U.S. DEPARTMENT OF LABOR, OFFICE OF WORKERS ...

U.S. DEPARTMENT OF LABOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS 2015 FEE SCHEDULE MODIFIER LEVEL TABLESEffective Date: August 14, 2015Last Update: August 14, 2015File: Effective_August_14_2015_Mod_table.xls

CPT/HCPCS MOD MOD LEV DESCRIPTION00100 291 Anest for proced on integ sys - head/or saliv glands00102 291 Anesthesia for plastic repair of cleft lip00103 291 Anesthesia for bepharoplasty00104 291 Anesthesia for electroconvulsive therapy00120 291 Anest; proc-esternal/middle/inner ear, inc biopsy nos00124 291 Anesthesia for otoscopy00126 291 Anesthesia for tympanotomy00140 291 Anesthesia for procedures on eye; nos00142 291 Anesthesia for procedures on eye; lens surgery00144 291 Anest; procedures on eye; corneal transplant00145 291 Anesthesia for procedures on eye; vitrectomy00147 291 Anesthesia for iridectomy00148 291 Anesthesia for procedures on eye; opthalmoscopy00160 291 Anest; proc-nose and accessory sinuses; nos00162 291 Anest; proced-nose/accesory sinuses; rad surg00164 291 Anesth-proced on nose & access sinuses; biop/soft tis00170 291 Anesthesia for intraoral procedures, incl biopsy; nos00172 291 Anesth-intraoral proced, w/biop; repair-cleft palate00174 291 Anest; intraoral pro-w/biop-ex/retropharyngeal tumor00176 291 Anesth-intraoral proced, w/biopsy; rad surg00190 291 Anesthesia for procedures on facial bones; nos00192 291 Anest - proced on facial bones; rad surg00210 291 Anesthesia for intracranial proacedures nos00211 291 Anesth, cran surg, hemotoma00212 291 Anest; intracranial procedures; subdural taps00214 291 Anesthesia for intracranial procedures; burr holes00215 291 Anesthesia for skull fracture00216 291 Anesthesia-intracranial proced; vascular00218 291 Anesth-intracranial proced, in sitting position00220 291 Anest - intracranial proced; spinal fluid shunting proc00222 291 Anest - intracranial proc; electrocoag-cranial nerve00300 291 Anest; proc-integ sys of neck, incl subcu tissue00320 291 Anesth neck organ 1 yr/>00322 291 Anest proced on neck: needle biopsy of thyroid00350 291 Anesth; proc-on major vessels of neck; nos00352 291 Anesth-proc on maj vessels of neck; simple ligation00400 291 Anesth; proc on ant integ sys-chest a/subcu tise00402 291 Anest; proc-ant integ sys of chest; reconstr on breast00404 291 Anest; proc-ant integ sys of chest; radical/mod rad; breast00406 291 Anest; ant integ sys chest; rad/mod rad proc; breast w/node disse00410 291 Anest; proc ant integ chest; elec convers of arrhythmias00450 291 Anest; proc-on clavicle and scapula; nos00452 291 Anest; proc-clavicle & scapula; rad surg end-dated 12/31/201400454 291 Anesthesia for procedures on clavicle, biopsy00470 291 Anesthesia for partial rib resection nos00472 291 Anest; partial rib resection, thoracoplasty (any type)00474 291 Anesth surgery of rib00500 291 Anesthesia for all procedures on esophagus00520 291 Anest for closed chest proc nos00522 291 Anest - closed chest proced; needle biopsy-pleura00524 291 Anest for closed chest procedure; pneumocentesis00528 291 Anes mediascpy & dx thorscpy00529 291 Anes medscpy&thorscpy 1 lung00530 291 Anesthesia for permanent transvenous pacemaker insertion00532 291 Anesthesia for accesss to central venous circula00534 291 Anest-transven insert/replace-cardioverter/debfib00537 291 Anest for cardiac electrophysiologic procedures00539 291 Anest; tracheobronchial reconstruction00540 291 Anest; thoracot proced-lungs/pleura/dia/media nos00541 291 Anest; thoracot proced; one lung ventilation00542 291 Anesth remvl pleura00546 291 Anesth-thoracot; pul resection w/thoracoplasty00548 291 Anesth-thoracotomy; repair-trauma to trachea/bronchi00550 291 Anesthesia for sternal debridement00560 291 Anest-heart/pericard/great ves-chest; w/o pump oxygenator, ped00562 291 Anest-heart/pericard/great ves-chest; w/pump oxygenator


