CMS Manual System Pub 100-04 Medicare Claims Processing
CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 2616 Date: December 21, 2012 Change Request 8137 SUBJECT: January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 I. SUMMARY OF CHANGES: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The information related to this RUN is found in Chapter 4, Section 40.1, of Publication 100-04. EFFECTIVE DATE: January 1, 2013 IMPLEMENTATION DATE: January 7, 2013 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE N/A III. FUNDING: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs): No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets For Medicare Administrative Contractors (MACs): The Medicare Administrative contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: Recurring Update Notification *Unless otherwise specified, the effective date is the date of service. Attachment - Recurring Update Notification Pub. 100-04 Transmittal: 2616 Date: December 21, 2012 Change Request: 8137 SUBJECT: January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 EFFECTIVE DATE: January 1, 2013 IMPLEMENTATION DATE: January 7, 2013 I. GENERAL INFORMATION A. Background: This instruction informs the Fiscal Intermediaries (FIs), A/B MACs, RHHIs and the Fiscal Intermediary Shared System (FISS) that the I/OCE was updated for January 1, 2013. The I/OCE routes all institutional outpatient claims (which includes non-OPPS hospital claims) through a single integrated OCE which eliminates the need to update, install, and maintain two separate OCE software packages on a quarterly basis. B. Policy: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The I/OCE specifications will be posted to the CMS Website and can be found at http://www.cms.gov/OutpatientCodeEdit/. II. BUSINESS REQUIREMENTS TABLE Use "Shall" to denote a mandatory requirement. Number Requirement Responsibility A/B D F MAC M I E P P a a M r r A t t C C A R R I E R R SharedOther H System H Maintainers I F M V C I C M W S S S F S A B 8137.1 The Shared System Maintainer shall install the Integrated OCE (I/OCE) into their systems. 8137.2 Medicare contractors shall identify the I/OCE specifications on the CMS Website at http://www.cms.gov/OutpatientCodeEdit/ III. X X X PROVIDER EDUCATION TABLE Number Requirement Responsibility X X A/B MAC P a r t 8137.3 IV. MLN Article : A provider education article related to this instruction will be available at http://www.cms.hhs.gov/MLNMattersArticles/ shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in the contractor’s next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly. P a r t A B X D F C R M I A H E R H R I M I A E C R X Other X SUPPORTING INFORMATION Section A: Recommendations and supporting information associated with listed requirements: N/A Use "Should" to denote a recommendation. X-Ref Requirement Number Recommendations or other supporting information: Section B: All other recommendations and supporting information: CR 5344, Transmittal 1107: Notification of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release V. CONTACTS Pre-Implementation Contact(s): Yvonne Young, [email protected] , Anita Antkowiak, [email protected] , Marina Kushnirova, [email protected] Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR) or Contractor Manager, as applicable. VI. FUNDING Section A: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs): No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets Section B: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS do not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. Attachment Appendix M Summary of Modifications The modifications of the IOCE for the January 2013 release (V14.0) are summarized in the table below. Readers should also read through the entire document and note the highlighted sections, which also indicate changes from the prior release of the software. Some IOCE modifications in the update may also be retroactively added to prior releases. If so, the retroactive date will appear in the 'Effective Date' column. # Type 1. Logic Effective Date 1/1/13 Edits Affected 24 2. Logic 1/1/13 3 Logic 1/1/13 4. Logic 1/1/13 5. 6. 7. 8. 9. 10. Logic Logic Logic Logic Content 1/1/13 1/1/13 1/1/13 4/1/06 1/1/13 63, 64 81 40 18 - Content 1/1/13 20, 40 11. 12. 13. 14. 15. 16. 17. 18. Content Content Content Content Content Content Content Content 1/1/13 1/1/13 1/1/13 1/1/13 1/1/13 1/1/13 1/1/13 1/1/13 71, 77 80, 81 19. Doc 1/1/13 - 20. Other 1/1/13 - Modification Modify the software to maintain 28 prior quarters (7 years) of programs in each release. Remove older versions with each release. (The earliest version date included in this January 2013 release will be 4/1/06. Modify the criteria for assignment of the electrophysiology/ablation composite APC (appK): *Assign the composite APC 8000 if there is a single code present from group C, or if there is one code from group A and one code from group B. *If multiple codes from group C are present, assign the APC to the code with the lowest numerical value and assign SI of N to additional group C codes on the same day. *If the criteria for APC assignment are met from group C as well as groups A&B, assign the APC to the group C code and assign the SI of N to the codes from groups A&B. * Terminated group C codes (with modifier 52 or 73) will be assigned to the composite APC and have the terminated procedure discount applied. 84 78 22 84 Apply edit 84 (claim lacks required primary code) to PHP claims if new psychiatric add-on codes are submitted without a code for the primary service on the same day. Modify the PHP logic to ignore the psychiatric add-on codes in the count of the number of services (3 or 4) required to assign the PHP APCs. Deactivate edits 63 and 64. Add Occupational therapy (G0129) and Activity therapy (G0176) to the list for edit 81. Add four modifiers (24, 57, LM and RI) to the list of NCCI modifiers. Remove code 58611 from the Inpatient Separate Procedure list. Make HCPCS/APC/SI changes as specified by CMS (data change files). Implement version 19.0 of the NCCI (as modified for applicable institutional providers). [All edits combined in a single file, in code1/code2 format; mutually exclusive pairs no longer differentiated]. Update procedure/device & device/procedure edit requirements Update the PHP list A &B Update code lists used for edits 80 and 81 Update composite APC requirements Update nuclear medicine/radiolabeled products list Add new modifiers CH, CI, CJ, CK, CL, CM, CN, LM and RI to the valid modifier list. Update the skin substitute list Update the list of primary procedures reportable with Add-on code 33225: Add 33222 and 33223. Create 508-compliant versions of the specifications & Summary of Data Changes documents for publication on the CMS web site. Deliver quarterly software update & all related documentation and files to users via electronic means. FINAL Summary of Data Changes Integrated OCE v 14.0 Effective January 1, 2013 Table of Contents CPT codes, descriptions, and material only are Copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. DEFINITIONS ............................................................................................................................................ 8 APC CHANGES ......................................................................................................................................... 9 Added APCs............................................................................................................................................ 9 Deleted APCs .......................................................................................................................................... 9 APC Description Changes .................................................................................................................... 10 APC Status Indicator Changes .............................................................................................................. 10 HCPCS/CPT PROCEDURE CODE CHANGES ..................................................................................... 10 Added HCPCS/CPT Procedure Codes .................................................................................................. 10 Deleted HCPCS/CPT Procedure Codes ................................................................................................ 17 HCPCS Description Changes................................................................................................................ 21 HCPCS Changes- APC, Status Indicator and/or Edit Assignments...................................................... 32 Hcpcs Edit Changes .............................................................................................................................. 40 Edit Assignments .................................................................................................................................. 41 Mental Health Changes ......................................................................................................................... 45 Procedure/ Device Pair Changes ........................................................................................................... 45 Device/Procedure Pair Changes ............................................................................................................ 48 Add-on/Primary Procedure Pair Changes ............................................................................................. 49 Skin Substitute Product Changes .......................................................................................................... 53 MODIFIERS ............................................................................................................................................. 53 Added Modifiers ................................................................................................................................... 53 DEFINITIONS • A blank in a field indicates ‘no change’ • The “old” column describes the attribute prior to the change being made in the current update, which is indicated in the “new” column. If the effective date of the change is the same as the effective date of the new update, ‘old’ describes the attribute up to the last day of the previous quarter. If the effective date is retroactive, then ‘old’ describes the attribute for the same date in the previous release of the software. • “Unassigned”, “Pre-defined” or “Placeholder” in APC or HCPCS descriptions indicates that the APC or HCPCS code is inactive. When the APC or HCPCS code is activated, it becomes valid for use in the OCE, and a new description appears in the “new description” column, with the appropriate effective date. • Activation Date (ActivDate) indicates the mid-quarter date of FDA approval for a drug, or the mid-quarter date of a new or changed code resulting from a National Coverage Determination (NCD). The Activation Date is the date the code becomes valid for use in the OCE. If the Activation Date is blank, then the effective date takes precedence. • Termination Date (TermDate) indicates the mid-quarter date when a code or change becomes inactive. A code is not valid for use in the OCE after its termination date. • For codes with SI of “Q1, Q2, and Q3”, the APC assignment is the standard APC to which the code would be assigned if it is paid separately. APC CHANGES Added APCs The following APC(s) were added to the IOCE, effective 01-01-13 APC 00059 00177 00178 01431 01432 01433 01434 01435 01437 01438 01439 01440 01441 01442 01443 01444 01445 01446 01447 09294 09295 09296 APCDesc Level I Strapping Level I Echocardiogram with Contrast Level II Echocardiogram with Contrast Centruroides immune f(ab) Arbutamine hcl injection Calcitonin salmon injection Testosterone enanthate inj Injection estrone per 1 MG Gatifloxacin injection Diazoxide injection Aprotonin, 10,000 kiu Inj desmopressin acetate Intraocular Fomivirsen na Non-HEU TC-99M add-on/dose Icatibant injection Oral everolimus Methylnaltrexone injection Visualization adjunct Interferon alfacon-1 inj Inj, taliglucerase alfa Injection, carfilzomib Injection, ziv-aflibercept StatusIndicator S S S G K K K K K K K K K K K K K K K G G G Deleted APCs The following APC(s) were deleted from the IOCE, effective 01-01-13 APC 00086 00128 00830 00865 01222 01226 01279 01304 