABLISHED PATIENT, ONE OR MORE VISITS
ER
ER
MANIPULATION TO FACILITATE DIAGNOSTIC EXAM; COMPLETE

MANIPULATION TO FACILITATE DIAGNOSTIC EXAM; LIMITED
ND
REPORT (SEPARATE PROCEDURE)
STI
SEM
OTT
ME
MULUS LEVEL AUTO TEST, EG OCTOPUS 3 OR 7 EQUIVALENT)

IQUANT, AUTO SUPRATHRESHOLD SCREEN PROGRAM, HUMPHREY
EDAND STATIC WITHIN THE CENTRAL 30, OR QUANT
DICAL TX OF ACUTE ELEVATION OF INTRAOCULAR PRESSURE)
HY,
GONIOPHOTOGRAPHY, STEREO-PHOTOGRAPHY)
EY
PHA
PHA
ES, EXCEPT FOR APHAKIA

KIA, ONE EYE
KIA, BOTH EYES
TEC
TEC
TEC
TEC
H;CORNEAL LENS, BOTH EYES, EXCEPT FOR APHAKIA

H;CORNEAL LENS FOR APHAKIA, ONE EYE
H;CORNEAL LENS FOR APHAKIA, BOTH EYES
H;CORNEOSCLERAL LENS
DAP
TATION
LC
ORRECTION.INC READING ADDITIONS UP TO 4D)
DIV
WIT
IDUALS
HOUT SPEECH PROCESSOR PROGRAMMING
TM
ULTIPLE LEVELS AND FREQUENCIES)
REP
ORT ONLY
OR
PRIMARY PROCEDURE)
T;I
ACH
NITIAL VESSEL (LIST SEP IN ADD TO CODE FOR PRIM PROC)

ADDITIONAL VESSEL
VE
SSEL (LIST SEPARATELY IN ADD TO CODE FOR PRIMARY)
TS
EPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
RE)
IEW
STR
STR
STR
STR
WITH INTERPRETATION AND REPORT ONLY

ESS; WITH PHYS SUPERVISION, INTERPRET AND REPORT
ESS; PHYS SUPERVISION ONLY, W/O INTERPRET & REPORT
ESS; TRACING ONLY, W/O INTERPRET AND REPORT
ESS; INTERPRETATION AND REPORT ONLY
,S
CLU
YSI
IEW
ABL
ABL
ABL
ABL
NGS
NGS
NGS
TR
G(
NG,
NR
CAN ANALYSIS W/ REPORT, PHYSICIAN REVIEW & INTERPRET

DES HOOK-UP, RECORDING, AND DISCONNECTION)
SWITH REPORT
AND INTERPRETATION
EOF FULL MINI PRINTOUT; RECORD & REPORT
EOF FULL MINI PRINTOUT; HOOK-UP DISCONNECT
EOF FULL MINI PRINTOUT; MICROPROCESSOR ANALYSIS
EOF FULL MINI PRINTOUT; PHYSICIAN REVIEW & INTERPRET
,W/ REPORT, PHYSICIAN REVIEW & INTERPRET
,POSSIBLY PATIENT ACTIVATED; REAL-TIME ANALYSIS
,POSSIBLY PT ACTIVATED; PHYSICIAN REV & INTERPRET
ANSMISSION, PHYSICIAN REVIEW AND INTERPRETATION
INCLUDES HOOK-UP, RECORDING, AND DISCONNECTION)
RECEIPT OF TRANSMISSIONS, AND ANALYSIS
EVIEW AND INTERPRETATION ONLY
AC
BE
NA
QUISITION, INTERPRETATION AND REPORT

ONLY
NDREPORT ONLY
RDI
IMA
UDY
AC PUMP FUNC & THERAPEUTIC MSURES IMMED TIME BA

GING); COMPLETE
(LIST SEP IN ADD TO CODES FOR ECHOCARDIOGRAPH IMAG)
PHA
RMACOL INDUCED STRESS, W INTERP & RPT
CO
NCOMITANT LEFT HEART CATHETERIZATION
THE
TERIZATION)
ETE
RIZATION)
HET
TH
USE
ERI
ERIZATION, FOR CONGENITAL CARDIAC ANOMALIES

EART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIE
DFOR BYPASS
ES
TIV
SEP
OU
IN
IN
ECORONARY ANGIOGRAPHY INC VENOUS BYPASS GRAFTS

ARATE PROCEDURE)
TPUT
CL PHARMACOLOGICALLY INDUCED STRESS; INITIAL VESSEL
CLUDING PHARMACOLOGICALLY INDUCED STRESS; EA ADD VESS
IA
(LIST SEPARATELY ADDITION TO CODE, PRIMARY PROCEDURE)
ATH
PAC
IAL
ARR
ETERS, WO INDUCTION/ATTEMPTED INDUCTION, ARRHYTHMIA

ING&REC, RIGHT VENTRICULAR PACING&REC, HIS BUNDLE
PACING & RECORDING FROM CORONARY SINUS /LEFT ATRI
HYTHMIA;W LEFT VENTRICULAR PACING & RECORDING
RHY
CTI
AR
IM
HMI
HOU
THMIA
ON
RHYTHMIA TERMINATION) AT TIME OF INIT IMPLANT/REPLACE
PLNT/REPLACE;TEST OF 1/2 CH PAC CARDIOV-DEF PULSE GEN
A TERM, & PROGRAM/REPROG OF SENS/THERAP PARAMETERS)
T TEMPORARY PACEMAKER PLACEMENT
YS,
ACCESSORY CONNECTIONS OR OTHER ATRIAL FOCI
TH
ADD
OR WITHOUT PHARMACOLOGICAL INTERVENTION

ITION TO CODE FOR PRIMARY PROCEDURE)
RDI
ETA
WI
;W
NG
EV
EV
FUN
AVIA IMPLANTED PACEMAKER & INTERPRET OF RECORDINGS)

TION OF RETRIEVED ECG DATA AND REPROGRAMMING)
THOUT REPROGRAMMING
ITH REPROGRAMMING
OFSENSORY FUNCTION OF PACEMAKER) TELEPHONIC ANALYSIS
ENT MARKERS & DEVICE RESPONSE); WITHOUT REPROGRAMMING
ENT MARKERS & DEVICE RESPONSE); WITH REPROGRAMMING
CTION OF PACEMAKER), TELEPHONIC ANALYSIS
ERP
ERP
ERP
ERP
RE OF REC AT REST & DUR EXER); 1 CHAMB, WO REPROGRAM

RE OF REC AT REST & DUR EXER); 1 CHAMB,WITH REPROGRAM
RE OF REC AT REST & DUR EXER); 2 CHAMBER,WO REPROGRAM
RE OF REC AT REST & DUR EXER); 2 CHAMBER,W REPROGRAM
G,
SCANNING ANALYSIS, INTERPRETATION AND REPORT
WIT
ITH
HREPORT
INTERPRETATION AND REPORT
LAR
PNEUMOPLETHYSMOGRAPHY, DOPPLER ULTRASOUND ANALYSIS)
EP
(SE
LETHYSMOGRAPHY, TRANSCUTANEOUS OXYGEN MEASUREMENT)

GMENTAL PRESSURE, DOPPLER WAVEFORM, PLETHYSMOGRAPHY)
PH
LEBORHEOGRAPHY, IMPEDANCE PLETHYSMOGRAPHY)
NTI
FT
APT
LATION
RANSMIT DATA,PERIODIC RECAL & PHYS REVIEW & INTERPRET
URE, TREND ANALYSIS, AND PERIODIC RECALIBRATION)
CAL
AGENT, WITH SUBSEQUENT SPIROMETRICS
ME
HAL
ER/INTERMITT POSITIVE PRESS BREATHING (IPPB) DEVIC
UMB
TES
EROF TESTS
TS
IFY
NUMBER OF TESTS
ING
ULT
ING
WO
HRE
OUR
IVE
BER
ST
NGL
SIN
ING
ING
CIF
ECT
LEINJECTION
IPLE INJECTIONS (SPECIFY NUMBER OF INJECTIONS)
LESTINGING INSECT VENOM
STINGING INSECT VENOMS
ESTINGING INSECT VENOMS
OF VIALS)
INGING INSECT VENOM
E STINGING INSECT VENOMS
GLE STINGING INSECT VENOMS
LE STINGING INSECT VENOMS
LE STINGING INSECT VENOMS
Y NUMBER OF DOSES)
OR OTHER ARTHROPOD (SPECIFY NUMBER OF DOSES)
ON&
ING
TRAIN, REC, DCION, DOWNLOADING W PRINTOUT, DATA)

MULTIPLE TRIALS TO ASSESS SLEEPINESS
SUR
ETHERAPY/BILEVEL VENTILATION,ATTEND BY A TECHNOLOGIST
ARA
EAC
SPINAL, CRANIAL NERVE SUPPLIED MUSCLES, OR SPHINCTERS

HMUSCLE STUDIED
REC
HNG
YS
SYS
SYS
SYS
R'D R-R INTERVAL, VALSALVA RATIO, AND 30:15 RATIO

SDURING VALSALVA MNVR & 5+ MINS OF PASSIVE TILT
WEAT TST&CHNGS IN SYMPATHETIC SKIN POTENTIAL
TEM; IN UPPER LIMBS
TEM; IN LOWER LIMBS
TEM; IN THE TRUNK OR HEAD
ATI
,F
AND
ON, EACH 24 HOURS

ORPRESURGICAL LOCALIZATION), EACH 24 HOURS
INTERPRETATION, EACH 24 HOURS
AND
INTERPRETATION, EACH 24 HOURS
/ID
;E
ENTIFY VITAL BRAIN STRUCT; INITIAL HOUR OF PHYS ATTN

ACH ADDITIONAL HOUR OF PHYSICIAN ATTENDANCE
EX
LIZ
,NE
LAR
RAT
NTR
TTE
TTE
LOCALIZATION)
ATION) (LIST SEPARATELY ADDITION CODE, 1 PROCEDURE)
UROMUSC) NEUROSTIM PULSE GEN/TRANSMIT, WO REPROGRAM
) NEUROSTIM PULSE GEN/TRANSMIT, W INTRAOP/SUBSEQ PROG
OR/TRANSMITTER, WITH INTRAOP/SUBSEQ PROG, FIRST HOUR
AOP/SUBSEQ PROG,EACH ADD 30 MINUTES AFTER FIRST HOUR
RY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATION
RY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATION
YNA
ORS
IAG
M FINE WIRE EMG, W WRITTEN RPT

CHACH, MMPI) WITH INTERPRETATION AND REPORT, PER HOUR
NOSTIC APHASIA EXAM) W/ INTERP & REPORT, PER HOUR
NFA
S,
NTDEVELOPMENT) W/ INTERPRETATION & REPORT, PER HOUR

LANGUAGE FNC, PLANNING) W/ INTERP & REPORT, PER HOUR
),
EAC
EA 15 MIN FACE-TO-FACE W THE PATIENT; INIT ASSESSMENT

H 15 MIN FACE-TO-FACE WITH THE PATIENT; RE-ASSESS
MAR
ABL
Y PROCEDURE)
EOR IMPLANTABLE PUMP
PRI
ORT
MARY PROCEDURE)
ABLE OR IMPLANTABLE PUMP
HOT
TO
DT
OSENSITIVE DRUG(S), EA PHOTOTHERAPY EXPOSURE SESSION

CODE FOR ENDOSC/BRONCHOSCOPY PROC OF LUNG & ESOPHAG)
O CODE FOR ENDOSC/BRONCHOSCOPY PROC OF LUNG & ESOPHG)
OUN
TS, OR STRUCTURAL HAIR SHAFT ABNORMALITY
PER
VISION OF THE PHYSICIAN (INC MEDICATION & DRESSINGS)
LIT
RE,
Y
&/ PROPRIOCEPTION FOR SITTING &/ STANDING ACTIVITIES
PER
CUSSION)
NTA
NT
APT
ANA
ND
OUN
15 MINUTES
CT BY THE PROVIDER, EACH 15 MINUTES
CONTACT BY THE PROVIDER, EACH 15 MINUTES
EQUIP) DRCT ONE-ON-ONE CONT PROVIDER, EA 15 MIN
LYSIS), DIRECT 1 ON 1 CONTACT BY PROVIDER, EA 15 MIN
ASSESSMNT,&INSTRUCTION(S), ONGOING CARE,/SESS

D ASSESSMENT,&INSTRUCTION(S), ONGOING CARE,/SESSN
TED
SUC
)
HAS ORTHOTICS, PROTECTIVES, PROSTHETICS
RUG
S,TRAYS, SUPPLIES, OR MATERIALS PROVIDED)
ED
HEALTH CARE PROFESSIONAL, REQUIR MIN, 30 MIN OF TME
PS
EUDOISOCHROMATIC PLATES, AND FIELD OF VISION
ND/
NSE
OUN
ELI
G,
MI
G.
NG
ATE
HIG
ORCOORDINATION OF CARE W/ PROVIDERS/AGENCIES

LING, COORDINATION OF CARE; LOW/MODERATE SEVERITY
SELING, COORDINATION OF CARE; MODERATE SEVERITY
NG, COORDINATION OF CARE; MODERATE TO HIGH SEVERITY
COORDINATION OD CARE; MODERATE TO HIGH SEVERITY
NUTES ARE SPENT PERFORMING OR SUPERVISING SERVICES
PROBLEM(S) ARE SELF LIMITED OR MINOR
LOW COMPLEXITY. PROBLEM(S) LOW TO MODERATE SEVERITY
COMPLEXITY. PROBLEM(S) MODERATE TO HIGH SEVERITY
HCOMPLEXITY. PROBLEM(S) MODERATE TO HIGH SEVERITY
QUI
Y.
.A
OBL
TY.
PRO
TY.
IEN
UN
&P
NEE
EDS
RING ADMISSION TO "OBSERVATION STATUS" LOW SEVERITY

ADMISSION TO "OBSERVATION STATUS" MODERATE SEVERITY
DMISSION TO "OBSERVATION STATUS" HIGH SEVERITY
EMS REQUIRING ADMISSION OF LOW SEVERITY
PROBLEMS REQUIRING ADMISSION OF MODERATE SEVERITY
BLEMS REQUIRING ADMISSION OF HIGH SEVERITY
PATIENT IS STABLE, RECOVERING OR IMPROVING
TIN ADEQUATELY RESPONDING TO THERAPY
STABLE, SIGNIFICANT COMPLICATION OR NEW PROBLEM
ATIENT'S &/ FAM'S NEEDS;PRES PROB REQ ADMIS, LOW SEV
DS;PRESENTING PROBLEM(S) REQ ADMISSION ARE OF MOD SEV
;PRESENTING PROBLEM(S) REQ ADMIS ARE OF HIGH SEV
GP
ROB
NTI
ENT
NG
SEN
KIN
NG
TIN
OF
ING
COM
UN
OR
.PR
Y
AR
EO
OBL
TIN
RES
M(S
SE
ROBLEM(S) ARE SELF LIMITED OR MINOR

ARE OF LOW SEVER,30 MIN FACE-TO-FACE W PAT &/ FAM
NG PROBLEM(S) ARE OF MODERATE SEVERITY
ING PROBLEM(S) ARE OF MODERATE TO HIGH SEVERITY
PROBLEM(S) ARE OF MODERATE TO HIGH SEVERITY
TING PROBLEM(S) ARE SELF LIMITED OR MINOR
G.PRESENTING PROBLEM(S) ARE OF LOW SEVERITY
PROBLEM(S) ARE OF MODERATE SEVERITY
G PROBLEM(S) MODERATE TO HIGH SEVERITY
HIGH COMPLEXITY, MODERATE TO HIGH SEVERITY
OR LOW COMPLEXITY; RECOVERING OR IMPROVING
PLEXITY; INADEQUATELY REPONDING, MINOR COMPLICATION
STABLE, SIGNIFICANT COMPLICATIONS OR NEW PROBLEM
MINOR
ESENTING PROBLEM(S) ARE OF LOW SEVERITY
E OF MODERATE TO HIGH SEVERITY
F MODERATE TO HIGH SEVERITY
EMS ARE SELF LIMITED OR MINOR
G PROBLEM(S) ARE OF LOW TO MODERATE SEVERITY
ENTING PROBLEM(S) ARE OF MODERATE SEVERITY
)HIGH SEVERITY, & REQUIRE URGENT EVAL BY PHYSICIAN
V & AN IMMED SIGNIF THREAT TO LIFE/PHYSIOLOGIC FUNC
HS,
E/L
AGE/LESS; 1ST 30-74 MIN, HANDS CARE DUR TRANSPORT

ESS; EA ADDITION 30 MIN (LST SEP ADDITION CD, 1 SV
CE
YOU
RY
CON
ORY
CRI
OF THE PHYSICIAN; EACH ADDITIONAL 30 MINUTES

NG CHILD
OUNG CHILD
T /FREQ VITAL SGN MNTRG,LAB &BLD GAS INTERPRET,FLW
SUPPORT,CONTINUOUS /FREQUENT VITAL SIGN MONITORIN
T ILL CONT REQUIRE INTENSIVE CARDIAC & RESPIR MNTR
ES,
RMA
HIG
IS
ATE
NG
PT IS STABLE,RECVRING/IMPROVING;CARE IS REQD,30 MIN

NENT STATUS CHANGE. NEW CARE PLAN REQUIRED
H COMPLEXITY. CREATION OF MEDICAL CARE PLAN REQUIRED
STABLE, RECVRING/IMPROVING PHYS SPEND 15 MIN,BEDSIDE
.PT RESPONDING INADEQUATELY; MINOR COMPLICATION
MODERATE/HIGH. SIGNIFICANT COMPLICATION/NEW PROBLEM
Y.
RAT
BLE
LOW
MO
MPL
OF
OF
#NAME?
HS
RE
EED
DS;
S;P
D-H
(EG
(EG
TAL
TAL
OTH
TO
AN/
ENT
ENT
PRESENTING PROBLEM(S) ARE OF LOW SEVERITY

E COMPLEXITY.PROBLEM(S) OF MODERATE SEVERITY
M(S) ARE OF HIGH COMPLEXITY
COMPLEXITY. STABLE, RECOVERING OR IMPROVING
DERATE COMPLEXITY. MINOR COMPLICATION/NEW PROBLEM
EXITY. UNSTABLE, SIGNIFICANT COMPLICATION/NEW PROBLEM
LOW SEV; 20 MIN FACE-TO-FACE W THE PATIENT &/ FAMILY
MOD SEV;30 MINUTES FACE-TO-FACE WITH PATIENT &/ FAM
GH SEV; 45 MINUTES FACE-TO-FACE W THE PATIENT &/ FAM
EV; PHYSICIANS SPEND 60 MIN FACE-TO-FACE W PAT &/ FAM
QIM MED PHYS ATTN;75 MIN FACE-TO-FACE W THE PAT &/FAM
S;PROB SELF-LIMIT/MIN;15 MIN FACE-TO-FACE W PAT &/FAM
PRES PROB LOW-MOD SEV;25 MIN FACE-TO-FACE W PAT &/FAM
RES PROB MOD-HIGH SEV;40 MIN FACE-TO-FACE W PAT &/FAM
IGH SEV;UNSTAB/SIGNIF NEW PROB;60 MIN W THE PAT &/FAM
, PROLONGED CARE AND TREATMENT OF AN ACUTE ASTHMATIC
, PROLONGED CARE AND TREATMENT OF AN ACUTE ASTHMATIC
MONITORING FOR HIGH RISK DELIVERY OR OTHER PHYSIOLOG
MONITORING FOR HIGH RISK DELIVERY OR OTHER PHYSIOLOG
PHYS SERVICE(S) &/ INPAT/OUTPAT E&M SERVICE)
CODE FOR PROLONGED PHYS SERVICE)
HIGH RISK DELIVERY,MONITORING EEG)
CARE (PATIENT NOT PRESENT); APPROX 30 MINS
CARE (PATIENT NOT PRESENT); APPROX 60 MINS
/CA
,SU
F,N
DT
RE DEC W HLTH CARE PROF,FAM,W/IN CAL MNTH;15-29 MIN

RROGATE DECISN MAKER&/KEY CARGIVER PT CARE,30 MN/MRE
W INFO,MED TX PLAN &/ ADJ,W/IN CAL MNTH; 15-29 MIN
X PLAN &/ ADJ, MED TX, W/IN CAL MONTH; 30 MIN/MORE
EP
CA
AB/
B/D
B/D
B/D
AP
AP
AP
LA
LA
LA
LA
S),
S),
S),
NUT
NUT
NUT
NUT
PRO
PRO
ROF,NEW INFO,MED TX PLAN&/ADJ,W/IN CAL MNTH;15-29 MIN

RE PROF,INFO,MED TX PLAN&/ADJ,MEDTX,W/IN MNTH;>30 MIN
DIAG PROCS, NEW PT; INFANT (AGE UNDER 1 YEAR)
IAG PROCS, NEW PT; (AGE 1 THRU 4 YEARS)
IAG PROCS, NEW PT; (AGE 5 THRU 11 YEARS)
IAG PROCS, NEW PT; ADOLE AGE 12-17 YEARS
PROP IMM(S), LAB/DIAG PROCS, NEW PT; 18-39 YEARS
PROP IMM(S), LAB/DIAG PROCS, NEW PT; 40-64 YEARS
PROP IMM(S), LAB/DIAG PROCS, NEW PT; 65 YEARS&OVER
B/DIAG PROCS, ESTABLISHED PT; UNDER 1 YEAR
B/DIAG PROCS, ESTABLISHED PT;AGE 1-4 YEARS
LAB/DIAG PROCS, ESTABLISHED PT; 18-39 YEARS
LAB/DIAG PROCS, ESTABLISHED PT; 40-64 YEARS
LAB/DIAG PROCS, ESTABLISHED PT; 65 YEARS&OVER
ES
ES
ES
ES
XIMATELY 30 MINUTES
XIMATELY 60 MINUTES
SHO
ULD ALSO BE USED FOR BIRTHING ROOM DELIVERIES)
DF
ROM THE HOSPITAL OR BIRTHING ROOM ON THE SAME DATE)
/OR
FOR
CUL
ULA
CARDIAC OUTPUT
MA; COLLECTION OF BLOOD SAMPLE AND/OR URINALYSIS
ATION OF IMPAIRMENT; FUTURE TREATMENT PLAN
TION OF IMPAIRMENT; FUTURE TREATMENT PLAN
NIT
ORING
ODE
ACH VESSEL
HAG

OGASTRIC JUNCTION
ITH
OUT TEMPORARY PACEMAKER
NI
NCLUDING RADIOLOGIC LOCALIZATION & EPIDUROGRAPHY
INI
IN,
TIAL ENDOPROSTHESIS
INITIAL ENDOPROSTHESIS
ON;
EAC
AL
END
END
INITIAL EXTENSION
H ADDITIONAL EXTENSION
DUC
REA
REA
EA
TION OR AUGMENTATION MAMMOPLASTY, MUSCLE FLAPS)

ST
STWITH INTERNAL MAMMARY NODE DISSECTION
EXTENSION, RADIOLOGICAL SUPERVISION&INTERPRETATION
BL
OOD FLOW, CEREBRAL BLOOD VOLUME, & MEAN TRANSIT TIME
LM
ELANOMA
OPROSTHESIS, RADIOLOGICAL SUPERVISION&INTERPRETATION

OPROSTHESIS, RADIOLOGICAL SUPERVISION&INTERPRETATION
CIF
VE
IED
NTILATION
EDU
RES ON THE TRACHEA AND BRONCHI
ING
LIVER BIOPSY)
0W
EEKS GESTATIONAL AGE AT TIME OF SURGERY
NEP
HRECTOMY
ECT
LY
OMY
MPHADENECTOMY
ETH
IAL PROCEEDURES
THO
UTGRAFT
JO
JO
JO
JO
JO
D
T
INT; NOT OTHERWISE SPECIFIED

INT; RADICAL RESECTION
INT; SHOULDER DISARTICULATION
INT; INTERTHORACOSCAPULAR (FOREQUARTER) AMPUTATION
INT; TOTAL SHOULDER REPLACEMENT
CUL
RCU
CUL
CUL
GER
GER
EA
ATION); NOT OTHERWISE SPECIFIED

LATION (EG, TRANSCUTANEOUS PORTO-CAVAL SHUNT (TIPS))
ATION); INTRATHORACIC OR JUGULAR
ATION); INTRACRANIAL
Y; LESS THAN FOUR % TOTAL BODY SURFACE AREA
Y; BETWEEN FOUR&NINE %, TOTAL BODY SURFACE AREA
ADDITION 9 % TOTAL BODY SURFACE AREA/PART THEREOF
NE
ED)
PER
CESSARY REPLACEMENT, AN EPIDURAL CATHETER DUR LABOR)
TH
TIO
E PRONE POSITION
N
PE
RMITTED IN BLS AMBULANCES)
FORMED)
MBU
LANCES)
PAR
TY PAYERS
YDR
OPHILIC, ETC.)
OPH
ILIC, ETC.)
MUL
HOE
,P
TI- DENSITY INSERT(S), PER SHOE

), PER SHOE
ER SHOE
PE
R SHOE
UT
ADHESIVE BORDER, EACH DRESSING
RES
SING
SSI
NG
RES
SING
EAC
H DRESSING
IT
1 UNIT
ANY
ANY
NY
NY
STRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX

STRENGTH, OVER 100 GRAMS OF PROTEIN - PREMIX
GTH
NY
ANY
,RENAL - AMIROSYN RF,NEPHRAMINE, RENAMINE - PREMIX

STRENGTH, HEPATIC - FREAMINE HBC, HEPATAMINE - PREMIX
STRENGTH, STRESS - BRANCH CHAIN AMINO ACIDS - PREMIX
MIS
SION OF WRITTEN REPORT
ON
SYSTEM
,A
ND TUBING
NNU
TU
LA OR MASK, AND TUBING

BING AND REFILL ADAPTER
OR
MASK, AND TUBING
AC
AND/OR DC)
NT
ALA
RM,IV POLES,PRESSURE GAUGE,CONCENTRATE CONTAINER
C)
LOG
MAC
IC)
OLOGIC)
MAC
PHA
OLOGIC)
RMACOLOGIC)
NG
NG
BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION

INTERPRETATION BY PHYSICIAN
Y,
TP
EACH 10 MINUTES BEYOND THE FIRST 5 MINUTES

ROGRAM, PER DAY
IAN
CRE
EN & RESCREEN BY CYTOTECHNOLOGIST UNDER PHYS SUPERVSN
AL
RE)
HEALTH PROBLEMS, PER SESSION (45 MINUTES OR MORE)
VW,
,PA
SES
SUBSEQNT RPTS,PAT STAT,REVW,LAB&OTHR STUDIES,COMMUNIC

T STAT,REVW,LAB&OTH STUDIES,COMMUNICTN W HLTH CR PROF
SIONS)
SM
AC
ION
ONITORING)
CURCY&DOS VERIFICATION ,ALL LESS TRTD,/COURSE,TX
S
NUT
ES) [DEMO PROJECT CODE ONLY]
NSE
L;CRISIS INTERVENTN,& ACT THERAPIES/EDUC
PR
TI
EV
EVENTION THROUGH POLICY AND LAW)

NCLUDE ASSESSMENT
ENTS)
WH
WH
EN DRUG IS SELF ADMINISTERED)

EN DRUG IS SELF ADMINISTERED)
ND
RUG IS SELF ADMINISTERED)
RU
SE WHEN DRUG IS SELF ADMINISTERED)
OR
USE WHEN DRUG IS SELF ADMINISTERED)
BUT
EROL)
NTR
OL AND BRAKING
SK
ILS
, WITH MATTRESS
VA
TYPE)
),
CUSTOM FABRICATED
DA
DJUSTMENT
ATE
BRI
T
D, INCLUDES FITTING AND ADJUSTMENT

CATED
JUS
TMENT
D
D
UST
JO
UST
EJ
OM FABRICATED
INT, CUSTOM FABRICATED
OM FABRICATED
OINT, CUSTOM FABRICATED
CU
BRI
STOM FABRICATED
CATED
MEN
TME
T
NT
AD
JUSTMENT
STA
MS
L JOINTS),PREFABRICATED,INCL FITTING&ADJUST
USPENSION SUPPORT, PREFABRICATED,INCL FITTNG& ADJUST
D,
INCLUDES FITTING & ADJUSTMENT
BE
ADD
E"
RTI
LOW KNEE
ITIONAL CAST CHANGE AND REALIGNMENT
AK" OR KNEE DISARTICULATION
CULATION, EACH ADDITIONAL CAST CHANGE AND REALIGNMENT
ED
OM
DI
MOL
EO
TO
ODEL
RECT FORMED
DED TO MODEL
PEN END SOCKET
MODEL
ONE
NE
CAS
CAST CHANGE, WRIST DISARTICULATION OR BELOW ELBOW

CAST CHANGE, ELBOW DISARTICULATION OR ABOVE ELBOW
T CHANGE,SHLDR DISARTICULATN/INTERSCAPULAR THORACIC
EN
BOW
DC
CON
AIR
FAI
CABLE CONTROL,USMC/=PYLON,NO COVR,MOLDED TO PAT MDL

DEN CABLE CONTROL,USMC/= PYLON,NO COVER,DIR FORMED
ABLE CONTROL, USMC/=PYLON,NO COVER,MOLD TO PAT MDL
TROL, USMC OR EQUAL PYLON, NO COVER, DIRECT FORMED
LD CABLE CONTRL,USMC/=PYLON,NO COVER,MOLD TO PAT MDL
R LEAD CABLE CONTROL,USMC/=PYLON,NO COVER, DIR FORMED
AND
&1
RGE
CH
2B
2B
BA
ES,
2B
BLE
,2
ES,
ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE

CHARGER,MYOELECTRONIC CONTROL OF TERMINL DEVICE
R, SWITCH CONTROL OF TERMINAL DEVICE
ARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE
ATTERIES & 1 CHARGER,SWITCH CONTROL OF TRMINAL DEVICE
ATTERIES & 1 CHARGER,MYOELECTRONIC CNTRL,TRMINAL DEVC
TTERIES & 1 CHARGER,SWITCH CONTROL OF TERMINAL DEVICE
2 BATTERIES& 1 CHRGER,MYOELECTRONIC CNTRL,TRMINL DEVC
ATTERIES&1 CHARGER,SWITCH CNTRL,TRMINL DEV
S, 2 BATTERIES& 1 CHRGER,MYOELECTRONIC CNTRL,TERM DEV
BATTERIES& 1 CHRGER,SWITCH CNTRL,TERM DEV
CABLES,2 BATTERIES &1 CHRGER,MYOELECT CNTRL,TERM DEV
LIT
Y DISORDERS
ENT
ENT
; PRORATED MILES ACTUALLY TRAVELLED.

; PRORATED TRIP CHARGE.
TIC
AT
CA
CA
OF
FC
AT TIME,CHEMO TX NOT TO EXCEED 48-HR DOSAGE REGIMEN

TIME,CHEMO TX, NOT TO EXCEED 48-HR DOSAGE REGIMEN
T TIME,CHEMO TX, NOT TO EXCEED 48-HR DOSAGE REGIMEN
T TIME,CHEMO TX, NOT TO EXCEED 24-HR DOSAGE REGIMEN
CHEMO TX, NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
HEMO TX, NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
MET
TIC
MET
MET
TIC
CA
OF
OF
TIM
TIM
AT
TI
OF
RE
MET
IC AT TIME,CHEMO TX,NOT TO EXCEED 48-HR DOSAGE REGIMN

AT TIME,CHEMO TX,NOT TO EXCEED 48-HR DOSAGE REGIMEN
AT TIME,CHEMO TX,NOT TO EXCEED 48-HR DOSAGE REGIMEN
T TIME OF CHEMO TX,NOT TO EXCEED 48-HR DOSAGE REGIMEN
CHEMO TX, NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
CHEMO TX,NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
E OF CHEMO TX, NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
E OF CHEMO TX, NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
TIME,CHEMO TX,NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
ME OF CHEMO TX,NOT TO EXCEED A 24-HOUR DOSAGE REGIMEN
CHEMO TX,NOT TO EXCEED A 48-HOUR DOSAGE REGIMEN
CENTIMETER
ER
PE
R PATIENT
HE
VACCINE
TIV
TIV
ITIES OF PATIENT CARE; APPROXIMATELY 30 MINUTES

ITIES OF PATIENT CARE; APPROXIMATELY 60 MINUTES
SER
VICE)
ETE
S), PER VISIT
HO
SPIZATION; MED, SURG, DIAG&EMRGNCY SVCS)
USI
USI
USI
USI
USI
NG ARTERIAL GRAFT(S), SINGLE CORONARY ARTERIAL GRAFT

NG ARTERIAL GRAFT(S), TWO CORONARY ARTERIAL GRAFTS
NG VENOUS GRAFT ONLY, SINGLE CORONARY VENOUS GRAFT
NG SINGLE ARTERIAL AND VENOUS GRAFT(S),1 VENOUS GRAFT
NG TWO ARTERIAL GRAFTS AND SINGLE VENOUS GRAFT
ERA
ST
SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
QUE
NT VISUALIZATION, DETERMINATION, DEVELOPMENT
SA
SE
ND NURSE VSTS CDD SEP),/DIEM

P),/DIEM
CDD
SE
SEP),/DIEM
CD, INTERIM MAINT,VASCACCSS NOT CURRENTLY USE)
ED)
EDU
CTN - 59866)
ALL
NECESSARY SUPPLIES & EQUIPMENT, PER DIEM
DI
NAN
EM
CE, PER MONTH
ES
S9802-S9803 CAN BE USED)
SC
EV
ARA
(N
(DO
ERD
CO
LIE
PPL
SUP
DD SEP),/DIEM (DO NO CD W HOME INFUS/DIEM CD)

STS CDD SEP),/DIEM (DO NO CD W HOME INFUS/DIEM CD)
TELY), PER DIEM (DO NO CD W HOME INFUS/DIEM CD)
OT CODE W HOME INFUS/DIEM CD)
NO CD W HOME INFUS/DIEM CD)
IEM (DO NO CD W HOME INFUS/DIEM CD)
DE WITH S9326, S9327/S9328)
S&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
IES&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
PLIES&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
DE
SUP
YS
SUP
DE
(D
ENT
QUI
TER
MEN
ARY
SU
SEP),/DIEM (DO NO CD W S9330/S9331)

PLIES&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
UPPL&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
PLIES AND EQUIPMENT (DRGS&NURSE VSTS CDD SEP),/DIEM
QUIPMENT (DRUG&NURSING VISITS CDD SEP),/DIEM
RUGS AND NURSING VISITS CDD SEP),/DIEM
ERAL FORMULA AND NURSING VSTS CDD SEP),/DIEM
PMENT (ENTERAL FORMULA&NURSING VISITS CDD SEP),/DIEM
AL FORMULA&NURSING VSTS CDD SEP),/DIEM
T (ENTERAL FORMULA&NURSING VISITS CDD SEP),/DIEM
SUPPLIES & EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM
PPLIES & EQUIPMENT (DRGS&NURSE VSTS CDD SEP),/DIEM
UPP
&E
ESS
SU
IPM
SUP
CES
L&E
YS
OA
SPE
,SP
DS,
FO
PLI
ON
TX
PPL
LIE
PPL
ECE
(D
LIES & EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM

QUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
ARY SUPPL & EQUIP (DRUGS&NURSING VSTS CDD SEP),/DIEM
PPL & EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
ENT(DRUGS&NURSING VSTS CDD SEP),/DIEM
PLIES & EQUIPMENT (DRGS&NURSE VSTS CDD SEP),/DIEM
SARY SUPPLIES & EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM
QUIPMENT (DRUGS&NURSING VSTS CDD SEP),/DIEM
UPPL&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
CID FORMULAS, DRGS,&NURSE VSTS CDD SEP),/DIEM
C AMINO ACID FORMULAS,DRGS,&NURSE VSTS CDD SEP),/DIEM
EC AMINO ACID FORMULAS,DRGS,&NURSE VSTS CDD SEP)/DIEM
SPEC AMINO ACIDS,DRGS,&NURSE VSTS CDD SEP),/DIEM
RMULAS,DRGS,&NURSE VSTS CDD SEP),/DIEM
ES&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
O CD,FLUSHING,INFUS S W HEPARIN MAINTAIN PATENCY)
CDS S9374-S9377 USNG DAILY SCALES)
IES&EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM
S & EQUIPMENT (DRGS AND NURSE VSTS CDD SEP),/DIEM
IES & EQUIPMENT (DRGS AND NURSE VSTS CDD SEP),/DIEM
SSARY SUPPLIES (DRUGS&NURSING VISITS CDD SEP),/DIEM
RGS AND NURSE VSTS CODE SEPARATELY),/DIEM
HOM
RY
RY
RY
YS
UP
UP
E INFUS CDS,HRLY DOSING SCHEDULES S9497-S9504)

SUP & EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM
UP & EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM
& EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM
& EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM
ESS
OD
S&N
ARY SUP&EQUIP (DRGS&NURSE VSTS CDD SEP),/DIEM

PRODUCTS, DRUGS,&NURSING VISITS CDD SEP),/DIEM
URSE VSTS CDD SEP),/DIEM
ES&
QUI
PLI
EQUIPMENT (DRUGS&NURSING VISITS CDD SEP),/DIEM

PMENT (DRUGS&NURSING VISITS CDD SEPARATELY),/DIEM
ES & EQUIPMENT (DRGS&NURSE VSTS CDD SEP),/DIEM
(D
RUGS & NURSING VISITS CODED SEPARATELY),PER DIEM
SSI
ERV
FIED,/HR (DO NO USE CD W ANY/DIEM CD)

ICES
AND
ONE CAREGIVER/COMPANION
NO
LAN
F TREATMENT
OF TREATMENT
TOC
OL, PER ENCOUNTER
IM
LI
PAIRMENTS, PER DIEM

MPAIRMENTS, PER HOUR
CPT_CODE
10021
10022
10040
10060
10061
10080
10081
10120
10121
10140
10160
10180
11000
11001
11010
11011
11012
11040
11041
11042
11043
11044
11055
11056
11057
11100
11101
11200
11201
11300
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400
11401
11402
11403
11404
11406
11420
CPT_SHORT_DESCRIPTION
FNA W/O IMAGE
FNA W/IMAGE
ACNE SURGERY OF SKIN ABSCESS
DRAINAGE OF SKIN ABSCESS
DRAINAGE OF SKIN ABSCESS
DRAINAGE OF PILONIDAL CYST
DRAINAGE OF PILONIDAL CYST
REMOVE FOREIGN BODY
REMOVE FOREIGN BODY
DRAINAGE OF HEMATOMA/FLUID
PUNCTURE DRAINAGE OF LESION
COMPLEX DRAINAGE, WOUND
DEBRIDE INFECTED SKIN
DEBRIDE INFECTED SKIN ADD-ON
DEBRIDE SKIN, FX
DEBRIDE SKIN/MUSCLE, FX
DEBRIDE SKIN/MUSCLE/BONE, FX
DEBRIDE SKIN, PARTIAL
DEBRIDE SKIN, FULL
DEBRIDE SKIN/TISSUE
DEBRIDE TISSUE/MUSCLE
DEBRIDE TISSUE/MUSCLE/BONE
TRIM SKIN LESION
TRIM SKIN LESIONS, 2 TO 4
TRIM SKIN LESIONS, OVER 4
BIOPSY OF SKIN LESION
BIOPSY, SKIN ADD-ON
REMOVAL OF SKIN TAGS
REMOVE SKIN TAGS ADD-ON
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
SHAVE SKIN LESION
EXC B9+MARG ARM DIAM 0.5 < CM
EXC B9+MARG ARM DIAM 0.6-1 CM
EXC B9+MARG ARM DIAM > 4.0 CM
EXC B9+MARG HND DIAM 0.5 < CM
11421
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11450
11451
11462
11463
11470
11471
11600
11601
11602
11603
11604
11606
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
11719
11720
11721
11730
11732
11740
11750
11752
11755
11760
11762
11765
11770
11771
EXC B9+MARG HND DIAM 0.6-1 CM

EXC B9+MARG HND DIAM > 4.0 CM
EXC B9+MARG EAR DIAM 0.5 < CM
EXC B9+MARG EAR DIAM 0.6-1 CM
EXC B9+MARG ARM DIAM > 4.0 CM
REMOVAL, SWEAT GLAND LESION
EXCIS MALIG ARM DIAM 0.5 < CM
EXCIS MALIG ARM DIAM 0.6-1 CM
EXCIS MALIG ARM DIAM > 4.0 CM
EXCIS MALIG HND DIAM 0.5 < CM
EXCIS MALIG HND DIAM 0.6-1 CM
EXCIS MALIG HND DIAM > 4.0 CM
EXCIS MALIG EAR DIAM 0.5 < CM
EXCIS MALIG EAR DIAM 0.6-1 CM
EXCIS MALIG EAR DIAM > 4.0 CM
TRIM NAIL(S)
DEBRIDE NAIL, 1-5
DEBRIDE NAIL, 6 OR MORE
REMOVAL OF NAIL PLATE
REMOVE NAIL PLATE, ADD-ON
DRAIN BLOOD FROM UNDER NAIL
REMOVAL OF NAIL BED
REMOVE NAIL BED/FINGER TIP
BIOPSY, NAIL UNIT
REPAIR OF NAIL BED
RECONSTRUCTION OF NAIL BED
EXCISION OF NAIL FOLD, TOE
REMOVAL OF PILONIDAL LESION
11772
11900
11901
11920
11921
11922
11950
11951
11952
11954
11960
11970
11971
11975
11976
11977
11980
11981
11982
11983
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
12020
12021
12031
12032
12034
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052

INJECTION INTO SKIN LESIONS
ADDED SKIN LESIONS INJECTION
CORRECT SKIN COLOR DEFECTS
THERAPY FOR CONTOUR DEFECTS
INSERT TISSUE EXPANDER(S)
REPLACE TISSUE EXPANDER
REMOVE TISSUE EXPANDER(S)
INSERT CONTRACEPTIVE CAP
REMOVAL OF CONTRACEPTIVE CAP
REMOVAL/REINSERT CONTRA CAP
IMPLANT HORMONE PELLET(S)
INSERT DRUG IMPLANT DEVICE
REMOVE DRUG IMPLANT DEVICE
REMOVE/INSERT DRUG IMPLANT
REPAIR SUPERFICIAL WOUND(S)
CLOSURE OF SPLIT WOUND
CLOSURE OF SPLIT WOUND
LAYER CLOSURE OF WOUND(S)
12053
12054
12055
12056
12057
13100
13101
13102
13120
13121
13122
13131
13132
13133
13150
13151
13152
13153
13160
14000
14001
14020
14021
14040
14041
14060
14061
14300
14350
15000
15001
15050
15100
15101
15120
15121
15200
15201
15220
15221
15240
15241
15260
15261
15342
15343
15350
15351
15400

REPAIR OF WOUND OR LESION
REPAIR WOUND/LESION ADD-ON
LATE CLOSURE OF WOUND
SKIN TISSUE REARRANGEMENT
SKIN GRAFT
SKIN GRAFT ADD-ON
SKIN PINCH GRAFT
SKIN SPLIT GRAFT
SKIN SPLIT GRAFT ADD-ON
SKIN SPLIT GRAFT
SKIN SPLIT GRAFT ADD-ON
SKIN FULL GRAFT
SKIN FULL GRAFT ADD-ON
SKIN FULL GRAFT
SKIN FULL GRAFT
SKIN FULL GRAFT
APP BILAM SKN SUB/NEOD;25 SQCM
APP BILAM SKN SUB/NEOD;ADD 25
SKIN HOMOGRAFT
SKIN HOMOGRAFT ADD-ON
SKIN HETEROGRAFT
15401
15570
15572
15574
15576
15600
15610
15620
15630
15650
15732
15734
15736
15738
15740
15750
15756
15757
15758
15760
15770
15775
15776
15780
15781
15782
15783
15786
15787
15788
15789
15792
15793
15810
15811
15819
15820
15821
15822
15823
15824
15825
15826
15828
15829
15831
15832
15833
15834
SKIN HETEROGRAFT ADD-ON

FORM SKIN PEDICLE FLAP
SKIN GRAFT
SKIN GRAFT
SKIN GRAFT
SKIN GRAFT
TRANSFER SKIN PEDICLE FLAP
MUSCLE-SKIN GRAFT, HEAD/NECK
MUSCLE-SKIN GRAFT, TRUNK
MUSCLE-SKIN GRAFT, ARM
MUSCLE-SKIN GRAFT, LEG
ISLAND PEDICLE FLAP GRAFT
NEUROVASCULAR PEDICLE GRAFT
FREE MYO FLAP W/MICROVASC
FREE SKIN FLAP, MICROVASC
FREE FASCIAL FLAP, MICROVASC
COMPOSITE SKIN GRAFT
DERMA-FAT-FASCIA GRAFT
HAIR TRANSPLANT PUNCH GRAFTS
HAIR TRANSPLANT PUNCH GRAFTS
ABRASION TREATMENT OF SKIN
ABRASION, LESION, SINGLE
ABRASION, LESIONS, ADD-ON
CHEMICAL PEEL, FACE, EPIDERM
CHEMICAL PEEL, FACE, DERMAL
CHEMICAL PEEL, NONFACIAL
CHEMICAL PEEL, NONFACIAL
SALABRASION
SALABRASION
PLASTIC SURGERY, NECK
REVISION OF LOWER EYELID
REVISION OF LOWER EYELID
REVISION OF UPPER EYELID
REVISION OF UPPER EYELID
REMOVAL OF FOREHEAD WRINKLES
REMOVAL OF NECK WRINKLES
REMOVAL OF BROW WRINKLES
REMOVAL OF FACE WRINKLES
REMOVAL OF SKIN WRINKLES
EXCISE EXCESSIVE SKIN TISSUE
15835
15836
15837
15838
15839
15840
15841
15842
15845
15850
15851
15852
15860
15876
15877
15878
15879
15920
15922
15931
15933
15934
15935
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
15956
15958
15999
16000
16010
16015
16020
16025
16030
16035
16036
17000
17003
17004
17106

GRAFT FOR FACE NERVE PALSY
GRAFT FOR FACE NERVE PALSY
GRFT,FAC NRVE PARAL;MICROSUR
SKIN AND MUSCLE REPAIR, FACE
REMOVAL OF SUTURES
REMOVAL OF SUTURES
DRESSING CHANGE,NOT FOR BURN
TEST FOR BLOOD FLOW IN GRAFT
SUCTION ASSISTED LIPECTOMY
REMOVAL OF TAIL BONE ULCER
REMOVAL OF TAIL BONE ULCER
REMOVE SACRUM PRESSURE SORE
REMOVE HIP PRESSURE SORE
REMOVE THIGH PRESSURE SORE
REMOVAL OF PRESSURE SORE
INITIAL TREATMENT OF BURN(S)
TREATMENT OF BURN(S)
ESCHAROTOMY; INITIAL INCISION
ESCHAROTOMY; EACH ADD INCISION
DETROY BENIGN/PREMAL LESION
DESTROY LESIONS, 2-14
DESTROY LESIONS, 15 OR MORE
DESTRUCTION OF SKIN LESIONS
17107
17108
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283
17284
17286
17304
17305
17306
17307
17310
17340
17360
17380
17999
19000
19001
19020
19030
19100
19101
19102
19103
19110
19112
19120
19125
19126
19140
19160
19162
19180

DESTRUCT LESION, 1-14
DESTRUCT LESION, 15 OR MORE
CHEMICAL CAUTERY, TISSUE
CHMO;1 STGE MOHS,UP TO 5 SPEC
CHMO;ADL STGE MOHS UP 5 SPEC
CHMO;ANY STGE MOHS >5 SPEC ECH
CRYOTHERAPY OF SKIN
SKIN PEEL THERAPY
HAIR REMOVAL BY ELECTROLYSIS
SKIN TISSUE PROCEDURE
DRAINAGE OF BREAST LESION
DRAIN BREAST LESION ADD-ON
INCISION OF BREAST LESION
INJECTION FOR BREAST X-RAY
BX OF BRST;PERCUTAN,NEEDL CORE
BIOPSY OF BREAST;OPEN,INCISION
BX,BREAST;PERCUT,NEED CORE,IMG
BX,BRST;PERCUT,AUT VAC/ROT,IMG
NIPPLE EXPLORATION
EXCISE BREAST DUCT FISTULA
EXC CYST,FIB/OTH BRN/MGL BRST
EXC BRST LES IDENT,PREOP PLACE
EXC BRST LES PLC RAD MRK,OPN
REMOVAL OF BREAST TISSUE
REMOVAL OF BREAST TISSUE
REMOVE BREAST TISSUE, NODES
REMOVAL OF BREAST
19182
19200
19220
19240
19260
19271
19272
19290
19291
19295
19316
19318
19324
19325
19328
19330
19340
19342
19350
19355
19357
19361
19364
19366
19367
19368
19369
19370
19371
19380
19396
19499
20000
20005
20100
20101
20102
20103
20150
20200
20205
20206
20220
20225
20240
20245
20250
20251
20500
REMOVAL OF BREAST
REMOVAL OF BREAST
REMOVAL OF BREAST
REMOVAL OF BREAST
REMOVAL OF CHEST WALL LESION
REVISION OF CHEST WALL
EXTENSIVE CHEST WALL SURGERY
PLACE NEEDLE WIRE, BREAST
PLACE NEEDLE WIRE, BREAST
IMG GUID,MET LOC CLIP,BREST BX
SUSPENSION OF BREAST
REDUCTION OF LARGE BREAST
ENLARGE BREAST
ENLARGE BREAST WITH IMPLANT
REMOVAL OF BREAST IMPLANT
REMOVAL OF IMPLANT MATERIAL
IMMEDIATE BREAST PROSTHESIS
DELAYED BREAST PROSTHESIS
BREAST RECONSTRUCTION
CORRECT INVERTED NIPPLE(S)
SURGERY OF BREAST CAPSULE
REMOVAL OF BREAST CAPSULE
REVISE BREAST RECONSTRUCTION
DESIGN CUSTOM BREAST IMPLANT
BREAST SURGERY PROCEDURE
INCISION OF ABSCESS
INCISION OF DEEP ABSCESS
EXPLORE WOUND, NECK
EXPLORE WOUND, CHEST
EXPLORE WOUND, ABDOMEN
EXPLORE WOUND, EXTREMITY
EXCISE EPIPHYSEAL BAR
MUSCLE BIOPSY
DEEP MUSCLE BIOPSY
NEEDLE BIOPSY, MUSCLE
BONE BIOPSY, TROCAR/NEEDLE
BONE BIOPSY, TROCAR/NEEDLE
BONE BIOPSY, EXCISIONAL
BONE BIOPSY, EXCISIONAL
OPEN BONE BIOPSY
OPEN BONE BIOPSY
INJECTION OF SINUS TRACT
20501
20520
20525
20526
20550
20551
20552
20553
20600
20605
20610
20612
20615
20650
20660
20661
20662
20663
20664
20665
20670
20680
20690
20692
20693
20694
20802
20805
20808
20816
20822
20824
20827
20838
20900
20902
20910
20912
20920
20922
20924
20926
20930
20931
20936
20937
20938
20950
20955
INJECT SINUS TRACT FOR X-RAY

REMOVAL OF FOREIGN BODY
THER INJECTION, CARPAL TUNNEL
INJ TENDON SHEATH/LIGAMENT
INJECT TENDON ORIGIN/INSERT
INJ SIGL/MULT TRIG PNT 1 OR 2
INJ SIGL/MULT TRIG PNT 3 +
ART,ASP &/ INJ;SML JNT /BURSA
ART,ASP &/ INJ;INTE JNT /BURSA
DRAIN/INJECT, JOINT/BURSA
ASPIRATE/INJ GANGLION CYST
TREATMENT OF BONE CYST
INSERT AND REMOVE BONE PIN
APPLY,REMOVE FIXATION DEVICE
APPLICATION OF HEAD BRACE
APPLICATION OF PELVIS BRACE
APPLICATION OF THIGH BRACE
HALO BRACE APPLICATION
REMOVAL OF FIXATION DEVICE
REMOVAL OF SUPPORT IMPLANT
REMOVAL OF SUPPORT IMPLANT
APPLY BONE FIXATION DEVICE
APPLY BONE FIXATION DEVICE
ADJUST BONE FIXATION DEVICE
REMOVE BONE FIXATION DEVICE
REPLANTATION, ARM, COMPLETE
REPLANT, FOREARM, COMPLETE
REPLANTATION HAND, COMPLETE
REPLANTATION DIGIT, COMPLETE
REPLANTATION DIGIT, COMPLETE
REPLANTATION THUMB, COMPLETE
REPLANTATION THUMB, COMPLETE
REPLANTATION FOOT, COMPLETE
REMOVAL OF BONE FOR GRAFT
REMOVAL OF BONE FOR GRAFT
REMOVE CARTILAGE FOR GRAFT
REMOVE CARTILAGE FOR GRAFT
REMOVAL OF FASCIA FOR GRAFT
REMOVAL OF FASCIA FOR GRAFT
REMOVAL OF TENDON FOR GRAFT
REMOVAL OF TISSUE FOR GRAFT
SPINAL BONE ALLOGRAFT
SPINAL BONE ALLOGRAFT
SPINAL BONE AUTOGRAFT
FLUID PRESSURE, MUSCLE
FIBULA BONE GRAFT, MICROVASC
20956
20957
20962
20969
20970
20972
20973
20974
20975
20979
20999
21010
21015
21025
21026
21029
21030
21031
21032
21034
21040
21044
21045
21046
21047
21048
21049
21050
21060
21070
21076
21077
21079
21080
21081
21082
21083
21084
21085
21086
21087
21088
21089
21100
21110
21116
21120
21121
21122
ILIAC BONE GRAFT, MICROVASC

MT BONE GRAFT, MICROVASC
OTHER BONE GRAFT, MICROVASC
BONE/SKIN GRAFT, MICROVASC
BONE/SKIN GRAFT, ILIAC CREST
BONE/SKIN GRAFT, METATARSAL
BONE/SKIN GRAFT, GREAT TOE
ELECTRICAL BONE STIMULATION
ELECTRICAL BONE STIMULATION
US BONE STIMULATION
MUSCULOSKELETAL SURGERY
INCISION OF JAW JOINT
RESECTION OF FACIAL TUMOR
EXCISION OF BONE, LOWER JAW
EXCISION OF FACIAL BONE(S)
CONTOUR OF FACE BONE LESION
EXCIS B9 TUMOR MAX/ZYGOMA
REMOVE EXOSTOSIS, MANDIBLE
REMOVE EXOSTOSIS, MAXILLA
EXCIS MLG TUMOR MAX/ZYGOMA
EXCIS B9 TMR MANDIBLE &/ CURET
REMOVAL OF JAW BONE LESION
EXTENSIVE JAW SURGERY
REMOVE MANDIBLE CYST COMPLEX
EXCISE LWR JAW CYST W/REPAIR
REMOVE MAXILLA CYST COMPLEX
EXCIS UPPR JAW CYST W/REPAIR
REMOVAL OF JAW JOINT
REMOVE JAW JOINT CARTILAGE
REMOVE CORONOID PROCESS
PREPARE FACE/ORAL PROSTHESIS
MAXILLOFACIAL FIXATION
INTERDENTAL FIXATION
INJECTION, JAW JOINT X-RAY
RECONSTRUCTION OF CHIN
21123
21125
21127
21137
21138
21139
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21175
21179
21180
21181
21182
21183
21184
21188
21193
21194
21195
21196
21198
21199
21206
21208
21209
21210
21215
21230
21235
21240
21242
21243
21244
21245
21246
21247
21248
21249
AUGMENTATION, LOWER JAW BONE
AUGMENTATION, LOWER JAW BONE
REDUCTION OF FOREHEAD
RECONSTRUCT MIDFACE, LEFORT
RECONSTRUCT ORBIT/FOREHEAD
RECONSTRUCT ORBIT/FOREHEAD
RECONSTRUCT ENTIRE FOREHEAD
RECONSTRUCT ENTIRE FOREHEAD
CONTOUR CRANIAL BONE LESION
RECONSTRUCT CRANIAL BONE
RECONSTRUCTION OF MIDFACE
RECONSTRUCT LOWER JAW BONE
OSTEOT,MAND,SEG;GENIOGLOS ADVN
RECONSTRUCT UPPER JAW BONE
AUGMENTATION OF FACIAL BONES
REDUCTION OF FACIAL BONES
FACE BONE GRAFT
LOWER JAW BONE GRAFT
RIB CARTILAGE GRAFT
EAR CARTILAGE GRAFT
RECONSTRUCTION OF JAW JOINT
RECONSTRUCTION OF LOWER JAW
RECONSTRUCTION OF JAW
21255
21256
21260
21261
21263
21267
21268
21270
21275
21280
21282
21295
21296
21299
21300
21310
21315
21320
21325
21330
21335
21336
21337
21338
21339
21340
21343
21344
21345
21346
21347
21348
21355
21356
21360
21365
21366
21385
21386
21387
21390
21395
21400
21401
21406
21407
21408
21421
21422

RECONSTRUCTION OF ORBIT
REVISE EYE SOCKETS
REVISE EYE SOCKETS
REVISE EYE SOCKETS
REVISE EYE SOCKETS
REVISE EYE SOCKETS
AUGMENTATION, CHEEK BONE
REVISION, ORBITOFACIAL BONES
REVISION OF EYELID
REVISION OF EYELID
REVISION OF JAW MUSCLE/BONE
REVISION OF JAW MUSCLE/BONE
CRANIO/MAXILLOFACIAL SURGERY
TREATMENT OF SKULL FRACTURE
TREATMENT OF NOSE FRACTURE
TREAT NASAL SEPTAL FRACTURE
TREAT NASAL SEPTAL FRACTURE
TREAT NASOETHMOID FRACTURE
TREAT NASOETHMOID FRACTURE
TREATMENT OF SINUS FRACTURE
TREATMENT OF SINUS FRACTURE
TREAT NOSE/JAW FRACTURE
TREAT CHEEK BONE FRACTURE
TREAT EYE SOCKET FRACTURE
TREAT MOUTH ROOF FRACTURE
21423
21431
21432
21433
21435
21436
21440
21445
21450
21451
21452
21453
21454
21461
21462
21465
21470
21480
21485
21490
21493
21494
21495
21497
21499
21501
21502
21510
21550
21555
21556
21557
21600
21610
21615
21616
21620
21627
21630
21632
21700
21705
21720
21725
21740
21742
21743
21750
21800

TREAT CRANIOFACIAL FRACTURE
TREAT DENTAL RIDGE FRACTURE
TREAT DENTAL RIDGE FRACTURE
TREAT LOWER JAW FRACTURE
RESET DISLOCATED JAW
RESET DISLOCATED JAW
REPAIR DISLOCATED JAW
TREAT HYOID BONE FRACTURE
INTERDENTAL WIRING
HEAD SURGERY PROCEDURE
DRAIN NECK/CHEST LESION
DRAIN CHEST LESION
DRAINAGE OF BONE LESION
BIOPSY OF NECK/CHEST
REMOVE LESION, NECK/CHEST
REMOVE LESION, NECK/CHEST
REMOVE TUMOR, NECK/CHEST
PARTIAL REMOVAL OF RIB
PARTIAL REMOVAL OF RIB
REMOVAL OF RIB
REMOVAL OF RIB AND NERVES
PARTIAL REMOVAL OF STERNUM
STERNAL DEBRIDEMENT
EXTENSIVE STERNUM SURGERY
EXTENSIVE STERNUM SURGERY
REVISION OF NECK MUSCLE
REVISION OF NECK MUSCLE/RIB
RECONSTRUCTION PECTS EXCAVATUM
REPAIR STERN/NUSS W/O SCOPE
REPAIR STERNUM/NUSS W/SCOPE
REPAIR OF STERNUM SEPARATION
TREATMENT OF RIB FRACTURE
21805
21810
21820
21825
21899
21920
21925
21930
21935
22100
22101
22102
22103
22110
22112
22114
22116
22210
22212
22214
22216
22220
22222
22224
22226
22305
22310
22315
22318
22319
22325
22326
22327
22328
22505
22520
22521
22522
22548
22554
22556
22558
22585
22590
22595
22600
22610
22612
22614
TREATMENT OF RIB FRACTURE

TREATMENT OF RIB FRACTURE(S)
TREAT STERNUM FRACTURE
TREAT STERNUM FRACTURE
NECK/CHEST SURGERY PROCEDURE
BIOPSY SOFT TISSUE OF BACK
BIOPSY SOFT TISSUE OF BACK
REMOVE LESION, BACK OR FLANK
REMOVE TUMOR, BACK
REMOVE PART OF NECK VERTEBRA
REMOVE PART, THORAX VERTEBRA
REMOVE PART, LUMBAR VERTEBRA
REMOVE EXTRA SPINE SEGMENT
REMOVE PART OF NECK VERTEBRA
REMOVE PART, THORAX VERTEBRA
REMOVE PART, LUMBAR VERTEBRA
REMOVE EXTRA SPINE SEGMENT
REVISION OF NECK SPINE
REVISION OF THORAX SPINE
REVISION OF LUMBAR SPINE
REVISE, EXTRA SPINE SEGMENT
REVISION OF NECK SPINE
REVISION OF THORAX SPINE
REVISION OF LUMBAR SPINE
REVISE, EXTRA SPINE SEGMENT
TREAT SPINE PROCESS FRACTURE
TREAT SPINE FRACTURE
TREAT ODONTOID FX W/O GRAFT
TREAT ODONTOID FX W/GRAFT
TREAT NECK SPINE FRACTURE
TREAT THORAX SPINE FRACTURE
TREAT EACH ADD SPINE FX
MANIPULATION OF SPINE
PERCUT VERTEBROPLAS,1;THORACIC
PERCUT VERTEBROPLASTY,1;LUMBAR
PERCUT VRTBRPL,1;ADD THOR/LMBR
NECK SPINE FUSION
NECK SPINE FUSION
THORAX SPINE FUSION
LUMBAR SPINE FUSION
ADDITIONAL SPINAL FUSION
SPINE & SKULL SPINAL FUSION
NECK SPINAL FUSION
NECK SPINE FUSION
THORAX SPINE FUSION
LUMBAR SPINE FUSION
SPINE FUSION, EXTRA SEGMENT
22630
22632
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22851
22852
22855
22899
22900
22999
23000
23020
23030
23031
23035
23040
23044
23065
23066
23075
23076
23077
23100
23101
23105
23106
23107
23120
23125
23130
23140
LUMBAR SPINE FUSION

SPINE FUSION, EXTRA SEGMENT
FUSION OF SPINE
FUSION OF SPINE
FUSION OF SPINE
FUSION OF SPINE
FUSION OF SPINE
FUSION OF SPINE
KYPHECTOMY, 1-2 SEGMENTS
KYPHECTOMY, 3 OR MORE
EXPLORATION OF SPINAL FUSION
INSERT SPINE FIXATION DEVICE
INSERT PELV FIXATION DEVICE
REINSERT SPINAL FIXATION
REMOVE SPINE FIXATION DEVICE
APPLY SPINE PROSTH DEVICE
SPINE SURGERY PROCEDURE
REMOVE ABDOMINAL WALL LESION
ABDOMEN SURGERY PROCEDURE
REMOVAL OF CALCIUM DEPOSITS
RELEASE SHOULDER JOINT
DRAIN SHOULDER LESION
DRAIN SHOULDER BURSA
DRAIN SHOULDER BONE LESION
EXPLORATORY SHOULDER SURGERY
EXPLORATORY SHOULDER SURGERY
BIOPSY SHOULDER TISSUES
BIOPSY SHOULDER TISSUES
REMOVAL OF SHOULDER LESION
REMOVAL OF SHOULDER LESION
REMOVE TUMOR OF SHOULDER
BIOPSY OF SHOULDER JOINT
SHOULDER JOINT SURGERY
REMOVE SHOULDER JOINT LINING
INCISION OF COLLARBONE JOINT
EXPLORE TREAT SHOULDER JOINT
PARTIAL REMOVAL, COLLAR BONE
REMOVAL OF COLLAR BONE
REMOVE SHOULDER BONE, PART
REMOVAL OF BONE LESION
23145
23146
23150
23155
23156
23170
23172
23174
23180
23182
23184
23190
23195
23200
23210
23220
23221
23222
23330
23331
23332
23350
23395
23397
23400
23405
23406
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23470
23472
23480
23485
23490
23491
23500
23505
23515
23520

REMOVAL OF HUMERUS LESION
REMOVE COLLAR BONE LESION
REMOVE SHOULDER BLADE LESION
REMOVE HUMERUS LESION
REMOVE COLLAR BONE LESION
REMOVE SHOULDER BLADE LESION
PARTIAL REMOVAL OF SCAPULA
REMOVAL OF HEAD OF HUMERUS
REMOVAL OF COLLAR BONE
REMOVAL OF SHOULDER BLADE
PARTIAL REMOVAL OF HUMERUS
REMOVE SHOULDER FOREIGN BODY
INJECTION FOR SHOULDER X-RAY
MUSCLE TRANSFER,SHOULDER/ARM
MUSCLE TRANSFERS
FIXATION OF SHOULDER BLADE
INCISION OF TENDON & MUSCLE
INCISE TENDON(S) & MUSCLE(S)
REPAIR ROTATOR CUFF, ACUTE
REPAIR ROTATOR CUFF, CHRONIC
RELEASE OF SHOULDER LIGAMENT
REPAIR OF SHOULDER
REPAIR BICEPS TENDON
REMOVE/TRANSPLANT TENDON
REPAIR SHOULDER CAPSULE
RECONSTRUCT SHOULDER JOINT
RECONSTRUCT SHOULDER JOINT
REVISION OF COLLAR BONE
REVISION OF COLLAR BONE
REINFORCE CLAVICLE
REINFORCE SHOULDER BONES
TREAT CLAVICLE FRACTURE
TREAT CLAVICLE DISLOCATION
23525
23530
23532
23540
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625
23630
23650
23655
23660
23665
23670
23675
23680
23700
23800
23802
23900
23920
23921
23929
23930
23931
23935
24000
24006
24065
24066
24075
24076
24077
24100
24101
24102
24105
24110
24115
24116
24120

TREAT SHOULDER BLADE FX
TREAT SHOULDER BLADE FX
TREAT SCAPULA FRACTURE
TREAT HUMERUS FRACTURE
TREAT SHOULDER DISLOCATION
TREAT DISLOCATION/FRACTURE
FIXATION OF SHOULDER
FUSION OF SHOULDER JOINT
FUSION OF SHOULDER JOINT
AMPUTATION OF ARM & GIRDLE
AMPUTATION AT SHOULDER JOINT
AMPUTATION FOLLOW-UP SURGERY
SHOULDER SURGERY PROCEDURE
DRAINAGE OF ARM LESION
DRAINAGE OF ARM BURSA
DRAIN ARM/ELBOW BONE LESION
EXPLORATORY ELBOW SURGERY
RELEASE ELBOW JOINT
BIOPSY ARM/ELBOW SOFT TISSUE
BIOPSY ARM/ELBOW SOFT TISSUE
REMOVE ARM/ELBOW LESION
REMOVE ARM/ELBOW LESION
REMOVE TUMOR OF ARM/ELBOW
BIOPSY ELBOW JOINT LINING
EXPLORE/TREAT ELBOW JOINT
REMOVE ELBOW JOINT LINING
REMOVAL OF ELBOW BURSA
REMOVE/GRAFT BONE LESION
REMOVE ELBOW LESION
24125
24126
24130
24134
24136
24138
24140
24145
24147
24149
24150
24151
24152
24153
24155
24160
24164
24200
24201
24220
24300
24301
24305
24310
24320
24330
24331
24332
24340
24341
24342
24343
24344
24345
24346
24350
24351
24352
24354
24356
24360
24361
24362
24363
24365
24366
24400
24410
24420

REMOVAL OF HEAD OF RADIUS
REMOVAL OF ARM BONE LESION
REMOVE RADIUS BONE LESION
REMOVE ELBOW BONE LESION
PARTIAL REMOVAL OF ARM BONE
PARTIAL REMOVAL OF RADIUS
PARTIAL REMOVAL OF ELBOW
RADICAL RESECTION OF ELBOW
EXTENSIVE HUMERUS SURGERY
EXTENSIVE HUMERUS SURGERY
EXTENSIVE RADIUS SURGERY
EXTENSIVE RADIUS SURGERY
REMOVAL OF ELBOW JOINT
REMOVE ELBOW JOINT IMPLANT
REMOVE RADIUS HEAD IMPLANT
REMOVAL OF ARM FOREIGN BODY
REMOVAL OF ARM FOREIGN BODY
INJECTION FOR ELBOW X-RAY
MANIPULATE ELBOW W/ANESTH
MUSCLE/TENDON TRANSFER
ARM TENDON LENGTHENING
REVISION OF ARM TENDON
REPAIR OF ARM TENDON
REVISION OF ARM MUSCLES
REVISION OF ARM MUSCLES
TENOLYSIS, TRICEPS
REPAIR OF BICEPS TENDON
REPAIR ARM TENDON/MUSCLE
REPAIR OF RUPTURED TENDON
REPR ELBOW LAT LIGMNT W/TISS
RECONSTRUCT ELBOW LAT LIGMNT
REPR ELBW MED LIGMNT W/TISS
RECONSTRUCT ELBOW MED LIGMNT
REPAIR OF TENNIS ELBOW
REVISION OF TENNIS ELBOW
RECONSTRUCT ELBOW JOINT
REPLACE ELBOW JOINT
RECONSTRUCT HEAD OF RADIUS
RECONSTRUCT HEAD OF RADIUS
REVISION OF HUMERUS
REVISION OF HUMERUS
REVISION OF HUMERUS
24430
24435
24470
24495
24498
24500
24505
24515
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
24576
24577
24579
24582
24586
24587
24600
24605
24615
24620
24635
24640
24650
24655
24665
24666
24670
24675
24685
24800
24802
24900
24920
24925
24930
24931
24935
24940
24999
25000
25001
REPAIR OF HUMERUS
REPAIR HUMERUS WITH GRAFT
REVISION OF ELBOW JOINT
DECOMPRESSION OF FOREARM
REINFORCE HUMERUS
TREAT HUMRL FRAC INTRAMDULLARY
TREAT ELBOW FRACTURE
TREAT ELBOW DISLOCATION
TREAT RADIUS FRACTURE
TREAT ULNAR FRACTURE
FUSION OF ELBOW JOINT
FUSION/GRAFT OF ELBOW JOINT
AMPUTATION OF UPPER ARM
AMPUTATION OF UPPER ARM
AMPUTATE UPPER ARM & IMPLANT
REVISION OF AMPUTATION
REVISION OF UPPER ARM
UPPER ARM/ELBOW SURGERY
INCISION OF TENDON SHEATH
INCISE FLEXOR CARPI RADIALIS
25020
25023
25024
25025
25028
25031
25035
25040
25065
25066
25075
25076
25077
25085
25100
25101
25105
25107
25110
25111
25112
25115
25116
25118
25119
25120
25125
25126
25130
25135
25136
25145
25150
25151
25170
25210
25215
25230
25240
25246
25248
25250
25251
25259
25260
25263
25265
25270
25272
DECOMPRESS FOREARM 1 SPACE

DECOMPRESS FOREARM 1 SPACE
DECOMPRESS FOREARM 2 SPACES
DECOMPRESS FORARM 2 SPACES
DRAINAGE OF FOREARM LESION
DRAINAGE OF FOREARM BURSA
TREAT FOREARM BONE LESION
EXPLORE/TREAT WRIST JOINT
BIOPSY FOREARM SOFT TISSUES
BIOPSY FOREARM SOFT TISSUES
REMOVE FOREARM LESION SUBCUT
REMOVE FOREARM LESION DEEP
REMOVE TUMOR, FOREARM/WRIST
INCISION OF WRIST CAPSULE
BIOPSY OF WRIST JOINT
EXPLORE/TREAT WRIST JOINT
REMOVE WRIST JOINT LINING
REMOVE WRIST JOINT CARTILAGE
REMOVE WRIST TENDON LESION
REMOVE WRIST TENDON LESION
REREMOVE WRIST TENDON LESION
REMOVE WRIST/FOREARM LESION
REMOVE WRIST/FOREARM LESION
EXCISE WRIST TENDON SHEATH
PARTIAL REMOVAL OF ULNA
REMOVAL OF FOREARM LESION
REMOVE/GRAFT FOREARM LESION
REMOVE/GRAFT FOREARM LESION
REMOVAL OF WRIST LESION
REMOVE & GRAFT WRIST LESION
REMOVE & GRAFT WRIST LESION
REMOVE FOREARM BONE LESION
EXTENSIVE FOREARM SURGERY
REMOVAL OF WRIST BONE
REMOVAL OF WRIST BONES
INJECTION FOR WRIST X-RAY
REMOVE FOREARM FOREIGN BODY
REMOVAL OF WRIST PROSTHESIS
REMOVAL OF WRIST PROSTHESIS
MANIPULATE WRIST W/ANESTHES
REPAIR FOREARM TENDON/MUSCLE
25274
25275
25280
25290
25295
25300
25301
25310
25312
25315
25316
25320
25332
25335
25337
25350
25355
25360
25365
25370
25375
25390
25391
25392
25393
25394
25400
25405
25415
25420
25425
25426
25430
25431
25440
25441
25442
25443
25444
25445
25446
25447
25449
25450
25455
25490
25491
25492
25500

REPAIR FOREARM TENDON SHEATH
REVISE WRIST/FOREARM TENDON
INCISE WRIST/FOREARM TENDON
RELEASE WRIST/FOREARM TENDON
FUSION OF TENDONS AT WRIST
FUSION OF TENDONS AT WRIST
TRANSPLANT FOREARM TENDON
TRANSPLANT FOREARM TENDON
REVISE PALSY HAND TENDON(S)
REVISE PALSY HAND TENDON(S)
CAPSULORRHAPHY/RECONSRCT WRIST
REVISE WRIST JOINT
REALIGNMENT OF HAND
RECONSTRUCT ULNA/RADIOULNAR
REVISION OF RADIUS
REVISION OF RADIUS
REVISION OF ULNA
REVISE RADIUS & ULNA
REVISE RADIUS OR ULNA
REVISE RADIUS & ULNA
SHORTEN RADIUS OR ULNA
LENGTHEN RADIUS OR ULNA
SHORTEN RADIUS & ULNA
LENGTHEN RADIUS & ULNA
REPAIR CARPAL BONE, SHORTEN
REPAIR RADIUS OR ULNA
REPAIR/GRAFT RADIUS OR ULNA
REPAIR RADIUS & ULNA
REPAIR/GRAFT RADIUS & ULNA
REPAIR/GRAFT RADIUS OR ULNA
REPAIR/GRAFT RADIUS & ULNA
VASC GRAFT INTO CARPAL BONE
REPAIR NONUNION CARPAL BONE
REPAIR/GRAFT WRIST BONE
RECONSTRUCT WRIST JOINT
WRIST REPLACEMENT
REPAIR WRIST JOINT(S)
REMOVE WRIST JOINT IMPLANT
REVISION OF WRIST JOINT
REVISION OF WRIST JOINT
REINFORCE RADIUS
REINFORCE ULNA
REINFORCE RADIUS AND ULNA
TREAT FRACTURE OF RADIUS
25505
25515
25520
25525
25526
25530
25535
25545
25560
25565
25574
25575
25600
25605
25611
25620
25622
25624
25628
25630
25635
25645
25650
25651
25652
25660
25670
25671
25675
25676
25680
25685
25690
25695
25800
25805
25810
25820
25825
25830
25900
25905
25907
25909
25915
25920
25922
25924
25927

TREAT FRACTURE OF ULNA
TREAT FRACTURE RADIUS & ULNA
TREAT FRACTURE RADIUS/ULNA
TREAT WRIST BONE FRACTURE
PIN ULNAR STYLOID FRACTURE
TREAT FRACTURE ULNAR STYLOID
TREAT WRIST DISLOCATION
PIN RADIOULNAR DISLOCATION
TREAT WRIST FRACTURE
TREAT WRIST FRACTURE
FUSION OF WRIST JOINT
FUSION/GRAFT OF WRIST JOINT
FUSION/GRAFT OF WRIST JOINT
FUSION OF HAND BONES
FUSE HAND BONES WITH GRAFT
FUSION, RADIOULNAR JNT/ULNA
AMPUTATION OF FOREARM
AMPUTATE HAND AT WRIST
AMPUTATE HAND AT WRIST
AMPUTATION OF HAND
25929
25931
25999
26010
26011
26020
26025
26030
26034
26035
26037
26040
26045
26055
26060
26070
26075
26080
26100
26105
26110
26115
26116
26117
26121
26123
26125
26130
26135
26140
26145
26160
26170
26180
26185
26200
26205
26210
26215
26230
26235
26236
26250
26255
26260
26261
26262
26320
26340

FOREARM OR WRIST SURGERY
DRAINAGE OF FINGER ABSCESS
DRAINAGE OF FINGER ABSCESS
DRAIN HAND TENDON SHEATH
DRAINAGE OF PALM BURSA
DRAINAGE OF PALM BURSA(S)
TREAT HAND BONE LESION
DECOMPRESS FINGERS/HAND
DECOMPRESS FINGERS/HAND
RELEASE PALM CONTRACTURE
INCISE FINGER TENDON SHEATH
INCISION OF FINGER TENDON
EXPLORE/TREAT HAND JOINT
EXPLORE/TREAT FINGER JOINT
EXPLORE/TREAT FINGER JOINT
BIOPSY HAND JOINT LINING
BIOPSY FINGER JOINT LINING
BIOPSY FINGER JOINT LINING
REMOVE HAND LESION SUBCUT
REMOVE HAND LESION, DEEP
REMOVE TUMOR, HAND/FINGER
REMOVE WRIST JOINT LINING
REVISE FINGER JOINT, EACH
REVISE FINGER JOINT, EACH
TENDON EXCISION, PALM/FINGER
REMOVE TENDON SHEATH LESION
REMOVAL OF PALM TENDON, EACH
REMOVAL OF FINGER TENDON
REMOVE FINGER BONE
REMOVE HAND BONE LESION
REMOVAL OF FINGER LESION
REMOVE/GRAFT FINGER LESION
PARTIAL REMOVAL OF HAND BONE
PARTIAL REMOVAL, FINGER BONE
PARTIAL REMOVAL, FINGER BONE
EXTENSIVE HAND SURGERY
EXTENSIVE HAND SURGERY
EXTENSIVE FINGER SURGERY
EXTENSIVE FINGER SURGERY
PARTIAL REMOVAL OF FINGER
REMOVAL OF IMPLANT FROM HAND
MANIPULATE FINGER W/ANESTH
26350
26352
26356
26357
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418
26420
26426
26428
26432
26433
26434
26437
26440
26442
26445
26449
26450
26455
26460
26471
26474
26476
26477
26478
26479
26480
26483
26485
26489
26490
26492
26494
26496
26497
26498
26499
26500
26502
26504
REPAIR FINGER/HAND TENDON

REPAIR/GRAFT HAND TENDON
REVISE HAND/FINGER TENDON
REPAIR HAND TENDON
EXCISION, HAND/FINGER TENDON
GRAFT HAND OR FINGER TENDON
REPAIR FINGER TENDON
REPAIR/GRAFT FINGER TENDON
REALIGNMENT OF TENDONS
RELEASE PALM/FINGER TENDON
RELEASE PALM & FINGER TENDON
RELEASE HAND/FINGER TENDON
RELEASE FOREARM/HAND TENDON
INCISION OF PALM TENDON
INCISION OF FINGER TENDON
INCISE HAND/FINGER TENDON
FUSION OF FINGER TENDONS
FUSION OF FINGER TENDONS
TENDON LENGTHENING
TENDON SHORTENING
LENGTHENING OF HAND TENDON
SHORTENING OF HAND TENDON
TRANSPLANT HAND TENDON
TRANSPLANT/GRAFT HAND TENDON
TRANSPLANT PALM TENDON
TRANSPLANT/GRAFT PALM TENDON
REVISE THUMB TENDON
TENDON TRANSFER WITH GRAFT
HAND TENDON/MUSCLE TRANSFER
REVISE THUMB TENDON
FINGER TENDON TRANSFER
FINGER TENDON TRANSFER
REVISION OF FINGER
HAND TENDON RECONSTRUCTION
26508
26510
26516
26517
26518
26520
26525
26530
26531
26535
26536
26540
26541
26542
26545
26546
26548
26550
26551
26553
26554
26555
26556
26560
26561
26562
26565
26567
26568
26580
26587
26590
26591
26593
26596
26600
26605
26607
26608
26615
26641
26645
26650
26665
26670
26675
26676
26685
26686
RELEASE THUMB CONTRACTURE