CPT/HCPCS MOD MOD LEV DESCRIPTION00563 291 Anest-heart/pericard/great ves-chest; w/pump oxyg w/hypotherm00566 291 Anest for direct coronary artery bypass graft w/out pump oxyg00567 291 Anesth, cabg w/pump00580 291 Anesthesia for heart transplant-heart/lung00600 291 Anesth for proced on cerv spine/cord; nos00604 291 Anesth-post cerv laminect-sitting position00620 291 Anesthesia-proced on thoracic spine/cord; nos00622 291 Anesthesia for thoracolumbar sympathectomy end-dated 12/31/201400625 291 Anes spine tranthor w/o vent00626 291 Anes, spine transthor w/vent00630 291 Anesthesia for procedures in lumbar region (nos)00632 291 Anesthesia for lumbar sympathectomy00634 291 Anesth-procedures in lum region; chemonucleolysis end-dated 12/31/201400635 291 Anesth-procedures in lum region; diag/therapeutic lum puncture00640 291 Anesth-manip of spine; closed proced on spine00670 291 Anesth-ext spine/spinal cord proced00700 291 Anesth-proced on upper ant abdom wall; (nos)00702 291 Anesthesia for percutaneous liver biopsy00730 291 Anesth-procedures on upper post abdominal wall00740 291 Anesth-upper gastrointestinal endoscopic proced00750 291 Anesthesia for hernia repairs in upper abdomen; (nos)00752 291 Anesth-repair lum/ventral hernias/wound dehiscence00754 291 Anesth-hernia repairs-up abdomen; omphalocele00756 291 Anesth-transabdominal repair-diaphragmatic hernia00770 291 Anesth-all procedures-major abdominal blood ves00790 291 Anesth-intraperitoneal proced-up abdo, w/laparos nos00792 291 Anesth-intraperitoneal proced up abdo-partial hepatectomy00794 291 Anesth-intraperitoneal pro/up abdo; pancreatect/part/tot00796 291 Anesth-intraperitoneal pro up abdo, shunts/liver transplant00797 291 Anesth-intraperitoneal pro up abdo, gastric restrict procedure00800 291 Anesth-pro low ant abdom wall nos00802 291 Anesth-pro low ant abdom wall; panniculectomy00810 291 Anesthesia for intestinal endoscopic procedures00820 291 Anesth-pro on low post abdominal wall00830 291 Anesthesia for hernia repairs in lower abdomen; (nos)00832 291 Anesth-hernia repair, ventral & incisional hernias00840 291 Anesth-intraperitoneal proced low abdo w/laparos; nos00842 291 Anesthesia for amniocentesis00844 291 Anesthesia for abdominoperitoneal resection00846 291 Anesthesia for radical hysterectomy00848 291 Anesthesia for pelvic exentration00851 291 Anesthesia for tubal ligation00860 291 Anesth-extraperitoneal low abdo, w/urinary tract-nos00862 291 Anesth-renal proced w/upper 1/3 ureter/donor nephrect00864 291 Aanesthesia for total cystectomy00865 291 Anest - extraperitoneal proced-lower abd; rad prostatectomy00866 291 Anesthesia for adrenalectomy00868 291 Anesthesia for renal transplant (recipient)00870 291 Anesthesia for cystolithiotomy00872 291 Anesth-lithotripsy/extracorp shock wave-w/h20 bath00873 291 Anesth-lithotripsy/extracorp shock wave-w/o h20 bath00880 291 Anesth-proced on maj low abdom ves; nos00882 291 Anesth-proced on maj low abdom ves; infer vena cava liga00902 291 Anesthesia for anorectal procedures00904 291 Anesthesia for radical perineal procedure00906 291 Anesthesia for vulvectomy00908 291 Anesthesia for perineal prostatectomy00910 291 Anesthesia for transurethral procedures00912 291 Anesthesia for transurethral resection of bladder00914 291 Anesthesia for transurethral resection of prostate00916 291 Anesthesia for post-transurethral resection bleeding00918 291 Anesthesia for transurethral procedures,w/fragmenta00920 291 Anesthesia-proced on male genital ext genitalia, nos00921 291 Anesthesia-vasectomy, unilat/bilateral00922 291 Anesthesia for procedures on seminal vesicles00924 291 Anesth-proced on undescended testis, unilat/bilat


CPT/HCPCS MOD MOD LEV DESCRIPTION00926 291 Anesthesia for radical orchiectomy, inguinal00928 291 Anesthesia for radical orchiectomy, abdominal00930 291 Anesthesia for orchiopexy, unilateral or bilateral00932 291 Anesthesia for complete amputation of penis00934 291 Anesth-radical amputat-penis w/bilat ing lymphaden00936 291 Anesth-rad amputa-penis w/bilat inguinal/iliac lymphaden00938 291 Anesth-insertion of penile prosthesis-perineal ap00940 291 Anesth-vaginal procedures, nos00942 291 Anesth-for colpotomy, colpectomy, colporrhaphy00944 291 Anesthesia for vaginal hysterectomy00948 291 Anesthesia for cervical cerclage00950 291 Anesthesia culdoscopy00952 291 Anesthesia for hysteroscopy01112 291 Anesthesia-bone marrow aspiration/biopsy, iliac crest01120 291 Anesthesia for procedures on bony pelvis01130 291 Anesthesia for body cast application or revision01140 291 Anesth for interpelviabdom amputation (hindquarter)01150 291 Anesth-rad proced tumor of pelvis, ex hindqtr amputation01160 291 Anesth-closed pro, involv symphysis pubis/sacroiliac jnt01170 291 Anesth-open pro involv symphysis pubis/sacroiliac jnt01173 291 Anesth-open repair, FX disrupt01180 291 Anesthesia for obturator neurectomy, extrapelvic01190 291 Anesthesia for obturator neurectomy, intrapelvic01200 291 Anesthesia for all closed procedures involving hip joint01202 291 Anesthesia for arthroscopic procedures of hip joint01210 291 Anesthesia for open procedures involving hip joint; (nos)01212 291 Anesthesia for hip disarticulation01214 291 Anesthesia for total hip replacement or revision01215 291 Anesthesia for revision of total hip arthroplasty01220 291 Anesth-all closed proced involv up 2/3 of femur-nos01230 291 Anesth-all open proced involv up 2/3 of femur nos01232 291 Anesth-open proced involv up 2/3 of femur; amputation01234 291 Anesth-open proced involv up 2/3 of femur; rad resect01250 291 Anesth-all proced nerves/mus/ten/fasc/bur-up leg01260 291 Anesth-all proced involv veins of up leg incl exploration01270 291 Anesth-all pro involv art-up leg, w/bypass graft; nos01272 291 Anesthesia for femoral artery ligation01274 291 Anesthesia for femoral artery embolectomy01320 291 Anest-all proc-nerves/mus/ten/fasc/bur-knee/popliteal area01340 291 Anesth-for all closed proced on lower 1/3 of femur01360 291 Anesth-for all open proced on lower 1/3 of femur01380 291 Anesth-for all closed proced on knee joint01382 291 Anesth-for diag. arthroscopic proced of knee joint01390 291 Anesth-all closed proced on up ends of tibia/fibula/patella01392 291 Anesth-all open proced on up ends of tibia/fibula/patella01400 291 Anesth-for open or surg arthro proced on knee joint nos01402 291 Anesthesia for total knee replacement01404 291 Anesthesia for disarticulation at knee01420 291 Anesth-all cast applica, removal/repair involv knee jnt01430 291 Anesth-proced on veins of knee/popliteal area nos01432 291 Anesth-proced - veins-knee/popli area; arterioven fistula01440 291 Anesth-for proced-arteries of knee/popli area nos01442 291 Anesth-popliteal thromboendarterectomy, w/wo pinch graft01444 291 Anesth-for popliteal excis/graft/repair for occlu/aneurysm01462 291 Anesthe-all closed proced on low leg/ankle/ft01464 291 Anesthesia for arthroscopic procedures on ankle/foot01470 291 Anest open proc-nerves/mus/tens/fascia, low leg/ank/ft01472 291 Anesth-repair of rupt achilles tendon, w/wo graft01474 291 Anest-pro-nerves/mus/ten/fascia-low leg/ank/ft; gastro recess01480 291 Anesth for open proced on bones-low leg/ank/ft nos01482 291 Anesth for open proced on bones-low leg/ank/ft; rad resect01484 291 Anesth-open proced; osteotomy/osteoplasty-tibia/fib01486 291 Anesthesia for open procedures; total ankle replacement01490 291 Anesthesia for lower leg cast application, removal or repair01500 291 Anesth-proced on arteries-low leg incl bypass graft nos01502 291 Anesth; proced-arteries-low leg; embolectomy-direct/cath