01306 01308 01358 01359 01360 01374 01412 01418 01425 01749 09046 09254 09275 09279 09288 APCDesc Level III Electrophysiologic Procedures Echocardiogram with Contrast Irinotecan injection Interferon alfa-n3 inj Pentastarch 10% solution Inj streptokinase /250000 IU Factor VIII (porcine) Perphenazine injeciton Urea injection Mecasermin injection Phentolaine mesylate inj Foscarnet sodium injection Apomorphine hydrochloride Sumatriptan succinate / 6 MG Vinorelbine tartrate inj Oral everolimus Thiethylperazine maleate Endo, colon, retro imaging Iron sucrose injection Injection, lacosamide Hexaminolevulinate HCl Injection, ibuprofen Inj, centruroides (scorpion) APC Description Changes The following APC(s) had description changes, effective 01-01-13 APC 00031 00058 00107 00108 00215 00216 00218 00412 00432 00814 01232 01244 01421 01429 09286 09287 09289 09366 Old Description Smoking Cessation Services Level I Strapping and Cast Application Insertion of Cardioverter-Defibrillator Pulse Generator Insertion/Replacement/Repair of AICD Leads, Generator, and Pacing Electrodes Level I Nerve and Muscle Tests Level III Nerve and Muscle Tests Level II Nerve and Muscle Tests IMRT Treatment Delivery Health and Behavior Services Asparaginase injection Mitomycin 5 MG inj Integra DRT skin sub Imported Lipodox inj Flexhd or allopatch hd Injection, belatacept Inj, brentuximab vedotin Inj, erwinia chrysanthemi EpiFix wound cover New Description Level I Health and Behavior Services Level I Cast Application Level I Implantation of Cardioverter-Defibrillators (ICDs) Level II Implantation of CardioverterDefibrillators (ICDs) Level I Nerve and Muscle Services Level III Nerve and Muscle Services Level II Nerve and Muscle Services Level III Radiation Therapy Level II Health and Behavior Services Asparaginase, NOS Mitomycin injection Integra DRT Imported lipodox inj Flexhd/Allopatchhd/matrixhd Belatacept injection Brentuximab vedotin inj Erwinaze injection Epifix APC Status Indicator Changes The following APC(s) had Status Indicator changes, effective 01-01-13 APC 00031 01339 01340 01352 01413 09258 09259 09260 09261 09263 09264 09265 09268 09269 09270 09271 09272 09273 09274 09276 09278 09367 Old SI X G G G G G G G G G G G G G G G G G G G G G New SI S K K K K K K K K K K K K K K K K K K K K K HCPCS/CPT PROCEDURE CODE CHANGES Added HCPCS/CPT Procedure Codes The following new HCPCS/CPT code(s) were added to the IOCE, effective 01-01-13 HCPCS 0309T 0310T 0311T 0312T 0313T 0314T 0315T 0316T 0317T 0318T 0319T 0320T 0321T 0322T 0323T 0324T 0325T 0326T 0327T 0328T 0580F 0581F 0582F 0583F 0584F 1500F 1501F 1502F 1503F 1504F 1505F 22586 23473 23474 24370 24371 31647 31648 31649 31651 31660 31661 32554 32555 32556 32557 32701 33361 33362 33363 33364 33365 33367 33368 33369 33990 33991 33992 33993 36221 CodeDesc Prescrl fuse w/ instr l4/l5 Motor function mapping ntms Cal & alys cntrl artl press Laps impltj nstim vagus Laps rmvl nstim array vagus Laps rmvl vgl arry & pls gen Rmvl vagus nerve pls gen Replc vagus nerve pls gen Elec alys vagus nrv pls gen Replace aortic valve tthorac Insert subq defib w/eltrd Insert subq defib electrode Insert subq defib pls gen Rmvl subq defib pls gen Rmvl & replc subq pls gen Rmvl subq defib electrode Repos subq defib eltrd &/gen Ephys eval subq implt defib Implt subq defib interogat Implt subq defib sys dev evl Multidisciplinary care plan Pt trnsfrd from anesth to cc No trnsfr from anesth to cc Transfer care checklist used No transfercare chklist used Symptom+sign symm polyneuro Not initial eval for cond Pt queried pain fxn w/ instr Pt queried symp resp insuff Pt has resp insufficiency Pt has no resp insufficiency Prescrl fuse w/ instr l5/s1 Revis reconst shoulder joint Revis reconst shoulder joint Revise reconst elbow joint Revise reconst elbow joint Bronchial valve init insert Bronchial valve addl insert Bronchial valve remov init Bronchial valve remov addl Bronch thermoplsty 1 lobe Bronch thermoplsty 2/> lobes Aspirate pleura w/o imaging Aspirate pleura w/ imaging Insert cath pleura w/o image Insert cath pleura w/ image Thorax stereo rad targetw/tx Replace aortic valve perq Replace aortic valve open Replace aortic valve open Replace aortic valve open Replace aortic valve open Replace aortic valve w/byp Replace aortic valve w/byp Replace aortic valve w/byp Insert vad artery access Insert vad art&vein access Remove vad different session Reposition vad diff session Place cath thoracic aorta SI C S S C T T T S S C T T T T T T T N S S E E E E E E E E E E E C T C T T T T T T T T T T T T B C C C C C C C C C C C C Q2 APC 00000 00218 00099 00000 00687 00688 00688 00039 00690 00000 00107 00106 00107 00105 00107 00105 00105 00000 00690 00690 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00425 00000 00425 00425 00415 00415 00076 00415 00415 00415 00070 00070 00070 00070 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00279 Edit 28 28 28 28 28 28 28 28 28 28 28 62 ActivDate TermDate HCPCS 36222 36223 36224 36225 36226 36227 36228 37197 37211 37212 37213 37214 3751F 3752F 3753F 3754F 3755F 3756F 3757F 3758F 3759F 3760F 3761F 3762F 3763F 38243 43206 43252 44705 4540F 4541F 4550F 4551F 4552F 4553F 4554F 4555F 4556F 4557F 4558F 4559F 4560F 4561F 4562F 4563F 52287 64615 78012 78013 78014 78071 78072 81161 81201 81202 81203 81235 81252 81253 81254 81321 CodeDesc Place cath carotid/inom art Place cath carotid/inom art Place cath carotd art Place cath subclavian art Place cath vertebral art Place cath xtrnl carotid Place cath intracranial art Remove intrvas foreign body Thrombolytic art therapy Thrombolytic venous therapy Thromblytic art/ven therapy Cessj therapy cath removal Electrodiag polyneuro 6mon no electrodiag polyneuro6mon Pt has symp+signs neuropathy Screening tests dm done Cog+behav imprmnt scrng done Pt w/pseudobulb affect/als Pt w/no pseudobulbaffect/als Pt ref pulmon fx test/peak Pt scrn dysphag/wt loss/nutr Pt w/dysphag/wt loss/nutr Pt w/o dysphag/wt loss/nutr Patient is dysarthric Patient is not dysarthric Transplj hematopoietic boost Esoph optical endomicroscopy Uppr gi opticl endomicrscopy Prepare fecal microbiota Disease modif pharmacothxpy Pt offered tx for pseudobulb noninvas resp support talk Nutritional support offered Pt ref for speech lang path Pt asst re end life issues Pt recvd inhal anesthetic Pt recvd no inhal anesthic Ptw/ 3+ post-op nausea+vomm Pt w/o 3+ post-opnausea+vomm Pt recvd 2 rx anti-emetagnts 1 bodytemp >=35.5cw/in 30min Anesth w/o gen/neurax anesth Pt w/coronary artery stent Pt w/o coronary artery stent Pt recvd aspirin w/in 24 hrs Cystoscopy chemodenervation Chemodenerv musc migraine Thyroid uptake measurement Thyroid imaging w/blood flow Thyroid imaging w/blood flow Parathyrd planar w/wo subtrj Parathyrd planar w/spect&ct DMD dup/delet analysis Apc gene full sequence Apc gene known fam variants Apc gene dup/delet variants Egfr gene com variants Gjb2 gene full sequence Gjb2 gene known fam variants Gjb6 gene com variants Pten gene full sequence SI Q2 Q2 Q2 Q2 Q2 N N T T T T T E E E E E E E E E E E E E S T T B E E E E E E E E E E E E E E E E T T S S S X X E A A A A A A A A APC 00279 00279 00280 00279 00280 00000 00000 00623 00621 00621 00622 00622 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00111 00419 00419 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00161 00204 00389 00390 00391 00317 00317 00000 00000 00000 00000 00000 00000 00000 00000 00000 Edit 28 28 28 28 28 28 28 28 28 28 28 28 28 62 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 9 ActivDate TermDate HCPCS 81322 81323 81324 81325 81326 81479 81500 81503 81506 81508 81509 81510 81511 81512 81599 82777 86152 86153 86711 86828 86829 86830 86831 86832 86833 86834 86835 87631 87632 87633 87910 87912 88375 90653 90672 90685 90686 90687 90688 90739 90785 90791 90792 90832 90833 90834 90836 90837 90838 90839 90840 90863 91112 92920 92921 92924 92925 92928 92929 92933 92934 CodeDesc Pten gene known fam variant Pten gene dup/delet variant Pmp22 gene dup/delet Pmp22 gene full sequence Pmp22 gene known fam variant Unlisted molecular pathology Onco (ovar) two proteins Onco (ovar) five proteins Endo assay seven anal Ftl cgen abnor two proteins Ftl cgen abnor 3 proteins Ftl cgen abnor three anal Ftl cgen abnor four anal Ftl cgen abnor five anal Unlisted maaa Galectin 3 Cell enumeration & id Cell enumeration phys interp John cunningham antibody Hla class i&ii antibody qual Hla class i/ii antibody qual Hla class i phenotype qual Hla class ii phenotype qual Hla class i high defin qual Hla class ii high defin qual Hla class i semiquant panel Hla class ii semiquant panel Resp virus 3-11 targets Resp virus 6-11 targets Resp virus 12-25 targets Genotype cytomegalovirus Genotype dna hepatitis b Optical endomicroscpy interp Flu vaccine adjuvant im Flu vaccine 4 valent nasal Flu vac no prsv 4 val 6-35 m Flu vac no prsv 4 val 3 yrs+ Flu vaccine 4 val 6-35 mo im Flu vacc 4 val 3 yrs plus im Hep b vacc adult 2 dose im Psytx complex interactive Psych diagnostic evaluation Psych diag eval w/med srvcs Psytx pt&/family 30 minutes Psytx pt&/fam w/e&m 30 min Psytx pt&/family 45 minutes Psytx pt&/fam w/e&m 45 min Psytx pt&/family 60 minutes Psytx pt&/fam w/e&m 60 min Psytx crisis initial 60 min Psytx crisis ea addl 30 min Pharmacologic mgmt w/psytx Gi wireless capsule measure Prq cardiac angioplast 1 art Prq cardiac angio addl art Prq card angio/athrect 1 art Prq card angio/athrect addl Prq card stent w/angio 1 vsl Prq card stent w/angio addl Prq card stent/ath/angio Prq card stent/ath/angio SI A A A A A A A A A A A A A A E A X X A A A A A A A A A A A A A A X E L E E E E E N Q3 Q3 Q3 N Q3 N Q3 N Q3 N E X T T T T T T T T APC 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00342 00342 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00342 00000 00000 00000 00000 00000 00000 00000 00000 00323 00323 00322 00000 00323 00000 00323 00000 00323 00000 00000 00361 00083 00083 00082 00082 00104 00104 00104 00104 Edit 9 9 28 28 28 28 9 28 ActivDate TermDate HCPCS 92937 92938 92941 92943 92944 93653 93654 93655 93656 93657 95017 95018 95076 95079 95782 95783 95907 95908 95909 95910 95911 95912 95913 95924 95940 95941 95943 99485 99486 99487 99488 99489 99495 99496 A4435 A9586 C9294 C9295 C9296 C9600 C9601 C9602 C9603 C9604 C9605 C9606 C9607 C9608 D0190 D0191 D0364 D0365 D0366 D0367 D0368 D0369 D0370 D0371 D0380 D0381 D0382 CodeDesc Prq revasc byp graft 1 vsl Prq revasc byp graft addl Prq card revasc mi 1 vsl Prq card revasc chronic 1vsl Prq card revasc chronic addl Ep & ablate supravent arrhyt Ep & ablate ventric tachy Ablate arrhythmia add on Tx atrial fib pulm vein isol Tx l/r atrial fib addl Perq & icut allg test venoms Perq&ic allg test drugs/biol Ingest challenge ini 120 min Ingest challenge addl 60 min Polysom <6 yrs 4/> paramtrs Polysom <6 yrs cpap/bilvl Motor&/sens 1-2 nrv cndj tst Motor&/sens 3-4 nrv cndj tst Motor&/sens 5-6 nrv cndj tst Motor&sens 7-8 nrv cndj test Motor&sen 9-10 nrv cndj test Motor&sen 11-12 nrv cnd test Motor&sens 13/> nrv cnd test Ans parasymp & symp w/tilt Ionm in operatng room 15 min Ionm remote/>1 pt or per hr Parasymp&symp hrt rate test Suprv interfacilty transport Suprv interfac trnsport addl Cmplx chron care w/o pt vsit Cmplx chron care w/ pt vsit Complx chron care addl30 min Trans care mgmt 14 day disch Trans care mgmt 7 day disch 1pc ost pch drain hgh output Florbetapir F18 Inj, taliglucerase alfa Injection, carfilzomib Injection, ziv-aflibercept Perc drug-el cor stent sing Perc drug-el cor stent bran Perc d-e cor stent ather s Perc d-e cor stent ather br Perc d-e cor revasc t cabg s Perc d-e cor revasc t cabg b Perc d-e cor revasc w AMI s Perc d-e cor revasc chro sin Perc d-e cor revasc chro add Screening of a patient Assessment of a patient Cone beam ct capt & interp Cone beam ct interprete man Cone beam ct interprete max Cone beam ct interp both jaw Cone beam ct interprete TMJ Max MRI capture & interprete Max ultrasound capt & interp Sialoendoscopy capt & interp Cone beam ct capture limited Cone beam ct capt mandible Cone beam ct capt maxilla SI T T T T T Q3 Q3 N Q3 N X X X X S S S S S S S S S S N N S B B N N N V V A E G G G T T T T T T T T T E E E E E E E E E E E E E APC 00104 00104 00104 00104 00104 08000 08000 00000 08000 00000 00381 00381 00361 00360 00209 00209 00215 00215 00215 00215 00218 00218 00218 00218 00000 00000 00215 00000 00000 00000 00000 