THUMB TENDON TRANSFER
FUSION OF KNUCKLE JOINT
FUSION OF KNUCKLE JOINTS
FUSION OF KNUCKLE JOINTS
RELEASE KNUCKLE CONTRACTURE
RELEASE FINGER CONTRACTURE
REVISE KNUCKLE JOINT
REVISE KNUCKLE WITH IMPLANT
REVISE FINGER JOINT
REVISE/IMPLANT FINGER JOINT
REPAIR HAND JOINT
REPAIR HAND JOINT WITH GRAFT
REPAIR HAND JOINT WITH GRAFT
RECONSTRUCT FINGER JOINT
REPAIR NONUNION HAND
RECONSTRUCT FINGER JOINT
CONSTRUCT THUMB REPLACEMENT
GREAT TOE-HAND TRANSFER
SINGLE TRANSFER, TOE-HAND
DOUBLE TRANSFER, TOE-HAND
POSITIONAL CHANGE OF FINGER
TOE JOINT TRANSFER
REPAIR OF WEB FINGER
CORRECT METACARPAL FLAW
CORRECT FINGER DEFORMITY
LENGTHEN METACARPAL/FINGER
REPAIR HAND DEFORMITY
RECONSTRUCT EXTRA FINGER
REPAIR FINGER DEFORMITY
REPAIR MUSCLES OF HAND
RELEASE MUSCLES OF HAND
EXCISION CONSTRICTING TISSUE
TREAT METACARPAL FRACTURE
TREAT THUMB DISLOCATION
TREAT THUMB FRACTURE
TREAT HAND DISLOCATION
PIN HAND DISLOCATION
TX CARPOMTACRPL DSLCT,NT THUMB
26700
26705
26706
26715
26720
26725
26727
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
26820
26841
26842
26843
26844
26850
26852
26860
26861
26862
26863
26910
26951
26952
26989
26990
26991
26992
27000
27001
27003
27005
27006
27025
27030
27033
27035
27036
27040
27041
TREAT KNUCKLE DISLOCATION

PIN KNUCKLE DISLOCATION
TREAT FINGER FRACTURE, EACH
PIN FINGER FRACTURE, EACH
TREAT FINGER DISLOCATION
PIN FINGER DISLOCATION
THUMB FUSION WITH GRAFT
FUSION OF THUMB
THUMB FUSION WITH GRAFT
FUSION OF HAND JOINT
FUSION/GRAFT OF HAND JOINT
FUSION OF KNUCKLE
FUSION OF KNUCKLE WITH GRAFT
FUSION OF FINGER JOINT
FUSION OF FINGER JNT, ADD-ON
FUSION/GRAFT OF FINGER JOINT
FUSE/GRAFT ADDED JOINT
AMPUTATE METACARPAL BONE
AMPUTATION OF FINGER/THUMB
AMPUTATION OF FINGER/THUMB
HAND/FINGER SURGERY
DRAINAGE OF PELVIS LESION
DRAINAGE OF PELVIS BURSA
INCISION OF HIP TENDON
INCISION OF HIP TENDONS
INCISION OF HIP/THIGH FASCIA
DRAINAGE OF HIP JOINT
EXPLORATION OF HIP JOINT
DENERVATION OF HIP JOINT
EXCISION OF HIP JOINT/MUSCLE
BIOPSY OF SOFT TISSUES
BIOPSY OF SOFT TISSUES
27047
27048
27049
27050
27052
27054
27060
27062
27065
27066
27067
27070
27071
27075
27076
27077
27078
27079
27080
27086
27087
27090
27091
27093
27095
27096
27097
27098
27100
27105
27110
27111
27120
27122
27125
27130
27132
27134
27137
27138
27140
27146
27147
27151
27156
27158
27161
27165
27170
REMOVE HIP/PELVIS LESION

REMOVE HIP/PELVIS LESION
REMOVE TUMOR, HIP/PELVIS
BIOPSY OF SACROILIAC JOINT
BIOPSY OF HIP JOINT
REMOVAL OF HIP JOINT LINING
REMOVAL OF ISCHIAL BURSA
REMOVE FEMUR LESION/BURSA
REMOVAL OF HIP BONE LESION
REMOVAL OF HIP BONE LESION
REMOVE/GRAFT HIP BONE LESION
PARTIAL REMOVAL OF HIP BONE
PARTIAL REMOVAL OF HIP BONE
EXTENSIVE HIP SURGERY
REMOVAL OF TAIL BONE
REMOVE HIP FOREIGN BODY
REMOVE HIP FOREIGN BODY
REMOVAL OF HIP PROSTHESIS
REMOVAL OF HIP PROSTHESIS
INJECTION FOR HIP X-RAY
INJECTION FOR HIP X-RAY
INJECT SACROILIAC JOINT
REVISION OF HIP TENDON
TRANSFER TENDON TO PELVIS
TRANSFER OF ABDOMINAL MUSCLE
TRANSFER OF SPINAL MUSCLE
TRANSFER OF ILIOPSOAS MUSCLE
TRANSFER OF ILIOPSOAS MUSCLE
RECONSTRUCTION OF HIP SOCKET
RECONSTRUCTION OF HIP SOCKET
PARTIAL HIP REPLACEMENT
TOTAL HIP ARTHROPLASTY
TOTAL HIP ARTHROPLASTY
REVISE HIP JOINT REPLACEMENT
TRANSPLANT FEMUR RIDGE
INCISION OF HIP BONE
REVISION OF HIP BONE
INCISION OF HIP BONES
REVISION OF HIP BONES
REVISION OF PELVIS
INCISION OF NECK OF FEMUR
INCISION/FIXATION OF FEMUR
REPAIR/GRAFT FEMUR HEAD/NECK
27175
27176
27177
27178
27179
27181
27185
27187
27193
27194
27200
27202
27215
27216
27217
27218
27220
27222
27226
27227
27228
27230
27232
27235
27236
27238
27240
27244
27245
27246
27248
27250
27252
27253
27254
27256
27257
27258
27259
27265
27266
27275
27280
27282
27284
27286
27290
27295
27299
TREAT SLIPPED EPIPHYSIS

REVISE HEAD/NECK OF FEMUR
REVISION OF FEMUR EPIPHYSIS
REINFORCE HIP BONES
TREAT PELVIC RING FRACTURE
TREAT TAIL BONE FRACTURE
TREAT TAIL BONE FRACTURE
TREAT PELVIC FRACTURE(S)
TREAT HIP SOCKET FRACTURE
TREAT HIP SOCKET FRACTURE
TREAT HIP WALL FRACTURE
TREAT HIP FRACTURE(S)
TREAT HIP FRACTURE(S)
TREAT THIGH FRACTURE
PERCUT SKEL FIX OF FEMRL FRACT
OPN TX FEM FX,PROX END,NCK,FIX
TREAT FEMRAL FRAC W/PLATE/SCRW
TREAT FEMRAL FRAC W/INTRAEDULL
TREAT HIP DISLOCATION
MANIPULATION OF HIP JOINT
FUSION OF SACROILIAC JOINT
FUSION OF PUBIC BONES
FUSION OF HIP JOINT
FUSION OF HIP JOINT
AMPUTATION OF LEG AT HIP
AMPUTATION OF LEG AT HIP
PELVIS/HIP JOINT SURGERY
27301
27303
27305
27306
27307
27310
27315
27320
27323
27324
27327
27328
27329
27330
27331
27332
27333
27334
27335
27340
27345
27347
27350
27355
27356
27357
27358
27360
27365
27370
27372
27380
27381
27385
27386
27390
27391
27392
27393
27394
27395
27396
27397
27400
27403
27405
27407
27409
27418
DRAIN THIGH/KNEE LESION

INCISE THIGH TENDON & FASCIA
INCISION OF THIGH TENDON
INCISION OF THIGH TENDONS
EXPLORATION OF KNEE JOINT
PARTIAL REMOVAL, THIGH NERVE
PARTIAL REMOVAL, THIGH NERVE
BIOPSY, THIGH SOFT TISSUES
BIOPSY, THIGH SOFT TISSUES
REMOVAL OF THIGH LESION
REMOVAL OF THIGH LESION
REMOVE TUMOR, THIGH/KNEE
BIOPSY, KNEE JOINT LINING
EXPLORE/TREAT KNEE JOINT
REMOVAL OF KNEE CARTILAGE
REMOVAL OF KNEE CARTILAGE
REMOVE KNEE JOINT LINING
REMOVE KNEE JOINT LINING
REMOVAL OF KNEECAP BURSA
REMOVAL OF KNEE CYST
REMOVE KNEE CYST
REMOVAL OF KNEECAP
REMOVE FEMUR LESION
REMOVE FEMUR LESION/GRAFT
REMOVE FEMUR LESION/GRAFT
REMOVE FEMUR LESION/FIXATION
PARTIAL REMOVAL, LEG BONE(S)
EXTENSIVE LEG SURGERY
INJECTION FOR KNEE X-RAY
REPAIR OF KNEECAP TENDON
REPAIR/GRAFT KNEECAP TENDON
REPAIR OF THIGH MUSCLE
REPAIR/GRAFT OF THIGH MUSCLE
INCISION OF THIGH TENDON
LENGTHENING OF THIGH TENDON
LENGTHENING OF THIGH TENDONS
LENGTHENING OF THIGH TENDONS
TRANSPLANT OF THIGH TENDON
TRANSPLANTS OF THIGH TENDONS
REVISE THIGH MUSCLES/TENDONS
REPAIR OF KNEE CARTILAGE
REPAIR OF KNEE LIGAMENT
REPAIR OF KNEE LIGAMENT
REPAIR OF KNEE LIGAMENTS
REPAIR DEGENERATED KNEECAP
27420
27422
27424
27425
27427
27428
27429
27430
27435
27437
27438
27440
27441
27442
27443
27445
27446
27447
27448
27450
27454
27455
27457
27465
27466
27468
27470
27472
27475
27477
27479
27485
27486
27487
27488
27495
27496
27497
27498
27499
27500
27501
27502
27503
27506
27507
27508
27509
27510
REVISION OF UNSTABLE KNEECAP

REVISION OF UNSTABLE KNEECAP
REVISION/REMOVAL OF KNEECAP
LAT RETINACULAR RELEASE OPEN
RECONSTRUCTION, KNEE
REVISION OF THIGH MUSCLES
INCISION OF KNEE JOINT
REVISE KNEECAP
REVISE KNEECAP WITH IMPLANT
REVISION OF KNEE JOINT
TOTAL KNEE ARTHROPLASTY
INCISION OF THIGH
INCISION OF THIGH
REALIGNMENT OF THIGH BONE
REALIGNMENT OF KNEE
REALIGNMENT OF KNEE
SHORTENING OF THIGH BONE
LENGTHENING OF THIGH BONE
SHORTEN/LENGTHEN THIGHS
REPAIR OF THIGH
REPAIR/GRAFT OF THIGH
SURGERY TO STOP LEG GROWTH
REVISE/REPLACE KNEE JOINT
REVISE/REPLACE KNEE JOINT
REMOVAL OF KNEE PROSTHESIS
REINFORCE THIGH
DECOMPRESSION OF THIGH/KNEE
TREATMENT OF THIGH FRACTURE
27511
27513
27514
27516
27517
27519
27520
27524
27530
27532
27535
27536
27538
27540
27550
27552
27556
27557
27558
27560
27562
27566
27570
27580
27590
27591
27592
27594
27596
27598
27599
27600
27601
27602
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27618
27619
27620
27625
27626

TREAT THIGH FX GROWTH PLATE
TREAT KNEECAP FRACTURE
TREAT KNEECAP FRACTURE
TREAT KNEE FRACTURE
TREAT KNEE FRACTURE
TREAT KNEE FRACTURE
TREAT KNEE FRACTURE
TREAT KNEE FRACTURE(S)
TREAT KNEE FRACTURE
TREAT KNEE DISLOCATION
TREAT KNEECAP DISLOCATION
FIXATION OF KNEE JOINT
FUSION OF KNEE
AMPUTATE LEG AT THIGH
AMPUTATE LOWER LEG AT KNEE
LEG SURGERY PROCEDURE
DECOMPRESSION OF LOWER LEG
DRAIN LOWER LEG LESION
DRAIN LOWER LEG BURSA
INCISION OF ACHILLES TENDON
INCISION OF ACHILLES TENDON
TREAT LOWER LEG BONE LESION
EXPLORE/TREAT ANKLE JOINT
EXPLORATION OF ANKLE JOINT
BIOPSY LOWER LEG SOFT TISSUE
BIOPSY LOWER LEG SOFT TISSUE
REMOVE TUMOR, LOWER LEG
REMOVE LOWER LEG LESION
REMOVE LOWER LEG LESION
EXPLORE/TREAT ANKLE JOINT
REMOVE ANKLE JOINT LINING
REMOVE ANKLE JOINT LINING
27630
27635
27637
27638
27640
27641
27645
27646
27647
27648
27650
27652
27654
27656
27658
27659
27664
27665
27675
27676
27680
27681
27685
27686
27687
27690
27691
27692
27695
27696
27698
27700
27702
27703
27704
27705
27707
27709
27712
27715
27720
27722
27724
27725
27727
27730
27732
27734
27740
REMOVAL OF TENDON LESION

REMOVE LOWER LEG BONE LESION
REMOVE/GRAFT LEG BONE LESION
REMOVE/GRAFT LEG BONE LESION
PARTIAL REMOVAL OF TIBIA
PARTIAL REMOVAL OF FIBULA
EXTENSIVE LOWER LEG SURGERY
EXTENSIVE LOWER LEG SURGERY
EXTENSIVE ANKLE/HEEL SURGERY
INJECTION FOR ANKLE X-RAY
REPAIR ACHILLES TENDON
REPAIR/GRAFT ACHILLES TENDON
REPAIR OF ACHILLES TENDON
REPAIR LEG FASCIA DEFECT
REPAIR OF LEG TENDON, EACH
REPAIR LOWER LEG TENDONS
REPAIR LOWER LEG TENDONS
RELEASE OF LOWER LEG TENDON
RELEASE OF LOWER LEG TENDONS
REVISION OF LOWER LEG TENDON
REVISE LOWER LEG TENDONS
REVISION OF CALF TENDON
REVISE LOWER LEG TENDON
REVISE LOWER LEG TENDON
REVISE ADDITIONAL LEG TENDON
REPAIR OF ANKLE LIGAMENT
REPAIR OF ANKLE LIGAMENTS
REPAIR OF ANKLE LIGAMENT
REVISION OF ANKLE JOINT
RECONSTRUCT ANKLE JOINT
RECONSTRUCTION, ANKLE JOINT
REMOVAL OF ANKLE IMPLANT
INCISION OF TIBIA
INCISION OF FIBULA
INCISION OF TIBIA & FIBULA
REALIGNMENT OF LOWER LEG
REVISION OF LOWER LEG
REPAIR OF TIBIA
REPAIR/GRAFT OF TIBIA
REPAIR/GRAFT OF TIBIA
REPAIR OF LOWER LEG
REPAIR OF LOWER LEG
ARREST,EPIPHYSEAL, OPEN TIBIA
ARREST,EPIPHYSEAL,OPEN FIBULA
ARST, EPI, OPN TIBIA & FIBULA
REPAIR OF LEG EPIPHYSES
27742
27745
27750
27752
27756
27758
27759
27760
27762
27766
27780
27781
27784
27786
27788
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
27840
27842
27846
27848
27860
27870
27871
27880
27881
27882
27884
27886
27888
27889
27892
27893
27894
REPAIR OF LEG EPIPHYSES

REINFORCE TIBIA
TREATMENT OF TIBIA FRACTURE
TREATMENT OF ANKLE FRACTURE
TREATMENT OF FIBULA FRACTURE
TREAT LOWER LEG FRACTURE
TREAT LOWER LEG JOINT
TREAT LOWER LEG DISLOCATION
TREAT ANKLE DISLOCATION
FIXATION OF ANKLE JOINT
ARTHRODESIS, ANKLE, OPEN
FUSION OF TIBIOFIBULAR JOINT
AMPUTATION OF LOWER LEG
AMPUTATION OF FOOT AT ANKLE
AMPUTATION OF FOOT AT ANKLE
DECOMPRESSION OF LEG
27899
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28030
28035
28043
28045
28046
28050
28052
28054
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
LEG/ANKLE SURGERY PROCEDURE

DRAINAGE OF BURSA OF FOOT
TREATMENT OF FOOT INFECTION
TREATMENT OF FOOT INFECTION
TREAT FOOT BONE LESION
INCISION OF FOOT FASCIA
INCISION OF TOE TENDON
INCISION OF TOE TENDONS
EXPLORATION OF FOOT JOINT
EXPLORATION OF FOOT JOINT
EXPLORATION OF TOE JOINT
REMOVAL OF FOOT NERVE
DECOMPRESSION OF TIBIA NERVE
EXCISION OF FOOT LESION
EXCISION OF FOOT LESION
RESECTION OF TUMOR, FOOT
BIOPSY OF FOOT JOINT LINING
BIOPSY OF FOOT JOINT LINING
BIOPSY OF TOE JOINT LINING
PARTIAL REMOVAL, FOOT FASCIA
REMOVAL OF FOOT FASCIA
REMOVAL OF FOOT JOINT LINING
REMOVAL OF FOOT JOINT LINING
REMOVAL OF FOOT LESION
EXCISE FOOT TENDON SHEATH
EXCISE FOOT TENDON SHEATH
REMOVAL OF TOE LESIONS
REMOVAL OF ANKLE/HEEL LESION
REMOVE/GRAFT FOOT LESION
REMOVAL OF TOE LESIONS
PART REMOVAL OF METATARSAL
REMOVAL OF METATARSAL HEADS
REVISION OF FOOT
REMOVAL OF HEEL BONE
REMOVAL OF HEEL SPUR
PART REMOVAL OF ANKLE/HEEL
PARTIAL REMOVAL OF FOOT BONE
PARTIAL REMOVAL OF TOE
REMOVAL OF ANKLE BONE
REMOVAL OF METATARSAL
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260
28261
28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
REMOVAL OF TOE
EXTENSIVE FOOT SURGERY
REMOVAL OF FOOT FOREIGN BODY
REPAIR OF FOOT TENDON
REPAIR/GRAFT OF FOOT TENDON
REPAIR OF FOOT TENDON
REPAIR/GRAFT OF FOOT TENDON
RELEASE OF FOOT TENDON
RELEASE OF FOOT TENDONS
RELEASE OF FOOT TENDON
RELEASE OF FOOT TENDONS
INCISION OF FOOT TENDON(S)
INCISION OF TOE TENDON
INCISION OF FOOT TENDON
REVISION OF FOOT TENDON
RELEASE OF BIG TOE
REVISION OF FOOT FASCIA
RELEASE OF MIDFOOT JOINT
REVISION OF FOOT TENDON
REVISION OF FOOT AND ANKLE
RELEASE OF MIDFOOT JOINT
RELEASE OF FOOT CONTRACTURE
RELEASE OF TOE JOINT, EACH
FUSION OF TOES
REPAIR OF HAMMERTOE
REPAIR OF HAMMERTOE
PARTIAL REMOVAL OF FOOT BONE
REPAIR HALLUX RIGIDUS
CORRECTION OF BUNION
INCISION OF HEEL BONE
INCISION OF ANKLE BONE
INCISION OF MIDFOOT BONES
INCISE/GRAFT MIDFOOT BONES
INCISION OF METATARSAL
28309
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
INCISION OF METATARSALS
REVISION OF BIG TOE
REVISION OF TOE
REPAIR DEFORMITY OF TOE
REMOVAL OF SESAMOID BONE
REPAIR OF FOOT BONES
REPAIR OF METATARSALS
RESECT ENLARGED TOE TISSUE
RESECT ENLARGED TOE
REPAIR EXTRA TOE(S)
REPAIR WEBBED TOE(S)
RECONSTRUCT CLEFT FOOT
TREATMENT OF HEEL FRACTURE
TREAT HEEL FRACTURE
TREAT/GRAFT HEEL FRACTURE
TREAT ANKLE FRACTURE
TREAT MIDFOOT FRACTURE, EACH
TREAT MIDFOOT FRACTURE
TREAT METATARSAL FRACTURE
TREAT BIG TOE FRACTURE
TREATMENT OF TOE FRACTURE
TREATMENT OF TOE FRACTURE
TREAT TOE FRACTURE
TREAT SESAMOID BONE FRACTURE
TREAT SESAMOID BONE FRACTURE
TREAT FOOT DISLOCATION
REPAIR FOOT DISLOCATION
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28899
29000
29010
29015
29020
29025
29035
29040
29044
29046
29049
29055
29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29220
29240

TREAT TOE DISLOCATION
REPAIR TOE DISLOCATION
REPAIR OF TOE DISLOCATION
FUSION OF FOOT BONES
REVISION OF FOOT BONES
FUSION OF BIG TOE JOINT
AMPUTATION OF MIDFOOT
AMPUTATION THRU METATARSAL
AMPUTATION TOE & METATARSAL
AMPUTATION OF TOE
PARTIAL AMPUTATION OF TOE
FOOT/TOES SURGERY PROCEDURE
APPLICATION OF BODY CAST
APPLICATION OF FIGURE EIGHT
APPLICATION OF SHOULDER CAST
APPLICATION OF SHOULDER CAST
APPLICATION OF LONG ARM CAST
APPLICATION OF FOREARM CAST
APPLY HAND/WRIST CAST
APPLY FINGER CAST
APPLY LONG ARM SPLINT
APPLY FOREARM SPLINT
APPLY FOREARM SPLINT
APPLICATION OF FINGER SPLINT
APPLICATION OF FINGER SPLINT
STRAPPING OF CHEST
STRAPPING OF LOW BACK
STRAPPING OF SHOULDER
29260
29280
29305
29325
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29590
29700
29705
29710
29715
29720
29730
29740
29750
29799
29800
29804
29805
29806
29807
29819
29820
29821
29822
29823
29824
29825
29826
29827
29830
29834
29835
29836
STRAPPING OF ELBOW OR WRIST

STRAPPING OF HAND OR FINGER
APPLICATION OF HIP CAST
APPLICATION OF HIP CASTS
APPLICATION OF LONG LEG CAST
APPLY LONG LEG CAST BRACE
APPLY SHORT LEG CAST
ADDITION OF WALKER TO CAST
APPLY RIGID LEG CAST
APPLICATION OF LEG CAST
APPLICATION, LONG LEG SPLINT
APPLICATION LOWER LEG SPLINT
STRAPPING OF HIP
STRAPPING OF KNEE
STRAPPING; ANKLE &/ FOOT
STRAPPING OF TOES
APPLICATION OF PASTE BOOT
APPLICATION OF FOOT SPLINT
REMOVAL/REVISION OF CAST
REPAIR OF BODY CAST
WINDOWING OF CAST
WEDGING OF CAST
WEDGING OF CLUBFOOT CAST
CASTING/STRAPPING PROCEDURE
JAW ARTHROSCOPY/SURGERY
JAW ARTHROSCOPY/SURGERY
SHOULDER ARTHROSCOPY, DX
SHOULDER ARTHROSCOPY/SURGERY
ARTHROSCOP ROTATOR CUFF REPR
ELBOW ARTHROSCOPY
ELBOW ARTHROSCOPY/SURGERY
29837
29838
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29863
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
29891
29892
29893
29894
29895
29897
29898
29899
29900
29901
29902
29999
30000
30020
WRIST ARTHROSCOPY
WRIST ARTHROSCOPY/SURGERY
WRIST ENDOSCOPY/SURGERY
KNEE ARTHROSCOPY/SURGERY
TIBIAL ARTHROSCOPY/SURGERY
TIBIAL ARTHROSCOPY/SURGERY
HIP ARTHROSCOPY, DX
HIP ARTHROSCOPY/SURGERY
KNEE ARTHROSCOPY, DX
KNEE ARTHROSCOPY/DRAINAGE
ANKLE ARTHROSCOPY/SURGERY
SCOPE, PLANTAR FASCIOTOMY
MCP JOINT ARTHROSCOPY, DX
MCP JOINT ARTHROSCOPY, SURG
MCP JOINT ARTHROSCOPY, SURG
ARTHROSCOPY OF JOINT
DRAINAGE OF NOSE LESION
DRAINAGE OF NOSE LESION
30100
30110
30115
30117
30118
30120
30124
30125
30130
30140
30150
30160
30200
30210
30220
30300
30310
30320
30400
30410
30420
30430
30435
30450
30460
30462
30465
30520
30540
30545
30560
30580
30600
30620
30630
30801
30802
30901
30903
30905
30906
30915
30920
30930
30999
31000
31002
31020
31030
INTRANASAL BIOPSY
REMOVAL OF NOSE POLYP(S)
REMOVAL OF NOSE POLYP(S)
REMOVAL OF INTRANASAL LESION
REMOVAL OF INTRANASAL LESION
REVISION OF NOSE
REMOVAL OF NOSE LESION
REMOVAL OF NOSE LESION
REMOVAL OF TURBINATE BONES
REMOVAL OF TURBINATE BONES
PARTIAL REMOVAL OF NOSE
REMOVAL OF NOSE
INJECTION TREATMENT OF NOSE
NASAL SINUS THERAPY
INSERT NASAL SEPTAL BUTTON
REMOVE NASAL FOREIGN BODY
RECONSTRUCTION OF NOSE
REVISION OF NOSE
REVISION OF NOSE
REVISION OF NOSE
REVISION OF NOSE
REVISION OF NOSE
REPR NASAL VESTIBULAR STENOSIS
REPAIR OF NASAL SEPTUM
REPAIR NASAL DEFECT
REPAIR NASAL DEFECT
RELEASE OF NASAL ADHESIONS
REPAIR UPPER JAW FISTULA
REPAIR MOUTH/NOSE FISTULA
INTRANASAL RECONSTRUCTION
REPAIR NASAL SEPTUM DEFECT
CAUTERIZATION, INNER NOSE
CAUTERIZATION, INNER NOSE
CONTROL OF NOSEBLEED
REPEAT CONTROL OF NOSEBLEED
LIGATION, NASAL SINUS ARTERY
LIGATION, UPPER JAW ARTERY
THERAPY, FRACTURE OF NOSE
NASAL SURGERY PROCEDURE
IRRIGATION, MAXILLARY SINUS
IRRIGATION, SPHENOID SINUS
EXPLORATION, MAXILLARY SINUS
EXPLORATION, MAXILLARY SINUS
31032
31040
31050
31051
31070
31075
31080
31081
31084
31085
31086
31087
31090
31200
31201
31205
31225
31230
31231
31233
31235
31237
31238
31239
31240
31254
31255
31256
31267
31276
31287
31288
31290
31291
31292
31293
31294
31299
31300
31320
31360
31365
31367
31368
31370
31375
31380
31382
31390
EXPLORE SINUS,REMOVE POLYPS

EXPLORATION BEHIND UPPER JAW
EXPLORATION, SPHENOID SINUS
SPHENOID SINUS SURGERY
EXPLORATION OF FRONTAL SINUS
EXPLORATION OF FRONTAL SINUS
REMOVAL OF FRONTAL SINUS
EXPLORATION OF SINUSES
REMOVAL OF ETHMOID SINUS
REMOVAL OF UPPER JAW
REMOVAL OF UPPER JAW
NASAL ENDOSCOPY, DX
NASAL/SINUS ENDOSCOPY, DX
NASAL/SINUS ENDOSCOPY, DX
NASAL/SINUS ENDOSCOPY, SURG
REVISION OF ETHMOID SINUS
EXPLORATION MAXILLARY SINUS
ENDOSCOPY, MAXILLARY SINUS
SINUS ENDOSCOPY, SURGICAL
SINUS SURGERY PROCEDURE
REMOVAL OF LARYNX LESION
DIAGNOSTIC INCISION, LARYNX
REMOVAL OF LARYNX
REMOVAL OF LARYNX
PARTIAL REMOVAL OF LARYNX
REMOVAL OF LARYNX & PHARYNX
31395
31400
31420
31500
31502
31505
31510
31511
31512
31513
31515
31520
31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31560
31561
31570
31571
31575
31576
31577
31578
31579
31580
31582
31584
31585
31586
31587
31588
31590
31595
31599
31600
31601
31603
31605
31610
31611
31612
RECONSTRUCT LARYNX & PHARYNX

REVISION OF LARYNX
REMOVAL OF EPIGLOTTIS
INSERT EMERGENCY AIRWAY
CHANGE OF WINDPIPE AIRWAY
DIAGNOSTIC LARYNGOSCOPY
LARYNGOSCOPY WITH BIOPSY
REMOVE FOREIGN BODY, LARYNX
INJECTION INTO VOCAL CORD
LARYNGOSCOPY FOR ASPIRATION
LARYNGOSCOPY FOR TREATMENT
LARYNGOSCOPY AND DILATION
LARYNGOSCOPY AND DILATION
OPERATIVE LARYNGOSCOPY
LARYNGOSCOPY WITH INJECTION
LARYNGOSCOPY WITH INJECTION
LARYNGOSCOPY WITH BIOPSY
REMOVE FOREIGN BODY, LARYNX
REVISION OF LARYNX
REVISION OF LARYNX
TREAT LARYNX FRACTURE
REVISION OF LARYNX
REVISION OF LARYNX
REINNERVATE LARYNX
LARYNX NERVE SURGERY
LARYNX SURGERY PROCEDURE
INCISION OF WINDPIPE
SURGERY/SPEECH PROSTHESIS
PUNCTURE/CLEAR WINDPIPE
31613
31614
31615
31622
31623
31624
31625
31628
31629
31630
31631
31635
31640
31641
31643
31645
31646
31656
31700
31708
31710
31715
31717
31720
31725
31730
31750
31755
31760
31766
31770
31775
31780
31781
31785
31786
31800
31805
31820
31825
31830
31899
32000
32002
32005
32020
32035
32036
32095
REPAIR WINDPIPE OPENING

REPAIR WINDPIPE OPENING
VISUALIZATION OF WINDPIPE
DX BRONCHOSCOPE/WASH
DX BRONCHOSCOPE/BRUSH
DX BRONCHOSCOPE/LAVAGE
BRONCHOSCOPY WITH BIOPSY
BRONCHOSCOPY WITH REPAIR
BRONCHOSCOPY WITH DILATION
REMOVE FOREIGN BODY, AIRWAY
BRONCHOSCOPY & REMOVE LESION
BRONCHOSCOPY, TREAT BLOCKAGE
DIAG BRONCHOSCOPE/CATHETER
BRONCHOSCOPY, CLEAR AIRWAYS
BRONCHOSCOPY, RECLEAR AIRWAY
BRONCHOSCOPY, INJ FOR XRAY
INSERTION OF AIRWAY CATHETER
INSTILL AIRWAY CONTRAST DYE
INSERTION OF AIRWAY CATHETER
INJECTION FOR BRONCHUS X-RAY
BRONCHIAL BRUSH BIOPSY
CLEARANCE OF AIRWAYS
CLEARANCE OF AIRWAYS
INTRO, WINDPIPE WIRE/TUBE
REPAIR OF WINDPIPE
REPAIR OF WINDPIPE
REPAIR OF WINDPIPE
RECONSTRUCTION OF WINDPIPE
REPAIR/GRAFT OF BRONCHUS
RECONSTRUCT BRONCHUS
RECONSTRUCT WINDPIPE
RECONSTRUCT WINDPIPE
REMOVE WINDPIPE LESION
REMOVE WINDPIPE LESION
REPAIR OF WINDPIPE INJURY
REPAIR OF WINDPIPE INJURY
CLOSURE OF WINDPIPE LESION
REPAIR OF WINDPIPE DEFECT
REVISE WINDPIPE SCAR
AIRWAYS SURGICAL PROCEDURE
DRAINAGE OF CHEST
TREATMENT OF COLLAPSED LUNG
TREAT LUNG LINING CHEMICALLY
INSERTION OF CHEST TUBE
EXPLORATION OF CHEST
BIOPSY THROUGH CHEST WALL
32100
32110
32120
32124
32140
32141
32150
32151
32160
32200
32201
32215
32220
32225
32310
32320
32400
32402
32405
32420
32440
32442
32445
32480
32482
32484
32486
32488
32491
32500
32501
32520
32522
32525
32540
32601
32602
32603
32604
32605
32606
32650
32651
32652
32653
32654
32655
32656
32657
EXPLORATION/BIOPSY OF CHEST
EXPLORE/REPAIR CHEST
RE-EXPLORATION OF CHEST
EXPLORE CHEST FREE ADHESIONS
REMOVAL OF LUNG LESION(S)
REMOVE/TREAT LUNG LESIONS
REMOVAL OF LUNG LESION(S)
REMOVE LUNG FOREIGN BODY
OPEN CHEST HEART MASSAGE
DRAIN, OPEN, LUNG LESION
DRAIN, PERCUT, LUNG LESION
TREAT CHEST LINING
RELEASE OF LUNG
PARTIAL RELEASE OF LUNG
REMOVAL OF CHEST LINING
FREE/REMOVE CHEST LINING
NEEDLE BIOPSY CHEST LINING
OPEN BIOPSY CHEST LINING
BIOPSY, LUNG OR MEDIASTINUM
PUNCTURE/CLEAR LUNG
REMOVAL OF LUNG
SLEEVE PNEUMONECTOMY
REMOVAL OF LUNG
PARTIAL REMOVAL OF LUNG
BILOBECTOMY
SEGMENTECTOMY
SLEEVE LOBECTOMY
COMPLETION PNEUMONECTOMY
LUNG VOLUME REDUCTION
PARTIAL REMOVAL OF LUNG
REPAIR BRONCHUS ADD-ON
REMOVE LUNG & REVISE CHEST
REMOVAL OF LUNG LESION
THORACOSCOPY, DIAGNOSTIC
THORACOSCOPY, SURGICAL
32658
32659
32660
32661
32662
32663
32664
32665
32800
32810
32815
32820
32850
32851
32852
32853
32854
32900
32905
32906
32940
32960
32997
32999
33010
33011
33015
33020
33025
33030
33031
33050
33120
33130
33140
33141
33200
33201
33206
33207
33208
33210
33211
33212
33213
33214
33215
33216
33217
REPAIR LUNG HERNIA
CLOSE CHEST AFTER DRAINAGE
CLOSE BRONCHIAL FISTULA
RECONSTRUCT INJURED CHEST
DONOR PNEUMONECTOMY
LUNG TRANSPLANT, SINGLE
LUNG TRANSPLANT WITH BYPASS
LUNG TRANSPLANT, DOUBLE
LUNG TRANSPLANT WITH BYPASS
REMOVAL OF RIB(S)
REVISE & REPAIR CHEST WALL
REVISE & REPAIR CHEST WALL
REVISION OF LUNG
THERAPEUTIC PNEUMOTHORAX
TOTAL LUNG LAVAGE
CHEST SURGERY PROCEDURE
DRAINAGE OF HEART SAC
REPEAT DRAINAGE OF HEART SAC
INCISION OF HEART SAC
PARTIAL REMOVAL OF HEART SAC
PARTIAL REMOVAL OF HEART SAC
REMOVAL OF HEART SAC LESION
REMOVAL OF HEART LESION
HEART REVASCULARIZE (TMR)
TRANSMYCD LSR REVAS,THORCT;OTH
INSERTION OF HEART PACEMAKER
INSERTION OF HEART ELECTRODE
INSERTION OF HEART ELECTRODE
INSERTION OF PULSE GENERATOR
INSERTION OF PULSE GENERATOR
UPGRADE OF PACEMAKER SYSTEM
REPOSITION PACING-DEFIB LEAD
INSERT TRANS ELECT SINGL CHAM
INSERT TRANS ELECT DUAL CHAMBR
33218
33220
33222
33223
33224
33225
33226
33233
33234
33235
33236
33237
33238
33240
33241
33243
33244
33245
33246
33249
33250
33251
33253
33261
33282
33284
33300
33305
33310
33315
33320
33321
33322
33330
33332
33335
33400
33401
33403
33404
33405
33406
33410
33411
33412
33413
33414
33415
33416
REVISE ELTRD PACING-DEFIB

REVISE ELTRD PACING-DEFIB
REVISE POCKET, PACEMAKER
REVISE POCKET, PACING-DEFIB
INSERT PACING LEAD & CONNECT
L VENTRIC PACING LEAD ADD-ON
REPOSITION L VENTRIC LEAD
REMOVAL OF PACEMAKER SYSTEM
REMOVAL OF PACEMAKER SYSTEM
REMOVAL PACEMAKER ELECTRODE
REMOVE ELECTRODE/THORACOTOMY
INSERT PULSE GENERATOR
REMOVE PULSE GENERATOR
REMOVE ELTRD/THORACOTOMY
REMOVE ELTRD, TRANSVEN
INSERT EPIC ELTRD PACE-DEFIB
INSERT EPIC ELTRD/GENERATOR
ELTRD/INSERT PACE-DEFIB
ABLATE HEART DYSRHYTHM FOCUS
RECONSTRUCT ATRIA
IMPLANT PAT-ACTIVE HT RECORD
REMOVE PAT-ACTIVE HT RECORD
REPAIR OF HEART WOUND
REPAIR OF HEART WOUND
EXPLORATORY HEART SURGERY
EXPLORATORY HEART SURGERY
REPAIR MAJOR BLOOD VESSEL(S)
REPAIR MAJOR VESSEL
REPAIR MAJOR BLOOD VESSEL(S)
INSERT MAJOR VESSEL GRAFT
REPAIR OF AORTIC VALVE
VALVULOPLASTY, OPEN
VALVULOPLASTY, W/CP BYPASS
PREPARE HEART-AORTA CONDUIT
REPLACEMENT OF AORTIC VALVE
REVISION, SUBVALVULAR TISSUE
REVISE VENTRICLE MUSCLE
33417
33420
33422
33425
33426
33427
33430
33460
33463
33464
33465
33468
33470
33471
33472
33474
33475
33476
33478
33496
33500
33501
33502
33503
33504
33505
33506
33508
33510
33511
33512
33513
33514
33516
33517
33518
33519
33521
33522
33523
33530
33533
33534
33535
33536
33542
33545
33572
33600

REVISION OF MITRAL VALVE
REPAIR OF MITRAL VALVE
REPLACEMENT OF MITRAL VALVE
REVISION OF TRICUSPID VALVE
VALVULOPLASTY, TRICUSPID
VALVULOPLASTY, TRICUSPID
REPLACE TRICUSPID VALVE
REVISION OF TRICUSPID VALVE
REVISION OF PULMONARY VALVE
VALVOTOMY, PULMONARY VALVE
REPLACEMENT, PULMONARY VALVE
REVISION OF HEART CHAMBER
REPAIR, PROSTH VALVE CLOT
REPAIR HEART VESSEL FISTULA
REPAIR HEART VESSEL FISTULA
CORONARY ARTERY CORRECTION
CORONARY ARTERY GRAFT
CORONARY ARTERY GRAFT
REPAIR ARTERY W/TUNNEL
REPAIR ARTERY, TRANSLOCATION
ENDOSCOPIC VEIN HARVEST
CABG, VEIN, SINGLE
CABG, VEIN, TWO
CABG, VEIN, THREE
CABG, VEIN, FOUR
CABG, VEIN, FIVE
CABG, VEIN, SIX OR MORE
CABG, ARTERY-VEIN, SINGLE
CABG, ARTERY-VEIN, TWO
CABG, ARTERY-VEIN, THREE
CABG, ARTERY-VEIN, FOUR
CABG, ARTERY-VEIN, FIVE
CABG, ART-VEIN, SIX OR MORE
CORONARY ARTERY, BYPASS/REOP
CABG, ARTERIAL, SINGLE
CABG, ARTERIAL, TWO
CABG, ARTERIAL, THREE
CABG, ARTERIAL, FOUR OR MORE
REPAIR OF HEART DAMAGE
OPEN CORONARY ENDARTERECTOMY
CLOSURE OF VALVE
33602
33606
33608
33610
33611
33612
33615
33617
33619
33641
33645
33647
33660
33665
33670
33681
33684
33688
33690
33692
33694
33697
33702
33710
33720
33722
33730
33732
33735
33736
33737
33750
33755
33762
33764
33766
33767
33770
33771
33774
33775
33776
33777
33778
33779
33780
33781
33786
33788
CLOSURE OF VALVE
ANASTOMOSIS/ARTERY-AORTA
REPAIR ANOMALY W/CONDUIT
REPAIR BY ENLARGEMENT
REPAIR DOUBLE VENTRICLE
REPAIR DOUBLE VENTRICLE
REPAIR, SIMPLE FONTAN
REPAIR, MODIFIED FONTAN
REPAIR SINGLE VENTRICLE
REPAIR HEART SEPTUM DEFECT
REVISION OF HEART VEINS
REPAIR HEART SEPTUM DEFECTS
REPAIR OF HEART DEFECTS
REPAIR OF HEART CHAMBERS
REINFORCE PULMONARY ARTERY
REPAIR OF HEART DEFECT
REPAIR OF HEART DEFECT
REPAIR HEART-VEIN DEFECT(S)
REPAIR HEART-VEIN DEFECT
MAJOR VESSEL SHUNT
MAJOR VESSEL SHUNT
MAJOR VESSEL SHUNT
MAJOR VESSEL SHUNT & GRAFT
MAJOR VESSEL SHUNT
MAJOR VESSEL SHUNT
REPAIR GREAT VESSELS DEFECT
REPAIR ARTERIAL TRUNK
REVISION OF PULMONARY ARTERY
33800
33802
33803
33813
33814
33820
33822
33824
33840
33845
33851
33852
33853
33860
33861
33863
33870
33875
33877
33910
33915
33916
33917
33918
33919
33920
33922
33924
33930
33935
33940
33945
33960
33961
33967
33968
33970
33971
33973
33974
33975
33976
33977
33978
33979
33980
33999
34001
34051
AORTIC SUSPENSION
REPAIR VESSEL DEFECT
REPAIR VESSEL DEFECT
REPAIR SEPTAL DEFECT
REVISE MAJOR VESSEL
REVISE MAJOR VESSEL
REVISE MAJOR VESSEL
REMOVE AORTA CONSTRICTION
ASCENDING AORTIC GRAFT
TRANSVERSE AORTIC ARCH GRAFT
THORACIC AORTIC GRAFT
THORACOABDOMINAL GRAFT
REMOVE LUNG ARTERY EMBOLI
REMOVE LUNG ARTERY EMBOLI
SURGERY OF GREAT VESSEL
REPAIR PULMONARY ARTERY
REPAIR PULMONARY ATRESIA
TRANSECT PULMONARY ARTERY
REMOVE PULMONARY SHUNT
REMOVAL OF DONOR HEART/LUNG
TRANSPLANTATION, HEART/LUNG
REMOVAL OF DONOR HEART
TRANSPLANTATION OF HEART
EXTERNAL CIRCULATION ASSIST
EXTERNAL CIRCULATION ASSIST
INSERT IA PERCUT DEVICE
REMOVE AORTIC ASSIST DEVICE
AORTIC CIRCULATION ASSIST
AORTIC CIRCULATION ASSIST
INSERT BALLOON DEVICE
REMOVE INTRA-AORTIC BALLOON
IMPLANT VENTRICULAR DEVICE
IMPLANT VENTRICULAR DEVICE
REMOVE VENTRICULAR DEVICE
REMOVE VENTRICULAR DEVICE
INSERT INTRACORPOREAL DEVICE
REMOVE INTRACORPOREAL DEVICE
CARDIAC SURGERY PROCEDURE
REMOVAL OF ARTERY CLOT
34101
34111
34151
34201
34203
34401
34421
34451
34471
34490
34501
34502
34510
34520
34530
34800
34802
34804
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
34900
35001
35002
35005
35011
35013
35021
35022
35045
35081
35082
35091
35092
35102
35103
35111
35112
35121
35122
35131

REMOVAL OF ARM ARTERY CLOT
REMOVAL OF LEG ARTERY CLOT
REMOVAL OF VEIN CLOT
REPAIR VALVE, FEMORAL VEIN
RECONSTRUCT VENA CAVA
TRANSPOSITION OF VEIN VALVE
CROSS-OVER VEIN GRAFT
LEG VEIN FUSION
ENDVS REP AB ARTC ANRYSM;AORTO
ENDV REP AB ART ANRYM;MOD BIFR
ENDV REP AB ART ANRYM;UNIB BIF
ENDOVS PLCE ILIAC ART OCCL DEV
OPN FEMRL ART XPSE ENDO PROSTH
PLACE FMRL GF,ENDVS AORT ANRYS
OPN ILC ART,ENDVS PROS,ILI,UNI
EXTEND PRSTH ENDVSC,INIT VESEL
EXTEND PRSTH ENDVSC,ADDL VESEL
OPEN REP AORT ANRYSM/DISS;TUBE
OPN REP AORT ANRYS/DISS;A-BI-I
OPN REP AORT ANRYS/DISS;AOR-BI
XPOSE FOR ENDOPROSTH, ILIAC
XPOSE, ENDOPROSTH, BRACHIAL
ENDOVASC ILIAC REPR W/GRAFT
REPAIR DEFECT OF ARTERY
REPAIR ARTERY RUPTURE, NECK
REPAIR ARTERY RUPTURE, ARM
REPAIR ARTERY RUPTURE, CHEST
REPAIR DEFECT OF ARM ARTERY
REPAIR ARTERY RUPTURE, AORTA
REPAIR ARTERY RUPTURE, AORTA
REPAIR ARTERY RUPTURE, GROIN
REPAIR ARTERY RUPTURE,SPLEEN
REPAIR ARTERY RUPTURE, BELLY
35132
35141
35142
35151
35152
35161
35162
35180
35182
35184
35188
35189
35190
35201
35206
35207
35211
35216
35221
35226
35231
35236
35241
35246
35251
35256
35261
35266
35271
35276
35281
35286
35301
35311
35321
35331
35341
35351
35355
35361
35363
35371
35372
35381
35390
35400
35450
35452
35454
REPAIR ARTERY RUPTURE, GROIN

REPAIR ARTERY RUPTURE, THIGH
REPAIR ARTERY RUPTURE, KNEE
REPAIR ARTERY RUPTURE
REPAIR BLOOD VESSEL LESION
RECHANNELING OF ARTERY
REOPERATION, CAROTID ADD-ON
ANGIOSCOPY
REPAIR ARTERIAL BLOCKAGE
35456
35458
35459
35460
35470
35471
35472
35473
35474
35475
35476
35480
35481
35482
35483
35484
35485
35490
35491
35492
35493
35494
35495
35500
35501
35506
35507
35508
35509
35511
35515
35516
35518
35521
35526
35531
35533
35536
35541
35546
35548
35549
35551
35556
35558
35560
35563
35565
35566

REPAIR VENOUS BLOCKAGE
ATHERECTOMY, OPEN
ATHERECTOMY, OPEN
ATHERECTOMY, OPEN
ATHERECTOMY, OPEN
ATHERECTOMY, OPEN
ATHERECTOMY, OPEN
ATHERECTOMY, PERCUTANEOUS
HARVEST VEIN FOR BYPASS
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
35571
35572
35582
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35636
35641
35642
35645
35646
35647
35650
35651
35654
35656
35661
35663
35665
35666
35671
35681
35682
35683
35685
35686
35691
35693
35694
35695
35700
35701
35721
35741
35761
35800
35820
35840
35860
35870
ARTERY BYPASS GRAFT

HARVEST FEMOROPOPLITEAL VEIN
VEIN BYPASS GRAFT
VEIN BYPASS GRAFT
VEIN BYPASS GRAFT
VEIN BYPASS GRAFT
HARV,UP EXT ART,1,CORO ART BYP
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
BYPASS GRAFT, NOT VEIN
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
ARTERY BYPASS GRAFT
COMPOSITE BYPASS GRAFT
BYPASS GRAFT PATENCY/PATCH
BYPASS GRAFT/AV FIST PATENCY
ARTERIAL TRANSPOSITION
REOPERATION, BYPASS GRAFT
EXPLORATION, CAROTID ARTERY
EXPLORATION, FEMORAL ARTERY
EXPLORATION POPLITEAL ARTERY
EXPLORATION OF ARTERY/VEIN
EXPLORE NECK VESSELS
EXPLORE CHEST VESSELS
EXPLORE ABDOMINAL VESSELS
EXPLORE LIMB VESSELS
REPAIR VESSEL GRAFT DEFECT
35875
35876
35879
35881
35901
35903
35905
35907
36000
36002
36005
36010
36011
36012
36013
36014
36015
36100
36120
36140
36145
36160
36200
36215
36216
36217
36218
36245
36246
36247
36248
36260
36261
36262
36299
36400
36405
36406
36410
36415
36416
36420
36425
36430
36440
36450
36455
36460
36468
REMOVAL OF CLOT IN GRAFT

REMOVAL OF CLOT IN GRAFT
REVISE GRAFT W/VEIN
REVISE GRAFT W/VEIN
EXCISION, GRAFT, NECK
EXCISION, GRAFT, EXTREMITY
EXCISION, GRAFT, THORAX
EXCISION, GRAFT, ABDOMEN
PLACE NEEDLE IN VEIN
PSEUDOANEURYSM INJECTION TRT
INJECTION EXT VENOGRAPHY
PLACE CATHETER IN VEIN
PLACE CATHETER IN ARTERY
ESTABLISH ACCESS TO ARTERY
ARTERY TO VEIN SHUNT
ESTABLISH ACCESS TO AORTA
PLACE CATHETER IN AORTA
INSERTION OF INFUSION PUMP
REVISION OF INFUSION PUMP
REMOVAL OF INFUSION PUMP
VESSEL INJECTION PROCEDURE
DRAWING BLOOD
DRAWING BLOOD
DRAWING BLOOD
DRAWING BLOOD
COLL VENOUS BLOOD VENIPUNCTURE
CAPILLARY BLOOD DRAW
ESTABLISH ACCESS TO VEIN
ESTABLISH ACCESS TO VEIN
BLOOD TRANSFUSION SERVICE
BLOOD TRANSFUSION SERVICE
EXCHANGE TRANSFUSION SERVICE
EXCHANGE TRANSFUSION SERVICE
TRANSFUSION SERVICE, FETAL
INJECTION(S), SPIDER VEINS
36469
36470
36471
36481
36488
36489
36490
36491
36493
36500
36510
36511
36512
36513
36514
36515
36516
36522
36530
36531
36532
36533
36534
36535
36536
36537
36540
36550
36600
36620
36625
36640
36660
36680
36800
36810
36815
36819
36820
36821
36822
36823
36825
36830
36831
36832
36833
36834
36835
INJECTION(S), SPIDER VEINS

INJECTION THERAPY OF VEIN
INJECTION THERAPY OF VEINS
INSERTION OF CATHETER, VEIN
REPOSITIONING OF CVC
APHERESIS WBC
APHERESIS RBC
APHERESIS PLATELETS
APHERESIS PLASMA
APHERESIS, ADSORP/REINFUSE
APHERESIS, SELECTIVE
PHOTOPHERESIS
INSERTION OF INFUSION PUMP
REVISION OF INFUSION PUMP
REMOVAL OF INFUSION PUMP
INSERTION OF ACCESS DEVICE
REVISION OF ACCESS DEVICE
REMOVAL OF ACCESS DEVICE
REMOVE CVA DEVICE OBSTRUCT
REMOVE CVA LUMEN OBSTRUCT
COLLECT BLOOD VENOUS DEVICE
DECLOT VASCULAR DEVICE
WITHDRAWAL OF ARTERIAL BLOOD
INSERTION CATHETER, ARTERY
INSERT NEEDLE, BONE CAVITY
INSERTION OF CANNULA
AV FUSION/UPPR ARM VEIN
AV FUSION/FOREARM VEIN
AV FUSION DIRECT ANY SITE
INSERTION OF CANNULA(S)
INSERTION OF CANNULA(S)
ARTERY-VEIN GRAFT
CREAT ARTVNUS NONAUTOGENS GRFT
THROMB,OP,AV FIST WO REVI,GRFT
REV,OP,AV FIST;WO THRMBCT,GRFT
REV,OP,AV FIST;W THROMBCT,GRFT
REPAIR A-V ANEURYSM
ARTERY TO VEIN SHUNT
36860
36861
36870
37140
37145
37160
37180
37181
37182
37183
37195
37200
37201
37202
37203
37204
37205
37206
37207
37208
37209
37250
37251
37500
37501
37565
37600
37605
37606
37607
37609
37615
37616
37617
37618
37620
37650
37660
37700
37720
37730
37735
37760
37780
37785
37788
37790
37799
38100
EXTERNAL CANNULA DECLOTTING

CANNULA DECLOTTING
THROMB,ARTER FIST,AUTO/NON GFT
VENOUS ANASTOMOSIS, OPN PRTCVL
VENOUS ANASTMSIS,OPN; RENOPRTL
VNOUS ANASTOMOSIS,OPN CVL-MESE
VNOUS ANASTOMOSI,OPN SPLEN,PRX
VNOUS ANASTMOSI,OPN SPLEN,DSTL
INSERT HEPATIC SHUNT (TIPS)
REMOVE HEPATIC SHUNT (TIPS)
THROMBOLYTIC THERAPY, STROKE
TRANSCATHETER BIOPSY
TRANSCATHETER THERAPY INFUSE
TRANSCATHETER THERAPY INFUSE
TRANSCATHETER RETRIEVAL
TRANSCATHETER OCCLUSION
TRANSCATHETER STENT
TRANSCATHETER STENT ADD-ON
TRANSCATHETER STENT
TRANSCATHETER STENT ADD-ON
EXCHANGE ARTERIAL CATHETER
IV US FIRST VESSEL ADD-ON
IV US EACH ADD VESSEL ADD-ON
ENDOSCOPY LIGATE PERF VEINS
UNLSTEDVASCENDOSCOPY PROCEDU
LIGATION OF NECK VEIN
LIGATION OF NECK ARTERY
LIGATION OF A-V FISTULA
TEMPORAL ARTERY PROCEDURE
LIGATION OF CHEST ARTERY
LIGATION OF ABDOMEN ARTERY
LIGATION OF EXTREMITY ARTERY
REVISION OF MAJOR VEIN
REVISE LEG VEIN
REMOVAL OF LEG VEIN
REMOVAL OF LEG VEINS
REMOVAL OF LEG VEINS/LESION
LIGATION VEINS W/WO SKN GRFT
REVISION OF LEG VEIN
REVISE SECONDARY VARICOSITY
REVASCULARIZATION, PENIS
PENILE VENOUS OCCLUSION
VASCULAR SURGERY PROCEDURE
REMOVAL OF SPLEEN, TOTAL
38101
38102
38115
38120
38129
38200
38204
38205
38206
38207
38208
38209
38210
38211
38212
38213
38214
38215
38220
38221
38230
38240
38241
38242
38300
38305
38308
38380
38381
38382
38500
38505
38510
38520
38525
38530
38542
38550
38555
38562
38564
38570
38571
38572
38589
38700
38720
38724
38740
REMOVAL OF SPLEEN, PARTIAL

REMOVAL OF SPLEEN, TOTAL
REPAIR OF RUPTURED SPLEEN
LAPAROSCOPY, SPLENECTOMY
LAPAROSCOPE PROC, SPLEEN
INJECTION FOR SPLEEN X-RAY
BL DONOR SEARCH MANAGEMENT
HARVEST ALLOGENIC STEM CELLS
HARVEST AUTO STEM CELLS
CRYOPRESERVE STEM CELLS
THAW PRESERVED STEM CELLS
WASH HARVEST STEM CELLS
T-CELL DEPLETION OF HARVEST
TUMOR CELL DEPLETE OF HARVST
RBC DEPLETION OF HARVEST
PLATELET DEPLETE OF HARVEST
VOLUME DEPLETE OF HARVEST
HARVEST STEM CELL CONCENTRTE
BONE MARROW ASPIRATION
BONE MARROW BIOPSY, NDLE/TROCR
BONE MARROW COLLECTION
BONE MARROW/STEM TRANSPLANT
BONE MARROW/STEM TRANSPLANT
LYMPHOCYTE INFUSE TRANSPLANT
DRAINAGE, LYMPH NODE LESION
DRAINAGE, LYMPH NODE LESION
INCISION OF LYMPH CHANNELS
THORACIC DUCT PROCEDURE
BX/EXCIS,LYMPH NODE;OPN,SPRFCL
NEEDLE BIOPSY, LYMPH NODES
BX/EXC,LYMPH NDE;DP CRVICL NDE
BX/EXC;OP,DP CRV NDE W EXC SCL
BX/EXC,NODE;OPN,DP AXILLAR NDE
BX/EXC,NODE;OPN,INTRNL MAMMRY
EXPLORE DEEP NODE(S), NECK
REMOVAL, NECK/ARMPIT LESION
REMOVAL, NECK/ARMPIT LESION
REMOVAL, PELVIC LYMPH NODES
REMOVAL, ABDOMEN LYMPH NODES
LAPAROSCOPY, LYMPH NODE BIOP
LAPAROSCOPY, LYMPHADENECTOMY
LAPAROSCOPY, LYMPHADENECTOMY
LAPAROSCOPE PROC, LYMPHATIC
REMOVAL OF LYMPH NODES, NECK
REMOVE ARMPIT LYMPH NODES
38745
38746
38747
38760
38765
38770
38780
38790
38792
38794
38999
39000
39010
39200
39220
39400
39499
39501
39502
39503
39520
39530
39531
39540
39541
39545
39560
39561
39599
40490
40500
40510
40520
40525
40527
40530
40650
40652
40654
40700
40701
40702
40720
40761
40799
40800
40801
40804
40805
REMOVE ARMPIT LYMPH NODES

REMOVE THORACIC LYMPH NODES
REMOVE ABDOMINAL LYMPH NODES
REMOVE GROIN LYMPH NODES
REMOVE GROIN LYMPH NODES
REMOVE PELVIS LYMPH NODES
REMOVE ABDOMEN LYMPH NODES
INJECT FOR LYMPHATIC X-RAY
IDENTIFY SENTINEL NODE
ACCESS THORACIC LYMPH DUCT
BLOOD/LYMPH SYSTEM PROCEDURE
REMOVAL CHEST LESION
REMOVAL CHEST LESION
VISUALIZATION OF CHEST
CHEST PROCEDURE
REPAIR DIAPHRAGM LACERATION
REPAIR PARAESOPHAGEAL HERNIA
REPAIR OF DIAPHRAGM HERNIA
REVISION OF DIAPHRAGM
RESECT DIAPHRAGM, SIMPLE
RESECT DIAPHRAGM, COMPLEX
DIAPHRAGM SURGERY PROCEDURE
BIOPSY OF LIP
PARTIAL EXCISION OF LIP
RECONSTRUCT LIP WITH FLAP
RECONSTRUCT LIP WITH FLAP
PARTIAL REMOVAL OF LIP
REPAIR LIP
REPAIR LIP
REPAIR LIP
REPAIR CLEFT LIP/NASAL
LIP SURGERY PROCEDURE
DRAINAGE OF MOUTH LESION
REMOVAL, FOREIGN BODY, MOUTH
REMOVAL, FOREIGN BODY, MOUTH
40806
40808
40810
40812
40814
40816
40818
40819
40820
40830
40831
40840
40842
40843
40844
40845
40899
41000
41005
41006
41007
41008
41009
41010
41015
41016
41017
41018
41100
41105
41108
41110
41112
41113
41114
41115
41116
41120
41130
41135
41140
41145
41150
41153
41155
41250
41251
41252
41500
INCISION OF LIP FOLD

BIOPSY OF MOUTH LESION
EXCISION OF MOUTH LESION
EXCISE/REPAIR MOUTH LESION
EXCISE/REPAIR MOUTH LESION
EXCISE ORAL MUCOSA FOR GRAFT
EXCISE LIP OR CHEEK FOLD
TREATMENT OF MOUTH LESION
REPAIR MOUTH LACERATION
REPAIR MOUTH LACERATION
RECONSTRUCTION OF MOUTH
MOUTH SURGERY PROCEDURE
INCISION OF TONGUE FOLD
BIOPSY OF TONGUE
BIOPSY OF TONGUE
BIOPSY OF FLOOR OF MOUTH
EXCISION OF TONGUE LESION
EXCISION OF TONGUE FOLD
PARTIAL REMOVAL OF TONGUE
PARTIAL REMOVAL OF TONGUE
TONGUE AND NECK SURGERY
REMOVAL OF TONGUE
TONGUE REMOVAL, NECK SURGERY
TONGUE, MOUTH, JAW SURGERY
TONGUE, MOUTH, NECK SURGERY
TONGUE, JAW, & NECK SURGERY
REPAIR TONGUE LACERATION
FIXATION OF TONGUE
41510
41520
41599
41800
41805
41806
41820
41821
41822
41823
41825
41826
41827
41828
41830
41850
41870
41872
41874
41899
42000
42100
42104
42106
42107
42120
42140
42145
42160
42180
42182
42200
42205
42210
42215
42220
42225
42226
42227
42235
42260
42280
42281
42299
42300
42305
42310
42320
42325
TONGUE TO LIP SURGERY

RECONSTRUCTION, TONGUE FOLD
TONGUE AND MOUTH SURGERY
DRAINAGE OF GUM LESION
REMOVAL FOREIGN BODY, GUM
REMOVAL FOREIGN BODY,JAWBONE
EXCISION, GUM, EACH QUADRANT
EXCISION OF GUM FLAP
EXCISION OF GUM LESION
REMOVAL OF GUM TISSUE
TREATMENT OF GUM LESION
GUM GRAFT
REPAIR GUM
REPAIR TOOTH SOCKET
DENTAL SURGERY PROCEDURE
DRAINAGE MOUTH ROOF LESION
BIOPSY ROOF OF MOUTH
EXCISION LESION, MOUTH ROOF
REMOVE PALATE/LESION
EXCISION OF UVULA
REPAIR PALATE, PHARYNX/UVULA
TREATMENT MOUTH ROOF LESION
REPAIR PALATE
REPAIR PALATE
RECONSTRUCT CLEFT PALATE
LENGTHENING OF PALATE
LENGTHENING OF PALATE
REPAIR PALATE
REPAIR NOSE TO LIP FISTULA
PREPARATION, PALATE MOLD
INSERTION, PALATE PROSTHESIS
PALATE/UVULA SURGERY
DRAINAGE OF SALIVARY GLAND
CREATE SALIVARY CYST DRAIN
42326
42330
42335
42340
42400
42405
42408
42409
42410
42415
42420
42425
42426
42440
42450
42500
42505
42507
42508
42509
42510
42550
42600
42650
42660
42665
42699
42700
42720
42725
42800
42802
42804
42806
42808
42809
42810
42815
42820
42821
42825
42826
42830
42831
42835
42836
42842
42844
42845
CREATE SALIVARY CYST DRAIN

REMOVAL OF SALIVARY STONE
BIOPSY OF SALIVARY GLAND
BIOPSY OF SALIVARY GLAND
EXCISION OF SALIVARY CYST
DRAINAGE OF SALIVARY CYST
EXCISE PAROTID GLAND/LESION
EXCISE SUBMAXILLARY GLAND
EXCISE SUBLINGUAL GLAND
REPAIR SALIVARY DUCT
REPAIR SALIVARY DUCT
PAROTID DUCT DIVERSION
INJECTION FOR SALIVARY X-RAY
DILATION OF SALIVARY DUCT
DILATION OF SALIVARY DUCT
LIGATION OF SALIVARY DUCT
SALIVARY SURGERY PROCEDURE
DRAINAGE OF TONSIL ABSCESS
DRAINAGE OF THROAT ABSCESS
DRAINAGE OF THROAT ABSCESS
BIOPSY OF THROAT
BIOPSY OF THROAT
BIOPSY OF UPPER NOSE/THROAT
BIOPSY OF UPPER NOSE/THROAT
EXCISE PHARYNX LESION
REMOVE PHARYNX FOREIGN BODY
EXCISION OF NECK CYST
EXCISION OF NECK CYST
REMOVE TONSILS AND ADENOIDS
REMOVE TONSILS AND ADENOIDS
REMOVAL OF TONSILS
REMOVAL OF TONSILS
REMOVAL OF ADENOIDS
REMOVAL OF ADENOIDS
REMOVAL OF ADENOIDS
REMOVAL OF ADENOIDS
EXTENSIVE SURGERY OF THROAT
42860
42870
42890
42892
42894
42900
42950
42953
42955
42960
42961
42962
42970
42971
42972
42999
43020
43030
43045
43100
43101
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
43130
43135
43200
43201
43202
43204
43205
43215
43216
43217
43219
43220
43226
43227
43228
43231
43232
EXCISION OF TONSIL TAGS

EXCISION OF LINGUAL TONSIL
PARTIAL REMOVAL OF PHARYNX
REVISION OF PHARYNGEAL WALLS
REVISION OF PHARYNGEAL WALLS
REPAIR THROAT WOUND
RECONSTRUCTION OF THROAT
REPAIR THROAT, ESOPHAGUS
SURGICAL OPENING OF THROAT
CONTROL THROAT BLEEDING
CONTROL NOSE/THROAT BLEEDING
THROAT SURGERY PROCEDURE
INCISION OF ESOPHAGUS
THROAT MUSCLE SURGERY
INCISION OF ESOPHAGUS
EXCISION OF ESOPHAGUS LESION
EXCISION OF ESOPHAGUS LESION
REMOVAL OF ESOPHAGUS
PARTIAL REMOVAL OF ESOPHAGUS
PARITAL REMOVAL OF ESOPHAGUS
REMOVAL OF ESOPHAGUS POUCH
REMOVAL OF ESOPHAGUS POUCH
ESOPHAGUS ENDOSCOPY
ESOPH SCOPE W/SUBMUCOUS INJ
ESOPHAGUS ENDOSCOPY, BIOPSY
ESOPHAGUS ENDOSCOPY & INJECT
ESOPHAGUS ENDOSCOPY/LIGATION
ESOPHAGUS ENDOSCOPY
ESOPHAGUS ENDOSCOPY/LESION
ESOPHAGUS ENDOSCOPY
ESOPHAGUS ENDOSCOPY
ESOPH ENDOSCOPY, DILATION
ESOPH ENDOSCOPY, REPAIR
ESOPH ENDOSCOPY, ABLATION
ESOPHAG,RIG/FLX;ENDOSC ULTRASD
ESOPHAG,RIG/FLX;ULTRSD,FN NEED
43234
43235
43236
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
43250
43251
43255
43256
43258
43259
43260
43261
43262
43263
43264
43265
43267
43268
43269
43271
43272
43280
43289
43300
43305
43310
43312
43313
43314
43320
43324
43325
43326
43330
43331
43340
43341
43350
43351
UPPER GI ENDOSCOPY, EXAM

UPPR GI ENDOSCOPY, DIAGNOSIS
UPPR GI SCOPE W/SUBMUC INJ
UPPER GI ENDOSCOPY, BIOPSY
UP GI ENDSCOP ESPHG,STOM;DRAIN
UP GI ENDO ESOP/STOM&EITH DUOD
UP GI ENDSCOP ESPHG,STOM;ULTSD
UPPER GI ENDOSCOPY & INJECT
UPPER GI ENDOSCOPY/LIGATION
OPERATIVE UPPER GI ENDOSCOPY
PLACE GASTROSTOMY TUBE
UPPR GI ENDOSCOPY/GUIDE WIRE
UPPER GI ENDOSCOPY/TUMOR
UP GI ENDSCOP ESPHG,STOM;STENT
ENDOSCOPIC ULTRASOUND EXAM
ENDO CHOLANGIOPANCREATOGRAPH
LAPAROSCOPY, FUNDOPLASTY
LAPAROSCOPE PROC, ESOPH
REPAIR OF ESOPHAGUS
REPAIR ESOPHAGUS AND FISTULA
REPAIR OF ESOPHAGUS
REPAIR ESOPHAGUS AND FISTULA
ESOPHAGOPLASTY CONGENTIAL
TRACHEO-ESOPHAGOPLASTY CONG
FUSE ESOPHAGUS & STOMACH
REVISE ESOPHAGUS & STOMACH
REPAIR OF ESOPHAGUS
REPAIR OF ESOPHAGUS
FUSE ESOPHAGUS & INTESTINE
FUSE ESOPHAGUS & INTESTINE
SURGICAL OPENING, ESOPHAGUS
43352
43360
43361
43400
43401
43405
43410
43415
43420
43425
43450
43453
43456
43458
43460
43496
43499
43500
43501
43502
43510
43520
43600
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43635
43638
43639
43640
43641
43651
43652
43653
43659
43750
43752
43760
43761
43800
43810
43820

GASTROINTESTINAL REPAIR
GASTROINTESTINAL REPAIR
LIGATE ESOPHAGUS VEINS
ESOPHAGUS SURGERY FOR VEINS
LIGATE/STAPLE ESOPHAGUS
REPAIR ESOPHAGUS WOUND
REPAIR ESOPHAGUS WOUND
REPAIR ESOPHAGUS OPENING
REPAIR ESOPHAGUS OPENING
DILATE ESOPHAGUS
DILATE ESOPHAGUS
DILATE ESOPHAGUS
DILATE ESOPHAGUS
PRESSURE TREATMENT ESOPHAGUS
FREE JEJUNUM FLAP, MICROVASC
ESOPHAGUS SURGERY PROCEDURE
SURGICAL OPENING OF STOMACH
SURGICAL REPAIR OF STOMACH
SURGICAL REPAIR OF STOMACH
SURGICAL OPENING OF STOMACH
INCISION OF PYLORIC MUSCLE
BIOPSY OF STOMACH
BIOPSY OF STOMACH
EXCISION OF STOMACH LESION
EXCISION OF STOMACH LESION
REMOVAL OF STOMACH
REMOVAL OF STOMACH
REMOVAL OF STOMACH
REMOVAL OF STOMACH, PARTIAL
VAGOTOMY & PYLORUS REPAIR
VAGOTOMY & PYLORUS REPAIR
LAPAROSCOPY, VAGUS NERVE
LAPAROSCOPY, VAGUS NERVE
LAPAROSCOPY, GASTROSTOMY
LAPAROSCOPE PROC, STOM
NASO/ORO-GASTR TUBE PLACE,PHYS
CHANGE GASTROSTOMY TUBE
REPOSITION GASTROSTOMY TUBE
RECONSTRUCTION OF PYLORUS
FUSION OF STOMACH AND BOWEL
43825
43830
43831
43832
43840
43842
43843
43846
43847
43848
43850
43855
43860
43865
43870
43880
43999
44005
44010
44015
44020
44021
44025
44050
44055
44100
44110
44111
44120
44121
44125
44126
44127
44128
44130
44132
44133
44135
44136
44139
44140
44141
44143
44144
44145
44146
44147
44150
44151

REPAIR OF STOMACH LESION
GASTROPLASTY FOR OBESITY
GASTROPLASTY FOR OBESITY
GASTRIC BYPASS FOR OBESITY
GASTRIC BYPASS FOR OBESITY
REVISION GASTROPLASTY
REVISE STOMACH-BOWEL FUSION
REPAIR STOMACH OPENING
REPAIR STOMACH-BOWEL FISTULA
STOMACH SURGERY PROCEDURE
FREEING OF BOWEL ADHESION
INCISION OF SMALL BOWEL
INSERT NEEDLE CATH BOWEL
EXPLORE SMALL INTESTINE
DECOMPRESS SMALL BOWEL
INCISION OF LARGE BOWEL
REDUCE BOWEL OBSTRUCTION
CORRECT MALROTATION OF BOWEL
BIOPSY OF BOWEL
EXCISE INTESTINE LESION(S)
EXCISION OF BOWEL LESION(S)
REMOVAL OF SMALL INTESTINE
ENTERECTOMY W/TAPER, CONG
ENTERECTOMY W/O TAPER, CONG
ENTERECTOMY CONG, ADD-ON
BOWEL TO BOWEL FUSION
DON ENTERECT,OPN,ALLOGFT;CADVR
DON ENTERECT,OPN,ALLOGF;PRT,LV
INTESTINAL ALLOTRANSPL;CADAVER
INTESTINAL ALLOTRANSPL; LIVING
MOBILIZATION OF COLON
PARTIAL REMOVAL OF COLON
REMOVAL OF COLON
REMOVAL OF COLON/ILEOSTOMY
44152
44153
44155
44156
44160
44200
44201
44202
44203
44204
44205
44206
44207
44208
44210
44211
44212
44238
44239
44300
44310
44312
44314
44316
44320
44322
44340
44345
44346
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380
44382
44383
44385
44386
44388
REMOVAL OF COLON
LAPAROSCOPY, ENTEROLYSIS
LAPAROSCOPY, JEJUNOSTOMY
LAP RESECT S/INTESTINE SINGL
LAP RESECT S/INTESTINE, ADDL
LAPARO PARTIAL COLECTOMY
LAP COLECTOMY PART W/ILEUM
LAP PART COLECTOMY W/STOMA
L COLECTOMY/COLOPROCTOSTOMY
LAP COLECTOMY/COLOPRCTOSTOMY
LAPARO TOTAL PROCTOCOLECTOMY
LAPAROSCOPE PROC, INTESTINE
UNLSTED LAP PROC, RECTUM
OPEN BOWEL TO SKIN
ILEOSTOMY/JEJUNOSTOMY
REVISION OF ILEOSTOMY
REVISION OF ILEOSTOMY
DEVISE BOWEL POUCH
COLOSTOMY
COLOSTOMY WITH BIOPSIES
REVISION OF COLOSTOMY
SMALL BOWEL ENDOSCOPY
SMALL BOWEL ENDOSCOPY/BIOPSY
SM INT ENDSCP,ENTS,NO ILM;STNT
SMALL BOWEL ENDOSCOPY/BIOPSY
SM INT ENDSCP,ENTS,ILEUM;STENT
ILEOSCO,STOMA;TRANSENDOSC STNT
ENDOSCOPY OF BOWEL POUCH
ENDOSCOPY, BOWEL POUCH/BIOP
COLON ENDOSCOPY
44389
44390
44391
44392
44393
44394
44397
44500
44602
44603
44604
44605
44615
44620
44625
44626
44640
44650
44660
44661
44680
44700
44701
44799
44800
44820
44850
44899
44900
44901
44950
44955
44960
44970
44979
45000
45005
45020
45100
45108
45110
45111
45112
45113
45114
45116
45119
45120
45121
COLONOSCOPY WITH BIOPSY

COLONOSCOPY FOR FOREIGN BODY
COLONOSCOPY FOR BLEEDING
COLONOSCOPY & POLYPECTOMY
COLONOSCOPY, LESION REMOVAL
COLONOSCOPY W/SNARE
COLONOSCPY,STOMA;TRANSENDOSCOP
INTRO, GASTROINTESTINAL TUBE
SUTURE, SMALL INTESTINE
SUTURE, SMALL INTESTINE
SUTURE, LARGE INTESTINE
REPAIR OF BOWEL LESION
INTESTINAL STRICTUROPLASTY
REPAIR BOWEL OPENING
REPAIR BOWEL-SKIN FISTULA
REPAIR BOWEL FISTULA
REPAIR BOWEL-BLADDER FISTULA
REPAIR BOWEL-BLADDER FISTULA
SURGICAL REVISION, INTESTINE
SUSPEND BOWEL W/PROSTHESIS
INTRAOP COLON LAVAGE ADD-ON
INTESTINE SURGERY PROCEDURE
EXCISION OF BOWEL POUCH
EXCISION OF MESENTERY LESION
REPAIR OF MESENTERY
BOWEL SURGERY PROCEDURE
DRAIN APP ABSCESS, OPEN
DRAIN APP ABSCESS, PERCUT
APPENDECTOMY
APPENDECTOMY ADD-ON
APPENDECTOMY
LAPAROSCOPY, APPENDECTOMY
LAPAROSCOPE PROC, APP
DRAINAGE OF PELVIC ABSCESS
DRAINAGE OF RECTAL ABSCESS
DRAINAGE OF RECTAL ABSCESS
BIOPSY OF RECTUM
REMOVAL OF ANORECTAL LESION
REMOVAL OF RECTUM
PARTIAL REMOVAL OF RECTUM
REMOVAL OF RECTUM
PARTIAL PROCTECTOMY
REMOVE RECTUM W/RESERVOIR
REMOVAL OF RECTUM
REMOVAL OF RECTUM AND COLON
45123
45126
45130
45135
45136
45150
45160
45170
45190
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
45342
45345
45355
45378
45379
45380
45381
45382
45383
45384
45385
45386
45387
45500
45505
45520
45540
45541
PARTIAL PROCTECTOMY
PELVIC EXENTERATION
EXCISION OF RECTAL PROLAPSE
EXCISION OF RECTAL PROLAPSE
EXCISE ILEOANAL RESERVOIR
EXCISION OF RECTAL STRICTURE
EXCISION OF RECTAL LESION
EXCISION OF RECTAL LESION
DESTRUCTION, RECTAL TUMOR
PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY DILATE
PROCTOSIGMOIDOSCOPY & BIOPSY
PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY
PROTOSIGMOIDOSCOPY BLEED
PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY
PROCTOSIG,RIGID;TRANSENDO STNT
DIAGNOSTIC SIGMOIDOSCOPY
SIGMOIDOSCOPY AND BIOPSY
SIGMOIDOSCOPY
SIGMOIDOSCOPY & POLYPECTOMY
SIGMOIDOSCOPY FOR BLEEDING
SIGMOIDOSCOPE W/SUBMUC INJ
SIGMOIDOSCOPY & DECOMPRESS
SIGMOIDOSCOPY
SIGMOIDOSCOPY
SIG W/BALLOON DILATION
SIGMOID,FLEX;ENDOSC ULTRSND EX
SIGM,FLEX;TRANSEND ULTRSND ASP
SIGMOIDOSC,FLEX;TRANSEND STENT
SURGICAL COLONOSCOPY
DIAGNOSTIC COLONOSCOPY
COLONOSCOPY
COLONOSCOPY AND BIOPSY
COLONOSCOPE, SUBMUCOUS INJ
COLONOSCOPY/CONTROL BLEEDING
LESION REMOVAL COLONOSCOPY
COLONOSCOPY
LESION REMOVAL COLONOSCOPY
COLONOSCOPE DILATE STRICTURE
COLON,FLX,PROX SPLN;TRNSN STNT
REPAIR OF RECTUM
REPAIR OF RECTUM
TREATMENT OF RECTAL PROLAPSE
CORRECT RECTAL PROLAPSE
CORRECT RECTAL PROLAPSE
45550
45560
45562
45563
45800
45805
45820
45825
45900
45905
45910
45915
45999
46020
46030
46040
46045
46050
46060
46070
46080
46083
46200
46210
46211
46220
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46285
46288
46320
46500
46600
46604
46606
46608
46610
46611
46612
REPAIR RECTUM/REMOVE SIGMOID