CPT/HCPCS MOD MOD LEV DESCRIPTION01520 291 Anesth for proced on veins of lower leg; nos01522 291 Anesth; proc veins-low leg; venous thrombect, direct-w/cath01610 291 Anest; proc-nerves/mus/tend, fascia/bursae-shoulder/axilla01620 291 Anesth; closed proc-hum head/neck/sternoclavic jnt/shoulder01622 291 Anesth; diag/arthroscopic procedures of shoulder joint01630 291 Anest; open/surg proc-hum head-neck/sternoclav/acromi/should jnts01634 291 Anesthesia for shoulder disarticulation01636 291 Anesthesia for interthoracoscapular (forquarter) amputation01638 291 Anesthesia for total shoulder replacment01650 291 Anesth-proced on arteries-shoulder/axilla nos01652 291 Anesth-proced on art-should-axilla; axil-brachial aneurysm01654 291 Anesth-proced-arteries of shoulder/axilla; bypass graft01656 291 Anesth-proced/art-shoulder/axilla; axillary-fem bypass graft01670 291 Anesthesia for all procedures on veins of shoulder/axilla01680 291 Anesthesia for shoulder cast application, repair or removal01682 291 Anesthesia for shoulder spica01710 291 Anest; proc-nerves/musc/tend/fascia/bursae-up arm/elbow nos01712 291 Anesthesia for tenotomy, elbow to shoulder, open01714 291 Anesthesia for tenoplasty, elbow to shoulder01716 291 Anesthesia for tenodesis, rupture of long tendon of biceps01730 291 Anesthesia for all closed procedures on humerus and elbow01732 291 Anesthesia for diagnostic arth proced, elbow jt01740 291 Anesthesia, open or surg arth proced on humerus/elbow (nos)01742 291 Anesthesia for osteotomy of humerus01744 291 Anesthesia for repair of nonunion or malunion of humerus01756 291 Anest for radical procedures (closed) on humerus or elbow01758 291 Anesthesia for excision of cyst or tumor of humerus01760 291 Anesthesia for total elbow replacement01770 291 Anesthesia-proced on arteries-upper arm/elbow; nos01772 291 Anesth-proced on arteries-up arm/elbow; embolectomy01780 291 Anesthesia for proced on veins of upper arm/elbow; nos01782 291 Anesth-proced on veins of upper arm/elbow; phleborrhaphy01810 291 Anest; proc-nerves/musc/tend/fascia/bursae/f-arm/wrist/hand01820 291 Anesth-all closed proced-radius/ulna/wrist/hand bones01829 291 Anesth, diag procedures on wrist01830 291 Anesth-open,surg arth/endosc proced-radius/ulna/wrist/hand jt, nos01832 291 Anesthesia for total wrist replacement01840 291 Anesth-proced on arteries of forearm, wrist/hand; nos01842 291 Anesthesia for embolectomy; forearm, wrist or hand01844 291 Anesth-for vascular shunt/shunt revision, any type01850 291 Anesth-proced-on veins of forearm, wrist/hand nos01852 291 Anesthesia for phleborrhaphy; forearm, wrist or hand01860 291 Anesth-forearm, wrist/hand cast applica, removal/repair01916 291 Anesth for arteriograms, needle; carotid/vertebral01920 291 Anest-cardiac cath w/coronary arterio/ventriculography01922 291 Anesthesia for cat scanning/mri01924 291 Anesthesia for ther interv radiol arterial procedure01925 291 Anesthesia for ther interv radiol arterial procedure01926 291 Anesthesia for ther interv radiol arterial procedure01930 291 Anesthesia for ther interv radiol venous procedure01931 291 Anesthesia for ther interv radiol venous procedure01932 291 Anesthesia for ther interv radiol venous procedure01933 291 Anes tx interv rad cran V 01935 291 Anesthesia for percutaneous img Dx Spinal proc 01936 291 Anesthesia for percutaneous img Tx Spinal proc 01951 291 Anesthesia for 2nd-3rd degree burn excis/debrid <1% body01952 291 Anesthesia for 2nd-3rd degree burn excis/debrid 1-9% body01953 291 Anesthesia for 2nd-3rd degree burn; each add'l 9% body01958 291 Anesthesia, external cephalic vesio01960 291 Anesthesia for vaginal delivery01961 291 Anesthesia for cesarean delivery01962 291 Anesthesia for urgent hysterectomy following delivery01963 291 Anesthesia for cesarean hysterectomy01965 291 Anesth incompl/missed abortion01967 291 Neuroaxial labor analgesia/anesthesia01968 291 Neuroaxial labor analgesia/anesthesia add-on code