00000 00605 00606 00000 00000 09294 09295 09296 00656 00656 00656 00656 00656 00656 00656 00656 00656 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 Edit 62 62 9 55 55 55 55 55 55 55 55 55 55 55 55 28 28 28 28 28 28 28 28 28 28 28 28 28 ActivDate TermDate HCPCS D0383 D0384 D0385 D0386 D0391 D1208 D2929 D2981 D2982 D2983 D2990 D4212 D4277 D4278 D6051 D6101 D6102 D6103 D6104 D7921 D7952 D9975 E0670 E2378 G0452 G0453 G0454 G0455 G0456 G0457 G0458 G8919 G8920 G8921 G8922 G8923 G8924 G8925 G8926 G8927 G8928 G8929 G8930 G8931 G8932 G8933 G8934 G8935 G8936 G8937 G8938 G8939 G8940 G8941 G8942 G8943 G8944 G8945 G8946 G8947 CodeDesc Cone beam ct both jaws Cone beam ct capture TMJ Max MRI image capture Max ultrasound image capture Imterprete diagnostic image Topical app of fluoride Prefab porc/ceram crown pri Inlay repair Onlay repair Veneer repair Resin infiltration of lesion Gingivectomy/plasty rest Soft tissue graft firsttooth Soft tissue graft addl tooth Interim abutment Debridement of a periimplant Debridement & contouring Bone graft repair perimplant Bone graft time of implant Collect & appl blood product Sinus augmentation vertical External bleaching home app Seg pneum int legs/trunk Pw actuator replacement Molecular pathology interpr Cont intraop neuro monitor MD document visit by NPP Fecal microbiota prep instil Neg pre wound <=50 sq cm Neg pres wound >50 sq cm LDR Prostate Brachy comp rat Mst rcnt sys bp <140mmg Mst rcnt sys bp >=140mmhg Mst rcnt dia bp <90mmhg Mst rcnt dia bp >=90mmhg LVEF < 40% or lvsd Spiro EV1/FVC <60% COPD sym Spiro>=60% or pt no COPD sym Spiro no perf or doc Adj chem pres AJCC III Adj chem not pres rsn spec Adj cmo not pres rsn not gvn Assess of dep @ initial eval Asses of dep not documented Suicd rsk assessed init eval Suicide risk not assessed LVEF <40% or dep lv sys fcn Rx ACE or ARB therapy Pt not eligible ACE/ARB No rx ACE/ARB therapy BMI calc, pt no f/u plan elg Pain assess doc, f/u no doc Srn clin dep doc no f/u pln No doc elder scrn, pt no el Doc fcn/care plan w/30 days LDLC not pres w/i 12 mo prir AJCC Mel cnr stg 0 - IIC Aneurysm <=6 cm for men MIBM but no dx of breast CA 1 or more neuropsych SI E E E E E E E E E E E E E E E E E E E E E E Y Y B N B X T T B M M M M M M APC 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00340 00016 00016 00000 00000 00000 00000 00000 00000 00000 Edit 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 61 61 62 M M M M M M M M M M M M M M M M M M M M M M M 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 62 62 72 72 72 72 72 72 ActivDate TermDate HCPCS G8948 G8949 G8950 G8951 G8952 G8953 G8954 G8955 G8956 G8957 G8958 G8959 G8960 G8961 G8962 G8963 G8964 G8965 G8966 G8967 G8968 G8969 G8970 G8971 G8972 G8973 G8974 G8975 G8976 G8977 G8978 G8979 G8980 G8981 G8982 G8983 G8984 G8985 G8986 G8987 G8988 G8989 G8990 G8991 G8992 G8993 G8994 G8995 G8996 G8997 G8998 G8999 G9158 G9159 G9160 G9161 G9162 G9163 G9164 G9165 G9166 CodeDesc No neuropsych symptoms Doc pt reas on counsel diet Pre-htn or htn doc, f/u indc Pre-htn/htn doc, no pt f/u Pre-htn/htn, no f/u, not gvn Oncology MG qual act perform Pt data rpt qual clin db reg Most recent assess vol mgmt Pt rcv HeDia outpt dyls fac Pt no HeDia in outpt fac Assess vol mgmt not doc Clin tx MDD comm to tx clin Clin tx MDD not comm CSIT lowrisk surg pts preop CSIT on pt any reas 30 days CSI per asx pt w/PCI 2 yrs CSI any other than PCI 2 yr CSIT perf on low CHD rsk CSIT perf sx or high CHD rsk Wrfrn or oral antigoag pres Md rsn no pres Wrfrn or othr Pt rsn no pres Wrfrn or othr No rsk fac or 1 mod risk TE Warfrn or othr antcog no rx 1>=risk or>= mod risk for TE Mst rcnt Hbb < 10g/dL Hgb not doc rns not gvn Hgb <10g/dL, med rsn Hgb >= 10 g/dL Oncology measures grp Mobility current status Mobility goal status Mobility D/C status Body pos current status Body pos goal status Body pos D/C status Carry current status Carry goal status Carry D/C status Self care current status Self care goal status Self care D/C status Other PT/OT current status Other PT/OT goal status Other PT/OT D/C status Sub PT/OT current status Sub PT/OT goal status Sub PT/OT D/C status Swallow current status Swallow goal status Swallow D/C status Motor speech current status Motor speech D/C status Lang comp current status Lang comp goal status Lang comp D/C status Lang express current status Lang express goal status Lang express D/C status Atten current status Atten goal status SI M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E APC 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 Edit 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 72 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 ActivDate TermDate HCPCS G9167 G9168 G9169 G9170 G9171 G9172 G9173 G9174 G9175 G9176 G9186 J0178 J0485 J0716 J0890 J1050 J1741 J1744 J2212 J7178 J7315 J7527 J9002 J9019 J9042 L5859 L7902 L8605 Q4131 Q4132 Q4133 Q4134 Q4135 Q4136 Q9969 S9110 V5281 V5282 V5283 V5284 V5285 V5286 V5287 V5288 V5289 V5290 CodeDesc Atten D/C status Memory current status Memory goal status Memory D/C status Voice current status Voice goal status Voice D/C status Speech lang current status Speech lang goal status Speech lang D/C status Motor speech goal status Aflibercept injection Belatacept injection Centruroides immune f(ab) Peginesatide injection Medroxyprogesterone acetate Ibuprofen injection Icatibant injection Methylnaltrexone injection Human fibrinogen conc inj Opthalmic mitomycin Oral everolimus Doxil injection Erwinaze injection Brentuximab vedotin inj Knee-shin pro flex/ext cont Tension ring, vac erect dev Inj bulking agent anal canal Epifix Grafix core Grafix prime hMatrix Mediskin EZderm Non-HEU TC-99M add-on/dose Telemonitoring/home per mnth Ald fm/dm system, monaural Ald fm/dm system binaural Ald neck, loop ind receiver Ald FM/DM ear level receiver Ald fm/dm aud input receiver Ald blu tooth fm/dm receiver Ald fm/dm receiver, NOS Ald fm/dm transmitter ald Ald fm/dm adapt/boot couplin Ald transmitter microphone SI E E E E E E E E E E E G G G A N N K K K N K K G G A A N G G G E E E K E E E E E E E E E E E APC 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 01420 09286 01431 00000 00000 00000 01443 01445 01414 00000 01444 07046 09289 09287 00000 00000 00000 09366 09368 09369 00000 00000 00000 01442 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 00000 Edit 28 28 28 28 28 28 28 28 28 28 28 ActivDate TermDate 28 28 28 28 50 50 50 50 50 50 50 50 50 50 Deleted HCPCS/CPT Procedure Codes The following HCPCS/CPT code(s) were deleted from the IOCE, effective 01-01-13 HCPCS 0030T 0048T 0050T 0173T 0242T 0250T 0251T 0252T 0256T CodeDesc Antiprothrombin antibody Implant ventricular device Removal circulation assist Iop monit io pressure Gi tract transit & pres meas Insert bronchial valve Remov bronchial valve Remov bronch valve addl Evasc aortic hrt valve HCPCS 0257T 0258T 0259T 0276T 0277T 0279T 0280T 29590 31656 31715 32420 32421 32422 37201 37203 37209 43234 65805 71040 71060 75650 75660 75662 75665 75671 75676 75680 75685 75900 75961 78000 78001 78003 78006 78007 78010 78011 83890 83891 83892 83893 83894 83896 83897 83898 83900 83901 83902 83903 83904 83905 83906 83907 83908 83909 83912 83913 83914 88384 88385 88386 CodeDesc Opn tthrc aortic hrt valve Aortic hrt valv w/o card byp Aortic hrt valve w/card byp Bronch thermoplasty 1 lobe Bronch thermoplasty lobes Ctc test Ctc test w/i & r Application of foot splint Bronchoscopy inj for x-ray Injection for bronchus x-ray Puncture/clear lung Thoracentesis for aspiration Thoracentesis w/tube insert Transcatheter therapy infuse Transcatheter retrieval Change iv cath at thromb tx Upper gi endoscopy exam Drainage of eye Contrast x-ray of bronchi Contrast x-ray of bronchi Artery x-rays head & neck Artery x-rays head & neck Artery x-rays head & neck Artery x-rays head & neck Artery x-rays head & neck Artery x-rays neck Artery x-rays neck Artery x-rays spine Intravascular cath exchange Retrieval broken catheter Thyroid single uptake Thyroid multiple uptakes Thyroid suppress/stimul Thyroid imaging with uptake Thyroid image mult uptakes Thyroid imaging Thyroid imaging with flow Molecule isolate Molecule isolate nucleic Molecular diagnostics Molecule dot/slot/blot Molecule gel electrophor Molecular diagnostics Molecule nucleic transfer Molecule nucleic ampli each Molecule nucleic ampli 2 seq Molecule nucleic ampli addon Molecular diagnostics Molecule mutation scan Molecule mutation identify Molecule mutation identify Molecule mutation identify Lyse cells for nucleic ext Nucleic acid signal ampli Nucleic acid high resolute Genetic examination Molecular rna stabilization Mutation ident ola/sbce/aspe Eval molecular probes 11-50 Eval molecul probes 51-250 Eval molecul probes 251-500 HCPCS 90665 90701 90718 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 90857 90862 92980 92981 92982 92984 92995 92996 93651 93652 95010 95015 95075 95900 95903 95904 95920 95934 95936 C9279 C9286 C9287 C9288 C9289 C9366 C9368 C9369 D0360 D0362 D1203 D1204 D4271 CodeDesc Lyme disease vaccine im Dtp vaccine im Td vaccine > 7 im 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 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 off 45-50 min Intac psytx 45-50 min w/e&m Intac psytx off 75-80 min Intac psytx 75-80 w/e&m Psytx hosp 20-30 min Psytx hosp 20-30 min w/e&m Psytx hosp 45-50 min Psytx hosp 45-50 min w/e&m Psytx hosp 75-80 min Psytx hosp 75-80 min w/e&m Intac psytx hosp 20-30 min Intac psytx hsp 20-30 w/e&m Intac psytx hosp 45-50 min Intac psytx hsp 45-50 w/e&m Intac psytx hosp 75-80 min Intac psytx hsp 75-80 w/e&m Intac group psytx Medication management Insert intracoronary stent Insert intracoronary stent Coronary artery dilation Coronary artery dilation Coronary atherectomy Coronary atherectomy add-on Ablate heart dysrhythm focus Ablate heart dysrhythm focus Percut allergy titrate test Id allergy titrate-drug/bug Ingestion challenge test Motor nerve conduction test Motor nerve conduction test Sense nerve conduction test Intraop nerve test add-on H-reflex test H-reflex test Injection, ibuprofen Injection, belatacept Inj, brentuximab vedotin Inj, centruroides (scorpion) Inj, erwinia chrysanthemi EpiFix wound cover Grafix core Grafix prime Cone beam ct Cone beam, two dimensional Topical app fluoride child Topical app fluoride adult Free soft tissue graft proc HCPCS D6254 D6795 D6970 D6972 D6973 D6976 D6977 G0290 G0291 G0911 G0912 G8447 G8448 G8468 G8469 G8470 G8471 G8472 G8524 G8525 G8526 G8546 G8550 G8675 G8676 G8677 G8678 G8679 G8680 G8695 G8715 G8716 G8727 G8750 G8760 G8786 G8787 G8788 G8789 G8802 G8803 G8805 G8819 G8820 G8821 G8822 G8823 G8824 G8828 G8829 G8830 G8831 G8832 G8836 G8837 G8847 G8901 G9141 G9142 J1051 J1055 CodeDesc Interim pontic Interim retainer crown Post & core plus retainer Prefab post & core plus reta Core build up for retainer Each addtnl cast post Each addtl prefab post Drug-eluting stents, single Drug-eluting stents,each add Assess activity symptoms No Assess activity symptoms Pt vis doc use EHR cer ATCB Pt vis doc w/PQRI qual EHR ACE/ARB rx pt w/abn lvef Pt w/abn lvef inelig ACE/ARB Pt w/ normal lvef LVEF not performed/doc ACE/ARB no rx pt w/abn lvef Patch closure conv CEA No patch closure CEA No patch closure conv CEA CAP measures grp CAP MG qual act perform BP Syst >= 140 mmHg BP Diast >= 90 mmHg BP Syst < 130 mmHg BP Syst >=130 - 139 mmHg BP Diast < 80 mmHg BP Diast 80-89 mmHg Lvef >=40% Hemodialysis not 3 times wk Pt reas not great 1.2Kt/V Hemo, perit, or kidney trans Signs of melanoma present Epilepsy MG qual act perform Severity of angina assess Angina present Angina absent Severity angina not assess Pregnancy test order Doc reas no pregnancy test Pregnancy test not order Aneurysm <= 5.5 cm Aneurysm 5.6-6.0 cm Aneurysm not infarenal Male aneurysms >6cm Female aneurysm >6cm Female aneurysm 5.6-6.0 cm Aneurysm <= 5.5cm for men Aneurysm 5.6-6.0 cm for men Aneurysm >6cm for men Aneurysm >-6cm for women Aneurysm 5.6-6.0 women Stroke or TIA <120 days CEA Stroke or TIA >120 days CEA Pos Air Press not prescribed Epilepsy Measures Group Influenza A H1N1,admin w cou Influenza A H1N1, vaccine Medroxyprogesterone inj Medrxyprogester acetate inj HCPCS J1056 J1680 J8561 J9001 K0741 K0742 Q2045 Q2046 Q2047 Q2048 S9109 CodeDesc MA/EC contraceptiveinjection Human fibrinogen conc inj Oral everolimus Doxorubicin hcl liposome inj Portable gaseous oxygen