REPAIR OF RECTOCELE
EXPLORATION/REPAIR OF RECTUM
EXPLORATION/REPAIR OF RECTUM
REPAIR RECT/BLADDER FISTULA
REPAIR FISTULA W/COLOSTOMY
REPAIR RECTOURETHRAL FISTULA
REPAIR FISTULA W/COLOSTOMY
REDUCTION OF RECTAL PROLAPSE
DILATION OF ANAL SPHINCTER
DILATION OF RECTAL NARROWING
REMOVE RECTAL OBSTRUCTION
RECTUM SURGERY PROCEDURE
PLACEMENT OF SETON
REMOVAL OF RECTAL MARKER
INCISION OF RECTAL ABSCESS
INCISION OF ANAL ABSCESS
INCISION OF ANAL SEPTUM
INCISION OF ANAL SPHINCTER
INCISE EXTERNAL HEMORRHOID
REMOVAL OF ANAL FISSURE
REMOVAL OF ANAL CRYPT
REMOVAL OF ANAL CRYPTS
REMOVAL OF ANAL TAB
LIGATION OF HEMORRHOID(S)
REMOVAL OF ANAL TABS
HEMORRHOIDECTOMY
HEMORRHOIDECTOMY
REMOVE HEMORRHOIDS & FISSURE
REMOVE HEMORRHOIDS & FISTULA
HEMORRHOIDECTOMY
REMOVE HEMORRHOIDS & FISSURE
REMOVE HEMORRHOIDS & FISTULA
REMOVAL OF ANAL FISTULA
REPAIR ANAL FISTULA
REMOVAL OF HEMORRHOID CLOT
INJECTION INTO HEMORRHOIDS
DIAGNOSTIC ANOSCOPY
ANOSCOPY AND DILATION
ANOSCOPY AND BIOPSY
ANOSCOPY/ REMOVE FOR BODY
ANOSCOPY/REMOVE LESION
ANOSCOPY
ANOSCOPY/ REMOVE LESIONS
46614
46615
46700
46705
46706
46715
46716
46730
46735
46740
46742
46744
46746
46748
46750
46751
46753
46754
46760
46761
46762
46900
46910
46916
46917
46922
46924
46934
46935
46936
46937
46938
46940
46942
46945
46946
46999
47000
47001
47010
47011
47015
47100
47120
47122
47125
47130
47133
47134
ANOSCOPY/CONTROL BLEEDING
ANOSCOPY
REPAIR OF ANAL STRICTURE
REPAIR OF ANAL STRICTURE
REPR, ANAL FIST W FIBRIN GLU
REPAIR OF ANOVAGINAL FISTULA
REPAIR OF ANOVAGINAL FISTULA
CONSTRUCTION OF ABSENT ANUS
REPAIR OF IMPERFORATED ANUS
REPAIR OF CLOACAL ANOMALY
REPAIR OF ANAL SPHINCTER
RECONSTRUCTION OF ANUS
REMOVAL OF SUTURE FROM ANUS
IMPLANT ARTIFICIAL SPHINCTER
DESTRUCTION, ANAL LESION(S)
CRYOSURGERY, ANAL LESION(S)
LASER SURGERY, ANAL LESIONS
EXCISION OF ANAL LESION(S)
DESTRUCTION OF HEMORRHOIDS
CRYOTHERAPY OF RECTAL LESION
CRYOTHERAPY OF RECTAL LESION
TREATMENT OF ANAL FISSURE
TREATMENT OF ANAL FISSURE
LIGATION OF HEMORRHOIDS
LIGATION OF HEMORRHOIDS
ANUS SURGERY PROCEDURE
NEEDLE BIOPSY OF LIVER
NEEDLE BIOPSY, LIVER ADD-ON
OPEN DRAINAGE, LIVER LESION
PERCUT DRAIN, LIVER LESION
INJECT/ASPIRATE LIVER CYST
WEDGE BIOPSY OF LIVER
PARTIAL REMOVAL OF LIVER
EXTENSIVE REMOVAL OF LIVER
REMOVAL OF DONOR LIVER
PARTIAL REMOVAL, DONOR LIVER
47135
47136
47300
47350
47360
47361
47362
47370
47371
47379
47380
47381
47382
47399
47400
47420
47425
47460
47480
47490
47500
47505
47510
47511
47525
47530
47550
47552
47553
47554
47555
47556
47560
47561
47562
47563
47564
47570
47579
47600
47605
47610
47612
47620
47630
47700
47701
47711
47712
TRANSPLANTATION OF LIVER
TRANSPLANTATION OF LIVER
SURGERY FOR LIVER LESION
REPAIR LIVER WOUND
REPAIR LIVER WOUND
REPAIR LIVER WOUND
REPAIR LIVER WOUND
LAPARO ABLATE LIVER TUMOR RF
LAPARO ABLATE LIVER CRYOSUG
UNLIST LAPAROSCOPIC PROC,LIVER
OPEN ABLATE LIVER TUMOR RF
OPEN ABLATE LIVER TUMOR CRYO
PERCUT ABLATE LIVER RF
LIVER SURGERY PROCEDURE
INCISION OF LIVER DUCT
INCISION OF BILE DUCT
INCISION OF BILE DUCT
INCISE BILE DUCT SPHINCTER
INCISION OF GALLBLADDER
INCISION OF GALLBLADDER
INJECTION FOR LIVER X-RAYS
INJECTION FOR LIVER X-RAYS
INSERT CATHETER, BILE DUCT
INSERT BILE DUCT DRAIN
CHANGE BILE DUCT CATHETER
REVISE/REINSERT BILE TUBE
BILE DUCT ENDOSCOPY ADD-ON
BILIARY ENDOSCOPY THRU SKIN
LAPAROSCOPY W/CHOLANGIO
LAPARO W/CHOLANGIO/BIOPSY
LAPAROSCOPIC CHOLECYSTECTOMY
LAPARO CHOLECYSTECTOMY/GRAPH
LAPARO CHOLECYSTECTOMY/EXPLR
LAPARO CHOLECYSTOENTEROSTOMY
LAPAROSCOPE PROC, BILIARY
REMOVAL OF GALLBLADDER
REMOVE BILE DUCT STONE
EXPLORATION OF BILE DUCTS
BILE DUCT REVISION
EXCISION OF BILE DUCT TUMOR
EXCISION OF BILE DUCT TUMOR
47715
47716
47720
47721
47740
47741
47760
47765
47780
47785
47800
47801
47802
47900
47999
48000
48001
48005
48020
48100
48102
48120
48140
48145
48146
48148
48150
48152
48153
48154
48155
48160
48180
48400
48500
48510
48511
48520
48540
48545
48547
48550
48554
48556
48999
49000
49002
49010
49020
EXCISION OF BILE DUCT CYST

FUSION OF BILE DUCT CYST
FUSE GALLBLADDER & BOWEL
FUSE UPPER GI STRUCTURES
FUSE BILE DUCTS AND BOWEL
FUSE LIVER DUCTS & BOWEL
RECONSTRUCTION OF BILE DUCTS
PLACEMENT, BILE DUCT SUPPORT
FUSE LIVER DUCT & INTESTINE
SUTURE BILE DUCT INJURY
BILE TRACT SURGERY PROCEDURE
DRAINAGE OF ABDOMEN
PLACEMENT OF DRAIN, PANCREAS
RESECT/DEBRIDE PANCREAS
REMOVAL OF PANCREATIC STONE
BIOPSY OF PANCREAS, OPEN
NEEDLE BIOPSY, PANCREAS
REMOVAL OF PANCREAS LESION
PARTIAL REMOVAL OF PANCREAS
PANCREATECTOMY
REMOVAL OF PANCREATIC DUCT
PANCREATECTOMY
PANCREATECTOMY
PANCREATECTOMY
REMOVAL OF PANCREAS
PANCREAS REMOVAL/TRANSPLANT
FUSE PANCREAS AND BOWEL
INJECTION, INTRAOP ADD-ON
SURGERY OF PANCREATIC CYST
DRAIN PANCREATIC PSEUDOCYST
DRAIN PANCREATIC PSEUDOCYST
FUSE PANCREAS CYST AND BOWEL
FUSE PANCREAS CYST AND BOWEL
PANCREATORRHAPHY
DUODENAL EXCLUSION
DONOR PANCREATECTOMY
TRANSPL ALLOGRAFT PANCREAS
REMOVAL, ALLOGRAFT PANCREAS
PANCREAS SURGERY PROCEDURE
EXPLORATION OF ABDOMEN
REOPENING OF ABDOMEN
EXPLORATION BEHIND ABDOMEN
DRAIN ABDOMINAL ABSCESS
49021
49040
49041
49060
49061
49062
49080
49081
49085
49180
49200
49201
49215
49220
49250
49255
49320
49321
49322
49323
49329
49400
49419
49420
49421
49422
49423
49424
49425
49426
49427
49428
49429
49491
49492
49495
49496
49500
49501
49505
49507
49520
49521
49525
49540
49550
49553
49555
49557
DRAIN ABDOMINAL ABSCESS

DRAIN, OPEN, ABDOM ABSCESS
DRAIN, PERCUT, ABDOM ABSCESS
DRAIN, OPEN, RETROP ABSCESS
DRAIN, PERCUT, RETROPER ABSC
DRAIN TO PERITONEAL CAVITY
PUNCTURE, PERITONEAL CAVITY
REMOVAL OF ABDOMINAL FLUID
REMOVE ABDOMEN FOREIGN BODY
BIOPSY, ABDOMINAL MASS
EXCIS INTRA-ABDM TMRS ENDOMETR
EXCS INTRA-ABOM TMRS ENDO;EXTE
EXCISE SACRAL SPINE TUMOR
MULTIPLE SURGERY, ABDOMEN
EXCISION OF UMBILICUS
REMOVAL OF OMENTUM
LAP,ABD/PERIT/OMEN,DX,WWO SPEC
LAPROSCPY,SRGL;W BX(SNGL/MULT)
LAPROSCPY,SRGL;W ASPRAT,CAVITY
LAPROSCPY,SRGL;W DRNGE,LYMPHCL
LAPARO PROC, ABDM/PER/OMENT
AIR INJECTION INTO ABDOMEN
INSRT ABDOM CATH FOR CHEMOTX
INSERT ABDOMINAL DRAIN
INSERT ABDOMINAL DRAIN
REMOVE PERM CANNULA/CATHETER
EXCHANGE DRAINAGE CATHETER
ASSESS CYST, CONTRAST INJECT
INSERT ABDOMEN-VENOUS DRAIN
REVISE ABDOMEN-VENOUS SHUNT
INJECTION, ABDOMINAL SHUNT
LIGATION OF SHUNT
REMOVAL OF SHUNT
REPAIRING HERN PREMIE REDUC
RPR ING HERN PREMIE, BLOCKED
RPR ING HERNIA BABY, REDUC
RPR ING HERNIA BABY, BLOCKED
REPAIR INGUINAL HERNIA
REPAIR INGUINAL HERNIA, INIT
REREPAIR INGUINAL HERNIA
REPAIR INGUINAL HERNIA, REC
REPAIR LUMBAR HERNIA
REPAIR FEMORAL HERNIA
REPAIR FEMORAL HERNIA, INIT
REPAIR FEMORAL HERNIA
REPAIR FEMORAL HERNIA, RECUR
49560
49561
49565
49566
49568
49570
49572
49580
49582
49585
49587
49590
49600
49605
49606
49610
49611
49650
49651
49659
49900
49904
49905
49906
49999
50010
50020
50021
50040
50045
50060
50065
50070
50075
50080
50081
50100
50120
50125
50130
50135
50200
50205
50220
50225
50230
50234
50236
50240
REPAIR ABDOMINAL HERNIA

REPAIR INCISIONAL HERNIA
REREPAIR ABDOMINAL HERNIA
REPAIR INCISIONAL HERNIA
HERNIA REPAIR W/MESH
REPAIR EPIGASTRIC HERNIA
REPAIR EPIGASTRIC HERNIA
REPAIR UMBILICAL HERNIA
REPAIR ABDOMINAL HERNIA
REPAIR UMBILICAL LESION
LAPARO HERNIA REPAIR INITIAL
LAPARO HERNIA REPAIR RECUR
LAPARO PROC, HERNIA REPAIR
REPAIR OF ABDOMINAL WALL
OMENTAL FLAP, EXTRA-ABDOM
OMENTAL FLAP, INTRA-ABDOM
FREE OMENTAL FLAP, MICROVASC
ABDOMEN SURGERY PROCEDURE
EXPLORATION OF KIDNEY
RENAL ABSCESS, OPEN DRAIN
RENAL ABSCESS, PERCUT DRAIN
DRAINAGE OF KIDNEY
REMOVAL OF KIDNEY STONE
INCISION OF KIDNEY
INCISION OF KIDNEY
REVISE KIDNEY BLOOD VESSELS
EXPLORE AND DRAIN KIDNEY
BIOPSY OF KIDNEY
BIOPSY OF KIDNEY
REMOVE KIDNEY, OPEN
REMOVAL KIDNEY OPEN, COMPLEX
REMOVAL KIDNEY OPEN, RADICAL
REMOVAL OF KIDNEY & URETER
REMOVAL OF KIDNEY & URETER
PARTIAL REMOVAL OF KIDNEY
50280
50290
50300
50320
50340
50360
50365
50370
50380
50390
50392
50393
50394
50395
50396
50398
50400
50405
50500
50520
50525
50526
50540
50541
50542
50543
50544
50545
50546
50547
50548
50549
50551
50553
50555
50557
50559
50561
50562
50570
50572
50574
50575
50576
50578
50580
50590
50600
50605
REMOVAL OF KIDNEY LESION

REMOVAL OF KIDNEY LESION
REMOVAL OF DONOR KIDNEY
REMOVAL OF DONOR KIDNEY
REMOVAL OF KIDNEY
TRANSPLANTATION OF KIDNEY
TRANSPLANTATION OF KIDNEY
REMOVE TRANSPLANTED KIDNEY
REIMPLANTATION OF KIDNEY
DRAINAGE OF KIDNEY LESION
INSERT KIDNEY DRAIN
INSERT URETERAL TUBE
INJECTION FOR KIDNEY X-RAY
CREATE PASSAGE TO KIDNEY
MEASURE KIDNEY PRESSURE
CHANGE KIDNEY TUBE
REVISION OF KIDNEY/URETER
REVISION OF KIDNEY/URETER
REPAIR OF KIDNEY WOUND
CLOSE KIDNEY-SKIN FISTULA
REPAIR RENAL-ABDOMEN FISTULA
REPAIR RENAL-ABDOMEN FISTULA
REVISION OF HORSESHOE KIDNEY
LAPARO ABLATE RENAL CYST
LAPARO ABLATE RENAL MASS
LAP, SURG; PARTIAL NEPHRCT
LAPAROSCOPY, PYELOPLASTY
LAPAROSCOP,SRG;RAD NEPHRECTOMY
LAPROSCPY,SRGL;NEPHRECTMY,PART
LAPARO REMOVAL DONOR KIDNEY
LAPROSCPY,SRGL;NEPHRECTMY,TOTL
LAPAROSCOPE PROC, RENAL
KIDNEY ENDOSCOPY
KIDNEY ENDOSCOPY
KIDNEY ENDOSCOPY & BIOPSY
KIDNEY ENDOSCOPY & TREATMENT
RENAL ENDOSCOPY/RADIOTRACER
RENAL SCOPE W/TUMOR RESECT
KIDNEY ENDOSCOPY
KIDNEY ENDOSCOPY
KIDNEY ENDOSCOPY & BIOPSY
KIDNEY ENDOSCOPY
RENAL ENDOSCOPY/RADIOTRACER
FRAGMENTING OF KIDNEY STONE
EXPLORATION OF URETER
INSERT URETERAL SUPPORT
50610
50620
50630
50650
50660
50684
50686
50688
50690
50700
50715
50722
50725
50727
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
50930
50940
50945
50947
50948
50949
50951
50953
50955
50957
50959
50961
50970
50972
50974
REMOVAL OF URETER STONE

REMOVAL OF URETER
REMOVAL OF URETER
INJECTION FOR URETER X-RAY
MEASURE URETER PRESSURE
CHANGE OF URETER TUBE
INJECTION FOR URETER X-RAY
REVISION OF URETER
RELEASE OF URETER
RELEASE OF URETER
RELEASE/REVISE URETER
REVISE URETER
REVISE URETER
FUSION OF URETER & KIDNEY
FUSION OF URETER & KIDNEY
FUSION OF URETERS
SPLICING OF URETERS
REIMPLANT URETER IN BLADDER
IMPLANT URETER IN BOWEL
FUSION OF URETER & BOWEL
URINE SHUNT TO INTESTINE
CONSTRUCT BOWEL BLADDER
CONSTRUCT BOWEL BLADDER
REVISE URINE FLOW
REPLACE URETER BY BOWEL
APPENDICO-VESICOSTOMY
TRANSPLANT URETER TO SKIN
REPAIR OF URETER
CLOSURE URETER/SKIN FISTULA
CLOSURE URETER/BOWEL FISTULA
RELEASE OF URETER
LAPROSCPY,SRGL;URETEROLITHOTMY
LAP,SRG;URTERNEOCYST,CYSTOSCPY
LAP,SRG;URTERNEOCYST,WO CYSTSC
UNLIST LAPAROSCOPY PROC,URETER
ENDOSCOPY OF URETER
ENDOSCOPY OF URETER
URETER ENDOSCOPY & BIOPSY
URETER ENDOSCOPY & TREATMENT
URETER ENDOSCOPY & TRACER
URETER ENDOSCOPY
URETER ENDOSCOPY & CATHETER
URETER ENDOSCOPY & BIOPSY
50976
50978
50980
51000
51005
51010
51020
51030
51040
51045
51050
51060
51065
51080
51500
51520
51525
51530
51535
51550
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51600
51605
51610
51700
51701
51702
51703
51705
51710
51715
51720
51725
51726
51736
51741
51772
51784
51785
51792

URETER ENDOSCOPY & TRACER
DRAINAGE OF BLADDER
DRAINAGE OF BLADDER
DRAINAGE OF BLADDER
INCISE & TREAT BLADDER
INCISE & TREAT BLADDER
INCISE & DRAIN BLADDER
INCISE BLADDER/DRAIN URETER
REMOVAL OF BLADDER STONE
REMOVE URETER CALCULUS
DRAINAGE OF BLADDER ABSCESS
REMOVAL OF BLADDER CYST
REMOVAL OF BLADDER LESION
REPAIR OF URETER LESION
PARTIAL REMOVAL OF BLADDER
PARTIAL REMOVAL OF BLADDER
REVISE BLADDER & URETER(S)
REMOVAL OF BLADDER
REMOVAL OF BLADDER & NODES
REMOVE BLADDER/REVISE TRACT
REMOVAL OF BLADDER & NODES
REMOVE BLADDER/CREATE POUCH
REMOVAL OF PELVIC STRUCTURES
INJECTION FOR BLADDER X-RAY
PREPARATION FOR BLADDER XRAY
INJECTION FOR BLADDER X-RAY
IRRIGATION OF BLADDER
INSERT BLADDER CATHETER
INSERT TEMP BLADDER CATH
INSERT BLADDER CATH, COMPLEX
CHANGE OF BLADDER TUBE
CHANGE OF BLADDER TUBE
ENDOSCOPIC INJECTION/IMPLANT
TREATMENT OF BLADDER LESION
SIMPLE CYSTOMETROGRAM
COMPLEX CYSTOMETROGRAM
URINE FLOW MEASUREMENT
ELECTRO-UROFLOWMETRY, FIRST
URETHRA PRESSURE PROFILE
ANAL/URINARY MUSCLE STUDY
ANAL/URINARY MUSCLE STUDY
URINARY REFLEX STUDY
51795
51797
51798
51800
51820
51840
51841
51845
51860
51865
51880
51900
51920
51925
51940
51960
51980
51990
51992
52000
52001
52005
52007
52010
52204
52214
52224
52234
52235
52240
52250
52260
52265
52270
52275
52276
52277
52281
52282
52283
52285
52290
52300
52301
52305
52310
52315
52317
52318
URINE VOIDING PRESSURE STUDY

INTRAABDOMINAL PRESSURE TEST
US URINE CAPACITY MEASURE
REVISION OF BLADDER/URETHRA
REVISION OF URINARY TRACT
ATTACH BLADDER/URETHRA
ATTACH BLADDER/URETHRA
REPAIR BLADDER NECK
REPAIR OF BLADDER WOUND
REPAIR OF BLADDER WOUND
REPAIR OF BLADDER OPENING
REPAIR BLADDER/VAGINA LESION
CLOSE BLADDER-UTERUS FISTULA
HYSTERECTOMY/BLADDER REPAIR
CORRECTION OF BLADDER DEFECT
REVISION OF BLADDER & BOWEL
CONSTRUCT BLADDER OPENING
LAPARO URETHRAL SUSPENSION
LAPARO SLING OPERATION
CYSTOSCOPY
CYSTO W IRRG &EVAC MULT OB CLT
CYSTOSCOPY & URETER CATHETER
CYSTOSCOPY AND BIOPSY
CYSTOSCOPY & DUCT CATHETER
CYSTOSCOPY
CYSTOSCOPY AND TREATMENT
CYSTOSCOPY AND RADIOTRACER
CYSTOSCOPY & REVISE URETHRA
CYSTOSCOPY & REVISE URETHRA
CYSTOSCOPY, IMPLANT STENT
REMOVE BLADDER STONE
REMOVE BLADDER STONE
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52347
52351
52352
52353
52354
52355
52400
52450
52500
52510
52601
52606
52612
52614
52620
52630
52640
52647
52648
52700
53000
53010
53020
53025
53040
53060
53080
53085
53200
53210
53215
53220
53230
53235
53240
53250
53260

CYSTOSCOPY, STONE REMOVAL
CYSTOSCOPY, INJECT MATERIAL
CREATE PASSAGE TO KIDNEY
CYSTOURETHRO;TREAT,URETER STRC
CYSTOURETHRO;TREAT,URETEROPELV
CYSTOURETHRO;TREAT,INTRA-RENAL
CYSTOURETHRO,URETRSCPY;URETERL
CYSTOURETHR,URTRSCOP;URETERPLV
CYSTOURETHR,URTRSCP;INTRA-RENL
CYSTOSCOPY, RESECT DUCTS
CYSTOURET,URETEROS,PYELOS;DIAG
CYSTOURE,URTRSC,PYELOS;REM/MAN
CYSTOURE,URTRSC,PYELS;LTHTRPSY
CYSTOURETHROSCOPY W/BIOPSY
CYSTOURETHROSCOPY W/RESECTION
CYSTOUR,INC,FLGR/RESC VAL/FOLD
INCISION OF PROSTATE
REVISION OF BLADDER NECK
DILATION PROSTATIC URETHRA
PROSTATECTOMY (TURP)
CONTROL POSTOP BLEEDING
PROSTATECTOMY, FIRST STAGE
PROSTATECTOMY, SECOND STAGE
REMOVE RESIDUAL PROSTATE
REMOVE PROSTATE REGROWTH
RELIEVE BLADDER CONTRACTURE
LASER SURGERY OF PROSTATE
LASER SURGERY OF PROSTATE
DRAINAGE OF PROSTATE ABSCESS
INCISION OF URETHRA
INCISION OF URETHRA
INCISION OF URETHRA
INCISION OF URETHRA
DRAINAGE OF URETHRA ABSCESS
DRAINAGE OF URETHRA ABSCESS
DRAINAGE OF URINARY LEAKAGE
DRAINAGE OF URINARY LEAKAGE
BIOPSY OF URETHRA
REMOVAL OF URETHRA
REMOVAL OF URETHRA
TREATMENT OF URETHRA LESION
REMOVAL OF URETHRA LESION
REMOVAL OF URETHRA LESION
SURGERY FOR URETHRA POUCH
REMOVAL OF URETHRA GLAND
53265
53270
53275
53400
53405
53410
53415
53420
53425
53430
53431
53440
53442
53444
53445
53446
53447
53448
53449
53450
53460
53502
53505
53510
53515
53520
53600
53601
53605
53620
53621
53660
53661
53665
53850
53852
53853
53899
54000
54001
54015
54050
54055
54056
54057
54060
54065
54100
54105

REMOVAL OF URETHRA GLAND
REPAIR OF URETHRA DEFECT
REVISE URETHRA, STAGE 1
REVISE URETHRA, STAGE 2
RECONSTRUCTION OF URETHRA
RECONSTRUCT URETHRA, STAGE 1
RECONSTRUCT URETHRA, STAGE 2
RECONSTRUCT URETHRA/BLADDER
SLNG OPERAT MALE URINARY INCON
REMOVE/REVISE SLING MALE URNRY
INSERT TANDEM CUFF
INSERT URO/VES NCK SPHINCTER
REMOVE URO SPHINCTER
REMOVE/REPLACE UR SPHINCTER
REMOV/REPLC UR SPHINCTR COMP
REPAIR URO SPHINCTER
REVISION OF URETHRA
REVISION OF URETHRA
REPAIR OF URETHRA INJURY
REPAIR OF URETHRA DEFECT
DILATE URETHRA STRICTURE
DILATION OF URETHRA
DILATION OF URETHRA
DILATION OF URETHRA
PROSTATIC MICROWAVE THERMOTX
PROSTATIC RF THERMOTX
PROSTATIC WATER THERMOTHER
UROLOGY SURGERY PROCEDURE
SLITTING OF PREPUCE
SLITTING OF PREPUCE
DRAIN PENIS LESION
DESTRUCTION, PENIS LESION(S)
CRYOSURGERY, PENIS LESION(S)
LASER SURG, PENIS LESION(S)
EXCISION OF PENIS LESION(S)
BIOPSY OF PENIS
BIOPSY OF PENIS
54110
54111
54112
54115
54120
54125
54130
54135
54150
54152
54160
54161
54162
54163
54164
54200
54205
54220
54230
54231
54235
54240
54250
54300
54304
54308
54312
54316
54318
54322
54324
54326
54328
54332
54336
54340
54344
54348
54352
54360
54380
54385
54390
54400
54401
54405
54406
54408
54410
TREATMENT OF PENIS LESION

TREAT PENIS LESION, GRAFT
TREAT PENIS LESION, GRAFT
PARTIAL REMOVAL OF PENIS
REMOVAL OF PENIS
REMOVE PENIS & NODES
REMOVE PENIS & NODES
CIRCUMCISION
CIRCUMCISION
CIRCUMCISION
CIRCUMCISION
LYSIS PENIL CIRCUMCIS LESION
REPAIR OF CIRCUMCISION
FRENULOTOMY OF PENIS
PREPARE PENIS STUDY
DYNAMIC CAVERNOSOMETRY
PENILE INJECTION
PENIS STUDY
PENIS STUDY
REVISION OF PENIS
REVISION OF PENIS
REVISE PENIS/URETHRA
SECONDARY URETHRAL SURGERY
RECONSTRUCT URETHRA/PENIS
PENIS PLASTIC SURGERY
REPAIR PENIS
REPAIR PENIS
REPAIR PENIS AND BLADDER
INSERT SEMI-RIGID PROSTHESIS
INSERT SELF-CONTD PROSTHESIS
INSERT MULTI-COMP PENIS PROS
REMOVE MULTI-COMP PENIS PROS
REPAIR MULTI-COMP PENIS PROS
REMOVE/REPLACE PENIS PROSTH
54411
54415
54416
54417
54420
54430
54435
54440
54450
54500
54505
54512
54520
54522
54530
54535
54550
54560
54600
54620
54640
54650
54660
54670
54680
54690
54692
54699
54700
54800
54820
54830
54840
54860
54861
54900
54901
55000
55040
55041
55060
55100
55110
55120
55150
55175
55180
55200
55250
REMV/REPLC PENIS PROS, COMP

REMOVE SELF-CONTD PENIS PROS
REMV/REPL PENIS CONTAIN PROS
REMV/REPLC PENIS PROS, COMPL
REVISION OF PENIS
REVISION OF PENIS
REVISION OF PENIS
REPAIR OF PENIS
PREPUTIAL STRETCHING
BIOPSY OF TESTIS
BIOPSY OF TESTIS
EXCS,EXTRAPARENCHYM LES,TESTIS
REMOVAL OF TESTIS
ORCHIECTOMY, PARTIAL
REMOVAL OF TESTIS
EXTENSIVE TESTIS SURGERY
EXPLORATION FOR TESTIS
EXPLORATION FOR TESTIS
REDUCE TESTIS TORSION
SUSPENSION OF TESTIS
SUSPENSION OF TESTIS
ORCHIOPEXY (FOWLER-STEPHENS)
REVISION OF TESTIS
REPAIR TESTIS INJURY
RELOCATION OF TESTIS(ES)
LAPAROSCOPY, ORCHIECTOMY
LAPAROSCOPY, ORCHIOPEXY
LAPAROSCOPE PROC, TESTIS
DRAINAGE OF SCROTUM
BIOPSY OF EPIDIDYMIS
EXPLORATION OF EPIDIDYMIS
REMOVE EPIDIDYMIS LESION
REMOVE EPIDIDYMIS LESION
REMOVAL OF EPIDIDYMIS
REMOVAL OF EPIDIDYMIS
FUSION OF SPERMATIC DUCTS
FUSION OF SPERMATIC DUCTS
DRAINAGE OF HYDROCELE
REMOVAL OF HYDROCELE
REMOVAL OF HYDROCELES
REPAIR OF HYDROCELE
DRAINAGE OF SCROTUM ABSCESS
EXPLORE SCROTUM
REMOVAL OF SCROTUM LESION
REMOVAL OF SCROTUM
REVISION OF SCROTUM
REVISION OF SCROTUM
INCISION OF SPERM DUCT
REMOVAL OF SPERM DUCT(S)
55300
55400
55450
55500
55520
55530
55535
55540
55550
55559
55600
55605
55650
55680
55700
55705
55720
55725
55801
55810
55812
55815
55821
55831
55840
55842
55845
55859
55860
55862
55865
55866
55870
55873
55899
55970
55980
56405
56420
56440
56441
56501
56515
56605
56606
56620
56625
56630
56631
PREPARE, SPERM DUCT X-RAY

REPAIR OF SPERM DUCT
LIGATION OF SPERM DUCT
REMOVAL OF HYDROCELE
REMOVAL OF SPERM CORD LESION
REVISE SPERMATIC CORD VEINS
REVISE SPERMATIC CORD VEINS
REVISE HERNIA & SPERM VEINS
LAPARO LIGATE SPERMATIC VEIN
LAPARO PROC, SPERMATIC CORD
INCISE SPERM DUCT POUCH
INCISE SPERM DUCT POUCH
REMOVE SPERM DUCT POUCH
REMOVE SPERM POUCH LESION
BIOPSY OF PROSTATE
BIOPSY OF PROSTATE
REMOVAL OF PROSTATE
EXTENSIVE PROSTATE SURGERY
REMOVAL OF PROSTATE
REMOVAL OF PROSTATE
PERCUT/NEEDLE INSERT, PROS
SURGICAL EXPOSURE, PROSTATE
LAPARO RADICAL PROSTATECTOMY
ELECTROEJACULATION
CRYOSURGICAL ABLATION,PROSTATE
GENITAL SURGERY PROCEDURE
SEX TRANSFORMATION, M TO F
SEX TRANSFORMATION, F TO M
I & D OF VULVA/PERINEUM
DRAINAGE OF GLAND ABSCESS
SURGERY FOR VULVA LESION
LYSIS OF LABIAL LESION(S)
DESTROY, VULVA LESIONS, SIMP
DESTROY VULVA LESION/S COMPL
BIOPSY OF VULVA/PERINEUM
BIOPSY OF VULVA/PERINEUM
PARTIAL REMOVAL OF VULVA
COMPLETE REMOVAL OF VULVA
EXTENSIVE VULVA SURGERY
56632
56633
56634
56637
56640
56700
56720
56740
56800
56805
56810
56820
56821
57000
57010
57020
57022
57023
57061
57065
57100
57105
57106
57107
57109
57110
57111
57112
57120
57130
57135
57150
57155
57160
57170
57180
57200
57210
57220
57230
57240
57250
57260
57265
57268
57270
57280
57282
57284

PARTIAL REMOVAL OF HYMEN
INCISION OF HYMEN
REMOVE VAGINA GLAND LESION
REPAIR OF VAGINA
REPAIR CLITORIS
REPAIR OF PERINEUM
COLPOSCOPY; VULVA
COLPOSCOPY, THE VULVA; W BX(
EXPLORATION OF VAGINA
DRAINAGE OF PELVIC ABSCESS
DRAINAGE OF PELVIC FLUID
I & D VAGINAL HEMATOMA, PP
I & D VAG HEMATOMA, NON-OB
DESTROY VAG LESIONS, SIMPLE
DESTROY VAG LESIONS, COMPLEX
BIOPSY OF VAGINA
BIOPSY OF VAGINA
REMOVE VAGINA WALL, PARTIAL
REMOVE VAGINA TISSUE, PART
VAGINECTOMY PARTIAL W/NODES
REMOVE VAGINA WALL, COMPLETE
REMOVE VAGINA TISSUE, COMPL
VAGINECTOMY W/NODES, COMPL
CLOSURE OF VAGINA
REMOVE VAGINA LESION
REMOVE VAGINA LESION
TREAT VAGINA INFECTION
INSERT UTERI TANDEMS/OVOIDS
INSERT PESSARY/OTHER DEVICE
FITTING OF DIAPHRAGM/CAP
TREAT VAGINAL BLEEDING
REPAIR OF VAGINA
REPAIR VAGINA/PERINEUM
REVISION OF URETHRA
REPAIR OF URETHRAL LESION
REPAIR BLADDER & VAGINA
REPAIR RECTUM & VAGINA
REPAIR OF VAGINA
EXTENSIVE REPAIR OF VAGINA
REPAIR OF BOWEL BULGE
REPAIR OF BOWEL POUCH
SUSPENSION OF VAGINA
REPAIR OF VAGINAL PROLAPSE
REPAIR PARAVAGINAL DEFECT
57287
57288
57289
57291
57292
57300
57305
57307
57308
57310
57311
57320
57330
57335
57400
57410
57415
57420
57421
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57520
57522
57530
57531
57540
57545
57550
57555
57556
57700
57720
57800
57820
58100
58120
58140
58145
58146
58150
REMV/REVIS,SLING,STRESS INCONT
REPAIR BLADDER DEFECT
REPAIR BLADDER & VAGINA
CONSTRUCTION OF VAGINA
CONSTRUCT VAGINA WITH GRAFT
REPAIR RECTUM-VAGINA FISTULA
REPAIR RECTUM-VAGINA FISTULA
FISTULA REPAIR & COLOSTOMY
FISTULA REPAIR, TRANSPERINE
REPAIR URETHROVAGINAL LESION
REPAIR URETHROVAGINAL LESION
REPAIR BLADDER-VAGINA LESION
REPAIR BLADDER-VAGINA LESION
REPAIR VAGINA
DILATION OF VAGINA
PELVIC EXAMINATION
REMOVE VAGINAL FOREIGN BODY
COLPOSCOPY, VAGINA W/CERVIX
COLPOSCOPY, VAG W/CER W/BX(S
COLPSPY CRVX UP/AJCNT VAGINA
CLPSPY CRVX UP/AJCT VAG W/BIPY
COLPOSCOPY, CERVIX W/BX(S)
COLPOSCOPY, CER W ENDOCERV
CLPSPY CRVX UP/AJCT VAG W/LOOP
COLPOSCOPY, CER W COZ OF CER
BIOPSY OF CERVIX
ENDOCERVICAL CURETTAGE
CAUTERIZATION OF CERVIX
CRYOCAUTERY OF CERVIX
LASER SURGERY OF CERVIX
CONIZATION OF CERVIX
CONIZATION OF CERVIX
REMOVAL OF CERVIX
REMOVAL OF CERVIX, RADICAL
REMOVAL OF RESIDUAL CERVIX
REMOVE CERVIX/REPAIR PELVIS
REMOVAL OF RESIDUAL CERVIX
REMOVE CERVIX/REPAIR VAGINA
REMOVE CERVIX, REPAIR BOWEL
REVISION OF CERVIX
REVISION OF CERVIX
DILATION OF CERVICAL CANAL
D & C OF RESIDUAL CERVIX
BIOPSY OF UTERUS LINING
DILATION AND CURETTAGE
MYOMECTOMY ABDOMINAL APPROACH
MYOMECTOMY VAGINAL APPROACH
MYOMECTOMY ABDOM COMPLEX
TOTAL HYSTERECTOMY
58152
58180
58200
58210
58240
58260
58262
58263
58267
58270
58275
58280
58285
58290
58291
58292
58293
58294
58300
58301
58321
58322
58323
58340
58345
58346
58350
58353
58400
58410
58520
58540
58545
58546
58550
58552
58553
58554
58555
58558
58559
58560
58561
58562
58563
58578
58579
58600
58605
TOTAL HYSTERECTOMY
PARTIAL HYSTERECTOMY
EXTENSIVE HYSTERECTOMY
REMOVAL OF PELVIS CONTENTS
VAGINAL HYSTERECT UTRS <250GMS
VAG HYST UTRS <250GMS RMV TUBE
VAG HYST W/RPAIR OF ENTEROCELE
VAG HYST W/COLPO W/WO ENDOSCOP
VAG HYST W/ REPAIR ENTEROCELE
HYSTERECTOMY/REVISE VAGINA
HYSTERECTOMY/REVISE VAGINA
VAG HYST UTER > 250 GRMS
VAG HYST UT > 250 W/RMV T&O
VAG HYST T/O & RPAR ENTEROCE
VAG HYST W/URO W/WO ENDOSCOP
VAG HYST W/ RPAR ENTEROCELE
INSERT INTRAUTERINE DEVICE
REMOVE INTRAUTERINE DEVICE
ARTIFICIAL INSEMINATION
ARTIFICIAL INSEMINATION
SPERM WASHING
CATHETER FOR HYSTEROGRAPHY
REOPEN FALLOPIAN TUBE
INSERT HEYMAN UTERI CAPSULE
REOPEN FALLOPIAN TUBE
ENDOMET ABLAT,THRM,WO HYSTERSC
SUSPENSION OF UTERUS
SUSPENSION OF UTERUS
REPAIR OF RUPTURED UTERUS
REVISION OF UTERUS
LAPAROSCOPIC MYOMECTOMY
LAPARO-MYOMECTOMY, COMPLEX
LAPARO SURG VAG HYSTERECTOMY
LAPARO-VAG HYST RMV T&/O
LAPARO-VAG HYST UTER >250
LAPARO-VAG HYST W RMV T&/O
HYSTEROSCOPY, DX, SEP PROC
HYSTEROSCOPY, BIOPSY
HYSTEROSCOPY, LYSIS
HYSTEROSCOPY, RESECT SEPTUM
HYSTEROSCOPY, REMOVE MYOMA
HYSTEROSCOPY, REMOVE FB
HYSTEROSCOPY, ABLATION
LAPARO PROC, UTERUS
HYSTEROSCOPE PROCEDURE
DIVISION OF FALLOPIAN TUBE
DIVISION OF FALLOPIAN TUBE
58611
58615
58660
58661
58662
58670
58671
58672
58673
58679
58700
58720
58740
58750
58752
58760
58770
58800
58805
58820
58822
58823
58825
58900
58920
58925
58940
58943
58950
58951
58952
58953
58954
58960
58970
58974
58976
58999
59000
59001
59012
59015
59020
59025
59030
59050
59051
59100
59120
LIGATE OVIDUCT(S) ADD-ON

OCCLUDE FALLOPIAN TUBE(S)
LAPAROSCOPY, LYSIS
LAPAROSCOPY, REMOVE ADNEXA
LAPAROSCOPY, EXCISE LESIONS
LAPAROSCOPY, TUBAL CAUTERY
LAPAROSCOPY, TUBAL BLOCK
LAPAROSCOPY, FIMBRIOPLASTY
LAPAROSCOPY, SALPINGOSTOMY
LAPARO PROC, OVIDUCT-OVARY
REMOVAL OF FALLOPIAN TUBE
REMOVAL OF OVARY/TUBE(S)
REVISE FALLOPIAN TUBE(S)
REPAIR OVIDUCT
REVISE OVARIAN TUBE(S)
REMOVE TUBAL OBSTRUCTION
CREATE NEW TUBAL OPENING
DRAINAGE OF OVARIAN CYST(S)
DRAINAGE OF OVARIAN CYST(S)
DRAIN OVARY ABSCESS, OPEN
DRAIN OVARY ABSCESS, PERCUT
DRAIN PELVIC ABSCESS, PERCUT
TRANSPOSITION, OVARY(S)
BIOPSY OF OVARY(S)
PARTIAL REMOVAL OF OVARY(S)
REMOVAL OF OVARIAN CYST(S)
REMOVAL OF OVARY(S)
OOPH,OVAR/TUB/PRI MAL,W BX,WSH
RESCT OVR/TUB/PRI MAL,W BSO
RESCT OVR/TB/MAL;W TAH,PEL&LTD
RESCT OVR/TUB/MAL;W RAD DISSCT
TAH, RAD DISSECT FOR DEBULK
TAH RAD DEBULK/LYMPH REMOVE
LAP,STGNG/RESTGNG O/T/MLG,O/P
RETRIEVAL OF OOCYTE
TRANSFER OF EMBRYO
TRANSFER OF EMBRYO
GENITAL SURGERY PROCEDURE
AMNIOCENTESIS, DIAGNOSTIC
AMNIOCENTESIS, THERAPEUTIC
FETAL CORD PUNCTURE,PRENATAL
CHORION BIOPSY
FETAL CONTRACT STRESS TEST
FETAL NON-STRESS TEST
FETAL SCALP BLOOD SAMPLE
FETAL MONITOR W/REPORT
FETAL MONITOR/INTERPRET ONLY
REMOVE UTERUS LESION
TREAT ECTOPIC PREGNANCY
59121
59130
59135
59136
59140
59150
59151
59160
59200
59300
59320
59325
59350
59400
59409
59410
59412
59414
59425
59426
59430
59510
59514
59515
59525
59610
59612
59614
59618
59620
59622
59812
59820
59821
59830
59840
59841
59850
59851
59852
59855
59856
59857
59866
59870
59871
59898
59899
60000

D & C AFTER DELIVERY
INSERT CERVICAL DILATOR
EPISIOTOMY OR VAGINAL REPAIR
REVISION OF CERVIX
REVISION OF CERVIX
REPAIR OF UTERUS
OBSTETRICAL CARE
OBSTETRICAL CARE
OBSTETRICAL CARE
ANTEPARTUM MANIPULATION
DELIVER PLACENTA
ANTEPARTUM CARE ONLY
ANTEPARTUM CARE ONLY
CARE AFTER DELIVERY
CESAREAN DELIVERY
CESAREAN DELIVERY ONLY
CESAREAN DELIVERY
REMOVE UTERUS AFTER CESAREAN
VBAC DELIVERY
VBAC DELIVERY ONLY
VBAC CARE AFTER DELIVERY
ATTEMPTED VBAC DELIVERY
ATTEMPTED VBAC DELIVERY ONLY
ATTEMPTED VBAC AFTER CARE
TREATMENT OF MISCARRIAGE
CARE OF MISCARRIAGE
TREATMENT OF MISCARRIAGE
TREAT UTERUS INFECTION
ABORTION
ABORTION
ABORTION
ABORTION
ABORTION
ABORTION
ABORTION
ABORTION
ABORTION (MPR)
EVACUATE MOLE OF UTERUS
REMOVE CERCLAGE SUTURE
LAPARO PROC, OB CARE/DELIVER
MATERNITY CARE PROCEDURE
DRAIN THYROID/TONGUE CYST
60001
60100
60200
60210
60212
60220
60225
60240
60252
60254
60260
60270
60271
60280
60281
60500
60502
60505
60512
60520
60521
60522
60540
60545
60600
60605
60650
60659
60699
61000
61001
61020
61026
61050
61055
61070
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61215
61250
61253
ASPIRATE/INJECT THYRIOD CYST

BIOPSY OF THYROID
REMOVE THYROID LESION
PARTIAL THYROID EXCISION
PARITAL THYROID EXCISION
TOTAL REMOVAL OF THYROID
TOTAL REMOVAL OF THYROID
REMOVAL OF THYROID
REMOVAL OF THYROID
EXTENSIVE THYROID SURGERY
REPEAT THYROID SURGERY
REMOVAL OF THYROID
REMOVAL OF THYROID
REMOVE THYROID DUCT LESION
REMOVE THYROID DUCT LESION
EXPLORE PARATHYROID GLANDS
RE-EXPLORE PARATHYROIDS
EXPLORE PARATHYROID GLANDS
AUTOTRANSPLANT PARATHYROID
REMOVAL OF THYMUS GLAND
EXPLORE ADRENAL GLAND
EXPLORE ADRENAL GLAND
REMOVE CAROTID BODY LESION
REMOVE CAROTID BODY LESION
LAPAROSCOPY ADRENALECTOMY
LAPARO PROC, ENDOCRINE
ENDOCRINE SURGERY PROCEDURE
REMOVE CRANIAL CAVITY FLUID
REMOVE CRANIAL CAVITY FLUID
REMOVE BRAIN CAVITY FLUID
INJECTION INTO BRAIN CANAL
REMOVE BRAIN CANAL FLUID
INJECTION INTO BRAIN CANAL
BRAIN CANAL SHUNT PROCEDURE
TWIST DRILL HOLE
DRILL SKULL FOR IMPLANTATION
DRILL SKULL FOR DRAINAGE
BURR HOLE FOR PUNCTURE
PIERCE SKULL FOR BIOPSY
PIERCE SKULL FOR DRAINAGE
PIERCE SKULL & REMOVE CLOT
PIERCE SKULL, IMPLANT DEVICE
INSERT BRAIN-FLUID DEVICE
PIERCE SKULL & EXPLORE
PIERCE SKULL & EXPLORE
61304
61305
61312
61313
61314
61315
61316
61320
61321
61322
61323
61330
61332
61333
61334
61340
61343
61345
61440
61450
61458
61460
61470
61480
61490
61500
61501
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61538
61539
61541
61542
OPEN SKULL FOR EXPLORATION

OPEN SKULL FOR EXPLORATION
OPEN SKULL FOR DRAINAGE
INCI & SUB CRAN BONE GRAFT
CRANIECTOMY W/O LOBECTOMY
CRANIECTOMY W/ LOBECTOMY
DECOMPRESS EYE SOCKET
EXPLORE/BIOPSY EYE SOCKET
EXPLORE ORBIT/REMOVE LESION
EXPLORE ORBIT/REMOVE OBJECT
SUBTEMPORAL DECOMPRESSION
INCISE SKULL (PRESS RELIEF)
RELIEVE CRANIAL PRESSURE
INCISE SKULL FOR SURGERY
INCISE SKULL FOR BRAIN WOUND
REMOVAL OF SKULL LESION
REMOVE INFECTED SKULL BONE
REMOVAL OF BRAIN LESION
REMOVE BRAIN LINING LESION
REMOVAL OF BRAIN ABSCESS
IMPLT BRAIN CHEMOTX ADD-ON
REMOVE BRAIN LINING LESION
REMOVAL OF BRAIN ABSCESS
IMPLANT BRAIN ELECTRODES
REMOVE BRAIN ELECTRODES
REMOVAL OF BRAIN TISSUE
INCISION OF BRAIN TISSUE
61543
61544
61545
61546
61548
61550
61552
61556
61557
61558
61559
61563
61564
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61609
61610
61611
61612
61613
61615
61616
61618
61619
61623
61624
61626

REMOVE & TREAT BRAIN LESION
EXCISION OF BRAIN TUMOR
REMOVAL OF PITUITARY GLAND
REMOVAL OF PITUITARY GLAND
RELEASE OF SKULL SEAMS
RELEASE OF SKULL SEAMS
INCISE SKULL/SUTURES
INCISE SKULL/SUTURES
EXCISION OF SKULL/SUTURES
EXCISION OF SKULL/SUTURES
EXCISION OF SKULL TUMOR
EXCISION OF SKULL TUMOR
REMOVE FOREIGN BODY, BRAIN
INCISE SKULL FOR BRAIN WOUND
SKULL BASE/BRAINSTEM SURGERY
SKULL BASE/BRAINSTEM SURGERY
CRANIOFACIAL APPROACH, SKULL
ORBITOCRANIAL APPROACH/SKULL
RESECT NASOPHARYNX, SKULL
INFRATEMPORAL APPROACH/SKULL
INFRATEMPORAL APPROACH/SKULL
TRANSTEMPORAL APPROACH/SKULL
TRANSCOCHLEAR APPROACH/SKULL
TRANSCONDYLAR APPROACH/SKULL
TRANSPETROSAL APPROACH/SKULL
RESECT/EXCISE CRANIAL LESION
TRANSECT ARTERY, SINUS
REMOVE ANEURYSM, SINUS
RESECT/EXCISE LESION, SKULL
RESECT/EXCISE LESION, SKULL
REPAIR DURA
REPAIR DURA
ENDOVASC TEMPORY VESSEL OCCL
TRANSCATH OCCLUSION, CNS
TRANSCATH OCCLUSION, NON-CNS
61680
61682
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710
61711
61720
61735
61750
61751
61760
61770
61790
61791
61793
61795
61850
61860
61862
61870
61875
61880
61885
61886
61888
62000
62005
62010
62100
62115
62116
62117
62120
62121
62140
62141
62142
62143
62145
62146
INTRACRANIAL VESSEL SURGERY

SRG,COMP INTRACRNL ANEUR;CARTD
SRG,COMP INTRCRN ANEU;VERTEBRO
SRG INTRACRN ANEUR,CAROTD CIRC
SRG INTRACRN ANEUR,VERTEBROBSL
CLAMP NECK ARTERY
REVISE CIRCULATION TO HEAD
FUSION OF SKULL ARTERIES
INCISE SKULL/BRAIN SURGERY
INCISE SKULL/BRAIN SURGERY
INCISE SKULL/BRAIN BIOPSY
STEREO BIOPSY W/CT/MR GUIDE
STEREOTACT,BURR HLE,CATH/PRB
TREAT TRIGEMINAL NERVE
TREAT TRIGEMINAL TRACT
FOCUS RADIATION BEAM
BRAIN SURGERY USING COMPUTER
IMPLANT NEUROELECTRODES
IMPLANT NEUROSTIMUL, SUBCORT
REVISE/REMOVE NEUROELECTRODE
IMPLANT NEUROSTIM ONE ARRAY
IMPLANT NEUROSTIM ARRAYS
REVISE/REMOVE NEURORECEIVER
TREAT SKULL FRACTURE
TREAT SKULL FRACTURE
TREATMENT OF HEAD INJURY
REPAIR BRAIN FLUID LEAKAGE
REDUCTION OF SKULL DEFECT
REPAIR SKULL CAVITY LESION
INCISE SKULL REPAIR
REPAIR OF SKULL DEFECT
REPAIR OF SKULL DEFECT
REMOVE SKULL PLATE/FLAP
REPLACE SKULL PLATE/FLAP
REPAIR OF SKULL & BRAIN
REPAIR OF SKULL WITH GRAFT
62147
62148
62160
62161
62162
62163
62164
62165
62180
62190
62192
62194
62200
62201
62220
62223
62225
62230
62252
62256
62258
62263
62264
62268
62269
62270
62272
62273
62280
62281
62282
62284
62287
62290
62291
62292
62294
62310
62311
62318
62319
62350
62351
62355
62360
62361
62362
62365
62367
REPAIR OF SKULL WITH GRAFT

INCI&RET SUBCUT CRAN BONE GR
NEUROENDOSCOPY VENT CATH ADD
NEUROENDOSCOPY W DISS OF ADH
NEUROENDOSCOPY W FENE OF COL
NEUROENDOSCOPY W/RETVE OF FB
NEUROENDOSCOPY W BRAIN TUMOR
NEUROENDOSCOPY W PITU TUMOR
ESTABLISH BRAIN CAVITY SHUNT
REPLACE/IRRIGATE CATHETER
VENTRICULOCISTER, NEURO METHOD
REPLACE/IRRIGATE CATHETER
REPLACE/REVISE BRAIN SHUNT
CSF SHUNT REPROGRAM
REMOVE BRAIN CAVITY SHUNT
REPLACE BRAIN CAVITY SHUNT
PERC LYSIS EPID MULT SESSIONS
EPIDURAL LYSIS ON SINGLE DAY
DRAIN SPINAL CORD CYST
NEEDLE BIOPSY, SPINAL CORD
SPINAL FLUID TAP, DIAGNOSTIC
DRAIN CEREBRO SPINAL FLUID
TREAT EPIDURAL SPINE LESION
TREAT SPINAL CORD LESION
TREAT SPINAL CORD LESION
TREAT SPINAL CANAL LESION
INJCT MYELO &/C TOMOGRPH SPINL
PERCUTANEOUS DISKECTOMY
INJECT FOR SPINE DISK X-RAY
INJECT FOR SPINE DISK X-RAY
INJECTION INTO DISK LESION
INJECTION INTO SPINAL ARTERY
INJECT SPINE C/T
INJECT SPINE L/S (CD)
INJECT SPINE W/CATH, C/T
INJECT SPINE W/CATH L/S (CD)
IMPLNT,REV/REP TUN INT/EPI CTH
IMPLANT SPINAL CANAL CATH
REMOVE SPINAL CANAL CATHETER
INSERT SPINE INFUSION DEVICE
IMPLANT SPINE INFUSION PUMP
IMPLANT SPINE INFUSION PUMP
REMOVE SPINE INFUSION DEVICE
ANALYZE SPINE INFUSION PUMP
62368
63001
63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
63042
63043
63044
63045
63046
63047
63048
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
63085
63086
63087
63088
63090
63091
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
ANALYZE SPINE INFUSION PUMP

REMOVAL OF SPINAL LAMINA
NECK SPINE DISK SURGERY
LOW BACK DISK SURGERY
SPINAL DISK SURGERY ADD-ON
LAMIN,DECOM NRV RT,FAC,REEX
LOW BACK DISK SURGERY
LAMINOT,DECMP NRV,1;EA ADD CRV
LAMINOT,DECM NRV,1;EA ADD LUMB
REMOVE SPINAL LAMINA ADD-ON
DECOMPRESS SPINAL CORD
DECOMPRESS SPINE CORD ADD-ON
DECOMPRESS SPINE CORD ADD-ON
SPINE DISK SURGERY, THORAX
SPINE DISK SURGERY, THORAX
REMOVAL OF VERTEBRAL BODY
REMOVE VERTEBRAL BODY ADD-ON
INCISE SPINAL CORD TRACT(S)
DRAINAGE OF SPINAL CYST
DRAINAGE OF SPINAL CYST
REVISE SPINAL CORD LIGAMENTS
REVISE SPINAL CORD LIGAMENTS
INCISE SPINAL COLUMN/NERVES
INCISE SPINAL COLUMN & CORD
63198
63199
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278
63280
63281
63282
63283
63285
63286
63287
63290
63300
63301
63302
63303
63304
63305
63306
63307
63308
63600
63610
63615
63650
63655
63660
63685
63688
63700
63702
63704
63706
63707
63709

RELEASE OF SPINAL CORD
REVISE SPINAL CORD VESSELS
EXCISE INTRASPINAL LESION
BIOPSY/EXCISE SPINAL TUMOR
REMOVE SPINAL CORD LESION
STIMULATION OF SPINAL CORD
REMOVE LESION OF SPINAL CORD
IMPLANT NEURORECEIVER
REPAIR OF SPINAL HERNIATION
REPAIR SPINAL FLUID LEAKAGE
REPAIR SPINAL FLUID LEAKAGE
63710
63740
63741
63744
63746
64400
64402
64405
64408
64410
64412
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447
64448
64450
64470
64472
64475
64476
64479
64480
64483
64484
64505
64508
64510
64520
64530
64550
64553
64555
64560
64561
64565
64573
64575
64577
64580
GRAFT REPAIR OF SPINE DEFECT

INSTALL SPINAL SHUNT
INSTALL SPINAL SHUNT
REVISION OF SPINAL SHUNT
REMOVAL OF SPINAL SHUNT
INJECTION FOR NERVE BLOCK
INJT,ANES AGNT;BRCHL PLEX,SNGL
NJECT B PLEX CONT INFUSE CAT
INJT,ANES AGNT;SCIAT NRVE,SNGL
NJECT S NERVE CONT INFUSE CA
NJECT FEMORAL NERVE SINGLE
NJECT F NERVE CONT INFUSE CA
INJ PARAVERTEBRAL C/T
INJ PARAVERTEBRAL C/T ADD-ON
INJ PARAVERTEBRAL L/S
INJ PARAVERTEBRAL L/S ADD-ON
INJ FORAMEN EPIDURAL C/T
INJ FORAMEN EPIDURAL ADD-ON
INJ FORAMEN EPIDURAL L/S
INJ FORAMEN EPIDURAL ADD-ON
APPLY NEUROSTIMULATOR
64581
64585
64590
64595
64600
64605
64610
64612
64613
64614
64620
64622
64623
64626
64627
64630
64640
64680
64702
64704
64708
64712
64713
64714
64716
64718
64719
64721
64722
64726
64727
64732
64734
64736
64738
64740
64742
64744
64746
64752
64755
64760
64761
64763
64766
64771
64772
64774
64776
IMPLANT NEURORECEIVER
INJECTION TREATMENT OF NERVE
CHEMODENERV;INNERVATD,FAC NRVE
CHEMODENERV;CERVICL SPINAL MSC
CHEMODEN,MUSC(S);EXT,TRNK MUSC
DESTR PARAVERTEBRL NERVE L/S
DESTR PARAVERTEBRAL N ADD-ON
DESTR PARAVERTEBRL NERVE C/T
DESTR PARAVERTEBRAL N ADD-ON
DESTRCT,NEURO AGNT;PUDENDL NRV
DESTRCT,NEURO;OTHR NRV/BRANCH
REVISE FINGER/TOE NERVE
REVISE HAND/FOOT NERVE
REVISE ARM/LEG NERVE
REVISION OF SCIATIC NERVE
REVISION OF ARM NERVE(S)
REVISE LOW BACK NERVE(S)
REVISION OF CRANIAL NERVE
REVISE ULNAR NERVE AT ELBOW
REVISE ULNAR NERVE AT WRIST
CARPAL TUNNEL SURGERY
RELIEVE PRESSURE ON NERVE(S)
RELEASE FOOT/TOE NERVE
INTERNAL NERVE REVISION
INCISION OF BROW NERVE
INCISION OF CHEEK NERVE
INCISION OF CHIN NERVE
INCISION OF JAW NERVE
INCISION OF TONGUE NERVE
INCISION OF FACIAL NERVE
INCISE NERVE, BACK OF HEAD
INCISE DIAPHRAGM NERVE
INCISION OF VAGUS NERVE
INCISION OF STOMACH NERVES
INCISION OF VAGUS NERVE
INCISION OF PELVIS NERVE
INCISE HIP/THIGH NERVE
INCISE HIP/THIGH NERVE
SEVER CRANIAL NERVE
INCISION OF SPINAL NERVE
REMOVE SKIN NERVE LESION
REMOVE DIGIT NERVE LESION
64778
64782
64783
64784
64786
64787
64788
64790
64792
64795
64802
64804
64809
64818
64820
64821
64822
64823
64831
64832
64834
64835
64836
64837
64840
64856
64857
64858
64859
64861
64862
64864
64865
64866
64868
64870
64872
64874
64876
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
DIGIT NERVE SURGERY ADD-ON

REMOVE LIMB NERVE LESION
LIMB NERVE SURGERY ADD-ON
REMOVE NERVE LESION
REMOVE SCIATIC NERVE LESION
IMPLANT NERVE END
REMOVE SKIN NERVE LESION
REMOVAL OF NERVE LESION
REMOVAL OF NERVE LESION
BIOPSY OF NERVE
REMOVE SYMPATHETIC NERVES
REPAIR OF DIGIT NERVE
REPAIR NERVE ADD-ON
REPAIR OF HAND OR FOOT NERVE
REPAIR NERVE ADD-ON
REPAIR OF LEG NERVE
REPAIR/TRANSPOSE NERVE
REPAIR ARM/LEG NERVE
REPAIR SCIATIC NERVE
NERVE SURGERY
REPAIR OF ARM NERVES
REPAIR OF LOW BACK NERVES
REPAIR OF FACIAL NERVE
REPAIR OF FACIAL NERVE
FUSION OF FACIAL/OTHER NERVE
SUBSEQUENT REPAIR OF NERVE
REPAIR & REVISE NERVE ADD-ON
REPAIR NERVE/SHORTEN BONE
NERVE GRAFT, HEAD OR NECK
NERVE GRAFT, HEAD OR NECK
NERVE GRAFT, HAND OR FOOT
NERVE GRAFT, ARM OR LEG
64901
64902
64905
64907
64999
65091
65093
65101
65103
65105
65110
65112
65114
65125
65130
65135
65140
65150
65155
65175
65205
65210
65220
65222
65235
65260
65265
65270
65272
65273
65275
65280
65285
65286
65290
65400
65410
65420
65426
65430
65435
65436
65450
65600
65710
65730
65750
65755
65760
NERVE GRAFT ADD-ON

NERVE GRAFT ADD-ON
NERVE PEDICLE TRANSFER
NERVE PEDICLE TRANSFER
NERVOUS SYSTEM SURGERY
REVISE EYE
REVISE EYE WITH IMPLANT
REMOVAL OF EYE
REMOVE EYE/INSERT IMPLANT
REMOVE EYE/ATTACH IMPLANT
REMOVAL OF EYE
REMOVE EYE/REVISE SOCKET
REMOVE EYE/REVISE SOCKET
REVISE OCULAR IMPLANT
INSERT OCULAR IMPLANT
INSERT OCULAR IMPLANT
ATTACH OCULAR IMPLANT
REVISE OCULAR IMPLANT
REINSERT OCULAR IMPLANT
REMOVAL OF OCULAR IMPLANT
REMOVE FOREIGN BODY FROM EYE
REPAIR OF EYE WOUND
REPAIR OF EYE WOUND
REPAIR OF EYE WOUND
REPAIR OF EYE WOUND
REPAIR OF EYE WOUND
REPAIR OF EYE WOUND
REPAIR OF EYE WOUND
REPAIR OF EYE SOCKET WOUND
REMOVAL OF EYE LESION
BIOPSY OF CORNEA
CORNEAL SMEAR
CURETTE/TREAT CORNEA
CURETTE/TREAT CORNEA
TREATMENT OF CORNEAL LESION
REVISION OF CORNEA
CORNEAL TRANSPLANT
CORNEAL TRANSPLANT
CORNEAL TRANSPLANT
CORNEAL TRANSPLANT
REVISION OF CORNEA
65765
65767
65770
65771
65772
65775
65800
65805
65810
65815
65820
65850
65855
65860
65865
65870
65875
65880
65900
65920
65930
66020
66030
66130
66150
66155
66160
66165
66170
66172
66180
66185
66220
66225
66250
66500
66505
66600
66605
66625
66630
66635
66680
66682
66700
66710
66720
66740
66761
REVISION OF CORNEA
CORNEAL TISSUE TRANSPLANT
REVISE CORNEA WITH IMPLANT
RADIAL KERATOTOMY
CORRECTION OF ASTIGMATISM
CORRECTION OF ASTIGMATISM
DRAINAGE OF EYE
DRAINAGE OF EYE
DRAINAGE OF EYE
DRAINAGE OF EYE
RELIEVE INNER EYE PRESSURE
INCISION OF EYE
LASER SURGERY OF EYE
INCISE INNER EYE ADHESIONS
REMOVE EYE LESION
REMOVE IMPLANT OF EYE
REMOVE BLOOD CLOT FROM EYE
INJECTION TREATMENT OF EYE
INJECTION TREATMENT OF EYE
REMOVE EYE LESION
GLAUCOMA SURGERY
GLAUCOMA SURGERY
GLAUCOMA SURGERY
GLAUCOMA SURGERY
GLAUCOMA SURGERY
INCISION OF EYE
IMPLANT EYE SHUNT
REVISE EYE SHUNT
REPAIR EYE LESION
REPAIR/GRAFT EYE LESION
FOLLOW-UP SURGERY OF EYE
INCISION OF IRIS
INCISION OF IRIS
REMOVE IRIS AND LESION
REMOVAL OF IRIS
REMOVAL OF IRIS
REMOVAL OF IRIS
REMOVAL OF IRIS
REPAIR IRIS & CILIARY BODY
REPAIR IRIS & CILIARY BODY
DESTRUCTION, CILIARY BODY
REVISION OF IRIS
66762
66770
66820
66821
66825
66830
66840
66850
66852
66920
66930
66940
66982
66983
66984
66985
66986
66990
66999
67005
67010
67015
67025
67027
67028
67030
67031
67036
67038
67039
67040
67101
67105
67107
67108
67110
67112
67115
67120
67121
67141
67145
67208
67210
67218
67220
67221
67225
67227
REVISION OF IRIS
REMOVAL OF INNER EYE LESION
INCISION, SECONDARY CATARACT
AFTER CATARACT LASER SURGERY
REPOSITION INTRAOCULAR LENS
REMOVAL OF LENS LESION
REMOVAL OF LENS MATERIAL
EXTRACTION OF LENS
EXTRACTION OF LENS
EXTRACTION OF LENS
CATARACT SURGERY, COMPLEX
REMOVE CATARACT/INSERT LENS
REMOVE CATARACT/INSERT LENS
INSERT LENS PROSTHESIS
EXCHANGE LENS PROSTHESIS
OPHTHALMIC ENDOSCOPE ADD-ON
EYE SURGERY PROCEDURE
PARTIAL REMOVAL OF EYE FLUID
PARTIAL REMOVAL OF EYE FLUID
RELEASE OF EYE FLUID
REPLACE EYE FLUID
IMPLANT EYE DRUG SYSTEM
INJECTION EYE DRUG
INCISE INNER EYE STRANDS
LASER SURGERY, EYE STRANDS
REMOVAL OF INNER EYE FLUID
STRIP RETINAL MEMBRANE
LASER TREATMENT OF RETINA
LASER TREATMENT OF RETINA
REPAIR DETACHED RETINA
REREPAIR DETACHED RETINA
RELEASE ENCIRCLING MATERIAL
REMOVE EYE IMPLANT MATERIAL
REMOVE EYE IMPLANT MATERIAL
TREATMENT OF RETINA
TREATMENT OF RETINA
TREATMENT OF RETINAL LESION
DESTRCT;PHOTOCOAGLAT,1 OR>SESS
DESTR,LOC LES,CHOROID;PHOTODYN
EYE PHOTODYNAMIC THER ADD-ON
67228
67250
67255
67299
67311
67312
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67350
67399
67400
67405
67412
67413
67414
67415
67420
67430
67440
67445
67450
67500
67505
67515
67550
67560
67570
67599
67700
67710
67715
67800
67801
67805
67808
67810
67820
67825
67830
67835

REINFORCE EYE WALL
REINFORCE/GRAFT EYE WALL
EYE SURGERY PROCEDURE
REVISE EYE MUSCLE
REVISE TWO EYE MUSCLES
REVISE EYE MUSCLE
REVISE TWO EYE MUSCLES
REVISE EYE MUSCLE(S)
REVISE EYE MUSCLE(S) ADD-ON
EYE SURGERY FOLLOW-UP ADD-ON
REREVISE EYE MUSCLES ADD-ON
REVISE EYE MUSCLE W/SUTURE
EYE SUTURE DURING SURGERY
REVISE EYE MUSCLE ADD-ON
RELEASE EYE TISSUE
DESTROY NERVE OF EYE MUSCLE
BIOPSY EYE MUSCLE
EYE MUSCLE SURGERY PROCEDURE
EXPLORE/DRAIN EYE SOCKET
EXPLORE/TREAT EYE SOCKET
EXPLR/DECOMPRESS EYE SOCKET
ASPIRATION, ORBITAL CONTENTS
EXPLORE/DRAIN EYE SOCKET
EXPLR/DECOMPRESS EYE SOCKET
INJECT/TREAT EYE SOCKET
INSERT EYE SOCKET IMPLANT
REVISE EYE SOCKET IMPLANT
DECOMPRESS OPTIC NERVE
ORBIT SURGERY PROCEDURE
DRAINAGE OF EYELID ABSCESS
INCISION OF EYELID
INCISION OF EYELID FOLD
REMOVE EYELID LESION
REMOVE EYELID LESIONS
REMOVE EYELID LESIONS
REMOVE EYELID LESION(S)
BIOPSY OF EYELID
REVISE EYELASHES
REVISE EYELASHES
REVISE EYELASHES
REVISE EYELASHES
67840
67850
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67909
67911
67914
67915
67916
67917
67921
67922
67923
67924
67930
67935
67938
67950
67961
67966
67971
67973
67974
67975
67999
68020
68040
68100
68110
68115
68130
68135
68200
68320
68325
68326
68328
68330
68335
68340
68360
REMOVE EYELID LESION

TREAT EYELID LESION
CLOSURE OF EYELID BY SUTURE
REVISION OF EYELID
REVISION OF EYELID
REPAIR BROW DEFECT
REPAIR EYELID DEFECT
REVISE EYELID DEFECT
REVISE EYELID DEFECT
REPAIR EYELID WOUND
REPAIR EYELID WOUND
REMOVE EYELID FOREIGN BODY
REVISION OF EYELID
REVISION OF EYELID
REVISION OF EYELID
RECONSTRUCTION OF EYELID
REVISION OF EYELID
INCISE/DRAIN EYELID LINING
TREATMENT OF EYELID LESIONS
BIOPSY OF EYELID LINING
REMOVE EYELID LINING LESION
TREAT EYELID BY INJECTION
REVISE/GRAFT EYELID LINING
REVISE EYELID LINING
SEPARATE EYELID ADHESIONS
68362
68399
68400
68420
68440
68500
68505
68510
68520
68525
68530
68540
68550
68700
68705
68720
68745
68750
68760
68761
68770
68801
68810
68811
68815
68840
68850
68899
69000
69005
69020
69090
69100
69105
69110
69120
69140
69145
69150
69155
69200
69205
69210
69220
69222
69300
69310
69320
69399

EYELID LINING SURGERY
INCISE/DRAIN TEAR GLAND
INCISE/DRAIN TEAR SAC
INCISE TEAR DUCT OPENING
REMOVAL OF TEAR GLAND
PARTIAL REMOVAL, TEAR GLAND
BIOPSY OF TEAR GLAND
REMOVAL OF TEAR SAC
BIOPSY OF TEAR SAC
CLEARANCE OF TEAR DUCT
REMOVE TEAR GLAND LESION
REMOVE TEAR GLAND LESION
REPAIR TEAR DUCTS
REVISE TEAR DUCT OPENING
CREATE TEAR SAC DRAIN
CREATE TEAR DUCT DRAIN
CREATE TEAR DUCT DRAIN
CLOSE TEAR DUCT OPENING
CLOSE TEAR DUCT OPENING
CLOSE TEAR SYSTEM FISTULA
DILATE TEAR DUCT OPENING
PROBE NASOLACRIMAL DUCT
EXPLORE/IRRIGATE TEAR DUCTS
INJECTION FOR TEAR SAC X-RAY
TEAR DUCT SYSTEM SURGERY
DRAIN EXTERNAL EAR LESION
DRAIN EXTERNAL EAR LESION
DRAIN OUTER EAR CANAL LESION
PIERCE EARLOBES
BIOPSY OF EXTERNAL EAR
BIOPSY OF EXTERNAL EAR CANAL
REMOVE EXTERNAL EAR, PARTIAL
REMOVAL OF EXTERNAL EAR
REMOVE EAR CANAL LESION(S)
REMOVE EAR CANAL LESION(S)
EXTENSIVE EAR CANAL SURGERY
EXTENSIVE EAR/NECK SURGERY
CLEAR OUTER EAR CANAL
CLEAR OUTER EAR CANAL
REMOVE IMPACTED EAR WAX
CLEAN OUT MASTOID CAVITY
CLEAN OUT MASTOID CAVITY
REVISE EXTERNAL EAR
REBUILD OUTER EAR CANAL
REBUILD OUTER EAR CANAL
OUTER EAR SURGERY PROCEDURE
69400
69401
69405
69410
69420
69421
69424
69433
69436
69440
69450
69501
69502
69505
69511
69530
69535
69540
69550
69552
69554
69601
69602
69603
69604
69605
69610
69620
69631
69632
69633
69635
69636
69637
69641
69642
69643
69644
69645
69646
69650
69660
69661
69662
69666
69667
69670
69676
69700
INFLATE MIDDLE EAR CANAL

INFLATE MIDDLE EAR CANAL
CATHETERIZE MIDDLE EAR CANAL
INSET MIDDLE EAR (BAFFLE)
INCISION OF EARDRUM
INCISION OF EARDRUM
VENT TUBE RMVL GEN ANESTHESIA
CREATE EARDRUM OPENING
CREATE EARDRUM OPENING
EXPLORATION OF MIDDLE EAR
EARDRUM REVISION
MASTOIDECTOMY
MASTOIDECTOMY
REMOVE MASTOID STRUCTURES
EXTENSIVE MASTOID SURGERY
EXTENSIVE MASTOID SURGERY
REMOVE PART OF TEMPORAL BONE
REMOVE EAR LESION
REMOVE EAR LESION
REMOVE EAR LESION
REMOVE EAR LESION
MASTOID SURGERY REVISION
REPAIR OF EARDRUM
REPAIR OF EARDRUM
REPAIR EARDRUM STRUCTURES
REBUILD EARDRUM STRUCTURES
REPAIR EARDRUM STRUCTURES
REVISE MIDDLE EAR & MASTOID
RELEASE MIDDLE EAR BONE
REVISE MIDDLE EAR BONE
REPAIR MIDDLE EAR STRUCTURES
REPAIR MIDDLE EAR STRUCTURES
REMOVE MASTOID AIR CELLS
REMOVE MIDDLE EAR NERVE
CLOSE MASTOID FISTULA
69710
69711
69714
69715
69717
69718
69720
69725
69740
69745
69799
69801
69802
69805
69806
69820
69840
69905
69910
69915
69930
69949
69950
69955
69960
69970
69979
69990
70010
70015
70030
70100
70110
70120
70130
70134
70140
70150
70160
70170
70190
70200
70210
70220
70240
70250
70260
70300
70310
IMPLANT/REPLACE HEARING AID

REMOVE/REPAIR HEARING AID
IMPL,TMP BNE,SPCH/COCH;WO MAST
IMPL,TMP BONE,SPCH/COCH;W MAST
REP,IMPL,BNE,SPCH/COCH;WO MAST
REP,IMPL,BONE,SPCH/COCH;W MAST
RELEASE FACIAL NERVE
REPAIR FACIAL NERVE
REPAIR FACIAL NERVE
MIDDLE EAR SURGERY PROCEDURE
INCISE INNER EAR
INCISE INNER EAR
EXPLORE INNER EAR
EXPLORE INNER EAR
ESTABLISH INNER EAR WINDOW
REVISE INNER EAR WINDOW
REMOVE INNER EAR
REMOVE INNER EAR & MASTOID
INCISE INNER EAR NERVE
IMPLANT COCHLEAR DEVICE
INNER EAR SURGERY PROCEDURE
INCISE INNER EAR NERVE
RELEASE INNER EAR CANAL
REMOVE INNER EAR LESION
TEMPORAL BONE SURGERY
MICROSURGERY ADD-ON
CONTRAST X-RAY OF BRAIN
CONTRAST X-RAY OF BRAIN
X-RAY EYE FOR FOREIGN BODY
X-RAY EXAM OF JAW
X-RAY EXAM OF JAW
X-RAY EXAM OF MASTOIDS
X-RAY EXAM OF MASTOIDS
X-RAY EXAM OF MIDDLE EAR
X-RAY EXAM OF FACIAL BONES
X-RAY EXAM OF FACIAL BONES
X-RAY EXAM OF NASAL BONES
X-RAY EXAM OF TEAR DUCT
X-RAY EXAM OF EYE SOCKETS
X-RAY EXAM OF EYE SOCKETS
X-RAY EXAM OF SINUSES
X-RAY EXAM OF SINUSES
X-RAY EXAM, PITUITARY SADDLE
X-RAY EXAM OF SKULL
X-RAY EXAM OF SKULL
X-RAY EXAM OF TEETH
X-RAY EXAM OF TEETH
70320
70328
70330
70332
70336
70350
70355
70360
70370
70371
70373
70380
70390
70450
70460
70470
70480
70481
70482
70486
70487
70488
70490
70491
70492
70496
70498
70540
70542
70543
70544
70545
70546
70547
70548
70549
70551
70552
70553
71010
71015
71020
71021
71022
71023
71030
71034
71035
71040
FULL MOUTH X-RAY OF TEETH

X-RAY EXAM OF JAW JOINT
X-RAY EXAM OF JAW JOINTS
X-RAY EXAM OF JAW JOINT
MAGNETC IMG,TEMPOROMANDIBUL JT
X-RAY HEAD FOR ORTHODONTIA
PANORAMIC X-RAY OF JAWS
X-RAY EXAM OF NECK
THROAT X-RAY & FLUOROSCOPY
SPEECH EVALUATION, COMPLEX
CONTRAST X-RAY OF LARYNX
X-RAY EXAM OF SALIVARY GLAND
X-RAY EXAM OF SALIVARY DUCT
CT HEAD/BRAIN W/O CONTST MATRL
CT HEAD/BRAIN W CONTST MATERL
CT HD/BRN WO CNTS MAT FURT SEC
CT ORBT/FOSS/EAR WO CNTRST MAT
CT ORBT/FOSS/EAR W CNTRST MATL
CT OBT/EAR WO CNTS MAT FRT SEC
CT MAXILLOFACIAL WO CNTRST MAT
CT MAXILLOFACIAL W/DYE
CT MAXILLOFACIAL W/O&W DYE
CT SFT TISE NECK WO CNTRST MAT
CT SFT TISE NECK W CNTRST MATL
CT NCK WO CNTST MAT FURT SECT
CT ANGIO,HEAD,WO CONT MAT,IMAG
CT ANGIO,NECK,WO CONT MAT,IMAG
MRI ORBT,FC,&NCK;WO CNTRST MAT
MRI,ORB,FCE,NCK;W CONTRAST MAT
MRI,ORB,FACE,NECK;WO CONT MAT
MAG RES ANGIO,HEAD;WO CONT MAT
MAG RES ANGIO,HEAD;W CONT MAT
MAG RES ANG,HEAD;WO,W CONT MAT
MAG RES ANGIO,NECK;WO CONT MAT
MAG RES ANGIO,NECK;W CONT MAT
MAG RES ANG,NECK;WO,W CONT MAT
MAGNETIC IMAGE, BRAIN (MRI)
CHEST X-RAY
CHEST X-RAY
CHEST X-RAY
CHEST X-RAY
CHEST X-RAY
CHEST X-RAY AND FLUOROSCOPY
CHEST X-RAY
CHEST X-RAY AND FLUOROSCOPY
CHEST X-RAY
CONTRAST X-RAY OF BRONCHI
71060
71090
71100
71101
71110
71111
71120
71130
71250
71260
71270
71275
71550
71551
71552
71555
72010
72020
72040
72050
72052
72069
72070
72072
72074
72080
72090
72100
72110
72114
72120
72125
72126
72127
72128
72129
72130
72131
72132
72133
72141
72142
72146
72147
72148
72149
72156
72157
72158
CONTRAST X-RAY OF BRONCHI

X-RAY & PACEMAKER INSERTION
X-RAY EXAM OF RIBS
X-RAY EXAM OF RIBS/CHEST
X-RAY EXAM OF RIBS
X-RAY EXAM OF RIBS/ CHEST
X-RAY EXAM OF BREASTBONE
X-RAY EXAM OF BREASTBONE
CT THORAX WO CONTRAST MATERIAL
CT THORAX W CONTRAST MATERIAL
CT THRAX WO CNTST MAT FUR SEC
CT ANGIO,CHEST,WO CONT MAT,IMG
MRI IMG,CHST;WO CNTRST MATRIAL
MAG RES IMAG,CHEST;W CONT MAT
MAG RES IMAG,CHEST;WO CONT MAT
MAGNETIC IMAGE, CHEST (MRA)
X-RAY EXAM OF SPINE
X-RAY EXAM OF SPINE
RAD EXAM,SPINE,CERVICAL;2/3 VW
X-RAY EXAM OF NECK SPINE
X-RAY EXAM OF NECK SPINE
X-RAY EXAM OF TRUNK SPINE
RAD EXAM,SPINE;THORACIC,2 VW
RAD EXAM,SPINE;THORACIC,3 VW
RAD EXAM,SPINE;THORAC,MIN 4 VW
RAD EXAM,SPINE;THRACOLUMB,2 VW
X-RAY EXAM OF TRUNK SPINE
RAD EXM,SPINE,LUMBOSCRL;2/3 VW
RAD EXM,SPN,LUMBOSCRL;MIN 4 VW
X-RAY EXAM OF LOWER SPINE
X-RAY EXAM OF LOWER SPINE
CT CRVICL SPINE WO CNTRST MAT
CT CRVCL SPNE W CNTRST MAT
CT CRV SPN WO CNTR MAT FUR SEC
CT THORACIC SPN WO CNTRST MAT
CT THORACIC SPN W CNTRST MAT
CT THRA SPN WO CNT MAT FUR SEC
CT LUMBAR SPNE, WO CNTRST MAT
CT LUMBAR SPNE, W CNTRST MAT
CT LMBR WO CNTR MAT FUR SEC
MAGNETIC IMAGE, NECK SPINE
MAGNETIC IMAGE, CHEST SPINE
MAGNETIC IMAGE, LUMBAR SPINE
72159
72170
72190
72191
72192
72193
72194
72195
72196
72197
72198
72200
72202
72220
72240
72255
72265
72270
72275
72285
72295
73000
73010
73020
73030
73040
73050
73060
73070
73080
73085
73090
73092
73100
73110
73115
73120
73130
73140
73200
73201
73202
73206
73218
73219
73220
73221
73222
73223
MAGNETIC IMAGE, SPINE (MRA)