CPT/HCPCS MOD MOD LEV DESCRIPTION01969 291 Neuroaxial labor analgesia/anesthesia add-on code01990 291 Physio sup-harvesting-organ(s) brain-dead patient01991 291 Anesth diag/therapeutic nerve block, inject, not prone01992 291 Anesth diag/therapeutic nerve block, inject, prone01996 291 Daily hospital mgmt of epidural/subarachoid drug adm01999 291 Unlisted anesthesia procedure(s)10021 142 Fine needle aspiration w/o image10022 142 Fine needle aspiration with image10030 104 Guide cathet fluid drainage 10040 22 Acne surgery10060 22 Drainage of skin abscess10061 24 Drainage of skin abscess10080 22 Drainage of pilonidal cyst10081 24 Drainage of pilonidal cyst10120 22 Remove foreign body, simple10121 24 Remove foreign body10140 22 Drainage of hematoma/fluid10160 22 Puncture drainage of lesion10180 24 Complex drainage, wound11000 92 Debride infected skin11001 244 Debride infected skin add-on11004 113 Debride genitalia & perineum11005 108 Debride abdom wall11006 113 Debride genit/per/abdom wall11008 246 Remove mesh from abd wall add-on11010 23 Debride skin, fx11011 103 Debride skin/muscle, fx11012 103 Debride skin/muscle/bone, fx11042 104 Debride skin/tissue11043 24 Debride tissue/muscle11044 24 Debride tissue/muscle/bone11045 244 Deb subq tissue add-on 11046 244 Deb musc fascia add-on 11047 244 Deb bone add-on 11055 100 Trim skin lesion11056 100 Trim skin lesions, 2 to 411057 100 Trim skin lesions, over 411100 100 Biopsy of skin lesion11101 243 Biopsy, skin add-on11200 53 Removal of skin tags11201 243 Remove skin tags add-on11300 254 Shave skin lesion11301 254 Shave skin lesion11302 254 Shave skin lesion11303 254 Shave skin lesion11305 254 Shave skin lesion11306 254 Shave skin lesion11307 254 Shave skin lesion11308 254 Shave skin lesion11310 254 Shave skin lesion11311 254 Shave skin lesion11312 254 Shave skin lesion11313 254 Shave skin lesion11400 22 Removal of skin lesion, 0.5 cm or less11401 22 Removal of skin lesion, 0.6 - 1.0 cm11402 22 Removal of skin lesion, 1.1 - 2.0 cm11403 24 Removal of skin lesion, 2.1 - 3.0 cm11404 24 Removal of skin lesion, 3.1 - 4.0 cm11406 24 Removal of skin lesion, over 4.0 cm11420 22 Removal of skin lesion, 0.5 cm or less11421 22 Removal of skin lesion, 0.6 - 1.0 cm11422 22 Removal of skin lesion, 1.1 - 2.0 cm11423 24 Removal of skin lesion, 2.1 - 3.0 cm11424 24 Removal of skin lesion, 3.1 - 4.0 cm11426 24 Removal of skin lesion, over 4.0 cm11440 22 Removal of skin lesion, 0.5 cm or less


CPT/HCPCS MOD MOD LEV DESCRIPTION11441 22 Removal of skin lesion, 0.6 - 1.0 cm11442 22 Removal of skin lesion, 1.1 - 2.0 cm11443 24 Removal of skin lesion, 2.1 - 3.0 cm11444 24 Removal of skin lesion, 3.1 - 4.0 cm11446 24 Removal of skin lesion, over 4.0 cm11450 24 Removal, sweat gland lesion11451 20 Removal, sweat gland lesion11462 20 Removal, sweat gland lesion11463 20 Removal, sweat gland lesion11470 24 Removal, sweat gland lesion11471 20 Removal, sweat gland lesion11600 24 Exc tr-ext mal+marg 0.5 < CM11601 24 Exc tr-ext mal+marg 0.6-1 CM11602 24 Exc tr-ext mal+marg 1.1-2 CM11603 24 Exc tr-ext mal+marg 2.1-3 CM11604 24 Exc tr-ext mal+marg 3.1-4 CM11606 24 Exc tr-ext mal+marg > 4 CM11620 24 Exc H-F-NK-SP mal+marg 0.5 <11621 24 Exc S/N/H/F/G mal+mrg 0.6-111622 24 Exc S/N/H/F/G mal+mrg 1.1-211623 24 Exc S/N/H/F/G aml+mrg 2.1-311624 24 Exc S/N/H/F/G mal+mrg 3.1-411626 24 Exc S/N/H/F/G mal+mrg > 4 CM11640 24 Exc F/E/E/N/L mal+mrg 0.5CM<11641 24 Exc F/E/E/N/L mal+mrg 0.6-111642 24 Exc F/E/E/N/L mal+mrg 1.1-211643 24 Exc F/E/E/N/L mal+mrg 2.1-311644 24 Exc F/E/E/N/L mal+mrg 3.1-411646 24 Exc F/E/E/N/L mal+mrg > 4 CM11719 100 Trim nail(s)11720 127 Debride nail, 1-511721 127 Debride nail, 6 or more11730 100 Removal of nail plate11732 243 Remove nail plate, add-on11740 126 Drain blood from under nail11750 22 Removal of nail bed11752 22 Remove nail bed/finger tip11755 93 Biopsy, nail unit11760 22 Repair of nail bed11762 22 Reconstruction of nail bed11765 22 Excision of nail fold, toe11770 53 Removal of pilonidal lesion11771 55 Removal of pilonidal lesion11772 55 Removal of pilonidal lesion11900 104 Injection into skin lesions11901 104 Added skin lesions injection11920 96 Correct skin color defects11921 96 Correct skin color defects11922 241 Correct skin color defects add-on11950 124 Therapy for contour defects11951 124 Therapy for contour defects11952 124 Therapy for contour defects11954 124 Therapy for contour defects11960 55 Insert tissue expander(s)11970 55 Replace tissue expander11971 50 Remove tissue expander(s)11981 205 Insert drug implant device11982 205 Remove drug implant device11983 205 Remove/reinsert drug implant12001 22 Repair superficial wound(s)12002 22 Repair superficial wound(s)12004 22 Repair superficial wound(s)12005 24 Repair superficial wound(s)12006 24 Repair superficial wound(s)12007 10 Repair superficial wound(s)12011 22 Repair superficial wound(s)