sys Portable gaseous oxygen Human fibrinogen conc inj Aflibercept injection Peginesatide injection Doxil injection CHF telemonitoring month HCPCS Description Changes The following code descriptions were changed, effective 10-01-12 HCPCS G9157 Old Description Transesophageal Doppler mon New Description Transesoph doppl cardiac mon The following code descriptions were changed, effective 01-01-13 HCPCS 00542 00561 01924 01925 01930 01931 0206T 0294T 0306T 0529F 1052F 1100F 11200 11300 11301 11302 11303 11305 11306 11307 11308 11310 11311 11312 11313 1134F 1135F 1136F 1137F 11400 11403 11406 11420 11426 11440 11446 11600 11606 11620 Old Description Anesth remvl pleura Anesth heart surg < 1 yr Anes ther interven rad art Anes ther interven rad car Anes ther interven rad vei Anes ther interven rad tip Pptr dbs alys car elec dta Ins lt atrl press mont addon Icar ischm mntrng interr eva Intrvl 3+yrs pts clnscp docd Type location activity asses Ptfalls assess-docd ge2+/yr Removal of skin tags 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 Epsd bk pain for =< 6 wks Epsd bk pain for > 6 wks Epsd bk pain for <= 12 wks Epsd bk pain for > 12 wks Exc tr-ext b9+marg 0.5 < cm Exc tr-ext b9+marg 2.1-3 cm Exc tr-ext b9+marg > 4.0 cm Exc h-f-nk-sp b9+marg 0.5 < Exc h-f-nk-sp b9+marg > 4 cm Exc face-mm b9+marg 0.5 < cm Exc face-mm b9+marg > 4 cm Exc tr-ext mal+marg 0.5 < cm Exc tr-ext mal+marg > 4 cm Exc h-f-nk-sp mal+marg 0.5 < New Description Anesthesia removal pleura Anesth heart surg <1 yr Anes ther interven rad artrl Anes ther interven rad card Anes ther interven rad vein Anes ther interven rad tips Remote algorithm analys ecg Ins lt atrl mont pres lead icar ischm mntr interr eval Intrvl 3/>yr pts clnscp docd Type location activityasses Ptfalls assess-docd ge2>/yr Removal of skin tags <w/15 Shave skin lesion 0.5 cm/< Shave skin lesion 0.6-1.0 cm Shave skin lesion 1.1-2.0 cm Shave skin lesion >2.0 cm Shave skin lesion 0.5 cm/< Shave skin lesion 0.6-1.0 cm Shave skin lesion 1.1-2.0 cm Shave skin lesion >2.0 cm Shave skin lesion 0.5 cm/< Shave skin lesion 0.6-1.0 cm Shave skin lesion 1.1-2.0 cm Shave skin lesion >2.0 cm Epsd bk pain for 6 wks/< Epsd bk pain for >6 wks Epsd bk pain for 12 wks/< Epsd bk pain for >12 wks Exc tr-ext b9+marg 0.5 cm< Exc tr-ext b9+marg 2.1-3cm/< Exc tr-ext b9+marg >4.0 cm Exc h-f-nk-sp b9+marg 0.5/< Exc h-f-nk-sp b9+marg >4 cm Exc face-mm b9+marg 0.5 cm/< Exc face-mm b9+marg >4 cm Exc tr-ext mal+marg 0.5 cm/< Exc tr-ext mal+marg >4 cm Exc h-f-nk-sp mal+marg 0.5/< HCPCS 11626 11646 11719 11770 11771 11772 11900 11901 11920 11921 11922 11950 11951 11952 11954 11976 12001 12002 12004 12005 12006 12007 12011 12013 12014 12015 12016 12017 12018 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 Old Description Exc s/n/h/f/g mal+mrg > 4 cm Exc f/e/e/n/l mal+mrg > 4 cm Trim nail(s) Removal of pilonidal lesion Removal of pilonidal lesion Removal of pilonidal lesion Injection into skin lesions Added skin lesions injection Correct skin color defects Correct skin color defects Correct skin color defects Therapy for contour defects Therapy for contour defects Therapy for contour defects Therapy for contour defects Removal of contraceptive cap Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Intmd wnd repair s/a/t/ext Intmd wnd repair s/a/t/ext Intmd wnd repair s/tr/ext Intmd wnd repair s/a/t/ext Intmd wnd repair s/a/t/ext Intmd wnd repair s/tr/ext Intmd wnd repair n-hf/genit Intmd wnd repair n-hf/genit Intmd wnd repair n-hf/genit Intmd wnd repair n-hf/genit Intmd wnd repair n-hf/genit Intmd wnd repair n-hf/genit Intmd wnd repair face/mm Intmd wnd repair face/mm Intmd wnd repair face/mm Intmd wnd repair face/mm Intmd wnd repair face/mm Intmd wnd repair face/mm Intmd wnd repair face/mm Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Repair of wound or lesion Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on New Description Exc s/n/h/f/g mal+mrg >4 cm Exc f/e/e/n/l mal+mrg >4 cm Trim nail(s) any number Remove pilonidal cyst simple Remove pilonidal cyst exten Remove pilonidal cyst compl Inject skin lesions </w 7 Inject skin lesions >7 Correct skin color 6.0 cm/< Corect skin color 6.1-20.0cm Correct skin color ea 20.0cm Tx contour defects 1 cc/< Tx contour defects 1.1-5.0cc Tx contour defects 5.1-10cc Tx contour defects >10.0 cc Remove contraceptive capsule Rpr s/n/ax/gen/trnk 2.5cm/< Rpr s/n/ax/gen/trnk2.6-7.5cm Rpr s/n/ax/gen/trk7.6-12.5cm Rpr s/n/a/gen/trk12.6-20.0cm Rpr s/n/a/gen/trk20.1-30.0cm Rpr s/n/ax/gen/trnk >30.0 cm Rpr f/e/e/n/l/m 2.5 cm/< Rpr f/e/e/n/l/m 2.6-5.0 cm Rpr f/e/e/n/l/m 5.1-7.5 cm Rpr f/e/e/n/l/m 7.6-12.5 cm Rpr fe/e/en/l/m 12.6-20.0 cm Rpr fe/e/en/l/m 20.1-30.0 cm Rpr f/e/e/n/l/m >30.0 cm Intmd rpr s/a/t/ext 2.5 cm/< Intmd rpr s/a/t/ext 2.6-7.5 Intmd rpr s/tr/ext 7.6-12.5 Intmd rpr s/a/t/ext 12.6-20 Intmd rpr s/a/t/ext 20.1-30 Intmd rpr s/tr/ext >30.0 cm Intmd rpr n-hf/genit 2.5cm/< Intmd rpr n-hf/genit2.6-7.5 Intmd rpr n-hf/genit7.6-12.5 Intmd rpr n-hf/genit12.6-20 Intmd rpr n-hf/genit20.1-30 Intmd rpr n-hf/genit >30.0cm Intmd rpr face/mm 2.5 cm/< Intmd rpr face/mm 2.6-5.0 cm Intmd rpr face/mm 5.1-7.5 cm Intmd rpr face/mm 7.6-12.5cm Intmd rpr face/mm 12.6-20 cm Intmd rpr face/mm 20.1-30.0 Intmd rpr face/mm >30.0 cm Cmplx rpr trunk 1.1-2.5 cm Cmplx rpr trunk 2.6-7.5 cm Cmplx rpr trunk addl 5cm/< Cmplx rpr s/a/l 1.1-2.5 cm Cmplx rpr s/a/l 2.6-7.5 cm Cmplx rpr s/a/l addl 5 cm/> Cmplx rpr f/c/c/m/n/ax/g/h/f Cmplx rpr f/c/c/m/n/ax/g/h/f Cmplx rpr f/c/c/m/n/ax/g/h/f Cmplx rpr e/n/e/l 1.0 cm/< Cmplx rpr e/n/e/l 1.1-2.5 cm Cmplx rpr e/n/e/l 2.6-7.5 cm Cmplx rpr e/n/e/l addl 5cm/< HCPCS 14000 14001 14020 14021 14040 14041 14060 14061 14301 14302 14350 15570 15572 15574 15576 15600 15610 15620 15630 15750 15775 15776 15780 15781 15782 15783 15832 15833 15834 15835 15836 15837 15838 15839 15840 15841 15842 15850 15851 15876 15877 15878 15879 20553 21011 21012 21141 21142 21143 21145 21146 21147 21150 21151 21154 21155 21159 21160 21310 21315 21320 Old Description Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrange add-on Skin tissue rearrangement Form skin pedicle flap Form skin pedicle flap Form skin pedicle flap Form skin pedicle flap Skin graft Skin graft Skin graft Skin graft Neurovascular pedicle graft Hair transplant punch grafts Hair transplant punch grafts Abrasion treatment of skin Abrasion treatment of skin Abrasion treatment of skin Abrasion treatment of skin Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Graft for face nerve palsy Graft for face nerve palsy Flap for face nerve palsy Removal of sutures Removal of sutures Suction assisted lipectomy Suction assisted lipectomy Suction assisted lipectomy Suction assisted lipectomy Inject trigger points =/> 3 Exc face les sc < 2 cm Exc face les sbq 2 cm/> Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Treatment of nose fracture Treatment of nose fracture Treatment of nose fracture New Description Tis trnfr trunk 10 sq cm/< Tis trnfr trunk 10.1-30sqcm Tis trnfr s/a/l 10 sq cm/< Tis trnfr s/a/l 10.1-30 sqcm Tis trnfr f/c/c/m/n/a/g/h/f Tis trnfr f/c/c/m/n/a/g/h/f Tis trnfr e/n/e/l 10 sq cm/< Tis trnfr e/n/e/l10.1-30sqcm Tis trnfr any 30.1-60 sq cm Tis trnfr addl 30 sq cm/< Filleted finger/toe flap Skin pedicle flap trunk Skin pedicle flap arms/legs Pedcle fh/ch/ch/m/n/ax/g/h/f Pedicle e/n/e/l/ntroral Delay flap trunk Delay flap arms/legs Delay flap f/c/c/n/ax/g/h/f Delay flap eye/nos/ear/lip Neurovascular pedicle flap Hair trnspl 1-15 punch grfts Hair trnspl >15 punch grafts Dermabrasion total face Dermabrasion segmental face Dermabrasion other than face Dermabrasion suprfl any site Excise excessive skin thigh Excise excessive skin leg Excise excessive skin hip Excise excessive skin buttck Excise excessive skin arm Excise excess skin arm/hand Excise excess skin fat pad Excise excess skin & tissue Nerve palsy fascial graft Nerve palsy muscle graft Nerve palsy microsurg graft Remove sutures same surgeon Remove sutures diff surgeon Suction lipectomy head&neck Suction lipectomy trunk Suction lipectomy upr extrem Suction lipectomy lwr extrem Inject trigger points 3/> Exc face les sc <2 cm Exc face les sbq 2 cm/< Lefort i-1 piece w/o graft Lefort i-2 piece w/o graft Lefort i-3/> piece w/o graft Lefort i-1 piece w/ graft Lefort i-2 piece w/ graft Lefort i-3/> piece w/ graft Lefort ii anterior intrusion Lefort ii w/bone grafts Lefort iii w/o lefort i Lefort iii w/ lefort i Lefort iii w/fhdw/o lefort i Lefort iii w/fhd w/ lefort i Closed tx nose fx w/o manj Closed tx nose fx w/o stablj Closed tx nose fx w/ stablj HCPCS 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 22015 22206 22207 22208 22210 22212 22214 22216 22220 22222 22224 22305 22310 22315 22800 22802 22804 22808 22810 22812 28890 3022F 3025F 3027F 3035F 3037F 3040F 3042F 3046F 3050F 3077F 3078F Old Description Treatment of nose fracture Treatment of nose fracture Treatment of nose fracture Treat nasal septal fracture Treat nasal septal fracture Treat nasoethmoid fracture Treat nasoethmoid fracture Treatment of nose fracture Treatment of sinus fracture Treatment of sinus fracture Treat nose/jaw fracture Treat nose/jaw fracture Treat nose/jaw fracture Treat nose/jaw fracture Treat cheek bone fracture Treat cheek bone fracture Treat cheek bone fracture Treat cheek bone fracture Treat cheek bone fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture I&d p-spine l/s/ls Cut spine 3 col thor Cut spine 3 col lumb Cut spine 3 col addl seg 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 Treat spine process fracture Treat spine fracture Treat spine fracture Fusion of spine Fusion of spine Fusion of spine Fusion of spine Fusion of spine Fusion of spine High energy eswt plantar f Lvef >=40% systolic Spirom fev/fvc<70% w/copd Spirom fev/fvc>=70%/w/o copd O2 saturation<=88% /pao<=55 O2 saturation> 88% /pao>55 Fev<40% predicted value Fev>=40% predicted value Hemoglobin a1c level > 9.0% Ldl-c >= 130 mg/dl Syst bp >= 140 mm hg Diast bp < 80 mm hg New Description Open tx nose fx uncomplicatd Open tx nose fx w/skele fixj Open tx nose & septal fx Open tx septal fx w/wo stabj Closed tx septal&nose fx Open nasoethmoid fx w/o fixj Open nasoethmoid fx w/ fixj Perq tx nasoethmoid fx Open tx dprsd front sinus fx Open tx compl front sinus fx Closed tx nose/jaw fx Opn tx nasomax fx w/fixj Opn tx nasomax fx multple Opn tx nasomax fx w/graft Perq tx malar fracture Opn tx dprsd zygomatic arch Opn tx dprsd malar fracture Opn tx complx malar fx Opn tx complx malar w/grft Opn tx orbit fx transantral Opn tx orbit fx periorbital Opn tx orbit fx combined Opn tx orbit periorbtl implt Opn tx orbit periorbt w/grft Closed tx orbit w/o manipulj Closed tx orbit w/ manipulj Opn tx orbit fx w/o implant Opn tx orbit fx w/implant Opn tx orbit fx w/bone grft I&d abscess p-spine l/s/ls Incis spine 3 column thorac Incis spine 3 column lumbar Incis spine 3 column adl seg Incis 1 vertebral seg cerv Incis 1 vertebral seg thorac Incis 1 vertebral seg lumbar Incis addl spine segment Incis w/discectomy cervical Incis w/discectomy thoracic Incis w/discectomy lumbar Closed tx spine process fx Closed tx vert fx w/o manj Closed tx vert fx w/manj Post fusion </6 vert seg Post fusion 7-12 vert seg Post fusion 13/> vert seg Ant fusion 2-3 vert seg Ant fusion 4-7 vert seg Ant fusion 8/> vert seg Hi enrgy eswt plantar fascia Lvef >/=40% systolic Spirom fev/fvc <70% w/copd Spirom fev/fvc>/=70%/w/ocopd O2 saturation</=88%/pao</=55 O2 saturation >88%/pao>55 hg Fev <40% predicted value Fev >/=40% predicted value Hemoglobin a1c level >9.0% Ldl-c >/= 130 mg/dl Syst bp >/= 140 mm hg Diast bp <80 mm hg HCPCS 3080F 3082F 3083F 3112F 3281F 3322F 3493F 3498F 35152 3520F 35501 35506 35508 35509 35510 35511 35512 35515 35516 35518 35521 35522 35523 35525 35526 35531 35533 35535 35536 35537 35538 35539 35540 35556 35558 35560 35563 35565 35566 35570 35571 35583 35585 35587 35601 35606 35612 35616 35621 35623 35626 35631 35632 35633 35634 35636 35637 35638 35642 35645 35646 Old Description Diast bp >= 90 mm hg Kt/v <1.2 Kt/v > 1.2 <1.7 Ct/mri brain done >24 hrs Hgb lvl < 11 g/dl Melanoma>ajcc stage 0 or ia No hist cd4+ cell count<350 Cd4+ cell >=15% (hiv) Repair artery rupture knee Cdifficile testing performe 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 Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Vein bypass graft Vein bypass graft Vein bypass graft 