1. No category

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