CPT/HCPCS MOD MOD LEV DESCRIPTION12013 22 Repair superficial wound(s)12014 22 Repair superficial wound(s)12015 22 Repair superficial wound(s)12016 22 Repair superficial wound(s)12017 18 Repair superficial wound(s)12018 6 Repair superficial wound(s)12020 22 Closure of split wound12021 22 Closure of split wound12031 24 Intmd wnd repair s/a/t/ext12032 24 Intmd wnd repair s/a/t/ext12034 24 Layer closure of wound(s)12035 24 Intmd wnd repair s/a/t/ext12036 24 Intmd wnd repair s/a/t/ext12037 8 Layer closure of wound(s)12041 24 Layer closure of wound(s)12042 24 Intmd wnd repair N-HF/GENIT12044 24 Intmd wnd repair N-HF/GENIT12045 24 Intmd wnd repair N-HF/GENIT12046 20 Intmd wnd repair N-HF/GENIT12047 8 Intmd wnd repair N-HF/GENIT12051 24 Layer closure of wound(s)12052 24 Layer closure of wound(s)12053 24 Layer closure of wound(s)12054 24 Layer closure of wound(s)12055 24 Layer closure of wound(s)12056 20 Layer closure of wound(s)12057 8 Layer closure of wound(s)13100 24 Repair of wound or lesion13101 24 Repair of wound or lesion13102 228 Repair wound/lesion add-on13120 24 Repair of wound or lesion13121 24 Repair of wound or lesion13122 228 Repair wound/lesion add-on13131 24 Repair of wound or lesion13132 24 Repair of wound or lesion13133 228 Repair wound/lesion add-on13150 24 Cmplx rpr e/n/e/l 1.0 cm/< end-dated 12/31/201313151 24 Repair of wound or lesion13152 24 Repair of wound or lesion13153 228 Repair wound/lesion add-on13160 24 Late closure of wound14000 24 Skin tissue rearrangement14001 24 Skin tissue rearrangement14020 24 Skin tissue rearrangement14021 24 Skin tissue rearrangement14040 24 Skin tissue rearrangement14041 24 Skin tissue rearrangement14060 24 Skin tissue rearrangement14061 24 Skin tissue rearrangement14301 20 Skin tissue rearrangement, 30.1-60 sq cm14302 241 Skin tissue rearrangement, add-on14350 20 Skin tissue rearrangement15002 97 Wnd prep, ch/inf, trk/arm/lg15003 241 Wnd prep, ch/inf addl 100 cm add-on15004 97 Wnd prep ch/inf, f/n/hf/g15005 241 Wnd prep, f/n/hf/g, addl cm15040 105 Harvest cultured skin graft15050 24 Skin pinch graft15100 24 Skin split graft15101 244 Skin split graft add-on15110 24 Epidrm autogrft trnk/arm/leg15111 244 Epidrm autogrft t/a/l add-on15115 24 Epidrm a-grft face/nck/hf/g15116 236 Epidrm a-grft f/n/hf/g addl15120 24 Skin split graft15121 236 Skin split graft add-on


CPT/HCPCS MOD MOD LEV DESCRIPTION15130 24 Derm autograft, trnk/arm/leg15131 236 Derm autograft t/a/l add-on15135 24 Derm autograft face/nck/hf/g15136 236 Derm autograft, f/n/hf/g add15150 24 Cult epiderm grft t/arm/leg15151 244 Cult skin grft t/a/l addl15152 244 Cult skin graft t/a/l +%15155 24 Cult skin graft f/n/hf/g15156 236 Cult skin frft f/n/hfg add15157 236 Cult epiderm grft f/n/hfg +%15200 24 Skin full graft15201 241 Skin full graft add-on15220 24 Skin full graft15221 244 Skin full graft add-on15240 24 Skin full graft15241 244 Skin full graft add-on15260 24 Skin full graft15261 244 Skin full graft add-on15271 24 Skin sub graft trnk/arm/leg 15272 244 Skin sub graft t/a/l add-on 15273 24 Skin sub graft t/arm/lg child 15274 244 Skn sub grft t/a/l child add 15275 24 Skin sub graft face/nk/hf/g 15276 244 Skin sub graft f/n/hf/g addl 15277 24 Skn sub grft f/n/hf/g child 15278 244 Skn sub grft f/n/hf/g/ch add 15570 24 Form skin pedicle flap15572 24 Form skin pedicle flap15574 24 Form skin pedicle flap15576 24 Form skin pedicle flap15600 20 Skin graft15610 20 Skin graft15620 24 Skin graft15630 24 Skin graft15650 20 Transfer skin pedicle flap15731 50 Forehead flap w/vasc pedicle15732 42 Muscle-skin graft, head/neck15734 8 Muscle-skin graft, trunk15736 10 Muscle-skin graft, arm15738 8 Muscle-skin graft, leg15740 24 Island pedicle flap graft15750 20 Neurovascular pedicle graft15756 12 Free muscle/myocutaneous flap, microvasc15757 12 Free skin flap, microvasc15758 12 Free fascial flap, microvasc15760 24 Composite skin graft15770 8 Derma-fat-fascia graft15775 96 Hair transplant punch grafts15776 96 Hair transplant punch grafts15777 63 Acellular derm matrix implt 15780 50 Abrasion treatment of skin15781 55 Abrasion treatment of skin15782 50 Abrasion treatment of skin15783 50 Abrasion treatment of skin15786 55 Abrasion, lesion, single15787 244 Abrasion, lesions, add-on15788 55 Chemical peel, face, epiderm15789 55 Chemical peel, face, dermal15792 50 Chemical peel, nonfacial15793 50 Chemical peel, nonfacial15823 57 Revision of upper eyelid15830 8 Exc skin abd15840 55 Graft for face nerve palsy15841 39 Graft for face nerve palsy15842 39 Graft for face nerve palsy15845 50 Skin and muscle repair, face


CPT/HCPCS MOD MOD LEV DESCRIPTION15847 234 Exc skin abd add-on15850 267 Removal of sutures, same surgeon15851 104 Removal of sutures15852 104 Dressing change,not for burn15860 96 Test for blood flow in graft15920 50 Removal of tail bone ulcer15922 39 Removal of tail bone ulcer15931 55 Remove sacrum pressure sore15933 50 Remove sacrum pressure sore15934 55 Remove sacrum pressure sore15935 39 Remove sacrum pressure sore15936 42 Remove sacrum pressure sore15937 42 Remove sacrum pressure sore15940 55 Remove hip pressure sore15941 50 Remove hip pressure sore15944 50 Remove hip pressure sore15945 50 Remove hip pressure sore15946 10 Remove hip pressure sore15950 55 Remove thigh pressure sore15951 39 Remove thigh pressure sore15952 39 Remove thigh pressure sore15953 42 Remove thigh pressure sore15956 42 Remove thigh pressure sore15958 42 Remove thigh pressure sore15999 198 Removal of pressure sore, unlisted16000 104 Initial treatment of burn(s)16020 104 Treatment of burn(s)16025 104 Treatment of burn(s)16030 104 Treatment of burn(s)16035 129 Incision of burn scab16036 249 Incise burn scab, ea addl incis17000 55 Destroy benign/premal lesion17003 244 Destroy lesions, 2-1417004 56 Destroy premal lesions 15/>17106 55 Destruction of skin lesions17107 55 Destruction of skin lesions17108 50 Destruction of skin lesions17110 55 Destruct lesion, 1-1417111 55 Destruct lesion, 15 or more17250 129 Chemical cautery, tissue17260 55 Destruction of skin lesions17261 55 Destruction of skin lesions17262 55 Destruction of skin lesions17263 55 Destruction of skin lesions17264 55 Destruction of skin lesions17266 55 Destruction of skin lesions17270 55 Destruction of skin lesions17271 55 Destruction of skin lesions17272 55 Destruction of skin lesions17273 55 Destruction of skin lesions17274 55 Destruction of skin lesions17276 55 Destruction of skin lesions17280 55 Destruction of skin lesions17281 55 Destruction of skin lesions17282 55 Destruction of skin lesions17283 55 Destruction of skin lesions17284 55 Destruction of skin lesions17286 55 Destruction of skin lesions17311 129 Mohs, 1 stage, h/n/hf/g17312 244 Mohs addl stage17313 129 Mohs, 1 stage, t/a/l17314 244 Mohs, addl stage, t/a/l17315 244 Mohs surg, addl block17340 55 Cryotherapy of skin17360 55 Skin peel therapy17999 198 Skin tissue procedure, unlisted