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 New Description Diast bp >/= 90 mm hg Kt/v >1.2 Kt/v =/> 1.2 & <1.7 Ct/mri brain done 24 hrs Hgb lvl <11 g/dl Melanomaajcc stage 0 or ia No hist cd4+ cell count <350 Cd4+ cell =15% (hiv) Repair ruptd popliteal art Cdifficile testing performed Art byp grft ipsilat carotid Art byp grft subclav-carotid Art byp grft carotid-vertbrl Art byp grft contral carotid Art byp grft carotid-brchial Art byp grft subclav-subclav Art byp grft subclav-brchial Art byp grft subclav-vertbrl Art byp grft subclav-axilary Art byp grft axillary-axilry Art byp grft axill-femoral Art byp grft axill-brachial Art byp grft brchl-ulnr-rdl Art byp grft brachial-brchl Art byp grft aor/carot/innom Art byp grft aorcel/aormesen Art byp grft axill/fem/fem Art byp grft hepatorenal Art byp grft splenorenal Art byp grft aortoiliac Art byp grft aortobi-iliac Art byp grft aortofemoral Art byp grft aortbifemoral Art byp grft fem-popliteal Art byp grft fem-femoral Art byp grft aortorenal Art byp grft ilioiliac Art byp grft iliofemoral Art byp fem-ant-post tib/prl Art byp tibial-tib/peroneal Art byp pop-tibl-prl-other Vein byp grft fem-popliteal Vein byp fem-tibial peroneal Vein byp pop-tibl peroneal Art byp common ipsi carotid Art byp carotid-subclavian Art byp subclav-subclavian Art byp subclav-axillary Art byp axillary-femoral Art byp axillary-pop-tibial Art byp aorsubcl/carot/innom Art byp aor-celiac-msn-renal Art byp ilio-celiac Art byp ilio-mesenteric Art byp iliorenal Art byp spenorenal Art byp aortoiliac Art byp aortobi-iliac Art byp carotid-vertebral Art byp subclav-vertebrl Art byp aortobifemoral HCPCS 35647 35650 35654 35656 35661 35663 35665 35666 35671 35681 35682 35683 35691 35693 35694 35695 36405 36406 36410 36440 38240 38241 38242 4142F 4175F 4194F 4240F 4242F 4481F 5010F 5020F 62310 62311 62318 62319 63001 63003 63005 63011 63012 63015 63016 63017 63045 63046 63047 63050 63055 63056 63064 63081 63085 63087 63090 63101 63102 63185 63190 63191 63194 63195 Old Description 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 Composite bypass graft Composite bypass graft Arterial transposition Arterial transposition Arterial transposition Arterial transposition Bl draw < 3 yrs scalp vein Bl draw < 3 yrs other vein Non-routine bl draw > 3 yrs Bl push transfuse 2 yr or < Bn marrow/stm transplt allo Bn marrow/stm transplt auto Lymphocyte infuse transplant Corticoster sparng txmnt rxd Vis of >= 20/40 w/in 90 days Pt rcvng>10mg daily predniso Instr xrcz 4bk pn >12 weeks Sprvsd xrcz bk pn >12 weeks Pt rcvng ace/arb blker<3mons Macul result to phy mng dm Txmnts 2 main Dr by 1 mon Inject spine c/t Inject spine l/s (cd) Inject spine w/cath c/t Inject spine w/cath l/s (cd) Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Cervical laminoplasty Decompress spinal cord Decompress spinal cord Decompress spinal cord Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Incise spinal column/nerves Incise spinal column/nerves Incise spinal column/nerves Incise spinal column & cord Incise spinal column & cord New Description Art byp aortofemoral Art byp axillary-axillary Art byp axill-fem-femoral Art byp femoral-popliteal Art byp femoral-femoral Art byp ilioiliac Art byp iliofemoral Art byp fem-ant-post tib/prl Art byp pop-tibl-prl-other Composite byp grft pros&vein Composite byp grft 2 veins Composite byp grft 3/> segmt Art trnsposj vertbrl carotid Art trnsposj subclavian Art trnsposj subclav carotid Art trnsposj carotid subclav Bl draw <3 yrs scalp vein Bl draw <3 yrs other vein Non-routine bl draw 3/> yrs Bl push transfuse 2 yr/< Transplt allo hct/donor Transplt autol hct/donor Transplt allo lymphocytes Corticoster sparng thrpy rxd Vis 20/40/> w/in 90 days Pt rcvng10mg daily predniso Instr xrcz back pain 12 wks Sprvsd xrcz back pn >12 wks Pt rcvng ace/arb blker >3mos Macul result phy/qhp mng dm Txmnts 2 phys/qhp by 1 mon Inject spine cerv/thoracic Inject spine lumbar/sacral Inject spine w/cath crv/thrc Inject spine w/cath lmb/scrl Remove spine lamina 1/2 crvl Remove spine lamina 1/2 thrc Remove spine lamina 1/2 lmbr Remove spine lamina 1/2 scrl Remove lamina/facets lumbar Remove spine lamina >2 crvcl Remove spine lamina >2 thrc Remove spine lamina >2 lmbr Remove spine lamina 1 crvl Remove spine lamina 1 thrc Remove spine lamina 1 lmbr Cervical laminoplsty 2/> seg Decompress spinal cord thrc Decompress spinal cord lmbr Decompress spinal cord thrc Remove vert body dcmprn crvl Remove vert body dcmprn thrc Remov vertbr dcmprn thrclmbr Remove vert body dcmprn lmbr Remove vert body dcmprn thrc Remove vert body dcmprn lmbr Incise spine nrv half segmnt Incise spine nrv >2 segmnts Incise spine accessory nerve Incise spine & cord cervical Incise spine & cord thoracic HCPCS 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 63295 63300 63301 63302 63303 63304 63305 63306 63307 64802 64820 64823 64885 64886 64890 64891 64892 64893 64895 64896 64897 64898 67810 70100 70110 70543 70551 70552 70553 71010 71015 71020 71021 Old Description Incise spinal column & cord Incise spinal column & cord Incise spinal column & cord Incise spinal column & cord Release of spinal cord Revise spinal cord vessels Revise spinal cord vessels Revise spinal cord vessels Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Repair of laminectomy defect Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Nerve graft head or neck Nerve graft head or neck Nerve graft hand or foot Nerve graft hand or foot Nerve graft arm or leg Nerve graft arm or leg Nerve graft hand or foot Nerve graft hand or foot Nerve graft arm or leg Nerve graft arm or leg Biopsy of eyelid X-ray exam of jaw X-ray exam of jaw Mri orbt/fac/nck w/o & w/dye Mri brain w/o dye Mri brain w/dye Mri brain w/o & w/dye Chest x-ray Chest x-ray Chest x-ray Chest x-ray New Description Incise spine&cord 2 trx crvl Incise spine&cord 2 trx thrc Incise spin&cord 2 stgs crvl Incise spin&cord 2 stgs thrc Release spinal cord lumbar Revise spinal cord vsls crvl Revise spinal cord vsls thrc Revise spine cord vsl thrlmb Excise intraspinl lesion crv Excise intrspinl lesion thrc Excise intrspinl lesion lmbr Excise intrspinl lesion scrl Excise intrspinl lesion crvl Excise intrspinl lesion thrc Excise intrspinl lesion lmbr Excise intrspinl lesion scrl Bx/exc xdrl spine lesn crvl Bx/exc xdrl spine lesn thrc Bx/exc xdrl spine lesn lmbr Bx/exc xdrl spine lesn scrl Bx/exc idrl spine lesn crvl Bx/exc idrl spine lesn thrc Bx/exc idrl spine lesn lmbr Bx/exc idrl spine lesn scrl Bx/exc idrl imed lesn cervl Bx/exc idrl imed lesn thrc Bx/exc idrl imed lesn thrlmb Bx/exc xdrl/idrl lsn any lvl Repair laminectomy defect Remove vert xdrl body crvcl Remove vert xdrl body thrc Remove vert xdrl body thrlmb Remov vert xdrl bdy lmbr/sac Remove vert idrl body crvcl Remove vert idrl body thrc Remov vert idrl bdy thrclmbr Remov vert idrl bdy lmbr/sac Sympathectomy cervical Sympathectomy digital artery Sympathectomy supfc palmar Nerve graft head/neck </4 cm Nerve graft head/neck >4 cm Nerve graft hand/foot </4 cm Nerve graft hand/foot >4 cm Nerve graft arm/leg <4 cm Nerve graft arm/leg >4 cm Nerve graft hand/foot </4 cm Nerve graft hand/foot >4 cm Nerve graft arm/leg </4 cm Nerve graft arm/leg >4 cm Biopsy eyelid & lid margin X-ray exam of jaw <4views X-ray exam of jaw 4/> views Mri orbt/fac/nck w/o &w/dye Mri brain stem w/o dye Mri brain stem w/dye Mri brain stem w/o & w/dye Chest x-ray 1 view frontal Chest x-ray stereo frontal Chest x-ray 2vw frontal&latl Chest x-ray frnt lat lordotc HCPCS 71022 71030 71034 71035 71100 71101 71110 71111 71120 71130 72010 72020 72040 72050 72052 72069 72070 72072 72074 72080 72090 72100 72110 72114 72120 72200 72202 72220 72240 72255 72265 72270 72285 74240 74241 74245 75600 75605 75625 75872 75885 75887 75889 76376 76377 78070 78075 82746 82985 83001 83002 83150 83491 83498 83499 83775 83880 84081 84402 84445 85210 Old Description Chest x-ray Chest x-ray Chest x-ray and fluoroscopy Chest x-ray 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 X-ray exam of spine X-ray exam of spine X-ray exam of neck spine X-ray exam of neck spine X-ray exam of neck spine X-ray exam of trunk spine X-ray exam of thoracic spine X-ray exam of thoracic spine X-ray exam of thoracic spine X-ray exam of trunk spine X-ray exam of trunk spine X-ray exam of lower spine X-ray exam of lower spine X-ray exam of lower spine X-ray exam of lower spine 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 spine X-ray c/t spine disk X-ray exam upper gi tract X-ray exam upper gi tract X-ray exam upper gi tract Contrast x-ray exam of aorta Contrast x-ray exam of aorta Contrast x-ray exam of aorta Vein x-ray skull Vein x-ray liver Vein x-ray liver Vein x-ray liver 3d render w/o postprocess 3d rendering w/postprocess Parathyroid nuclear imaging Adrenal nuclear imaging Blood folic acid serum Glycated protein Gonadotropin (FSH) Gonadotropin (LH) Assay of for hva Assay of corticosteroids Assay of progesterone Assay of progesterone Assay of md enzyme Natriuretic peptide Amniotic fluid enzyme test Assay of testosterone Assay of tsi Blood clot factor II test New Description Chest x-ray frnt lat oblique Chest x-ray 4/> views Chest x-ray&fluoro 4/> views Chest x-ray special views X-ray exam ribs uni 2 views X-ray exam unilat ribs/chest X-ray exam ribs bil 3 views X-ray exam ribs/chest4/> vws X-ray exam breastbone 2/>vws X-ray strenoclavic jt 3/>vws X-ray exam spine ap&lat X-ray exam of spine 1 view X-ray exam neck spine 3/<vws X-ray exam neck spine 4/5vws X-ray exam neck spine 6/>vws X-ray exam trunk spine stand X-ray exam thorac spine 2vws X-ray exam thorac spine 3vws X-ray exam thorac spine4/>vw X-ray exam trunk spine 2 vws X-ray exam scloiosis erect X-ray exam l-s spine 2/3 vws X-ray exam l-2 spine 4/>vws X-ray exam l-s spine bending X-ray bend only l-s spine X-ray exam si joints X-ray exam si joints 3/> vws X-ray exam sacrum tailbone Myelography neck spine Myelography thoracic spine Myelography l-s spine Myelogphy 2/> spine regions Discography cerv/thor spine X-ray upper gi delay w/o kub X-rayupper gi delay w/kub X-ray upper gi&small intest Contrast exam thoracic aorta Contrast exam thoracic aorta Contrast exam abdominl aorta Vein x-ray skull epidural Vein x-ray liver w/hemodynam Vein x-ray liver w/o hemodyn Vein x-ray liver w/hemodynam 3d render w/intrp postproces 3d render w/intrp postproces Parathyroid planar imaging Adrenal cortex & medulla img Assay of folic acid serum Assay of glycated protein Assay of gonadotropin (fsh) Assay of gonadotropin (lh) Assay of homovanillic acid Assay of corticosteroids 17 Assay of progesterone 17-d Assay of progesterone 20Assay malate dehydrogenase Assay of natriuretic peptide Assay phosphatidylglycerol Assay of free testosterone Assay of tsi globulin Clot factor ii prothrom spec HCPCS 85220 85230 85240 85244 85245 85246 85247 85250 85260 85270 85280 85290 85291 85292 85293 85300 85301 85302 85303 85305 85306 85345 85347 85348 85380 85384 85385 85390 85475 86000 86077 86078 86079 86146 86147 86148 86225 86308 86309 86310 86329 86376 86403 86406 86430 86651 86652 86653 86654 86664 86665 86671 86677 86684 86689 86692 86694 86695 86696 86698 86701 Old Description Blood clot factor V test Blood clot factor VII test Blood clot factor VIII test Blood clot factor VIII test Blood clot factor VIII test Blood clot factor VIII 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 Coagulation time Coagulation time Coagulation time Fibrin degradation vte Fibrinogen Fibrinogen Fibrinolysins screen Hemolysin Agglutinins febrile Physician blood bank service Physician blood bank service Physician blood bank service Glycoprotein antibody Cardiolipin antibody Phospholipid antibody DNA antibody Heterophile antibodies Heterophile antibodies Heterophile antibodies Immunodiffusion Microsomal antibody Particle agglutination test Particle agglutination test Rheumatoid factor test Encephalitis antibody Encephalitis antibody Encephalitis antibody Encephalitis antibody Epstein-barr antibody Epstein-barr antibody Fungus antibody Helicobacter pylori Hemophilus influenza HTLV/HIV confirmatory test Hepatitis delta agent Herpes simplex test Herpes simplex test Herpes simplex type 2 Histoplasma HIV-1 New Description Blooc clot factor v test Clot factor vii proconvertin Clot factor viii ahg 1 stage Clot factor viii reltd antgn Clot factor viii vw ristoctn Clot factor viii vw antigen