RAD EXAM,PELVIS;1 OR 2 VIEWS
X-RAY EXAM OF PELVIS
CT ANGIO,PELVIS,WO CONT MAT
CT PELVIS, WO CONTRAST MATERIA
CT PELVIS, W CONTRAST MATERIAL
CT PLVS WO CNTRST MAT FUR SEC
MAG RES IMG,PELVIS;WO CONT MAT
MRI,PELVIS;W CONTRST MAT(S)
MAG RES IMG,PELV;WO,W CONT MAT
MAGNETIC IMAGE, PELVIS (MRA)
X-RAY EXAM SACROILIAC JOINTS
X-RAY EXAM SACROILIAC JOINTS
X-RAY EXAM OF TAILBONE
CONTRAST X-RAY OF NECK SPINE
CONTRAST X-RAY, THORAX SPINE
CONTRAST X-RAY, LOWER SPINE
CONTRAST X-RAY OF SPINE
EPIDUROGRAPHY
X-RAY C/T SPINE DISK
X-RAY OF LOWER SPINE DISK
X-RAY EXAM OF COLLAR BONE
X-RAY EXAM OF SHOULDER BLADE
X-RAY EXAM OF SHOULDER
X-RAY EXAM OF SHOULDER
CONTRAST X-RAY OF SHOULDER
X-RAY EXAM OF SHOULDERS
X-RAY EXAM OF HUMERUS
RADIOLOGIC EXAM,ELBOW;2 VIEWS
X-RAY EXAM OF ELBOW
CONTRAST X-RAY OF ELBOW
RADIOLOGIC EXAM;FOREARM,2 VIEW
X-RAY EXAM OF ARM, INFANT
RADIOLOGIC EXAM,WRIST;2 VIEWS
X-RAY EXAM OF WRIST
CONTRAST X-RAY OF WRIST
X-RAY EXAM OF HAND
X-RAY EXAM OF HAND
X-RAY EXAM OF FINGER(S)
CT UP EXTRM WO CNTRAST MATERIA
CT UP EXTRM W CNTRAST MATERIAL
CT UP EXTM WO CNTR MAT FUR SEC
CT ANGIO,UP EXTRM,WO,W CON MAT
MAG RES IMG,UP EXT,NO JT;WO CM
MAG RES IMG,UP EXT,NO JT;W CM
MRI UPPR EXTREMITY W/O&W DYE
MRI,JOINT,UP EXTRM;WO CONT MAT
MRI JOINT UPR EXTREM W/ DYE
MRI JOINT UPR EXTR W/O&W DYE
73225
73500
73510
73520
73525
73530
73540
73542
73550
73560
73562
73564
73565
73580
73590
73592
73600
73610
73615
73620
73630
73650
73660
73700
73701
73702
73706
73718
73719
73720
73721
73722
73723
73725
74000
74010
74020
74022
74150
74160
74170
74175
74181
74182
74183
74185
74190
74210
74220
MAGNETIC IMAGE, UPPER (MRA)

X-RAY EXAM OF HIP
X-RAY EXAM OF HIP
X-RAY EXAM OF HIPS
CONTRAST X-RAY OF HIP
X-RAY EXAM OF HIP
X-RAY EXAM OF PELVIS & HIPS
X-RAY EXAM, SACROILIAC JOINT
RADIOLOGIC EXAM,FEMUR,2 VIEWS
X-RAY EXAM OF KNEE, 1 OR 2
X-RAY EXAM OF KNEE, 3
X-RAY EXAM, KNEE, 4 OR MORE
X-RAY EXAM OF KNEES
CONTRAST X-RAY OF KNEE JOINT
RADIOLOG EXAM;TIBIA&FIBLA,2 VW
X-RAY EXAM OF LEG, INFANT
RADIOLOGIC EXAM,ANKLE;2 VIEWS
X-RAY EXAM OF ANKLE
CONTRAST X-RAY OF ANKLE
RADIOLOGIC EXAM,FOOT;2 VIEWS
X-RAY EXAM OF FOOT
X-RAY EXAM OF HEEL
X-RAY EXAM OF TOE(S)
CT LW EXTRM WO CNTRAST MATERIA
CT LOWER EXTREMITY W/DYE
CT LW EXTM WO CNTR MAT FUR SEC
CT ANGIO,LOW EXT,WO,W CONT MAT
MAG RES IMG,LW EXT,NO JT;WO CM
MAG RES IMG,LOW EXT,NO JT;W CM
MRI LWR EXTREMITY W/O&W DYE
MRI,JNT,LOW EXT;WO CNTRST MAT
MAG RES IMG,ANY JT,LW EXT;W CM
MAG RES IM,ANY JT,LW EXT;WO CM
MAGNETIC IMAGE/LOWER (MRA)
X-RAY EXAM OF ABDOMEN
RADIO EXAM ABDM,SNGL VIEW CHST
CT, ABDOM WO CNTRAST MATERIAL
CT, ABDOM W CNTRAST MATERIAL
CT ABDOM WO CNTRST MAT FUR SEC
CT ANGIO,ABDOMEN,WO,W CONT MAT
MRI, ABDOMEN;WO CNTRST MAT
MAG RES IMG,ABDOMEN;W CONT MAT
MAG RES IM,ABDOMEN;WO,W CON MT
MAGNETIC IMAGE/ABDOMEN (MRA)
X-RAY EXAM OF PERITONEUM
CONTRST X-RAY EXAM OF THROAT
CONTRAST X-RAY, ESOPHAGUS
74230
74235
74240
74241
74245
74246
74247
74249
74250
74251
74260
74270
74280
74283
74290
74291
74300
74301
74305
74320
74327
74328
74329
74330
74340
74350
74355
74360
74363
74400
74410
74415
74420
74425
74430
74440
74445
74450
74455
74470
74475
74480
74485
74710
74740
74742
74775
75552
75553
CINE/VIDEO X-RAY, THROAT/ESO

REMOVE ESOPHAGUS OBSTRUCTION
X-RAY EXAM, UPPER GI TRACT
CONTRST X-RAY UPPR GI TRACT
X-RAY EXAM OF SMALL BOWEL
CONTRAST X-RAY EXAM OF COLON
CONTRAST X-RAY, GALLBLADDER
CONTRAST X-RAYS, GALLBLADDER
X-RAY BILE DUCTS/PANCREAS
X-RAYS AT SURGERY ADD-ON
X-RAY BILE DUCTS/PANCREAS
CONTRAST X-RAY OF BILE DUCTS
X-RAY BILE STONE REMOVAL
XRAY BILE DUCT ENDOSCOPY
X-RAY FOR PANCREAS ENDOSCOPY
X-RAY BILE/PANC ENDOSCOPY
X-RAY GUIDE FOR GI TUBE
X-RAY GUIDE, STOMACH TUBE
X-RAY GUIDE, INTESTINAL TUBE
X-RAY GUIDE, GI DILATION
X-RAY, BILE DUCT DILATION
CONTRST X-RAY, URINARY TRACT
CONTRAST X-RAY, BLADDER
X-RAY, MALE GENITAL TRACT
X-RAY EXAM OF PENIS
X-RAY, URETHRA/BLADDER
X-RAY, URETHRA/BLADDER
X-RAY EXAM OF KIDNEY LESION
X-RAY CONTROL, CATH INSERT
X-RAY CONTROL, CATH INSERT
X-RAY GUIDE, GU DILATION
X-RAY MEASUREMENT OF PELVIS
X-RAY, FEMALE GENITAL TRACT
X-RAY, FALLOPIAN TUBE
X-RAY EXAM OF PERINEUM
MAGNETIC IMAGE, MYOCARDIUM
MAGNETIC IMAGE, MYOCARDIUM
75554
75555
75556
75600
75605
75625
75630
75635
75650
75658
75660
75662
75665
75671
75676
75680
75685
75705
75710
75716
75722
75724
75726
75731
75733
75736
75741
75743
75746
75756
75774
75790
75801
75803
75805
75807
75809
75810
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
CARDIAC MRI/FUNCTION
CARDIAC MRI/LIMITED STUDY
CARDIAC MRI/FLOW MAPPING
CONTRAST X-RAY EXAM OF AORTA
X-RAY AORTA, LEG ARTERIES
CT ANGIO,ABDM AORT,BILAT ILIOF
ARTERY X-RAYS, HEAD & NECK
ARTERY X-RAYS, ARM
ARTERY X-RAYS, NECK
ARTERY X-RAYS, NECK
ARTERY X-RAYS, SPINE
ARTERY X-RAYS, SPINE
ARTERY X-RAYS, ARM/LEG
ARTERY X-RAYS, ARMS/LEGS
ARTERY X-RAYS, KIDNEY
ARTERY X-RAYS, KIDNEYS
ARTERY X-RAYS, ABDOMEN
ARTERY X-RAYS, ADRENAL GLAND
ARTERY X-RAYS, ADRENALS
ARTERY X-RAYS, PELVIS
ARTERY X-RAYS, LUNG
ARTERY X-RAYS, LUNGS
ARTERY X-RAYS, LUNG
ARTERY X-RAYS, CHEST
ARTERY X-RAY, EACH VESSEL
VISUALIZE A-V SHUNT
LYMPH VESSEL X-RAY, ARM/LEG
LYMPH VESSEL X-RAY,ARMS/LEGS
LYMPH VESSEL X-RAY, TRUNK
LYMPH VESSEL X-RAY, TRUNK
SHUNTOGRM,INVSTIGTN PRV PLCD
VEIN X-RAY, SPLEEN/LIVER
VEIN X-RAY, ARM/LEG
VEIN X-RAY, ARMS/LEGS
VEIN X-RAY, TRUNK
VEIN X-RAY, CHEST
VEIN X-RAY, KIDNEY
VEIN X-RAY, KIDNEYS
VEIN X-RAY, ADRENAL GLAND
VEIN X-RAY, ADRENAL GLANDS
VEIN X-RAY, NECK
VEIN X-RAY, SKULL
VEIN X-RAY, SKULL
75880
75885
75887
75889
75891
75893
75894
75896
75898
75900
75901
75902
75940
75945
75946
75952
75953
75954
75960
75961
75962
75964
75966
75968
75970
75978
75980
75982
75984
75989
75992
75993
75994
75995
75996
76000
76001
76003
76005
76006
76010
76012
76013
76020
76040
76061
76062
76065
76066
VEIN X-RAY, EYE SOCKET

VEIN X-RAY, LIVER
VEIN X-RAY, LIVER
VEIN X-RAY, LIVER
VEIN X-RAY, LIVER
VENOUS SAMPLING BY CATHETER
X-RAYS, TRANSCATH THERAPY
X-RAYS, TRANSCATH THERAPY
FOLLOW-UP ANGIOGRAPHY
ARTERIAL CATHETER EXCHANGE
REMOVE CVA DEVICE OBSTRUCT
REMOVE CVA LUMEN OBSTRUCT
X-RAY PLACEMENT, VEIN FILTER
INTRAVASCULAR US
INTRAVASCULAR US ADD-ON
ENDOVS REP INF ABDM AORT ANEUR
PRXM PROS ENDO RPR ART ANRYM
ENDOVAS RPR ILIAC ANEURYSM
TRANSCATHETER INTRO, STENT
RETRIEVAL, BROKEN CATHETER
REPAIR ARTERY BLOCKAGE, EACH
REPAIR ARTERY BLOCKAGE, EACH
VASCULAR BIOPSY
CONTRAST XRAY EXAM BILE DUCT
CONTRAST XRAY EXAM BILE DUCT
XRAY CONTROL CATHETER CHANGE
RADIO DRAIN W/ CATH & INTERP
ATHERECTOMY, X-RAY EXAM
FLUOROSCOPE EXAMINATION
FLUOROSCOPE EXAM, EXTENSIVE
FLUOROSCOP GUID,NDL PLACE
FLUOROGUIDE FOR SPINE INJECT
APP STRES JNT RDIO INCLUDE JNT
RADIO EXM,NSE TO RECTM FRN BDY
RAD SUP&INT,VERTEBROPLS;FLUORS
RAD SUP&INT,VERTEBROPL;CT GUID
X-RAYS FOR BONE AGE
X-RAYS, BONE EVALUATION
X-RAYS, BONE SURVEY
X-RAYS, BONE SURVEY
X-RAYS, BONE EVALUATION
JOINT SURVEY, SINGLE VIEW
76070
76071
76075
76076
76078
76080
76085
76086
76088
76090
76091
76092
76093
76094
76095
76096
76098
76100
76101
76102
76120
76125
76140
76150
76350
76355
76360
76362
76370
76375
76380
76390
76393
76394
76400
76490
76496
76497
76498
76499
76506
76511
76512
76513
76516
76519
76529
76536
76604
CT BNE MNERAL DENS 1+ SITES

CT BONE DENSITY, PERIPHERAL
DUAL ENERGY X-RAY STUDY
DUAL ENERGY X-RAY STUDY
RADIOGRAPHIC ABSORPTIOMETRY
X-RAY EXAM OF FISTULA
DIG FLM W/ COMP ANALYS MAMMO
X-RAY OF MAMMARY DUCT
X-RAY OF MAMMARY DUCTS
MAMMOGRAM, ONE BREAST
MAMMOGRAM, BOTH BREASTS
MAMM0GRAM, SCREENING
MAGNETIC IMAGE, BREAST
MAGNETIC IMAGE, BOTH BREASTS
STEREOTACT LOC GD,BRST BX/NDL
MAMMOGRAPH GD,NDL,BRST,EA LSN
X-RAY EXAM, BREAST SPECIMEN
X-RAY EXAM OF BODY SECTION
COMPLEX BODY SECTION X-RAY
COMPLEX BODY SECTION X-RAYS
CINE/VIDEO X-RAYS
CINE/ VIDEO X-RAYS ADD-ON
X-RAY CONSULTATION
X-RAY EXAM, DRY PROCESS
SPECIAL X-RAY CONTRAST STUDY
CT GUIDANCE STEROTCT LOCAL
CT GUID NEDLE PLACEMENT
CAT SCAN FOR TISSUE ABLATION
CT GUID PLACE RADIO THRPY FELD
3D/HOLOGRAPH RECONSTR ADD-ON
CT LMTED LOCAL FOLOW-UP STUDY
MR SPECTROSCOPY
MAG RES,NEED PLACE RAD SUP&INT
MRI FOR TISSUE ABLATION
MAGNETIC IMAGE, BONE MARROW
US FOR TISSUE ABLATION
UNLIST FLUOROSCOPIC PROCEDUR
UNLIST COMP TOMOGRAPHY PROC
UNLIST MAGNET RESONACE PROC
ULISTED DIAG RADIOGRAPH PROC
ECHO EXAM OF HEAD
ECHO EXAM OF EYE
ECHO EXAM OF EYE
ECHO EXAM OF EYE, WATER BATH
ECHO EXAM OF EYE
ECHO EXAM OF EYE
ECHO EXAM OF EYE
US EXAM OF HEAD AND NECK
US EXAM, CHEST, B-SCAN
76645
76700
76705
76770
76775
76778
76800
76801
76802
76805
76810
76811
76812
76815
76816
76817
76818
76819
76825
76826
76827
76828
76830
76831
76856
76857
76870
76872
76873
76880
76885
76886
76930
76932
76936
76941
76942
76945
76946
76948
76950
76965
76970
76975
76977
76986
76999
77261
77262
US EXAM, BREAST(S)
US EXAM, ABDOM, COMPLETE
US EXAM, ABDOM, LIMITED
US EXAM ABDO BACK WALL, COMP
US EXAM ABDO BACK WALL, LIM
US EXAM KIDNEY TRANSPLANT
US EXAM, SPINAL CANAL
ULTRASOUND 1ST TRI SINGLE
ULTRASOUND 1ST TRI ADD GEST
ULTRASND >/=14WK 0 DAY; SNGL
ULTRASND >/=14WK 0 DAY;ADD'L
ULTRASOUND ANATOMIC EXAM SGN
ULTSOUND ANTOMIC EXAM ADD GE
ULTRASND LIMITED 1+ FETUSES
ULTRASND FOLOW-UP TRANS APRCH
ULTRASOUND, TRANSVAGINAL
FTL BIOPHYS PROF;NON-STRSS TST
FETAL BIOPHYS PROFIL W/O NST
ECHO EXAM OF FETAL HEART
US EXAM, TRANSVAGINAL
ECHO EXAM, UTERUS
US EXAM, PELVIC, COMPLETE
US EXAM, PELVIC, LIMITED
US EXAM, SCROTUM
ECHO EXAM, TRANSRECTAL
ECHOGRAP TRANS R, PROS STUDY
US EXAM, EXTREMITY
US EXAM INFANT HIPS, DYNAMIC
US EXAM INFANT HIPS, STATIC
ULTRASON GD,PERICARDIOCENTESIS
ULTRASON GD,ENDOMYOCARDIAL BX
ECHO GUIDE FOR ARTERY REPAIR
US GD,INTRAUTER TRANSFS/CORDOC
ULTRASONIC GD,NDL PLACEMENT
ULTRASONIC GD,CHORIONIC VILLUS
ULTRASONIC GD,AMNIOCENTESIS
ULTRASONIC GD,ASPIRATION,OVA
ULTRASNC GD,PLACEMNT,RAD THER
ECHO GUIDANCE RADIOTHERAPY
ULTRASOUND EXAM FOLLOW-UP
GASTROINTSTIN ENDOSC ULTRASND
US BONE DENSITY MEASURE
ULTRASONIC GD,INTRAOPERATIVE
UNLISTED ULTRASOUND PROC
RADIATION THERAPY PLANNING
77263
77280
77285
77290
77295
77299
77300
77301
77305
77310
77315
77321
77326
77327
77328
77331
77332
77333
77334
77336
77370
77399
77401
77402
77403
77404
77406
77407
77408
77409
77411
77412
77413
77414
77416
77417
77418
77427
77431
77432
77470
77499
77520
77522
77523
77525
77600
77605
77610

SET RADIATION THERAPY FIELD
RADIATION THERAPY DOSE PLAN
RADIOLTHERAPY DOS PLAN, IMRT
RADIATION THERAPY PORT PLAN
BRACHYTX ISODOSE CALC SIMP
BRACHYTX ISODOSE CALC INTERM
BRACHYTX ISODOSE PLAN COMPL
SPECIAL RADIATION DOSIMETRY
RADIATION TREATMENT AID(S)
RADIATION PHYSICS CONSULT
RADIATION PHYSICS CONSULT
EXTERNAL RADIATION DOSIMETRY
RADIATION TREATMENT DELIVERY
RADIOLOGY PORT FILM(S)
RADIATION TX DELIVERY, IMRT
RADIATION TX MANAGEMENT, X5
RADIATION THERAPY MANAGEMENT
STEREOTACTIC RADIATION TRMT
SPECIAL TREATMENT PROCEDURE
RADIATION THERAPY MANAGEMENT
PROTON TX DEL;SMPL,WO COMPNSAT
PROTON TREAT DEL;SIMPLE,COMPEN
PROTON TX DEL;INTERMEDIATE
PROTON TREAT DELIVERY; COMPLEX
HYPERTHERMIA TREATMENT
77615
77620
77750
77761
77762
77763
77776
77777
77778
77781
77782
77783
77784
77789
77790
77799
78000
78001
78003
78006
78007
78010
78011
78015
78016
78018
78020
78070
78075
78099
78102
78103
78104
78110
78111
78120
78121
78122
78130
78135
78140
78160
78162
78170
78172
78185
78190
78191
78195
INFUSE RADIOACTIVE MATERIALS
INTRACAV RAD SRC APPL;SIMPLE
INTRACAV RAD SRC APPL;INTERMED
INTRACAV RAD SRC APPL;COMPLEX
INTRSTIT RAD SRC APPL;SIMPLE
INTRSTIT RAD SRC APPL;INTERMED
INTRSTIT RAD SRC APPL;COMPLEX
HIGH INTENSITY BRACHYTHERAPY
SURFACE APPL,RADIATION SOURCE
SUPERVIS,HANDLNG,LOAD,RAD SRC
RADIUM/RADIOISOTOPE THERAPY
THYROID, SINGLE UPTAKE
THYROID, MULTIPLE UPTAKES
THYROID SUPPRESS/STIMUL
THYROID IMAGING WITH UPTAKE
THYROID IMAGE, MULT UPTAKES
THYROID IMAGING
THYROID IMAGING WITH FLOW
THYROID MET IMAGING
THYROID MET IMAGING/STUDIES
THYROID MET IMAGING, BODY
THYROID MET UPTAKE
PARATHYROID NUCLEAR IMAGING
ADRENAL NUCLEAR IMAGING
ENDOCRINE NUCLEAR PROCEDURE
BONE MARROW IMAGING, LTD
BONE MARROW IMAGING, MULT
BONE MARROW IMAGING, BODY
PLASMA VOLUME, SINGLE
PLASMA VOLUME, MULTIPLE
RED CELL MASS, SINGLE
RED CELL MASS, MULTIPLE
BLOOD VOLUME
RED CELL SURVIVAL STUDY
RED CELL SURVIVAL KINETICS
RED CELL SEQUESTRATION
PLASMA IRON TURNOVER
IRON ABSORPTION EXAM
RED CELL IRON UTILIZATION
TOTAL BODY IRON ESTIMATION
SPLEEN IMAGING
PLATELET SURVIVAL, KINETICS
PLATELET SURVIVAL
LYMPH SYSTEM IMAGING
78199
78201
78202
78205
78206
78215
78216
78220
78223
78230
78231
78232
78258
78261
78262
78264
78267
78268
78270
78271
78272
78278
78282
78290
78291
78299
78300
78305
78306
78315
78320
78350
78351
78399
78414
78428
78445
78455
78456
78457
78458
78459
78460
78461
78464
78465
78466
78468
78469
BLOOD/LYMPH NUCLEAR EXAM

LIVER IMAGING
LIVER IMAGING WITH FLOW
LIVER IMAGING (3D)
LIVER IMAGE (3D) W/FLOW
LIVER AND SPLEEN IMAGING
LIVER & SPLEEN IMAGE/FLOW
LIVER FUNCTION STUDY
HEPATOBILIARY IMAGING
SALIVARY GLAND IMAGING
SERIAL SALIVARY IMAGING
SALIVARY GLAND FUNCTION EXAM
ESOPHAGEAL MOTILITY STUDY
GASTRIC MUCOSA IMAGING
GASTROESOPHAGEAL REFLUX EXAM
GASTRIC EMPTYING STUDY
BREATH TST ATTAIN/ANAL C-14
BREATH TEST ANALYSIS, C-14
VIT B-12 ABSORPTION EXAM
VIT B-12 ABSORP EXAM, IF
VIT B-12 ABSORP, COMBINED
ACUTE GI BLOOD LOSS IMAGING
GI PROTEIN LOSS EXAM
MECKEL'S DIVERT EXAM
LEVEEN/SHUNT PATENCY EXAM
GI NUCLEAR PROCEDURE
BONE IMAGING, LIMITED AREA
BONE IMAGING, MULTIPLE AREAS
BONE IMAGING, WHOLE BODY
BONE IMAGING, 3 PHASE
BONE IMAGING (3D)
BONE MINERAL, SINGLE PHOTON
BONE MINERAL, DUAL PHOTON
MUSCULOSKELETAL NUCLEAR EXAM
NON-IMAGING HEART FUNCTION
CARDIAC SHUNT IMAGING
VASCULAR FLOW IMAGING
VENOUS THROMBOSIS STUDY
ACUTE VENOUS THROMBUS IMAGE
VENOUS THROMBOSIS IMAGING
VEN THROMBOSIS IMAGES, BILAT
HEART MUSCLE IMAGING (PET)
HEART MUSCLE BLOOD, SINGLE
HEART MUSCLE BLOOD, MULTIPLE
HEART IMAGE (3D), SINGLE
HEART IMAGE (3D), MULTIPLE
HEART INFARCT IMAGE
HEART INFARCT IMAGE (EF)
HEART INFARCT IMAGE (3D)
78472
78473
78478
78480
78481
78483
78491
78492
78494
78496
78499
78580
78584
78585
78586
78587
78588
78591
78593
78594
78596
78599
78600
78601
78605
78606
78607
78608
78609
78610
78615
78630
78635
78645
78647
78650
78660
78699
78700
78701
78704
78707
78708
78709
78710
78715
78725
78730
78740
GATED HEART, PLANAR, SINGLE

GATED HEART, MULTIPLE
HEART WALL MOTION ADD-ON
HEART FUNCTION ADD-ON
HEART FIRST PASS, SINGLE
HEART FIRST PASS, MULTIPLE
HEART IMAGE (PET), SINGLE
HEART IMAGE (PET), MULTIPLE
HEART IMAGE, SPECT
HEART FIRST PASS ADD-ON
CARDIOVASCULAR NUCLEAR EXAM
LUNG PERFUSION IMAGING
LUNG V/Q IMAGE SINGLE BREATH
LUNG V/Q IMAGING
AEROSOL LUNG IMAGE, SINGLE
AEROSOL LUNG IMAGE, MULTIPLE
PERFUSION LUNG IMAGE
VENT IMAGE, 1 BREATH, 1 PROJ
VENT IMAGE, 1 PROJ, GAS
VENT IMAGE, MULT PROJ, GAS
LUNG DIFFERENTIAL FUNCTION
RESPIRATORY NUCLEAR EXAM
BRAIN IMAGING, LTD STATIC
BRAIN IMAGING, LTD W/ FLOW
BRAIN IMAGING, COMPLETE
BRAIN IMAGING, COMPL W/FLOW
BRAIN IMAGING (3D)
BRAIN IMAGING (PET)
BRAIN IMAGING (PET)
BRAIN FLOW IMAGING ONLY
CEREBRAL VASCULAR FLOW IMAGE
CEREBROSPINAL FLUID SCAN
CSF VENTRICULOGRAPHY
CSF SHUNT EVALUATION
CEREBROSPINAL FLUID SCAN
CSF LEAKAGE IMAGING
NUCLEAR EXAM OF TEAR FLOW
NERVOUS SYSTEM NUCLEAR EXAM
KIDNEY IMAGING, STATIC
KIDNEY IMAGING WITH FLOW
IMAGING RENOGRAM
KIDNEY FLOW/FUNCTION IMAGE
KIDNEY IMAGING (3D)
RENAL VASCULAR FLOW EXAM
KIDNEY FUNCTION STUDY
URINARY BLADDER RETENTION
URETERAL REFLUX STUDY
78760
78761
78799
78800
78801
78802
78803
78805
78806
78807
78810
78890
78891
78990
78999
79000
79001
79020
79030
79035
79100
79200
79300
79400
79420
79440
79900
79999
80048
80050
80051
80053
80055
80061
80069
80074
80076
80100
80101
80102
80103
80150
80152
80154
80156
80157
80158
80160
80162
TESTICULAR IMAGING
TESTICULAR IMAGING/FLOW
GENITOURINARY NUCLEAR EXAM
TUMOR IMAGING, LIMITED AREA
TUMOR IMAGING, MULT AREAS
TUMOR IMAGING, WHOLE BODY
TUMOR IMAGING (3D)
RADIOPHRM LOCALZTN,LIMTED AREA
RADIOPHARM LOCALZTN,WHOLE BODY
RADIOPHARM LOCALZTN,TOMOGRPHC
TUMOR IMAGING (PET)
NUCLEAR MEDICINE DATA PROC
NUCLEAR MED DATA PROC
PROVIDE DIAG RADIONUCLIDE(S)
NUCLEAR DIAGNOSTIC EXAM
INIT HYPERTHYROID THERAPY
REPEAT HYPERTHYROID THERAPY
THYROID ABLATION
THYROID ABLATION, CARCINOMA
THYROID METASTATIC THERAPY
HEMATOPOETIC NUCLEAR THERAPY
INTRACAVITARY NUCLEAR TRMT
INTERSTITIAL NUCLEAR THERAPY
NONHEMATO NUCLEAR THERAPY
INTRAVASCULAR NUCLEAR THER
NUCLEAR JOINT THERAPY
PROVIDE THER RADIOPHARM(S)
NUCLEAR MEDICINE THERAPY
BASIC METABOLIC PANEL
GENERAL HEALTH PANEL
ELECTROLYTE PANEL
COMPREHEN METABOLIC PANEL
OBSTETRIC PANEL
LIPID PANEL
RENAL FUNCTION PANEL
ACUTE HEPATITIS PANEL
HEPATIC FUNCTION PANEL
DRUG SCRN,QUALIT;MULT DRG CLSS
DRUG SCRN,QUALIT;SNGL DRG CLSS
DRUG CONFIRMATION
DRUG ANALYSIS, TISSUE PREP
ASSAY OF AMIKACIN
ASSAY OF AMITRIPTYLINE
ASSAY OF BENZODIAZEPINES
CARBAMAZEPINE; TOTAL
ASSAY, CARBAMAZEPINE, FREE
ASSAY OF CYCLOSPORINE
ASSAY OF DESIPRAMINE
ASSAY OF DIGOXIN
80164
80166
80168
80170
80172
80173
80174
80176
80178
80182
80184
80185
80186
80188
80190
80192
80194
80196
80197
80198
80200
80201
80202
80299
80400
80402
80406
80408
80410
80412
80414
80415
80416
80417
80418
80420
80422
80424
80426
80428
80430
80432
80434
80435
80436
80438
80439
80440
80500
ASSAY, DIPROPYLACETIC ACID

ASSAY OF DOXEPIN
ASSAY OF ETHOSUXIMIDE
ASSAY OF GENTAMICIN
ASSAY OF GOLD
ASSAY OF HALOPERIDOL
ASSAY OF IMIPRAMINE
ASSAY OF LIDOCAINE
ASSAY OF LITHIUM
ASSAY OF NORTRIPTYLINE
ASSAY OF PHENOBARBITAL
ASSAY OF PHENYTOIN, TOTAL
ASSAY OF PHENYTOIN, FREE
ASSAY OF PRIMIDONE
ASSAY OF PROCAINAMIDE
ASSAY OF PROCAINAMIDE
ASSAY OF QUINIDINE
ASSAY OF SALICYLATE
ASSAY OF TACROLIMUS
ASSAY OF THEOPHYLLINE
ASSAY OF TOBRAMYCIN
ASSAY OF TOPIRAMATE
ASSAY OF VANCOMYCIN
QUANTITATIVE ASSAY, DRUG
ACTH STIMULATION PANEL
ALDOSTERONE SUPPRESSION EVAL
CALCITONIN STIMUL PANEL
CRH STIMULATION PANEL
TESTOSTERONE RESPONSE
ESTRADIOL RESPONSE PANEL
RENIN STIMULATION PANEL
RENIN STIMULATION PANEL
PITUITARY EVALUATION PANEL
DEXAMETHASONE PANEL
GLUCAGON TOLERANCE PANEL
GLUCAGON TOLERANCE PANEL
GONADOTROPIN HORMONE PANEL
GROWTH HORMONE PANEL
GROWTH HORMONE PANEL
INSULIN SUPPRESSION PANEL
INSULIN TOLERANCE PANEL
INSULIN TOLERANCE PANEL
METYRAPONE PANEL
TRH STIMULATION PANEL
LAB PATHOLOGY CONSULTATION
80502
81000
81001
81002
81003
81005
81007
81015
81020
81025
81050
81099
82000
82003
82009
82010
82013
82016
82017
82024
82030
82040
82042
82043
82044
82055
82075
82085
82088
82101
82103
82104
82105
82106
82108
82120
82127
82128
82131
82135
82136
82139
82140
82143
82145
82150
82154
82157
82160
LAB PATHOLOGY CONSULTATION

URINALYSIS, NONAUTO W/SCOPE
URINALYSIS, AUTO W/SCOPE
URINALYSIS NONAUTO W/O SCOPE
URINALYSIS, AUTO, W/O SCOPE
URINALYSIS
URINALYSIS;BACTERIURIA SCREEN
MICROSCOPIC EXAM OF URINE
URINALYSIS, GLASS TEST
URINE PREGNANCY TEST
URINALYSIS, VOLUME MEASURE
URINALYSIS TEST PROCEDURE
ASSAY OF BLOOD ACETALDEHYDE
ASSAY OF ACETAMINOPHEN
TEST FOR ACETONE/KETONES
ACETONE ASSAY
ACETYLCHOLINESTERASE ASSAY
ACYLCARNITINES, QUAL
ACYLCARNITINES, QUANT
ASSAY OF ACTH
ASSAY OF ADP & AMP
ASSAY OF SERUM ALBUMIN
ALBUMIN;URINE OR OTHER SOURCE
MICROALBUMIN, QUANTITATIVE
MICROALBUMIN, SEMIQUANT
ASSAY OF ETHANOL
ASSAY OF BREATH ETHANOL
ASSAY OF ALDOLASE
ASSAY OF ALDOSTERONE
ASSAY OF URINE ALKALOIDS
ALPHA-1-ANTITRYPSIN, TOTAL
ALPHA-1-ANTITRYPSIN, PHENO
ALPHA-FETOPROTEIN, SERUM
ALPHA-FETOPROTEIN, AMNIOTIC
ASSAY OF ALUMINUM
AMINES, VAGINAL FLUID QUAL
AMINO ACID, SINGLE QUAL
AMINO ACIDS, MULT QUAL
AMINO ACIDS, SINGLE QUANT
ASSAY, AMINOLEVULINIC ACID
AMINO ACIDS, QUANT, 2-5
AMINO ACIDS, QUAN, 6 OR MORE
ASSAY OF AMMONIA
AMNIOTIC FLUID SCAN
ASSAY OF AMPHETAMINES
ASSAY OF AMYLASE
ANDROSTANEDIOL GLUCURONIDE
ASSAY OF ANDROSTENEDIONE
ASSAY OF ANDROSTERONE
82163
82164
82172
82175
82180
82190
82205
82232
82239
82240
82247
82248
82252
82261
82270
82273
82274
82286
82300
82306
82307
82308
82310
82330
82331
82340
82355
82360
82365
82370
82373
82374
82375
82376
82378
82379
82380
82382
82383
82384
82387
82390
82397
82415
82435
82436
82438
82441
82465
ASSAY OF ANGIOTENSIN II
ANGIOTENSIN I ENZYME TEST
ASSAY OF APOLIPOPROTEIN
ASSAY OF ARSENIC
ASSAY OF ASCORBIC ACID
ATOMIC ABSORPTION
ASSAY OF BARBITURATES
ASSAY OF BETA-2 PROTEIN
BILE ACIDS, TOTAL
BILE ACIDS, CHOLYLGLYCINE
BILIRUBIN, TOTAL
BILIRUBIN, DIRECT
FECAL BILIRUBIN TEST
ASSAY OF BIOTINIDASE
TEST FOR BLOOD, FECES
TEST FOR BLOOD, OTHER SOURCE
ASSAY TEST FOR BLOOD, FECAL
ASSAY OF BRADYKININ
ASSAY OF CADMIUM
ASSAY OF VITAMIN D
ASSAY OF VITAMIN D
ASSAY OF CALCITONIN
ASSAY OF CALCIUM
ASSAY OF CALCIUM
CALCIUM INFUSION TEST
ASSAY OF CALCIUM IN URINE
CALCULUS ANALYSIS, QUAL
CALCULUS ASSAY, QUANT
CALCULUS SPECTROSCOPY
X-RAY ASSAY, CALCULUS
CARBOHYD DEFICIENT TRANSFERRIN
ASSAY, BLOOD CARBON DIOXIDE
ASSAY, BLOOD CARBON MONOXIDE
TEST FOR CARBON MONOXIDE
CARCINOEMBRYONIC ANTIGEN
ASSAY OF CARNITINE
ASSAY OF CAROTENE
ASSAY, URINE CATECHOLAMINES
ASSAY, BLOOD CATECHOLAMINES
ASSAY, THREE CATECHOLAMINES
ASSAY OF CATHEPSIN-D
ASSAY OF CERULOPLASMIN
CHEMILUMINESCENT ASSAY
ASSAY OF CHLORAMPHENICOL
ASSAY OF BLOOD CHLORIDE
ASSAY OF URINE CHLORIDE
ASSAY, OTHER FLUID CHLORIDES
TEST FOR CHLOROHYDROCARBONS
CHOLESTEROL,SERUM/WHOLE BLOOD
82480
82482
82485
82486
82487
82488
82489
82491
82492
82495
82507
82520
82523
82525
82528
82530
82533
82540
82541
82542
82543
82544
82550
82552
82553
82554
82565
82570
82575
82585
82595
82600
82607
82608
82615
82626
82627
82633
82634
82638
82646
82649
82651
82652
82654
82657
82658
82664
82666
ASSAY, SERUM CHOLINESTERASE

ASSAY, RBC CHOLINESTERASE
ASSAY, CHONDROITIN SULFATE
GAS/LIQUID CHROMATOGRAPHY
PAPER CHROMATOGRAPHY
PAPER CHROMATOGRAPHY
THIN LAYER CHROMATOGRAPHY
CHROMOTOGRAPHY, QUANT, SING
CHROMOTOGRAPHY, QUANT, MULT
ASSAY OF CHROMIUM
ASSAY OF CITRATE
ASSAY OF COCAINE
COLLAGEN CROSSLINKS
ASSAY OF COPPER
ASSAY OF CORTICOSTERONE
CORTISOL, FREE
TOTAL CORTISOL
ASSAY OF CREATINE
COLUMN CHROMOTOGRAPHY, QUAL
COLUMN CHROMOTOGRAPHY, QUANT
COLUMN CHROMOTOGRAPH/ISOTOPE
COLUMN CHROMOTOGRAPH/ISOTOPE
ASSAY OF CK (CPK)
ASSAY OF CPK IN BLOOD
CREATINE, MB FRACTION
CREATINE, ISOFORMS
ASSAY OF CREATININE
ASSAY OF URINE CREATININE
CREATININE CLEARANCE TEST
ASSAY OF CRYOFIBRINOGEN
CRYOGLOBULIN, QUAL/SEMI-QUANT
ASSAY OF CYANIDE
VITAMIN B-12
B-12 BINDING CAPACITY
TEST FOR URINE CYSTINES
DEHYDROEPIANDROSTERONE
DEHYDROEPIANDROSTERONE
DESOXYCORTICOSTERONE
DEOXYCORTISOL
ASSAY OF DIBUCAINE NUMBER
ASSAY OF DIHYDROCODEINONE
ASSAY OF DIHYDROMORPHINONE
ASSAY OF DIHYDROTESTOSTERONE
ASSAY OF DIHYDROXYVITAMIN D
ASSAY OF DIMETHADIONE
ENZYME CELL ACTIVITY
ENZYME CELL ACTIVITY, RA
ELECTROPHORETIC TEST
ASSAY OF EPIANDROSTERONE
82668
82670
82671
82672
82677
82679
82690
82693
82696
82705
82710
82715
82725
82726
82728
82731
82735
82742
82746
82747
82757
82759
82760
82775
82776
82784
82785
82787
82800
82803
82805
82810
82820
82926
82928
82938
82941
82943
82945
82946
82947
82948
82950
82951
82952
82953
82955
82960
82962
ASSAY OF ERYTHROPOIETIN
ASSAY OF ESTRADIOL
ASSAY OF ESTROGENS
ASSAY OF ESTROGEN
ASSAY OF ESTRIOL
ASSAY OF ESTRONE
ASSAY OF ETHCHLORVYNOL
ASSAY OF ETHYLENE GLYCOL
ASSAY OF ETIOCHOLANOLONE
FATS/LIPIDS, FECES, QUAL
FATS/LIPIDS, FECES, QUANT
ASSAY OF FECAL FAT
ASSAY OF BLOOD FATTY ACIDS
LONG CHAIN FATTY ACIDS
ASSAY OF FERRITIN
ASSAY OF FETAL FIBRONECTIN
ASSAY OF FLUORIDE
ASSAY OF FLURAZEPAM
BLOOD FOLIC ACID SERUM
ASSAY OF FOLIC ACID, RBC
ASSAY OF SEMEN FRUCTOSE
ASSAY OF RBC GALACTOKINASE
ASSAY OF GALACTOSE
ASSAY GALACTOSE TRANSFERASE
GALACTOSE TRANSFERASE TEST
ASSAY OF GAMMAGLOBULIN IGM
ASSAY OF GAMMAGLOBULIN IGE
GAMMAGLOB;IMMUNOGLOB SUBCLASS
BLOOD PH
BLOOD GASES: PH, PO2 & PCO2
BLOOD GASES W/02 SATURATION
BLOOD GASES, O2 SAT ONLY
HEMOGLOBIN-OXYGEN AFFINITY
ASSAY OF GASTRIC ACID
ASSAY OF GASTRIC ACID
GASTRIN TEST
ASSAY OF GASTRIN
ASSAY OF GLUCAGON
GLUCOSE,BDY FLUID,OTH THN BLOD
GLUCAGON TOLERANCE TEST
GLUCOSE; QUANTITATIVE, BLOOD
REAGENT STRIP/BLOOD GLUCOSE
GLUCOSE TEST
GLUCOSE TOLERANCE TEST (GTT)
GTT-ADDED SAMPLES
GLUCOSE-TOLBUTAMIDE TEST
ASSAY OF G6PD ENZYME
TEST FOR G6PD ENZYME
GLUCOSE BLOOD TEST
82963
82965
82975
82977
82978
82979
82980
82985
83001
83002
83003
83008
83010
83012
83013
83014
83015
83018
83020
83021
83026
83030
83033
83036
83045
83050
83051
83055
83060
83065
83068
83069
83070
83071
83080
83088
83090
83150
83491
83497
83498
83499
83500
83505
83516
83518
83519
83520
83525
ASSAY OF GLUCOSIDASE
ASSAY OF GDH ENZYME
ASSAY OF GLUTAMINE
ASSAY OF GGT
ASSAY OF GLUTATHIONE
ASSAY, RBC GLUTATHIONE
ASSAY OF GLUTETHIMIDE
GLYCATED PROTEIN
GONADOTROPIN (FSH)
GONADOTROPIN (LH)
ASSAY, GROWTH HORMONE (HGH)
ASSAY OF GUANOSINE
ASSAY OF HAPTOGLOBIN, QUANT
ASSAY OF HAPTOGLOBINS
H PYLORI ANALYSIS
H PYLORI DRUG ADMIN/COLLECT
HEAVY METAL SCREEN
QUANTITATIVE SCREEN, METALS
HEMOGLOBIN ELECTROPHORESIS
HEMOGLOBIN CHROMOTOGRAPHY
HEMOGLOBIN, COPPER SULFATE
FETAL HEMOGLOBIN ASSAY
HEMOGLOBIN;F(FETAL),QUALITATVE
GLYCATED HEMOGLOBIN TEST
BLOOD METHEMOGLOBIN TEST
BLOOD METHEMOGLOBIN ASSAY
ASSAY OF PLASMA HEMOGLOBIN
BLOOD SULFHEMOGLOBIN TEST
BLOOD SULFHEMOGLOBIN ASSAY
ASSAY OF HEMOGLOBIN HEAT
HEMOGLOBIN STABILITY SCREEN
ASSAY OF URINE HEMOGLOBIN
ASSAY OF HEMOSIDERIN, QUAL
ASSAY OF HEMOSIDERIN, QUANT
ASSAY OF B HEXOSAMINIDASE
ASSAY OF HISTAMINE
HOMOCYSTINE
ASSAY OF FOR HVA
ASSAY OF CORTICOSTEROIDS
ASSAY OF 5-HIAA
ASSAY OF PROGESTERONE
ASSAY, FREE HYDROXYPROLINE
ASSAY, TOTAL HYDROXYPROLINE
IMMUNOASSAY, NONANTIBODY
IMMUNOASSAY, DIPSTICK
IMMUNOASSAY, NONANTIBODY
IMMUNOASSAY, RIA
ASSAY OF INSULIN
83527
83528
83540
83550
83570
83582
83586
83593
83605
83615
83625
83632
83633
83634
83655
83661
83662
83663
83664
83670
83690
83715
83716
83718
83719
83721
83727
83735
83775
83785
83788
83789
83805
83825
83835
83840
83857
83858
83864
83866
83872
83873
83874
83880
83883
83885
83887
83890
83891
ASSAY OF INSULIN
ASSAY OF INTRINSIC FACTOR
ASSAY OF IRON
IRON BINDING TEST
ASSAY OF IDH ENZYME
ASSAY OF KETOGENIC STEROIDS
ASSAY 17- KETOSTEROIDS
FRACTIONATION, KETOSTEROIDS
ASSAY OF LACTIC ACID
LACTATE (LD) (LDH) ENZYME
ASSAY OF LDH ENZYMES
PLACENTAL LACTOGEN
TEST URINE FOR LACTOSE
ASSAY OF URINE FOR LACTOSE
ASSAY OF LEAD
FETAL LUNG MATURITY;L/S RATIO
FETL LUNG MATUR;FOAM STABL TST
FETAL LUNG MAT;FLUORESC POLAR
FETAL LUNG MAT;LAMELL BDY DENS
ASSAY OF LAP ENZYME
ASSAY OF LIPASE
ASSAY OF BLOOD LIPOPROTEINS
ASSAY OF BLOOD LIPOPROTEINS
ASSAY OF LIPOPROTEIN
ASSAY OF BLOOD LIPOPROTEIN
ASSAY OF BLOOD LIPOPROTEIN
ASSAY OF LRH HORMONE
ASSAY OF MAGNESIUM
ASSAY OF MD ENZYME
ASSAY OF MANGANESE
MASS SPECTROMETRY QUAL
MASS SPECTROMETRY QUANT
ASSAY OF MEPROBAMATE
ASSAY OF MERCURY
ASSAY OF METANEPHRINES
ASSAY OF METHADONE
ASSAY OF METHEMALBUMIN
ASSAY OF METHSUXIMIDE
MUCOPOLYSACCHARIDES
MUCOPOLYSACCHARIDES SCREEN
ASSAY SYNOVIAL FLUID MUCIN
ASSAY OF CSF PROTEIN
ASSAY OF MYOGLOBIN
NATRIURETIC PEPTIDE
ASSAY, NEPHELOMETRY NOT SPEC
ASSAY OF NICKEL
ASSAY OF NICOTINE
MOLECULE ISOLATE
MOLECULE ISOLATE NUCLEIC
83892
83893
83894
83896
83897
83898
83901
83902
83903
83904
83905
83906
83912
83915
83916
83918
83919
83921
83925
83930
83935
83937
83945
83950
83970
83986
83992
84022
84030
84035
84060
84061
84066
84075
84078
84080
84081
84085
84087
84100
84105
84106
84110
84119
84120
84126
84127
84132
84133
MOLECULAR DIAGNOSTICS
MOLECULE DOT/SLOT/BLOT
MOLECULE GEL ELECTROPHOR
MOLECULE NUCLEIC TRANSFER
MOLECUL DX;AMPLIF PT NUCL ACD
MOLECULE NUCLEIC AMPLI
MOLECULE MUTATION SCAN
MOLECULE MUTATION IDENTIFY
GENETIC EXAMINATION
ASSAY OF NUCLEOTIDASE
OLIGOCLONAL BANDS
ORGANIC ACIDS;TOT,QUANTITATIVE
ASSAY, ORGANIC ACIDS QUAL
ORGANIC ACID,SING,QUANTITATIVE
ASSAY OF OPIATES
ASSAY OF BLOOD OSMOLALITY
ASSAY OF URINE OSMOLALITY
ASSAY OF OSTEOCALCIN
ASSAY OF OXALATE
ONCORPROTEIN, HER-2/NEU
ASSAY OF PARATHORMONE
ASSAY OF BODY FLUID ACIDITY
ASSAY FOR PHENCYCLIDINE
ASSAY OF PHENOTHIAZINE
ASSAY OF BLOOD PKU
ASSAY OF PHENYLKETONES
ASSAY ACID PHOSPHATASE
PHOSPHATASE, FORENSIC EXAM
ASSAY PROSTATE PHOSPHATASE
ASSAY ALKALINE PHOSPHATASE
ASSAY ALKALINE PHOSPHATASE
ASSAY ALKALINE PHOSPHATASES
AMNIOTIC FLUID ENZYME TEST
ASSAY OF RBC PG6D ENZYME
ASSAY PHOSPHOHEXOSE ENZYMES
ASSAY OF PHOSPHORUS
ASSAY OF URINE PHOSPHORUS
TEST FOR PORPHOBILINOGEN
ASSAY OF PORPHOBILINOGEN
TEST URINE FOR PORPHYRINS
ASSAY OF URINE PORPHYRINS
ASSAY OF FECES PORPHYRINS
ASSAY OF FECES PORPHYRINS
ASSAY OF SERUM POTASSIUM
ASSAY OF URINE POTASSIUM
84134
84135
84138
84140
84143
84144
84146
84150
84152
84153
84154
84155
84160
84165
84181
84182
84202
84203
84206
84207
84210
84220
84228
84233
84234
84235
84238
84244
84252
84255
84260
84270
84275
84285
84295
84300
84302
84305
84307
84311
84315
84375
84376
84377
84378
84379
84392
84402
84403
ASSAY OF PREALBUMIN
ASSAY OF PREGNANEDIOL
ASSAY OF PREGNANETRIOL
ASSAY OF PREGNENOLONE
ASSAY OF 17-HYDROXYPREGNENO
ASSAY OF PROLACTIN
ASSAY OF PROSTAGLANDIN
PSA;COMPLEXED (DIRECT MEASURE)
ASSAY OF PSA, TOTAL
ASSAY OF PSA, FREE
ASSAY OF PROTEIN
ASSAY OF SERUM PROTEIN
ASSAY OF SERUM PROTEINS
WESTERN BLOT TEST
PROTEIN, WESTERN BLOT TEST
ASSAY RBC PROTOPORPHYRIN
TEST RBC PROTOPORPHYRIN
ASSAY OF PROINSULIN
ASSAY OF VITAMIN B-6
ASSAY OF PYRUVATE
ASSAY OF PYRUVATE KINASE
ASSAY OF QUININE
ASSAY OF ESTROGEN
ASSAY OF ENDOCRINE HORMONE
ASSAY, NONENDOCRINE RECEPTOR
ASSAY OF RENIN
ASSAY OF SELENIUM
ASSAY OF SEROTONIN
ASSAY OF SEX HORMONE GLOBUL
ASSAY OF SIALIC ACID
ASSAY OF SILICA
ASSAY OF SERUM SODIUM
ASSAY OF URINE SODIUM
SODIUM; OTHER SOURCE
ASSAY OF SOMATOMEDIN
ASSAY OF SOMATOSTATIN
SPECTROPHOTOMETRY
BODY FLUID SPECIFIC GRAVITY
CHROMATOGRAM ASSAY, SUGARS
SUGARS, SINGLE, QUAL
SUGARS, MULTIPLE, QUAL
SUGARS SINGLE QUANT
SUGARS MULTIPLE QUANT
ASSAY OF URINE SULFATE
ASSAY OF TESTOSTERONE
ASSAY OF TOTAL TESTOSTERONE
84425
84430
84432
84436
84437
84439
84442
84443
84445
84446
84449
84450
84460
84466
84478
84479
84480
84481
84482
84484
84485
84488
84490
84510
84512
84520
84525
84540
84545
84550
84560
84577
84578
84580
84583
84585
84586
84588
84590
84591
84597
84600
84620
84630
84681
84702
84703
84830
84999

ASSAY OF THIOCYANATE
ASSAY OF THYROGLOBULIN
ASSAY OF TOTAL THYROXINE
ASSAY OF NEONATAL THYROXINE
ASSAY OF FREE THYROXINE
ASSAY OF THYROID ACTIVITY
ASSAY THYROID STIM HORMONE
ASSAY OF TSI
ASSAY OF VITAMIN E
ASSAY OF TRANSCORTIN
TRANSFERASE (AST) (SGOT)
ALANINE AMINO (ALT) (SGPT)
ASSAY OF TRANSFERRIN
ASSAY OF TRIGLYCERIDES
ASSAY OF THYROID (T3 OR T4)
ASSAY, TRIIODOTHYRONINE (T3)
FREE ASSAY (FT-3)
T3 REVERSE
ASSAY OF TROPONIN, QUANT
ASSAY DUODENAL FLUID TRYPSIN
TEST FECES FOR TRYPSIN
ASSAY OF FECES FOR TRYPSIN
ASSAY OF TYROSINE
ASSAY OF TROPONIN, QUAL
ASSAY OF UREA NITROGEN
UREA NITROGEN SEMI-QUANT
ASSAY OF URINE/UREA-N
UREA-N CLEARANCE TEST
ASSAY OF BLOOD/URIC ACID
ASSAY OF URINE/URIC ACID
ASSAY OF FECES/UROBILINOGEN
TEST URINE UROBILINOGEN
ASSAY OF URINE UROBILINOGEN
ASSAY OF URINE UROBILINOGEN
ASSAY OF URINE VMA
ASSAY OF VIP
ASSAY OF VASOPRESSIN
ASSAY OF VITAMIN A
VITAMIN, NOS
ASSAY OF VITAMIN K
ASSAY OF VOLATILES
XYLOSE TOLERANCE TEST
ASSAY OF ZINC
ASSAY OF C-PEPTIDE
CHORIONIC GONADOTROPIN TEST
CHORIONIC GONADOTROPIN ASSAY
OVULATION TESTS
CLINICAL CHEMISTRY TEST
85002
85004
85007
85008
85009
85013
85014
85018
85025
85027
85032
85041
85044
85045
85046
85048
85049
85060
85097
85130
85170
85175
85210
85220
85230
85240
85244
85245
85246
85247
85250
85260
85270
85280
85290
85291
85292
85293
85300
85301
85302
85303
85305
85306
85307
85335
85337
85345
85347
BLEEDING TIME TEST

BC; AUTOMATED DIFF WBC COUNT
BL SMEAR W/DIFF WBC COUNT
BL SMEAR W/O DIFF WBC COUNT
MANUAL DIFF WBC COUNT B-COAT
HEMATOCRIT
BLD CNT; HEMATOCRIT
BLD CNT; HEMOGLOBIN
COMPLETE CBC W/AUTO DIFF WBC
COMPLETE CBC, AUTOMATED
BC; MANUAL CELL COUNT, EACH
BLD CNT; RBC COUNT AUTOMATED
BLD CNT; RETICULOCYTE, MANUAL
BLD CNT; RETICULOCYTE, AUTO
RETICYTE/HGB CONCENTRATE
BLD CNT; LEUKOCYTE, AUTOMATED
BLOOD COUNT; PLATELET, AUTO
BLOOD SMEAR INTERPRETATION
BONE MARROW INTERPRETATION
CHROMOGENIC SUBSTRATE ASSAY
BLOOD CLOT RETRACTION
BLOOD CLOT LYSIS TIME
BLOOD CLOT FACTOR II TEST
BLOOD CLOT FACTOR V TEST
BLOOD CLOT FACTOR VII TEST
BLOOD CLOT FACTOR VIII TEST
BLOOD CLOT FACTOR IX TEST
BLOOD CLOT FACTOR X TEST
BLOOD CLOT FACTOR XI TEST
BLOOD CLOT FACTOR XII TEST
BLOOD CLOT FACTOR XIII TEST
BLOOD CLOT FACTOR XIII TEST
BLOOD CLOT FACTOR ASSAY
BLOOD CLOT FACTOR ASSAY
ANTITHROMBIN III TEST
ANTITHROMBIN III TEST
BLOOD CLOT INHIBITOR ANTIGEN
BLOOD CLOT INHIBITOR TEST
BLOOD CLOT INHIBITOR ASSAY
BLOOD CLOT INHIBITOR TEST
ACTIV PROT C (APC) RESIST ASSA
FACTOR INHIBITOR TEST
THROMBOMODULIN
COAGULATION TIME
COAGULATION TIME
85348
85360
85362
85366
85370
85378
85379
85380
85384
85385
85390
85400
85410
85415
85420
85421
85441
85445
85460
85461
85475
85520
85525
85530
85536
85540
85547
85549
85555
85557
85576
85597
85610
85611
85612
85613
85635
85651
85652
85660
85670
85675
85705
85730
85732
85810
85999
86000
86001
COAGULATION TIME
EUGLOBULIN LYSIS
FIBRIN DEGRADATION PRODUCTS
FIBRINOGEN TEST
FIBRINOGEN TEST
FIBRIN DEGRADE, SEMIQUANT
FIBRIN DEGRADATION, QUANT
FIBRIN DEGRADATION, VTE
FIBRINOGEN
FIBRINOGEN
FIBRINOLYSINS SCREEN
FIBRINOLYTIC PLASMIN
FIBRINOLYTIC ANTIPLASMIN
FIBRINOLYTIC PLASMINOGEN
HEINZ BODIES, DIRECT
HEINZ BODIES, INDUCED
HEMOGLOBIN, FETAL
HEMOGLOBIN, FETAL
HEMOLYSIN
HEPARIN ASSAY
HEPARIN
HEPARIN-PROTAMINE TOLERANCE
IRON STAIN, PERIPHERAL BLOOD
WBC ALKALINE PHOSPHATASE
RBC MECHANICAL FRAGILITY
MURAMIDASE
RBC OSMOTIC FRAGILITY
RBC OSMOTIC FRAGILITY
BLOOD PLATELET AGGREGATION
PLATELET NEUTRALIZATION
PROTHROMBIN TIME
PROTHROMBIN TEST
VIPER VENOM PROTHROMBIN TIME
RUSSELL VIPER VENOM, DILUTED
REPTILASE TEST
RBC SED RATE, NONAUTOMATED
RBC SED RATE, AUTOMATED
RBC SICKLE CELL TEST
THROMBIN TIME, PLASMA
THROMBIN TIME, TITER
THROMBOPLASTIN INHIBITION
THROMBOPLASTIN TIME, PARTIAL
THROMBOPLASTIN TIME, PARTIAL
BLOOD VISCOSITY EXAMINATION
HEMATOLOGY PROCEDURE
AGGLUTININS, FEBRILE
ALLERGN SPEC IGG QUAN/SEMIQ,EA
86003
86005
86021
86022
86023
86038
86039
86060
86063
86077
86078
86079
86140
86141
86146
86147
86148
86155
86156
86157
86160
86161
86162
86171
86185
86215
86225
86226
86235
86243
86255
86256
86277
86280
86294
86300
86301
86304
86308
86309
86310
86316
86317
86318
86320
86325
86327
86329
86331
ALLERGEN SPECIFIC IGE

ALLERGEN SPECIFIC IGE
WBC ANTIBODY IDENTIFICATION
PLATELET ANTIBODIES
IMMUNOGLOBULIN ASSAY
ANTINUCLEAR ANTIBODIES
ANTINUCLEAR ANTIBODIES (ANA)
ANTISTREPTOLYSIN O, TITER
ANTISTREPTOLYSIN O, SCREEN
PHYSICIAN BLOOD BANK SERVICE
C-REACTIVE PROTEIN
C-REACTIVE PROTEIN, HS
BETA 2 GLYCOPROT I ANTIBODY,EA
CARDIOLIPN(PHOSPHOLIPD)ANTIBDY
PHOSPHOLIPID ANTIBODY
CHEMOTAXIS ASSAY
COLD AGGLUTININ, SCREEN
COLD AGGLUTININ, TITER
COMPLEMENT, ANTIGEN
COMPLEMENT/FUNCTION ACTIVITY
COMPLEMENT, TOTAL (CH50)
COMPLEMENT FIXATION, EACH
COUNTERIMMUNOELECTROPHORESIS
DEOXYRIBONUCLEASE, ANTIBODY
DNA ANTIBODY
DNA ANTIBODY, SINGLE STRAND
NUCLEAR ANTIGEN ANTIBODY
FC RECEPTOR
FLUORESCENT ANTIBODY, SCREEN
FLUORESCENT ANTIBODY, TITER
GROWTH HORMONE ANTIBODY
HEMAGGLUTINATION INHIBITION
IMMUNOASSA,TUM ANT,QUAL/SEMIQN
IMMUNOAS,TUM ANT,QUANT;CA 15-3
IMMUNOAS,TUM ANT,QUANT;CA 19-9
IMMUNOAS,TUM ANT,QUANT; CA 125
HETEROPHILE ANTIBODIES
IMMUNOASSAY,TUMOR ANTGN;QUANT
IMMUNOASSAY,INFECTIOUS AGENT
IMMUNOASSAY,INFECTIOUS AGENT
SERUM IMMUNOELECTROPHORESIS
OTHER IMMUNOELECTROPHORESIS
IMMUNOELECTROPHORESIS ASSAY
IMMUNODIFFUSION
IMMUNODIFFUSION OUCHTERLONY
86332
86334
86336
86337
86340
86341
86343
86344
86353
86359
86360
86361
86376
86378
86382
86384
86403
86406
86430
86431
86485
86490
86510
86580
86585
86586
86590
86592
86593
86602
86603
86606
86609
86611
86612
86615
86617
86618
86619
86622
86625
86628
86631
86632
86635
86638
86641
86644
86645
IMMUNE COMPLEX ASSAY

IMMUNOFIXATION PROCEDURE
INHIBIN A
INSULIN ANTIBODIES
INTRINSIC FACTOR ANTIBODY
ISLET CELL ANTIBODY
LEUKOCYTE HISTAMINE RELEASE
LEUKOCYTE PHAGOCYTOSIS
LYMPHOCYTE TRANSFORMATION
T CELLS, TOTAL COUNT
T CELL, ABSOLUTE COUNT/RATIO
T CELL, ABSOLUTE COUNT
MICROSOMAL ANTIBODY
MIGRATION INHIBITORY FACTOR
NEUTRALIZATION TEST, VIRAL
NITROBLUE TETRAZOLIUM DYE
PARTICLE AGGLUTINATION TEST
PARTICLE AGGLUTINATION TEST
RHEUMATOID FACTOR TEST
RHEUMATOID FACTOR, QUANT
SKIN TEST, CANDIDA
COCCIDIOIDOMYCOSIS SKIN TEST
HISTOPLASMOSIS SKIN TEST
TB INTRADERMAL TEST
TB TINE TEST
SKIN TEST, UNLISTED
STREPTOKINASE, ANTIBODY
BLOOD SEROLOGY, QUALITATIVE
BLOOD SEROLOGY, QUANTITATIVE
ANTINOMYCES ANTIBODY
ADENOVIRUS ANTIBODY
ASPERGILLUS ANTIBODY
BACTERIUM ANTIBODY
ANTIBODY; BARTONELLA
BLASTOMYCES ANTIBODY
BORDETELLA ANTIBODY
LYME DISEASE ANTIBODY
LYME DISEASE ANTIBODY
BORRELIA ANTIBODY
BRUCELLA ANTIBODY
CAMPYLOBACTER ANTIBODY
CANDIDA ANTIBODY
CHLAMYDIA ANTIBODY
CHLAMYDIA IGM ANTIBODY
COCCIDIOIDES ANTIBODY
Q FEVER ANTIBODY
CRYPTOCOCCUS ANTIBODY
CMV ANTIBODY
CMV ANTIBODY, IGM
86648
86651
86652
86653
86654
86658
86663
86664
86665
86666
86668
86671
86674
86677
86682
86684
86687
86688
86689
86692
86694
86695
86696
86698
86701
86702
86703
86704
86705
86706
86707
86708
86709
86710
86713
86717
86720
86723
86727
86729
86732
86735
86738
86741
86744
86747
86750
86753
86756
DIPHTHERIA ANTIBODY
ENCEPHALITIS ANTIBODY
ENTEROVIRUS ANTIBODY
EPSTEIN-BARR ANTIBODY
ANTIBODY; EHRLICHIA
FRANCISELLA TULARENSIS
FUNGUS ANTIBODY
GIARDIA LAMBLIA ANTIBODY
HELICOBACTER PYLORI
HELMINTH ANTIBODY
HEMOPHILUS INFLUENZA
HTLV-I ANTIBODY
HTLV-II ANTIBODY
HTLV/HIV CONFIRMATORY TEST
HEPATITIS, DELTA AGENT
HERPES SIMPLEX TEST
HERPES SIMPLEX TEST
ANTIBODY;HERPES SIMPLEX,TYPE 2
HISTOPLASMA
HIV-1
HIV-2
HIV-1/HIV-2, SINGLE ASSAY
HEP B CORE ANTIBODY(HBCAB),TOT
IGM ANTIBODY
HEP B SURFACE ANTIBODY
HEP BE ANTIBODY
HEPATITIS A ANTIBODY(HAAB),TOT
HEP A ANTIBDY(HAAB),IGM ANTBDY
INFLUENZA VIRUS ANTIBODY
LEGIONELLA ANTIBODY
LEISHMANIA ANTIBODY
LEPTOSPIRA ANTIBODY
LISTERIA MONOCYTOGENES AB
LYMPH CHORIOMENINGITIS AB
LYMPHO VENEREUM ANTIBODY
MUCORMYCOSIS ANTIBODY
MUMPS ANTIBODY
MYCOPLASMA ANTIBODY
NEISSERIA MENINGITIDIS
NOCARDIA ANTIBODY
PARVOVIRUS ANTIBODY
MALARIA ANTIBODY
PROTOZOA ANTIBODY NOS
RESPIRATORY VIRUS ANTIBODY
86757
86759
86762
86765
86768
86771
86774
86777
86778
86781
86784
86787
86790
86793
86800
86803
86804
86805
86806
86807
86808
86812
86813
86816
86817
86821
86822
86849
86850
86860
86870
86880
86885
86886
86890
86891
86900
86901
86903
86904
86905
86906
86910
86911
86920
86921
86922
86927
86930
ANTIBODY; RICKETTSIA
ROTAVIRUS ANTIBODY
RUBELLA ANTIBODY
RUBEOLA ANTIBODY
SALMONELLA ANTIBODY
SHIGELLA ANTIBODY
TETANUS ANTIBODY
TOXOPLASMA ANTIBODY
TOXOPLASMA ANTIBODY, IGM
TREPONEMA PALLIDUM, CONFIRM
TRICHINELLA ANTIBODY
VARICELLA-ZOSTER ANTIBODY
VIRUS ANTIBODY NOS
YERSINIA ANTIBODY
THYROGLOBULIN ANTIBODY
HEPATITIS C AB TEST
HEP C AB TEST, CONFIRM
LYMPHOCYTOTOXICITY ASSAY
LYMPHOCYTOTOXICITY ASSAY
CYTOTOXIC ANTIBODY SCREENING
CYTOTOXIC ANTIBODY SCREENING
HLA TYPING, A, B, OR C
HLA TYPING, A, B, OR C
HLA TYPING, DR/DQ
HLA TYPING, DR/DQ
LYMPHOCYTE CULTURE, MIXED
LYMPHOCYTE CULTURE, PRIMED
IMMUNOLOGY PROCEDURE
RBC ANTIBODY SCREEN
RBC ANTIBODY ELUTION
RBC ANTIBODY IDENTIFICATION
COOMBS TEST
COOMBS TEST
COOMBS TEST
AUTOLOGOUS BLOOD PROCESS
AUTOLOGOUS BLOOD, OP SALVAGE
BLOOD TYPING, ABO
BLOOD TYPING, RH (D)
BLOOD TYPING, ANTIGEN SCREEN
BLOOD TYPING, PATIENT SERUM
BLOOD TYPING, RBC ANTIGENS
BLOOD TYPING, RH PHENOTYPE
BLOOD TYPING, PATERNITY TEST
BLOOD TYPING, ANTIGEN SYSTEM
COMPATIBILITY TEST
COMPATIBILITY TEST
COMPATIBILITY TEST
PLASMA, FRESH FROZEN
FROZEN BLOOD, EACH UNIT FREEZE
86931
86932
86940
86941
86945
86950
86965
86970
86971
86972
86975
86976
86977
86978
86985
86999
87001
87003
87015
87040
87045
87046
87070
87071
87073
87075
87076
87077
87081
87084
87086
87088
87101
87102
87103
87106
87107
87109
87110
87116
87118
87140
87143
87147
87149
87152
87158
87164
87166
FROZEN BLOOD, EACH UNIT THAW

FRZN BLOD,EACH UNIT FREZE&THAW
HEMOLYSINS/AGGLUTININS, AUTO
HEMOLYSINS/AGGLUTININS
BLOOD PRODUCT/IRRADIATION
LEUKACYTE TRANSFUSION
POOLING BLOOD PLATELETS
RBC PRETREATMENT
RBC PRETREATMENT
RBC PRETREATMENT
RBC PRETREATMENT, SERUM
SPLIT BLOOD OR PRODUCTS
TRANSFUSION PROCEDURE
SMALL ANIMAL INOCULATION
SMALL ANIMAL INOCULATION
CONCNTRAT(ANY TYPE),INFCT AGNT
CULT,BACT;BLD,W ISOLAT&PRESUMP
FECES CULTURE, BACTERIA
STOOL CULTR, BACTERIA, EACH
CULT,BACT;SRC EXC UR/BLD/STL
CULT,BAC;QUANT,AEROBIC,NO URIN
CULT,BAC;QUANT,ANAEROBC,NO URN
CULT,BACT;ANAERBC W ISOL&PRESM
CULT,BACT;ANAEROB ISL,ADD METH
CULT,BAC;AEROBIC,ADD ID,EA ISO
CULT,PRESUMP,PATHOGEN ORGANISM
CULTURE OF SPECIMEN BY KIT
CULT,BACT;QUANTIT COLONY COUNT
CULT,BACT;ISOLAT&PRESUM,URINE
CULT,FUNGI ISOL;SKN/HAIR/NAIL
CULT,FUNG ISOL;OTH SRC EXC BLD
CULT,FUNGI ISOLAT,W ID,ISL;BLD
CULT,FNGI,IDNT,EA ORGNSM;YEAST
CULT,FUNGI,DEF ID,EA ORGN;MOLD
MYCOPLASMA CULTURE
CULT,CHLAMYDIA, ANY SOURCE
CULT,TUB/OTH ACID-FST BACIL
CULT,MYCOBACTERL,DEF IDENT,ISL
CULT,TYP;IMMUNFLR METH,ANTISER
CULT,TYP;GAS LIQD CHROMATOGRPH
CULT,TYP;IMMUNOLOG METH,ANTISR
CULT,TYP;ID,NUCLEIC ACID PROBE
CULT,TYP;ID,PULSE FIELD GEL TY
CULTURE TYPING, ADDED METHOD
DARK FIELD EXAMINATION
DARK FIELD EXAMINATION
87168
87169
87172
87176
87177
87181
87184
87185
87186
87187
87188
87190
87197
87205
87206
87207
87210
87220
87230
87250
87252
87253
87254
87255
87260
87265
87267
87270
87271
87272
87273
87274
87275
87276
87277
87278
87279
87280
87281
87283
87285
87290
87299
87300
87301
87320
87324
87327
87328
MACROSCOPIC EXAM; ARTHROPOD

MACROSCOPIC EXAM; PARASITE
PINWORM EXAM (CELLOPHANE TAPE)
HOMOGENIZATION, TISSUE,CULTURE
OVA AND PARASITES SMEARS
SUSPT STD,AGAR DILTN METH,AGNT
SUSPT STD,DISK METH,PR PLT
SUSCEPT STY,ANTIMICROB;ENZ DET
SUSPT STD,MICR/AGR DIL,MC/BKPT
SUSPT STD,MICR/AGR DIL,MLC,PL
SUSPT STD,MACR DIL MTHD,EA AGT
SUSPT STD,MYCOBACT,PROPOR MTH
BACTERICIDAL LEVEL, SERUM
SMEAR,GRM/GIEM STN,BACT,FUNG
SMR,FLUO &/OR AC FS ST BCT/FNG
SMEAR, SPECIAL STAIN
SMR,PRI SRC;WET MT,INFECT AGNT
TISS EXM,KOH SLD SMP FRM SK/HR
ASSAY, TOXIN OR ANTITOXIN
VIR ISL;INOC,EMBRYO EGG/SML
VIR ISL;TISS CULT INOC,CYTOPTH
VIR ISOL;TISS CULT,STUD/DEFIN
VIRUS INOCULATION, SHELL VIL
VIRUS ISOLATE; CYTOPATH EFCT
INFECT AGT;IMMUNO TECH;ADNOVRS
INFCT AGT;BRDET PRTUS/PARAPERT
ENTEROVIRUS ANTIBODY, DFA
INFECT AGT;CHLAMYDIA TRACHOMAT
CRYPTOSPORIDUM ANTIBODY, DFA
INFECT AGT;CRYPTOSPRID/GIARDIA
INF AG AN,IMMUNOF;HRP SMP VIR2
INFECT AGT;IMMUNOFL,HSV TYPE 1
INF AG ANT,IMMUNOF;INFLU B VIR
INFECT AGT;INFLUENZA A VIRUS
INF AG AN,IMMU;LEGION MICDADEI
INFECT AGT;LEGIONLLA PNEUMOPHL
INF AG AN,IMMU;PARAINFLUEN VIR
INFECT AGT;IMMUNOFLR TECH;RSV
INF AG AN,IMM;PNEUMOCYS CARINI
INFEC AGT ANT,IMMUNOFL;RUBEOLA
INFECT AGT;TREPONEMA PALLIDUM
INFECT AGT;VARICLLA ZOSTR VIR
INFECT AGT; NOS, EA ORGSM
INF AG AN,IMM,POLYVAL,EA ANTIS
ADENOVIRUS AG, EIA
CHYLMD TRACH AG, EIA
INFECT AG;MLT STP MTH;C-DIF TX
INF AG AN,IMM;CRYPTOCOC NEOFRM
CRYPTOSPOR AG, EIA
87332
87335
87336
87337
87338
87339
87340
87341
87350
87380
87385
87390
87391
87400
87420
87425
87427
87430
87449
87450
87451
87470
87471
87472
87475
87476
87477
87480
87481
87482
87485
87486
87487
87490
87491
87492
87495
87496
87497
87510
87511
87512
87515
87516
87517
87520
87521
87522
87525
CYTOMEGALOVIRUS AG, EIA

E COLI 0157 AG, EIA
INF AG AN,;ENTAMOE HISTOLY DIS
INF AG AN,IMM;ENTAMOE HISTOLYT
HPYLORI, STOOL, EIA
INF AG ANT;HELICOBACTER PYLORI
HEPATITIS B SURFACE AG, EIA
INF AG ANT;HEP B SURF ANT NEUT
HEPATITIS BE AG, EIA
HEPATITIS DELTA AG, EIA
HISTOPLASMA CAPSUL AG, EIA
HIV-1 AG, EIA
HIV-2 AG, EIA
INFECT AG ANT;INFLUENZA,A/B,EA
RESP SYNCYTIAL AG, EIA
ROTAVIRUS AG, EIA
INF AG AN,IMM;SHIGA-LIKE TOXIN
STREP A AG, EIA
INFECT AG;ML ST MTH,NOS,EA ORG
INFECT AG;SN ST MTH,NOS,EA ORG
INF AG ANT,QUAL;POLYVAL,EA ANT
BARTONELLA, DNA, DIR PROBE
BARTONELLA, DNA, AMP PROBE
BARTONELLA, DNA, QUANT
LYME DIS, DNA, DIR PROBE
LYME DIS, DNA, AMP PROBE
LYME DIS, DNA, QUANT
CANDIDA, DNA, DIR PROBE
CANDIDA, DNA, AMP PROBE
CANDIDA, DNA, QUANT
CHYLMD PNEUM, DNA, DIR PROBE
CHYLMD PNEUM, DNA, AMP PROBE
CHYLMD PNEUM, DNA, QUANT
CHYLMD TRACH, DNA, DIR PROBE
CHYLMD TRACH, DNA, AMP PROBE
CHYLMD TRACH, DNA, QUANT
CYTOMEG, DNA, DIR PROBE
CYTOMEG, DNA, AMP PROBE
CYTOMEG, DNA, QUANT
GARDNER VAG, DNA, DIR PROBE
GARDNER VAG, DNA, AMP PROBE
GARDNER VAG, DNA, QUANT
HEPATITIS B, DNA, DIR PROBE
HEPATITIS B, DNA, AMP PROBE
HEPATITIS B, DNA, QUANT
HEPATITIS C, RNA, DIR PROBE
HEPATITIS C, RNA, AMP PROBE
HEPATITIS C, RNA, QUANT
HEPATITIS G, DNA, DIR PROBE
87526
87527
87528
87529
87530
87531
87532
87533
87534
87535
87536
87537
87538
87539
87540
87541
87542
87550
87551
87552
87555
87556
87557
87560
87561
87562
87580
87581
87582
87590
87591
87592
87620
87621
87622
87650
87651
87652
87797
87798
87799
87800
87801
87802
87803
87804
87810
87850
87880
HEPATITIS G, DNA, AMP PROBE

HEPATITIS G, DNA, QUANT
HSV, DNA, DIR PROBE
HSV, DNA, AMP PROBE
HSV, DNA, QUANT
HHV-6, DNA, DIR PROBE
HHV-6, DNA, AMP PROBE
HHV-6, DNA, QUANT
HIV-1, DNA, DIR PROBE
HIV-1, DNA, AMP PROBE
HIV-1, DNA, QUANT
HIV-2, DNA, DIR PROBE
HIV-2, DNA, AMP PROBE
HIV-2, DNA, QUANT
LEGION PNEUMO, DNA, DIR PROB
LEGION PNEUMO, DNA, AMP PROB
LEGION PNEUMO, DNA, QUANT
MYCOBACTERIA, DNA, DIR PROBE
MYCOBACTERIA, DNA, AMP PROBE
MYCOBACTERIA, DNA, QUANT
M.TUBERCULO, DNA, DIR PROBE
M.TUBERCULO, DNA, AMP PROBE
M.TUBERCULO, DNA, QUANT
M.AVIUM-INTRA, DNA, DIR PROB
M.AVIUM-INTRA, DNA, AMP PROB
M.AVIUM-INTRA, DNA, QUANT
M.PNEUMON, DNA, DIR PROBE
M.PNEUMON, DNA, AMP PROBE
M.PNEUMON, DNA, QUANT
N.GONORRHOEAE, DNA, DIR PROB
N.GONORRHOEAE, DNA, AMP PROB
N.GONORRHOEAE, DNA, QUANT
HPV, DNA, DIR PROBE
HPV, DNA, AMP PROBE
HPV, DNA, QUANT
STREP A, DNA, DIR PROBE
STREP A, DNA, AMP PROBE
STREP A, DNA, QUANT
INFECT AGT;DIR PRB TECH,EA ORG
INFECT AGT;AMPLFD PRB TECH,EA
INFECT AGT;NOS;QUANTFCT,EA ORG
INF AG,NUC ACID,MULT;DIR PROBE
INF AG,NUC ACD,MULT;AMPL PROBE
STREP B ASSAY W/OPTIC
CLOSTRIDIUM TOXIN A W/OPTIC
INFLUENZA ASSAY W/OPTIC
CHYLMD TRACH ASSAY W/OPTIC
N. GONORRHOEAE ASSAY W/OPTIC
STREP A ASSAY W/OPTIC
87899
87901
87902
87903
87904
87999
88000
88005
88007
88012
88014
88016
88020
88025
88027
88028
88029
88036
88037
88040
88045
88099
88104
88106
88107
88108
88125
88130
88140
88141
88142
88143
88147
88148
88150
88152
88153
88154
88155
88160
88161
88162
88164
88165
88166
88167
88172
88173
88174
AGENT NOS ASSAY W/OPTIC