CPT/HCPCS MOD MOD LEV DESCRIPTION19000 129 Drainage of breast lesion19001 244 Drain breast lesion add-on19020 57 Incision of breast lesion19030 140 Injection for breast x-ray19081 131 Bx breast 1st lesion strtctc 19082 229 Bx breast add lesion strtctc 19083 131 Bx breast 1st lesion us imag 19084 229 Bx breast add lesion us imag 19085 131 Bx breast 1st lesion mr imag 19086 229 Bx breast add lesion mr imag 19100 131 Biopsy of breast19101 57 Biopsy of breast19102 31 Bx breast percut w/image end-dated 12/31/201319103 31 Bx breast percut w/device end-dated 12/31/201319105 131 Cryosurg ablate fa, each19110 57 Nipple exploration19112 52 Excise breast duct fistula19120 57 Removal of breast lesion19125 43 Excision, breast lesion19126 236 Excision, addl breast lesion19260 14 Removal of chest wall lesion19271 14 Revision of chest wall19272 14 Extensive chest wall surgery19281 241 Perq device breast 1st imag 19282 227 Perq device breast ea imag 19283 241 Perq dev breast 1st strtctc 19284 227 Perq dev breast add strtctc 19285 241 Perq dev breast 1st us imag 19286 227 Perq dev breast add us imag 19287 241 Perq dev breast 1st mr guide 19288 227 Perq dev breast add mr guide 19290 140 Place needle wire breast end-dated 12/31/201319291 246 Place needle wire breast end-dated 12/31/201319295 246 Place breast clip percut end-dated 12/31/201319296 125 Place po breast cath for rad19297 241 Place breast cath for rad add-on19298 125 Place breast rad tube/caths19300 57 Removal of breast tissue19301 52 Partial mastectomy 19302 40 P-mastectomy w/ln removal19303 40 Mast, simple, complete19304 40 Mast, subq19305 46 Mast, radical19306 46 Mast, rad, urban type19307 46 Mast, mod rad19316 40 Suspension of breast19318 40 Reduction of large breast19324 52 Enlarge breast19325 52 Enlarge breast with implant19328 57 Removal of breast implant19330 57 Removal of implant material19340 237 Immediate breast prosthesis19342 40 Delayed breast prosthesis19350 57 Breast reconstruction19355 52 Correct inverted nipple(s)19357 40 Breast reconstruction19361 46 Breast reconstruction19364 46 Breast reconstruction19366 40 Breast reconstruction19367 46 Breast reconstruction19368 46 Breast reconstruction19369 46 Breast reconstruction19370 57 Surgery of breast capsule19371 57 Removal of breast capsule19380 57 Revise breast reconstruction19396 125 Design custom breast implant


CPT/HCPCS MOD MOD LEV DESCRIPTION19499 199 Breast surgery procedure, unlisted20005 24 Incision of deep abscess20100 29 Explore wound, neck20101 30 Explore wound, chest20102 30 Explore wound, abdomen20103 20 Explore wound, extremity20150 40 Excise epiphyseal bar20200 104 Muscle biopsy20205 104 Deep muscle biopsy20206 104 Needle biopsy, muscle20220 104 Bone biopsy, trocar/needle20225 104 Bone biopsy, trocar/needle20240 24 Bone biopsy, excisional20245 24 Bone biopsy, excisional20250 24 Open bone biopsy20251 20 Open bone biopsy20500 24 Injection of sinus tract20501 113 Inject sinus tract for x-ray20520 24 Removal of foreign body20525 24 Removal of foreign body20526 106 Ther injection carpal tunnel20527 106 Inj dupuytren cord w/enzyme 20550 104 Injection(s), tendon sheath/ligament20551 104 Inject tendon origin/insert20552 104 Inject trigger points, 1 or 2 muscle groups20553 104 Inject trigger points, 3 or more muscle groups20555 124 Place needle musc/tiss for interstitial rad tx 20600 106 Drain/inject, joint/bursa20604 50 Drain/inject, joint/bursa w/us20605 106 Drain/inject, joint/bursa20606 50 Drain/inject, joint/bursa w/us20610 106 Drain/inject, joint/bursa20611 50 Drain/inject, joint/bursa w/us20612 129 Aspirate/inj. ganglion cyst20615 24 Treatment of bone cyst20650 10 Insert and remove bone pin20660 113 Apply,remove fixation device20661 30 Application of head brace20662 50 Application of pelvis brace20663 50 Application of thigh brace20665 20 Removal of fixation device20670 24 Removal of support implant20680 20 Removal of support implant20690 24 Apply bone fixation device20692 8 Apply bone fixation device20693 24 Adjust bone fixation device20694 24 Remove bone fixation device20696 8 Comp multiplane ext fixation20697 87 Comp ext fixate strut change20802 46 Replantation, arm, complete20805 46 Replant, forearm, complete20808 46 Replantation hand, complete20816 45 Replantation digit, complete20822 39 Replantation digit, complete20824 46 Replantation thumb, complete20827 46 Replantation thumb, complete20838 46 Replantation foot, complete20900 87 Removal of bone for graft20902 87 Removal of bone for graft20910 20 Remove cartilage for graft20912 20 Remove cartilage for graft20920 10 Removal of fascia for graft20922 8 Removal of fascia for graft20924 8 Removal of tendon for graft20926 24 Removal of tissue for graft20930 226 Sp bone algrft morsel add-on