Clot factor viii multimetric Clot factor ix ptc/chrstmas Clot factor x stuart-power Clot factor xi pta Clot factor xii hageman Clot factor xiii fibrin stab Clot factor xiii fibrin scrn Clot factor fletcher fact Clot factor wght kininogen Antithrombin iii activity Antithrombin iii antigen Clot inhibit prot c antigen Clot inhibit prot c activity Clot inhibit prot s total Clot inhibit prot s free Coagulation time lee & white Coagulation time activated Coagulation time otr method Fibrin degradj d-dimer Fibrinogen activity Fibrinogen antigen Fibrinolysins screen i&r Hemolysin acid Agglutinins febrile antigen Phys blood bank serv xmatch Phys blood bank serv reactj Phys blood bank serv authrj Beta-2 glycoprotein antibody Cardiolipin antibody ea ig Anti-phospholipid antibody Dna antibody native Heterophile antibody screen Heterophile antibody titer Heterophile antibody absrbj Immunodiffusion nes Microsomal antibody each Particle agglut antbdy scrn Particle agglut antbdy titr Rheumatoid factor test qual Encephalitis californ antbdy Encephaltis east eqne anbdy Encephaltis st louis antbody Encephaltis west eqne antbdy Epstein-barr nuclear antigen Epstein-barr capsid vca Fungus nes antibody Helicobacter pylori antibody Hemophilus influenza antibdy Htlv/hiv confirmj antibody Hepatitis delta agent antbdy Herpes simplex nes antbdy Herpes simplex type 1 test Herpes simplex type 2 test Histoplasma antibody Hiv-1antibody HCPCS 86702 86703 86707 86708 86709 86723 86970 86971 86972 86975 86976 86977 87015 87045 87046 87070 87071 87498 87521 87522 87535 87536 87538 87539 87902 87906 90655 90700 90702 90714 90715 90746 90951 90952 90953 90963 91038 92012 92014 92015 92315 92316 92317 92340 92341 92342 92352 92353 92354 92355 92358 92601 92602 92603 92604 92973 93282 93286 93287 93880 93882 Old Description HIV-2 Hiv-1/hiv-2 single result Hep be antibody Hep a antibody total Hep a antibody igm Listeria monocytogenes ab RBC pretreatment RBC pretreatment RBC pretreatment Rbc pretreatment serum Rbc pretreatment serum Rbc pretreatment serum Specimen concentration Feces culture bacteria Stool cultr bacteria each Culture bacteria other Culture bacteri aerobic othr Enterovirus dna amp probe Hepatitis c rna amp probe Hepatitis c rna quant Hiv-1 dna amp probe Hiv-1 dna quant Hiv-2 dna amp probe Hiv-2 dna quant Genotype dna hepatitis c Genotype dna hiv reverse t Flu vaccine no preserv 6-35m Dtap vaccine < 7 yrs im Dt vaccine < 7 im Td vaccine no prsrv >/= 7 im Tdap vaccine >7 im Hep b vaccine adult im Esrd serv 4 visits p mo <2 Esrd serv 2-3 vsts p mo <2 Esrd serv 1 visit p mo <2 Esrd home pt serv p mo <2 Esoph imped funct test > 1h Eye exam established pat Eye exam & treatment Refraction Prescription of contact lens Prescription of contact lens Prescription of contact lens Fitting of spectacles Fitting of spectacles Fitting of spectacles Special spectacles fitting Special spectacles fitting Special spectacles fitting Special spectacles fitting Eye prosthesis service Cochlear implt f/up exam < 7 Reprogram cochlear implt < 7 Cochlear implt f/up exam 7 > Reprogram cochlear implt 7 > Percut coronary thrombectomy Icd device prog eval 1 sngl Pre-op pm device eval Pre-op icd device eval Extracranial study Extracranial study New Description Hiv-2 antibody Hiv-1/hiv-2 1 result antbdy Hepatitis be antibody Hepatitis a total antibody Hepatitis a igm antibody Listeria monocytogenes Rbc pretx incubatj w/chemicl Rbc pretx incubatj w/enzymes Rbc pretx incubatj w/density Rbc serum pretx incubj drugs Rbc serum pretx id dilution Rbc serum pretx incubj/inhib Specimen infect agnt concntj Feces culture aerobic bact Stool cultr aerobic bact ea Culture othr specimn aerobic Culture aerobic quant other Enterovirus probe&revrs trns Hepatitis c probe&rvrs trnsc Hepatitis c revrs trnscrpj Hiv-1 probe&reverse trnscrpj Hiv-1 quant&revrse trnscrpj Hiv-2 probe&revrse trnscripj Hiv-2 quant&revrse trnscripj Genotype dna/rna hep c Genotype dna/rna hiv Flu vac no prsv 3 val 6-35 m Dtap vaccine > 7 yrs im Dt vaccine > 7 yrs im Td vaccine no prsrv 7/> im Tdap vaccine 7 yrs/> im Hep b vacc adult 3 dose im Esrd serv 4 visits p mo <2yr Esrd serv 2-3 vsts p mo <2yr Esrd serv 1 visit p mo <2yrs Esrd home pt serv p mo <2yrs Esoph imped funct test > 1hr Eye exam establish patient Eye exam&tx estab pt 1/>vst Determine refractive state Rx cntact lens aphakia 1 eye Rx cntact lens aphakia 2 eye Rx corneoscleral cntact lens Fit spectacles monofocal Fit spectacles bifocal Fit spectacles multifocal Fit aphakia spectcl monofocl Fit aphakia spectcl multifoc Fit spectacles single system Fit spectacles compound lens Aphakia prosth service temp Cochlear implt f/up exam <7 Reprogram cochlear implt 7/> Cochlear implt f/up exam 7/> Reprogram cochlear implt 7/> Prq coronary mech thrombect Icd device progr eval 1 sngl Peri-px pacemaker device evl Peri-px icd device eval&prgr Extracranial bilat study Extracranial uni/ltd study HCPCS 93886 93888 94729 95024 95027 95028 95125 95130 95131 95132 95133 95134 95808 95810 95811 95905 95921 95922 95923 96922 97140 97598 97605 97606 98925 98926 98927 98928 98929 98940 98941 98942 98943 99000 99001 99002 99070 99143 99144 99145 99148 99149 99150 99174 99363 99364 99366 99381 99391 99441 99442 99443 99444 A9584 C9724 D0220 D0270 D0272 D0273 D0274 D0277 Old Description Intracranial study Intracranial study C0 diffuse capacity Id allergy test drug/bug Id allergy titrate-airborne Id allergy test-delayed type Immunotherapy many antigens Immunotherapy insect venom Immunotherapy insect venoms Immunotherapy insect venoms Immunotherapy insect venoms Immunotherapy insect venoms Polysomnography 1-3 Polysomnography 4 or more Polysomnography w/cpap Motor/sens nrve conduct test Autonomic nerv function test Autonomic nerv function test Autonomic nerv function test Laser tx skin > 500 sq cm Manual therapy Rmvl devital tis addl 20 cm< Neg press wound tx < 50 cm Neg press wound tx > 50 cm Osteopathic manipulation Osteopathic manipulation Osteopathic manipulation Osteopathic manipulation Osteopathic manipulation Chiropractic manipulation Chiropractic manipulation Chiropractic manipulation Chiropractic manipulation Specimen handling Specimen handling Device handling Special supplies Mod cs by same phys < 5 yrs Mod cs by same phys 5 yrs + Mod cs by same phys add-on Mod cs diff phys < 5 yrs Mod cs diff phys 5 yrs + Mod cs diff phys add-on Ocular photoscreening Anticoag mgmt init Anticoag mgmt subseq Team conf w/pat by hc pro Init pm e/m new pat inf Per pm reeval est pat inf Phone e/m by phys 5-10 min Phone e/m by phys 11-20 min Phone e/m by phys 21-30 min Online e/m by phys Iodine i-123 ioflupane EPS gast cardia plic Intraoral periapical first f Dental bitewing single film Dental bitewings two films Bitewings - three films Dental bitewings four films Vert bitewings-sev to eight New Description Intracranial complete study Intracranial limited study Co/membane diffuse capacity Icut allergy test drug/bug Icut allergy titrate-airborn Icut allergy test-delayed Immunotherapy 2/> injections Immntx 1 sting insect Immntx 2 sting insects Immntx 3 sting insects Immntx 4 sting insects Immntx 5 sting insects Polysom any age 1-3> param Polysom 6/> yrs 4/> param Polysom 6/>yrs cpap 4/> parm Motor &/ sens nrve cndj test Autonomic nrv parasym inervj Autonomic nrv adrenrg inervj Autonomic nrv syst funj test Laser tx skin >500 sq cm Manual therapy 1/> regions Rmvl devital tis addl 20cm/< Neg press wound tx </=50 cm Neg press wound tx >50 cm Osteopath manj 1-2 regions Osteopath manj 3-4 regions Osteopath manj 5-6 regions Osteopath manj 7-8 regions Osteopath manj 9-10 regions Chiropract manj 1-2 regions Chiropract manj 3-4 regions Chiropractic manj 5 regions Chiropract manj xtrspinl 1/> Specimen handling office-lab Specimen handling pt-lab Device handling phys/qhp Special supplies phys/qhp Mod sedat phys/qhp <5 yrs Mod sedat phys/qhp 5yrs/> Mod sedat phys/qhp ea 15 min Mod sed diff phys/qhp<5 yrs Mod sed diff phys/qhp 5/>yrs Mod sed diff phys/qhp add on Ocular instrumnt screen bil Anticoagulant mgmt initial Anticoagulant mgmt subseq Team conf w/pat by hc prof Init pm e/m new pat infant Per pm reeval est pat infant Phone e/m phys/qhp 5-10 min Phone e/m phys/qhp 11-20 min Phone e/m phys/qhp 21-30 min Online e/m by phys/qhp Iodine I-123 ioflupane EPS stomach plic Intraoral periapical first Dental bitewing single image Dental bitewings two images Bitewings - three images Bitewings four images Vert bitewings 7 to 8 images HCPCS D0290 D0321 D0330 D0340 D4210 D4211 D4260 D4261 D6975 D6980 D7951 E2368 E2369 E2370 G0416 G0444 G8895 G8896 G8897 G8908 G8909 G8912 G8918 G9151 J1561 J9020 J9280 Q2049 Q4126 Q4128 V5267 Old Description Dental film skull/facial bon Dental other tmj films Dental panoramic film Dental cephalometric film Gingivectomy/plasty per quad Gingivectomy/plasty per toot Osseous surgery per quadrant Osseous surgl-3teethperquad Coping metal Bridge repair Sinus aug w bone/bone sup Power wc motor replacement Pwr wc gear box replacement Pwr wc motor/gear box combo Sat biopsy prostate 1-20 spc Depression Screen annual Anticoag prescribe Doc med reas no anticoag Anticoag not prescribe Pt doc w burn prior to D/C Pt doc no burn prior to D/C Pt doc with wrong event Pt w/o preop order IV AB pr MAPCP demo State Gamunex, Gamunex-C, Gammaked Asparaginase injection Mitomycin 5 MG inj Imported Lipodox inj Memoderm Flexhd or allopatch hd Hearing aid supply/accessory New Description Skull/facial bone image Other TMJ images by report Panoramic image Cephalometric image Gingivectomy/plasty 4 or mor Gingivectomy/plasty 1 to 3 Osseous surgery 4 or more Osseous surg 1 to 3 teeth Coping Fixed partial repair Sinus aug w bone or bone sub Pwr wc drivewheel motor repl Pwr wc drivewheel gear repl Pwr wc dr wh motor/gear comb Sat biopsy 10-20 Depression screen annual Antrom prescribe Doc med reas no antihtrom Antithrom not prescribe Pt doc w burn prior to D/C Pt doc no burn prior to D/C Pt doc with wrong event Pt w/o preop order IV AB pro MAPCP demo state Gamunex-C/Gammaked Asparaginase, NOS Mitomycin injection Imported lipodox inj Memoderm/derma/tranz/integup Flexhd/Allopatchhd/matrixhd Hearing aid sup/access/dev HCPCS Changes- APC, Status Indicator and/or Edit Assignments The following code(s) had an APC and/or SI and/or edit change, effective 10-01-12 **A blank in the field indicates no change. HCPCS G9157 CodeDesc Transesoph doppl cardiac mon Old APC New APC Old SI M New SI B Old Edit 72 New Edit 62 The following code(s) had an APC and/or SI and/or edit change, effective 01-01-13 **A blank in the field indicates no change. HCPCS 0183T 0184T 0249T 0299T 0300T 0528F 1052F 11047 1110F 1116F 1121F 11623 15115 19290 2014F 2035F CodeDesc Wound ultrasound Exc rectal tumor endoscopic Ligation hemorrhoid w/us Esw wound healing init wound Esw wound healing addl wound Rcmnd flw-up 10 yrs docd Type location activityasses Deb bone add-on Pt lft inpt fac w/in 60 days Auric/peri pain assessed Subs eval for condition Exc s/n/h/f/g mal+mrg 2.1-3 Epidrm a-grft face/nck/hf/g Place needle wire breast Mental status assess Tymp memb motion examd Old APC 00015 00149 00155 00340 00340 00020 00021 00135 00000 New APC 00013 00150 00150 00133 00133 Old SI New SI Old Edit New Edit X X T T E M M E 28 72 72 28 M M M E E E 72 72 72 28 28 28 N M M Q1 E E 72 72 28 28 00019 00020 00136 00340 HCPCS 20926 21010 21026 21029 21044 21073 21085 21120 21181 21195 21198 21230 21235 21338 21346 21360 21401 21421 21451 21454 21485 21497 21685 22856 23931 29130 29131 29200 29240 29260 29280 29520 29530 29540 29550 29582 29583 29584 30110 30115 30124 30130 30220 3025F 3027F 3028F 30320 30400 3074F 3075F 3077F 3078F 3079F 30801 3080F 3085F 30930 31070 3110F CodeDesc Removal of tissue for graft Incision of jaw joint Excision of facial bone(s) Contour of face bone lesion Removal of jaw bone lesion Mnpj of tmj w/anesth Prepare face/oral prosthesis Reconstruction of chin Contour cranial bone lesion Reconst lwr jaw w/o fixation Reconstr lwr jaw segment Rib cartilage graft Ear cartilage graft Open nasoethmoid fx w/o fixj Opn tx nasomax fx w/fixj Opn tx dprsd malar fracture Closed tx orbit w/ manipulj Treat mouth roof fracture Treat lower jaw fracture Treat lower jaw fracture Reset dislocated jaw Interdental wiring Hyoid myotomy & suspension Cerv artific diskectomy Drainage of arm bursa Application of finger splint Application