GENOTYPE, DNA, HIV REVERSE T
GENOTYPE, DNA, HEPATITIS C
PHENOTYPE, DNA HIV W/CULTURE
PHENOTYPE, DNA HIV W/CLT ADD
MICROBIOLOGY PROCEDURE
AUTOPSY (NECROPSY), GROSS
AUTOPSY (NECROPSY), COMPLETE
LIMITED AUTOPSY
LIMITED AUTOPSY
FORENSIC AUTOPSY (NECROPSY)
CORONER'S AUTOPSY (NECROPSY)
NECROPSY (AUTOPSY) PROCEDURE
CYTOPATHOLOGY, FLUIDS
CYTOPATH, CONCENTRATE TECH
FORENSIC CYTOPATHOLOGY
SEX CHROMATIN IDENTIFICATION
SEX CHROMATIN IDENTIFICATION
CYTOPATH, C/V, INTERPRET
CYTOPATH, C/V, THIN LAYER
CYTOPATH C/V THIN LAYER REDO
CYTOPATH, C/V, AUTOMATED
CYTOPATH, C/V, AUTO RESCREEN
CYTOPATH, C/V, MANUAL
CYTOPATH, C/V, AUTO REDO
CYTOPATH, C/V, REDO
CYTOPATH, C/V, SELECT
CYTOPATH, C/V, INDEX ADD-ON
CYTOPATH SMEAR, OTHER SOURCE
CYTOPATH TBS, C/V, MANUAL
CYTOPATH TBS, C/V, REDO
CYTOPATH TBS, C/V, AUTO REDO
CYTOPATH TBS, C/V, SELECT
CYTOPATH;IMM CYTOHSTO STD DETR
CYTOPATH; INTERPRET & REPORT
CYTOPATH, C/V AUTO, IN FLUID
88175
88180
88182
88199
88230
88233
88235
88237
88239
88240
88241
88245
88248
88249
88261
88262
88263
88264
88267
88269
88271
88272
88273
88274
88275
88280
88283
88285
88289
88291
88299
88300
88302
88304
88305
88307
88309
88311
88312
88313
88314
88318
88319
88321
88323
88325
88329
88331
88332
CYTOPATH C/V AUTO FLUID REDO

FLW CYTOMTRY;CYTOPLS/NUCL MRKR
CELL MARKER STUDY
CYTOPATHOLOGY PROCEDURE
TISSUE CULTURE, LYMPHOCYTE
TISSUE CULTURE, SKIN/BIOPSY
TISSUE CULTURE, PLACENTA
TISSUE CULTURE, BONE MARROW
TISSUE CULTURE, TUMOR
CELL CRYOPRESERVE/STORAGE
FROZEN CELL PREPARATION
CHROMOSOME ANALYSIS, 20-25
CHROMOSOME ANALYSIS, 100
CHROMOSOME ANALYS, PLACENTA
CHROMOSOME ANALYS, AMNIOTIC
CYTOGENETICS, DNA PROBE
CYTOGENETICS, 3-5
CYTOGENETICS, 10-30
CYTOGENETICS, 25-99
CYTOGENETICS, 100-300
CHROMOSOME KARYOTYPE STUDY
CHROMOSOME BANDING STUDY
CHROMOSOME COUNT, ADDITIONAL
CHROMOSOME STUDY, ADDITIONAL
CYTO/MOLECULAR REPORT
CYTOGENETIC STUDY
SURGICAL PATH, GROSS
TISSUE EXAM BY PATHOLOGIST
LVL V-SURG PATHO,GROSS&MICROSC
DECALCIFY TISSUE
SPECIAL STAINS
SPECIAL STAINS
HISTOCHEMICAL STAIN
CHEMICAL HISTOCHEMISTRY
ENZYME HISTOCHEMISTRY
MICROSLIDE CONSULTATION
MICROSLIDE CONSULTATION
COMPREHENSIVE REVIEW OF DATA
PATHOLOGY CONSULT IN SURGERY
PATH CONSULT DUR SRG;TISS BLCK
PATHOLOGY CONSULT IN SURGERY
88342
88346
88347
88348
88349
88355
88356
88358
88362
88365
88371
88372
88380
88399
88400
89050
89051
89055
89060
89100
89105
89125
89130
89132
89135
89136
89140
89141
89160
89190
89250
89251
89252
89253
89254
89255
89256
89257
89258
89259
89260
89261
89264
89300
89310
89320
89321
89325
89329
IMMUNOCYTOCHEMISTRY
IMMUNOFLUORESCENT STUDY
IMMUNOFLUORESCENT STUDY
ELECTRON MICROSCOPY
SCANNING ELECTRON MICROSCOPY
ANALYSIS, SKELETAL MUSCLE
ANALYSIS, NERVE
ANALYSIS, TUMOR
NERVE TEASING PREPARATIONS
TISSUE HYBRIDIZATION
PROTEIN, WESTERN BLOT TISSUE
PROTEIN ANALYSIS W/PROBE
MICRODISSECTION
SURGICAL PATHOLOGY PROCEDURE
BILIRUBIN,TOTAL,TRANSCUTANEOUS
BODY FLUID CELL COUNT
BODY FLUID CELL COUNT
LEUKOCYTE COUNT, FECAL
EXAM,SYNOVIAL FLUID CRYSTALS
SAMPLE INTESTINAL CONTENTS
SAMPLE INTESTINAL CONTENTS
FAT STN,FECES,URINE,/RESP SECR
SAMPLE STOMACH CONTENTS
EXAM FECES FOR MEAT FIBERS
NASAL SMEAR FOR EOSINOPHILS
FERTILIZATION OF OOCYTE
CULTURE OOCYTE W/EMBRYOS
ASSIST OOCYTE FERTILIZATION
EMBRYO HATCHING
OOCYTE IDENTIFICATION
PREPARE EMBRYO FOR TRANSFER
PREPARE CRYOPRESERVED EMBRYO
SPERM IDENTIFICATION
CRYOPRESERVATION, EMBRYO
CRYOPRESERVATION, SPERM
SPERM ISOLATION, SIMPLE
SPERM ISOLATION, COMPLEX
IDENTIFY SPERM TISSUE
SEMEN ANALYSIS
SEMEN ANALY; MOTILITY & CNT
SEMEN ANALYSIS
SEMEN ANAL,PRES &/ MOTIL,SPERM
SPERM ANTIBODY TEST
SPERM EVALUATION TEST
89330
89350
89355
89360
89365
89399
90281
90283
90287
90288
90291
90296
90371
90375
90376
90378
90379
90384
90385
90386
90389
90393
90396
90399
90471
90472
90473
90474
90476
90477
90581
90585
90586
90632
90633
90634
90636
90645
90646
90647
90648
90657
90658
90659
90660
90665
90669
90675
90676
EVALUATION, CERVICAL MUCUS

SPUTUM SPECIMEN COLLECTION
EXAM FECES FOR STARCH
COLLECT SWEAT FOR TEST
WATER LOAD TEST
PATHOLOGY LAB PROCEDURE
HUMAN IG, IM
HUMAN IG, IV
BOTULINUM ANTITOXIN
BOTULISM IG, IV
CMV IG, IV
DIPHTHERIA ANTITOXIN
HEP B IG, IM
RABIES IG, IM/SC
RABIES IG, HEAT TREATED
RSV-IGIM,FOR IM USE, 50 MG, EA
RSV IG, IV
RH IG, FULL-DOSE, IM
RH IG, MINIDOSE, IM
RH IG, IV
TETANUS IG, IM
VACCINA IG, IM
VARICELLA-ZOSTER IG, IM
IMMUNE GLOBULIN
IMMUNIZATION ADMIN
IMMUNIZATION ADMIN, EACH ADD
IMMUNE ADMIN ORAL/NASAL
IMMUNE ADMIN ORAL/NASAL ADDL
ADENOVIRUS VACCINE, TYPE 4
ADENOVIRUS VACCINE, TYPE 7
ANTHRAX VACCINE, SC
BCG VACCINE, PERCUT
BCG VACCINE, INTRAVESICAL
HEP A VACCINE, ADULT IM
HEP A VACC, PED/ADOL, 2 DOSE
HEP A VACC, PED/ADOL, 3 DOSE
HEP A/HEP B VACC, ADULT IM
HIB VACCINE, HBOC, IM
HIB VACCINE, PRP-D, IM
HIB VACCINE, PRP-OMP, IM
HIB VACCINE, PRP-T, IM
FLU VACCINE, 6-35 MO, IM
FLU VACCINE, 3 YRS, IM
FLU VACCINE, WHOLE, IM
FLU VACCINE, NASAL
LYME DISEASE VACCINE, IM
PNEUMCOCCL CONJGT VACC,PLYVLNT
RABIES VACCINE, IM
RABIES VACCINE, ID
90680
90690
90691
90692
90693
90700
90701
90702
90703
90704
90705
90706
90707
90708
90710
90712
90713
90716
90717
90718
90719
90720
90721
90723
90725
90727
90732
90733
90735
90740
90743
90744
90746
90747
90748
90749
90780
90781
90782
90783
90784
90788
90799
90801
90802
90804
90805
90806
90807
ROTOVIRUS VACCINE, ORAL

TYPHOID VACCINE, ORAL
TYPHOID VACCINE, IM
TYPHOID VACCINE, H-P, SC/ID
TYPHOID VACCINE, AKD, SC
DTAP VACCINE, IM
DTP VACCINE, IM
DT ADSRB,USE IN INDVD<7YRS,IM
TETANUS VACCINE, IM
MUMPS VACCINE, SC
MEASLES VACCINE, SC
RUBELLA VACCINE, SC
MMR VACCINE, SC
MEASLES-RUBELLA VACCINE, SC
MMRV VACCINE, SC
ORAL POLIOVIRUS VACCINE
POLIOVIRUS, IPV, SC
CHICKEN POX VACCINE, SC
YELLOW FEVER VACCINE, SC
TD ADSRB,INDVD 7YRS OR>,IM/JET
DIPHTHERIA VACCINE, IM
DTP/HIB VACCINE, IM
DTAP/HIB VACCINE, IM
DTAP-HEPB-IPV,INACT,INTRAMUSC
CHOLERA VACCINE, INJECTABLE
PLAGUE VACCINE, IM
PNEUMOCOCCAL VACCINE
MENINGOCOCCAL VACCINE, SC
ENCEPHALITIS VACCINE, SC
HEPATITIS B VACC,3 DOSE,INTRAM
HEPATITS B VACC,ADOLE,2,INTRAM
HEP B VACC,PED/ADLESCNT DOS
HEP B VACCINE, ADULT, IM
HEP B VACC,DIAL/IMMNSUPPRS DOS
HEP B/HIB VACCINE, IM
VACCINE TOXOID
IV INFUSION THERAPY, 1 HOUR
IV INFUSION, ADDITIONAL HOUR
INJECTION, SC/IM
INJECTION, IA
INJECTION, IV
INJECTION OF ANTIBIOTIC
THER/PROPHYLACTIC/DX INJECT
PSY DX INTERVIEW
INTAC PSY DX INTERVIEW
PSYTX, OFFICE, 20-30 MIN
PSYTX, OFF, 20-30 MIN W/E&M
PSYTX, OFF, 45-50 MIN
PSYTX, OFF, 45-50 MIN W/E&M
90808
90809
90810
90811
90812
90813
90814
90815
90816
90817
90818
90819
90821
90822
90823
90824
90826
90827
90828
90829
90845
90846
90847
90849
90853
90857
90862
90865
90870
90871
90875
90876
90880
90882
90885
90887
90889
90899
90901
90911
90918
90919
90920
90921
90922
90923
90924
90925
90935
PSYTX, OFFICE, 75-80 MIN

PSYTX, OFF, 75-80, W/E&M
INTAC PSYTX, OFF, 20-30 MIN
INTAC PSYTX, 20-30, W/E&M
INTAC PSYTX, 45-50 MIN W/E&M
INTAC PSYTX, 75-80 W/E&M
PSYTX, HOSP, 20-30 MIN
PSYTX, HOSP, 20-30 MIN W/E&M
INTAC PSYTX, HOSP, 20-30 MIN
INTAC PSYTX, HSP 20-30 W/E&M
PSYCHOANALYSIS
FAMILY PSYTX W/O PATIENT
FAMILY PSYTX W/PATIENT
MULTIPLE FAMILY GROUP PSYTX
GROUP PSYCHOTHERAPY
INTAC GROUP PSYTX
MEDICATION MANAGEMENT
NARCOSYNTHESIS
ELECTROCONVULSIVE THERAPY
ELECTROCONVULSIVE THERAPY
PSYCHOPHYSIOLOGICAL THERAPY
PSYCHOPHYSIOLOGICAL THERAPY
HYPNOTHERAPY
ENVIRONMENTAL MANIPULATION
PSY EVALUATION OF RECORDS
CONSULTATION WITH FAMILY
PREPARATION OF REPORT
PSYCHIATRIC SERVICE/THERAPY
BIOFEEDBACK TRAIN, ANY METH
BIOFEEDBACK PERI/URO/RECTAL
ESRD RELATED SERVICES, MONTH
ESRD RELATED SERVICES, DAY
HEMODIALYSIS, ONE EVALUATION
90937
90939
90940
90945
90947
90989
90993
90997
90999
91000
91010
91011
91012
91020
91030
91032
91033
91052
91055
91060
91065
91100
91105
91122
91123
91132
91133
91299
92002
92004
92012
92014
92015
92018
92019
92020
92060
92065
92070
92081
92082
92083
92100
92120
92130
92135
92136
92140
92225
HEMODIALYSIS, REPEATED EVAL

HEMODIALYSIS STUDY, TRANSCUT
HEMODIALYSIS ACCESS STUDY
DIAL PROC,W 1 PHYS EVALUATION
DIAL PROC,REQ REP PHY EVL
DIALYSIS TRAINING, COMPLETE
DIALYSIS TRAINING, INCOMPL
HEMOPERFUSION
DIALYSIS PROCEDURE
ESOPHAGEAL INTUBATION
ESOPHAGUS MOTILITY STUDY
GASTRIC MOTILITY
ACID PERFUSION OF ESOPHAGUS
ESOPHAGUS, ACID REFLUX TEST
PROLONGED ACID REFLUX TEST
GASTRIC ANALYSIS TEST
GASTRIC INTUBATION FOR SMEAR
GASTRIC SALINE LOAD TEST
BREATH HYDROGEN TEST
PASS INTESTINE BLEEDING TUBE
GASTRIC INTUBATION TREATMENT
ANAL PRESSURE RECORD
IRRIGATE FECAL IMPACTION
ELECTROGASTROGRP,DIAG,TRANSCUT
ELECTROGASTR,DIAG;PROVOCAT TST
GASTROENTEROLOGY PROCEDURE
EYE EXAM, NEW PATIENT
EYE EXAM, NEW PATIENT
EYE EXAM ESTABLISHED PAT
EYE EXAM & TREATMENT
REFRACTION
NEW EYE EXAM & TREATMENT
EYE EXAM & TREATMENT
SPECIAL EYE EVALUATION
SPECIAL EYE EVALUATION
ORTHOPTIC/PLEOPTIC TRAINING
FITTING OF CONTACT LENS
VISUAL FIELD EXAMINATION(S)
SERIAL TONOMETRY EXAM(S)
TONOGRAPHY & EYE EVALUATION
WATER PROVOCATION TONOGRAPHY
OPTHALMIC DX IMAGING
OPHTHALMIC BIOMETRY
GLAUCOMA PROVOCATIVE TESTS
SPECIAL EYE EXAM, INITIAL
92226
92230
92235
92240
92250
92260
92265
92270
92275
92283
92284
92285
92286
92287
92310
92311
92312
92313
92314
92315
92316
92317
92325
92326
92330
92335
92340
92341
92342
92352
92353
92354
92355
92358
92370
92371
92390
92391
92392
92393
92395
92396
92499
92502
92504
92506
92507
92508
92510
SPECIAL EYE EXAM, SUBSEQUENT

EYE EXAM WITH PHOTOS
ICG ANGIOGRAPHY
OPHTHALMOSCOPY/DYNAMOMETRY
EYE MUSCLE EVALUATION
ELECTRO-OCULOGRAPHY
ELECTRORETINOGRAPHY
COLOR VISION EXAMINATION
DARK ADAPTATION EYE EXAM
EYE PHOTOGRAPHY
INTERNAL EYE PHOTOGRAPHY
INTERNAL EYE PHOTOGRAPHY
CONTACT LENS FITTING
PRESCRIPTION OF CONTACT LENS
MODIFICATION OF CONTACT LENS
REPLACEMENT OF CONTACT LENS
FITTING OF ARTIFICIAL EYE
FITTING OF ARTIFICIAL EYE
FITTING OF SPECTACLES
SPECIAL SPECTACLES FITTING
EYE PROSTHESIS SERVICE
REPAIR & ADJUST SPECTACLES
REPAIR & ADJUST SPECTACLES
SUPPLY OF SPECTACLES
SUPPLY OF CONTACT LENSES
SUPPLY OF LOW VISION AIDS
SUPPLY OF ARTIFICIAL EYE
SUPPLY OF SPECTACLES
SUPPLY OF CONTACT LENSES
EYE SERVICE OR PROCEDURE
EAR AND THROAT EXAMINATION
EAR MICROSCOPY EXAMINATION
SPEECH/HEARING EVALUATION
SPEECH/HEARING THERAPY
SPEECH/HEARING THERAPY
REHAB FOR EAR IMPLANT
92511
92512
92516
92520
92526
92531
92532
92533
92534
92541
92542
92543
92544
92545
92546
92547
92548
92551
92552
92553
92555
92556
92557
92559
92560
92561
92562
92563
92564
92565
92567
92568
92569
92571
92572
92573
92575
92576
92577
92579
92582
92583
92584
92585
92586
92587
92588
92589
92590
NASOPHARYNGOSCOPY
NASAL FUNCTION STUDIES
FACIAL NERVE FUNCTION TEST
LARYNGEAL FUNCTION STUDIES
ORAL FUNCTION THERAPY
SPONTANEOUS NYSTAGMUS STUDY
CALORIC VESTIBULAR TEST
SPONTANEOUS NYSTAGMUS TEST
CALORIC VESTIBULAR TEST
OSCILLATING TRACKING TEST
SINUSOIDAL ROTATIONAL TEST
SUPPLEMENTAL ELECTRICAL TEST
POSTUROGRAPHY
PURE TONE HEARING TEST, AIR
PURE TONE AUDIOMETRY, AIR
AUDIOMETRY, AIR & BONE
SPEECH THRESHOLD AUDIOMETRY
SPEECH AUDIOMETRY, COMPLETE
COMPREHENSIVE HEARING TEST
GROUP AUDIOMETRIC TESTING
BEKESY AUDIOMETRY, SCREEN
BEKESY AUDIOMETRY, DIAGNOSIS
LOUDNESS BALANCE TEST
TONE DECAY HEARING TEST
SISI HEARING TEST
STENGER TEST, PURE TONE
TYMPANOMETRY
ACOUSTIC REFLEX TESTING
ACOUSTIC REFLEX DECAY TEST
FILTERED SPEECH HEARING TEST
STAGGERED SPONDAIC WORD TEST
LOMBARD TEST
SENSORINEURAL ACUITY TEST
SYNTHETIC SENTENCE TEST
STENGER TEST, SPEECH
VISUAL AUDIOMETRY (VRA)
CONDITIONING PLAY AUDIOMETRY
SELECT PICTURE AUDIOMETRY
ELECTROCOCHLEOGRAPHY
AUDIT EVOK POTNT EVOK RSPN AUD
AUD EVK POT,RESP &/TST CNS;LTD
EVOKED AUDITORY TEST
EVOKED AUDITORY TEST
AUDITORY FUNCTION TEST(S)
HEARING AID EXAM, ONE EAR
92591
92592
92593
92594
92595
92596
92597
92601
92602
92603
92604
92605
92606
92607
92608
92609
92610
92611
92612
92613
92614
92615
92616
92617
92700
92950
92953
92960
92961
92970
92971
92973
92974
92975
92977
92978
92979
92980
92981
92982
92984
92986
92987
92990
92992
92993
92995
92996
92997
HEARING AID EXAM, BOTH EARS

HEARING AID CHECK, ONE EAR
HEARING AID CHECK, BOTH EARS
ELECTRO HEARNG AID TEST, ONE
ELECTRO HEARNG AID TST, BOTH
EAR PROTECTOR EVALUATION
EVAL VOICE DVIC ORAL SPEECH
COCHLEAR IMPLT <7 W PROGRAM
COCHLEAR IMPLT <7 REPROGRAM
COCHLEAR IMPLT >7 W PROGRAM
COCHLEAR IMPLT >7 REPROGRAM
EVAL FOR RX NONSPEECH DEVICE
SERV USE OF NON-SPEECH DEVIC
EX FOR RX SPEECH DEVICE, 1HR
EX RX SPEECH DEVICE, ADDL 30
SERV USE OF SPEECH DEVICE
EVAL ORAL&PHARY SWALL FUNCT
MOTION FLUOROSCOPY/SWALLOW
FIBER ENDOSCO EVAL SWALLOW
FIBER ENDO EVAL SWALOW REPOR
LARYNGEAL SENSORY TESTING
LARYNGEAL SENSORY TESTING RP
ENDO EVAL SWAL&LARYN TESTING
ENDO EVAL SWAL&LARYN TEST RP
OTORHINOLARYNFOLOGICAL PROC
HEART/LUNG RESUSCITATION CPR
TEMPORARY EXTERNAL PACING
CARDIOVERSION ELECTRIC, EXT
CARDIOVERSION, ELECTRIC, INT
CARDIOASSIST, INTERNAL
CARDIOASSIST, EXTERNAL
PERCUT CORONARY THROMBECTOMY
CATH PLACE, CARDIO BRACHYTX
DISSOLVE CLOT, HEART VESSEL
DISSOLVE CLOT, HEART VESSEL
INTRAVASC US, HEART ADD-ON
INTRAVASC US, HEART ADD-ON
INSERT INTRACORONARY STENT
INSERT INTRACORONARY STENT
CORONARY ARTERY DILATION
CORONARY ARTERY DILATION
REVISION OF AORTIC VALVE
CORONARY ATHERECTOMY
CORONARY ATHERECTOMY ADD-ON
PUL ART BALLOON REPR, PERCUT
92998
93000
93005
93010
93012
93014
93015
93016
93017
93018
93024
93025
93040
93041
93042
93224
93225
93226
93227
93230
93231
93232
93233
93235
93236
93237
93268
93270
93271
93272
93278
93303
93304
93307
93308
93312
93313
93314
93315
93316
93317
93318
93320
93321
93325
93350
93501
93503
93505
PUL ART BALLOON REPR, PERCUT

ELECTROCARDIOGRAM, COMPLETE
ELECTROCARDIOGRAM, TRACING
ELECTROCARDIOGRAM REPORT
TELE TRANS ELECT RYTH;TRACING
TELE TRANS ELECT RYTH; REPORT
CARDIOVASCULAR STRESS TEST
CARDIAC DRUG STRESS TEST
MICROVOLT T-WAVE ASSESS
RHYTHM ECG WITH REPORT
RHYTHM ECG, TRACING
RHYTHM ECG, REPORT
ECG MONITOR/REPORT, 24 HRS
ECG MONITOR/RECORD, 24 HRS
ECG MONITOR/REVIEW, 24 HRS
ECG MONITOR/RECORD, 24 HRS
SNGL/MULT RECRD W PRESYMP MEMY
SNGL/MULT RECRD W PRESYMP RCRD
SNGL/MULT RECRD W PRESYMP MNTR
SNGL/MULT RECRD W PRESYMP RVEW
ECG/SIGNAL-AVERAGED
ECHO TRANSTHORACIC
ECHO TRANSTHORACIC
ECHO EXAM OF HEART
ECHO EXAM OF HEART
ECHO TRANSESOPHAGEAL
ECHOCARD,TRANSESOPH,PROBE,IMMD
DOPPLER ECHO EXAM, HEART
DOPPLER ECHO EXAM, HEART
DOPPLER COLOR FLOW ADD-ON
ECHO TRANSTHORACIC
RIGHT HEART CATHETERIZATION
INSERT/PLACE HEART CATHETER
BIOPSY OF HEART LINING
93508
93510
93511
93514
93524
93526
93527
93528
93529
93530
93531
93532
93533
93539
93540
93541
93542
93543
93544
93545
93555
93556
93561
93562
93571
93572
93580
93581
93600
93602
93603
93609
93610
93612
93613
93615
93616
93618
93619
93620
93621
93622
93623
93624
93631
93640
93641
93642
93650
CATH PLACEMENT, ANGIOGRAPHY

LEFT HEART CATHETERIZATION
RT & LT HEART CATHETERS
RT, LT HEART CATHETERIZATION
RT HEART CATH, CONGENITAL
R & L HEART CATH, CONGENITAL
INJECTION, CARDIAC CATH
INJECTION, CARDIAC CATH
INJECTION FOR LUNG ANGIOGRAM
INJECTION FOR HEART X-RAYS
INJECTION FOR HEART X-RAYS
INJECTION FOR AORTOGRAPHY
INJECT FOR CORONARY X-RAYS
IMAGING, CARDIAC CATH
IMAGING, CARDIAC CATH
CARDIAC OUTPUT MEASUREMENT
CARDIAC OUTPUT MEASUREMENT
HEART FLOW RESERVE MEASURE
HEART FLOW RESERVE MEASURE
TRANSCATH CLOS OF CONGENT IN
TRANSCATH CLOS OF CONGENT VE
BUNDLE OF HIS RECORDING
INTRA-ATRIAL RECORDING
RIGHT VENTRICULAR RECORDING
MAP TACHYCARDIA, ADD-ON
INTRA-ATRIAL PACING
INTRAVENTRICULAR PACING
ELECTROPHYS MAP, 3D, ADD-ON
ESOPHAGEAL RECORDING
ESOPHAGEAL RECORDING
HEART RHYTHM PACING
ELECTROPHYSIOLOGY EVALUATION
ELECTROPHYSIOLO EVAL RGT VENTR
ELECTROPHYSIOLO EVAL LFT ATRUM
ELECTROPHYSIOLO EVAL LFT VENTR
STIMULATION, PACING HEART
ELECTROPHYSIOLOGIC STUDY
HEART PACING, MAPPING
EVALUATION HEART DEVICE
93651
93652
93660
93662
93668
93701
93720
93721
93722
93724
93727
93731
93732
93733
93734
93735
93736
93740
93741
93742
93743
93744
93760
93762
93770
93784
93786
93788
93790
93797
93798
93799
93875
93880
93882
93886
93888
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
93975
93976

TILT TABLE EVALUATION
INTRACARD ECHOCARD,THR/DG,IMAG
PERIPH ART DIS (PAD) REHAB/SES
BIOIMPEDANCE, THORACIC
TOTAL BODY PLETHYSMOGRAPHY
PLETHYSMOGRAPHY TRACING
PLETHYSMOGRAPHY REPORT
ANALYZE PACEMAKER SYSTEM
ANALYZE ILR SYSTEM
TELEPHONE ANALY, PACEMAKER
TELEPHONE ANALY, PACEMAKER
TEMPERATURE GRADIENT STUDIES
ANALYZE HT PACE DEVICE SNGL
ANALYZE HT PACE DEVICE SNGL
ANALYZE HT PACE DEVICE DUAL
ANALYZE HT PACE DEVICE DUAL
CEPHALIC THERMOGRAM
PERIPHERAL THERMOGRAM
MEASURE VENOUS PRESSURE
AMBULATORY BP MONITORING
AMBULATORY BP RECORDING
AMBULATORY BP ANALYSIS
REVIEW/REPORT BP RECORDING
CARDIAC REHAB
CARDIAC REHAB/MONITOR
CARDIOVASCULAR PROCEDURE
EXTRACRANIAL STUDY
EXTRACRANIAL STUDY
EXTRACRANIAL STUDY
INTRACRANIAL STUDY
INTRACRANIAL STUDY
EXTREMITY STUDY
EXTREMITY STUDY
EXTREMITY STUDY
LOWER EXTREMITY STUDY
LOWER EXTREMITY STUDY
UPPER EXTREMITY STUDY
UPPER EXTREMITY STUDY
EXTREMITY STUDY
EXTREMITY STUDY
EXTREMITY STUDY
VASCULAR STUDY
VASCULAR STUDY
93978
93979
93980
93981
93990
94010
94014
94015
94016
94060
94070
94150
94200
94240
94250
94260
94350
94360
94370
94375
94400
94450
94620
94621
94640
94642
94656
94657
94660
94662
94664
94667
94668
94680
94681
94690
94720
94725
94750
94760
94761
94762
94770
94772
94799
95004
95010
95015
95024
VASCULAR STUDY
VASCULAR STUDY
PENILE VASCULAR STUDY
PENILE VASCULAR STUDY
DOPPLER FLOW TESTING
BREATHING CAPACITY TEST
PATIENT RECORDED SPIROMETRY
PATIENT RECORDED SPIROMETRY
REVIEW PATIENT SPIROMETRY
EVALUATION OF WHEEZING
EVALUATION OF WHEEZING
VITAL CAPACITY TEST
LUNG FUNCTION TEST (MBC/MVV)
RESIDUAL LUNG CAPACITY
EXPIRED GAS COLLECTION
THORACIC GAS VOLUME
LUNG NITROGEN WASHOUT CURVE
MEASURE AIRFLOW RESISTANCE
BREATH AIRWAY CLOSING VOLUME
RESPIRATORY FLOW VOLUME LOOP
CO2 BREATHING RESPONSE CURVE
HYPOXIA RESPONSE CURVE
PULMONARY STRESS TEST/SIMPLE
PULM STRESS TEST/COMPLEX
INHALATION TREAT ACUTE AIRWAY
AEROSOL INHALATION TREATMENT
INITIAL VENTILATOR MGMT
CONTINUED VENTILATOR MGMT
POS AIRWAY PRESSURE, CPAP
NEG PRESS VENTILATION, CNP
EVAL UTIL AEROS INHALER DEVICE
CHEST WALL MANIPULATION
CHEST WALL MANIPULATION
EXHALED AIR ANALYSIS, O2
EXHALED AIR ANALYSIS, O2/CO2
EXHALED AIR ANALYSIS
MONOXIDE DIFFUSING CAPACITY
MEMBRANE DIFFUSION CAPACITY
PULMONARY COMPLIANCE STUDY
MEASURE BLOOD OXYGEN LEVEL
EXHALED CARBON DIOXIDE TEST
BREATH RECORDING, INFANT
PULMONARY SERVICE/PROCEDURE
ALLERGY SKIN TESTS
SENSITIVITY SKIN TESTS
SENSITIVITY SKIN TESTS
ALLERGY SKIN TESTS
95027
95028
95044
95052
95056
95060
95065
95070
95071
95075
95078
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
95180
95199
95250
95805
95806
95807
95808
95810
95811
95812
95813
95816
95819
95822
95824
95827
95829
95830
95831
95832
95833
INTRAC TEST W ALRG AIRBORN

ALLERGY SKIN TESTS
ALLERGY PATCH TESTS
PHOTO PATCH TEST
PHOTOSENSITIVITY TESTS
EYE ALLERGY TESTS
NOSE ALLERGY TEST
BRONCHIAL ALLERGY TESTS
BRONCHIAL ALLERGY TESTS
INGESTION CHALLENGE TEST
PROVOCATIVE TESTING
IMMUNOTHERAPY, ONE INJECTION
IMMUNOTHERAPY INJECTIONS
IMMUNOTHERAPY, ONE INJECTION
IMMUNOTHERAPY, MANY ANTIGENS
IMMUNOTHERAPY, INSECT VENOM
IMMUNOTHERAPY, INSECT VENOMS
ANTIGEN THERAPY SERVICES
RAPID DESENSITIZATION
ALLERGY IMMUNOLOGY SERVICES
GLUCOSE MONITORING, CONT
MULTIPLE SLEEP LATENCY TEST
SLEEP STUDY, UNATTENDED
SLEEP STUDY, ATTENDED
POLYSOMNOGRAPHY, 1-3
POLYSOMNOGRAPHY, 4 OR MORE
POLYSOMNOGRAPHY W/CPAP
EEG EXTEND MONIT 41-60 MINS
EEG, OVER 1 HOUR
EEG INCLDE RCRD AWAKE & DROWSY
EEG INCLDE RCRD AWAKE & ASLEEP
EEG RECORD IN COMA / SLEEP ONY
EEG, CEREBRAL DEATH ONLY
EEG ALL NIGHT RECORDING
SURGERY ELECTROCORTICOGRAM
INSERT ELECTRODES FOR EEG
LIMB MUSCLE TESTING, MANUAL
HAND MUSCLE TESTING, MANUAL
BODY MUSCLE TESTING, MANUAL
95834
95851
95852
95857
95858
95860
95861
95863
95864
95867
95868
95869
95870
95872
95875
95900
95903
95904
95920
95921
95922
95923
95925
95926
95927
95930
95933
95934
95936
95937
95950
95951
95953
95954
95955
95956
95957
95958
95961
95962
95965
95966
95967
95970
95971
95972
95973
95974
95975
BODY MUSCLE TESTING, MANUAL

RANGE OF MOTION MEASUREMENTS
RANGE OF MOTION MEASUREMENTS
TENSILON TEST
TENSILON TEST & MYOGRAM
MUSCLE TEST, ONE LIMB
MUSCLE TEST, TWO LIMBS
MUSCLE TEST, 3 LIMBS
MUSCLE TEST, 4 LIMBS
NEDL ELECTRO CRNAL NRVE,UNILAT
MUSCLE TEST, HEAD OR NECK
NEDL ELECTRO THORACIC MUSCLES
MUSCLE TEST, NONPARASPINAL
MUSCLE TEST, ONE FIBER
ISCHEMIC LIMB EXERCISE TEST
MOTOR NERVE CONDUCTION TEST
MOTOR NERVE CONDUCTION TEST
SENSE NERVE CONDUCTION TEST
INTRAOP NERVE TEST ADD-ON
AUTONOMIC NERV FUNCTION TEST
SOMATOSENSORY TESTING
VISUAL EVOKED POTENTIAL TEST
BLINK REFLEX TEST
H-REFLEX TEST
H-REFLEX TEST
NEUROMUSCULAR JUNCTION TEST
AMBULATORY EEG MONITORING
EEG MONITORING/VIDEORECORD
EEG MONITORING/COMPUTER
EEG MONITORING/GIVING DRUGS
EEG DURING SURGERY
EEG MONITORING, CABLE/RADIO
EEG DIGITAL ANALYSIS
EEG MONITORING/FUNCTION TEST
ELECTRODE STIMULATION, BRAIN
ELECTRODE STIM, BRAIN ADD-ON
MEG, SPONTANEOUS
MEG, EVOKED, SINGLE
MEG, EVOKED, EACH ADDL
ANALYZE NEUROSTIM, NO PROG
ANALYZE NEUROSTIM, SIMPLE
ANALYZE NEUROSTIM, COMPLEX
ANALYZE NEUROSTIM, COMPLEX
CRANIAL NEUROSTIM, COMPLEX
CRANIAL NEUROSTIM, COMPLEX
95990
95999
96000
96001
96002
96003
96004
96100
96105
96110
96111
96115
96117
96150
96151
96152
96153
96154
96155
96400
96405
96406
96408
96410
96412
96414
96420
96422
96423
96425
96440
96445
96450
96520
96530
96542
96545
96549
96567
96570
96571
96900
96902
96910
96912
96913
96920
96921
96922
REFIL & MAIN SPIN/BRAIN PUMP

NEUROLOGICAL PROCEDURE
MOTION ANALYSIS, VIDEO/3D
MOTION TEST W/FT PRESS MEAS
DYNAMIC SURFACE EMG
DYNAMIC FINE WIRE EMG
PHYS REVIEW OF MOTION TESTS
PSYCHOLOGICAL TESTING
ASSESSMENT OF APHASIA
DEVELOPMENTAL TEST, LIM
DEVELOPMENTAL TEST, EXTEND
NEUROBEHAVIOR STATUS EXAM
NEUROPSYCH TEST BATTERY
ASSESS HLTH/BEHAVE, INIT
ASSESS HLTH/BEHAVE, SUBSEQ
INTERVENE HLTH/BEHAVE, INDIV
INTERVENE HLTH/BEHAVE, GROUP
INTERV HLTH/BEHAV, FAM W/PT
INTERV HLTH/BEHAV FAM NO PT
CHEMOTHERAPY, SC/IM
INTRALESIONAL CHEMO ADMIN
INTRALESIONAL CHEMO ADMIN
CHEMOTHERAPY, PUSH TECHNIQUE
CHEMOTHERAPY,INFUSION METHOD
CHEMO, INFUSE METHOD ADD-ON
CHEMOTHERAPY, PUSH TECHNIQUE
CHEMOTHERAPY, INTRACAVITARY
CHEMOTHERAPY, INTRACAVITARY
CHEMOTHERAPY, INTO CNS
PUMP REFILLING, MAINTENANCE
REFILL&MAIN IMPLANT PUMP SYS
CHEMOTHERAPY INJECTION
PROVIDE CHEMOTHERAPY AGENT
CHEMOTHERAPY, UNSPECIFIED
PHOTODYNAMIC TX, SKIN
PHOTODYNAMIC TX, 30 MIN
PHOTODYNAMIC TX, ADDL 15 MIN
ULTRAVIOLET LIGHT THERAPY
TRICHOGRAM
PHOTOCHEMOTHERAPY WITH UV-B
PHOTOCHEMOTHERAPY WITH UV-A
PHOTOCHEMOTHERAPY, UV-A OR B
LASER TX, SKIN < 250 SQ CM
LASER TX, SKIN 250-500 SQ CM
LASER TX, SKIN > 500 SQ CM
96999
97001
97002
97003
97004
97005
97006
97010
97012
97014
97016
97018
97020
97022
97024
97026
97028
97032
97033
97034
97035
97036
97039
97110
97112
97113
97116
97124
97139
97140
97150
97504
97520
97530
97532
97533
97535
97537
97542
97545
97546
97601
97602
97703
97750
97780
97781
97799
97802
DERMATOLOGICAL PROCEDURE
PT EVALUATION
PT RE-EVALUATION
OT EVALUATION
OT RE-EVALUATION
ATHLETIC TRAIN EVAL
ATHLETIC TRAIN REEVAL
HOT OR COLD PACKS THERAPY
MECHANICAL TRACTION THERAPY
ELECTRIC STIMULATION THERAPY
VASOPNEUMATIC DEVICE THERAPY
PARAFFIN BATH THERAPY
MICROWAVE THERAPY
WHIRLPOOL THERAPY
DIATHERMY TREATMENT
INFRARED THERAPY
ULTRAVIOLET THERAPY
ELECTRICAL STIMULATION
ELECTRIC CURRENT THERAPY
CONTRAST BATH THERAPY
ULTRASOUND THERAPY
HYDROTHERAPY
PHYSICAL THERAPY TREATMENT
THERAPEUTIC EXERCISES
NEUROMUSCULAR REEDUCATION
AQUATIC THERAPY/EXERCISES
GAIT TRAINING THERAPY
MASSAGE THERAPY
PHYSICAL MEDICINE PROCEDURE
MANUAL THERAPY
GROUP THERAPEUTIC PROCEDURES
ORTHOTIC TRAINING
PROSTHETIC TRAINING
THERAPEUTIC ACTIVITIES
DEV COGN SKL,ATT,MEM,DIR,EA 15
SENSOR TECH,SEN PROC,DIR,EA 15
SELF CARE MNGMENT TRAINING
COMMUNITY/WORK REINTEGRATION
WHEELCHAIR MNGMENT TRAINING
WORK HARDENING
WORK HARDENING ADD-ON
WOUND(S) CARE, SELECTIVE
WOUND(S) CARE NON-SELECTIVE
PROSTHETIC CHECKOUT
PHYSICAL PERFORMANCE TEST
ACUPUNCTURE W/O STIMUL
ACUPUNCTURE W/STIMUL
PHYSICAL MEDICINE PROCEDURE
MED NUT THER;INIT ASSESS,EA 15
97803
97804
98925
98926
98927
98928
98929
98940
98941
98942
98943
99000
99001
99002
99024
99025
99026
99027
99050
99052
99054
99056
99058
99070
99071
99075
99078
99080
99082
99090
99091
99100
99116
99135
99140
99141
99142
99170
99172
99173
99175
99183
99185
99186
99190
99191
99192
99195
99199
MED NUT THR;RE-ASSESS,EA 15 MN

MED NUTR THER;GRP(2/+),EA 30MN
OSTEOPATHIC MANIPULATION
CHIROPRACTIC MANIPULATION
SPECIMEN HANDLING
SPECIMEN HANDLING
DEVICE HANDLING
POSTOP FOLLOW-UP VISIT
INITIAL SURGICAL EVALUATION
HOSP ON CALL; IN-HOSP EACH H
HOSP ON CALL; OUT-OF-HOSP HR
MEDICAL SERVICES AFTER HRS
MEDICAL SERVICES AT NIGHT
MEDICAL SERVCS, UNUSUAL HRS
NON-OFFICE MEDICAL SERVICES
OFFICE EMERGENCY CARE
SPECIAL SUPPLIES
PATIENT EDUCATION MATERIALS
MEDICAL TESTIMONY
GROUP HEALTH EDUCATION
SPECIAL REPORTS OR FORMS
UNUSUAL PHYSICIAN TRAVEL
COMPUTER DATA ANALYSIS
COLLECT/REVIEW DATA FROM PT
SPECIAL ANESTHESIA SERVICE
ANESTHESIA WITH HYPOTHERMIA
SPECIAL ANESTHESIA PROCEDURE
EMERGENCY ANESTHESIA
SEDATION, IV/IM OR INHALANT
SEDATION, ORAL/RECTAL/NASAL
ANOGENITAL EXAM, CHILD
VIS FUNC SCRN,BILAT,ALGN,COLOR
VISUAL SCREENING TEST
INDUCTION OF VOMITING
HYPERBARIC OXYGEN THERAPY
REGIONAL HYPOTHERMIA
TOTAL BODY HYPOTHERMIA
SPECIAL PUMP SERVICES
PHLEBOTOMY
SPECIAL SERVICE/PROC/REPORT
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99217
99218
99219
99220
99221
99222
99223
99231
99232
99233
99234
99235
99236
99238
99239
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99261
99262
99263
99271
99272
99273
99274
99275
99281
99282
99283
99284
99285
99288
OFFICE/OUTPATIENT VISIT, NEW

OFFICE/OUTPATIENT VISIT, EST
OBSERVATION CARE DISCHARGE
OBSERVATION CARE
OBSERVATION CARE
OBSERVATION CARE
INITIAL HOSPITAL CARE
SUBSEQUENT HOSPITAL CARE
OBSERV/HOSP SAME DATE
HOSPITAL DISCHARGE DAY
HOSPITAL DISCHARGE DAY
OFFICE CONSULTATION
OFFICE CONSULTATION
OFFICE CONSULTATION
OFFICE CONSULTATION
OFFICE CONSULTATION
INITIAL INPATIENT CONSULT
FOLLOW-UP INPATIENT CONSULT
CONFIRMATORY CONSULTATION
EMERGENCY DEPT VISIT
DIRECT ADVANCED LIFE SUPPORT
99289
99290
99291
99292
99293
99294
99295
99296
99298
99299
99301
99302
99303
99311
99312
99313
99315
99316
99321
99322
99323
99331
99332
99333
99341
99342
99343
99344
99345
99347
99348
99349
99350
99354
99355
99356
99357
99358
99359
99360
99361
99362
99371
99372
99373
99374
99375
99377
99378
PED CRIT CARE TRANSPORT

PED CRIT CARE TRANSPORT ADDL
CRITICAL CARE, FIRST HOUR
CRITICAL CARE, ADDL 30 MIN
INITIAL PED CRITICAL CARE
SUBSEQ PED CRITICAL CARE
NEONATE CRIT CARE, INITIAL
NEONATE CRITICAL CARE SUBSEQ
IC FOR LBW INFANT < 1500 GM
IC, LBW INFANT 1500-2500 GM
NURSING FACILITY CARE
NURSING FAC CARE, SUBSEQ
NURSING FAC DISCHARGE DAY
NURSING FAC DISCHARGE DAY
REST HOME VISIT, NEW PATIENT
REST HOME VISIT, EST PAT
HOME VISIT, NEW PATIENT
HOME VISIT, EST PATIENT
PROLONGED SERVICE, OFFICE
PROLONGED SERVICE, OFFICE
PROLONGED SERVICE, INPATIENT
PROLONGED SERVICE, INPATIENT
PROLONGED SERV, W/O CONTACT
PROLONGED SERV, W/O CONTACT
PHYSICIAN STANDBY SERVICES
PHYSICIAN/TEAM CONFERENCE
PHYSICIAN/TEAM CONFERENCE
PHYSICIAN PHONE CONSULTATION
HOME HEALTH CARE SUPERVISION
HOME HEALTH CARE SUPERVISION
HOSPICE CARE SUPERVISION
HOSPICE CARE SUPERVISION
99379
99380
99381
99382
99383
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99411
99412
99420
99429
99431
99432
99433
99435
99436
99440
99450
99455
99456
99499
99500
99501
99502
99503
99504
99505
99506
99507
99509
99510
99511
99512
99551
99552
99553
NURSING FAC CARE SUPERVISION

NURSING FAC CARE SUPERVISION
PREV VISIT, NEW, INFANT
PREV VISIT, NEW, AGE 1-4
PREV VISIT, NEW, 65 & OVER
PREV VISIT, EST, INFANT
PREV VISIT, EST, AGE 1-4
PREV VISIT, EST, 65 & OVER
PREVENTIVE COUNSELING, INDIV
PREVENTIVE COUNSELING, GROUP
PREVENTIVE COUNSELING, GROUP
HEALTH RISK ASSESSMENT TEST
UNLISTED PREVENTIVE SERVICE
INITIAL CARE, NORMAL NEWBORN
NEWBORN CARE, NOT IN HOSP
NORMAL NEWBORN CARE/HOSPITAL
NEWBORN DISCHARGE DAY HOSP
ATTENDANCE, BIRTH
NEWBORN RESUSCITATION
LIFE/DISABILITY EVALUATION
DISABILITY EXAMINATION
DISABILITY EXAMINATION
UNLISTED E&M SERVICE
HOME VISIT, PRENATAL
HOME VISIT, POSTNATAL
HOME VISIT, NB CARE
HOME VISIT, RESP THERAPY
HOME VISIT MECH VENTILATOR
HOME VISIT, STOMA CARE
HOME VISIT, IM INJECTION
HOME VISIT, CATH MAINTAIN
HOME VISIT DAY LIFE ACTIVITY
HOME VISIT, SING/M/FAM COUNS
HOME VISIT, FECAL/ENEMA MGMT
HOME VISIT, HEMODIALYSIS
HOME INFUS, PAIN MGMT, IV/SC
HM INFUS PAIN MGMT, EPID/ITH
HOME INFUSE, TOCOLYTIC THRPY
99554
99555
99556
99557
99558
99559
99560
99561
99562
99563
99564
99565
99566
99567
99568
99569
99600
0001T
0002T
0003T
0005T
0006T
0007T
0008T
0009T
100
102
103
104
0010T
120
124
126
0012T
0013T
140
142
144
145
147
148
0014T
160
162
164
0016T
170
172
174
HOME INFUS, HORMONE/PLATELET

HOME INFUSE, CHEMOTHERAPHY
HOME INFUS, ANTIBIO/FUNG/VIR
HOME INFUSE, ANTICOAGULANT
HOME INFUSE, IMMUNOTHERAPY
HOME INFUS, PERITON DIALYSIS
HOME INFUS, ENTERO NUTRITION
HOME INFUSE, HYDRATION THRPY
HOME INFUS, PARENT NUTRITION
HOME ADMIN, PENTAMIDINE
HME INFUS, ANTIHEMOPHIL AGNT
HOME INFUS, PROTEINASE INHIB
HOME INFUSE,LNG TRM IV TREAT
HOME INFUSE, SYMPATH AGENT
HOME INFUS,MISC DRUG,PER VISIT
HOME INFUSE, EACH ADDL THRPY
UNLSTED HOME VST SVC/PROC
ENDOVS REP INFRARNL AAA/DISCTN
ENDOVS REP INFRARNL AAA/DISCTN
CERVICOGRAPHY
TRANSCATHETER PLACEMENT
UGI ENDOSCOPY
ENDOMETRIAL CRYOABLATION
ANESTH, SALIVARY GLAND
ANESTH, REPAIR OF CLEFT LIP
ANESTH, BLEPHAROPLASTY
ANESTH, ELECTROSHOCK
TUBERCULOSIS TEST
ANESTH, EAR SURGERY
ANESTH, EAR EXAM
ANESTH, TYMPANOTOMY
ARTHRS,KNEE,SUR,IMPLANT GRAFT
ARTHRS,KNEE,SUR,IMPLANT GRAFT
ANESTH, PROCEDURES ON EYE
ANESTH, LENS SURGERY
ANESTH, CORNEAL TRANSPLANT
ANESTHES,VITREORETINAL SURGERY
ANESTH, IRIDECTOMY
ANESTH, EYE EXAM
MENISCAL TRANSPLANTATION
ANESTH, NOSE/SINUS SURGERY
ANESTH, NOSE/SINUS SURGERY
ANESTH, BIOPSY OF NOSE
DESTRCTN,LOCLZD LESION CHOROID
ANESTH, PROCEDURE ON MOUTH
ANESTH, CLEFT PALATE REPAIR
ANESTH, PHARYNGEAL SURGERY
176
0017T
0018T
190
192
0019T
0020T
210
212
214
215
216
218
0021T
220
222
0023T
0024T
0025T
0026T
0027T
0028T
0029T
300
0030T
0031T
320
322
326
0032T
0033T
0034T
350
352
0035T
0036T
0037T
0038T
0039T
400
402
404
406
0040T
410
0041T
0042T
0043T
0044T
ANESTH, PHARYNGEAL SURGERY

DESTRUCTION OF MACULAR DRUSEN
DELVRY MAGNETC PULSES
ANES,FACIAL BONE/SKULL;NOS
ANES,FACE BNE/SKULL;RADCL SURG
EXTRACORPOREAL SHOCK WAVE TX
EXTRACORPOREAL SHOCK WAVE TX
ANESTH, OPEN HEAD SURGERY
ANESTH, SKULL DRAINAGE
ANESTH, SKULL DRAINAGE
ANES INTRACRN;CRANIOPLS,XTRADR
ANESTH, HEAD VESSEL SURGERY
ANESTH, SPECIAL HEAD SURGERY
TRANSCERV/TRANSVAG FETAL SENSR
ANESTH, INTRCRN NERVE
ANESTH, HEAD NERVE SURGERY
INFCT AGT DRG PHENTP PREDCT
NON-SX SEPTAL REDUCT TX
DETERMINATN,CORNEAL THICKNESS
LIPOPROTEIN,DIR MEASUREMNT
ENDOSCOPIC EPIDURAL LYSIS
DEXA BODY COMPOSITION STUDY
MAGNETIC TX FOR INCONTINENCE
ANESTH, HEAD/NECK/PTRUNK
ANTIPROTHROMBIN ANTIBODY
SPECULOSCOPY
ANESTH, NECK ORGAN, 1 & OVER
ANESTH, BIOPSY OF THYROID
ANESTH, LARYNX/TRACH, < 1 YR
SPECULOSCOPY W/DIRECT SAMPLE
ENDOVASC TAA REPR INCL SUBCL
ENDOVASC TAA REPR W/O SUBCL
ANESTH, NECK VESSEL SURGERY
ANESTH, NECK VESSEL SURGERY
INSERT ENDOVASC PROSTH, TAA
ENDOVASC PROSTH, TAA, ADD-ON
ARTERY TRANSPOSE/ENDOVAS TAA
RAD ENDOVASC TAA RPR W/COVER
RAD S/I, ENDOVASC TAA REPAIR
ANESTH, SKIN, EXT/PER/ATRUNK
ANESTH, SURGERY OF BREAST
RAD S/I, ENDOVASC TAA PROSTH
ANESTH, CORRECT HEART RHYTHM
DETECT UR INFECT AGNT W/CPAS
CT PERFUSION W/CONTRAST, CBF
CO EXPIRED GAS ANALYSIS
WHOLE BODY PHOTOGRAPHY
450
452
454
470
472
474
500
520
522
524
528
530
532
534
537
539
540
541
542
544
546
548
550
560
562
563
566
580
600
604
620
622
630
632
634
635
640
670
700
702
730
740
750
752
754
756
770
790
792
ANESTH, SURGERY OF SHOULDER

ANESTH, COLLAR BONE BIOPSY
ANESTH, REMOVAL OF RIB
ANESTH, CHEST WALL REPAIR
ANESTH, SURGERY OF RIB(S)
ANESTH, ESOPHAGEAL SURGERY
ANESTH, CHEST PROCEDURE
ANESTH, CHEST LINING BIOPSY
ANESTH, CHEST DRAINAGE
ANESTH, CHEST PARTITION VIEW
ANES,PERM TRANSVEN PACEMKR
ANESTH, VASCULAR ACCESS
ANES,TRANSVEN CARDIVRTR-DEFIB
ANES CARD ELECTROPHY,RAD ABLAT
ANES, TRACHEOBRONCH RECONS
ANESTH, CHEST SURGERY
ANESTH, ONE LUNG VENTILATION
ANESTH, RELEASE OF LUNG
ANESTH, CHEST LINING REMOVAL
ANESTH, LUNG,CHEST WALL SURG
ANESTH, TRACHEA,BRONCHI SURG
ANES FOR STERNAL DEBRIDEMENT
ANESTH, OPEN HEART SURGERY
ANESTH, OPEN HEART SURGERY
ANESTH, HEART PROC W/PUMP
ANES COR ART BYP GF WO PMP OXY
ANESTH HEART/LUNG TRANSPLANT
ANESTH, SPINE, CORD SURGERY
ANES,PROC,CERVCL SPN & CORD
ANESTH, REMOVAL OF NERVES
ANESTH, REMOVAL OF NERVES
ANESTH FOR CHEMONUCLEOLYSIS
ANES LUMB;DIAG/THER LMBR PUNCT
ANESTH, SPINE MANIPULATION
ANES,XTENSIVE SPINE&SPINL CORD
ANESTH, ABDOMINAL WALL SURG
ANESTH, FOR LIVER BIOPSY
ANESTH, UPPER GI VISUALIZE
ANESTH, REPAIR OF HERNIA
ANESTH, BLOOD VESSEL REPAIR
ANESTH, SURG UPPER ABDOMEN
ANES INTRPERIT PROC IN UP ABD
794
796
797
800
802
810
820
830
832
834
836
840
842
844
846
848
851
860
862
864
865
866
868
870
872
873
880
882
902
904
906
908
910
912
914
916
918
920
921
922
924
926
928
930
932
934
936
938
940
ANESTH, PANCREAS REMOVAL

ANESTH, FOR LIVER TRANSPLANT
ANESTH, SURGERY FOR OBESITY
ANESTH, FAT LAYER REMOVAL
ANESTH, LOW INTESTINE SCOPE
ANESTH, HERNIA REPAIR< 1 YR
ANESTH HERNIA REPAIR PREEMIE
ANESTH, SURG LOWER ABDOMEN
ANESTH, AMNIOCENTESIS
ANESTH, PELVIS SURGERY
ANESTH, HYSTERECTOMY
ANESTH, PELVIC ORGAN SURG
ANESTH, TUBAL LIGATION
ANESTH, SURGERY OF ABDOMEN
ANESTH, KIDNEY/URETER SURG
ANESTH, REMOVAL OF BLADDER
ANESTH, REMOVAL OF PROSTATE
ANESTH, REMOVAL OF ADRENAL
ANESTH, KIDNEY TRANSPLANT
ANESTH, BLADDER STONE SURG
ANESTH KIDNEY STONE DESTRUCT
ANESTH KIDNEY STONE DESTRUCT
ANESTH, ABDOMEN VESSEL SURG
ANESTH, MAJOR VEIN LIGATION
ANESTHESIA,ANORECTAL PROCEDURE
ANESTHESIA,RADCL PERINEAL PROC
ANESTHESIA FOR; VULVECTOMY
ANES,PERINEAL PROSTATECTOMY
ANESTH, BLADDER SURGERY
ANESTH, BLADDER TUMOR SURG
ANESTH, REMOVAL OF PROSTATE
ANESTH, BLEEDING CONTROL
ANESTH, STONE REMOVAL
ANES,MALE GEN(INC OP URTH);NOS
ANESTH, VASECTOMY
ANES,MALE GEN(URTH);SEMIN VES
ANES,MALE GEN;UNDESCND TESTI
ANS,ML GEN;RAD ORCHIECT,INGUIN
ANES,MALE GEN;RAD ORCHIECT,ABD
ANES,MALE GEN;ORCHIOPX, UNI/BI
ANES,MALE GEN;COMP AMP,PENIS
ANS,ML GEN;BI NGUIN LYMPHADNCT
ANS,ML GN; NGUIN&IL LYMPHDNCT
ANS,ML GEN;INSRT PENILE PROSTH
ANESTH, VAGINAL PROCEDURES
942
944
948
950
952
1112
1120
1130
1140
1150
1160
1170
1180
1190
1200
1202
1210
1212
1214
1215
1220
1230
1232
1234
1250
1260
1270
1272
1274
1320
1340
1360
1380
1382
1390
1392
1400
1402
1404
1420
1430
1432
1440
1442
1444
1462
1464
1470
1472
ANESTH, SURG ON VAG/URETHAL

ANESTH, VAGINAL HYSTERECTOMY
ANESTH, REPAIR OF CERVIX
ANESTH, VAGINAL ENDOSCOPY
ANESTH, HYSTEROSCOPE/GRAPH
ANES BNE MAR ASP/BX,ILIAC CRST
ANESTH, BODY CAST PROCEDURE
ANESTH, AMPUTATION AT PELVIS
ANESTH, PELVIC TUMOR SURGERY
ANESTH, PELVIS PROCEDURE
ANESTH, PELVIS NERVE REMOVAL
ANESTH, PELVIS NERVE REMOVAL
ANESTH, HIP JOINT PROCEDURE
ANESTH, ARTHROSCOPY OF HIP
ANESTH, HIP JOINT SURGERY
ANESTH, HIP DISARTICULATION
ANESTH, HIP ARTHROPLASTY
ANES OPN,HIP JT;TOT HIP ARTHRO
ANESTH, PROCEDURE ON FEMUR
ANESTH, SURGERY OF FEMUR
ANESTH, AMPUTATION OF FEMUR
ANESTH, RADICAL FEMUR SURG
ANESTH, UPPER LEG SURGERY
ANESTH, UPPER LEG VEINS SURG
ANESTH, THIGH ARTERIES SURG
ANESTH, FEMORAL ARTERY SURG
ANESTH, FEMORAL EMBOLECTOMY
ANESTH, KNEE AREA SURGERY
ANESTH, KNEE AREA PROCEDURE
ANESTH, KNEE JOINT PROCEDURE
ANESTH, DX ARTHROSCOPY KNEE
ANESTH, KNEE AREA PROCEDURE
ANESTH, SURGERY KNEE JOINT
ANESTH, KNEE ARTHROPLASTY
ANESTH,DISARTICULATION AT KNEE
ANESTH, KNEE JOINT CASTING
ANESTH, KNEE VEINS SURGERY
ANESTH, KNEE VESSEL SURG
ANESTH, KNEE ARTERIES SURG
ANESTH, KNEE ARTERY SURG
ANESTH, KNEE ARTERY REPAIR
ANESTH, LOWER LEG PROCEDURE
ANESTH, ARTHROSCOPY ANKLE/FT
ANESTH, LOWER LEG SURGERY
ANESTH, ACHILLES TENDON SURG
1474
1480
1482
1484
1486
1490
1500
1502
1520
1522
1610
1620
1622
1630
1632
1634
1636
1638
1650
1652
1654
1656
1670
1680
1682
1710
1712
1714
1716
1730
1732
1740
1742
1744
1756
1758
1760
1770
1772
1780
1782
1810
1820
1829
1830
1832
1840
1842
1844
ANESTH, LOWER LEG SURGERY

ANESTH, LOWER LEG BONE SURG
ANS OPN,PRC BNE LOW LEG,ANK,FT
ANESTH, LOWER LEG REVISION
ANESTH, ANKLE REPLACEMENT
ANESTH, LOWER LEG CASTING
ANESTH, LEG ARTERIES SURG
ANESTH, LWR LEG EMBOLECTOMY
ANESTH, LOWER LEG VEIN SURG
ANESTH, LOWER LEG VEIN SURG
ANESTH, SHOULDER PROCEDURE
ANES DX ARTHROSCOPY SHOULDER
ANESTH,SURG ARTHROSCP SHOULDER
ANES,SURG OF SHOULDER RAD RESE
ANES, DISARTICULATION SHOULDER
ANESTH, SURG FOREQUARTER AMPUT
ANESTH, SHOULDER REPLACEMENT
ANESTH, SHOULDER ARTERY SURG
ANESTH, SHOULDER VESSEL SURG
ANESTH, SHOULDER VESSEL SURG
ANESTH, ARM-LEG VESSEL SURG
ANESTH, SHOULDER VEIN SURG
ANESTH, SHOULDER CASTING
ANESTH, AIRPLANE CAST
ANESTH, ELBOW AREA SURGERY
ANESTH, UPPR ARM TENDON SURG
ANESTH, UPPR ARM TENDON SURG
ANESTH, BICEPS TENDON REPAIR
ANESTH, UPPR ARM PROCEDURE
ANESTH, DX ARTHROSCOPY ELBOW
ANESTH, SURG ARTHROSCOPY ELBOW
ANESTH, SURG OSTEOTOMY HUMERUS
ANESTH, SURG REPAIR HUMERUS
ANESTH,SURG ARTH EBOW RAD PROC
ANESTH,SURG EBOW EXCS HUMERAL
ANESTH, ELBOW REPLACEMENT
ANESTH, UPPR ARM ARTERY SURG
ANESTH, UPPR ARM EMBOLECTOMY
ANESTH, UPPER ARM VEIN SURG
ANESTH, UPPR ARM VEIN REPAIR
ANESTH, LOWER ARM SURGERY
ANESTH, LOWER ARM PROCEDURE
ANESTH, DX WRIST ARTHROSCOPY
ANESTH, SURG ARTHRO HAND JOINT
ANESTH, WRIST REPLACEMENT
ANESTH, LWR ARM ARTERY SURG
ANESTH, LWR ARM EMBOLECTOMY
ANESTH, VASCULAR SHUNT SURG
1850
1852
1860
1905
1916
1920
1922
1924
1925
1926
1930
1931
1932
1933
1951
1952
1953
1960
1961
1962
1963
1964
1967
1968
1969
1990
1991
1992
1995
1996
1999
A0021
A0080
A0090
A0100
A0110
A0120
A0130
A0140
A0160
A0170
A0180
A0190
A0200
A0210
A0225
A0380
A0382
A0384
ANESTH, LOWER ARM VEIN SURG

ANESTH, LWR ARM VEIN REPAIR
ANESTH, LOWER ARM CASTING
ANES, SPINE INJECT, X-RAY/RE
ANESTH, DX ARTERIOGRAPHY
ANESTH, CATHETERIZE HEART
ANESTH, CAT OR MRI SCAN
ANES, THER INTERVEN RAD, ART
ANES, THER INTERVEN RAD, CAR
ANES, TX INTERV RAD HRT/CRAN
ANES, THER INTERVEN RAD, VEI
ANES, THER INTERVEN RAD, TIP
ANES, TX INTERV RAD, TH VEIN
ANES, TX INTERV RAD, CRAN V
ANESTH, BURN, LESS 4 PERCENT
ANESTH, BURN, 4-9 PERCENT
ANESTH, BURN, EACH 9 PERCENT
ANESTH, VAGINAL DELIVERY
ANESTH, CESAREAN DELIVERY
ANESTH, URGENT HYSTERECTOMY
ANESTH, CESAREAN HYST WO LABOR
ANESTH, ABORTION PROCEDURES
ANESTH/ANALG, VAG DELIVERY
ANES CS DELIV NEURAXIAL LABOR
ANES CS DELIV HYST NEURAX LABR
SUPPORT FOR ORGAN DONOR
ANESTH, NERVE BLOCK/INJ
ANESTH, N BLOCK/INJ, PRONE
REGIONAL ANESTHESIA LIMB
HOSP MANAGE CONT DRUG ADMIN
UNLISTED ANESTH PROCEDURE
OUTSIDE STATE AMBULANCE SERV
NON-EMERG,/MILE-VOLUNTER VHCL
NON-EMERG,/MILE-VHCL INDVDUAL
NON-EMRGNCY TRNSPRTATION; TAXI
NONEMERGENCY TRANSPORT BUS
NON-EMERG: MINI-BUS,/ OTHER
NONER TRANSPORT WHEELCH VAN
NONEMERGENCY TRANSPORT AIR
NONER TRANSPORT CASE WORKER
TRANSPORT ANCILLARY:PARK FEES
NONER TRANSPORT LODGNG RECIP
NONER TRANSPORT MEALS RECIP
NONER TRANSPORT LODGNG ESCRT
NONER TRANSPORT MEALS ESCORT
NEONATAL EMERGENCY TRANSPORT
BASIC LIFE SUPPORT MILEAGE
BLS ROUTINE DISPOS SUPPLIES
BLS DEFIBRILLATION SUPPLIES
A0390
A0392
A0394
A0396
A0398
A0420
A0422
A0424
A0425
A0426
A0427
A0428
A0429
A0430
A0431
A0432
A0433
A0434
A0435
A0436
A0888
A0999
A4206
A4207
A4208
A4209
A4210
A4211
A4212
A4213
A4214
A4215
A4220
A4221
A4222
A4230
A4231
A4232
A4244
A4245
A4246
A4247
A4250
A4253
A4254
A4255
A4256
A4257
A4258
ADVANCED LIFE SUPPORT MILEAG

ALS DEFIBRILLATION SUPPLIES
ALS IV DRUG THERAPY SUPPLIES
ALS ESOPHAGEAL INTUB SUPPLS
ALS ROUTINE DISPOSABLE SUPPLS
AMBULANCE WAIT 1/2 HR INCRMTS
ALS/BLS 02 LIFE SUSTAIN SIT
EXTRA AMBULANCE ATTENDANT,AIR
GROUND MILEAGE,PER STATUTE MLE
AMB SRV,ADV LF SPT,NON-EMG,LV1
AMB SRV,ADV LF SPT,EMRG,LEVEL1
AMB SRV,BSC LF SPT,NON-EMR TRN
AMB SRV,BSC LF SPT,EMERG TRNSP
AMB,CONVN AIR,TRNS,1WY FXD WNG
AMB,CONVN AIR,TRNS,1WY RTR WNG
PI,RURL,VOLUN AMB,PRHB,3RD PTY
ADVND LF SPPRT,LEVEL 2 (ALS 2)
SPECIALTY CARE TRANSPORT (SCT)
FXD WNG AR MLG,PER STATUTE MLE
RTRY WNG AIR MLG,PER STAT MILE
NONCOVERED AMBULANCE MILEAGE
UNLISTED AMBULANCE SERVICE
1 CC STERILE SYRINGE&NEEDLE
5+ CC STERILE SYRINGE&NEEDLE
NONNEEDLE INJECTION DEVICE
SUPP FOR SELF-ADM INJECTIONS
NON CORING NEEDLE OR STYLET
20+ CC SYRINGE ONLY
30 CC STERILE WATER/ SALINE
STERILE NEEDLE
INFUSION PUMP REFILL KIT
MAINT DRUG INFUS CATH PER WK
DRUG INFUSION PUMP SUPPLIES
INFUS INSULIN PUMP NON NEEDLE
INFUSION INSULIN PUMP NEEDLE
SYRINGE W/NEEDLE INSULIN 3CC
ALCOHOL OR PEROXIDE PER PINT
ALCOHOL WIPES PER BOX
BETADINE/PHISOHEX SOLUTION
BETADINE/IODINE SWABS/ WIPES
URINE REAGENT STRIPS/ TABLETS
BLOOD GLUCOSE/REAGENT STRIPS
BATTERY FOR GLUCOSE MONITOR
GLUCOSE MONITOR PLATFORMS
CALIBRATOR SOLUTION/CHIPS
REPLACE LENSSHIELD CARTRIDGE
LANCET DEVICE EACH
A4259
A4260
A4261
A4262
A4263
A4265
A4266
A4267
A4268
A4269
A4270
A4280
A4281
A4282
A4283
A4284
A4285
A4286
A4290
A4300
A4301
A4305
A4306
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4319
A4320
A4321
A4322
A4323
A4324
A4325
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4338
A4340
A4344
LANCETS PER BOX

LEVONORGESTREL IMPLANT
CERV CAP FOR CONTRACEPTION USE
TEMPORARY TEAR DUCT PLUG
PERMANENT TEAR DUCT PLUG
PARAFFIN
DIAPHRAGM, CONTRACEPTIVE USE
CONTRACEPTIVE,CONDOM,MALE
CONTRACEPTIVE,CONDOM,FEMALE
CONTRACEPTIVE,SPERMICIDE
DISPOSABLE ENDOSCOPE SHEATH
ADH SKN SUP,EXT BREAST PROS,EA
TUBING FOR BREAST PUMP
ADAPTER FOR BREAST PUMP
CAP FOR BREAST PUMP BOTTLE
BREST SHIELD&SPLASH PROTECTOR
POLYCARBONATE BOTTLE,REPLACE
LOCKING RING FOR BREAST PUMP
SACRL NRV STMLTN TST LEAD,EACH
CATH IMPL VASC ACCESS PORTAL
IMPLANTABLE ACCESS TOTAL CATH
DRUG DELIVERY SYSTEM >=50 ML
DRUG DELIVERY SYSTEM <=5 ML
INSERT TRAY W/O BAG/ CATH
CATHETER W/O BAG 2-WAY LATEX
CATH W/O BAG 2-WAY SILICONE
CATHETER W/BAG 3-WAY
CATH W/DRAINAGE 2-WAY LATEX
CATH W/DRAINAGE 2-WAY SILCNE
CATH W/DRAINAGE 3-WAY
STRLE WTR IRGTN SLTION,1000 ML
IRRIGATION TRAY
CATH THERAPEUTIC IRRIG AGENT
IRRIGATION SYRINGE
SALINE IRRIGATION SOLUTION
MLE EXTNL CATH,W ADHSV CTNG,EA
MLE EXTNL CATH,W ADHSV STRP,EA
MALE EXTERNAL CATHETER
FEM URINARY COLLECT DEV CUP
FEM URINARY COLLECT POUCH
STOOL COLLECTION POUCH
EXT DRNG TBG,TP,LEN,W CNCT/ADP
LUBRCT,IND STRL,INSRT URIN CTH
URN CATH ANCHR,ADHSV SKN ATTCH
URN CATH ANCHR,LEG STRAP, EACH
INCONTINENCE SUPPLY
INDWELLING CATHETER LATEX
INDWELLING CATHETER SPECIAL
CATH INDW FOLEY 2 WAY SILICN
A4346
A4347
A4348
A4351
A4352
A4353
A4354
A4355
A4356
A4357
A4358
A4359
A4361
A4362
A4364
A4365
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4400
A4402
A4404
CATH INDW FOLEY 3 WAY

MALE EXTERNAL CATHETER
MAL EXT CTH W INTG CMPT,EXT WR
STRAIGHT TIP URINE CATHETER
COUDE TIP URINARY CATHETER
INTERMTTNT URINARY CATH W/SPLY
CATH INSERT TRY W/BAG W/O CATH
BLADDER IRRIGATION TUBING
EXT URETH CLMP OR COMPR DVC
BEDSIDE DRAINAGE BAG
URINARY LEG OR ABDOMEN BAG
URINARY SUSPENSORY W/O LEG B
OSTOMY FACE PLATE
SOLID SKIN BARRIER
ADHESIVE,LIQUID,/=,ANY TYPE
ADHS REMOVR WIPE,ANY TYP,PR 50
OSTOMY BELT
OSTOMY FILTER
OSTOMY SKIN BARR, LIQ, PER OZ
OSTOMY SKIN BARR,POWDER,PER OZ
OSTOMY BARRIER,4X4,W CONVEXTY
OSTOMY BARRER,W FLNG,W CNVXTY
OSTOMY PCH,DRN,FCE ATT,PLST,EA
OSTOMY PCH,DRN,FCE ATT,RUBB,EA
OSTOMY PCH,DRN USE FCE,PLAS,EA
OSTOMY PCH,DRN USE FCE,RUBB,EA
OSTOMY PCH,URI,FCE ATT,PLST,EA
OSTOMY PCH,URI,FCE ATT,RUBB,EA
OSTMOMY POUCH,URN,FCEPLT,PLSTC
OSTOMY PCH,UR,USE FCE,HV PL,EA
OSTOMY PCH,URI,USE FACE,RUB,EA
OSTOMY FACEPL EQU,SILIC RNG,EA
OSTOMY SKN BAR,4X4,WO CONVX,EA
OSTOMY,CLSD,W BARRIER ATTACH
OSTOMY,DRAIN,W EXTEND BARRIER
OSTOMY,DRAIN,W BARRIER ATTACH
OSTOMY POUCH,DRAIN,EXT,CONV,EA
OSTOMY,URIN,W EXTEND BARRIER
OSTOMY POUCH,URI,STD,CONVEX,EA
OSTOMY POUCH,URI,EXT,CONVEX,EA
OSTOMY DEODORANT,LIQ,/FLUID OZ
OSTOMY DEODORANT,SOLID,/TABLET
OSTOMY BLT W PERSTML HRN SUPPT
IRRIGATION SUPPLY SLEEVE
OSTOMY IRRIGATION BAG
OSTOMY IRRIG CONE/CATH W BRS
OSTOMY IRRIGATION SET
LUBRICANT PER OUNCE
OSTOMY RING EACH
A4405
A4406
A4407
A4408
A4409
A4410
A4413
A4414
A4415
A4421
A4422
A4450
A4452
A4455
A4458
A4462
A4465
A4470
A4480
A4481
A4483
A4490
A4495
A4500
A4510
A4521
A4522
A4523
A4524
A4525
A4526
A4527
A4528
A4529
A4530
A4531
A4532
A4533
A4534
A4535
A4536
A4537
A4538
A4550
A4554
A4556
A4557
A4558
A4561
OSTOMY BARRIER,NON-PECTIN BSED

OSTOMY BARRIER,PECTIN-BASED
OSTOMY SKIN,W CNVXTY,4 X 4/<
OSTOMY SKIN,W CNVXTY,> 4 X 4
OSTOMY SKIN,WO CNVXTY,4 X 4
OSTOMY SKIN,WO CNVXTY, > 4 X 4
OSTOMY POUCH,DRAIN,HIGH OUTPUT
OSTOMY,W FLNG,WO CNVTY,4 X 4/<
OSTOMY,W FLNG,WO CNVTY,>4X4
OSTOMY SUPPLY MISC
OSTOMY ABSORB MATERIAL,POUCH
TAPE,NON-H20PROOF,PER 18 SQ IN
TAPE,H20PROOF,PER 18 SQ IN
ADHESIVE REMOVER PER OUNCE
ENEMA BAG W TUBING,REUSABLE
ABDOMINAL DRESS HOLDER, EACH
NON-ELASTIC EXTREMITY BINDER
GRAVLEE JET WASHER
VABRA ASPIRATOR
TRACHEOSTOMA FILTER
MOIST EXCH,DISP,INVAS MECH VEN
ABOVE KNEE SURGICAL STOCKING
THIGH LENGTH SURG STOCKING
BELOW KNEE SURGICAL STOCKING
FULL LENGTH SURG STOCKING
ADULT-SZ,DIAPER,SM SIZE,EACH
ADULT-SZ,DIAPER,MED SIZE,EACH
ADULT-SZ,DIAPER,LG SIZE, EACH
ADULT-SZ,DIAPER,XL SIZE,EACH
ADULT-SZ,BRIEF,SM SIZE, EACH
ADULT-SZ,BRIEF,MED SIZE, EACH
ADULT-SZ,BRIEF,LG SIZE, EACH
ADULT-SZ,BRIEF,XL SIZE,EACH
CHILD-SZ,DIAPER,SM/MED SIZE
CHILD-SZ,DIAPER,LG SIZE,EACH
CHILD-SZ,BRIEF,SM/MED SIZE
CHILD-SZ,BRIEF,LG SIZE,EACH
CHILD-SZ,DIAPER, EACH
CHILD-SZ,BRIEF, EACH
DISPOSABLE LINER/SHIELD
PROTECTIVE UNDERWEAR, WASHABLE
UNDER PAD, REUSABLE/WASHABLE
DIAPER SERVICE, REUSABLE DIAPE
SURGICAL TRAYS
DISPOSABLE UNDERPADS
ELECTRODES, PER PAIR
LEAD WIRES, PER PAIR
CONDUCTIVE PASTE OR GEL
PESSARY, RUBBER, ANY TYPE
A4562
A4565
A4570
A4575
A4580
A4590
A4595
A4606
A4608
A4609
A4610
A4611
A4612
A4613
A4614
A4615
A4616
A4617
A4618
A4619
A4620
A4621
A4622
A4623
A4624
A4625
A4626
A4627
A4628
A4629
A4630
A4631
A4632
A4633
A4634
A4635
A4636
A4637
A4639
A4640
A4641
A4642
A4643
A4644
A4645
A4646
A4647
A4649
A4651
PESSARY, NON RUBBER, ANY TYPE

SLINGS
SPLINT
HYPERBARIC O2 CHAMBER DISPS
CAST SUPPLIES (PLASTER)
SPECIAL CASTING MATERIAL
ELECTRIC STIMULATOR SUPPLIES
OXYGEN PROBE W OXIMETER DEVICE
TRANSTRACHEAL OXYGEN CATH,EACH
TRACHEAL SUCTION CATH,< 72 HRS
TRACHEAL SUCTION CATH,72/+ HRS
HEAVY DUTY BATTERY
BATTERY CABLES
BATTERY CHARGER
PEAK EXPIR FLOW RATE MET, HAND
CANNULA NASAL
TUBING (OXYGEN) PER FOOT
MOUTH PIECE
BREATHING CIRCUITS
FACE TENT
VARIABLE CONCENTRATION MASK
TRACHEOTOMY MASK OR COLLAR
TRACHEOSTOMY OR LARNGECTOMY
TRACHEOSTOMY INNER CANNULA
TRACHEAL SUCTION CATHETER
TRACH CARE KIT FOR NEW TRACH
TRACHEOSTOMY CLEANING BRUSH
SPACER BAG/RESERVOIR
OROPHARYNGEAL SUCTION CATH
TRACHEOSTOMY CARE KIT
REPL BAT TENS OWN BY PT
WHEELCHAIR BATTERY
REPLACE BATRY,EXTERN INFUSION
REPLACE BULB ULTRAVIOLET THRPY
REPLACE BULB THERAPEUTIC BOX
UNDERARM CRUTCH PAD
HANDGRIP FOR CANE ETC
REPL TIP CANE/CRUTCH/ WALKER
REPLACE PAD INFRARED HEATING
ALTERNATING PRESS PAD RPLCMNT
DIAGNOSTIC IMAGING AGENT
SATUMOMAB PENDETIDE PER DOSE
HIGH DOSE CONTRAST MRI
CONTRAST 100-199 MGS IODINE
SUPP- PARAMAGNETIC CONTR MAT
SURGICAL SUPPLIES
CALIBRATED MICROCAP TUBE
A4652
A4653
A4656
A4657
A4660
A4663
A4670
A4680
A4690
A4706
A4707
A4708
A4709
A4712
A4714
A4719
A4720
A4721
A4722
A4723
A4724
A4725
A4726
A4730
A4736
A4737
A4740
A4750
A4755
A4760
A4765
A4766
A4770
A4771
A4772
A4773
A4774
A4802
A4860
A4870
A4890
A4911
A4913
A4918
A4927
A4928
A4929
A4930
A4931
MICROCAPILLARY TUBE SEALANT