CPT/HCPCS MOD MOD LEV DESCRIPTION20931 226 Spinal bone allograft20936 225 Sp bone agrft local add-on20937 225 Spinal bone autograft20938 225 Spinal bone autograft20950 124 Fluid pressure, muscle20955 45 Fibula bone graft, microvasc20956 45 Iliac bone graft, microvasc20957 45 Mt bone graft, microvasc20962 14 Other bone graft, microvasc20969 45 Bone/skin graft, microvasc20970 45 Bone/skin graft, iliac crest20972 50 Bone/skin graft, metatarsal20973 39 Bone/skin graft, great toe20974 114 Electrical bone stimulation20975 121 Electrical bone stimulation20979 130 Us bone stimulation20982 131 Ablation, bone tumor(s) (osteoid os)20983 50 Drain/Inj Joint/Bursa W/US20985 230 Cptr asst dir ms px20999 198 Musculoskeletal surgery, unlisted21010 52 Incision of jaw joint21011 20 Excise facial lesion sc < 2 cm21012 20 Exc face les sbq 2 CM/>21013 20 Excise facial tumor deep < 2 cm21014 20 Exc face tum deep 2 CM/>21015 24 Resect face/scalp tum < 2 cm 21016 50 Resect face/scalp tum 2 cm/> 21025 24 Excision of bone, lower jaw21026 24 Excision of facial bone(s)21029 50 Contour of face bone lesion21030 55 Excise max/zygoma benign tumor21031 55 Remove exostosis, mandible21032 55 Remove exostosis, maxilla21034 39 Excise max/zygoma mal tumor21040 55 Excise mandible lesion, simple21044 8 Removal of jaw bone lesion21045 45 Extensive jaw surgery21046 39 Remove mandible cyst, complex21047 39 Excise lwr jaw cyst w/repair21048 39 Remove maxilla cyst, complex21049 45 Excise uppr jaw cyst w/repair21050 21 Removal of jaw joint21060 9 Remove jaw joint cartilage21070 21 Remove coronoid process21073 21 Manipulation of TMJ, w/ anesth21076 50 Prepare face/oral prosthesis21077 52 Prepare face/oral prosthesis21079 55 Prepare face/oral prosthesis21080 55 Prepare face/oral prosthesis21081 50 Prepare face/oral prosthesis21082 50 Prepare face/oral prosthesis21083 50 Prepare face/oral prosthesis21084 50 Prepare face/oral prosthesis21085 50 Prepare face/oral prosthesis21086 52 Prepare face/oral prosthesis21087 50 Prepare face/oral prosthesis21088 51 Prepare face/oral prosthesis21089 219 Prepare face/oral prosthesis, unlisted21100 50 Maxillofacial fixation21110 55 Interdental fixation21116 137 Injection, jaw joint x-ray21120 42 Reconstruction of chin21121 20 Reconstruction of chin21122 50 Reconstruction of chin21123 8 Reconstruction of chin21125 50 Augmentation, lower jaw bone


CPT/HCPCS MOD MOD LEV DESCRIPTION21127 39 Augmentation, lower jaw bone21137 50 Reduction of forehead21138 39 Reduction of forehead21139 39 Reduction of forehead21141 14 Reconstruct midface, lefort21142 14 Reconstruct midface, lefort21143 14 Reconstruct midface, lefort21145 59 Reconstruct midface, lefort21146 45 Reconstruct midface, lefort21147 59 Reconstruct midface, lefort21150 50 Reconstruct midface, lefort21151 59 Reconstruct midface, lefort21154 14 Reconstruct midface, lefort21155 27 Reconstruct midface, lefort21159 14 Reconstruct midface, lefort21160 27 Reconstruct midface, lefort21172 45 Reconstruct orbit/forehead21175 59 Reconstruct orbit/forehead21179 59 Reconstruct entire forehead21180 45 Reconstruct entire forehead21181 50 Contour cranial bone lesion21182 45 Reconstruct cranial bone21183 45 Reconstruct cranial bone21184 59 Reconstruct cranial bone21188 27 Reconstruction of midface21193 13 Reconst lwr jaw w/o graft21194 58 Reconst lwr jaw w/graft21195 26 Reconst lwr jaw w/o fixation21196 44 Reconst lwr jaw w/fixation21198 8 Reconstr lwr jaw segment21199 8 Reconstr lwr jaw w/advance21206 8 Reconstruct upper jaw bone21208 20 Augmentation of facial bones21209 50 Reduction of facial bones21210 55 Face bone graft21215 42 Lower jaw bone graft21230 50 Rib cartilage graft21235 55 Ear cartilage graft21240 40 Reconstruction of jaw joint21242 40 Reconstruction of jaw joint21243 40 Reconstruction of jaw joint21244 39 Reconstruction of lower jaw21245 20 Reconstruction of jaw21246 50 Reconstruction of jaw21247 45 Reconstruct lower jaw bone21248 24 Reconstruction of jaw21249 50 Reconstruction of jaw21255 45 Reconstruct lower jaw bone21256 45 Reconstruction of orbit21260 8 Revise eye sockets21261 45 Revise eye sockets21263 45 Revise eye sockets21267 8 Revise eye sockets21268 45 Revise eye sockets21270 39 Augmentation, cheek bone21275 39 Revision, orbitofacial bones21280 21 Revision of eyelid21282 25 Revision of eyelid21295 50 Revision of jaw muscle/bone21296 50 Revision of jaw muscle/bone21299 198 Cranio/maxillofacial surgery, unlisted21310 104 Treatment of nose fracture21315 24 Treatment of nose fracture21320 24 Treatment of nose fracture21325 20 Treatment of nose fracture21330 20 Treatment of nose fracture