of finger splint Strapping of chest Strapping of shoulder Strapping of elbow or wrist Strapping of hand or finger Strapping of hip Strapping of knee Strapping of ankle and/or ft Strapping of toes Apply multlay comprs upr leg Apply multlay comprs upr arm Appl multlay comprs arm/hand Removal of nose polyp(s) Removal of nose polyp(s) Removal of nose lesion Excise inferior turbinate Insert nasal septal button Spirom fev/fvc <70% w/copd Spirom fev/fvc>/=70%/w/ocopd O2 saturation doc rev Remove nasal foreign body Reconstruction of nose Syst bp lt 130 mm hg Syst bp ge 130 - 139mm hg Syst bp >/= 140 mm hg Diast bp <80 mm hg Diast bp 80-89 mm hg Ablate inf turbinate superf Diast bp >/= 90 mm hg Suicide risk assessed Ther fx nasal inf turbinate Exploration of frontal sinus Pres/absn hmrhg/lesion docd Old APC 00135 00254 00256 00256 00256 00252 00253 00254 00254 00256 00256 00256 00254 00254 00254 00254 00253 00254 00252 00254 00253 00253 00252 00000 00008 00058 00058 00058 00058 00058 00058 00058 00058 00058 00058 00058 00058 00058 New APC 00136 00256 00254 00254 00254 00254 00252 00256 00256 00254 00254 00254 00253 00256 00256 00256 00252 00256 00253 00256 00254 00252 00254 00208 00007 00059 00059 00059 00059 00059 00059 00059 00059 00059 00059 00059 00059 00059 00253 00253 00252 00253 00252 00252 00254 00254 00254 00253 00253 00256 00252 00253 00254 Old SI New SI Old Edit New Edit C T M M E E 72 72 28 28 M E 72 28 M M M M M E E E E E 72 72 72 72 72 28 28 28 28 28 M M E E 72 72 28 28 M E 72 28 00254 00254 00253 00254 00256 HCPCS 3111F 3112F 31200 31201 31205 31240 31528 31529 31541 31578 31610 31612 31629 31634 32552 4012F 4050F 40527 40805 40814 40819 40842 41000 41007 41016 41017 41116 41500 41512 41520 4165F 4180F 41820 41823 41828 41830 41850 41870 41872 4200F 4201F 42107 42120 42140 42145 42182 42225 42235 42300 42305 42335 42408 42409 42450 42508 42650 42665 4267F 42800 42825 42830 CodeDesc Ct/mri brain done w/in 24hrs Ct/mri brain done 24 hrs Removal of ethmoid sinus Removal of ethmoid sinus Removal of ethmoid sinus Nasal/sinus endoscopy surg Laryngoscopy and dilation Laryngoscopy and dilation Larynscop w/tumr exc + scope Removal of larynx lesion Incision of windpipe Puncture/clear windpipe Bronchoscopy/needle bx each Bronch w/balloon occlusion Remove lung catheter Warfarin therapy rx Ht care plan doc Reconstruct lip with flap Removal foreign body mouth Excise/repair mouth lesion Excise lip or cheek fold Reconstruction of mouth Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Excision of mouth lesion Fixation of tongue Tongue suspension Reconstruction tongue fold 3d-crt/imrt received Adjv thxpyrxd/rcvd colon ca Excision gum each quadrant Excision of gum lesion Excision of gum lesion Removal of gum tissue Treatment of gum lesion Gum graft Repair gum External beam to prost only Extrnl beam other than prost Excision lesion mouth roof Remove palate/lesion Excision of uvula Repair palate pharynx/uvula Repair palate Reconstruct cleft palate Repair palate Drainage of salivary gland Drainage of salivary gland Removal of salivary stone Excision of salivary cyst Drainage of salivary cyst Excise sublingual gland Parotid duct diversion Dilation of salivary duct Ligation of salivary duct Comprssion thxpy prescribed Biopsy of throat Removal of tonsils Removal of adenoids Old APC New APC 00256 00256 00256 00074 00074 00074 00074 00075 00254 00254 00076 00076 00078 00254 00254 00254 00075 00075 00075 00075 00074 00256 00256 00415 00415 00070 00254 00252 00253 00252 00254 00253 00253 00252 00252 00253 00254 00252 00252 00252 00254 00253 00253 00253 00254 00253 Old SI M M New SI E E Old Edit 72 72 New Edit 28 28 S M M T E E 72 72 28 28 M M E E 72 72 28 28 M M E E 72 72 28 28 M E 72 28 00256 00254 00254 00253 00256 00252 00254 00254 00253 00254 00253 00254 00254 00254 00256 00254 00254 00254 00256 00254 00254 00256 00252 00254 00256 00256 00253 00253 00253 00253 00253 00253 00254 00256 00252 00254 00256 00254 00253 00256 00254 00254 00254 00252 00254 00254 00254 00254 00256 00254 00253 00256 00252 00254 00254 00253 00256 00256 HCPCS 42842 42860 42900 4290F 4293F 42950 42962 43030 4330F 43770 43887 45005 45100 45172 45337 45338 45341 45905 45910 45990 46040 46060 46080 46230 46288 46320 46505 46606 46608 46706 46754 46940 49442 60502 6070F 6090F 64569 65779 65930 66155 66185 66605 69005 69140 69150 69222 69405 69440 69502 69650 69666 69667 69676 69700 70110 70120 70150 70200 70220 71030 CodeDesc Extensive surgery of throat Excision of tonsil tags Repair throat wound Pt scrned for inj drug use Pt scrnd hgh-risk sex behav Reconstruction of throat Control throat bleeding Throat muscle surgery Cnslng epi spec sfty issues Lap place gastr adj device Remove gastric port open Drainage of rectal abscess Biopsy of rectum Exc rect tum transanal full Sigmoidoscopy & decompress Sigmoidoscopy w/tumr remove Sigmoidoscopy w/ultrasound Dilation of anal sphincter Dilation of rectal narrowing Surg dx exam anorectal Incision of rectal abscess Incision of rectal abscess Incision of anal sphincter Removal of anal tags Repair anal fistula Removal of hemorrhoid clot Chemodenervation anal musc Anoscopy and biopsy Anoscopy remove for body Repr of anal fistula w/glue Removal of suture from anus Treatment of anal fissure Place cecostomy tube perc Re-explore parathyroids Pt asked/cnsld aed effects Pt/caregiver counsel safety Revise/repl vagus n eltrd Cover eye w/membrane suture Remove blood clot from eye Glaucoma surgery Revise eye shunt Removal of iris Drain external ear lesion Remove ear canal lesion(s) Extensive ear canal surgery Clean out mastoid cavity Catheterize middle ear canal Exploration of middle ear Mastoidectomy Release middle ear bone Repair middle ear structures Repair middle ear structures Remove middle ear nerve Close mastoid fistula X-ray exam of jaw 4/> views X-ray exam of mastoids X-ray exam of facial bones X-ray exam of eye sockets X-ray exam of sinuses Chest x-ray 4/> views Old APC 00254 00254 00252 New APC 00256 00256 00254 00254 00256 00253 00256 00254 00254 00131 00135 00149 00149 00149 00146 00146 00132 00136 00155 00155 00150 00147 00147 00146 00149 00149 00149 00149 00149 00149 00149 00149 00149 00149 00146 00146 00150 00149 00149 00149 00256 00147 00155 00155 00155 00155 00155 00155 00155 00150 00155 00155 00147 00147 00149 00155 00155 00155 00254 00687 00040 00234 00234 00234 00234 00008 00254 00252 00253 00252 00254 00254 00254 00256 00256 00256 00256 00260 00260 00260 00260 00260 00260 00673 00673 00673 00673 00007 00256 00254 00252 00253 00256 00256 00256 00254 00254 00254 00254 00261 00261 00261 00261 00261 00261 Old SI New SI Old Edit New Edit M M E E 72 72 28 28 M E 72 28 M M T T E E S Q2 72 72 28 28 HCPCS 71101 71110 72072 72120 73520 73564 74240 74241 74246 74247 74270 74283 75898 76001 76873 77073 77424 77425 77469 80500 81200 81205 81206 81207 81208 81209 81210 81211 81212 81213 81214 81215 81216 81217 81220 81221 81222 81223 81224 81225 81226 81227 81228 81229 81240 81241 81242 81243 81244 81245 81250 81251 81255 81256 81257 81260 81261 81262 81263 81264 CodeDesc X-ray exam unilat ribs/chest X-ray exam ribs bil 3 views X-ray exam thorac spine 3vws X-ray bend only l-s spine X-ray exam of hips X-ray exam knee 4 or more X-ray upper gi delay w/o kub X-rayupper gi delay w/kub Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract Contrast x-ray exam of colon Contrast x-ray exam of colon Follow-up angiography Fluoroscope exam extensive Echograp trans r pros study X-rays bone length studies Io rad tx delivery by x-ray Io rad tx deliver by elctrns Io radiation tx management Lab pathology consultation Aspa gene Bckdhb gene Bcr/abl1 gene major bp Bcr/abl1 gene minor bp Bcr/abl1 gene other bp Blm gene Braf gene Brca1&2 seq & com dup/del Brca1&2 185&5385&6174 var Brca1&2 uncom dup/del var Brca1 full seq & com dup/del Brca1 gene known fam variant Brca2 gene full sequence Brca2 gene known fam variant Cftr gene com variants Cftr gene known fam variants Cftr gene dup/delet variants Cftr gene full sequence Cftr gene intron poly t Cyp2c19 gene com variants Cyp2d6 gene com variants Cyp2c9 gene com variants Cytogen micrarray copy nmbr Cytogen m array copy no&snp F2 gene F5 gene Fancc gene Fmr1 gene detection Fmr1 gene characterization Flt3 gene G6pc gene Gba gene Hexa gene Hfe gene Hba1/hba2 gene Ikbkap gene Igh gene rearrange amp meth Igh gene rearrang dir probe Igh vari regional mutation Igk rearrangeabn clonal pop Old APC 00260 00260 00260 00260 00260 00260 00276 00276 00276 00276 00276 00276 00261 New APC 00261 00261 00261 00261 00261 00261 00277 00277 00277 00277 00277 00277 00397 00266 00260 00000 00000 00267 00261 00065 00065 00342 Old SI New SI Old Edit New Edit N B N/A 62 N N N S S B N/A 62 E E E E E E E E E A A A A A A A A A 28 28 28 28 28 28 28 28 28 N/A N/A N/A N/A N/A N/A N/A N/A N/A E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 00433 HCPCS 81265 81266 81267 81268 81270 81275 81280 81281 81282 81290 81291 81292 81293 81294 81295 81296 81297 81298 81299 81300 81301 81302 81303 81304 81310 81315 81316 81317 81318 81319 81330 81331 81332 81340 81341 81342 81350 81355 81370 81371 81372 81373 81374 81375 81376 81377 81378 81379 81380 81381 81382 81383 81400 81401 81402 81403 81404 81405 81406 81407 81408 CodeDesc Str markers specimen anal Str markers spec anal addl Chimerism anal no cell selec Chimerism anal w/cell select Jak2 gene Kras gene Long qt synd gene full seq Long qt synd known fam var Long qt syn gene dup/dlt var Mcoln1 gene Mthfr gene Mlh1 gene full seq Mlh1 gene known variants Mlh1 gene dup/delete variant Msh2 gene full seq Msh2 gene known variants Msh2 gene dup/delete variant Msh6 gene full seq Msh6 gene known variants Msh6 gene dup/delete variant Microsatellite instability Mecp2 gene full seq Mecp2 gene known variant Mecp2 gene dup/delet variant Npm1 gene Pml/raralpha com breakpoints Pml/raralpha 1 breakpoint Pms2 gene full seq analysis Pms2 known familial variants Pms2 gene dup/delet variants Smpd1 gene common variants Snrpn/ube3a gene Serpina1 gene Trb@ gene rearrange amplify Trb@ gene rearrange dirprobe Trg gene rearrangement anal Ugt1a1 gene Vkorc1 gene Hla i & ii typing lr Hla i & ii type verify lr Hla i typing complete lr Hla i typing 1 locus lr Hla i typing 1 antigen lr Hla ii typing ag equiv lr Hla ii typing 1 locus lr Hla ii type 1 ag equiv lr Hla i & ii typing hr Hla i typing complete hr Hla i typing 1 locus hr Hla i typing 1 allele hr Hla ii typing 1 loc hr Hla ii typing 1 allele hr Mopath procedure level 1 Mopath procedure level 2 Mopath procedure level 3 Mopath procedure level 4 Mopath procedure level 5 Mopath procedure level 6 Mopath procedure level 7 Mopath procedure level 8 Mopath procedure level 9 Old APC New APC Old SI E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E New SI A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Old Edit 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 28 New Edit N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A HCPCS 86078 86079 86870 86975 88112 88120 88121 88160 88161 88162 88185 88187 88188 88189 88304 88309 88321 88329 88331 88334 88347 88356 88361 88365 89257 89280 90477 90644 90706 90867 90868 90869 93229 93740 94010 94014 94015 94453 94680 94770 95145 95250 96120 96153 96366 99406 99407 C1749 C8921 C8922 C8923 C8924 C8925 C8926 C8927 C8928 C8929 C8930 C9254 CodeDesc Phys blood bank serv reactj Phys blood bank serv authrj RBC antibody identification Rbc serum pretx incubj drugs Cytopath cell enhance tech Cytp urne 3-5 probes ea spec Cytp urine 3-5 probes cmptr Cytopath smear other source Cytopath smear other source Cytopath smear other source Flowcytometry/tc add-on Flowcytometry/read 2-8 Flowcytometry/read 9-15 Flowcytometry/read 16 & > Tissue exam by pathologist Tissue exam by pathologist Microslide consultation Path consult introp Path consult intraop 1 bloc Intraop cyto path consult 2 Immunofluorescent study Analysis nerve Tumor immunohistochem/comput Insitu hybridization (fish) Sperm identification Assist oocyte fertilization Adenovirus vaccine type 7 Meningoccl hib vac 4 dose im Rubella vaccine sc Tcranial magn stim tx plan Tcranial magn stim tx deli Tcran magn stim redetemine Remote 30 day ecg tech supp Temperature gradient studies Breathing capacity test Patient recorded spirometry Patient recorded spirometry Hast w/oxygen titrate Exhaled air analysis o2 Exhaled carbon