PERITONEAL DIALYSI CATH ANCHOR
NEEDLE, ANY SIZE, EACH
SYRINGE, W/WO NEEDLE, EACH
SPHYGMOMANO & STETHOSCOPE
BLOOD PRESSURE CUFF ONLY
AUTOMATIC BLD PRESS MONITOR
ACTIFICIAL CARBON FILTER, EA
DIALYZER, EACH
BICARBONATE CONC SOL PER GAL
BICARBONATE CONC POW PER PAC
ACETATE CONC SOL PER GALLON
ACID CONC SOL PER GALLON
H20,STERILE,INJECTION,/10 ML
TREATED WATER PER GALLON
"Y SET" TUBING
DIALYSAT SOL FLD VOL > 249CC
DIALYSAT SOL FLD VOL > 999CC
DIALYS SOL FLD VOL > 1999CC
FISTULA CANNULATION SET, EA
TOPICAL ANESTHETIC, PER GRAM
INJ ANESTHETIC PER 10 ML
SHUNT ACCESSORY
ART OR VENOUS BLOOD TUBING
COMB ART/VENOUS BLOOD TUBING
DIALYSATE SOL TEST KIT, EACH
DIALYSATE CONC POW PER PACK
DIALYSATE CONC SOL ADD 10 ML
BLOOD COLLECTION TUBE/VACUUM
SERUM CLOTTING TIME TUBE
BLOOD GLUCOSE TEST STRIPS
OCCULT BLOOD TEST STRIPS
AMMONIA TEST STRIPS
PROTAMINE SULFATE PER 50 MG
DISPOSABLE CATHETER TIPS
PLUMB/ELEC WK HM HEMO EQUIP
REPAIR/MAINT CONT HEMO EQUIP
DRAIN BAG/BOTTLE
MISC DIALYSIS SUPPLIES NOC
VENOUS PRESSURE CLAMP
GLOVES, NON-STERILE, PER 100
SURGICAL MASK, PER 20
TOURNIQUET FOR DIALYSIS, EA
GLOVES, STERILE, PER PAIR
ORAL THERMOMETER, REUSABLE
A4932
A5051
A5052
A5053
A5054
A5055
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5093
A5102
A5105
A5112
A5113
A5114
A5119
A5121
A5122
A5126
A5131
A5200
A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
A5509
A5510
A5511
A6000
A6010
A6011
A6021
A6022
A6023
A6024
A6025
A6154
A6196
A6197
A6198
RECTAL THERMOMETER, REUSABLE

OSTOMY,CLSD;W BARRIER,EACH
OSTOMY,CLSD;WO BARRIER,EACH
OSTOMY,CLSD;ON FACEPLATE,EA
OSTOMY,CLSD;ON BARR W FLNGE
STOMA CAP
OSTOMY,DRAIN;W BARRIER,EACH
OSTOMY,DRAIN;WO BARRIER,EA
OSTOMY,DRAIN;ON BARRI W FLG
OSTOMY,URIN;W BARRIER, EACH
OSTOMY,URIN;WO BARRIER,EACH
OSTOMY,URIN;BARRI W FLANGE
CONTINENT STOMA PLUG
CONTINENT STOMA CATHETER
OSTOMY ACCESSORY CONVEX INSE
BEDSIDE DRAIN BTL W/WO TUBE
URINARY SUSPENSORY
URINARY LEG BAG
LEG STRAP;LATEX, REPL ONLY/SET
LEG STRP;FOAM/FAB,REP ONLY/SET
SKIN BARRIER WIPES BOX PR 50
SOLID SKIN BARRIER 6X6
SOLID SKIN BARRIER 8X8
ADHES/NON-ADHES; DISK/FOAM PAD
APPLIANCE CLEANER
PERCUT CATH/TUBE ANCH,ADH SKIN
DIAB SHOE FOR DENSITY INSERT
DIABETIC CUSTOM MOLDED SHOE
DIABETIC SHOE W/ROLLER/ ROCKR
DIABETIC SHOE WITH WEDGE
DIAB SHOE W/METATARSAL BAR
DIABETIC SHOE W/OFF SET HEEL
MODIFICATION DIABETIC SHOE
DIABET,OTS-DEP-INLAY SHOE/SHOE
DIRECT HEAT FORM SHOE INSERT
COMPRESSION FORM SHOE INSERT
CUSTOM FAB MOLDED SHOE INSER
WOUND WARMING WOUND COVER
COLLAGEN BASED WOUND FILLER
COLLAGEN BASED WOUND FILER,GEL
CLLGEN DRG,PD SZ16SQ IN OR<,EA
CLGN DRG,PD SZ>16 /<=48SQIN,EA
CLGN DRG,PD SZ>THN 48 SQ IN,EA
CLGN DRG WND FILL,PER 6 INCHES
SILICONE GEL SHEET, EACH
WOUND POUCH EACH
ALGINATE DRESSING <=16 SQ IN
ALGINATE DRSG >16 <=48 SQ IN
ALGINATE DRESSING > 48 SQ IN
A6199
A6200
A6201
A6202
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220
A6221
A6222
A6223
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
A6248
A6250
A6251
ALGINATE DRSG WOUND FILLER

COMP DRESS,16 SQ/IN OR <, EACH
COMP DRESS, > 16, <= 48 SQ/IN
COMP DRESS, > 48 SQ/IN, EACH
COMPOSITE DRSG <= 16 SQ IN
COMPOSITE DRSG >16<=48 SQ IN
COMPOSITE DRSG > 48 SQ IN
CONTACT LAYER <= 16 SQ IN
CONTACT LAYER >16<= 48 SQ IN
CONTACT LAYER > 48 SQ IN
FOAM DRSG <=16 SQ IN W/ O BDR
FOAM DRG >16<=48 SQ IN W/O B
FOAM DRG > 48 SQ IN W/O BRDR
FOAM DRG <=16 SQ IN W/ BORDER
FOAM DRG >16<=48 SQ IN W/BDR
FOAM DRG > 48 SQ IN W/ BORDER
FOAM DRESSING WOUND FILLER
NON-STERILE GAUZE<=16 SQ IN
NON-STERILE GAUZE>16<=48 SQ
NON-STERILE GAUZE > 48 SQ IN
GAUZE <= 16 SQ IN W/ BORDER
GAUZE >16 <=48 SQ IN W/ BORDR
GAUZE > 48 SQ IN W/ BORDER
GZ,IMPRG,PD SZ 16SQ.IN.OR<
GZ,PD SZ>16SQ.IN.<=48SQ.IN
GZ,IMPRG,PD SZ>48SQ.IN
GAUZE <= 16 SQ IN WATER/ SAL
GAUZE >16<=48 SQ IN WATR/SAL
GAUZE > 48 SQ IN WATER/ SALNE
GZ,IMP,HYD,DIR WND,PD16SQIN<EA
GZ,DIR WND,PD>16<OR=48SQ IN,EA
GZ,IMP,DIR WND,PAD>48SQ IN,EA
HYDROCOLLD DRG <=16 W/O BDR
HYDROCOLLD DRG >16<=48 W/O B
HYDROCOLLD DRG > 48 IN W/O B
HYDROCOLLD DRG <=16 IN W/BDR
HYDROCOLLD DRG >16<=48 W/BDR
HYDROCOLLD DRG > 48 IN W/BDR
HYDROCOLLD DRG FILLER PASTE
HYDROCOLLOID DRG FILLER DRY
HYDROGEL DRG <=16 IN W/ O BDR
HYDROGEL DRG >16<=48 W/O BDR
HYDROGEL DRG >48 IN W/O BDR
HYDROGEL DRG <= 16 IN W/ BDR
HYDROGEL DRG >16<=48 IN W/B
HYDROGEL DRG > 48 SQ IN W/B
HYDROGEL DRSG GEL FILLER
SKIN SEAL PROTECT MOISTURIZR
ABSORPT DRG <=16 SQ IN W/O B
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6260
A6261
A6262
A6266
A6402
A6403
A6404
A6410
A6411
A6412
A6421
A6422
A6424
A6426
A6428
A6430
A6432
A6434
A6436
A6438
A6440
A6501
A6502
A6503
A6504
A6505
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A7000
A7001
A7002
A7003
A7004
A7005
A7006
A7007
ABSORPT DRG >16 <=48 W/ O BDR

ABSORPT DRG > 48 SQ IN W/O B
ABSORPT DRG <=16 SQ IN W/BDR
ABSORPT DRG >16<=48 IN W/BDR
ABSORPT DRG > 48 SQ IN W/BDR
TRANSPARENT FILM <= 16 SQ IN
TRANSPARENT FILM >16<=48 IN
TRANSPARENT FILM > 48 SQ IN
WOUND CLEANSER ANY TYPE/ SIZE
WOUND FILL,GEL/PASTE/FL OZ,NEC
WOUND FILL, DRY FORM/GRAM, NEC
GAUZE,IMPREGNATED,NOT H20
STERILE GAUZE <= 16 SQ IN
STERILE GAUZE>16 <= 48 SQ IN
STERILE GAUZE > 48 SQ IN
EYE PAD, STERILE, EACH
EYE PAD, NON-STERILE, EACH
EYE PATCH, OCCLUSIVE, EACH
PAD BNDGE,WIDTH >/=3IN&<5IN
CONFORM BNDG,WIDTH >/=3IN&<5IN
CONFORM,KNITTED,WIDTH >/=5 IN
CONFORM,KNIT,WIDTH >/=3IN&<5IN
CONFORM,KNIT,STRLE,WIDTH>/=5IN
LT CMPRSS,WIDTH >/=3 IN & >5IN
LT CMPRSS, WIDTH >/=5 IN
MOD CMPRSS,WIDTH >/=3IN/<5IN
HGH CMPRSS,WIDTH >/= 3IN &<5IN
SELF-ADHERENT,WIDTH>/=3IN&<5IN
ZINC PASTE IMPREGNATED BANDAGE
COMPRESS BURN GARMENT,BODYSUIT
CMPRSS BURN GARMENT,CHIN STRAP
CMPRSS BURN GARMENT,FCAL HOOD
CMPRSS BURN,GLOVE TO WRIST
CMPRSS BURN,GLOVE TO ELBOW
CMPRSS BURN,GLOVE TO AXILLA
CMPRSS BURN,FOOT TO KNEE
COMPRESS BURN,FOOT TO THIGH
CMPRSS BURN,TRUNK TO WAIST+ARM
CMPRSS BURN,TRUNK+ARMS TO LEG
CMPRSS BURN,LOWER TRUNK+LEG
CMPRSS BURN,NOT CLASSIFIED
CANISTER,DISPOS,W SUCT PUMP,EA
CANISTER,NON-DISPOS,SUC PMP,EA
TUBING, USED W SUCTION PUMP,EA
ADM,SM VOL NONFIL PNEU NEB,DIS
SM VOL NONFIL PNEUM NEB,DISPOS
ADM,SM VL NONF PNEU NEB,NONDIS
ADM,SM VOL FILT PNEU NEBULIZER
LG VOL NEB,DISP,UNFIL,AERO COM
A7008
A7009
A7010
A7011
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7019
A7020
A7025
A7026
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7042
A7043
A7044
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A9150
A9270
A9300
A9500
A9502
A9503
A9504
A9505
A9507
A9508
A9510
A9511
LG VOL NEB,DISP,PREFIL,AER COM

RESERV BOT,NONDIS,LG VL ULT NB
CORR TUB,DIS,LG VOL NEB,100 FT
CORR TUB,NONDIS,LG VL NEB,10FT
WATER COL DEV,LG VOL NEBULIZER
FILTER,DISP,AEROSOL COMPRESSOR
FILTER,NONDIS,AERO CMP/ULT GEN
AEROSOL MASK, W DME NEBULIZER
DOME & MOUTHPCE,SM VOL ULT NEB
NEB,GLASS/AUTOCL PLS,BOT,NO O2
WTR,DIST,W/LG VOLM NEB,1000 ML
SAL SOL,10 ML,MET DOS,W INH DG
STRL H2O/SAL,1000 ML,W VOL NEB
HGH FREQ CHST OSCILAT SYS VEST
HGH FREQ CHST OSCILAT SYS HOSE
FCE MSK W PSTVE AIRWAY PRESURE
MASK INTERFACE, REPLACEMENT
REPLACEMENT CUSHION,NASAL APP
REPLACEMENT PILLOWS,NASAL APP
NASAL INTRFACE W PSTVE AIRWAY
HEADGER W PSTVE AIRWAY PRESSUR
CHNSTRP W PSTVE AIRWAY PRESSUR
TUBING W PSTVE AIRWAY PRESSURE
FLTR DISPOSABLE,W PSTVE AIRWAY
FLTR,NON DISPOS,W PSTVE AIRWAY
IMPLANTED PLEURAL CATH, EACH
VACUM DRAIN BTLE&TUBING W CATH
INTRFCE W PSTVE AIRWAY PRESURE
TRACHESTMA VLV,INCLD DPHRGM,EA
RPLCM DIPRM/F/P TRCHSTM VLV,EA
FLTR HLD/CP,TRCH HT&MST EXC,EA
FLTR TRCHST HT&MST EXCH SYS,EA
HOUS,WO AD,HT&MS EXC&/TR VL,EA
ADH DS,HT&MS EXC&/TR VL,ANY,EA
INTG FLT&HLD WO ADH,TRH EXC,EA
HSNG&ADHS,TRCHT EXCHG & VLV,EA
INTGR FLT HSG/HLD,&ADHS,TRH EA
MISC/EXPER NON- PRESCRIPT DRU
NON-COVERED ITEM OR SERVICE
EXERCISE EQUIPMENT
TECHNETIUM TC 99M SESTAMIBI
TECHNETIUM TC99M TETROFOSMN/UD
TECHNETIUM TC 99M MEDRONATE
TECHNETIUM TC 99M APCITIDE
THALLOUS CHLORIDE TL 201/MCI
SUPP RADIO,IND 111 CAP PEN/DOS
RAD AG,IOBEN SLF I-131,0.5 MCI
RAD DG,TCHNTM TC 99M DISOFENIN
TECHNETIUM TC 99M DEPREOTIDE
A9512
A9513
A9514
A9515
A9516
A9517
A9518
A9519
A9520
A9521
A9522
A9523
A9524
A9600
A9603
A9605
A9699
A9700
A9900
A9901
B4034
B4035
B4036
B4081
B4082
B4083
B4086
B4100
B4150
B4151
B4152
B4153
B4154
B4155
B4156
B4164
B4168
B4172
B4176
B4178
B4180
B4184
B4186
B4189
B4193
B4197
B4199
B4216
B4220
SUPLY RADIOPHARM DIAG,PRTCHNTE

SUPLY RADIOPHARM DIAG,MEBROFEN
RADIOPHARM DIAG,PYROPHOS,/MCI
RADIOPHARM DIAG,PENTETATE,/MCI
RDIOPHRM DIAG,I-123 SOD IODIDE
RDIOPHRM THRPTC,IODIDE CAPSULE
RDIOPHRM THRPTC,IODIDE SOLUTIN
RDIOPHRM DIAG,MCROAGRE ALBUMIN
RADIOPHRM DIAG,SUL COLOID,/MCI
RADIOPHARM DIAG,XETAZINE,/DOS
RDIOPHRM DIAG,INDIM-111 IBRTUM
RADIOPHARM THRPTC,YTTRIUM 90
RDIOPHRM DIAG,IODIN I-131 SRUM
STRONTIUM-89 CHLORIDE PER MCI
THRPTC RDIOPHRM,I-131 SODIUM
SUP RAD,SAM SM 153 LEXI,50 MCI
RDIOPHRM THRPTC,NOT CLASSIFIED
INJCTBL CNTRST MAT,ECHOCRDGRPH
MSC DME SPP,ACCSSRY,&/ANTHR CD
DME DLVRY,SET UP,&/ANTHR CD
ENTERAL FEEDING KIT; SYRINGE
ENTERAL FEEDING KIT; PUMP FED
ENTERAL FEEDING KIT; GRAVITY
NASOGASTRIC TUBING W/ STYLET
NASOGASTRIC TUBING W/O STYLET
STOMACH TUBE - LEVINE TYPE
GASTROSTOMY/JEJUNOSTOMY TUBE
THICKENER,ADMINISTERED ORALLY
ENTRL FRM;CAT I;SEMI-SYNTH PRT
ENTRL FRM;CAT I:NATRL PRT/ ISL
ENTRL FRM;CAT II:INTCT PRTN
ENTRL FRM;CAT III:HYDRLZD PRT
ENTRL FRM;CAT IV:DEFND FRM
ENTRL FRM;CAT V:MODLR COMP
ENTRL FRM;CAT VI:STND NUTRNT
P.NUTR SOLN: CARBO <=50%-HOME
P.NUTR SOLN; A.A.3.5% - HOME
P.NUTR SOLN; A.A. 5.5-7%-HOME
P.NUTR SOLN; A.A.7-8.5%-HOME
P.NUTR SOLN: A.A.> 8.5% -HOME
P.NUTR SOLN; CARBO >50% -HOME
P.NUTR SOLN; LIPIDS 10% W/SET
P.NUTR SOLN, LIPIDS 20% W/SET
P.NUTR SOLN; 10-51 GM OF PROT
P.NUTR SOLN; 52-73 GM OF PROT
P.NUTR SOLN; 74-100 GM PROT
P.NUTR SOLN; >100 GM OF PROT
P.NUTR ADDITIVES HOME MIX
PARENTERAL NUTRITION SUPPLY
B4222
B4224
B5000
B5100
B5200
B9000
B9002
B9004
B9006
B9998
B9999
C1010
C1011
C1015
C1016
C1017
C1018
C1020
C1021
C1022
C1031
C1079
C1088
C1091
C1092
C1122
C1146
C1166
C1167
C1170
C1177
C1178
C1200
C1201
C1300
C1305
C1321
C1322
C1323
C1324
C1329
C1368
C1713
C1716
C1718
C1719
C1720
C1765
C1774
PARENTERAL NTRN SUPPLY KIT

PARENTERAL NTRN ADMIN KIT
P.NUTR SOLN RENAL AMIROSYN RF
P.NUTR SOLN HEP-FREAMINE HBC
P.NUTR SOLN: STRESS-BRANCH
ENTER NTRN INF PUMP-W/O ALARM
ENTER NUTR INF PUMP - W/ ALARM
P NUTR INFUSION PUMP, PORTABLE
P NUTR INF PUMP, STATIONARY
NOC FOR ENTERNAL SUPPLIES
NOC FOR PARENTER SUPP DURABLE
BLD/RBC,LEUKOREDUCED,CMV NEG
PLT,HLA-MTCH LR,APHRS/PHRS, EA
PLTLTS,PHERES,LEUKOCYTE-RDUCD
BLD/RBC,LEUKORED,FROZ,DEGLYC
PLT,LR,CMV-NG,APHRS/PHRS,EA UN
BLD,LEUKOREDUCED,IRRADIATED
RED BLD CELS,FRZN,LEUKOCYTE
RED BLD CELL,LEUKOCYTE-RDCED
PLSM,FRZN 24 HRS OF COLLECT
ELCTRD,ABL,MR CMP LEVN/MOD NDL
CO 57/58 PER 0.5 UCI
LASER OPTC TRTMNT SYSTM,INDIGO
IN111 OXYQUINOLINE,PER0.5MCI
IN 111 PENTETATE PER 0.5 MCI
RAD,TECHNTM TC 99M ARCITMMB/VL
ET, VETT TRACHEOBRONCHIAL TUBE
INJECTION,CYTARABINE LIPOSOME
INJECTION, EPIRUBICIN HCL,2 MG
BX DEVICE, BREAST, ABBI DEVICE
BX DVC,11-GAUG MAMMTM PB W VCM
INJECTION, BUSULFAN, PER 6MG
RAD IMG,TECH TC 99M SODM GLCHP
RAD TECHNT TC 99M SUCCIMR,VIAL
HYPRBR OX PRS,FULL BD CHM,30MN
APLIGRAF, PER 44 SQ CM
ELCTRD,PALATE SOMNPLSTY COAGLT
ELCTRD,TURBNT SOMNPLSTY COAGLT
ELCTRD,VAPR/VAPR T THERMAL
ELECTRODE,LIGASURE DISPOSABLE
ELECTRDE,DISP,GYNECRE VERSAPNT
INFUSN SYS,ON-Q PAIN MGMT SYST
ANCH BNE TO BNE/SFT TIS TO BNE
BRACHYTHERAPY SEED, GOLD 198
BRACHYTHERAPY SEED, IODINE 125
BRCHYTHRPY SEED,NON-HDR IR-192
BRACHYTHRPY SEED,PALLADIUM 103
ADHESION BARRIER
INJECT,DARBEPOETIN ALFA,/1 MCG
C1775
C1783
C1888
C1900
C2600
C2614
C2616
C2618
C2632
C8900
C8901
C8902
C8903
C8904
C8905
C8906
C8907
C8908
C8909
C8910
C8911
C8912
C8913
C8914
C9000
C9003
C9007
C9008
C9009
C9010
C9013
C9102
C9103
C9105
C9109
C9111
C9112
C9113
C9116
C9119
C9120
C9121
C9200
C9201
C9503
C9701
C9703
C9711
D0120
RADIOPHARM,FLURDEOXYGLUCOSE
OCULARR IMPLANT,AQUEOUS DRAIN
CATH,ABLATION,NON-CARDIAC,ENDO
LFT VENTRIC CRNARY VENOUS SYS
CTH,GOLD PRB1-USE ELCTRHMSTSIS
PERCUTANEOUS LUMBAR DISCECTOMY
BRACHYTHERAPY SEED, YTTRIUM-90
PROBE, CRYOABLATION
BRACHYTHERAPY SOL, IODINE-125
MRA W/CONT, ABD
MRA W/O CONT, ABD
MRA W/O FOL W/CONT, ABD
MRI W/CONT, BREAST, UNI
MRI W/O CONT, BREAST, UNI
MRI W/O FOL W/CONT, BRST, UN
MRI W/CONT, BREAST, BI
MRI W/O CONT, BREAST, BI
MRI W/O FOL W/CONT, BREAST,
MRA W/CONT, CHEST
MRA W/O CONT, CHEST
MRA W/O FOL W/CONT, CHEST
MRA W/CONT, LWR EXT
MRA W/O CONT, LWR EXT
MRA W/O FOL W/CONT, LWR EXT
INJ,SOD CHROMATE CR51/0.25 MCI
PALIVIZUMAB-RSV-IGM, PER 50 MG
BACLOFN INTRATHECAL SCRN,1 AMP
BACLOFEN INTRATH REFIL/500 MCG
BACLOFEN REFILL KIT/2000 MCG
BACLOFN INTRATH REFIL/4000 MCG
CO 57 COBALTOUS CHLORIDE
SUPP,51 SODIUM CHROMATE/50 MCI
SOD IOTHALAM I-125 INJ,/10 UCI
INJ,HEPATITIS B IMM GLOB/1 ML
TIROFIBAN HCL, 6.25 MG
INJ, BIVALIRUDIN, 250MG VIAL
PERFLUTREN LIPID MICRO, 2ML
INJ PANTOPRAZOLE SODIUM,VIAL
INJCT,ERTAPENEM SODIUM,/1GRAM
INJCT,PEGFILGRASTIM,/6 MG
INJECTION,FULVESTRANT,/50 MG
INJECTION,ARGATROBAN,/5 MG
ORCEL, PER 36 CM2
DERMAGRAFT, PER 37.5 SQ CM
FRESH FROZ PLASMA,DON RETST,EA
STRETTA SYSTEM
BARD ENDOSCOPIC SUTURING SYS
H.E.L.P. APHERESIS SYSTEM
PERIODIC ORAL EVALUATION
D0140
D0150
D0160
D0170
D0180
D0210
D0220
D0230
D0240
D0250
D0260
D0270
D0272
D0274
D0277
D0290
D0310
D0320
D0321
D0322
D0330
D0340
D0350
D0415
D0425
D0460
D0470
D0472
D0473
D0474
D0480
D0502
D0999
D1110
D1120
D1201
D1203
D1204
D1205
D1310
D1320
D1330
D1351
D1510
D1515
D1520
D1525
D1550
D2140
LIMIT ORAL EVAL PROBLM FOCUS

COMPREHENSIVE ORAL EVAL
EXTENSV ORAL EVAL PROB FOCUS
RE-EVAL-LIM,PROB FOCUS(EST PT)
COMPREHENSIVE PERIODONTAL EVAL
INTRAOR COMPLETE FILM SERIES
INTRAORAL PERIAPICAL FIRST F
INTRAORAL PERIAPICAL EA ADD
INTRAORAL OCCLUSAL FILM
EXTRAORAL FIRST FILM
EXTRAORAL EA ADDITIONAL FILM
DENTAL BITEWING SINGLE FILM
DENTAL BITEWINGS TWO FILMS
DENTAL BITEWINGS FOUR FILMS
VERTICAL BITEWINGS - 7-8 FILMS
DENTAL FILM SKULL/ FACIAL BON
DENTAL SALIOGRAPHY
DENTAL TMJ ARTHROGRAM INCL I
DENTAL OTHER TMJ FILMS
DENTAL TOMOGRAPHIC SURVEY
DENTAL PANORAMIC FILM
DENTAL CEPHALOMETRIC FILM
ORAL/FACIAL IMAGES (INT & EXT)
BACTERIOLOGIC STUDY
CARIES SUSCEPTIBILITY TEST
PULP VITALITY TEST
DIAGNOSTIC CASTS
ACCESS TISS,GROSS EXM,WRIT RPT
ACC TISS,GROS&MIC EXM,WRIT RPT
ACC TISS,GROS&MIC,SURG MAR,RPT
PROCESS,INTERP,CYTOLG SMRS,RPT
OTHER ORAL PATHOLOGY PROCEDU
UNSPECIFIED DIAGNOSTIC PROCE
DENTAL PROPHYLAXIS ADULT
DENTAL PROPHYLAXIS CHILD
TOPICAL FLUOR W/ PROPHY CHILD
TOPICAL FLUOR W/O PROPHY CHI
TOPICAL FLUOR W/O PROPHY ADU
TOPICAL FLUORIDE W/ PROPHY A
NUTRI COUNSEL-CONTROL CARIES
TOBACCO COUNSELING
ORAL HYGIENE INSTRUCTION
DENTAL SEALANT PER TOOTH
SPACE MAINTAINER FXD UNILAT
FIXED BILAT SPACE MAINTAINER
REMOVE UNILAT SPACE MAINTAIN
REMOVE BILAT SPACE MAINTAIN
RECEMENT SPACE MAINTAINER
AMALGAM-1 SURFACE,PRIM/PERM
D2150
D2160
D2161
D2330
D2331
D2332
D2335
D2390
D2391
D2392
D2393
D2394
D2410
D2420
D2430
D2510
D2520
D2530
D2542
D2543
D2544
D2610
D2620
D2630
D2642
D2643
D2644
D2650
D2651
D2652
D2662
D2663
D2664
D2710
D2720
D2721
D2722
D2740
D2750
D2751
D2752
D2780
D2781
D2782
D2783
D2790
D2791
D2792
D2799
AMALGAM-2 SURFACES,PRIM/PERM
AMALGAM-3 SURFACES,PRIM/PERM
AMALGAM-4+SURFACES,PRIM/PERM
RESIN ONE SURFACE- ANTERIOR
RESIN TWO SURFACES- ANTERIOR
RESIN THREE SURFACES- ANTERIO
RESIN 4/> SURF OR W/ INCIS AN
BASED COMPOSITE CROWN,ANTERIOR
BASED CMPSTE -1 SURFACE,POSTER
BASED CMPSTE -4+SURFACE,POSTER
DENTAL GOLD FOIL ONE SURFACE
DENTAL GOLD FOIL TWO SURFACE
DENTAL GOLD FOIL THREE SURFA
DENTAL INLAY METALIC 1 SURF
DENTAL INLAY METALLIC 2 SURF
DENTAL INLAY METL 3/ MORE SUR
ONLAY-METALLIC-TWO SURFACES
DENTAL ONLAY METALLIC 3 SURF
DENTAL ONLAY METL 4/ MORE SUR
INLAY-RESIN-COMPOSITE - 1 SURF
INLAY-RESIN-COMPOSITE - 2 SURF
INLAY-RESIN-COMPOSITE-3/+ SURF
ONLAY-RESIN-COMPOSITE - 2 SURF
ONLAY-RESIN-COMPOSITE - 3 SURF
ONLAY-RESIN-COMPOSITE-4/+ SURF
CROWN - RESIN (INDIRECT)
CROWN RESIN W/ HIGH NOBLE ME
CROWN RESIN W/ BASE METAL
CROWN RESIN W/ NOBLE METAL
CROWN PORCELAIN/CERAMIC SUBS
CROWN PORCELAIN W/ H NOBLE M
CROWN PORCELAIN FUSED BASE M
CROWN PORCELAIN W/ NOBLE MET
CROWN- 3/4 CAST HIGH NOBLE MET
CROWN-3/4 CAST PREDOM BASE MET
CROWN - 3/4 CAST NOBLE METAL
CROWN - 3/4 PORCELAIN/CERAMIC
CROWN FULL CAST HIGH NOBLE M
CROWN FULL CAST BASE METAL
CROWN FULL CAST NOBLE METAL
PROVISIONAL CROWN
D2910
D2920
D2930
D2931
D2932
D2933
D2940
D2950
D2951
D2952
D2953
D2954
D2955
D2957
D2960
D2961
D2962
D2970
D2980
D2999
D3110
D3120
D3220
D3221
D3230
D3240
D3310
D3320
D3330
D3331
D3332
D3333
D3346
D3347
D3348
D3351
D3352
D3353
D3410
D3421
D3425
D3426
D3430
D3450
D3460
D3470
D3910
D3920
D3950
DENTAL RECEMENT INLAY

DENTAL RECEMENT CROWN
PREFAB STNLSS STEEL CRWN PRI
PREFAB STNLSS STEEL CROWN PE
PREFABRICATED RESIN CROWN
PREFAB STAINLESS STEEL CROWN
DENTAL SEDATIVE FILLING
CORE BUILD-UP INCL ANY PINS
TOOTH PIN RETENTION
POST AND CORE CAST + CROWN
EA ADD CAST POST - SAME TOOTH
PREFAB POST/CORE + CROWN
POST REMOVAL
EA ADD PREFAB POST- SAME TOOTH
LAMINATE LABIAL VENEER
LAB LABIAL VENEER RESIN
LAB LABIAL VENEER PORCELAIN
TEMPORARY- FRACTURED TOOTH
CROWN REPAIR
DENTAL UNSPEC RESTORATIVE PR
PULP CAP DIRECT
PULP CAP INDIRECT
THERAPEUTIC PULPOTOMY & MEDICM
PULPAL DEBRIDE, 1&PERM TEETH
PULPAL THERAPY ANTERIOR PRIM
PULPAL THERAPY POSTERIOR PRI
ANTERIOR
TREAT ROOT CANAL OBST;NON-SURG
INCOM ENDODON;INOP/FRACT TOOTH
INTERN ROOT REP PERFORA DEFECT
RETREAT ROOT CANAL ANTERIOR
RETREAT ROOT CANAL BICUSPID
RETREAT ROOT CANAL MOLAR
APEXIFICATION/RECALC INITIAL
APEXIFICATION/RECALC INTERIM
APEXIFICATION/RECALC FINAL
APICOECT/PERIRAD SURG ANTER
ROOT SURGERY BICUSPID
ROOT SURGERY MOLAR
ROOT SURGERY EA ADD ROOT
RETROGRADE FILLING
ROOT AMPUTATION
ENDODONTIC ENDOSSEOUS IMPLAN
INTENTIONAL REPLANTATION
ISOLATION-TOOTH W RUBB DAM
TOOTH SPLITTING
CANAL PREP/FITTING OF DOWEL
D3999
D4210
D4211
D4240
D4241
D4245
D4249
D4260
D4261
D4263
D4264
D4265
D4266
D4267
D4268
D4270
D4271
D4273
D4274
D4275
D4276
D4320
D4321
D4341
D4342
D4355
D4381
D4910
D4920
D4999
D5110
D5120
D5130
D5140
D5211
D5212
D5213
D5214
D5281
D5410
D5411
D5421
D5422
D5510
D5520
D5610
D5620
D5630
D5640
ENDODONTIC PROCEDURE
GINGIVECTOMY/GINGIVOPLASTY-4+
GINGIVECTOMY/GINGIVOPLASTY-1-3
GINGIVAL FLAP,ROOT PLANING -4+
VAL FLAP,ROOT PLAN- 1 3 TEETH
APICALLY POSITIONED FLAP
CROWN LENGTHEN HARD TISSUE
OSSEOUS SURGERY -4+ TEETH
US SURGERY- 1 3 TEETH,/QUAD
BONE REPLCE GRAFT FIRST SITE
BONE REPLCE GRAFT EACH ADD
BIOLOGIC MATER AID SFT&OSSEOUS
GUIDED TISS REGEN-RESORB,/SITE
GUID TISS REGEN-NONRESRB,/SITE
SURG REVISION PROC, PER TOOTH
PEDICLE SOFT TISSUE GRAFT PR
FREE SOFT TISSUE GRAFT PROC
SUBEPITHELIAL CONECTIVE TISSUE
DISTAL/PROXIMAL WEDGE PROC
TISSUE ALLOGRAFT
CMBNED CNNECT TISS&DBLE PDICLE
PROVISION SPLNT INTRACORONAL
PROVISIONAL SPLINT EXTRACORO
PERIODON SCALING& ROOT PLANING
PERIODONT SCALING&ROOT PLANING
FULL MOUTH DEBRIDEMENT
LOCALIZED CHEMO DELIVERY
PERIODONTAL MAINTENANCE
UNSCHEDULED DRESSING CHANGE
UNSPECIFIED PERIODONTAL PROC
DENTURES COMPLETE MAXILLARY
DENTURES COMPLETE MANDIBLE
DENTURES IMMEDIAT MAXILLARY
DENTURES IMMEDIAT MANDIBLE
DENTURES MAXILL PART RESIN
DENTURES MAND PART RESIN
DENTURES MAXILL PART METAL
DENTURES MANDIBL PART METAL
REMOVABLE PARTIAL DENTURE
DENTURES ADJUST CMPLT MAXIL
DENTURES ADJUST CMPLT MAND
DENTURES ADJUST PART MAXILL
DENTURES ADJUST PART MANDBL
DENTUR REPR BROKEN COMPL BAS
REPLACE DENTURE TEETH COMPLT
DENTURES REPAIR RESIN BASE
REP PART DENTURE CAST FRAME
REP PARTIAL DENTURE CLASP
REPLACE PART DENTURE TEETH
D5650
D5660
D5670
D5671
D5710
D5711
D5720
D5721
D5730
D5731
D5740
D5741
D5750
D5751
D5760
D5761
D5810
D5811
D5820
D5821
D5850
D5851
D5860
D5861
D5862
D5867
D5875
D5899
D5911
D5912
D5913
D5914
D5915
D5916
D5919
D5922
D5923
D5924
D5925
D5926
D5927
D5928
D5929
D5931
D5932
D5933
D5934
D5935
D5936
ADD TOOTH TO PARTIAL DENTURE

ADD CLASP TO PARTIAL DENTURE
REPLACE,ACRYLIC CAST MTAL(MAX)
REPLACE,ACRYLC CAST METAL(MAN)
DENTURES REBASE CMPLT MAXIL
DENTURES REBASE CMPLT MAND
DENTURES REBASE PART MAXILL
DENTURES REBASE PART MANDBL
DENTURE RELN CMPLT MAXIL CH
DENTURE RELN CMPLT MAND CHR
DENTURE RELN PART MAXIL CHR
DENTURE RELN PART MAND CHR
DENTURE RELN CMPLT MAX LAB
DENTURE RELN CMPLT MAND LAB
DENTURE RELN PART MAXIL LAB
DENTURE RELN PART MAND LAB
DENTURE INTERM CMPLT MAXILL
DENTURE INTERM CMPLT MANDBL
DENTURE INTERM PART MAXILL
DENTURE INTERM PART MANDBL
DENTURE TISS CONDITN MAXILL
DENTURE TISS CONDTIN MANDBL
OVERDENTURE COMPLETE
OVERDENTURE PARTIAL
PRECISION ATTACHMENT
REPL PART,SEMI-PRECISON/ATTACH
MOD REM PROSTH FOLL IMPLT SURG
REMOVABLE PROSTHODONTIC PROC
FACIAL MOULAGE SECTIONAL
FACIAL MOULAGE COMPLETE
NASAL PROSTHESIS
AURICULAR PROSTHESIS
ORBITAL PROSTHESIS
OCULAR PROSTHESIS
FACIAL PROSTHESIS
NASAL SEPTAL PROSTHESIS
OCULAR PROSTHESIS INTERIM
CRANIAL PROSTHESIS
FACIAL AUGMENTATION IMPLANT
REPLACEMENT NASAL PROSTHESIS
AURICULAR REPLACEMENT
ORBITAL REPLACEMENT
FACIAL REPLACEMENT
SURGICAL OBTURATOR
POSTSURGICAL OBTURATOR
REFITTING OF OBTURATOR
MANDIBULAR FLANGE PROSTHESIS
MANDIBULAR DENTURE PROSTH
TEMP OBTURATOR PROSTHESIS
D5937
D5951
D5952
D5953
D5954
D5955
D5958
D5959
D5960
D5982
D5983
D5984
D5985
D5986
D5987
D5988
D5999
D6010
D6020
D6040
D6050
D6053
D6054
D6055
D6056
D6057
D6058
D6059
D6060
D6061
D6062
D6063
D6064
D6065
D6066
D6067
D6068
D6069
D6070
D6071
D6072
D6073
D6074
D6075
D6076
D6077
D6078
D6079
D6080
TRISMUS APPLIANCE
FEEDING AID
PEDIATRIC SPEECH AID
ADULT SPEECH AID
SUPERIMPOSED PROSTHESIS
PALATAL LIFT PROSTHESIS
INTRAORAL CON DEF INTER PLT
INTRAORAL CON DEF MOD PALAT
MODIFY SPEECH AID PROSTHESIS
SURGICAL STENT
RADIATION APPLICATOR
RADIATION SHIELD
RADIATION CONE LOCATOR
FLUORIDE APPLICATOR
COMMISSURE SPLINT
SURGICAL SPLINT
MAXILLOFACIAL PROSTHESIS
ODONTICS ENDOSTEAL IMPLANT
ODONTICS ABUTMENT PLACEMENT
ODONTICS EPOSTEAL IMPLANT
ODONTICS TRANSOSTEAL IMPLNT
IMPLNT RMV DENTRE,COMP EDENTUL
IMPLNT RMV DENTRE,PART EDENTUL
IMPLANT CONNECTING BAR
PREFABRICATED ABUTMENT
CUSTOM ABUTMENT
ABUT SUPP PORCEL/CERAMIC CROWN
ABUT,PORC FUSE-HI NOB MET CRWN
ABUTM,PORC FUSE-BASE MET CROWN
ABUTM,PORC FUSE-NOB METAL CRWN
ABUTM,CAST HI NOBL METAL CROWN
ABUTMENT,CAST BASE METAL CROWN
ABUTMENT,CAST NOBL METAL CROWN
IMPLNT,PORCELAIN/CERAMIC CROWN
IMPL SUP PORC FUSE - MET CROWN
IMPLANT SUPPORTED METAL CROWN
ABUTM,RETAINER, PORC/CERAM FPD
ABUT,PORC FUSE-HI NOB MET FPD
ABUTM,PORC FUSE-BASE METAL FPD
ABUTM,PORC FUSE-NOBL METAL FPD
ABUTM, CAST HI NOBLE METAL FPD
ABUTM,RET, CAST BASE METAL FPD
ABUTM,RET,CAST NOBLE METAL FPD
IMPLT SUPP RETAINR,CERAMIC FPD
IMPL SUP RET,PORC FUSE,MET FPD
IMPLT SUPP RET, CAST METAL FPD
IMPL/ABUT,FIX DENT, EDENT ARCH
IMPL/ABUT,FIX DEN,PART EDEN AR
IMPLANT MAINTENANCE
D6090
D6095
D6100
D6199
D6210
D6211
D6212
D6240
D6241
D6242
D6245
D6250
D6251
D6252
D6253
D6545
D6548
D6600
D6601
D6602
D6603
D6604
D6605
D6606
D6607
D6608
D6609
D6610
D6611
D6612
D6613
D6614
D6615
D6720
D6721
D6722
D6740
D6750
D6751
D6752
D6780
D6781
D6782
D6783
D6790
D6791
D6792
D6793
D6920
REPAIR IMPLANT
ODONTICS REPR ABUTMENT
REMOVAL OF IMPLANT
IMPLANT PROCEDURE
PROSTHODONT HIGH NOBLE METAL
BRIDGE BASE METAL CAST
BRIDGE NOBLE METAL CAST
BRIDGE PORCELAIN HIGH NOBLE
BRIDGE PORCELAIN BASE METAL
BRIDGE PORCELAIN NOBEL METAL
PONTIC - PORCELAIN/CERAMIC
BRIDGE RESIN W/HIGH NOBLE
BRIDGE RESIN BASE METAL
BRIDGE RESIN W/NOBLE METAL
PROVISIONAL PONTIC
DENTAL RETAINR CAST METL
RETAINR-POR/CERAM,RES,FIX PROS
INLAY-PRCLAN/CRMC,2 SURFACES
INLAY-PRCLAN/CRMC,3+ SURFACES
INLAY-CAST HGH NOBLE,2 SURFACE
INLAY-CAST HGH NOBLE,3+SURFACE
INLAY-CAST PREDOM BASE,2 SRFCE
INLAY-CAST PREDOM BASE,3+SRFCE
INLAY-CAST NOBLE METAL,2 SRFCE
INLAY-CAST NOBLE METAL,3+SRFCE
ONLAY-PRCLAN/CRMC, 2 SURFACES
ONLAY-PRCLAN/CRMC,3+ SURFACES
ONLAY-CAST HGH NOBLE,2 SURFACE
ONLAY-CAST HGH NOBLE,3+SURFACE
ONLAY-CAST PREDOM BASE,2 SRFCE
ONLAY-CAST PREDOM BASE,3+SRFCE
ONLAY-CAST NOBLE METAL,2 SRFCE
ONLAY-CAST NOBLE METAL,3+SRFCE
RETAIN CROWN RESIN W HI NBLE
CROWN RESIN W/BASE METAL
CROWN RESIN W/NOBLE METAL
CROWN - PORCELAIN/CERAMIC
CROWN PORCELAIN HIGH NOBLE
CROWN PORCELAIN BASE METAL
CROWN PORCELAIN NOBLE METAL
CROWN \3/4\ HIGH NOBLE METAL
CRWN-3/4 CAST PREDOM BASED MET
CROWN - 3/4 CAST NOBLE METAL
CROWN - 3/4 PORCELAIN/CERAMIC
CROWN FULL HIGH NOBLE METAL
CROWN FULL BASE METAL CAST
CROWN FULL NOBLE METAL CAST
PROVISIONAL RETAINER CROWN
DENTAL CONNECTOR BAR
D6930
D6940
D6950
D6970
D6971
D6972
D6973
D6975
D6976
D6977
D6980
D6985
D6999
D7111
D7140
D7210
D7220
D7230
D7240
D7241
D7250
D7260
D7261
D7270
D7272
D7280
D7281
D7282
D7285
D7286
D7287
D7290
D7291
D7310
D7320
D7340
D7350
D7410
D7411
D7412
D7413
D7414
D7415
D7440
D7441
D7450
D7451
D7460
D7461
DENTAL RECEMENT BRIDGE

STRESS BREAKER
PRECISION ATTACHMENT
POST & CORE PLUS RETAINER
CAST POST BRIDGE RETAINER
PREFAB POST & CORE PLUS RETA
CORE BUILD UP FOR RETAINER
COPING METAL
EACH ADD CAST POST- SAME TOOTH
EA ADD PREFAB POST- SAME TOOTH
BRIDGE REPAIR
PEDIATRIC PARTIAL DENTRE,FIXED
FIXED PROSTHODONTIC PROC
CORONAL RMNNTS-DECIDUOUS TOOTH
EXTRCT,ERPTD TOOTH/EXPSED ROOT
REM IMP TOOTH W MUCOPER FLP
IMPACT TOOTH REMOV SOFT TISS
IMPACT TOOTH REMOV PART BONY
IMPACT TOOTH REMOV COMP BONY
IMPACT TOOTH REM BONY W/ COMP
TOOTH ROOT REMOVAL
ORAL ANTRAL FISTULA CLOSURE
PRIM CLSUR SINUS PERFORATION
TOOTH REIMPL &/ STABILIZATION
TOOTH TRANSPLANTATION
SURG ACCESS UNERUPTED TOOTH
EXPOSURE TOOTH AID ERUPTION
MOBILIZ ERUPTED TOOTH AID ERPT
BIOPSY OF ORAL TISSUE - HARD
BIOPSY OF ORAL TISSUE - SOFT
CYTOLOGY SAMPLE COLLECTION
REPOSITIONING OF TEETH
TRANSSEPTAL FIBEROTOMY/SUPRA
ALVEOPLASTY W/ EXTRACTION
ALVEOPLASTY W/O EXTRACTION
VESTIBULOPLASTY RIDGE EXTENS
VESTIBULOPLASTY EXTEN GRAFT
EXCIS B9 LESION UP TO 1.25 CM
EXCISION OF B9 LESION>1.25 CM
EXCISION OF B9 LESION,COMPLCAT
EXCI MALIGNANT LESION <1.25 CM
EXCI MALIGNANT LESION >1.25 CM
EXCI MALIGNANT LESION,CMPLICTD
MALIG TUMOR EXC TO 125 CM
MALIG TUMOR > 125 CM
REM,B9 ODON CYST DIAM <1.25 CM
REM,B9 ODON CYST DIAM >1.25 CM
REM,B9 NONODO CYST DIA <1.25CM
REM,B9 NONODO CYST DIAM>1.25CM
D7465
D7471
D7472
D7473
D7485
D7490
D7510
D7520
D7530
D7540
D7550
D7560
D7610
D7620
D7630
D7640
D7650
D7660
D7670
D7671
D7680
D7710
D7720
D7730
D7740
D7750
D7760
D7770
D7771
D7780
D7810
D7820
D7830
D7840
D7850
D7852
D7854
D7856
D7858
D7860
D7865
D7870
D7871
D7872
D7873
D7874
D7875
D7876
D7877
LESION DESTRUCTION
REMOVAL OF LATERAL EXOSTOSIS
REMOVAL OF TORUS PALATINUS
REMOVAL OF TORUS MANDIBULARIS
SURG REDUCT OSSEOUS TUBEROSITY
MANDIBLE RESECTION
I&D ABSC INTRAORAL SOFT TISS
I&D ABSCESS EXTRAORAL
RMVL,FB,MUCOSA,/SUBCUTANEOUS
REMOVAL OF FB REACTION
PART OSTECTOMY,RMVL,NON-VITAL
MAXILLARY SINUSOTOMY
MAXILLA OPEN REDUCT SIMPLE
CLSD REDUCT SIMPL MAXILLA FX
OPEN RED SIMPL MANDIBLE FX
CLSD RED SIMPL MANDIBLE FX
OPEN RED SIMP MALAR/ ZYGOM FX
CLSD RED SIMP MALAR/ ZYGOM FX
ALVEOLUS-CLOSED REDUCTION
ALVEOLUS-OPN REDCT,STBLZ TEETH
REDUCT SIMPLE FACIAL BONE FX
MAXILLA OPEN REDUCT COMPOUND
CLSD REDUCT COMPD MAXILLA FX
OPEN REDUCT COMPD MANDBLE FX
CLSD REDUCT COMPD MANDBLE FX
OPEN RED COMP MALAR/ ZYGMA FX
CLSD RED COMP MALAR/ ZYGMA FX
ALVEOLUS-OPEN REDUCTION
ALVEOLUS,CLS REDCT,STBLZ TEETH
REDUCT COMPND FACIAL BONE FX
TMJ OPEN REDUCT- DISLOCATION
CLOSED TMP MANIPULATION
TMJ MANIPULATION UNDER ANEST
REMOVAL OF TMJ CONDYLE
TMJ MENISCECTOMY
TMJ REPAIR OF JOINT DISC
TMJ EXCISN OF JOINT MEMBRANE
TMJ CUTTING OF A MUSCLE
TMJ RECONSTRUCTION
TMJ CUTTING INTO JOINT
TMJ RESHAPING COMPONENTS
TMJ ASPIRATION JOINT FLUID
NON-ARTHROSCOPIC LYS & LAVAGE
TMJ DIAGNOSTIC ARTHROSCOPY
TMJ ARTHROSCOPY LYSIS ADHESN
TMJ ARTHROSCOPY DISC REPOSIT
TMJ ARTHROSCOPY SYNOVECTOMY
TMJ ARTHROSCOPY DISCECTOMY
TMJ ARTHROSCOPY DEBRIDEMENT
D7880
D7899
D7910
D7911
D7912
D7920
D7940
D7941
D7943
D7944
D7945
D7946
D7947
D7948
D7949
D7950
D7955
D7960
D7970
D7971
D7972
D7980
D7981
D7982
D7983
D7990
D7991
D7995
D7996
D7997
D7999
D8010
D8020
D8030
D8040
D8050
D8060
D8070
D8080
D8090
D8210
D8220
D8660
D8670
D8680
D8690
D8691
D8692
D8999
OCCLUSAL ORTHOTIC APPLIANCE

TMJ UNSPECIFIED THERAPY
DENT SUTUR RECENT WND TO 5 CM
DENTAL SUTURE WOUND TO 5 CM
SUTURE COMPLICATE WND > 5 CM
DENTAL SKIN GRAFT
RESHAPING BONE ORTHOGNATHIC
OSTEOTOMY- MANDIBULAR RAMI
OSTEOTOMY-MAND RAM,BNE GFT;OBT
BONE CUTTING SEGMENTED
BONE CUTTING BODY MANDIBLE
RECONSTRUCTION MAXILLA TOTAL
RECONSTRUCT MAXILLA SEGMENT
RECONSTRUCT MIDFACE NO GRAFT
RECONSTRUCT MIDFACE W/ GRAFT
MANDIBLE GRAFT
REPAIR MAXILLOFACIAL DEFECTS
FRENULECTOMY/ FRENULOTOMY
EXCISION HYPERPLASTIC TISSUE
EXCISION PERICORONAL GINGIVA
SURG REDUCT FIBROUS TUBEROSITY
SIALOLITHOTOMY
EXCISION OF SALIVARY GLAND
SIALODOCHOPLASTY
EMERGENCY TRACHEOTOMY
DENTAL CORONOIDECTOMY
SYNTHETIC GRAFT FACIAL BONES
IMPLANT MANDIBLE FOR AUGMENT
APPLIANCE REM, INC REM ARCHBAR
ORAL SURGERY PROCEDURE
LIMITED DENTAL TX PRIMARY
LIMITED DENTAL TX TRANSITION
LIMITED DENTAL TX ADOLESCENT
LIMITED DENTAL TX ADULT
INTERCEP DENTAL TX PRIMARY
INTERCEP DENTAL TX TRANSITION
COMPRE DENTAL TX TRANSITION
COMPRE DENTAL TX ADOLESCENT
COMPRE DENTAL TX ADULT
ORTHODONTIC REM APPLIANCE TX
FIXED APPLIANCE THERAPY HABT
PREORTHODONTIC TX VISIT
PERIODIC ORTHODONTIC TX VISIT
ORTHODONTIC RETENTION
ORTHODONTIC TREATMENT
REPAIR, ORTHODONTIC APPLIANCE
REPLACE, LOST/BROKEN RETAINER
ORTHODONTIC PROCEDURE
D9110
D9210
D9211
D9212
D9215
D9220
D9221
D9230
D9241
D9242
D9248
D9310
D9410
D9420
D9430
D9440
D9450
D9610
D9630
D9910
D9911
D9920
D9930
D9940
D9941
D9950
D9951
D9952
D9970
D9971
D9972
D9973
D9974
D9999
E0100
E0105
E0110
E0111
E0112
E0113
E0114
E0116
E0117
E0130
E0135
E0141
E0142
E0143
E0144
TX DENTAL PAIN MINOR PROC

DENT ANESTHESIA W/O SURGERY
REGIONAL BLOCK ANESTHESIA
TRIGEMINAL BLOCK ANESTHESIA
LOCAL ANESTHESIA
DEEP SEDATION -1ST 30 MINUTES
DEEP SEDATION-EACH ADDL 15 MIN
ANALGES,ANXIOLYS,INHAL NITR OX
IV CONSCIOUS SEDAT-1ST 30 MIN
IV CONSCIOUS SEDAT-ADDL 15 MIN
NON-INTRAVENS CONSCIOUS SEDAT
DENTAL CONSULTATION
HOUSE/EXTENDED CARE FACIL CALL
HOSPITAL CALL
OFFICE VISIT DURING HOURS
OFFICE VISIT AFTER HOURS
CASE PRESENTATION,TREAT PLNING
DENT THERAPEUTIC DRUG INJECT
OTHER DRUGS/MEDICAMENTS
DENT APPL DESENSITIZING MED
APP DESEN RES,CERV &/RT,/TOOTH
BEHAVIOR MANAGEMENT
TREATMENT OF COMPLICATIONS
DENTAL OCCLUSAL GUARD
FABRICATION ATHLETIC GUARD
OCCLUSION ANALYSIS
LIMITED OCCLUSAL ADJUSTMENT
COMPLETE OCCLUSAL ADJUSTMENT
ENAMEL MICROABRASION
ODONTOPLAS 1-2;REMOV ENAM PROJ
EXTERNAL BLEACHING - PER ARCH
EXTERNAL BLEACHING - PER TOOTH
INTERNAL BLEACHING - PER TOOTH
ADJUNCTIVE PROCEDURE
CANE, ADJUSTABLE/FIXED, W/TIP
CANE QUAD, ADJ/FIXED, W/TIPS
CRUTCHES FOREARM ADJ/FIXED
CRUTCH FOREARM ADJ/FIXED,W/TIP
CRTCHS UNDERARM WOOD ADJ/FIXED
CRUTCH UNDERARM WOOD ADJ/FIXED
CRUTCHES UNDERARM, NOT WOOD
CRUTCH UNDERARM, NOT WOOD
CRUTCH,UNDERARM,SPRING ASISTED
WALKER, RIGID, ADJ/FIXD HT
WALKER, FOLDING ADJ/FIXD HT
RIGID WALKR, WHEELED, W/O SEAT
RIGID WALKR, WHEEL, W/ SEAT
FOLD WALKER, WHEELED, W/O SEAT
ENCL,FRAM FOLD WALK,WHEEL,SEAT
E0145
E0146
E0147
E0148
E0149
E0153
E0154
E0155
E0156
E0157
E0158
E0159
E0160
E0161
E0162
E0163
E0164
E0165
E0166
E0167
E0168
E0169
E0175
E0176
E0177
E0178
E0179
E0180
E0181
E0182
E0184
E0185
E0186
E0187
E0188
E0189
E0191
E0192
E0193
E0194
E0196
E0197
E0198
E0199
E0200
E0202
E0203
E0205
E0210
WLKR, WHEELED W/SEAT&CRUTCH

FOLD WALKER, WHEELED, W/ SEAT
HVY DTY, VARI WHEEL WALKER
WALKR,HV,WO WHEL,RG/FLD,ANY,EA
WALKR,HV,WHEEL,RIG/FOLD,ANY,EA
PLTFRM ATTCHMNT, FOREARM CRTCH
PLTFRM ATTCHMNT, WALKER,
WHEEL ATT,PICK-UP WALKER,/PAIR
SEAT ATTACHMENT, WALKER
CRUTCH ATTACHMENT, WALKER
LEG EXTENS,WALKER,PER SET OF 4
BRAKE; WHEELED WALKER, REPL EA
SITZ BATH, PORT, COMMODE SEAT
SITZ BATH, PORT, W/FAUCET
SITZ BATH CHAIR
COMMODE CHAIR, STATION, W/ARMS
COMMODE CHAIR, MOBILE, W/ARMS
COMMODE CHR, STNRY, W/DET ARMS
COMMODE CH, MOBILE, W/DET ARMS
PAIL/PAN FOR COMMODE CHAIR
COMMDE CHAIR,EX WIDE,HV,ANY,EA
SEATLIFT INCORP COMMODECHAIR
FOOT REST, FOR COMMODE CHAIR
AIR PRESS PAD/CUSHION, NONPOS
H20 PRESS PAD/CUSHION, NONPOS
GEL PRESS PAD/CUSHION NONPOSIT
DRY PRESS PAD/CUSHION, NONPOS
PRESS PAD, ALTERNATING W/ PUMP
PRESS PAD, ALT W/PUMP, HVY DTY
ALTERNATING PRESSURE PAD PUMP
DRY PRESSURE MATTRESS DRY
GEL PRESS PAD;MATTRESS,STD L&W
AIR PRESSURE MATTRESS
WATER PRESSURE MATTRESS
SYNTHETIC SHEEPSKIN PAD
LAMBSWOOL SHEEPSKIN PAD
HEEL OR ELBOW PROTECTOR, EACH
LOW PRESS/POSIT EQ PAD;WHEELCH
POWERED AIR FLOTATATION BED
AIR FLUIDIZED BED
GEL PRESSURE MATTRESS
AIR PRESS PAD;MATTRESS,STD L&W
H2O PRESS PAD;MATTRESS,STD L&W
DRY PRESS PAD;MATTRESS,STD L&W
HEAT LAMP W/O STAND W/BULB
BILIRUBIN LIGHT W/ PHOTOMETER
THRPTC LIGHTBOX,MIN 10,000 LUX
HEAT LAMP, W/ STAND, W/ BULB
ELECTRIC HEAT PAD, STANDARD
E0215
E0217
E0218
E0220
E0221
E0225
E0230
E0231
E0232
E0235
E0236
E0238
E0239
E0241
E0242
E0243
E0244
E0245
E0246
E0249
E0250
E0251
E0255
E0256
E0260
E0261
E0265
E0266
E0270
E0271
E0272
E0273
E0274
E0275
E0276
E0277
E0280
E0290
E0291
E0292
E0293
E0294
E0295
E0296
E0297
E0305
E0310
E0315
E0316
ELECTRIC HEAT PAD, MOIST

WATER CRCULAT HEAT PAD W/ PUMP
WATER CRCULAT COLD PAD W/ PUMP
HOT WATER BOTTLE
INFRARED HEATING PAD SYSTEM
HYDROCOLLATOR UNIT, W/ PADS
ICE CAP OR COLLAR
WOUND WARMING DEVICE
WARMING CARD FOR NWT
PARAFFIN BATH UNIT, PORTABLE
PUMP FOR WATER CIRCULATING PAD
NON-ELECTRIC HEAT PAD, MOIST
HYDROCOLLATOR UNIT, PORTABLE
BATH TUB WALL RAIL, EACH
BATH TUB RAIL, FLOOR BASE
TOILET RAIL, EACH
RAISED TOILET SEAT
TUB STOOL OR BENCH
TRANSFER TUB RAIL ATTACHMENT
WATER CIRCULATNG HEAT UNIT PAD
BED FXD HGT W/RAILS, W/MATTRS
BED FXD HGT W/RAILS, W/O MTRS
BED VAR HT, W/RAIL&MATTRESS
BED VAR HT W/RAIL W/O MTTRS
HOSP BED SEMI-ELEC, W/MATTRESS
BED SEMI-ELEC, W/O MATTRESS
BED TOT ELEC, W/RAILS&MATTRSS
BED TOT ELEC, W/RAIL W/O MTTRS
HOS BED STRYKER FRAME,W/MTTRS
MATTRESS, INNERSPRING
MATTRESS, FOAM RUBBER
BED BOARD
OVER-BED TABLE
BED PAN, STD, METAL OR PLASTIC
BED PAN, FRACT, METAL/PLASTIC
POWER PRESS-REDUC AIR MATTRESS
BED CRADLE, ANY TYPE
BED FIX HT, W/O RAILS,W/MTRS
BED FIX HT, W/O RAIL & MTTRS
BED VAR HT, W/O RAIL, W/MTRS
BED VAR HT, W/O RAIL, W/O MTRS
BED SEMI-ELEC W/O RAIL, W/MTRS
BED SEMI-ELEC W/O RAIL&W/OMTRS
BED ELEC W/O RAILS, W/MTRSS
BED ELEC W/O RAILS, W/OMTRSS
BED SIDE RAILS, HALF LENGTH
BED SIDE RAILS, FULL LENGTH
BED ACCESSORY: ANY TYPE
BED SAFETY ENCLOSURE
E0325
E0326
E0350
E0352
E0370
E0371
E0372
E0373
E0424
E0425
E0430
E0431
E0434
E0435
E0439
E0440
E0441
E0442
E0443
E0444
E0445
E0450
E0454
E0455
E0457
E0459
E0460
E0461
E0462
E0480
E0481
E0482
E0483
E0484
E0500
E0550
E0555
E0560
E0565
E0570
E0571
E0572
E0574
E0575
E0580
E0585
E0590
E0600
E0601
URINAL; MALE, JUG-TYPE

URINAL; FEMALE, JUG-TYPE
CTRL UNT ELEC BOWEL IRRIG SYS
ELEC BOWEL IRRIGATION SYS
AIR PRESSURE ELEVATOR FOR HEEL
NONPOW OVERLAY,MATTRESS,STD LW
POW AIR OVRLAY,MATTRESS STD LW
NONPOW ADV PRESS REDUC MATRESS
STATNRY COMPRSS GAS OX SYST
STNRY COMPRSS GAS SYS, PURCHAS
PORTABLE GAS O2 SYS, PURCHASE
PORTBL GAS OX SYS,RENT;INC CNT
PORTABLE LIQ O2 SYSTEM, RENTAL
PORT LIQ O2 SYSTEM, PURCHASE
STATNRY LIQD OX SYS,RENT
STATIONARY LIQ O2 SYS, PURCHAS
OXYGEN,GASEOUS,1 MONTH SUPPLY
OXYGEN,LIQUID, 1 MONTH SUPPLY
PORTABLE OXYGEN,GAS,1 MONTH
PORTABLE OXYGEN,LIQUID,1 MONTH
OXIMTR DVCE MEASUR BLD OXYGEN
VOL VENT,STA/PORT,INVAS INTERF
PRSSRE VENT W PRSSRE CNTRL
O2 TENT, EXCL CROUP/ PEDI TENT
CHEST SHELL (CUIRASS)
CHEST WRAP
NEG PRESS VENTITLATOR
VOL VNT,STION/PRT,W BCKUP FEAT
ROCKING BED W/ OR W/O RAILS
PERCUSSOR, ELECTRIC/PNEUMATIC
INTRPULMNRY PERCUSS VENT SYS
COUGH STIMULATING DEVICE
HGH FREQ CHEST WALL OSCILATION
OSCLLTRY PSTVE EXPRTRY PRESURE
IPPB MACHINE, BUILT-IN NEBULIZ
HUMID EXTEN SUPPLE IPPB TX/O2
HUMIDIFIER GLASS/PLASTIC BOTLE
HUMIDIFYING IPPB TX/O2 DELIV
COMPRESSOR AIR POWER FOR EQUIP
NEBULIZER, WITH COMPRESSOR
AEROS COMP,BATT,SM VOL NEBULIZ
AEROS COMP,ADJ,LIGHT,INTERMITT
ULTRASONIC/ELECTRON W SM NEBUL
NEBULIZER,ULTRASONIC,LRGE VOLM
NEBULIZER GLASS/PLASTIC BOTTLE
NEBULIZER, W/COMPRESS & HEATER
DISP FEE COV DRUG ADM, DME NEB
SUCTION PUMP PORTAB HOM MODL
CONTINUOUS AIRWAY PRESSURE DVC
E0602
E0603
E0604
E0605
E0606
E0607
E0610
E0615
E0616
E0617
E0618
E0619
E0620
E0621
E0625
E0627
E0628
E0629
E0630
E0635
E0636
E0650
E0651
E0652
E0655
E0660
E0665
E0666
E0667
E0668
E0669
E0671
E0672
E0673
E0691
E0692
E0693
E0694
E0700
E0701
E0710
E0720
E0730
E0731
E0740
E0744
E0745
E0746
E0747
MANUAL BREAST PUMP

ELECTRIC BREAST PUMP
HOSP GRADE ELEC BREAST PUMP
VAPORIZER, ROOM TYPE
POST DRAINBOARDMONITORING EQMT
HOME BLOOD GLUCOSE MONITOR
PACEMAKER W/ AUDIBL/VISIBL SYS
PACEMAKER DIGITAL/VISIBLE SYS
IMPL CARD EVT REC,MEM,ACT,PROG
EXTERN DEFIBRILLA, ELECTROCARD
APNEA MONITOR, WO RECORD FEAT
APNEA MONITOR,W RECORDING FEAT
CAP BLD SKIN PIERCING LASER
SLING/SEAT, PATIENT LIFT
PAT. LIFT, KARTOP BATH/TOILET
SEAT LIFT/CHAIR LIFT MECHANISM
SEP SEAT LIFT MECHANISM, ELECT
SEP SEAT LIFT MECHNISM NONELEC
PATIENT LIFT, HYDRAULIC
PATIENT LIFT, ELECTRIC
MULTIPSTNAL PT SUPP SYS,W LIFT
PNEUM CMPRESSOR, NON-SEGMENTAL
PNEUM CMPRESS W/O CAL GRADIENT
PNEUM COMPRESS W/CAL GRADIENT
NONSEG PNEUM APPL: 1/2 ARM
NONSEG PNEUM APPL: FULL LEG
NONSEG PNEUM APPL: FULL ARM
NONSEG PNEUM APPL: HALF LEG
SEG PNEUM APPL: FULL LEG
SEG PNEUM APPL: FULL ARM
SEG PNEUM APPL: HALF LEG
SEG GRAD PNEUM APPL, FULL LEG
SEG GRAD PNEUM APPL, FULL ARM
SEG GRAD PNEU APPL, HALF LEG
UV THRPY,BULBS;TREAT 2SQFT/<
UV THRPY,BULBS, 4 FT PANEL
UV THRPY,BULBS, 6 FT PANEL
UV MLTIDRCT THRPY 6FT CAB
SAFETY EQUIPMENT
HLMT W FCE GRD&SFT INTRFCE MAT
RESTRAINTS, ANY TYPE
TENS, 2 LEAD, LOCALIZED STIMUL
TRNSCUT ELECAL,4+ LDS,MULT NRV
FORM FIT CONDUCTIVE GARMENT
PELVIC FLOOR STIM, MONITOR
NEUROMUSCULAR STIML, SCOLIOSIS
NEUROMUSC STIMULR, ELEC SHOCK
EMG, BIOFEEDBACK DEVICE
ELEC OSTEOGEN STIM, NOT SPINAL
E0748
E0749
E0752
E0754
E0755
E0756
E0757
E0758
E0759
E0760
E0761
E0765
E0776
E0779
E0780
E0781
E0782
E0783
E0784
E0785
E0786
E0791
E0830
E0840
E0850
E0855
E0860
E0870
E0880
E0890
E0900
E0910
E0920
E0930
E0935
E0940
E0941
E0942
E0943
E0944
E0945
E0946
E0947
E0948
E0950
E0951
E0952
E0953
E0954
OSTEOGEN STIM, NONINVAS SPINAL

OSTEOGENESS STIM,ELCTR,SRG IMP
NEUROSTIMULATOR ELECTRODE
PULSEGENERATOR PT PROGRAMMER
ELEC SALIVARY REFLEX STIMULR
IMPL NEUROSTIM PULSE GENERATOR
IMPL NEUROSTIM RADIOFREQ RECVR
RADIOFREQ TRANSMITTER (EXTERN)
REPLACE RDFRQUNCY TRANSMITTR
OSTOGEN STIM, ULTRASOUND
NON-THRML PLSD HGH FREQ RDIOWV
FDA,NRVE STIM,REP BAT,NAUS,VOM
IV POLE
AMB INFUS PUMP,MECH,REUS,8 HR+
AMB INFUS PUMP,MECH,REUS,< 8HR
AMBUL INFUS PUMP,1/+ CHAN,PAT
INFUSI PUMP,IMPLNT,NON-PROGRAM
INFUS PUMP SYS,IMPLANT,PROGRAM
EXTN AMBUL INFUS PMP, INSULIN
IMPLT INTRASPIN,CATH,PUMP,REPL
IMPLT PROG INFUS PUMP, REPLACE
PARENTL INFUS PMP, MULTI-CHAN
AMBULAT TRACT DEV,ALL TYPE,EA
TRACT FRAME, HDBRD, CERV TRCT
TRACT STAND, FREE STAND, CERV
CERV TRAC EQP,NO ADD STD/FRAME
TRACT EQMNT, OVERDOOR, CERVIC
TRACT FRAME, FTBRD, EXTREMITY
TRACT STAND, FREE STAND, EXTRM
TRACT FRAME, FTBRD, PELVIC
TRCT STAND, FREE STAND, PELVIC
TRAPEZE BARS, W/GRAB BAR
FRACT FRAME, W/WGTS
FRACT FRAME, FREE STAND, W/WTS
PASSIVE MOTION EXERCISE DEVICE
TRAPEZE BAR, FREE STAND, COMPL
GRAVITY ASST TRACTION DEVICE
CERVICAL HEAD HARNESS/HALTER
CERVICAL PILLOW
PELVIC BELT/HARNESS/BOOT
EXTREMITY BELT/HARNESS
FRACT FRAME, W/X-BARS, BED
FRACT FRAME, COMPLEX PELVIC
FRACT FRAME, COMPLEX CERVICAL
TRAY
LOOP HEEL, EACH
LOOP TOE, EACH
PNEUMATIC TIRE, EACH
SEMI-PNEUMATIC CASTER, EACH
E0958
E0959
E0961
E0962
E0963
E0964
E0965
E0966
E0967
E0968
E0969
E0970
E0971
E0972
E0973
E0974
E0975
E0976
E0977
E0978
E0979
E0980
E0990
E0991
E0992
E0993
E0994
E0995
E0996
E0997
E0998
E0999
E1000
E1001
E1011
E1012
E1013
E1014
E1015
E1016
E1017
E1018
E1020
E1025
E1026
E1027
E1031
E1035
E1037
WHEELCHAIR ATTCH, 1 ARM DRIVE

AMPUTEE ADAPTER
BRAKE EXTENSION, FOR WHEELCHR
1 IN CUSHION, FOR WHEELCHAIR
2 INCH CUSHION, FOR WHEELCHAIR
HOOK ON HEAD REST EXTENSION
WHEELCHAIR HAND RIMS
COMMODE SEAT, WHEELCHAIR
NARROWING DEVICE, WHEELCHAIR
#2 FOOTPLATE, EX ELEV LEG REST
ANTI-TIPPING DEVICE WHEELCHAIR
TRANSFER BOARD, WHEELCHAIR
ADJ HGT DETCH ARM, FULL WCHAIR
GRADE AID WHEELCHAIR
REINF SEAT UPHOLSTERY, WCHAIR
REINFORCED BACK, WHEELCHAIR
WEDGE CUSHION, WHEELCHAIR
WCHAIR W/SFTY BELT, W/ BUCKLE
WCHAIR W SFTY BELT W/ VELCRO
SAFETY VEST, WHEELCHAIR
ELEVATING LEG REST, EACH
UPHOLSTERY SEAT
SOLID SEAT INSERT
BACK, UPHOLSTERY
ARM REST, EACH
CALF REST, EACH
TIRE, SOLID, EACH
CASTER WITH A FORK
CASTER WITHOUT FORK
PNEUMATIC TIRE WITH WHEEL
TIRE, PNEUMATIC CASTER
WHEEL, SINGLEROLLABOUT CHAIR
MOD PEDIATRIC WC,WIDTH ADJSTMT
INTGRTD SEAT SYS,PLANAR,PED WC
INTGRTD SEAT SYS,CNTURD,PED WC
RECLINING BACK,ADD PED WC
SHOCK ABSORBER MANUAL WC
SHOCK ABSORBER POWER WC
HVY DUTY SHCK ABSORBER MAN WC
HVY DUTY SHCK ABSRBER,POWER WC
RESIDUAL LIMB SUPPORT SYS WC
LTRL THRC SUP,NON-CNTRD,PED WC
LTRL THRC SUPP,CONTRED,PED WC
LTRL/ANTROR SUPP,PEDC WC
ROLLABOUT CHAIR, W/=>5 CASTORS
MULT-POSIT PAT TRNSF,INTG SEAT
TRANSPORT CHAIR, PED SIZE
E1038
E1050
E1060
E1065
E1066
E1069
E1070
E1083
E1084
E1085
E1086
E1087
E1088
E1089
E1090
E1092
E1093
E1100
E1110
E1130
E1140
E1150
E1160
E1161
E1170
E1171
E1172
E1180
E1190
E1195
E1200
E1210
E1211
E1212
E1213
E1220
E1221
E1222
E1223
E1224
E1225
E1226
E1227
E1228
E1230
E1231
E1232
E1233
E1234
TRANSPORT CHAIR, ADULT SIZE

RECLN WCHAIR, DETACH LEG REST
RECLN WCHAIR, DTCH ARMS& LEG
WHEELCHAIR POWER ATTACHMENT
BATTERY CHARGER
DEEP CYCLE BATTERY
WHEELCH, DET ARMS, SWING FOOT
HEMIWHCHAIR, FIX ARMS ELEV LEG
HEMIWHCHAIR, DET ARMS/ELEV LEG
HEMIWHCHAIR, FIX ARMS DET FOOT
HEMIWHCHAR, DET ARMS/FOOT DESK
LTWT WHLCHR, FIX ARMS, DET LEG
LTWT WHLCHR ARMS DESK ELEV LEG
LTWT WHLCHR, FIX ARMS DET FOOT
LTWT WHLCHR DESK ARMS, DETFOOT
WDE H DTY WHLCHR DESK ARMS LEG
WDE H DTY WHLCHR DET FOOTRESTS
SMI RCLN WHLCH FIX ARM DET LEG
SMI RCLN WHLCH DET ARM ELV LEG
STD WHLCH FULL ARM F/S/D FOOT
WHELCH DET DSK/FULL ARM DET FT
WHELCH DET ARM DSK ELEV LEG
WHLCH, FIX ARM, DET ELEV LEG
MANUAL ADULT SIZE WC,TLT SPACE
AMP WHLCH FUL ARM DET ELV LEG
AMP WHLCH FUL ARM W/O FT REST
AMP WHLCH DET ARM W/O FT REST
AMP WHLCH DET ARM DET FT REST
AMP WHLCH DET ARM DET ELEV LEG
H DTY WHLCH FUL ARM DET/ELV LG
AMP WHLCH FUL ARM DET FT REST
MTR WHLCH FUL ARM ELV LEG REST
MTR WHLCH DET ARM DET/ELV LEG
MTR WHEELCH FUL ARM DET FT RST
MTR WHLCH DET ARM DET FT RESTS
WHLCHR SPEC SIZED/CONSTRUCTED
WHLCHAIR W/FIX ARM, FOOTRESTS
WHLCHR W/FIX ARM ELEV LEG RST
WHLCHR W/DET ARM & FOOTRESTS
WHLCHR W/DET ARM ELEV LEG REST
SEMI-RECLN BACK CUSTM WHLCHR
FULL RECLN BACK CUSTM WHLCHR
SPEC HT ARMS FOR WHEELCHAIR
SPEC BACK HT FOR WHEELCHAIR
PWRD VEHICLE 3 OR 4 WHEEL
W/C,PED SZ,TLT-N-SPCE,RIG,W SS
W/C,PED SZ,TLT-N-SPCE,FLD,W SS
W/C,PED SZ,TLT-N-SPC,RIG,WO SS
W/C,PED SZ,TLT-N-SPC,FLD,WO SS
E1235
E1236
E1237
E1238
E1240
E1250
E1260
E1270
E1280
E1285
E1290
E1295
E1296
E1297
E1298
E1300
E1310
E1340
E1353
E1355
E1372
E1390
E1399
E1405
E1406
E1500
E1510
E1520
E1530
E1540
E1550
E1560
E1570
E1575
E1580
E1590
E1592
E1594
E1600
E1610
E1615
E1620
E1625
E1630
E1632
E1635
E1636
E1637
E1639
W/C,PED SZ,RIG,ADJ,W SEAT SYS

W/C,PED SZ,FOLD,ADJ,W SEAT SYS
W/C,PED SZ,RIG,ADJ,WO SEAT SYS
W/C,PED SZ,FLD,ADJ,WO SEAT SYS
LTWT WHLCH DET ARMS DET ELV LG
LTWT WHLCH FIX ARM DET FT REST
LTWT WHLCH DET ARM DET FT REST
LTWT WHLCH FUL ARM DET ELV LEG
H DTY WHLCH DET ARM ELV LEG
H DTY WHLCH FIX ARM DET FT RST
H DTY WHLCH DET ARM DET FT RST
H DTY WHLCH FIX FUL ARM ELV LG
SPEC WHLCH SEAT HT FROM FLOOR
SPEC WHLCH SEAT DPTH BY UPLSRY
SPEC WHLCH SEAT DPTH AND WIDTH
WHIRLPOOL, PORTABLE OVERTUB
WHIRLPOOL, NON-PORTABLE
NONROUT SVC DME REQ SKILD TECH
REGULATOR
STAND/RACK
NEBUL IMMERSION EXTNL HEATER
OXYGEN CONCENTRATOR,DEL 85% /+
MISC DURABLE MEDICAL EQUIPMNT
O2 & H20 VAPOR SYS W/ HEAT
O2 AND H20 VAPOR SYS W/O HEAT
CENTRIFUGE
KIDNEY, DIALYSATE DELIVERY SYS
HEPARIN INFUSION PUMP
REPLACEMENT AIR BUBBLE DETEC
REPLACEMENT PRESSURE ALARM
BATH CONDUCTIVITY METER
REPLACE BLOOD LEAK DETECTOR
ADJ CHAIR, FOR ESRD PATIENTS
TRANSDUCER PROTECT/FLD BAR
UNIPUNCTURE CONTROL SYSTEM
HEMODIALYSIS MACHINE
AUTO INTERMITTENT DIALYSIS SYS
CYCLER DIALYSIS MACHINE
DELI/INSTALL CHRG HEMO EQUIP
REVERSE OSMOSIS H2O PURI SYS
DEIONIZER H2O PURI SYSTEM
REPLACEMENT BLOOD PUMP
WATER SOFTENING SYSTEM
RECIPROCATING DIALYSIS SYSTEM
WEARABLE ARTIFICIAL KIDNEY
TRAVEL HEMODIALYZER SYS
SORBENT CARTRIDGES PER 10
HEMOSTATS, EACH
SCALE, EACH
E1699
E1700
E1701
E1702
E1800
E1801
E1802
E1805
E1806
E1810
E1811
E1815
E1816
E1818
E1820
E1821
E1825
E1830
E1840
E1902
E2000
E2100
E2101
G0001
G0008
G0009
G0010
G0025
G0030
G0031
G0032
G0033
G0034
G0035
G0036
G0037
G0038
G0039
G0040
G0041
G0042
G0043
G0044
G0045
G0046
G0047
G0101
G0102
G0103
DIALYSIS EQUIPMENT NOC

JAW MOTION REHAB SYSTEM (JMRS)
REPLACEMNT CUSHIONS, JMRS SYS
REPLACMNT MEAS SCALES, JMRS
ADJUST ELBOW EXT/FLEX DEVICE
SPS ELBOW DEVICE
DYNAMIC ADJ FOREARM PRONATION
ADJUST WRIST EXT/FLEX DEVICE
SPS WRIST DEVICE
ADJUST KNEE EXT/FLEX DEVICE
SPS KNEE DEVICE
ADJUST ANKLE EXT/FLEX DEVICE
SPS ANKLE DEVICE
SPS FOREARM DEVICE
SOFT INTERFACE MATERIAL
REPLACEMENT INTERFACE SPSD
ADJUST FINGER EXT/FLEX DEVC
ADJUST TOE EXT/FLEX DEVICE
ADJ SHOULDER EXT/FLEX DEVICE
AAC NON-ELECTRONIC BOARD
GASTRIC SUCTION PUMP HME MDL
BLD GLUCOSE MONITOR W VOICE
BLD GLUCOSE MONITOR W LANCE
DRAWING BLOOD FOR SPECIMEN
ADMIN INFLUENZA VIRUS VAC
ADMIN PNEUMOCOCCAL VACCINE
ADMIN HEPATITIS B VACCINE
COLLAGEN SKIN TEST KIT
PET IMAGING PREV PET SINGLE
PET IMAGING PREV PET MULTPLE
PET FOLLOW SPECT 78464 SINGL
PET FOLLOW SPECT 78464 MULT
PET FOLLOW SPECT 76865 SINGL
PET FOLLOW SPECT 78465 MULT
PET FOLLOW CORNRY ANGIO SING
PET FOLLOW CORNRY ANGIO MULT
PET FOLLOW MYOCARD PERF SING
PET FOLLOW MYOCARD PERF MULT
PET FOLLOW STRESS ECHO SINGL
PET FOLLOW STRESS ECHO MULT
PET FOLLOW VENTRICULOGM SING
PET FOLLOW VENTRICULOGM MULT
PET FOLLOWING REST ECG SINGL
PET FOLLOWING REST ECG MULT
PET FOLLOW STRESS ECG SINGL
PET FOLLOW STRESS ECG MULT
CER/VAG CA SCR;PELV&BREAST EXM
PROSTATE CANCER SCRN;DIGT RECT
PROSTATE CANCER SCREEN;PSA,TOT
G0104
G0105
G0106
G0107
G0108
G0109
G0110
G0111
G0112
G0113
G0114
G0115
G0116
G0117
G0118
G0120
G0121
G0122
G0123
G0124
G0125
G0127
G0128
G0129
G0130
G0141
G0143
G0144
G0145
G0147
G0148
G0151
G0152
G0153
G0154
G0155
G0156
G0166
G0167
G0168
G0173
G0175
G0176
G0177
G0179
G0180
G0181
G0182
G0186
COLOREC CA SCR;FLX SIGMOIDSCPY