dioxide test Antigen therapy services Glucose monitoring cont Neuropsych tst admin w/comp Intervene hlth/behave group Ther/proph/diag iv inf addon Behav chng smoking 3-10 min Behav chng smoking > 10 min Endo, colon, retro imaging TTE w or w/o fol w/cont, com TTE w or w/o fol w/cont, f/u 2D TTE w or w/o fol w/con,co 2D TTE w or w/o fol w/con,fu 2D TEE w or w/o fol w/con,in TEE w or w/o fol w/cont,cong TEE w or w/o fol w/cont, mon TTE w or w/o fol w/con,stres TTE w or wo fol wcon,Doppler TTE w or w/o contr, cont ECG Injection, lacosamide Old APC 00343 00342 00346 00346 00343 00344 00344 00433 00433 00343 00433 00342 00343 00343 00343 00344 00433 00433 00343 00433 00343 00344 00344 New APC 00433 00433 00347 00347 00433 00661 00661 00342 00342 00433 00342 00433 00433 00433 00433 00661 00342 00342 00433 00342 00433 00343 00343 00344 00343 00344 00343 00433 00343 00218 00218 00218 00209 00367 00367 00367 00367 00367 00368 00368 00437 00607 00382 00432 00437 Old SI New SI Old Edit New Edit E E N N N E 9 9 N/A N/A N/A 28 X X H S S N K N 00216 00216 00216 00213 00368 00368 00368 00368 00368 00369 00369 00436 00606 00373 00031 00436 01749 00128 00128 00128 00128 00128 00128 00128 00128 00128 00000 00178 00177 00177 00177 00178 00178 00177 00178 00178 00128 09254 00178 00000 HCPCS C9275 C9367 G0010 G0130 G0175 G0246 G0379 G0397 G0417 G0418 G0419 G0436 G0437 J0221 J0350 J0364 J0365 J0395 J0588 J0597 J0630 J0775 J0840 J0897 J0900 J1290 J1435 J1452 J1455 J1557 J1590 J1730 J1756 J2170 J2460 J2513 J2597 J2670 J2760 J2995 J3030 J3095 J3262 J3310 J3350 J3357 J3385 J3400 J7183 J7191 J7335 J7665 J8562 J9043 J9206 J9212 J9215 J9302 J9307 J9315 J9390 CodeDesc Hexaminolevulinate HCl Endoform Dermal Template Admin hepatitis b vaccine Single energy x-ray study OPPS Service,sched team conf Followup eval of foot pt lop Direct refer hospital observ Alcohol/subs interv >30 min Sat biopsy prostate 21-40 Sat biopsy prostate 41-60 Sat biopsy prostate: >60 Tobacco-use counsel 3-10 min Tobacco-use counsel>10min Lumizyme injection Injection anistreplase 30 u Apomorphine hydrochloride Aprotonin, 10,000 kiu Arbutamine hcl injection Incobotulinumtoxin a C-1 esterase, berinert Calcitonin salmon injection Collagenase, clost hist inj Crotalidae poly immune fab Denosumab injection Testosterone enanthate inj Ecallantide injection Injection estrone per 1 MG Intraocular Fomivirsen na Foscarnet sodium injection Gammaplex injection Gatifloxacin injection Diazoxide injection Iron sucrose injection Mecasermin injection Oxytetracycline injection Pentastarch 10% solution Inj desmopressin acetate Totazoline hcl injection Phentolaine mesylate inj Inj streptokinase /250000 IU Sumatriptan succinate / 6 MG Telavancin injection Tocilizumab injection Perphenazine injeciton Urea injection Ustekinumab injection Velaglucerase alfa Triflupromazine hcl inj Wilate injection Factor VIII (porcine) Capsaicin 8% patch Mannitol for inhaler Oral fludarabine phosphate Cabazitaxel injection Irinotecan injection Interferon alfacon-1 inj Interferon alfa-n3 inj Ofatumumab injection Pralatrexate injection Romidepsin injection Vinorelbine tartrate inj Old APC 09275 New APC 00000 00437 00260 00607 00605 00604 00322 01505 01506 01508 00436 00261 00608 00604 00608 00432 00661 00661 00661 00031 00432 01360 00000 00000 00000 01439 01432 00000 01433 00000 01434 00000 00000 01359 01435 01441 00000 00000 00000 09046 01308 01437 01438 00000 00000 01222 00000 00000 01440 01358 01226 01374 00000 00000 00000 01304 01306 00000 00000 01279 00000 00830 00000 00865 00000 01447 00000 01412 00000 Old SI G G New SI N K S S S X X G E K N E G G N G G G N G E E K G N N K K E K N N K K K G G K K G G E G K G M G G K N K G G G K X X X S S K N N K K K K K K K K K K K K N K K K N N N N K E N N N K K N N K K N K N K N K K N K N K K K N Old Edit New Edit 9 N/A 9 N/A 9 9 N/A N/A 9 N/A N/A 28 9 N/A 72 N/A HCPCS L8680 L8682 L8683 L8684 L8685 L8686 L8687 L8688 M0064 Q0174 Q2043 Q9968 CodeDesc Implt neurostim elctr each Implt neurostim radiofq rec Radiofq trsmtr for implt neu Radiof trsmtr implt scrl neu Implt nrostm pls gen sng rec Implt nrostm pls gen sng non Implt nrostm pls gen dua rec Implt nrostm pls gen dua non Visit for drug monitoring Thiethylperazine maleate10mg Sipuleucel-T auto CD54+ Visualization adjunct Old APC New APC 00607 01425 00606 00000 00000 01446 Old SI N N A A N N N N New SI E E E E E E E E K G N N K K Old Edit N/A N/A N/A N/A N/A N/A N/A N/A Hcpcs Edit Changes The following code(s) were added to the list of male procedures, effective 01-01-13 Hcpcs G0458 The following code(s) were added to the list of female procedures, effective 01-01-13 Hcpcs 81500 81503 81508 81509 81510 81511 81512 New Edit 28 28 28 28 28 28 28 28 Edit Assignments The following code(s) were added to the conditional bilateral list, effective 01-01-13 HCPCS 11450 11451 11462 11463 15832 15833 15834 15836 20663 20973 21030 21031 21116 21247 21255 21256 21267 21268 21270 21295 21296 21355 21356 21360 21365 21366 21385 21386 21387 21390 21395 21400 21401 21406 21407 21408 21465 21700 21705 23120 23473 23474 23802 23920 23921 24370 24371 25215 25251 26025 26030 26037 26508 26516 26517 26518 26550 HCPCS 26551 26553 26554 26580 26641 26645 26650 26665 26820 26841 26842 27078 27295 27390 27393 27396 27397 27570 27681 27860 28035 28055 28062 28220 28222 28225 28226 28230 28286 28310 28320 28344 28360 28490 28495 28496 28505 28530 28531 28540 28545 28546 28555 28570 28575 28576 28585 28705 28715 28725 28730 28735 28737 29240 29520 29530 29540 29550 31040 31595 32035 HCPCS 32036 32215 32220 32225 32554 32555 32556 32557 32650 32651 32652 32654 32655 32656 37215 37565 37660 42340 42410 42415 42420 42425 42426 42440 42810 42815 50010 50040 50045 50060 50065 50070 50075 50100 50234 50236 50240 50280 50391 50400 50405 50541 50542 50544 50650 50700 50740 50750 50760 50900 52345 52346 54700 54800 54830 54840 55000 55500 55520 55680 56740 HCPCS 58350 58750 58752 58820 58822 60545 61332 61333 61334 61564 61790 61791 64505 64508 64510 64520 64605 64610 64712 64713 64714 64718 64719 64732 64734 64736 64738 64740 64742 64746 64786 64831 64834 64835 64836 64840 64858 64861 64862 67331 67332 67334 67335 69000 69005 69020 69105 69110 69140 69145 69205 69310 69320 69400 69401 69405 The following code(s) were added to the inherently bilateral list, effective 01-01-13 HCPCS 36221 HCPCS 64615 The following code(s) were added to the nuclear medicine list, effective 01-01-13 HCPCS 78012 78013 78014 78071 78072 Mental Health Changes The following code(s) were added to the mental health list that are not approved for the partial hospitalization program, effective 01-01-13 HCPCS 90839 The following code(s) were added to the mental health list that are not payable outside the partial hospitalization program, effective 01-01-13 HCPCS G0129 G0176 Procedure/ Device Pair Changes The following procedure/device code pair requirements were added, effective 07-01-12 Proc 33221 33228 33263 Device1 C2619 C2621 C1882 The following procedure/device code pair requirements were added, effective 01-01-13 Proc 0316T 0316T 0319T 0320T 0321T 0323T 92920 92924 92924 92924 92928 92928 92928 92928 92929 92929 92929 92929 92933 92933 92933 92933 92934 Device1 C1767 C1820 C1722 C1896 C1722 C1722 C1725 C1714 C1724 C1885 C1874 C1875 C1876 C1877 C1874 C1875 C1876 C1877 C1874 C1875 C1876 C1877 C1874 Proc 92934 92934 92934 92937 92937 92937 92937 92937 92937 92937 92937 92941 92941 92941 92941 92941 92941 92941 92941 92943 92943 92943 92943 92943 92943 92943 92943 C9600 C9600 C9601 C9601 C9602 C9602 C9603 C9603 C9604 C9604 C9604 C9604 C9604 C9604 C9606 C9606 C9606 C9606 C9606 C9606 C9607 C9607 C9607 C9607 C9607 C9607 Device1 C1875 C1876 C1877 C1714 C1724 C1725 C1874 C1875 C1876 C1877 C1885 C1714 C1724 C1725 C1874 C1875 C1876 C1877 C1885 C1714 C1724 C1725 C1874 C1875 C1876 C1877 C1885 C1874 C1875 C1874 C1875 C1874 C1875 C1874 C1875 C1714 C1724 C1725 C1874 C1875 C1885 C1714 C1724 C1725 C1874 C1875 C1885 C1714 C1724 C1725 C1874 C1875 C1885 The following procedure/device code pair requirements were removed, effective 01-01-13 Proc 0267T 0268T 0268T 0268T Device1 L8680 L8685 L8686 L8687 Proc 0268T 0282T 37209 37209 37209 43647 61885 61885 61886 61886 63650 63655 63685 63685 63685 63685 64553 64555 64561 64565 64568 64568 64568 64568 64575 64580 64581 64590 64590 64590 64590 92980 92980 92980 92980 92981 92981 92981 92981 92982 92982 92982 92982 92984 92984 92984 92984 92995 92995 92995 92996 92996 92996 93651 93651 93651 93651 93651 93651 93651 93651 Device1 L8688 L8680 C1750 C1751 C1752 L8680 L8685 L8686 L8687 L8688 L8680 L8680 L8685 L8686 L8687 L8688 L8680 L8680 L8680 L8680 L8685 L8686 L8687 L8688 L8680 L8680 L8680 L8685 L8686 L8687 L8688 C1874 C1875 C1876 C1877 C1874 C1875 C1876 C1877 C1725 C1874 C1876 C1885 C1725 C1874 C1876 C1885 C1714 C1724 C1885 C1714 C1724 C1885 C1732 C1733 C1766 C1892 C1893 C1894 C2629 C2630 Proc 93652 93652 93652 93652 93652 93652 93652 93652 G0290 G0290 G0291 G0291 Device1 C1732 C1733 C1766 C1892 C1893 C1894 C2629 C2630 C1874 C1875 C1874 C1875 The following procedure/device code pair requirements were added, effective 01-01-12 Proc 33249 Device2 C1898 The following procedure/device code pair requirements were added, effective 07-01-12 Proc 33249 33249 Device2 C1779 C1896 The following procedure/device code pair requirements were added, effective 01-01-13 Proc 0319T 92933 92933 92933 92934 92934 92934 C9602 C9602 C9602 C9603 C9603 C9603 Device2 C1896 C1714 C1724 C1885 C1714 C1724 C1885 C1714 C1724 C1885 C1714 C1724 C1885 The following procedure/device code pair requirements were removed, effective 01-01-13 Proc 64568 Device2 L8680 Device/Procedure Pair Changes The following device/procedure code pair requirements were added, effective 07-01-12 Device C1882 C2619 C2621 Proc 33263 33221 33228 The following device/procedure code pair requirements were added, effective 01-01-13 Device C1722 C1722 C1722 C1767 C1778 Proc 0319T 0321T 0323T 0316T 0313T Device C1820 C1896 Proc 0316T 0320T The following device/procedure code pair requirements were removed, effective 01-01-13 Device L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8680 L8685 L8685 L8685 L8685 L8685 L8686 L8686 L8686 L8686 L8686 L8687 L8687 L8687 L8687 L8687 L8688 L8688 L8688 L8688 L8688 Proc 0267T 0282T 0283T 43647 63650 63655 64553 64555 64561 64565 64568 64575 64580 64581 0268T 61885 63685 64568 64590 0268T 61885 63685 64568 64590 0268T 61886 63685 64568 64590 0268T 61886 63685 64568 64590 Add-on/Primary Procedure Pair Changes The following add-on/primary procedure pair requirements were added, effective 01-01-13 Addon 33225 33225 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 Primary 33222 33223 90791 90792 90832 90833 90834 90836 90837 90838 99201 99202 99203 99204 99205 Addon 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90785 90833 90833 90833 90833 90833 90833 90833 90833 Primary 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99224 99225 99226 99231 99232 99233 99234 99235 99236 99238 99239 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 G0410 G0411 99201 99202 99203 99204 99205 99211 99212 99213 Addon 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90833 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 Primary 99214 99215 99217 99218 99219 99220 99221 99222 99223 99224 99225 99226 99231 99232 99233 99234 99235 99236 99238 99239 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 Addon 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90836 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 Primary 99220 99221 99222 99223 99224 99225 99226 99231 99232 99233 99234 99235 99236 99238 99239 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99224 Addon 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 90838 Primary 99225 99226 99231 99232 99233 99234 99235 99236 99238 99239 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 Skin Substitute Product Changes The following code(s) were added to the skin substitute product list, effective 01-01-13 HCPCS Q4131 Q4132 Q4133 The following code(s) were removed from the skin substitute product list, effective 01-01-13 HCPCS Q4100 Q4130 MODIFIERS Added Modifiers The following modifier(s) were added to the list of valid modifiers, effective 01-01-13 modif CH CI CJ CK CL CM CN LM RI ACTIVATIONDATE 0 0 0 0 0 0 0 0 0
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