COLOREC CA;COLONOSCOPY,HI RISK
COLOREC CA;SIGMOIDSCPY,BAR ENM
COLOREC CA;FEC-OCCULT,1-3 SIML
DIABETES SELF-MGMT,INDVD,30 MN
DIABETES SELF-MGMT,GRP SESSN
NETT PULM-REHAB;EDU/SKILLS,IND
NETT PULM-REHAB;EDU/SKILLS,GRP
NETT PULM-REHAB;NUTRIT,INITIAL
NETT PULM-REHAB;NUTRI,SUBSEQNT
NETT PULM-REHAB;PSYCHOSOC CONS
NETT PULM-REHAB;PSYCHOLOG TEST
NETT PULM-REHAB;PSYCHOSOC COUN
GLAUCOMA SCRN HGH RISK DIREC
GLAUCOMA SCRN HGH RISK DIREC
COLOREC CA;COLONSCPY,BAR ENEMA
COLONSCPY,NOT MEET CRIT,HI RSK
COLORECTAL CA SCR;BARIUM ENEMA
SCRN CYTO,CERV/VAG,PHYS SUPERV
SCRN CYT,CER/VAG,INTERPRET PHY
PET IMAGIN REGIONAL/WHOLE BODY
TRIM DYSTROPH NAILS,ANY NUMBER
DIR NUR SERV,EA 10 MIN,> 5 MIN
OCCUPAT THER,OT,PART HOSP,/DAY
SEXA, BONE, 1+SITE; APPEN SKEL
SCREEN CYTO SMR,INTERPRET PHYS
SCRN CYTO,CERV/VAG,MAN,PHY SUP
SCREEN CYTOPATH,CRVC AUTO SYS
SCREEN CYTOPATH,CRVC,SYS&MAN
SCR CYTO, AUTO SYS, PHYS SUPER
SCR CYTO,AUTO SYS,MAN RESCREEN
SERV,PHYS THER,HOME, EA 15 MIN
SERV,OCCUP THER,HOME,EA 15 MIN
SERV,SPECH&LANG,HOME,EA 15 MIN
SERV,NURSE,HOME SET, EA 15 MIN
SERV,CLN SOC WRK,HME,EA 15 MIN
SERV,HEALTH AIDE,HME,EA 15 MIN
EXTER COUNTERPULSATION/TX SESS
HYPERBAR O2, NO PHYS ATTN/SESS
WOUND CLOS UTL TISS ADHES ONLY
STEREOTAC RADSRG,COMPLT,1 SESS
SCHD INTERDISC TEAM CONF,W PAT
ACT THER,NO REC,MENTL HLTH,45+
TRAIN,ED,MENTL HEALTH,45 MIN/+
PHYS RE-CERT MEDCARE-HOME HLTH
PHYS CERT MEDICARE- HOME HLTH
PHYS SUP PAT,HME HLTH AG,30MN+
PHYS SUP PAT,HOSPICE,30 MIN/+
DES,LOC LES,CHOR;PHOTOCOA,FEED
G0202
G0204
G0206
G0210
G0211
G0212
G0213
G0214
G0215
G0216
G0217
G0218
G0219
G0220
G0221
G0222
G0223
G0224
G0225
G0226
G0227
G0228
G0229
G0230
G0231
G0232
G0233
G0234
G0236
G0237
G0238
G0239
G0242
G0243
G0244
G0245
G0246
G0247
G0248
G0249
G0250
G0251
G0252
G0253
G0254
G0255
G0256
G0257
G0258
SCREENINGMAMMOGRAPHYDIGITAL
DIAGNOSTICMAMMOGRAPHYDIGITAL
DIAGNOSTICMAMMOGRAPHYDIGITAL
PET IMG BODY;DIAGN;LUNG CANCER
PET IMG BDY;INT STGNG;LNG CA
PET IMG BDY;RESTAG;LNG CANCER
PET IMG BDY;DIAG;COLORECTAL
PET IMG BDY;INIT STAG;COLORE
PET IMG BDY;RESTGNG;COLOREC CA
PET IMG BDY;DIAGNOSI; MELANOMA
PET IMG BDY;INIT STAG;MELANOMA
PET IMG BODY;RESTAG;MELANOMA
PET IMG BODY;MELANOMA NON-CVER
PET IMG BODY;DIAGNOS;LYMPHOMA
PET IMG BDY;INIT STAG;LYMPHOMA
PET IMG BODY;RESTAG;LYMPHOMA
PET IMG BDY;DIAG;HEAD&NECK
PET IMG BDY;INIT;HEAD&NECK
PET IMG BDY;RESTAG;HEAD&NECK
PET IMG BDY;DIAG;ESOPHAGEAL
PET IMG BDY;INIT;ESOPHAGEAL
PET IMG ODY;RESTAG;ESOPHAGEAL
PET IMG;METAB BRAIN,PRE-SURG
PET IMG;METAB ASSES MYOCARDIAL
PET WHBD COLOREC; GAMMA CAM
PET WHBD LYMPHOMA; GAMMA CAM
PET WHBD MELANOMA; GAMMA CAM
PET WHBD PULM NOD; GAMMA CAM
DIGITIZATION,FILM RADIOGRAPHIC
THERAPEUTIC PROCD STRG ENDUR
OTH RESP PROC, INDIV
THERAPEUT PROC;IMPRVE RESPIRAT
MULTISOURCE PHOTON STER PLAN
MULTISOUR PHOTON STERO TREAT
OBSERV CARE BY FACILITY TOPT
INIT PHYS EVAL&MNGT DIABT NURO
FLW-UP PHYS EVL&MGT DIABT NURO
RUTNE FT CARE DIABETIC W NEURO
DMNSTRT,INIT,HME INR MNTR PATE
PROVIS TST MATR&EQUP HME MNTOR
PHYSI RVEW,INTERPRET&MANAG HME
LNEAR ACCELER BSED STREOTACTIC
PET IMG,INIT DIAG BRST CNCER
PET IMG BRST CNCER,STAGING
PET IMG BRST CNCER,EVAL RESP
CURENT PERCP THRSHLD/SNRY NRVE
PRSTE BRACHYTHRPY PERM IMPLANT
UNSCHEDLD/EMERG DIALYSIS TREAT
IV INFUS DURING SPRT PAY OBSRV
G0259
G0260
G0261
G0262
G0263
G0264
G0265
G0266
G0267
G0268
G0269
G0270
G0271
G0272
G0273
G0274
G0275
G0278
G0279
G0280
G0281
G0282
G0283
G0288
G0289
G0290
G0291
G0292
G0293
G0294
G0295
G9001
G9002
G9003
G9004
G9005
G9006
G9007
G9008
G9009
G9010
G9011
G9012
G9016
H0001
H0002
H0003
H0004
H0005
INJECT SACROILIAC JNT;ARTRGRPY

INJECT SACROILIAC JNTANESTHETC
PROST BRACHYTHRPY PERM IMPLNTD
SM INTEST IMG;INTRLMINAL,LGMNT
DRCT ADM,PT W DX,CHF,CHST PAIN
INIT NURS ASSES PT DRCT ADMTTD
CRYOPRESERVATION,FREZNG&STRGE
THAW&EXPAN,FRZN CELLS THRAPETC
BNE MARW/PRPHRL STEM CEL HRVST
RMVL IMPACTED CERUMEN
PLCE OCCLSVE DVCE VENUS/ARTRAL
MEDICAL NUTRIT THRPY;INDIVDUAL
MEDICAL NUTRIT THRPY;GROUP
NASO/ORO GASTRIC TUBE PLACE
RADIOPHARM BIODISTRI,S/M SCANS
RADIOPHARM THRPY,NON-HODGKIN'S
RENAL ART ANGIOGRPHY TIME CATH
ILIAC ART ANGIOGRPHY TIME CATH
XTRACORPOREAL THRPY;ELBW EPCND
XTRACORPOREAL THRPY;NOT ELBW
ELECT STM,1/+ AREAS,STG3&4 ULC
ELECT STM,1/+ AREAS,WOUND CARE
ELECT STM,1/+ AREA NOT WND CAR
RECNSTRCT,CTA,AORTA,SURG PLAN
ARTHROSCPY,KNEE,SURG,RMVL LSE
TRANSCATH PLCE DRUG,SIGL VESS
TRANSCATH PLCE DRUG,ADDL VESS
ADMIN EXPRI DRUG CLNCAL TRIAL
NONCVERED SURG CNSCIS SEDAT
NONCVRD PROC NO ANES/LCAL ANES
ELECTROMAGNETIC STIMULATION
COORD CARE FEE, INITIAL RATE
COORD CARE FEE, MAINT RATE
COORD CARE FEE,RSK ADJ HI,INIT
COORD CARE FEE,RSK ADJ LOW,INT
COORD CARE FEE, RISK ADJ MAINT
COORD CARE FEE, HOME MONITOR
COORD CARE FEE,SCHED TEAM CONF
COORD CARE FEE,PHYS CARE SERV
MCCD, RISK ADJ, LEVEL 3
OTHER SPECIFIED CASE MGMT
SMOK CESS COUN,IND/SESS,6-10MN
ALCOHOL AND/OR DRUG ASSESSMENT
BEHAVL HLTH SCREEN,ADM TX PRGM
ALCOHOL &/ DRUG SCRN; LAB ANAL
BEHAVL HEALTH COUNSELI & THRPY
ALCOHOL &/ DRUG SERV;GRP COUNS
H0006
H0007
H0008
H0009
H0010
H0011
H0012
H0013
H0014
H0015
H0016
H0017
H0018
H0019
H0020
H0021
H0022
H0023
H0024
H0025
H0026
H0027
H0028
H0029
H0030
H0031
H0032
H0033
H0034
H0035
H0036
H0037
H0038
H0039
H0040
H0041
H0042
H0043
H0044
H0045
H0046
H0047
H0048
H1000
H1001
H1002
H1003
H1004
H1005
ALCOHOL &/ DRUG SERV;CASE MGT

ALCOHOL &/DRUG SER;CRIS,OUTPAT
ALCOHOL &/DRUG;SUB-ACT,HOSP IN
ALCOHOL &/DRUG;ACUTE,HOSP INPT
ALCOHOL &/DRUG;SUB-ACUTE INPAT
ALCOHOL &/DRUG SER;ACUTE INPAT
ALCOHL &/DRUG;SUB-ACUTE OUTPAT
ALCOHOL &/DRG SER;ACUTE OUTPAT
ALCOHL &/DRG SERV; AMBUL DETOX
ALCOHL &/DRG SERV;INTEN OUTPAT
ALCOHOL &/ DRUG SERV;MED/SOMAT
BEHAVL HLTH;RES,WO ROOM&BOARD
BEHAVL HLTH;SHORT-TRM RESIDENT
BEHAVL HLTH;LONG-TERM RESIDENT
ALCOHOL &/ DRUG SERV;METHADONE
ALCOHOL &/ DRUG TRAINING SERV
ALCOHOL &/ DRUG INTERVENT SERV
BEHAVL HEALTH OUTREACH SERVICE
BEHAVL HEALTH PREVENTION INFO
BEHAVL HLTH PREVENT EDUCATION
ALCOHOL &/ DRUG PREVENT,COMMUN
ALCOHOL &/ DRUG PREVENTION ENV
ALCOHL &/DRG PREV,REF,NO ASSES
ALCOHL &/ DRG PREVEN ALTERN SR
BEHAVL HEALTH HOTLINE SERVICE
MENTAL HEALTH ASSESS,NON-PHYS
MENTAL HEALTH SRVCE PLAN DEVEL
ORAL MEDICATION ADMINISTRATION
MEDICATION TRAINING & SUPPORT
MNTL HEALTH PART HSPTL,<24 HRS
CMMUN PSYCHAT SUPP TREAT/15MIN
CMMUN PSYCHAT SUPP TREAT PRGRM
SELF-HELP/PEER SRVCS,/15 MIN
ASSERT COMMUN TREAT,FCE-2-FCE
ASSERT COMMUN TREAT PROGRAM
FOSTER CARE,CHILD, PER DIEM
FOSTER CARE, CHILD, PER MONTH
SUPPORTED HOUSING, PER DIEM
SUPPORTED HOUSING, PER MONTH
RESPTE CARE SRVCE,NOT IN HME
MENTAL HEALTH SERVICES, NOS
ALCHL&/OTH DRUG ABUSE SRVCS
ALCOHOL&/OTH DRG TSTING:COLL
PRENATAL CARE ATRISK ASSESSM
ANTEPARTUM MANAGEMENT
CARECOORDINATION PRENATAL
PRENATAL AT RISK EDUCATION
FOLLOW UP HOME VISIT/PRENTAL
PRENATALCARE ENHANCED SRV PK
H1010
H1011
H2000
H2001
J0120
J0130
J0150
J0151
J0170
J0190
J0200
J0205
J0207
J0210
J0256
J0270
J0275
J0280
J0282
J0285
J0287
J0288
J0289
J0290
J0295
J0300
J0330
J0350
J0360
J0380
J0390
J0395
J0456
J0460
J0470
J0475
J0476
J0500
J0515
J0520
J0530
J0540
J0550
J0560
J0570
J0580
J0585
J0587
J0592
NON-MEDICAL FAMILY PLANNING

FAM ASSESS STATE DEFIND PURP
COMPREHEN MULTIDISCIPLIN EVAL
REHABILITATION PROGRAM,1/2 DAY
TETRACYCLIN INJ <= 250 MG
INJECTION ABCIXIMAB, 10 MG
INJECTION, ADENOSINE, 6 MG
INJECT, ADENOSINE, 90 MG
ADRENALN EPINEPHRIN INJ <=1 ML
INJ BIPERIDEN LACTATE/5 MG
INJ,ALATROFLOXACIN MESYL,100MG
ALGLUCERASE INJ / 10 UNITS
INJECTION, AMIFOSTINE, 500 MG
METHYLDOPATE HCL INJ <=250 MG
INJ, ALPHA 1-PROTEIN INHIB-HUM
INJECT, ALPROSTADIL, 1.25 MCG
ALPROSTADIL URETHRAL SUPPOSIT
AMINOPHYLLIN 250 MG INJ
INJ,AMIODARONE HYDROCHLR,30 MG
INJECT, AMPHOTERICIN B, 50 MG
INJECT,AMPHOTERICIN B LIPID
INJECT,AMPHOTERICIN B CHLSTRYL
INJECT,AMPHOTERICIN B LIPOSOME
INJEC,AMPICILLIN SODIUM,500 MG
AMPI/SULBACT / 1.5 GM INJ
AMOBARBITAL 125 MG INJ
SUCCINYCHOLINE CL INJ <=2- MG
INJECTION ANISTREPLASE 30 U
HYDRALAZINE HCL INJ <=20 MG
INJ METARAMINL BITARTRTE /10MG
CHLOROQUINE INJ <=250 MG
INJECTION, ARBUTAMINE HCL,1 MG
INJECTION,AZITHROMYCIN, 500 MG
ATROPINE SULFATE INJECTION
DIMECAPROL INJECTION / 100 MG
BACLOFEN 10 MG INJECTION
INJ,BACLOFEN,50 MCG,INTR TRIAL
DICYCLOMINE INJECTION <= 20 MG
INJ BENZTROPINE MESYLATE
BETHANECHOL CHLORIDE INJECT
PENICILLIN G BENZATHINE INJ
BOTULINUM TOXIN A PER UNIT
BOTULINUM TOXIN TYPE B
INJECT,BUPRENORPHINE HYDROCHLO
J0600
J0610
J0620
J0630
J0636
J0637
J0640
J0670
J0690
J0692
J0694
J0696
J0697
J0698
J0702
J0704
J0706
J0710
J0713
J0715
J0720
J0725
J0735
J0740
J0743
J0744
J0745
J0760
J0770
J0780
J0800
J0835
J0850
J0880
J0895
J0900
J0945
J0970
J1000
J1020
J1030
J1040
J1051
J1055
J1056
J1060
J1070
J1080
J1094
EDETATE CALCIUM DISODIUM INJ

CALCIUM GLUCONATE INJECTION
CALCIUM GLYCER & LACT/ 10 ML
CALCITONIN SALMON INJECTION
INJECTION, CALCITRIOL, 0.1 MCG
INJECT,CASPOFUNGIN ACETAT,5 MG
LEUCOVORIN CALCIUM INJECTION
INJ MEPIVACAINE HCL/10 ML
INJECT,CEFAZOLIN SODIUM,500 MG
CEFEPIME HCL FOR INJECTION
CEFOXITIN SODIUM INJ 1 GM
CEFTRIAXONE SODIUM INJ/250 MG
STERILE CEFUROXIME INJECTION
CEFOTAXIME SODIUM INJ /GM
BETAMETHASONE ACET&SOD PHOSP
BETAMETHASONE SOD PHOSP/ 4 MG
CAFFEINE CITRATE INJECTION
CEPHAPIRIN SODIUM INJ, <= 1 GM
INJ CEFTAZIDIME PER 500 MG
CEFTIZOXIME SODIUM INJ/500 MG
CHLORAMPHENICOL NA INJ <=1 GM
CHORIONIC GONADOTROPIN/ 1000U
INJECTION, CLONIDINE HCL, 1 MG
INJECTION, CIDOFOVIR, 375 MG
CILASTATIN SODIUM INJ / 250 MG
CIPROFLOXACIN IV
INJ CODEINE PHOSPHATE / 30 MG
COLCHICINE INJECTION
COLISTIMETHATE SODIUM INJ
PROCHLORPERAZINE INJECTION
CORTICOTROPIN INJECTION
INJ COSYNTROPIN PER 025 MG
CYTOMEGALOVIRUS IMM IV / VIAL
INJECT,DARBEPOETIN ALFA, 5 MCG
INJCTN,DEFEROXAMINE MESYLATE
TESTOSTERONE ENANTHATE INJ
BROMPHENIRAMINE MALEATE INJ
ESTRADIOL VALERATE INJECTION
DEPO-ESTRADIOL CYPIONATE INJ
METHYLPREDNISOLONE 20 MG INJ
INJECT,MEDROXYPROGESTER ACTATE
MEDRXYPROGESTER ACETATE INJ
MA/EC CONTRACEPTIVEINJECTION
TESTOSTERONE CYPIONATE 1 ML
TESTOSTERONE CYPIONATE 100 MG
TESTOSTERONE CYPIONATE 200 MG
INJECT,DEXAMETHASONE ACETATE
J1100
J1110
J1120
J1160
J1165
J1170
J1180
J1190
J1200
J1205
J1212
J1230
J1240
J1245
J1250
J1260
J1270
J1320
J1325
J1327
J1330
J1364
J1380
J1390
J1410
J1435
J1436
J1438
J1440
J1441
J1450
J1452
J1455
J1460
J1470
J1480
J1490
J1500
J1510
J1520
J1530
J1540
J1550
J1560
J1563
J1564
J1565
J1570
J1580
INJCTN,DEXAMETHASONE SDM PHOS

INJ DIHYDROERGOTAMINE MESYLT
ACETAZOLAMID NA INJECTN <500
DIGOXIN INJECTION <= 5 MG
PHENYTOIN SODIUM INJECTION
HYDROMORPHONE INJECTION
DYPHYLLINE INJECTION
DEXRAZOXANE HCL INJECTION
DIPHENHYDRAMNE HCL INJ <=50 MG
CHLOROTHIAZIDE NA INJ/500 MG
DIMETHYL SULFOXIDE 50% 50 ML
METHADONE INJECTION
DIMENHYDRINATE INJ <= 50 MG
DIPYRIDAMOLE INJECTION / 10 MG
INJ DOBUTAMINE HCL/250 MG
INJ, DOLASETRON MESYLATE,10 MG
INJECTION, DOXERCALCIFEROL
AMITRIPTYLINE INJECTION
INJECTION,EPOPROSTENOL, 0.5 MG
INJECTION, EPTIFIBATIDE, 5 MG
ERGONOVINE MALEATE INJECTION
ERYTHRO LACTOBIONATE / 500 MG
ESTRADIOL VALERATE 10 MG INJ
ESTRADIOL VALERATE 20 MG INJ
INJ ESTROGEN CONJUGATE 25 MG
INJECTION ESTRONE PER 1 MG
ETIDRONATE DISODIUM INJ
INJECTION, ETANERCEPT, 25 MG
FILGRASTIM 300 MCG INJECTION
FILGRASTIM 480 MCG INJECTION
INJECTION FLUCONAZOLE, 200 MG
INJ,FOMIVIR SOD,INTRAOC,1.65MG
FOSCARNET SODIUM INJECTION
GAMMA GLOBULIN 1 CC INJ
GAMMA GLOBULIN > 10 CC INJ
INJ,IMM GLOBULIN, INTRAVEN,1 G
INJECT,IMMUNE GLOBULIN, 10 MG
INJ, RSV IMM GLOB,INTRAV,50 MG
GANCICLOVIR SODIUM INJECTION
GARAMYCIN GENTAMICIN INJ
J1590
J1600
J1610
J1620
J1626
J1630
J1631
J1642
J1644
J1645
J1650
J1652
J1655
J1670
J1700
J1710
J1720
J1730
J1742
J1745
J1750
J1756
J1785
J1790
J1800
J1810
J1815
J1817
J1825
J1830
J1835
J1840
J1850
J1885
J1890
J1910
J1940
J1950
J1955
J1956
J1960
J1990
J2000
J2010
J2020
J2060
J2150
J2175
J2180
GATIFLOXACIN INJECTION
GOLD SODIUM THIOMALEATE INJ
GLUCAGON HYDROCHLORIDE/ 1 MG
GONADORELIN HYDROCH/ 100 MCG
INJEC,GRANISETRON HCL, 100 MCG
HALOPERIDOL INJECTION
HALOPERIDOL DECANOATE INJ
INJ HEPARIN SODIUM PER 10 U
INJ HEPARIN SODIUM PER 1000 U
DALTEPARIN SODIUM / 2500 IU
INJECT,ENOXAPARIN SODIUM,10 MG
INJECT,FONDAPARINUX SODIUM
TINZAPARIN SODIUM INJECTION
TETANUS IMMUNE GLOBULIN INJ
HYDROCORTISONE ACETATE INJ
HYDROCORTISONE SODIUM PH INJ
HYDROCORTISONE SODIUM SUCC I
DIAZOXIDE INJECTION <= 300 MG
INJECT,IBUTILIDE FUMARATE,1 MG
INJECTION INFLIXIMAB, 10 MG
INJECTION, IRON DEXTRAN, 50 MG
INJECT, IRON SUCROSE, 1 MG
INJECTION IMIGLUCERASE / UNIT
DROPERIDOL INJECTION
PROPRANOLOL INJECTION
DROPERIDOL/FENTANYL INJ <=2 ML
INJECTION,INSULIN,/5 UNITS
INSULIN,ADMIN THRU DME/50 UNIT
INJECT,INTERFER BETA-1A,33MCG
INJ INTERFERON BETA-1B,0.25 MG
INTRACONAZOLE INJECTION
KANAMYCIN SULFATE 500 MG INJ
KANAMYCIN SULFATE 75 MG INJ
KETOROLAC TROMETHAMINE INJ
CEPHALOTHIN NA INJ, <= 1 GM
KUTAPRESSIN INJECTION
FUROSEMIDE INJECTION
LEUPROLIDE ACETATE / 375 MG
INJ LEVOCARNITINE PER 1 GM
INJECTION, LEVOFLOXACIN,250 MG
LEVORPHANOL TARTRATE INJ
CHLORDIAZEPOXIDE INJ <= 100 MG
LIDOCAINE INJECTION
LINCOMYCIN INJECTION
LINEZOLID INJECTION
LORAZEPAM INJECTION
MANNITOL INJECTION
MEPERIDINE HYDROCHL / 100 MG
MEPERIDINE/PROMETHAZINE INJ
J2210
J2250
J2260
J2270
J2271
J2275
J2300
J2310
J2320
J2321
J2322
J2324
J2352
J2355
J2360
J2370
J2400
J2405
J2410
J2430
J2440
J2460
J2501
J2510
J2515
J2540
J2543
J2545
J2550
J2560
J2590
J2597
J2650
J2670
J2675
J2680
J2690
J2700
J2710
J2720
J2725
J2730
J2760
J2765
J2770
J2780
J2788
J2790
J2792
METHYLERGONOVIN MALEATE INJ

INJ MIDAZOLAM HYDROCHLORIDE
INJECTION,MILRINON LACTATE,5MG
MORPHINE SULFATE INJECTION
INJECT,MORPHINE SULFATE,100 MG
MORPHINE SULFATE INJECTION
INJ NALBUPHINE HYDROCHLORIDE
INJ NALOXONE HYDROCHLORIDE
NANDROLONE DECANOATE 50 MG
INJECTION, NESIRITIDE, 0.5 MG
INJECT,OCTREOTIDE ACETATE,1 MG
INJECTION, OPRELVEKIN, 5 MG
ORPHENADRINE INJECTION
PHENYLEPHRINE HCL INJECTION
CHLOROPROCAINE HCL INJ/30 ML
ONDANSETRON HCL INJECTION
OXYMORPHONE HCL INJECTION
PAMIDRONATE DISODIUM / 30 MG
PAPAVERIN HCL INJECTION
OXYTETRACYCLINE INJECTION
INJECTION, PARICALCITOL, 1 MCG
PENICILLIN G PROCAINE INJ
PENTOBARBITAL SODIUM INJ
PENICILLIN G POTASSIUM INJ
INJCTN,PIPERACILLN SDM/TAZBCTM
PENTAMIDINE ISETHIONTE/ 300MG
PROMETHAZINE HCL INJECTION
PHENOBARBITAL SODIUM INJ
OXYTOCIN INJECTION
INJ DESMOPRESSIN ACETATE
PREDNISOLONE ACETATE INJ
TOTAZOLINE HCL INJECTION
INJECTION, PROGESTERONE,/50 MG
FLUPHENAZINE DECANOATE 25 MG
PROCAINAMIDE HCL INJECTION
OXACILLIN SODIUM INJECITON
NEOSTIGMINE METHYLSLFTE INJ
INJ PROTAMINE SULFATE/ 10 MG
INJ PROTIRELIN PER 250 MCG
PRALIDOXIME CHLORIDE INJ
PHENTOLAINE MESYLATE INJ
METOCLOPRAMIDE HCL INJECTION
INJ,QUINU/DALFOPRISTIN,500 MG
INJ,RANITIDINE HYDROCHLOR,25MG
INJECT,RHO D IMMUNE GLOBULIN
INJECT,RHO D IMMUNE GLOBULIN
INJ,RHO D IMM GLOB,INTR,100 IU
J2795
J2800
J2810
J2820
J2910
J2912
J2916
J2920
J2930
J2940
J2941
J2950
J2993
J2995
J2997
J3000
J3010
J3030
J3070
J3100
J3105
J3120
J3130
J3140
J3150
J3230
J3240
J3245
J3250
J3260
J3265
J3280
J3301
J3302
J3303
J3305
J3310
J3315
J3320
J3350
J3360
J3364
J3365
J3370
J3395
J3400
J3410
J3420
J3430
INJ,ROPIVACAINE HYDROCHLR,1 MG
METHOCARBAMOL INJECTION
INJ THEOPHYLLINE PER 40 MG
INJECT, SARGRAMOSTIM, 50 MCG
AUROTHIOGLUCOSE <= 50 MG INJ
SODIUM CHLORIDE INJECTION
INJECT,SODIUM FERRIC GLUCONATE
METHYLPREDNISOLONE INJECTION
METHYLPREDNISOLONE INJECTION
SOMATREM INJECTION
SOMATROPIN INJECTION
PROMAZINE HCL INJECITON
RETEPLASE INJECTION
INJ STREPTOKINASE / 250000 IU
INJ,ALTEPLASE RECOMBINANT,1 MG
STREPTOMYCIN INJECTION
INJCTN,FENTANYL CITRATE,0.1 MG
INJ,SUMATRIPTAN SUCCINATE,6 MG
INJECT,PENTAZOCINE, 30 MG
TENECTEPLASE INJECTION
TERBUTALINE SULFATE INJ
TESTOSTERONE SUSPENSION INJ
TESTOSTERON PROPIONATE INJ
CHLORPROMAZINE HCL INJ <=50 MG
INJECT,THYROTROPIN ALPHA,0.9MG
INJ,TIROFIBAN HYDROCHL,12.5 MG
TRIMETHOBENZAMIDE HCL INJ
TOBRAMYCIN SULFATE INJECTION
INJECTION TORSEMIDE 10 MG/ML
THIETHYLPERAZINE MALEATE INJ
TRIAMCINOLONE ACETONIDE INJ
TRIAMCINOLONE DIACETATE INJ
TRIAMCINOLONE HEXACETONL INJ
INJ TRIMETREXATE GLUCORONATE
PERPHENAZINE INJECITON
INJECT,TRIPTORELIN PAMOATE
SPECTINOMYCN DI-HCL INJ
UREA INJECTION
DIAZEPAM INJECTION <= 5 MG
UROKINASE 5000 IU INJECTION
UROKINASE 250,000 IU INJ
INJECT, VANCOMYCIN HCL, 500 MG
VERTEPORFIN INJECTION
TRIFLUPROMAZINE HCL INJ
HYDROXYZINE HCL INJECTION
VITAMIN B12 INJECTION
VITAMIN K PHYTONADIONE INJ
J3470
J3475
J3480
J3485
J3487
J3490
J3520
J3530
J3535
J3570
J3590
J7030
J7040
J7042
J7050
J7051
J7060
J7070
J7100
J7110
J7120
J7130
J7190
J7191
J7192
J7193
J7194
J7195
J7197
J7198
J7199
J7300
J7302
J7308
J7310
J7317
J7320
J7330
J7340
J7342
J7350
J7500
J7501
J7502
J7504
J7505
J7506
J7507
J7508
HYALURONIDASE INJECTION
INJ MAGNESIUM SULFATE
INJ POTASSIUM CHLORIDE
INJECTION, ZIDOVUDINE, 10 MG
INJECT,ZOLEDRONIC ACID, 1 MG
DRUGS UNCLASSIFIED INJECTION
EDETATE DISODIUM PER 150 MG
NASAL VACCINE INHALATION
METERED DOSE INHALER DRUG
LAETRILE AMYGDALIN VIT B17
UNCLASSIFIED BIOLOGICS
NORMAL SALINE SOLUTION INFUS
5% DEXTROSE/NORMAL SALINE
STERILE SALINE/WATER
5% DEXTROSE/WATER
D5W INFUSION. 100 CC
DEXTRAN 40 / 500 ML INFUSION
DEXTRAN 75 / 500 ML INFUSION
RINGERS LACTATE INFUSION
HYPERTONIC SALINE SOLUTION
FACTOR VIII(ANTIHM,HUM) PER IU
FACTOR VIII (PORCINE)
FACTOR VIII(ANTIHM,REC) PER IU
FACTOR IX NON-RECOMBINANT
FACTOR IX COMPLEX
FACTOR IX RECOMBINANT
ANTITHROMBIN III INJECTION
ANTI-INHIBITOR, PER I.U.
HEMOPHILIA CLOTT FACTOR, NOC
INTRAUT COPPER CONTRACEPTIVE
LEVONORGESTREL IU CONTRACEPT
AMINOLEVULINIC ACID HCL TOP
GANCICLOVIR LONG ACT IMPLANT
SODIUM HYALURONT,INTRA-ARTICLR
HYLAN G-F 20,16 MG,INT ART INJ
AUTOLOG CULT CHONDROCYTES,IMPL
DERMAL& EPIDERMAL TISSUE;HUMAN
DERM TISS,HUMAN,W META,/SQCNT
DERM TISS,HUMAN,INJECT,WO META
AZATHIOP PO TAB 50MG 100S EA
AZATHIOPRNE PARENTL 100MG/20ML
CYCLOSPORINE ORAL SOLUTION
LYMPHOCYTE IMMUNE GLOBULIN
MUROMONAB-CD3, PARENTERAL,5 MG
PREDNISONE ORAL
TACROLIMUS ORAL PER 1 MG
TACROLIMUS ORAL PER 5 MG
J7509
J7510
J7511
J7513
J7515
J7516
J7517
J7520
J7525
J7599
J7608
J7618
J7619
J7622
J7624
J7626
J7628
J7629
J7631
J7633
J7635
J7636
J7637
J7638
J7639
J7641
J7642
J7643
J7644
J7648
J7649
J7658
J7659
J7668
J7669
J7680
J7681
J7682
J7683
J7684
J7699
J7799
J8499
J8510
J8520
J8521
J8530
J8560
J8600
METHYLPREDNISOLONE ORAL
PREDNISOLONE ORAL PER 5 MG
ANTITHYMOCYTE GLOBULN RABBIT
DACLIZUMAB, PARENTERAL, 25 MG
CYCLOSPORINE,PARENTERAL,250 MG
MYCOPHENOLATE MOFET,ORL,250 MG
SIROLIMUS, ORAL, 1 MG
TACROLIMUS, PARENTERAL, 5 MG
IMMUNOSUPPRESSIVE DRUG NOC
ACETYLCYST,INH,DME,UNT DOSE/GM
ALBUTEROL INH SOL CON
ALBUTEROL INH SOL U D
BECLOMETHASONE INHALATN SOL
BETAMETHASONE INHALATION SOL
BUDESONIDE INHALATION,THRU DME
BITOLTER MESYL,INH,DME,CONC/MG
BITOLTER MESYL,INH,DME,UNT,/MG
CROMOLYN SOD,INH,DME,UNT/10 MG
BUDESON,INHAL THRU DME,CONCENT
ATROPINE, INH,DME,CONCN,PER MG
ATROPINE,INH,DME,UNIT DOSE /MG
DEXAMETHASONE,INH,DME,CONCN/MG
DEXAMETHASONE,INH,DME,UNIT,/MG
DORNASE ALPHA,INH,DME,UNIT,/MG
FLUNISOLIDE, INHALATION SOL
GLYCOPYRROLATE,INH,DME,CONC/MG
GLYCOPYRROLATE,INH,DME,UNIT/MG
IPRATROPIUM BROMIDE,INH,UNT/MG
ISOETHARINE HCL,INH,CONCEN,/MG
ISOETHARINE HCL,INHAL,UNIT,/MG
ISOPROTERENOL HCL,INH,CONC,/MG
ISOPROTERENOL HCL,INH,UNIT,/MG
METAPROTEREN SULF,INH,CON/10MG
METAPROTEREN SULF,INH,UNT/10MG
TERBUTALINE SULF,INH,CONC, /MG
TERBUTALINE SULFATE,INH,UNT/MG
TOBRAMYCIN,UNIT DOSE,300MG,INH
TRIAMCINOLONE,INHAL,CONCEN,/MG
TRIAMCINOLONE,INHAL, UNIT, /MG
INHALATION SOLUTION FOR DME
NON-INHALATION DRUG FOR DME
ORAL PRESCRIP DRUG NON CHEMO
BUSULFAN; ORAL, 2 MG
CYCLOPHOSPHAMIDE ORAL 25 MG
ETOPOSIDE ORAL 50 MG
MELPHALAN ORAL 2 MG
J8610
J8700
J8999
J9000
J9001
J9010
J9015
J9017
J9020
J9031
J9040
J9045
J9050
J9060
J9062
J9065
J9070
J9080
J9090
J9091
J9092
J9093
J9094
J9095
J9096
J9097
J9100
J9110
J9120
J9130
J9140
J9150
J9151
J9160
J9165
J9170
J9180
J9181
J9182
J9185
J9190
J9200
J9201
J9202
J9206
J9208
J9209
J9211
J9212
METHOTREXATE ORAL 25 MG
TEMOZOLOMIDE, ORAL, 5 MG
ORAL PRESCRIPTION DRUG CHEMO
DOXORUBIC HCL 10 MG VL CHEMO
DOXORUB HYDROCHL,ALL LIP,10 MG
ALEMTUZUMAB, 10 MG
ALDESLEUKIN/SINGLE USE VIAL
ARSENIC TRIOXIDE
ASPARAGINASE INJECTION
BCG LIVE INTRAVESICAL VAC
BLEOMYCIN SULFATE INJECTION
CARBOPLATIN INJECTION
CARMUS BISCHL NITRO INJ
CISPLATIN, PWDR/SOLN /10 MG
CISPLATIN 50 MG
INJ CLADRIBINE PER 1 MG
CYCLOPHOSPHAMIDE 100 MG INJ
CYCLOPHOSPHAMIDE 10 GRM INJ
CYCLOPHOSPHAMIDE 20 GRM INJ
CYCLOPHOSPHAMIDE LYOPH 100 MG
CYCLOPHOSPHAMIDE LYOPH 1.0 GM
CYCLOPHOSPHAMIDE LYOPH 2.0 GM
CYTARABINE HCL 100 MG INJ
CYTARABINE HCL 500 MG INJ
DACTINOMYCIN/ACTINOMYCN 0.5 MG
DACARBAZINE 100 MG INJ
DACARBAZINE 200 MG INJ
DAUNORUBICIN, 10 MG
DAUNORUBICIN CITRAT,LIPO,10 MG
DENILEUKIN DIFTITOX, 300 MCG
DIETHYLSTILBESTROL IN 250 MG
DOCETAXEL, 20 MG
EPIRUBICIN HYDROCHLORIDE,50 MG
ETOPOSIDE 10 MG INJ
ETOPOSIDE 100 MG INJ
FLUDARABINE PHOSPHATE INJ
FLUOROURACIL INJECTION
FLOXURIDINE INJECTION
GEMCITABINE HCL, 200 MG
GOSERELIN ACETATE IMPLANT
IRINOTECAN, 20 MG
IFOSFOMIDE INJECTION
MESNA INJECTION
IDARUBICIN HCL INJECTION
INJ,INTERFERON ALFACON-1,1 MCG
J9213
J9214
J9215
J9216
J9217
J9218
J9219
J9230
J9245
J9250
J9260
J9265
J9266
J9268
J9270
J9280
J9290
J9291
J9293
J9300
J9310
J9320
J9340
J9350
J9355
J9357
J9360
J9370
J9375
J9380
J9390
J9600
J9999
K0001
K0002
K0003
K0004
K0005
K0006
K0007
K0009
K0010
K0011
K0012
K0014
K0015
K0016
K0017
K0018
INTERFERON ALFA-2A INJ

INTERFERON ALFA-2B INJ
INTERFERON ALFA-N3 INJ
INTERFERON GAMMA 1-B INJ
LEUPROLIDE ACETATE SUSPENSION
LEUPROLIDE ACETATE INJECTION
LEUPROLIDE ACETATE IMPLT,65 MG
MECHLORETHAMINE HCL INJ
INJ MELPHALAN HYDROCHL 50 MG
METHOTREXATE SODIUM INJ 5 MG
METHOTREXATE SODIUM INJ 50 MG
PACLITAXEL INJECTION
PEGASPARGASE/SINGL DOSE VIAL
PENTOSTATIN INJECTION
PLICAMYCIN (MITHRAMYCIN) INJ
MITOMYCIN 5 MG INJ
MITOMYCIN 20 MG INJ
MITOMYCIN 40 MG INJ
MITOXANTRONE HYDROCHL/5 MG
GEMTUZUMAB OZOGAMICIN
RITUXIMAB, 100 MG
STREPTOZOCIN INJECTION
THIOTEPA INJECTION
TOPOTECAN, 4 MG
TRASTUZUMAB, 10 MG
VALRUBICIN,INTRAVESICAL,200 MG
VINBLASTINE SULFATE INJ
VINCRISTINE SULFATE 1 MG INJ
VINORELBINE TARTRATE/10 MG
PORFIMER SODIUM, 75 MG
CHEMOTHERAPY DRUG
STANDARD WHEELCHAIR
STD HEMI WHEELCHAIR
LIGHTWEIGHT WHEELCHAIR
HIGH STRENGTH, LT WT WCHAIR
ULTRALIGHTWEIGHT WHEELCHAIR
HEAVY DUTY WHEELCHAIR
EXTRA HEAVY DUTY WHEELCHAIR
OTHER MANUAL WHEELCHAIR/BASE
STD, WT FRAME POWER WHEELCHAIR
STD WT POWER PROGRAM WCHAIR
LT WT PORTABLE POWER WCHAIR
OTHER POWER WHEELCHAIR BASE
DETACH, NON-ADJUST HGT ARMREST
DET, ADJ HGT ARMREST, COMPLETE
DETACH, ADJ HGT ARMREST, BASE
DETACH, ADJ HGT ARMREST, UPPR
K0019
K0020
K0022
K0023
K0024
K0025
K0026
K0027
K0028
K0029
K0030
K0031
K0032
K0033
K0035
K0036
K0037
K0038
K0039
K0040
K0041
K0042
K0043
K0044
K0045
K0046
K0047
K0048
K0049
K0050
K0051
K0052
K0053
K0054
K0055
K0056
K0057
K0058
K0059
K0060
K0061
K0062
K0063
K0064
K0065
K0066
K0067
K0068
K0069
ARM PAD, EACH

FIX/ADJ HEIGHT ARMREST, PAIR
REINFORCED BACK UPOSTERY
BACK INSERT, PLANAR W/STRAPS
SOLID BACK INSERT, PLANAR BACK
HOOK-ON HEADREST EXTENSION
BACK UPHOLSTERY LT WT WHEELCH
BACK UPHOLS WHEELCH, NOT LTWT
MANUAL, FULLY RECLINING BACK
REINFORCED SEAT UPHOLSTERY
SOLID SEAT INSERT, PLANAR SEAT
SAFETY BELT/PELVIC STRAP, EACH
SEAT UPHOLS: LT WT WHEELCHAIR
SEAT UPHOLS: WCHAIR NOT LT WT
HEEL LOOP W/ANKLE STRAP
TOE LOOP, EACH
HIGH MOUNT FLIP-UP FOOTREST
LEG STRAP, EACH
LEG STRAP, H STYLE, EACH
ADJUSTABLE ANGLE FOOTPLATE
LARGE SIZE FOOTPLATE, EACH
STANDARD SIZE FOOTPLATE, EACH
FOOTREST, LOWER EXTENSION TUBE
FOOTREST, UPPER HANGER BRACKET
FOOTREST, COMPLETE ASSEMBLY
ELEV LEGREST, LOWER EXTEN TUBE
ELEV LEGREST, UP HANGER BRACKT
ELEVLEGREST, COMPLETE ASSEMBLY
CALF PAD, EACH
RATCHET ASSEMBLY
CAM RELEAS ASSY, FOOT/LEG REST
SWINGAWAY, DETACH, FOOTRESTS
ELEV FOOTRESTS, ARTICULATING
SEAT WID 10,11,12,15,17 OR 20
SEAT DEPTH 15, 17, OR 18
SEAT HEIGHT < 17" OR => 21"
SEAT WIDTH 19
SEAT DEPTH 17
PLASTIC COATED HANDRIM, EACH
STEEL HANDRIM, EACH
ALUMINUM HANDRIM, EACH
HANDRIM W/8-10 VERT/OBLI PROJS
HANDRIM W/12-16 VERT/OLB PROJS
ZERO PRESSURE TUBE
SPOKE PROTECTORS, EACH
SOLID TIRE, ANY SIZE EACH
PNEUMATIC TIRE, ANY SIZE, EACH
PNEUMATIC TIRE TUBE, EACH
R WHEEL ASSY, SOLID TIRE SPOKE
K0070
K0071
K0072
K0073
K0074
K0075
K0076
K0077
K0078
K0079
K0080
K0081
K0082
K0083
K0084
K0085
K0086
K0087
K0088
K0089
K0090
K0091
K0092
K0093
K0094
K0095
K0096
K0097
K0098
K0099
K0100
K0102
K0103
K0104
K0105
K0106
K0107
K0108
K0112
K0113
K0114
K0115
K0116
K0195
K0268
K0415
K0416
K0452
K0455
R WHEEL ASSY, PNEUM TIRE SPOKE

FR CASTER ASSY, W/ PNEUM TIRE
FR CSTER ASSY, W/SEMIPNEU TIRE
CASTER PIN LOCK,EACH
PNEUM CASTER TIRE, ANY SIZE
SEMI-PNEUMATIC CASTER TIRE
SOLID CASTER TIRE, ANY SIZE
FRT CASTER ASSY, W/ SOLID TIRE
PNEUM CASTER TIRE TUBE, EACH
WHEEL LOCK EXTENSION, PAIR
ANTI-ROLLBACK DEVICE, PAIR
WHEEL LOCK ASSEMBLY, COMPLETE
22NF NON-SEALED LEAD ACID BATT
22 NF SEALED LEAD ACID BATTERY
GROUP 24 NON-SEALED LEAD ACID
GROUP 24 SEAL LEAD ACID BATERY
U-1 NON-SEAL LEAD ACID BATTERY
U-1 SEALED LEAD ACID BATTERY
BATT CHRGR,1 MODE,W 1 BATT TYP
BATT CHRGR,DL MODE,W BATT TYPE
R WHEEL TIRE, POWER WHEELCHAIR
R TIRE TUBE, POWER WHEELCH
R WHEEL ASSY, POWER WHEELCHAIR
R WHEEL, 0 PRESS TUBE PWR WCHR
WHEEL TIRE FOR POWER BASE
WHEEL TIRE TUBE, NOT 0 PRESSUR
WHEEL ASSEMBLY FOR POWER BASE
WHEEL 0 PRESS TUBE, POWER BASE
DRIVE BELT FOR POWER WHEELCHR
FRONT CASTER,POW WHEELCHAIR,EA
WHEELCH ADAPTER, AMPUTEE, PAIR
CRUTCH AND CANE HOLDER, EACH
TRANSFER BOARD,< 25
CYLINDER TANK CARRIER, EACH
IV HANGER, EACH
ARM TROUGH, EACH
WHEELCHAIR TRAY
WHEELCH COMPONENT/ACCESS, NOS
TRUNK SUP VEST, W/INNER FRAME
TRUNK SUP VEST, W/O INNR FRAME
BACK SUP, WHLCHAIR, W/IN FRAME
ORTHO SEAT, BACK MOD, CUSTOM
ORTHO SEAT, COMBO BACK & SEAT
ELEV LEG RESTS, PR
HUMID,NON-HEAT,W POS AIR PRESS
RX ANTIEMETIC, ORAL, 1 MG
RX ANTIEMETIC, RECTAL, 1 MG
WHEELCHAIR BEARINGS, ANY TYPE
INF PMP,UNINTERPT,EPOPROSTENOL
K0460
K0461
K0462
K0531
K0532
K0533
K0534
K0538
K0539
K0540
K0541
K0542
K0543
K0544
K0545
K0546
K0547
K0549
K0550
K0556
K0557
K0558
K0559
K0581
K0582
K0583
K0584
K0585
K0586
K0587
K0588
K0589
K0590
K0591
K0592
K0593
K0594
K0595
K0596
K0597
L0100
L0110
L0120
L0130
L0140
L0150
L0160
L0170
L0172
POW ADD,CONV MAN TO MOTOR, JOY

POW ADD,MAN TO POW VEH, TILLER
TEMP REPL,PAT OWN EQUP,REP,ANY
HUMIDIF,HEAT,W POSIT AIR PRESS
RESPIR ASSIS,WO BACK,W NONINVA
RESPIR ASSIS,W BACKUP,W NONINV
RESPIR ASSIS,W BACKUP,W INVAS
NEG PRESS WND,ELEC PMP,STA/POR
DRESS,NEG PRESS WND,ELC PMP,EA
CANNIS,NEG PRES WND,ELC PMP,EA
SGD PRERECORDED MSG <= 8 MIN
SPEECH GEN DEV,DIGIT,REC >8 MN
SPEECH GEN DEV,SYNTH,SPELL,CON
SPEECH GEN DEV,SYNTH,MULT MESS
SPEECH GEN PRG,PC/PER DIG ASST
ACCESS,SPEECH GEN DEV,MOUNT SY
ACCESS,SPEECH GENERAT DEV, NOC
HOSP BED HVY DTY XTRA WIDE
HOSP BED XTRA HVY DTY X WIDE
ADD LWR EXTRM,KNEE,W LOCK MECH
ADD LWR EXTRM,KNEE,WO LCK MECH
ADD,KNEE,CONG W/WO LCK MECH
ADD,KNEE,NOT CONG WWO LCK MECH
OSTOMY,CLSD,W BARRIER,W FILTER
OSTOMY,CLSD,W BARRIER,W CNVXTY
OSTOMY,CLSD;WO BARRIER,W FILTR
OSTOMY,CLSD;BARR W FLNG,W FLTR
OSTOMY,CLSD;BARR W LCK FLANGE
OSTMY,CLSD;BARR W LCK FLNG,FIL
OSTOMY,DRN,W BARR,W FILTER
OSTOMY,DRN;BARR W FLNG,W FILTE
OSTOMY,DRN;BARR W LCK FLNGE
OSTMY,DRN;BARR W LCK FLNG,W FI
OSTMY,URNRY,W EXT WEAR,W VLVE
OSTMY,URNRY,W CNVXTY,W VLVE
OSTMY,URNY,W EXT WEAR,W CNVXTY
OSTMY,URNRY;W FAUCET,W VALVE
OSTMY,URNY;BARR,W FLNG,W FACET
OSTMY,URNY;USE BARR W LCK FLNG
OSTMY,URNRY;BARR W LCK FLNGE
CRANIAL ORTHOSIS/HELMET MOLD
CRANIAL ORTHOSIS/HELMET NONM
FOAM COLLAR FLEXIBLE, NON-ADJ
FLEX, THERMOPLSTC COLLAR, MOLD
PLASTIC COLLR, SEMI-RIGID, ADJ
CHIN CUP, SEMI-RIGID, ADJ MOLD
CRV, SEMI-RIG WIRE OCCIPIT SUP
CERV, COLLAR, MOLDED
CERV CLLR, SEMI-RGD FOAM, 2 PC
L0174
L0180
L0190
L0200
L0210
L0220
L0450
L0452
L0454
L0456
L0458
L0460
L0462
L0464
L0466
L0468
L0470
L0472
L0474
L0476
L0478
L0480
L0482
L0484
L0486
L0488
L0490
L0500
L0510
L0515
L0520
L0530
L0540
L0550
L0560
L0561
L0565
L0600
L0610
L0620
L0700
L0710
L0810
L0820
L0830
L0860
L0960
L0970
L0972
CERV CLLR SEMI-RGD 2 PC, THORC

MULT POST CLLR OCCIP/MANDIB
CRV MULT PST COLLR OCCIP/MANDB
CRV MULT PST COLLAR CRV BARS
THORACIC, RIB BELT
THORACIC, RIB BELT, CUSTOM FAB
TLSO,FLX,TRNK SUPP,THRC,PREFAB
TLSO,FLX,TRNK SUPP,THRC,C FAB
TLSO FLX,TRNK SUPP,SAC TO T-9
TLSO,FLX,TRNK SUPP,RIG PST PAN
TLSO,TRIPLANAR,PUBIS TO XIPHOI
TLSO,TRIPLANAR,PUBIS TO STERNA
TLSO,TRPLNR,MDLR,3 RIG PLSTSHL
TLSO,TRPLNR,MDLR,4 RIG PLSTSHL
TLSO,SAGITAL,RIG POST FRAME&FL
TLSO,SGTL-CRNL,RIG PST FRME&FL
TLSO,TRIPLNR,RIG PSTER FRME&FL
TLSO,TRPLNR,HYPEREXT,RIG ANTRI
TLSO,TRPLNR,RGID W FLX SFT ANT
TLSO,SGTL-CRNAL SACROCOC TO XI
TLSO,SGTL-CRNL,SACROCOC TO T-9
TLSO,TRPLNR,1 PIECE RIG WO LNE
TLSO,TRPLNR,1 PIECE RIG W LINE
TLSO,TRPLNR,2 PIECE RIG WO LNE
TLSO,TRPLNR,2 PIECE RIG W LINE
TLSO,TRPLNR,1 RIG SHELL,PREFAB
TLSO,SGTTL-CRNL,1 RIG,W OVERLA
LUMBAR-SACRAL-ORTHOSIS, FLEX
LSO, FLEXIBLE,CUSTOM FABRICATE
LSO FLEX ELAS W/ RIG POST PA
LSO, ANT/POST/LAT CTRL W/APRON
LSO, AP CONTROL W/APRON FRONT
LSO, LUMBAR FLEXION, Y JACKET
LSO, ANT/POS/LAT CTRL, MOLDED
LSO, AP-LAT CTRL MOLD W/INTERF
PREFAB LSO
LSO, AP-LAT CONTROL, CUSTOM
SACROILIAC, FLEXIBLE SURG SUPP
SACROILIAC, FLEX CUSTOM FAB
SACROILAC SEMI-RIG W/APRN FRNT
CTLSO AP-L CTRL, MINERVA TYPE
CTLSO APL CTRL MINERVA W/INTRF
CERV HALO INCORP TO JACKETVEST
CERV HALO PLASTER BODY JACKET
CERV HALO MILWAUKEE ORTHOSIS
ADD HALO PROC MRI COMPAT SYS
TORSO SUP, POST SURG SUP PADS
TLSO, CORSET FRONT
LSO, CORSET FRONT
L0974
L0976
L0978
L0980
L0982
L0984
L0999
L1000
L1005
L1010
L1020
L1025
L1030
L1040
L1050
L1060
L1070
L1080
L1085
L1090
L1100
L1110
L1120
L1200
L1210
L1220
L1230
L1240
L1250
L1260
L1270
L1280
L1290
L1300
L1310
L1499
L1500
L1510
L1520
L1600
L1610
L1620
L1630
L1640
L1650
L1652
L1660
L1680
L1685
TLSO, FULL CORSET

LSO, FULL CORSET
AXILLARY CRUTCH EXTENSION
PERONEAL STRAPS, PAIR
STOCKING SUPRTER GRIPS, SET-4
PROTECTIVE BODY SOCK, EACH
ADD TO SPINAL ORTHOSIS, NOS
CTLSO INITL ORTHOSIS,W/ MODEL
TENSION BASED SCOLIOSIS ORTH
ADD CTLSO AXILLA SLING
ADD CTLSO KYPHOSIS PAD
ADD CTLSO KYPHOSIS PAD FLOAT
ADD CTLSOLUMBAR BOLSTER PAD
ADD CTLSO LUMBAR RIB PAD
ADD CTLSO STERNAL PAD
ADD CTLSO THORACIC PAD
ADD CTLSO TRAPEZIUS SLING
ADD CTLSO OUTRIGGER
ADD CTLSO OUTRIG BILT W/EXTNS
ADD CTLSO LUMBAR SLING
ADD CTLSO RING FLNG PLST/LTHR
ADD CTLSO RING FLNGE MODED
ADD CTLSO COVER FOR UPRIGHT
TLSO FURNSH INIT ORTHOSIS ONLY
ADD TLSO, LAT-THORACIC EXTEN
ADD TLSO, ANT-THORACIC EXTEN
ADD TLSO MILWAUKEE SUPERSTRUCT
ADD TLSO, LUMBR DEROTATION PAD
ADD TLSO, ANTERIOR ASIS PAD
ADD TLSO ANT-THOR DEROTATN PAD
ADD TLSO, ABDOMINAL PAD
ADDI TLSO, RIB GUSSET ELASTIC
ADD TLSO, LAT-TROCHANTERIC PAD
OTH/SCOLIO PROC, BODY JACKET
OTH SCOLIO PROC, POST-OP JACKT
SPINAL ORTHOSIS, NOS
THKAO, NEWINGTN, PARAPODM FRAM
THKAO STANDING FRAME
THKAO, SWIVEL WALKER
HO,FLXB,FRJKA TYP W CVR,PREFB
HO,FLXB,FRJKA CVR ONLY,PREFB
HO,FLXB,PAVLK HRNSS,PREFB
HO,SEM-FLXBL(VON ROSEN TYP),CU
HO,STAT,PLV BND/SPR BAR,THGH C
HO,STAT,ADJSTBL,PREFAB,FTNG&AD
HIP ORTHOSIS,BILTRL THIGH CUFF
HO,STAT,PLSTC,PREFAB,FTNG&ADJS
HO,DYNMC,PLV,ADJ HP MTN,CST FB
HO,POSTOP HIP ABDCTN TP,CST FB
L1686
L1690
L1700
L1710
L1720
L1730
L1750
L1755
L1800
L1810
L1815
L1820
L1825
L1830
L1832
L1834
L1836
L1840
L1843
L1844
L1845
L1846
L1847
L1850
L1855
L1858
L1860
L1870
L1880
L1885
L1900
L1901
L1902
L1904
L1906
L1910
L1920
L1930
L1940
L1945
L1950
L1960
L1970
L1980
L1990
L2000
L2010
L2020
L2030
HO,PSTOP HP ABD TP,PRFB,FTG&AD

COMB,BI,L/S,HP,FMR ORTH PRV
LEGG ORTHOS,(TORNTO TP),CST FB
LEGG ORTHOS,(NWNGTN TP),CST FB
LEGG ORTHOS,TRILAT,TACHDIJ TP
LEGG ORTHOS,SCOTTISH RITE TP
LEGG ORTHOS,LEGG PRTHS SLING
LEGG ORTHOS,PATTEN BTTM TP
KO,ELASTIC W STAYS,INC FTNG&AD
KO,ELASTC W JOINTS,INC FTNG&AD
NO,ELASTC/OTH ELSTC TP MAT
KO,ELASTIC W CNDYLR PDS&JNTS
KO,ELASTC KNEE CAP,PREFABRICTD
KO,IMMBILIZR,CANVS LONGITUDINL
KO,ADJST KNEE JT,POSITL ORTHSS
KO,WO KNEE JT,RIGID,CSTM FB
KNEE ORTHOSIS,RIG,WO JNT(S)
KO,DROTAT,MDIAL-LAT,CRUC LGMNT
KNEE ORTHOSI,THIGH&CALF,PREFAB
KNEE ORTHO,THIGH&CALF,CUST FAB
KO,2 UPT,THI&CF,ADJ FLX&EXT JT
KO,2 UPT,THI&CLF,W ADJ FLX&EXT
KO,2 UPT W ADJ JT,SPT CHMBRS
KO,SWEDSH TP,PRFAB,INC FTNG&AD
KO,MOLD PLAS,THIGH&CALF SECT
KO,MOLD PLAS,POLYCENTR KNEE JT
KO,MOD,SUPRACNDYLR PROSTH SCKT
KO,DBL UPRT,THIGH&CALF LACERS
KO,DBL UPRT,NONMOLD THI&CLF
KO,1/2 UPRT,THI&CLF,RES CTRL
AFO,SPRING WR,DORSIFLX CLF BD
ANKL ORTHO,ELSC,PREFAB,FIT&ADJ
AFO,ANKLE GAUNTLET,PREFAB,FTNG
AFO,MOLD ANKLE GAUNTLET,CST FB
AFO,MULTILIGAMENTUS ANKL SPPRT
AFO,POST,1 BAR,CLASP SHOE CNTR
AFO,1 UPRT STAT/ADJ STP,CST FB
AFO PLASTIC
AFO MOLDED TO PATIENT PLASTI
AFO,MLD PAT MODL,PLAS,TIBL SCT
AFO,SPIRAL,IRM TYPE,PLASTIC
AFO,POSTERR SOLID ANKLE,PLASTC
AFO,PLAST,W ANKLE JNT,CUST FAB
AFO,SGLUPRT FR PLANTAR DRSIFLX
AFO,DBLUPRT FR PLANTAR DRSIFLX
KAFO,SGLUPRT,FR KNEE,FR ANKL
KAFO,SGLUPRT,FR ANKL,WO KNJT
KAFO,DBLUPRT,FR KNEE,FR ANKL
KAFO,DBLUPRT,FR ANKL,WO KNJT
L2035
L2036
L2037
L2038
L2039
L2040
L2050
L2060
L2070
L2080
L2090
L2102
L2104
L2106
L2108
L2112
L2114
L2116
L2122
L2124
L2126
L2128
L2132
L2134
L2136
L2180
L2182
L2184
L2186
L2188
L2190
L2192
L2200
L2210
L2220
L2230
L2240
L2250
L2260
L2265
L2270
L2275
L2280
L2300
L2310
L2320
L2330
L2335
L2340
KAFO,STATIC,PREFAB,INC FIT&ADJ
KAFO,DBL UPRT,FR KNEE,CST FABR
KAFO,SGL UPRT,FR KNEE,CST FABR
KAFO,WO KNEE JT,MLTIAX ANKL
KAFO,SGL UPRT,POLYX HNG,RT CTL
HKAFO,BILAT ROTATN STRAPS
HKAFO,BI TRSN CBLS,HIP JNT
HKAFO,BI TRSN CBL,BLLBRG HP JT
HKAFO,UNI ROTATION STRAPS
HKAFO,UNI TRSN CBL,HIP JNT
HKAFO,UNI TRSN CBL,BLBRG HP JT
AFO,FX ORTH,TIBL,PLSTR CST MTL
AFO,FX ORTH,TBL,SYNTHTC CST MT
AFO,FX ORTH,TIBL,THRMPLS MATL
AFO,FX ORTH,TIBL FRCT CST ORTH
AFO,FX ORTH,TIBL FRCT,SOFT
AFO,FX ORTH,TIBL ORTH,SEMIRGD
AFO,FX ORTH,TIBL FRCT,RIGID
KAFO,FX ORTH,PLASTR CST MATL
KAFO,FX ORTH,SYNTHETIC MATL
KAFO,FX ORTH,THERMOPLAST MATL
KAFO,FX ORTH,CUSTOM FABRICATED
KAFO,FX ORTH,SOFT,PREFB,FT&ADJ
KAFO,FX ORTH,SEMIRGD,PREFAB
KAFO,FX ORTH,RIGD,PREFB,FT&ADJ
LE FX ORTHO PLSTC INSRT W/ANKL
LE FX ORTHOS DRP LCK KNEE JT
LE FX ORTHO LTD MOTION KNEE JT
LE FX ORTHO MOTION KNEE LERMAN
LE FX ORTHOSIS, QUADRILAT BRIM
LE FX ORTHOSIS, WAIST BELT
LE FX ORTH PELV BND THGH FLNGE
LE, LIMITED ANKLE MOTION,
LE DORSIFLEX ASSIST EACH JOINT
LE DORSIFLEX&PLNTR ASST/REST
LE SPLIT FLT CALPR STIRUP&PLTE
LE, ROUND CALIPER&PLATE ATTACH
LE, FT PLT, MOLD STIRUP ATTACH
LE, REINF SLD STIRUP SCOTT-CRA
LE, LONG TONGUE STIRRUP
LE, VARUS/VALGUS CORRECT STRP
LE, VRS/VLGS CORRCT PAD/LINED
LE, MOLDED INNER BOOT
LE, ABDUCT BAR JOINTED, ADJ
LE, ABDUCTION BAR-STRAIGHT
LE, NON-MOLDED LACER
LE, LACER MOLDED TO PATIENT
LE, ANTERIOR SWING BAND
LE, PRE-TIBIAL SHELL,MOLDED
L2350
L2360
L2370
L2375
L2380
L2385
L2390
L2395
L2397
L2405
L2415
L2425
L2430
L2435
L2492
L2500
L2510
L2520
L2525
L2526
L2530
L2540
L2550
L2570
L2580
L2600
L2610
L2620
L2622
L2624
L2627
L2628
L2630
L2640
L2650
L2660
L2670
L2680
L2750
L2755
L2760
L2768
L2770
L2780
L2785
L2795
L2800
L2810
L2820
LE, PROST (BK) SCKT, MOLDED

LE, EXTENDED STEEL SHANK
LE, PATTEN BOTTOM
LE, TORSN CTRL ANKL&HALF STRUP
LE, TORSN CTRL STRGHT KNEE JNT
LE, STRAIGHT KNEE JT, HVY DTY
LE, OFFSET KNEE JOINT
LE, OFFSET KNEE JOINT, HVY DTY
LE ORTHOSIS, SUSPENSION SLEEVE
KNEE JOINT, DROP LOCK
KNEE JOINT CAM LOCK EACH JNT
KNEE JT, DISC/DIAL LOCK
KNEE JT,RATCHET LOCK
KNEE JT, POLYCENT JOINT
KNEE JT LIFT LOOP, DRP LCK RNG
LE, THIGH GLUT/ISCH, RING
LE, THIGH, QUAD-LAT BRIM, MOLD
LE, TIGH QUAD-LAT BRIM, CUSTOM
LE, ISCH CNT/NRW M-L BRIM MOLD
LE ISCH CTNMT/NAR M-L BRIM CUS
LE, THGH WT BEAR, LACR, NN-MLD
LE, THIGH/WT BEAR, LACER, MOLD
LE, THIGH/WT BEAR, HIROLL CUFF
PELV CTRL HIP JT, CLEVIS 2 POS
PELVIC CTRL, PELVIC SLING
PELV CTRL HIP JT CLEVIS, FREE
PELV CTRL HIP JT CLEVIS, LOCK
LE, PELV CTRL, HIP JT, HVY DTY
LE, PELV CTRL, HIP JT ADJ FLEX
PELV CTRL ADJ FLEX EXT ABD CRL
PELV CTRL PLST RECP HIP JT&CBL
PELV CTRL METL RECP HIP JT&CBL
LE, PELV CTRL BAND&BELT UNILAT
LE, PELV CTRL BAND&BELT, BILAT
LE, PELV&THORAC CTRL GLUTL PAD
LE, THORACIC CTRL, THORAC BAND
LE, THRAC CTRL, PRASPINL UPRTS
LE, THRAC CTRL, LAT SUP UPRTS
LE ORTHOSIS, CHROME OR NICKLE
CARBON GRAPHITE LAMINATION
LE ORTHOSIS, EXTEN, PEREXTENS
ORTHO SIDEBAR DISCONNECT
LE ORTHOSIS, ANY MATERIAL
LE ORTHOSIS, NON-CORROSIVE FIN
LE ORTHOSIS, DROP LOCK RETAINR
LE ORTHOSS KNEE CTRL, FULL CAP
LE ORTH KNEE CTRL MED/LAT PULL
LE ORTH KNEE CTRL CONDYLAR PAD
LE ORTH SFT MLD PLSTC BLW KNEE
L2830
L2840
L2850
L2860
L2999
L3000
L3001
L3002
L3003
L3010
L3020
L3030
L3040
L3050
L3060
L3070
L3080
L3090
L3100
L3140
L3150
L3160
L3170
L3201
L3202
L3203
L3204
L3206
L3207
L3208
L3209
L3211
L3212
L3213
L3214
L3215
L3216
L3217
L3219
L3221
L3222
L3224
L3225
L3230
L3250
L3251
L3252
L3253
L3254
LE ORTH SFT MLD PLSTC ABV KNEE

LE ORTH, TIBIAL SOCK, FX
LE ORTH, FEMORAL LNGTH SOCK
LE JT, KNEE/ANKL, TORSION MECH
LOWER EXTREMITY ORTHOSIS, NOS
FT INSRT MOLD UCB BERLELY SHEL
FOOT INSERT, MOLDE, SPENCO
FOOT INSRT, MOLD, PLASTAZOTE
FT INSRT, MOLD, SILICONEGEL
FT INSRT MOLD ARCH SUP LONGIT
FT INSRT MOLD SUP LNGIT/METATR
FT INSRT FORM SUP RMOV PREMOLD
ARCH SUP, REMOV, PREMLD, LNGIT
ARCH SUP REMV, PREMOLD MTATRSL
ARCH SUP REMOVABLE, PREMOLD
FT ARCH SUP NON-REMOV, LONGIT
FT ARCH SUP NON-REMOV, MTATRSL
FT ARCH SUP NN-REMOV LNGT/META
HALLUS-VALGUS NGHT DYNAM SPLNT
FT, ROTATN POSIT DEV, W/SHOE
FT, ROTATN POSIT DEV, W/O SHOE
FOOT, ADJ SHOE-STYL POSIT DEV
FOOT, PLASTIC HEEL STABILZER
ORTHO SHOE OXFRD W/SUPIN,INFNT
ORTHO SHOE OXFRD W/SUPIN, CHLD
ORTHO SHOE OXFRD W/SUPIN, JR
ORTHO SHOE HITOP W/SUPIN INFNT
ORTHO SHOE HITOP W/SUPIN CHLD
ORTHO SHOE HITOP W/SUPIN JR
SURGICAL BOOT, EACH, INFANT
SURGICAL BOOT, EACH, CHILD
SURGICAL BOOT, EACH, JUNIOR
BENESCH BOOT, PAIR, INFANT
BENESCH BOOT, PAIR, CHILD
BENESCH BOOT, PAIR, JUNIOR
ORTHO LADIES SHOES, OXFORD
ORTHO LADIES SHOES DEPTH INLAY
ORTHO LADIES SHOES HITOP INLAY
ORTHOP MENS SHOES, OXFORD
ORTHO MENS SHOES, DEPTH INLAY
ORTHO MENS SHOES, HITOP, INLAY
ORTHO, WOMAN SHOE OXFRD, BRACE
ORTHO, MAN SHOE, OXFRD, BRACE
ORTHO, CUSTOM SHOES, INLAY
ORTHO CUSTM MOLDED PROSTH SHOE
SHOE MOLD TO PATIENT, SILICONE
SHOE MOLD PLASTAZOTE CUSTM FAB
SHOE MOLD PLASTAZOTE CUSTM FIT
NON-STANDARD SIZE OR WIDTH
L3255
L3257
L3260
L3265
L3300
L3310
L3320
L3330
L3332
L3334
L3340
L3350
L3360
L3370
L3380
L3390
L3400
L3410
L3420
L3430
L3440
L3450
L3455
L3460
L3465
L3470
L3480
L3485
L3500
L3510
L3520
L3530
L3540
L3550
L3560
L3570
L3580
L3590
L3595
L3600
L3610
L3620
L3630
L3640
L3649
L3650
L3651
L3652
L3660
NON-STANDARD SIZE OR LENGTH

ORTHO FOOTWEAR SPLIT SIZE
SURGICAL BOOT/SHOE, EACH
PLASTAZOTE SANDAL
LIFT, ELEV, HEEL, TAPERED
LIFT, ELEV, HEEL&SOLE NEOPRENE
LIFT, ELEV, HEEL& SOLE, CORK
LIFT, ELEV, METAL EXTENSION
LIFT, ELEV, INSIDE SHOE TAPERD
LIFT, ELEVATION, HEEL
HEEL WEDGE, SACH
HEEL WEDGE
SOLE WEDGE, OUTSIDE SOLE
SOLE WEDGE, BETWEEN SOLE
CLUBFOOT WEDGE
OUTFLARE WEDGE
METATARSAL BAR WEDGE, ROCKER
METATRSL BAR WEDGE, BETWN SOLE
FULL SOLE&HEEL WEDGE BTWN SOLE
HEEL, COUNTER, PLASTIC REINFOR
HEEL, COUNTER, LEATHER REINFOR
HEEL, SACH CUSHION TYPE
HEEL, NEW LEATHER, STANDARD
HEEL, NEW RUBBER, STANDARD
HEEL, THOMAS WITH WEDGE
HEEL, THOMAS EXTENDED TO BALL
HEEL, PAD& DEPRESSION FOR SPUR
HEEL, PAD, REMOVABLE FOR SPUR
ORTHOPED SHOE ADD,INSOLE,LEATH
ORTHOPED SHOE ADD,INSOL,RUBBER
ORTH SHOE ADD,INSOL,FELT,LEATH
ORTHOPED SHOE ADD, SOLE, HALF
ORTHOPED SHOE ADD, SOLE, FULL
ORTHO SHOE ADD, TOE TAP STAND
ORTH SHOE ADD,TOE TAP, HORSESH
ORTH SHOE ADD,SPEC EXTN,INSTEP
ORTH SHOE ADD,CONV INSTEP,VELC
ORTHOPED SHOE ADD,FIRM TO SOFT
ORTHOPEDIC SHOE ADD, MARCH BAR
TRNSFR ORTHO 1 SHOE CALPR EX
TRNSFR ORTHO 1 SHOE CALPR NEW
TRNSFR ORTHO 1 SHOE STRUP EXST
TRNSFR ORTHO 1 SHOE STRUP NEW
TRNSFR ORTHO, D. BROWNE 2 SHOE
ORTH SHOE,MOD,ADD/TRANSFER,NOS
SO,PREFAB,INCL FIT & ADJUST
SHLDER ORTHO,SNG SHLDR,ELASTIC
SHLDER ORTHO,DBL SHLDR,ELASTIC
SO,CANVAS&WEB,PREFAB,FIT & ADJ
L3670
L3675
L3677
L3700
L3701
L3710
L3720
L3730
L3740
L3760
L3762
L3800
L3805
L3807
L3810
L3815
L3820
L3825
L3830
L3835
L3840
L3845
L3850
L3855
L3860
L3890
L3900
L3901
L3902
L3904
L3906
L3907
L3908
L3909
L3910
L3911
L3912
L3914
L3916
L3918
L3920
L3922
L3923
L3924
L3926
L3928
L3930
L3932
L3934
SO,ACROMIO/CLAVICL,PREFB,FT&AD
SO,VST TYP ABD RESTR,/=,PREFAB
SO HARD PLASTIC STABILIZER
EO,ELASTC W STYS,PREFABRICATED
ELBOW ORTH,ELSTC,PREFAB
EO,ELASTC W METL JT,PREFABRICT
EO,2 UPRT,FREE MOTN,CUST FABR
EO,2 UPRT,EXTNSN/FLX ASSIST
EO,2 UPRT,ADJ POS LCK W CNTL
ELBOW ORTHOSIS,ADJ LOCK JT,ANY
ELBW ORTH,RIG,WO JTS,SFT MATER
WHFO,SHRT OPPONENS,NO ATTACH
WHFO,LONG OPPONENS,NO ATTACH
WHFO,WO JT,PREFAB,INC FIT&ADJ
WHFO, THUMB ABDUCTION (C BAR)
WHFO, 2ND M.P.ABDUCTION ASSIST
WHFO, I.P. EXT ASSIST W/M.P.
WHFO, M.P. EXTENSION STOP
WHFO, M.P. EXTENSION ASSIST
WHFO, M.P. SPRING EXT ASSIST
WHFO, SPRING SWIVEL THUMB
WHFO, THUMB I.P. EXT ASST
WHO, ACTN WRST, W/DORSIFLX AST
WHFO, ADJ M.P. FLEX CONTROL
WHFO, ADJ M.P. FLEX CNTRL&I.P.
WRIST/ELBOW, CONC ADJ TORSION
WHFO,DYNFLXR HNG,WRST/FGR EXT
WHFO,DYNFLXR HNG,CBLDRV,CST FB
WHFO,COMPRESSED GAS,CUST FABR
WHFO,ELECTRIC, CUSTOM FABRICAT
WHO,WRIST GAUNTLT,MOLD PAT MDL
WHFO,WRIST GAUNTLT W THMB SPCA
WHO,WRST CNTL COCK-UP,NONMLD
WRIST ORTH,ELSTC,PREFAB
WHFO,SWANSON DESIGN,PREFAB
WRIST HAND FINGER,ELSTC,PREFAB
HFO,FLEXN GLVE W ELSTC FGR CTL
WHO, WRIST EXTENSION COCK-UP
WHFO,WRST COCK-UP,W OUTRGGR
HFO,KNUCKLE BENDER,PREFAB,F&A
HFO,KNUCKLE BENDER,W OUTRIGGER
HFO,KNUCKLE BENDR,2 SGM FLX JT
HAND FINGER ORTHOSIS,WO JT,ANY
WHFO,OPPENHEIMER,PREFAB,FIT&AD
WHFO,THOMAS SUSPENSION,PREFABR
HFO,FINGR XTNSN,W CLOCK SPRING
WHFO,FINGR XTNSN,W WRIST SUPP
FO,SAFETY PIN,SPRING WIRED
FO, SAFETY PIN,MOD PREFABRICTD
L3936
L3938
L3940
L3942
L3944
L3946
L3948
L3950
L3952
L3954
L3956
L3960
L3962
L3963
L3964
L3965
L3966
L3968
L3969
L3970
L3972
L3974
L3980
L3982
L3984
L3985
L3986
L3995
L3999
L4000
L4010
L4020
L4030
L4040
L4045
L4050
L4055
L4060
L4070
L4080
L4090
L4100
L4110
L4130
L4205
L4210
L4350
L4360
L4370
WHFO, PALMER, PREFAB,INC F&ADJ

WHFO,DORSAL WRST,PREFABRICATED
WHFO,DORSAL WRST,W OUTRGGR ATT
HFO,REVERSE KNUCKLE BENDER
HFO,REVRS KNCKL BNDR,W OUTRGGR
HFO,COMPOSITE ELASTIC,PREFABR
FO,FINGER KNUCKLE BENDER,PRFB
WHFO,OPPNHMR,W KNCKL BNDR&2 AT
WHFO,OPPNHMR,W RVRS KNCKL&2 AT
HFO,SPREADING HAND,PREFABRICTD
ADD UPPR EXTREMITY ORTHOSIS
SEWHO,ABD POSITN,AIRPLN DESIGN
SEWHO,ABD POSIT,ERB PALSY DSGN
SEWHO,MOLD SHLDR,ARM,FRARM
SEO,ARM SPT WHEELCH,BALAN,ADJ
SEO,ARM SPT,BALAN,ADJUST RNCHO
SEO,ARM SPT,BALAN,RECLINING
SEO,ARM SPT,BALAN,FRCT ARM SPT
SEO,MBLARM,MONOARM&HND,OVRLBFR
SEO, ARM SUP, ELE PROXIMAL ARM
SEO, ARM SPT OFFSET/LAT ROCKER
SEO, ADD ARM SUPPRT, SUPINATOR
UP EXTREM FRACT ORTHOS,HUMERAL
UP XTRM FRCT ORTH,RADIUS/ULNAR
UP XTRM FRACT ORTHOSIS,WRIST
UP XTRM FX ORTH,FOREARM,HAND
UP XTRM FX ORTH,COMBO HUMERAL
UE ORTHO, SOCK, FX
UPPER LIMB ORTHOSIS, NOS
REPL GIRDLE MILWAUKEE ORTH
REPLACE TRILATERAL SOCKET BRIM
REPL QUAD SOCKET BRIM, MOLDED
REPL QUAD SOCKET BRIM, CUSTOM
REPLACE MOLDED THIGH LACER
REPLACE NON-MOLDED THIGH LACER
REPLACE MOLDED CALF LACER
REPLACE NON-MOLDED CALF LACER
REPLACE HIGH ROLL CUFF
REPL PROXML& DISTL UPRGHT KAFO
REPL METAL BANDS KAFO, THIGH
RPL METAL BANDS KAFO-AFO, CALF
REPL CUFF KAFO, PROXIMAL THIGH
REPL CUFF KAFO-AFO, DISTL THGH
REPLACE PRETIBIAL SHELL
REPAIR OF ORTHOTIC DEVICE
REPR OF ORTHO DEV, MINOR PRTS
PNEUMATIC ANKLE CNTRL SPLINT
PNEUMATIC AFO,WWO JOINTS,PREFA
PNEUMATIC LEG SPLINT, PREFAB
L4380
L4386
L4392
L4394
L4396
L4398
L5000
L5010
L5020
L5050
L5060
L5100
L5105
L5150
L5160
L5200
L5210
L5220
L5230
L5250
L5270
L5280
L5301
L5311
L5321
L5331
L5341
L5400
L5410
L5420
L5430
L5450
L5460
L5500
L5505
L5510
L5520
L5530
L5535
L5540
L5560
L5570
L5580
L5585
L5590
L5595
L5600
L5610
L5611
PNEUMATIC KNEE SPLINT, PREFAB

NON-PNEUMTC WLK SPLNT,WWO JNTS
REPLACEMENT SOFT INTERFACE MAT
REPL MATERL, FOOT DROP SPLINT
STATIC AFO
FT DROP SPLINT,RECMB POS DVC
SHOE INSERT W/LONGITUDINL ARCH
MOLDED SOCKET, ANKLE HEIGHT
MOLDD SOCKT TIBIAL TUBERCLE HT
ANKLE, SYMES, MOLD SOCKT, SACH
ANKLE SYMES METAL FRAME MOLDED
BELW KNEE, MOLDED SOCKET, SHIN
BELW KNEE PLASTIC SOCKET JTS
KNEE DISARTIC, EXT KNEE JNTS
KNEE DISARTIC BENT KNEE JNTS
ABV KNEE MOLDED SOCKET 1 AXIS
ABV KNEE SHT PROSTH FOOT BLCKS
ABV KNE SHT PROSTH ARTIC ALIGN
ABV KNE PROX FEM FOCAL DEFIC
HIP DISARTIC CANADIAN TYPE
HIP DISARTIC, TILT TABLE TYPE
HEMIPELVECTOMY, CANADIAN TYPE
BK MOLD SOCKET SACH FT ENDO
KNEE DISART, SACH FT, ENDO
AK OPEN END SACH
HIP DISART CANADIAN SACH FT
HEMIPELVECTOMY CANADIAN SACH
IMD P-SURG RGD DRSSG BLW KNEE
P-SURG BLW KNEE CST CHNG&RELGN
IMD POST SURG/EARLY FIT
IMMED POST SURG RIGID DRESS
IMD P-SRG NN-WT DRSSG BLW KNEE
IMD P-SRG NN-WT DRSG ABV KNEE
INIT, BLW KNEE PTB, PLSTR, DIR
INIT ABV KNEE ISCH, PLSTR, DIR
PREP, BLW KNEE, PLASTER, MOLD
PREP, BLW KNEE, THRMPLST DIRCT
PREP, BLW KNEE, THRMPLST, MOLD
PRP, BLW KNE, PREFAB, ADJ OPEN
PREP, BLW KNEE, LAMINATD, MOLD
PRP ABV KNEE ISCH, PLSTR, MOLD
PRP ABV KNEE ISCH THRMPLAS DIR
PRP ABV KNEE ISCH THRMPLAS MLD
PRP ABV KNEE ISCH PREFAB, ADJ
PRP ABV KNEE ISCH LMNTD, MOLD
PREP HIP DISRT THERMPLAST MOLD
PREP HIP DISRT LAMNT SCKT MOLD
LE ENSKL ABV KNEE HYDRACAD SYS
LE ENSKL ABV KNEE 4 BAR FRICT
L5613
L5614
L5616
L5617
L5618
L5620
L5622
L5624
L5626
L5628
L5629
L5630
L5631
L5632
L5634
L5636
L5637
L5638
L5639
L5640
L5642
L5643
L5644
L5645
L5646
L5647
L5648
L5649
L5650
L5651
L5652
L5653
L5654
L5655
L5656
L5658
L5661
L5665
L5666
L5668
L5670
L5671
L5672
L5674
L5675
L5676
L5677
L5678
L5680
LE ENSKL ABV KNEE 4 BAR HYDRAL

LE, ENSKL ABV KNEE 4-BAR PNEUM
LE ENSKL ABV KNEE UNI SWNG CTL
LE, SELF-ALIGN, ABVEBLW KNEE
ADD LE, TEST SCKT, SYMES
ADD LE, TEST SCKT, BLW KNEE
ADD LE, TEST SCKT KNEE DISARTC
ADD LE, TEST SCKT, ABV KNEE
ADD LE, TEST SCKT HIP DISARTC
ADD LE, TEST SCKT HEMIPELVCTMY
ADD LE BLW KNEE, ACRYLIC SCKT
ADD LE, SYMES, EXPAND WALLSCKT
ADD LE ABV KNEE, ACRYLIC SCKT
ADD LE, SYMES TYPE
ADD LE, SYMES CANADIAN SCKT
ADD LE SYMES, MEDIAL OPEN SCKT
ADD LE, BLW KNEE, TOTL CONTACT
ADD LE, BLW KNEE, LEATHR SOCKT
ADD LE, BLW KNEE, WOOD SOCKET
ADD LE KNEE DISART LEATHR SCKT
ADD LE, ABV KNEE, LEATHR SOCKT
ADD LE HIP DISARTC, EXT FRAME
ADD LE, ABV KNEE, WOOD SOCKET
ADD LE, BLW KNEE, FLX EXT FRME
ADD LE, BLW KNEE, AIR CUSHION
ADD LE, BLW KNEE SUCTION SOCKT
ADD LE, ABV KNEE, AIR CUSHION
ADD LE, ISCH CONTNMT NAR SCKT
ADD LE TOT CNTCT ABV KNEE SCKT
ADD LE ABV KNEE FLX EXTN FRAME
ADD LE, SUCT SUSP ABV KNEE/DIS
ADD LE, KNEE DISART EXPND SCKT
ADD LE, SCKT INSRT, SYMES
ADD LE, SCKT INSRT BLW KNEE
ADD LE SCKT INSRT KNEE DISARTC
ADD LE, SCKT INSRT, ABV KNEE
ADD LE, SCKT INSRT, MULTI-DURO
ADD LE, MULTI-DUROMTR BLW KNEE
ADD LE, BLW KNEE CUFF SUSPENSN
AD LE BLW KNE MOLD DISTL CUSHN
BLW KNEE SUPRACONDYLAR SUSP
BK/AK LOCKING MECHANISM
BLW KNEE REMOV MEDIALBRIM SUSP
ADD LOW EXTRM,ANY MATERIAL,EA
ADD LOW EXTRM,HVY DTY,ANY MATL
BLW KNEE, KNEE JOINTS, 1 AXIS
BLW KNEE, KNEE JNTS POLYCENTRC
ADD LE, BLW KNEE, JOINT COVERS
BLW KNEE, THIGH LACER NON-MOLD
L5682
L5684
L5686
L5688
L5690
L5692
L5694
L5695
L5696
L5697
L5698
L5699
L5700
L5701
L5702
L5704
L5705
L5706
L5707
L5710
L5711
L5712
L5714
L5716
L5718
L5722
L5724
L5726
L5728
L5780
L5781
L5782
L5785
L5790
L5795
L5810
L5811
L5812
L5814
L5816
L5818
L5822
L5824
L5826
L5828
L5830
L5840
L5845
L5846
BLW KNEE, LACER,GLUTEAL, MOLD

ADD LE, BLW KNEE, FORK STRAP
ADD LE, BLW KNEE, BACK CHECK
BLW KNEE, WAIST BELT, WEBBING
BLW KNEE WAIST BELT, PAD&LINED
ABV KNEE, PELVIC CTRL BELT, LT
ABV KNEE, PELV CTRL BELT, PAD
ABV KNE PELV CTRL SLEVE NEOPRN
ABV KNEE/DISARTC, PELVIC JNT
ABV KNEE/DISARTC, PELVIC BAND
ABV KNEE/DISARTC, SILESIAN BND
ALL LE PROST, SHOULDER HARNESS
REPLCMT, SCKT, BLW KNEE, MOLD
REPL, SCKT ABV KNEE ATTCH PLTE
REPL SCKT HIP DISARTIC MOLDED
CUSTOM SHAPE COVER BK
CUSTOM SHAPE COVER AK
CUSTOM SHAPE CVR KNEE DISART
CUSTOM SHAPE CVR HIP DISART
EXOSKEL KNEE-SHIN SYS 1 AXIS
EXOSKL K-S SYS 1 AXIS ULTRA-LT
1 AXIS SAFETY KNEE
1 AXIS, VARI FRICT SWING PHASE
EXOSKEL K-S SYS, POLYCENTRIC
K-S SYS, POLYCEN, SWING&STANCE
1 AXIS, PNEUM SWING, FRICTION
1 AXIS, FLUID SWING PHASE CTRL
1 AXIS, EXT JNT FLD SWING CTRL
1 AXIS, FLD SWING& STANCE CTRL
1 AXIS PNEUMATIC SWING CONTROL
ADD LWR LIMB PROSTH,VAC PUMP
ADD LWR LIMB PRSTH,VAC,HVY DTY
EXOSKEL SYS BLW KNEE UL-LT MAT
EXOSKEL SYS ABV KNEE UL-LT MAT
EXOSKEL HIP DISARTIC UL-LT MAT
ENDOSKL K-S SYS 1 AXIS MAN LCK
1 AXIS, MAN LOCK, ULTRA-LT MAT
1 AXIS FRICT SWING&STANCE CTRL
POLYCENT, HYDRL SWING PHS CTL
POLYCENT, MECHAN STNCE PHS LCK
POLYCN FRIC SWING&STANCE CNTRL
1 AXIS, PNEUM SWING FRICT CTRL
1 AXIS, ADD FLD SWINGPHSE CTRL
ENDOS K-SH,1 AX,MINI HI ACT FR
1 AXIS FLUID SWING&STANCE CTRL
1 AXIS, PNEUM/SWING PHASE CTRL
ADD, ENDOSKEL KNEE/SHIN SYSTEM
ENDOSKL, K-S, STANCE FLEX, ADJ
ENDOSKL, K-S, MICRO CTL, SWING
L5847
L5848
L5850
L5855
L5910
L5920
L5925
L5930
L5940
L5950
L5960
L5962
L5964
L5966
L5968
L5970
L5972
L5974
L5975
L5976
L5978
L5979
L5980
L5981
L5982
L5984
L5985
L5986
L5987
L5988
L5989
L5990
L5995
L5999
L6000
L6010
L6020
L6025
L6050
L6055
L6100
L6110
L6120
L6130
L6200
L6205
L6250
L6300
L6310
MICROPROCESSOR CNTRL FEATURE

ADD ENDOSKEL,KNEE-SHIN SYS
ABV KNEE/HIP DISARTC EXTN ASST
ENDOSK HIP DISART MECH HIP AST
ENDOSKEL, BLW KNEE, ALIGN SYS
ABV KNEE/HIP DISARTC, ALIGN SY
ADD,ENDOSKL,ABOV KNEE,MAN LOCK
ENDOSKL, HI ACT KNEE CTRL FRAM
BLW KNEE, ULTRA-LIGHT MATERIAL
ENDOSKEL, ABV KNEE, ULT-LT MAT
ENDOSKL, HIP DISART ULT-LT MAT
BLW KNEE, FLEX OUT SURFACE CVR
ABV KNEE, FLEX OUT SURFACE CVR
HIP DISART FLEX OUT SURFAC CVR
ADD,LOW LIMB PROS,MULTIAX ANKL
LE PROST FOOT, EXTNL KEEL SACH
ALL LE PROST, FLEXI KEEL FOOT
LE PROST, FOOT, 1 AXIS ANKL/FT
ALL LOW PRO,COMB,1 AXI ANK+FLX
LE PROST, ENERGY STORING FOOT
LE PROST, FT MULTIAXIL ANKL/FT
ALL LOW EXT PRSTH,MULT-AXL ANK
LE PROST, FLEX FOOT SYSTEM
LE PROSTHESES, FLEX-WALK SYS
EXOSKEL LE PRST AXIL ROTAT UNT
ENDOSKL LE PRST AXIL ROTAT UNT
ENDOSKL LE PROST DYNAM PYLON
LE PROST, MULTI-AXIL ROTAT UNT
LE PROST SHANK FOOT WVERT PYLN
ADD,LOW LIMB PROS,VRT SHCK RED
PYLON W ELCTRNC FORCE SENSOR
USER ADJUSTABLE HEEL HEIGHT
ADD LOW EXTREM PRSTH,HVY DTY
LOWER EXTREMITY PROSTHESIS,NOS
PART HND, ROBIN-AID THUMB REMN
PRT HND, R-A, LTL +/RING FNGR
PRT HND, R-A, NO FINGER REMAIN
TRANSCARPAL HAND DISARTICULAT
WRST DISART SCKT FLX HNG TRICP
WRST DISART W/EX INTRF FLX HNG
BLW ELBW SCKT FLX HNGE, TRICEP
BELOW ELBOW MOLDED SOCKET
BLW ELBW DBL WALL SCKT, STEPUP
BLW ELB MOLD 2 SPLIT SCKT STMP
ELBW DISART MOLD SCKT OUT LOCK
ELBW DISART MOLD SCKT EXPAND
ABV ELB MOLD 2 SCKT INTRN LOCK
SHLDR DISART SCKT BULKHD HMERL
SHLDR DISART, PASS RESTORATION
L6320
L6350
L6360
L6370
L6380
L6382
L6384
L6386
L6388
L6400
L6450
L6500
L6550
L6570
L6580
L6582
L6584
L6586
L6588
L6590
L6600
L6605
L6610
L6615
L6616
L6620
L6623
L6625
L6628
L6629
L6630
L6632
L6635
L6637
L6638
L6640
L6641
L6642
L6645
L6646
L6647
L6648
L6650
L6655
L6660
L6665
L6670
L6672
L6675
SHLDR DISRT PASS RSTR CAP ONLY

I-T MOLD SCKT SHLDR BLKHD HMRL
INTERSCAP THORACIC COMP PROSTH
INTRSCAP THRC PASS RESTR CAP
P SURG DRSS WRST DISAR/BLW ELB
P SURG DRSS ELB DISART/ABV ELB
P SURG SHLD DISRT/INTRSCP THOR
P SURG CAST CHANGE AND REALIGN
P SURG APP RIGID DRESSING ONLY
BLW ELB SCKT W/SOFT TISSU SHAP
ELB DISART SCKT W/SOFT TIS SHP
ABV ELB W/SOFT PROST TISS SHAP
SHLDR DISART W/SOFT TISS SHAPG
ENDOSKELINTERSCAP THORAC SCKET
PREP WRIST DISARTICUL MOLDED
PREP WRIST DISARTICUL DIRECT
PREP ELBOW DISARTICUL MOLDED
PREP ELBOW DISARTICUL DIRECT
PREP SHLDR DISARTIC
PREP SHOULDER DISARTIC DIRECT
UE ADD, POLYCEN HINGE
UE ADDITION, 1 PIVOT HINGE
UE ADDITIONS, FLEX METAL HINGE
UE ADD DISCONCT LOCK WRST UNIT
UE DISCONCT INSRT LCK WRST UNT
UE, FLEXION-FRICTN WRIST UNIT
UE SPRING ROTATE WRST W/LATCH
UE, ROTAT WRST UNT W/CABLE LCK
UE QUICK DISCON HOOK ADAPTER
UE QUK DISC LAMIN COLLAR W/CPL
UE, STAINLESS STEEL, ANY WRIST
UE, LATEX SUSPENSION SLEEVE
UE, LIFT ASSIST FOR ELBOW
UE, NUDGE CONTROL ELBOW LOCK
UP EXTRM ADD PRSTH, LCK FEAT
UE, SHOULDER ABDUCTION JOINT
UE, EXCURS AMPLIFIER, PULLEY
UE, EXCURSION AMPLIFIER, LEVER
UE SHLDR FLEXN-ABDUCTION JNT
UP EXTRM ADD,SHLDER JNT,FLEX
UP EXTRM ADD,BODY PWD ACTUATOR
UP EXTRM ADD,EXTRL PWD ACTUATR
UE, SHOULDER UNIVERSAL JOINT
UE, STD CONTROL CABLE, EXTRA
UE, HEAVY DUTY CONTROL CABLE
UE, TEFLON, CABLE LINING
UE, HOOK-HAND, CABLE ADAPTER
UE, HARNSS, CHEST/SHLDR SADDLE
UE, HARNESS, FIG 8 SINGLE CTRL
L6676
L6680
L6682
L6684
L6686
L6687
L6688
L6689
L6690
L6691
L6692
L6693
L6700
L6705
L6710
L6715
L6720
L6725
L6730
L6735
L6740
L6745
L6750
L6755
L6765
L6770
L6775
L6780
L6790
L6795
L6800
L6805
L6806
L6807
L6808
L6809
L6810
L6825
L6830
L6835
L6840
L6845
L6850
L6855
L6860
L6865
L6867
L6868
L6870
UE, HARNESS, FIG 8 DUAL CTRL

UE TST SCKT WRST DISAR/BLW ELB
UE TST SCKT ELBW DISAR/ABV ELB
UE TST SCKT SHDR DISAR/INTRSCP
UE ADD, SUCTION SOCKET
UE FRME SCKT BLW ELB/WRST DISR
UE FRME SCKT ABV ELB/ELB DISAR
UE FRME SCKT SHLDR DISARTICUL
UE FRME SCKT INTERSCAP-THORAC
UE, REMOVABLE INSERT
UE, SILICONE GEL INSERT
UP EXT ADD,LOCK ELB,COUNTERBAL
TERMNL DEV, HOOK, DORRANCE #3
TERMNL DEV, HOOK, DORRANCE #5X
TRMNNL DEV, HOOK, DORRANC #5XA
TERMNL DEV, HOOK, DORRANC #7LO
TERMNL DEV, HOOK, DORRANCE #8X
TERMNL DEV, HOOK, DORRANC #88X
TERMNL DEV, HOOK, DORRANC #10P
TERMNL DEV, HOOK, DORRANC #12P
TERMNL DEV, HOOK, DORRANC #555
TERMNL DEV, HK, DORRANC #SS555
TERMNL DEV, HOOK-ACCU HOOK
TERMINAL DEVICE, HOOK-2 LOAD
TERMINAL DEVICE, HOOK-APRL VC
TRMNL DEV, MODFR WRST FLEX UNT
TRMNL DEV, HK, TRS GRIP III,VC
TRMNL DEV, HK, GRIP I,II, VC
TRMNL DEV, TRS ADEPT,INFNTCHLD
TRMNL DEV, TRS SUPR SPORT PASS
TRMNL DEV, PINCH TL, OTTO BOCK
TRMNL DEV, HAND, DORRANCE, VO
TERMNL DEVICE, HAND, APRL, VC
TERMNL DEV, HAND, SIERRA, VO
TRMNL DEV, HND, BECKER IMPERIL
TRMNL DEV, HND, BECKR LOCK GRP
TEMNL DEV, HND, BECKER PLYLITE
TRMNL DEV, HND, ROBIN-AIDS, VO
TRMNL DEV, HND, R-AIDS VO SOFT
TRMNL DEV, HAND, PASSIVE HAND
TRMNL DEV, HND, DETROIT INFANT
TRMNL DEV, HAND, PASS INFANT
TRMNL DEV, HAND, CHILD MITT
L6872
L6873
L6875
L6880
L6881
L6882
L6890
L6895
L6900
L6905
L6910
L6915
L6920
L6925
L6930
L6935
L6940
L6945
L6950
L6955
L6960
L6965
L6970
L6975
L7010
L7015
L7020
L7025
L7030
L7035
L7040
L7045
L7170
L7180
L7185
L7186
L7190
L7191
L7260
L7261
L7266
L7272
L7274
L7360
L7362
L7364
L7366
L7367
L7368
TRMNL DEV, HAND, NYU CHILD

TRMNL DEV, HD INFNT STEEPER
TRMNL DEV, HAND, BOCK, VC
TRMNL DEV, HAND, BOCK, VO
AUTOGRASP FEATURE UL TERM DV
MICROPROCESSOR CONTROL UPLMB
TRMNL DEV, GLOVE ABV HANDS
TRMNL DEV, GLVE ABV HANDS CUST
HAND RESTR W/GLOVE TMB/1 FINGR
HAND RESTR W/GLVE, MULTI FINGR
HAND RESTR W/GLOVE, NO FINGERS
HAND RESTOR REPLACEMENT GLOVE
TRM DV WRST DIST EX PWR SW CRL
TRM DV WRT DIST EX PWR MYO CRL
TRM DV BLW ELB EX PWR SW CTRL
TRM DV BLW ELB EX PWR MYOC CRL
TRM DV ELB DIST EX PWR SW CTRL
TRM DV ELB DIST EX PWR MYE CRL
TRM DV ABV ELB EX PWR SW CTRL
TRM DV ABV ELB EX PWR MYOE CRL
TRM DV SHLD DIST EX PWR SW CRL
TRM DV SHLD DIS EX PWR MYO CRL
TRM DV INTSC-THR EX PWR SW CRL
TRM DV INTSC-THR EX PWR MY CRL
EL HND, O-B, STEEPER, SWH CTRL
EL HAND TEKNIK/VV SWITCH CTRL
ELEC GREIFER, O-B, SWITCH CTRL
EL HND OTTO BOCK, MYOELEC CTRL
EL HND TEKNIK/VV, MYOELEC CTRL
EL HND GREIFR, O-B, MYOEL CTRL
PREHENS ACTR, HOSMER, SWH CTRL
EL HOOK, CHILD, MICH, SW CTRL
ELEC ELB, HOSMER, SWITCH CTRL
ELEC ELB, BOSTON/UTAH MYOELEC
ELEC ELBOW ADOLESC, SWITCH
ELEC ELBOW CHILD, VARI, SWITCH
ELEC ELBOW ADOLSC, VAR MYOELEC
ELEC ELBOW CHILD VARI MYOELEC
ELEC WRIST ROTATOR, OTTO BOCK
ELEC WRIST ROTATOR, UTAH ARM
SERVO CONTROL, STEEPER
ANALOGUE CONTROL, UNB OR EQUAL
PROPORTIONAL CNTRL, 6-12 VOLT
6 V BATTERY, OTTO BOCK
6 V BATTERY CHARGER, OTTO BOCK
12 VOLT BATTERY, UTAH OR EQUAL
BATTERY CHARGER, 12 VOLT, UTAH
LITHIUM ION BATERY,REPLACEMENT
LITHIUM ION BATTERY CHARGER
L7499
L7500
L7510
L7520
L7900
L8000
L8001
L8002
L8010
L8015
L8020
L8030
L8035
L8039
L8040
L8041
L8042
L8043
L8044
L8045
L8046
L8047
L8048
L8049
L8100
L8110
L8120
L8130
L8140
L8150
L8160
L8170
L8180
L8190
L8195
L8200
L8210
L8220
L8230
L8239
L8300
L8310
L8320
L8330
L8400
L8410
L8415
L8417
L8420
UPPER EXTREMITY PROSTHESIS,NOS

REP PROSTHETIC DEVICE, HRLY
REPAIR PROSTHETIC DEVICE
REPAIR PROSTH DEVICE, LABOR
VACUUM ERECTION SYSTEM
BREAST PROSTH, MASTECTOMY BRA
BREAST PROSTHESIS BRA & FORM
BRST PRSTH BRA & BILAT FORM
BREAST PROSTH, MASTCTMY SLEEVE
EXT BREAST PRO,POST MASTECTOMY
BREAST PROSTH, MASTECTOMY FORM
BREAST PROSTH, SILICONE
CUST BREAST PROS, POST MASTECT
BREAST PROSTHESIS, NOS
NASAL PROSTHESIS,NON-PHYSICIAN
MIDFACIAL PROSTHESIS,NON-PHYSN
ORBITAL PROSTHESIS,NON-PHYSICN
UPPER FACIAL PROSTHES,NON-PHYS
HEMI-FACIAL PROSTH,NON-PHYSICN
AURICULAR PROSTH,NON-PHYSICIAN
PART FACIAL PROS,NON-PHYSICIAN
NASAL SEPTL PROS,NON-PHYSICIAN
UNSPEC MAXILLOFAC PROS,NON-PHY
REP,MAXILLOFAC PROS,15,NON-PHY
ELASTIC SUP, BELOW KNEE MED WT
ELAST SUP, BELW KNEE, HEAVY WT
ELAST SUP, BELOW KNEE, SURG WT
ELAST SUP, ABOVE KNEE, MED WT
ELAST SUP, ABOVE KNEE, HVY WT
ELAST SUP, ABOVE KNEE, SURG WT
ELAST SUP, FULL LENGTH, MED WT
ELAST SUP, FULL LENGTH, HVY WT
ELAST SUP, FUL LN, HVY SURG WT
ELAST SUP, LEOTARDS, MED WT
GRAD STOCK,WAIST,30-40 MMHG,EA
ELAST SUPRT, LEOTARDS, SURG WT
GRAD COMPRES STOCK,CUSTOM MADE
GRAD COMPRES STOCK, LYMPHEDEMA
GRAD COMPRES STOCK,GARTER BELT
GRAD COMPRESSION STOCKING, NOS
TRUSS, 1 WITH STANDARD PAD
TRUSS, DOUBLE W/ STANDARD PADS
TRUSS, ADD TO STD/WATER PAD
TRUSS, ADD TO STD/SCROTAL PAD
PROSTHETIC SHEATH, BELOW KNEE
PROSTHETIC SHEATH, ABOVE KNEE
PROSTHETIC SHEATH, UPPER LIMB
PROSTH SHEATH/SOCK, INCL GEL
PROS SOCK,MULT PLY, BELOW KNEE
L8430
L8435
L8440
L8460
L8465
L8470
L8480
L8485
L8490
L8499
L8500
L8501
L8505
L8507
L8509
L8510
L8600
L8603
L8606
L8610
L8612
L8613
L8614
L8619
L8630
L8641
L8642
L8658
L8670
L8699
L9900
M0064
M0075
M0076
M0100
M0300
M0301
P2028
P2029
P2031
P2033
P2038
P3000
P3001
P7001
P9010
P9011
P9012
P9016
PROS SOCK,MULT PLY, ABOVE KNEE

PROS SOCK,MULT PLY,UP LIMB, EA
PROSTH SHRINKER, BELOW KNEE
PROSTH SHRINKER, ABOVE KNEE
PROSTH SHRINKER, UPPER LIMB
PROS SOCK,1 PLY,FIT,BELOW KNEE
PROS SOCK,1 PLY,FIT,ABOVE KNEE
PROS SOCK,1 PLY,FIT,UPPER LIMB
ADD PROST SOCK, AIR SEAL
UNLIST PROCED, MISC PROST SERV
ARTIFICIAL LARYNX, ANY TYPE
TRACHEOSTOMY SPEAKING VALVE
ARTIFICIAL LARYNX, ACCESSORY
TRACH-ESOPH VOICE PROS PT IN
TRACH-ESOPH VOICE PROS MD IN
VOICE AMPLIFIER
IMPLANT BREAST PROST, SILICONE
INJCT BLK AGNT,COLLGN IMPL
INJ BULK AG,SYNT,URIN,1 ML SYR
OCULAR IMPLANT
AQUEOUS SHUNT
OSSICULA IMPLANT
COCHLEAR DEVICE/SYSTEM
CHCHLAR IMPLT, EXT SPCH RPLCMT
METACARPOPHALANGEAL JNT IMPLNT
METATARSAL JOINT IMPLANT
HALLUX IMPLANT
INTERPHALANGEAL JOINT IMPLANT
VASCULAR GRAFT, SYNTH IMPLANT
PROSTHETIC IMPLANT, NOS
ORTHOT &PROS SUP,AC&/SER,OTH L
VISIT FOR DRUG MONITORINGBRIEF
CELLULAR THERAPY
PROLOTHERAPY
INTRAGASTRIC HYPOTHERMIA INTRA
IV CHELATIONTHERAPY
FABRIC WRAPPING OF ANEURYSM
CEPHALIN FLOCULATION TEST
CONGO RED BLOOD TEST
HAIR ANALYSIS HAIR
BLOOD THYMOL TURBIDITY
BLOOD MUCOPROTEIN
SCREEN PAP BY TECH W MD SUPV
SCREENING PAP SMEAR BY PHYS
CULTURE BACTERIAL URINE
WHOLE BLOOD,FOR TRNSFSN, UNIT
BLOOD SPLIT UNIT
CRYOPRECIPITATE EACH UNIT
RED BLOOD CELLS,LEUKOCYTES RED
P9017
P9019
P9020
P9021
P9022
P9023
P9031
P9032
P9033
P9034
P9035
P9036
P9037
P9038
P9039
P9040
P9041
P9043
P9044
P9045
P9046
P9047
P9048
P9050
P9603
P9604
P9612
P9615
Q0035
Q0081
Q0083
Q0084
Q0085
Q0086
Q0091
Q0092
Q0111
Q0112
Q0113
Q0114
Q0115
Q0136
Q0144
Q0163
Q0164
Q0165
Q0166
Q0167
Q0168
FRSH FROZ PLSMA(1 DONOR),EA UN

PLATELETS, EACH UNIT
PLAELET RICH PLASMA UNIT
RED BLOOD CELLS UNIT
RED BLOOD CELLS,WASHED,EA UNIT
PLASM,POOL MUL DON,FROZ,EA UNT
PLATELETS,LEUKOCYTES RED,EA UN
PLATELETS, IRRADIATED, EACH UN
PLATE,LEUKOCYTES RED,IRR,EA UN
PLATELETS, PHERESIS, EACH UNIT
PLAT,PHERES,LEUKOCYT RED,EA UN
PLATELETS, PHERESIS, IRR,EA UN
PLAT,PHERES,LEUK RED,IRR,EA UN
RBC, IRRADIATED, EACH UNIT
RBC, DEGLYCEROLIZED, EACH UNIT
RBC,LEUKOCYTES RED,IRR,EA UNIT
ALBUMIN (HUMAN),5%, 50ML
PLASMA PROTEIN FRACT,5%,50ML
PLASMA,CRYOPRECIP RED,EA UNIT
ALBUMIN (HUMAN), 5%, 250 ML
ALBUMIN (HUMAN), 25%, 20 ML
ALBUMIN (HUMAN), 25%, 50ML
PLASMAPROTEIN FRACT,5%,250ML
GRANULOCYTES, PHERESIS UNIT
ONE-WAY ALLOW PRORATED MILES
ONE-WAY ALLOW PRORATED TRIP
CATH,COLL SPECIMEN,1,ALL PLACE
CATH CLCT SPECMN MULTI-PATNTS
CARDIOKYMOGRAPHY
INFUS THER W/ OTHER THAN CHEMO
CHEMO ADMIN,OTHER THAN INFUSN
CHEMO ADMIN BY INFUSION
CHEMO ADMIN, BOTH INFUS/OTHER
PHYS THERAPY EVAL/TREATMENT
OBTAINING SCREEN PAP SMEAR
SET UP PORT X-RAY EQUIPMENT
WET MOUNTS/ W PREPARATIONS
POTASSIUM HYDROXIDE PREPS
PINWORM EXAMINATIONS
FERN TEST
POST-COITAL MUCOUS EXAM
NON ESRD EPOETIN ALPHA INJ
AZITHRROMYCIN DIHYDRATE,ORAL
DIPHENHYDRAMINE HYDROCHLORIDE
PROCHLORPERAZINE MALEATE, 5 MG
PROCHLORPERAZINE MALEATE,10 MG
GRANISETRON HYDROCHLORIDE,1 MG
DRONABINOL, 2.5 MG, ORAL
DRONABINOL, 5 MG, ORAL
Q0169
Q0170
Q0171
Q0172
Q0173
Q0174
Q0175
Q0176
Q0177
Q0178
Q0179
Q0180
Q0181
Q0183
Q0184
Q0187
Q1001
Q1002
Q1003
Q1004
Q1005
Q2001
Q2002
Q2003
Q2004
Q2005
Q2006
Q2007
Q2008
Q2009
Q2010
Q2011
Q2012
Q2013
Q2014
Q2017
Q2018
Q2019
Q2020
Q2021
Q2022
Q3000
Q3001
Q3002
Q3003
Q3004
Q3005
Q3006
Q3007
PROMETHAZINE HYDROCHL, 12.5 MG

PROMETHAZINE HYDROCHLOR, 25 MG
CHLORPROMAZINE HYDROCHL, 10 MG
CHLORPROMAZINE HYDROCHL, 25 MG
TRIMETHOBENZAMIDE HYDROCHLOR
THIETHYLPERAZINE MALEATE,10 MG
PERPHENZAINE, 4 MG, ORAL
PERPHENZAINE, 8 MG, ORAL
HYDROXYZINE PAMOATE,25 MG,ORAL
HYDROXYZINE PAMOATE,50 MG,ORAL
ONDANSETRON HYDROCHLORIDE 8 MG
DOLASETRON MESYLATE, 100 MG
UNSPECIFIED ORAL DOSAGE FORM
DERMAL TISSUE,HUM,W/O META ELE
DERMAL TISSUE,HUM, W META ELEM
FACTOR VIIA (COAG,RECMB)/1.2MG
NEW TECH LENS CAT 1,FED RG NTC
NEW TECH LENS CAT 2,FED RG NTC
NEW TECH INTRAOCULAR LEN CAT 3
ORAL, CABERGOLINE, 0.5 MG
INJECT, ELLIOTTS B SOLUTION/ML
INJECT, APROTININ, 10,000 KIU
IRR SOL,BLADDER CALCULI/500 ML
INJ,CORTICOR OVINE TRIFLUT/DSE
INJ,DIGOXIN IMM FAB (OVINE)/VL
INJ,ETHANOLAMINE OLEATE,100 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOSPHENYTOIN, 50 MG
INJCT,GLATIRAMER ACETATE,/DOSE
INJECTION, HEMIN, PER 1 MG
INJECT,PEGADEMASE BOVINE,25 IU
INJ,PENTASTARCH,10% SOL/100 ML
INJ,SERMORELIN ACETATE, 0.5 MG
INJECTION, TENIPOSIDE, 50 MG
INJECT, UROFOLLITROPIN, 75 IU
INJECTION, BASILIXIMAB, 20 MG
INJ, HISTRELIN ACETATE,10 MCG
INJECTION, LEPIRUDIN, 50 MG
VON WILLEBRND FCT CMP,HUMAN/IU
RUBIDIUM RB-82, PER DOSE
RADIOELEM,BRACHYTHERAPY,ANY,EA
SUPPLY, GALLIUM GA 67, PER MCI
SUP,TECHNET TC 99M BICIS/UN DS
SUPP, XENON XE 133, PER 10 MCI
SUP,TECHNET TC 99M MERTIAT/MCI
SUP,TECHN TC 99M GLUCEPA/5 MCI
SUPP,SODIUM PHOSPHATE P32/MCI
Q3008
Q3009
Q3010
Q3011
Q3012
Q3014
Q3019
Q3020
Q3021
Q3022
Q3023
Q3025
Q3026
Q4001
Q4002
Q4003
Q4004
Q4005
Q4006
Q4007
Q4008
Q4009
Q4010
Q4011
Q4012
Q4013
Q4014
Q4015
Q4016
Q4017
Q4018
Q4019
Q4020
Q4021
Q4022
Q4023
Q4024
Q4025
Q4026
Q4027
Q4028
Q4029
Q4030
Q4031
Q4032
Q4033
Q4034
Q4035
Q4036
SUP,IND 111-IN PENTETREO/3 MCI

SUP,TECHNET TC 99M OXIDRON/MCI
SUPP,TECHNETIUM TC 99M-RBC/MCI
SUP,CHROM PHOSPH P32 SUSPN/MCI
SUP,CYANOCOB COBLT CO57/0.5MCI
TELEHEALTH FACILITY FEE
ALS VEHICLE,EMRGNCY TRANS
ALS VEHICLE,NON-EMRGNCY TRNS
INJECT,HPATI B, PED,PER DOSE
INJECT,HPATI B, ADULT,PER DOSE
INJECT,HPATI B,IMMUNONSUPPRESS
INJECT,BETA-1A,INTRAMUSCUL USE
INJECT,BETA-1A,SUBCUTANEOU USE
CAST SUP BODY CAST PLASTER
CAST SUP BODY CAST FIBERGLAS
CAST SUP SHOULDER CAST PLSTR
CAST SUP SHOULDER CAST FBRGL
CAST SUP LONG ARM ADULT PLST
CAST SUP LONG ARM ADULT FBRG
CAST SUP LONG ARM PED PLSTER
CAST SUP LONG ARM PED FBRGLS
CAST SUP SHT ARM ADULT PLSTR
CAST SUP SHT ARM ADULT FBRGL
CAST SUP SHT ARM PED PLASTER
CAST SUP SHT ARM PED FBRGLAS
CAST SUP GAUNTLET PLASTER
CAST SUP GAUNTLET FIBERGLASS
CAST SUP GAUNTLET PED PLSTER
CAST SUP GAUNTLET PED FBRGLS
CAST SUP LNG ARM SPLINT PLST
CAST SUP LNG ARM SPLINT FBRG
CAST SUP LNG ARM SPLNT PED P
CAST SUP LNG ARM SPLNT PED F
CAST SUP SHT ARM SPLINT PLST
CAST SUP SHT ARM SPLINT FBRG
CAST SUP SHT ARM SPLNT PED P
CAST SUP SHT ARM SPLNT PED F
CAST SUP HIP SPICA PLASTER
CAST SUP HIP SPICA FIBERGLAS
CAST SUP HIP SPICA PED PLSTR
CAST SUP HIP SPICA PED FBRGL
CAST SUP LONG LEG PLASTER
CAST SUP LONG LEG FIBERGLASS
CAST SUP LNG LEG PED PLASTER
CAST SUP LNG LEG PED FBRGLS
CAST SUP LNG LEG CYLINDER PL
CAST SUP LNG LEG CYLINDER FB
CAST SUP LNGLEG CYLNDR PED P
CAST SUP LNGLEG CYLNDR PED F
Q4037
Q4038
Q4039
Q4040
Q4041
Q4042
Q4043
Q4044
Q4045
Q4046
Q4047
Q4048
Q4049
Q4050
Q4051
Q9920
Q9921
Q9922
Q9923
Q9924
Q9925
Q9926
Q9927
Q9928
Q9929
Q9930
Q9931
Q9932
Q9933
Q9934
Q9935
Q9936
Q9937
Q9938
Q9939
Q9940
R0070
R0075
R0076
S0009
S0012
S0014
S0016
S0017
S0020
S0021
S0023
S0028
S0030
CAST SUP SHRT LEG PLASTER

CAST SUP SHRT LEG FIBERGLASS
CAST SUP SHRT LEG PED PLSTER
CAST SUP SHRT LEG PED FBRGLS
CAST SUP LNG LEG SPLNT PLSTR
CAST SUP LNG LEG SPLNT FBRGL
CAST SUP LNG LEG SPLNT PED P
CAST SUP LNG LEG SPLNT PED F
CAST SUP SHT LEG SPLNT PLSTR
CAST SUP SHT LEG SPLNT FBRGL
CAST SUP SHT LEG SPLNT PED P
CAST SUP SHT LEG SPLNT PED F
FINGER SPLINT, STATIC
CAST SUPPLIES UNLISTED
SPLINT SUPPLIES MISC
EPOETIN WITH HCT <= 20
EPOETIN WITH HCT = 21
EPOETIN WITH HCT >= 40
TRANSPORT PORTABLE X- RAY
TRANSPORT PORT X-RAY MULTIPL
TRANSPORT PORTABLE EKG
INJCT,BUTORPHANOL TARTRATE,1MG
BUTORPHANOL TARTRATE,NASL,25MG
TACRINE HYDROCHLORIDE, 10 MG
INJECT,AMIKACIN SULFATE,500 MG
INJECT,AMINOCAPROIC ACID,5 GMS
INJ,BUPIVICAINE HYDROCHLR,30ML
INJT,CEFTOPERAZONE SODIUM,1 GM
INJ,CIMETIDINE HYDROCHL, 300MG
INJECTION, FAMOTIDINE, 20 MG
INJECTION,METRONIDAZOLE,500 MG
S0032
S0034
S0039
S0040
S0071
S0072
S0073
S0074
S0077
S0078
S0079
S0080
S0081
S0088
S0090
S0091
S0092
S0093
S0104
S0106
S0108
S0114
S0122
S0124
S0126
S0128
S0130
S0132
S0135
S0155
S0156
S0157
S0170
S0171
S0172
S0173
S0174
S0175
S0176
S0177
S0178
S0179
S0181
S0182
S0183
S0187
S0189
S0190
S0191
INJ, NAFCILLIN SODIUM, 2 GRAMS

INJECTION, OFLOXACIN, 400 MG
INJ,SULFAMETHOX & TRIMETH,10ML
INJ,TICAR DIS & CLAV POT,3.1GM
INJECT,ACYCLOVIR SODIUM, 50 MG
INJECT,AMIKACIN SULFATE,100 MG
INJECTION, AZTREONAM, 500 MG
INJ,CEFOTETAN DISODIUM, 500 MG
INJ,CLINDAMYCIN PHOSPHT,300 MG
INJ,FOSPHENYTOIN SODIUM,750 MG
OCTREOTIDE 100 MCG
INJ,PENTAMIDINE ISETHION,300MG
INJ,PIPERACILLIN SODIUM,500 MG
ALEMTUZUMAB INJECTION, 30 MG
SILDENAFIL CITRATE, 25 MG
GRAINSETRON HYDROCHLORIDE, 1MG
INJECT,HYROMORPHONE, 250MG
INJECT,MORPHINE SULFATE, 500MG
ZIDOVUDINE, ORAL, 100MG
BUPROPION HCL SUSTAIND RELEASE
MERCAPTOPURINE,ORAL,50 MG
INJECT,TREPROSTINIL SODIUM
INJECT,MENOTROPINS,75 IU
INJECT,UROFOLLITROPIN,PURIFIED
INJECT,FOLLITROPIN ALFA, 75 IU
INJECT,FOLLITROPIN BETA, 75 IU
INJECT,CHORIONIC GONADOTROPIN
INJECT,GANIREL ACETATE,250 MCG
INJECTION, PEGFILGRASTIM, 6MG
EPOPROSTENOL DILUTANT
EXEMESTANE, 25 MG
BECAPLERMIN GEL 0.01%, 0.5 GM
ANASTROZOLE 1 MG
BUMETANIDE 0.5 MG
CHLORAMBUCIL 2 MG
DEXAMETHASONE 4 MG
DOLASETRON 50 MG
FLUTAMIDE 125 MG
HYDROXYUREA 500 MG
LEVAMISOLE 50 MG
LOMUSTINE 10 MG
MEGESTROL 20 MG
ONDANSETRON 4 MG
PROCARBAZINE 5 MG
PROCHLORPERAZINE 5 MG
TAMOXIFEN 10 MG
TESTOSTERONE PELLET 75 MG
MIFEPRISTONE, ORAL, 200 MG
MISOPROSTOL, ORAL, 200 MCG
S0195
S0199
S0201
S0207
S0208
S0209
S0215
S0220
S0221
S0250
S0255
S0260
S0302
S0310
S0315
S0316
S0320
S0340
S0341
S0342
S0390
S0395
S0400
S0500
S0504
S0506
S0508
S0510
S0512
S0514
S0516
S0518
S0580
S0581
S0590
S0592
S0601
S0605
S0610
S0612
S0620
S0621
S0622
S0630
S0800
S0810
S0812
S0820
S0830
PNEUMOCOCAL CNJGT VACNE,AGE5-9

MED ABORTION INC ALL EX DRUG
PARTIAL HOSPITALIZATION SERV
PARAMEDIC INTERCPT,NON-HOSPTAL
PARAMED INTRCEPT NONVOL
WC VAN MILEAGE PER MI
NON-EMERG TRANSPORT; MILEAGE
MED CONF,PHYS,INTERDISC;APP 30
MED CONF,PHYS,INTERDISC;APP 60
COMP GERIATR ASSMT TEAM
HOSPICE REFER VISIT NONMD
H&P FOR SURGERY
COMPLETED EPSDT
HOSPITALIST VISIT
DISEASE MANAGEMENT PROGRAM
FOLLOW-UP/REASSESSMENT
RN TELEPHONE CALLS TO DMP
LIFESTYLE MOD 1ST STAGE
LIFESTYLE MOD 2 OR 3 STAGE
LIFESTYLE MOD 4TH STAGE
ROUTINE FT CARE;RMVAL CORNS
IMPRESSION CASTING FT
GLOBAL ESWL KIDNEY
DISPOS CONT LENS
SINGL PRSCRP LENS
BIFOC PRSCP LENS
TRIFOC PRSCRP LENS
NON-PRSCRP LENS
DAILY CONT LENS
COLOR CONT LENS
SAFETY FRAMES
SUNGLASS FRAMES
POLYCARB LENS
NONSTND LENS
MISC INTEGRAL LENS SERV
COMP CONT LENS EVAL
SCREENING PROCTOSCOPY
DIGITAL RECTAL EXAM, ANNUAL
ANN GYNECOLOGICAL EXAM,NEW PAT
ANN GYNECOLOGICAL EXAM,EST PAT
ROUT OPHTHALMOLOG EXAM,REF;NEW
ROUT OPHTHALMOLOG EXAM,REF;EST
PHYS EXAM FOR COLLEGE
REM SUTURES;PHYS NOT ORIG PHYS
LASER IN SITU KERATOMILE,LASIK
PHOTOREFRACT KERATECTOMY (PRK)
PHOTOTHERAP KERATECT
COMPUT CORNEAL TOPOGRAPHY,UNIL
ULTRASD PACHYM,CORN THICK,UNIL
S1001
S1002
S1015
S1016
S1025
S1030
S1031
S1040
S2053
S2054
S2055
S2060
S2061
S2065
S2080
S2102
S2103
S2107
S2112
S2115
S2120
S2130
S2140
S2142
S2150
S2202
S2205
S2206
S2207
S2208
S2209
S2211
S2250
S2260
S2262
S2265
S2266
S2267
S2300
S2340
S2341
S2342
S2350
S2351
S2360
S2361
S2370
S2371
S2400
DELUXE ITEM
CUSTOM ITEM
IV TUBING EXTENSION SET
NON-PVC IV AD,DRG NOT STAB,PVC
INHAL NITRIC OXIDE NEONATE
GLUC MONITOR PURCHASE
GLUC MONITOR RENTAL
CRAINAL REMOLDING ORTHOSIS
TRANSPL,SM INTEST & LIV ALLOGF
TRANSPL, MULTIVISCERAL ORGANS
HARV,MULTIVISC ORG,ALLOGFT;CAD
LOBAR LUNG TRANSPLANTATION
DON LOBECT (LUNG),TRANSPLT,LIV
SIMULT PANC KIDN TRANS
LAUP
ISLET CELL TISSUE TRANSPLANT
ADRENAL TISS TRANSPLANT, BRAIN
ADOP IMMUNOTHRPY I.E. DEVEL
KNEE ARTHROSCP HARV
PERIACETABULAR OSTEOTOMY
LDL APHERES,HEPARIN,EXTRACORPL
ENDOLUMINAL RADIOFREQ ABLATION
CORD BLD HARVEST,TRANSPL,ALLOG
CORD BLD-STEM-CEL TRANSP,ALLOG
BMT HARV/TRANSPL 28D PKG
ECHOSCLEROTHERAPY
SURG,MINI-THORAC/STRN;1 ART GF
SURG,MINI-THORAC/STRN;2 ART GF
SURG,MINI-THORAC/STRN;1 VEN GF
SURG,MIN-THORAC/STRN;1 ART&VEN
SRG,MIN-THORA/STRN;2 ART,1 VEN
TRANSCATH PLACE INTRAVAS STENT
UTERINE ARTERY EMBOLIZ
INDUCED ABORTION 17-24 WEEKS
ABORTION MATERNAL INDIC,>=25W
ABORTION,25-28WKS FETAL INDICA
ABORTION,29-31WKS FETAL INDICA
ABORTION,>=32 WKS FETAL INDICA
ARTHROSCOP,SHOULD;THERM CAPSUL
CHEMODENERVAT,ABDUCTOR MUS,VOC
CHEMODENERV ADDUCT VOCAL
NASAL ENDOSCOP PO DEBRID
DISKECT,ANT,DECOM,SP/NER;LUM,1
DISKECT,DECOM,SP/NER;LUM,EA AD
VERTEBROPLAST CERV 1ST
VERTEBROPLAST CERV ADDL
INTRADISCAL ELECTROTHERML TH;1
EACH ADDITIONAL INTERSPACE
REPAIR,CONGENI DIAPHRAG HERNIA
S2401
S2402
S2403
S2404
S2405
S2409
S2411
S3600
S3601
S3620
S3630
S3645
S3650
S3652
S3655
S3701
S3708
S3818
S3819
S3830
S3831
S3835
S3837
S3900
S3902
S3904
S4005
S4011
S4013
S4014
S4015
S4016
S4017
S4018
S4020
S4021
S4022
S4023
S4025
S4026
S4027
S4028
S4030
S4031
S4035
S4036
S4037
S4040
S4981
FETAL SURG URIN TRAC OBSTR

FETAL SURG CONG CYST MALF
FETAL SURG PULMON SEQUEST
FETAL SURG MYELOMENINGO
REPAIR,SACROCOCCYGEAL TERATOMA
FETAL SURG NOC
FETOSCOP LASER THER TTTS
STAT LAB
STAT LAB HOME/NF
NEWBORN METABOLIC SCREENING
EOSINOPHIL BLOOD COUNT
HIV-1 ANTIBODY TEST,ORAL MUCOS
SALIVA TEST,HORM LEV;MENOPAUSE
SALIVA TEST,HORM;PRETERM LABOR
ANTISPERM ANTIBODIES TEST
NMP-22 ASSAY
GASTROINTESTIN FAT ABSORPT STD
BRCA1 GENE ANAL
BRCA2 GENE ANAL
GENE TEST HNPCC COMP
GENE TEST HNPCC SINGLE
GENE TEST CYSTIC FIBROSIS
GENE TEST HEMOCHROMATO
SURFACE EMG
BALLISTOCARDIOGRAM
MASTERS TWO STEP
INTERIM LABOR FAC GLOBAL
IVF PACKAGE
COMPLETE CYC,GAMETE TRANSFER
COMPLETE CYC,ZYGOTE TRANSFER
COMP VITRO FERTILIZATION CYCLE
FROZEN IVF CASE RATE
COMPLETE CYC,CNCLD PRIOR STIM
F EMB TRNS CANC CASE RATE
IVF CANC A ASPIR CASE RATE
IVF CANC P ASPIR CASE RATE
ASST OOCYTE FERT CASE RATE
DONOR EGG CYCLE,INCOMPLETE
DONOR SERV IVF CASE RATE
PROCURE DONOR SPERM
STORE PREV FROZ EMBRYOS
MICROSURG EPI SPERM ASP
SPERM PROCURE INIT VISIT
SPERM PROCURE SUBS VISIT
STMLTD INTRAUTERN INSEMINATION
INTRAVAGINAL CULTURE,CASE RATE
CRYOPRESERVED EMBRYO TRANSFER
MONITOR&STORAGE CRYOPR EMBRYOS
INSERT LEVONORGESTREL IUS
S4989
S4990
S4991
S4993
S4995
S5000
S5001
S5010
S5011
S5012
S5013
S5014
S5035
S5036
S5100
S5101
S5102
S5105
S5110
S5111
S5115
S5116
S5120
S5121
S5125
S5126
S5130
S5131
S5135
S5136
S5140
S5141
S5145
S5146
S5150
S5151
S5160
S5161
S5162
S5165
S5170
S5175
S5180
S5181
S5185
S5190
S5199
S5497
S5498
CONTRACEPT IUD
NICOTINE PATCH LEGEND
NICOTINE PATCH NONLEGEND
CNTRCEPTVE PILLS BIRTH CONTROL
SMOKING CESSATION GUM
PRESCRIPTION DRUG, GENERIC
PRESCRIPTION DRUG, BRAND NAME
5% DEXTRS,0.45% NOR SAL,1000ML
5% DEXTROSE,LACT RING, 1000 ML
5% DEXTROS,POTAS CHLOR,1000 ML
5% DEXTRS/0.45% NOR SAL,1000ML
D5W/0.45NS W KCL AND MGS04
HIT ROUTINE DEVICE MAINT
HIT DEVICE REPAIR
ADULT DAY CARE SERVICES 15 MIN
ADULT DAY CARE PER HALF DAY
ADULT DAY CARE PER DIEM
CENTER-BASED DAYCARE PER DIEM
FAMILY HOME CARE TRAIN 15 MIN
FAMILY HOMECARE TRAIN/SESSION
NON-FAMILY HOMECARE 15 MINUTES
NON-FAMILY HC TRAINING/SESSION
CHORE SERVICES; PER 15 MINUTES
CHORE SERVICES; PER DIEM
ATTENDANT CARE SERVICE/15 MIN
ATTENDANT CARE SERVICE/DIEM
HOMEMAKER SERVICES,NOS;/15 MIN
HOMEMAKER SERVICES,NOS;/DIEM
COMPAINION CARE,ADULT;/15 MIN
COMPAINION CARE,ADULT;/DIEM
FOSTER CARE, ADULT; PER DIEM
FOSTER CARE, ADULT;PER MONTH
CHILD FOSTER CARE,THERAP;/DIEM
CHILD FOSTER CARE,THERP;/MONTH
UNSKILLED RESPITE CARE;/15 MIN
UNSKILLED RESPITE CARE;/DIEM
EMER RESPNSE SYS;INSTAL & TEST
EMER RSPNS SYS;SERV FEE,/MONTH
EMERGENCY RESPONSE SYS;PURCHSE
HOME MODIFICATIONS; PER SERVCE
HOME DELIVERED PREPARED MEAL
LAUNDRY SERVICE,EXTRNAL;/ORDER
HH RESPIRATORY THRPY,INIT EVAL
HH RESPIRATORY THRPY,NOS,/DIEM
MED REMINDER SERV;PER MONTH
WELLNESS ASSESSMENT NON-PHYSIC
PERSONAL CARE ITEM, NOS, EACH
HIT CATH CARE NOC
HIT SIMPLE CATH CARE
S5501
S5502
S5517
S5518
S5520
S5521
S5522
S5523
S8004
S8030
S8035
S8037
S8040
S8042
S8049
S8055
S8080
S8085
S8092
S8095
S8096
S8097
S8100
S8101
S8110
S8180
S8181
S8182
S8183
S8185
S8186
S8189
S8190
S8210
S8260
S8262
S8265
S8415
S8420
S8421
S8422
S8423
S8424
S8425
S8426
S8427
S8428
S8429
S8430
HIT COMPLEX CATH CARE

HIT INTERIM CATH CARE
HIT DECLOTTING KIT
HIT CATH REPAIR KIT
HIT PICC INSERT KIT
HIT MIDLINE CATH INSERT KIT
HIT PICC INSERT NO SUPP
HIP MIDLINE CATH INSERT KIT
WHOLEBODY RADIOPHARM TRG CELLS
TANTALUM RING APPLICATION
MAGNETIC SOURCE IMAGING
MRCP
TOPOGRAPHIC BRAIN MAPPING
MAGNETIC RESONANCE IMAGING
INTRAOP RADIATION THER (1 ADM)
US GUIDANCE FETAL REDUCT
SCINTIMAMMOGRAP,UNILAT,RADIOPH
FLUOR-18 FLUORODEOXYGL IM,2 HD
ELECTRON BEAM COMPUT TOMOGRPHY
WIG
PORTABLE PEAK FLOW METER
ASTHMA KIT
SPACER WITHOUT MASK
SPACER WITH MASK
PEAK EXPIRATORY FLOW RATE
TRACH SHOWER PROTECTOR
TRACH TUBE HOLDER
HUMIDIFIER NON-SERVO
HUMIDIFIER DUAL SERVO
FLUTTER DEVICE
SWIVEL ADAPTOR
TRACH SUPPLY NOC
ELECTRONIC SPIROMETER
MUCUS TRAP
ORAL ORTHOTIC, TX, SLEEP APNEA
MANDBULAR ORTHOPEDC REPOSITION
HABERMAN FEEDER CLEFT LIP
SUPPLIES FOR HOME DELIVERY
CUSTOM GRADIENT SLEEV/GLOV
READY GRADIENT SLEEV/GLOV
CUSTOM GRAD SLEEVE MED
CUSTOM GRAD SLEEVE HEAVY
READY GRADIENT SLEEVE
CUSTOM GRAD GLOVE MED
CUSTOM GRAD GLOVE HEAVY
READY GRADIENT GLOVE
READY GRADIENT GAUNTLET
GRADIENT PRESSURE WRAP
PADDING FOR COMPRSSN BDG
S8431
S8450
S8451
S8452
S8490
S8945
S8950
S8999
S9001
S9007
S9015
S9022
S9024
S9025
S9034
S9055
S9056
S9061
S9075
S9083
S9088
S9090
S9092
S9098
S9109
S9117
S9122
S9123
S9124
S9125
S9126
S9127
S9128
S9129
S9131
S9140
S9141
S9145
S9150
S9208
S9209
S9211
S9212
S9213
S9214
S9325
S9326
S9327
S9328
COMPRESSION BANDAGE
SPLINT DIGIT
SPLINT WRIST OR ANKLE
SPLINT ELBOW
100 INSULIN SYRINGES
PHYS MED TREAT 1 AREA,30 MIN
COMPL LYMPHEDEMA THER,EA 15 MN
RESUSCITATION BAG (POWER FAIL)
HOME UTERINE MONITOR WWO NURSE
ULTRAFILTRATION MONITOR
AUTOMATED EEG MONITORING
DIGITAL SUBTRACTION ANGIOGRPHY
PARANASAL SINUS ULTRASOUND
OMNICARDIOGRAM/CARDIOINTEGRAM
EXTRACORPOR SHCKWVE GALL STNE
PROCUREN/OTH GROW FAC,WND HEAL
COMA STIMULATION PER DIEM
MEDICAL SUPPLIES AND EQUIP
SMOKING CESSATION TREATMENT
URGENT CARE CENTER GLOBAL
SERVICES PROVIDED IN URGENT
VERTEBRAL AXIAL DECOMPRESS/SES
CANOLITH REPOSITIONING
HOME PHOTOTHERAPY VISIT
CHF TELEMONITORING MONTH
BACK SCHOOL VISIT
HOME HLT AIDE/CNA,HOME; PER HR
NURSING CARE,IN HOME;REG NURSE
NURSE CARE,HME;LIC PRAC NUR/HR
RESPITE CARE, HOME, PER DIEM
HOSPICE CARE, HOME, PER DIEM
SOCIAL WRK VISIT,HOME,PER DIEM
SPEECH THERAPY, HOME, PER DIEM
OCCUPATIONAL THER,HME,PER DIEM
PT IN THE HOME PER DIEM
DIABET MGT PG,FOL-UP,NO-MD PRV
DIABET MGT PG,FOL-UP,MD PROVID
INSULIN PMP INITIATION,INSTRCT
EVALUATION BY OCULARIST
HOME MGMT PRETERM LABOR
HOME MGMT PPROM
HOME MGMT GEST HYPERTENSION
HM POSTPAR HYPER PER DIEM
HM PREECLAMP PER DIEM
HM GEST DM PER DIEM
HIT PAIN MGMT PER DIEM
HIT CONT PAIN PER DIEM
HIT INT PAIN PER DIEM
HIT PAIN IMP PUMP DIEM
S9329
S9330
S9331
S9336
S9338
S9339
S9340
S9341
S9342
S9343
S9345
S9346
S9347
S9348
S9349
S9351
S9353
S9355
S9357
S9359
S9361
S9363
S9364
S9365
S9366
S9367
S9368
S9370
S9372
S9373
S9374
S9375
S9376
S9377
S9379
S9381
S9401
S9430
S9435
S9436
S9437
S9438
S9439
S9441
S9442
S9443
S9444
S9445
S9446
HIT CHEMO PER DIEM

HIT CONT CHEM DIEM
HIT INTERMIT CHEMO DIEM
HIT CONT ANTICOAG DIEM
HIT IMMUNOTHERAPY DIEM
HIT PERITON DIALYSIS DIEM
HIT ENTERAL PER DIEM
HIT ENTERAL GRAV DIEM
HIT ENTERAL PUMP DIEM
HIT ENTERAL BOLUS NURS
HIT ANTI-HEMOPHIL DIEM
HIT ALPHA-1-PROTEINAS DIEM
HOME INFUS TX,UNINTER,LONG-TRM
HIT SYMPATHOMIM DIEM
HIT TOCOLYSIS DIEM
HIT CONT ANTIEMETIC DIEM
HIT CONT INSULIN DIEM
HIT CHELATION DIEM
HIT ENZYME REPLACE DIEM
HIT ANTI-TNF PER DIEM
HIT DIURETIC INFUS DIEM
HIT ANTI-SPASMOTIC DIEM
HIT TPN TOTAL DIEM
HIT TPN 1 LITER DIEM
HIT TPN OVER 3L DIEM
HT INJ ANTIEMETIC DIEM
HT INJ ANTICOAG DIEM
HIT HYDRA TOTAL DIEM
HIT HYDRA 1 LITER DIEM
HIT HYDRA OVER 3L DIEM
HIT NOC PER DIEM
HIT HIGH RISK/ESCORT
ANTICOAGULATION CLINIC
PHARMACY COMPOUND&DISPENS SERV
MED FOODS,INBORN ERROR,METABOL
CHILDBIRTH PREP/LAMAZE CLASSES
CHILDBIRTH REFRESHER CLASSES
CESAREAN BIRTH CLASSES
VBAC CLASS,NON-PHYSICIAN
ASTHMA EDUCATION
BIRTHING CLASS
LACTATION CLASS
PARENTING CLASS,NON-PHYSICIAN
PT EDUCATION NOC INDIVID
PT EDUCATION NOC GROUP
S9447
S9449
S9451
S9452
S9453
S9454
S9455
S9460
S9465
S9470
S9472
S9473
S9474
S9475
S9480
S9484
S9485
S9490
S9494
S9497
S9500
S9501
S9502
S9503
S9504
S9524
S9529
S9537
S9538
S9542
S9546
S9558
S9559
S9560
S9562
S9590
S9802
S9803
S9806
S9810
S9900
S9970
S9975
S9981
S9982
S9986
S9989
S9990
S9991
INFANT SAFETY CLASSES

WEIGHT MANAGEMENT CLASSES
EXERCISE CLASS,NON-PHYSICIAN
NUTRITION CLASS,NON-PHYSICIAN
SMOKING CESSATION CLASSES
STRESS MANAGEMENT CLASSES
DIABETIC MGT PROG, GROUP SESS
DIABETIC MGT PROG, NURSE VISIT
DIABET MGT PROG, DIETITIAN VIS
NUTRITN COUNSEL, DIETITIAN VIS
CARD REHAB PRG,NON-PHYS, /DIEM
PULMON REHAB PRG,NON-PHY,/DIEM
ENTEROSTOM,THER,RN CERT, /DIEM
AMBUL,SUBST ABSE TX/DETOX/DIEM
INTENS OUTPAT PSYCHIATRIC/DIEM
CRISIS INTERBENTION, PER HOUR
CRISIS INTERVEN MENT HLTH/DIEM
HIT CORTICOSTEROID /DIEM
HIT ANTIBIOTIC TOTAL DIEM
HIT ANTIBIOTIC Q3H DIEM
NURSING SERV,HOME IV THER/DIEM
VENIPUNCTURE HOME/SNF
HT HEM HORM INJ DIEM
HIT BLOOD PRODUCTS DIEM
HT INJ NOC PER DIEM
HOME INFUSION BLD,NURSING SERV
HT INJ GROWTH HORM DIEM
HIT INJ INTERFERON DIEM
HT INJ HORMONE DIEM
HOME THRPY,PALIVIZ,ADMIN,PHRMY
HOME THRPY,IRRIGAT;ADMIN,PHRMY
HOME INFUS/SPECIAL DRUG ADMIN
EACH ADDITIONAL HOUR
RN INFUSION SUITE VISIT
HT PHARM PER HOUR
CHRISTIAN SCI PRACT VISIT
HEALTH CLUB MEMBERSHIP, ANNUAL
TRNSPLNT RELATED LODGING,MEALS
MED RECORD COPY ADMIN
MED RECORD COPY PER PAGE
NOT MEDICALLY NECESSARY SVC
SERVICES OUTSIDE US
SERV PROV, PHASE II CLIN TRIAL
SERV PROV,PHASE III CLIN TRIAL
S9992
S9994
S9996
S9999
T1000
T1001
T1002
T1003
T1004
T1005
T1006
T1007
T1008
T1009
T1010
T1011
T1012
T1013
T1014
T1015
T1016
T1017
T1018
T1019
T1020
T1021
T1022
T1023
T1024
T1025
T1026
T1027
T1028
T1029
T1030
T1031
T1500
T1502
T1999
T2001
T2002
T2003
T2004
T2005
T2006
T2007
V2020
V2025
V2100
TRANSP COSTS TO & FM TRIAL LOC

LODG COSTS,CLIN TRIAL PART & 1
MEALS,CLIN TRIAL PART & 1 COMP
SALES TAX
PRIVATE DUTY/INDEPENDENT NSG
NURSING ASSESSMENT/EVALUATN
RN SERVICES UP TO 15 MINUTES
LPN/LVN SERVICES UP TO 15MIN
NSG AIDE SERVICE UP TO 15MIN
RESPITE CARE SERVICE 15 MIN
FAMILY/COUPLE COUNSELING
TREATMENT PLAN DEVELOPMENT
DAY TREATMENT FOR INDIVIDUAL
CHILD SITTING SERVICES
MEALS WHEN RECEIVE SERVICES
ALCOHOL/SUBSTANCE ABUSE NOC
ALCOHOL/SUBSTANCE ABUSE SKIL
SIGN LANGUAGE/ORAL INTERPRTIVE
TELEHEALTH TRANSMIT, PER MIN
CLINIC SERVICE
CASE MANGEMENT,EACH 15 MINUTES
TARGETED CASE MANAG,15 MINUTES
SCHOOL-BASED INDIVIDUAL EDCAT
PRSNAL CARE,/15 MIN,NOT INPAT
PRSNAL CARE,/DIEM,NOT INPAT
HME HEALTH AIDE/NURSE ASSIST
CONTACTED HHA SVCS, ALL SVCS
SCREEN APPROPRIATENESS INDIVL
EVAL&TREAT,SPCLTY COORD CARE
INTNSVE,EXT MULTIDSCPLIN,/DIEM
INTENSIVE,EXT MULTIDSCPLIN,/HR
FMLY TRAIN&COUNSL CHILD DEVEL
ASSES HME,PHYSICAL&FMLY ENVIR
COMPREHEN ENVAL LD INVESTIGAT
NURSING CARE,IN HOME,REG NURSE
NURSING CARE,HOME,PRACT NURSE
DIAPER/INCNTINENT PANT, REUSE
ADMIN ORAL,INTRAMUS&/SUBCUTAN
MIS THRP ITMS&SUPP,RTAIL PURC
NON-EMERG TRNSPRT;PT ATENDANT
NON-EMERG TRANSPORT; PER DIEM
NON-EMERG TRANSPORT; ENCOUNTR
NON-EMRG TRNSPRT;COMRCAL CARRI
NON-EMRG TRNSPRT;NON-AMBULATRY
AMBLNCE RSPNSE&TREAT,NO TRNSPT
TRNSPRT WAIT TIME,AIR AMBUL
VISION SVCS FRAMES PURCHASES
EYEGLASSES DELUX FRAMES
LENS SPHER SINGLE PLANO 400
V2101
V2102
V2103
V2104
V2105
V2106
V2107
V2108
V2109
V2110
V2111
V2112
V2113
V2114
V2115
V2116
V2117
V2118
V2199
V2200
V2201
V2202
V2203
V2204
V2205
V2206
V2207
V2208
V2209
V2210
V2211
V2212
V2213
V2214
V2215
V2216
V2217
V2218
V2219
V2220
V2299
V2300
V2301
V2302
V2303
V2304
V2305
V2306
V2307
SINGLE VISN SPHERE 412- 700

SINGL VISN SPHERE 712- 2000
SPHEROCYLINDR 400D/12- 200D
SPHEROCYLINDR 400D/ 212-4D
SPHEROCYLINDER 400D/ 425-6D
SPHEROCYLINDER 400D/ >600D
SPHEROCYLINDER 425D/12- 2D
SPHEROCYLINDER 425D/ OVER 6D
SPHEROCYLINDR 725D/25- 225
SPHEROCYLINDER OVER 1200D
LENS LENTICULAR BIFOCAL
NONASPHERIC LENS BIFOCAL
ASPHERIC LENS BIFOCAL
LENS ANISEIKONIC SINGLE
LENS SINGLE VISION NOT OTH C
LENS SPHER BIFOC PLANO 400D
LENS SPHERE BIFOCAL 412-70
LENS SPHERE BIFOCAL 712-20
LENS SPHCYL BIFOCAL 400D/1
LENS SPHCY BIFOCAL 400D/21
LENS SPHCY BIFOCAL 400D/42
LENS SPHCY BIFOCAL 400D/OVE
LENS SPHCY BIFOCAL 425- 7D/
LENS SPHCY BIFOCAL 425- 7/2
LENS SPHCY BIFOCAL 425- 7/4
LENS SPHCY BIFOCAL 425- 7/OV
LENS SPHCY BIFO 725-12/ 25LENS SPHCYL BIFO 725- 12/22
LENS SPHCYL BIFO 725- 12/42
LENS SPHCYL BIFOCAL OVER 12
LENS LENTICULAR BIFOCAL
LENS LENTICULAR NONASPHERIC
LENS LENTICULAR ASPHERIC BIF
LENS ANISEIKONIC BIFOCAL
LENS BIFOCAL SEG WIDTH OVER
LENS BIFOCAL ADD OVER 325D
LENS BIFOCAL SPECIALITY
LENS SPHERE TRIFOCAL 400D
LENS SPHERE TRIFOCAL 412-7
LENS SPHERE TRIFOCAL 712-20
LENS SPHCY TRIFOCAL 40/ 12LENS SPHCY TRIFOCAL 40/ 225
LENS SPHCY TRIFOCAL 40/ 425
LENS SPHCYL TRIFOCAL 400/>6
LENS SPHCY TRIFOCAL 425-7/
V2308
V2309
V2310
V2311
V2312
V2313
V2314
V2315
V2316
V2317
V2318
V2319
V2320
V2399
V2410
V2430
V2499
V2500
V2501
V2502
V2503
V2510
V2511
V2512
V2513
V2520
V2521
V2522
V2523
V2530
V2531
V2599
V2600
V2610
V2615
V2623
V2624
V2625
V2626
V2627
V2628
V2629
V2630
V2631
V2632
V2700
V2710
V2715
V2718
LENS SPHC TRIFOCAL 425- 7/2

LENS SPHC TRIFOCAL 425- 7/4
LENS SPHC TRIFOCAL 425- 7/>6
LENS SPHC TRIFO 725-12/ 25LENS SPHC TRIFO 725-12/ 225
LENS SPHC TRIFO 725-12/ 425
LENS SPHCYL TRIFOCAL OVER 12
LENS LENTICULAR TRIFOCAL
LENS LENTICULAR NONASPHERIC
LENS LENTICULAR ASPHERIC TRI
LENS ANISEIKONIC TRIFOCAL
LENS TRIFOCAL SEG WIDTH > 28
LENS TRIFOCAL ADD OVER 325D
LENS TRIFOCAL SPECIALITY
LENS VARIAB ASPHERICITY SING
LENS VARIABLE ASPHERICITY BI
VARIABLE ASPHERICITY LENS
CONTACT LENS PMMA SPHERICAL
CNTCT LENS PMMA-TORIC/ PRISM
CONTACT LENS PMMA BIFOCAL
CNTCT LENS PMMA COLOR VISION
CNTCT GAS PERMEABLE SPHERICL
CNTCT TORIC PRISM BALLAST
CNTCT LENS GAS PERMBL BIFOCL
CONTACT LENS EXTENDED WEAR
CONTACT LENS HYDROPHILIC
CNTCT LENS HYDROPHILIC TORIC
CNTCT LENS HYDROPHIL BIFOCL
CNTCT LENS HYDROPHIL EXTEND
CONTACT LENS GAS IMPERMEABLE
CONTACT LENS GAS PERMEABLE
CONTACT LENS/ES OTHER TYPE
HAND HELD LOW VISION AIDS
SINGLE LENS SPECTACLE MOUNT
TELESCOP/OTHR COMPOUND LENS
PLASTIC EYE PROSTH CUSTOM
POLISHING ARTIFICIAL EYE
ENLARGEMNT OF EYE PROSTHESIS
REDUCTION OF EYE PROSTHESIS
SCLERAL COVER SHELL
FABRICATION & FITTING
PROSTHETIC EYE OTHER TYPE
ANTER CHAMBER INTRAOCUL LENS
IRIS SUPPORT INTRAOCLR LENS
POST CHMBR INTRAOCULAR LENS
BALANCE LENS
GLASS/PLASTIC SLAB OFF PRISM
PRISM LENS/ES
FRESNELL PRISM PRESS-ON LENS
V2730
V2740
V2741
V2742
V2743
V2744
V2750
V2755
V2760
V2770
V2780
V2781
V2785
V2790
V2799
V5008
V5010
V5011
V5014
V5020
V5030
V5040
V5050
V5060
V5070
V5080
V5090
V5095
V5100
V5110
V5120
V5130
V5140
V5150
V5160
V5170
V5180
V5190
V5200
V5210
V5220
V5230
V5240
V5241
V5242
V5243
V5244
V5245
V5246
SPECIAL BASE CURVE

ROSE TINT PLASTIC
NON-ROSE TINT PLASTIC
ROSE TINT GLASS
NON-ROSE TINT GLASS
TINT PHOTOCHROMATIC LENS/ES
ANTI-REFLECTIVE COATING
UV LENS/ES
SCRATCH RESISTANT COATING
OCCLUDER LENS/ES
OVERSIZE LENS/ES
PROGRESSIVE LENS PER LENS
CORNEAL TISSUE PROCESSING
AMNIOT MEMB,SURG RECONSTR/PROC
MISCELLANEOUS VISION SERVICE
HEARING SCREENING
ASSESSMENT FOR HEARING AID
HEARING AID FITTING/ CHECKING
HEARING AID REPAIR/ MODIFYING
CONFORMITY EVALUATION
BODY-WORN HEARING AID AIR
BODY-WORN HEARING AID BONE
BODY-WORN HEARING AID IN EAR
BEHIND EAR HEARING AID
GLASSES AIR CONDUCTION
GLASSES BONE CONDUCTION
HEARING AID DISPENSING FEE
SEMI-IMPLNTBL MIDDLE EAR PRSTH
BODY-WORN BILAT HEARING AID
HEARING AID DISPENSING FEE
BODY-WORN BINAUR HEARING AID
IN EAR BINAURAL HEARING AID
BEHIND EAR BINAUR HEARING AID
GLASSES BINAURAL HEARING AID
DISPENSING FEE BINAURAL
WITHIN EAR CROS HEARING AID
BEHIND EAR CROS HEARING AID
GLASSES CROS HEARING AID
CROS HEARING AID DISPENS FEE
IN EAR BICROS HEARING AID
BEHIND EAR BICROS HEARING AID
GLASSES BICROS HEARING AID
DISPENSING FEE BICROS
DISPENSING FEE, MONAURAL
HEARING AID, MONAURAL, CIC
HEARING AID, MONAURAL, ITC
HEARING AID, PROG, MON, CIC
HEARING AID, PROG, MON, ITC
HEARING AID, PROG, MON, ITE
V5247
V5248
V5249
V5250
V5251
V5252
V5253
V5254
V5255
V5256
V5257
V5258
V5259
V5260
V5261
V5262
V5263
V5264
V5265
V5266
V5267
V5268
V5269
V5270
V5271
V5272
V5273
V5274
V5275
V5298
V5299
V5336
V5362
V5363
V5364
HEARING AID, PROG, MON, BTE

HEARING AID, BINAURAL, CIC
HEARING AID, BINAURAL, ITC
HEARING AID, PROG, BIN, CIC
HEARING AID, PROG, BIN, ITC
HEARING AID, PROG, BIN, ITE
HEARING AID, PROG, BIN, BTE
HEARING ID, DIGIT, MON, CIC
HEARING AID, DIGIT, MON, ITC
HEARING AID, DIGIT, MON, ITE
HEARING AID, DIGIT, MON, BTE
HEARING AID, DIGIT, BIN, CIC
HEARING AID, DIGIT, BIN, ITC
HEARING AID, DIGIT, BIN, ITE
HEARING AID, DIGIT, BIN, BTE
HEARING AID, DISP, MONAURAL
HEARING AID, DISP, BINAURAL
EAR MOLD/INSERT
EAR MOLD/INSERT, DISP
BATTERY FOR HEARING DEVICE
HEARING AID SUPPLY/ACCESSORY
ALD TELEPHONE AMPLIFIER
ALERTING DEVICE, ANY TYPE
ALD, TV AMPLIFIER, ANY TYPE
ALD, TV CAPTION DECODER
TDD
ALD FOR COCHLEAR IMPLANT
ALD NOC
EAR IMPRESSION
HEARING AID, NOC
HEARING SERVICE
REPAIR COMMUNICATION DEVICE
SPEECH SCREENING
LANGUAGE SCREENING
DYSPALGIA SCREENING

CPT Codes

Uploaded by

CPT Codes

Uploaded by

CPT_CODE

EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); BUTTOCK

INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM)

BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST

OPEN TREATMENT OF RIB FRACTURE WITHOUT FIXATION, EACH

ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISKECTOMY TO PREPA

CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION

REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)

DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT; WITHOUT DE

CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION

TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE OR SCAR REVISION

RELEASE OF THENAR MUSCLE(S) (EG, THUMB CONTRACTURE)

CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANEST

EXCISION, TUMOR, PELVIS AND HIP AREA; SUBCUTANEOUS TISSUE

TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY TRACTION, WITHOUT REDUCTION

RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)

OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERCONDYLAR

UNLISTED PROCEDURE, LEG OR ANKLE

PHALANGECTOMY, TOE, EACH TOE

OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; MULTIP

STRAPPING; ELBOW OR WRIST

ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED

SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITH REMOVAL OF ANTROCHOANAL POLYPS

PHARYNGOLARYNGECTOMY, WITH RADICAL NECK DISSECTION; WITH RECONSTRUCTION

TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION

THORACOTOMY, MAJOR; WITH EXPLORATION AND BIOPSY

AORTOPLASTY (GUSSET) FOR SUPRAVALVULAR STENOSIS

CLOSURE OF SEMILUNAR VALVE (AORTIC OR PULMONARY) BY SUTURE OR PATCH

EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLA

TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; FEMORAL-POPLITEAL

THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA)

SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS (TELANGIECTASIA); FACE

EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER

SPLENECTOMY; PARTIAL(SEPARATE PROCEDURE)

AXILLARY LYMPHADENECTOMY; COMPLETE

INCISION OF LABIAL FRENUM (FRENOTOMY)

SUTURE OF TONGUE TO LIP FOR MICROGNATHIA (DOUGLAS TYPE PROCEDURE)

FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA); WITH PROSTHESIS

EXCISION OF TONSIL TAGS

ESOPHAGOSTOMY, FISTULIZATION OF ESOPHAGUS, EXTERNAL; CERVICAL APPROACH

GASTROJEJUNOSTOMY; WITH VAGOTOMY, ANY TYPE

COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE

PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH

PROCTOPEXY COMBINED WITH SIGMOID RESECTION, ABDOMINAL APPROACH

EXCISION OF CHOLEDOCHAL CYST

DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS, EXCLUSIVE OF APPENDICEAL ABSCESS; PERC

REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE

EXCISION OR UNROOFING OF CYST(S) OF KIDNEY

URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER

URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETERO

VOIDING PRESSURE STUDIES (VP); BLADDER VOIDING PRESSURE, ANY TECHNIQUE

CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS

EXCISION OR FULGURATION; URETHRAL CARUNCLE

EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);

REMOVAL&REPLACEMENT OF ALL COMPONENTS OF MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS THROU

VASOTOMY FOR VASOGRAMS, SEMINAL VESICULOGRAMS, OR EPIDIDYMOGRAMS, UNILATERAL OR BILATERAL

VULVECTOMY, RADICAL, PARTIAL; WITH BILATERAL INGUINOFEMORAL LYMPHADENECTOMY

REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

ASPIRATION AND/OR INJECTION, THYROID CYST

CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; SUPRATENTORIAL

CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR PARTIAL OR SUBTOTAL HEMISPHERECTOMY

SURGERY OF INTRACRANIAL ARTERIOVENOUS MALFORMATION; SUPRATENTORIAL, SIMPLE

DURAL GRAFT, SPINAL

INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; SACRAL NERVE (TRANSFORAMINAL PLACEM

DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SE

EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITH CATHETERIZATION

IMPLANTATION OR REPLACEMENT OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL B

RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH

BRONCHOGRAPHY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION

MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY, WITH OR WITHOUT CONTRAST MATERIAL(S)

SWALLOWING FUNCTION, WITH CINERADIOGRAPHY/VIDEORADIOGRAPHY

VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION

THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX

HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN 5 INTERSTITIAL APPLICATORS

UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE, DIAGNOSTIC NUCLEAR MEDIC