CPT/HCPCS MOD MOD LEV DESCRIPTION21335 24 Treatment of nose fracture21336 20 Treat nasal septal fracture21337 20 Treat nasal septal fracture21338 20 Treat nasoethmoid fracture21339 8 Treat nasoethmoid fracture21340 50 Treatment of nose fracture21343 14 Treatment of sinus fracture21344 45 Treatment of sinus fracture21345 20 Treat nose/jaw fracture21346 47 Treat nose/jaw fracture21347 45 Treat nose/jaw fracture21348 45 Treat nose/jaw fracture21355 20 Treat cheek bone fracture21356 20 Treat cheek bone fracture21360 20 Treat cheek bone fracture21365 14 Treat cheek bone fracture21366 45 Treat cheek bone fracture21385 45 Treat eye socket fracture21386 59 Treat eye socket fracture21387 59 Treat eye socket fracture21390 8 Treat eye socket fracture21395 14 Treat eye socket fracture21400 20 Treat eye socket fracture21401 20 Treat eye socket fracture21406 8 Treat eye socket fracture21407 39 Treat eye socket fracture21408 45 Treat eye socket fracture21421 20 Treat mouth roof fracture21422 14 Treat mouth roof fracture21423 45 Treat mouth roof fracture21431 27 Treat craniofacial fracture21432 59 Treat craniofacial fracture21433 45 Treat craniofacial fracture21435 59 Treat craniofacial fracture21436 45 Treat craniofacial fracture21440 20 Treat dental ridge fracture21445 20 Treat dental ridge fracture21450 20 Treat lower jaw fracture21451 20 Treat lower jaw fracture21452 50 Treat lower jaw fracture21453 20 Treat lower jaw fracture21454 8 Treat lower jaw fracture21461 10 Treat lower jaw fracture21462 8 Treat lower jaw fracture21465 8 Treat lower jaw fracture21470 45 Treat lower jaw fracture21480 106 Reset dislocated jaw21485 21 Reset dislocated jaw21490 40 Repair dislocated jaw21495 50 Treat hyoid bone fracture21497 50 Interdental wiring21499 198 Head surgery procedure, unlisted21501 24 Drain neck/chest lesion21502 50 Drain chest lesion21510 59 Drainage of bone lesion21550 24 Biopsy of neck/chest21552 20 Exc neck les sc 3 cm/>21554 20 Exc neck tum deep 5 cm/>21555 24 Remove lesion, neck/chest21556 24 Remove lesion, neck/chest21557 8 Resect neck thorax tumor<5cm 21558 39 Resect neck tumor 5 cm/> 21600 8 Partial removal of rib21610 20 Partial removal of rib21615 15 Removal of rib21616 60 Removal of rib and nerves


CPT/HCPCS MOD MOD LEV DESCRIPTION21620 14 Partial removal of sternum21627 27 Sternal debridement21630 14 Extensive sternum surgery21632 45 Extensive sternum surgery21685 39 Hyoid myotemy & suspension21700 20 Revision of neck muscle21705 59 Revision of neck muscle/rib21720 20 Revision of neck muscle21725 39 Revision of neck muscle21740 45 Reconstruction of sternum21742 14 Repair stern/nuss w/o scope21743 14 Repair sternum/nuss w/ scope21750 14 Repair of sternum separation21800 24 Treatment of rib fracture end-dated 12/31/201421805 20 Treatment of rib fracture21810 59 Treatment of rib fracture(s) end-dated 12/31/201421811 24 Optx of rib fx w/fixj scope21812 24 Treatment of rib fracture21813 24 Treatment of rib fracture21820 55 Treat sternum fracture21825 45 Treat sternum fracture21899 198 Neck/chest surgery procedure, unlisted21920 24 Biopsy soft tissue of back21925 24 Biopsy soft tissue of back21930 24 Remove lesion, back or flank21931 20 Exc back les sc 3 cm/>21932 20 Ecise back tumor deep < 5 cm21933 20 Exc back tum deep 5 cm/>21935 10 Resect back tum < 5 cm 21936 39 Resect back tum 5 cm/> 22010 27 I&d, p-spine, c/t/cerv-thor22015 30 I&d, p-spine, l/s/ls22100 14 Remove part of neck vertebra22101 14 Remove part, thorax vertebra22102 8 Remove part, lumbar vertebra22103 234 Remove extra spine segment22110 14 Remove part of neck vertebra22112 14 Remove part, thorax vertebra22114 14 Remove part, lumbar vertebra22116 238 Remove extra spine segment22206 45 Cut spine 3 col, thor22207 14 Cut spine 3 col, lumb22208 238 Revision of spine, 3 column, addl seg22210 14 Revision of neck spine22212 27 Revision of thorax spine22214 14 Revision of lumbar spine22216 238 Revise, extra spine segment22220 14 Revision of neck spine22222 27 Revision of thorax spine22224 14 Revision of lumbar spine22226 238 Revise, extra spine segment22305 24 Treat spine process fracture22310 24 Treat spine fracture22315 24 Treat spine fracture22318 45 Treat odontoid fx w/o graft22319 45 Treat odontoid fx w/graft22325 14 Treat spine fracture22326 45 Treat neck spine fracture22327 14 Treat thorax spine fracture22328 238 Treat each add spine fx22505 24 Manipulation of spine22510 225 Perq cervico thoracic inject22511 225 Perq lumbosacral inject22512 225 Vertebroplasty addl inject22513 225 Perq vertebral augmentation22514 225 Perq vertebral augmentation


CPT/HCPCS MOD MOD LEV DESCRIPTION22515 225 Perq vertebral augmentation22520 55 Percut vertebroplasty thor end-dated 12/31/201422521 55 Percut vertebroplasty lumb end-dated 12/31/201422522 244 Percut vertebroplasty, ea addl end-dated 12/31/201422523 55 Percut kyphoplasty, thor end-dated 12/31/201422524 55 Percut kyphoplasty, lumbar end-dated 12/31/201422525 244 Percut kyphoplasty, add-on end-dated 12/31/201422526 61 Idet, single level22527 249 Idet, 1 or more levels22532 45 Arthrodesis, lateral extracavitary, thoracic22533 45 Arthrodesis, lateral extracavitary, lumbar22534 238 Arthrodesis, lateral extracavitary, thoracic or lumbar22548 45 Neck spine fusion22551 14 Neck spine fuse&remove addl 22552 225 Addl neck spine fusion22554 14 Neck spine fusion22556 45 Thorax spine fusion22558 14 Lumbar spine fusion22585 238 Additional spinal fusion22586 14 Prescrl fuse w/ instr l5-s1 22590 45 Spine & skull spinal fusion22595 45 Neck spinal fusion22600 14 Neck spine fusion22610 14 Thorax spine fusion22612 45 Lumbar spine fusion22614 225 Spine fusion, extra segment22630 14 Lumbar spine fusion22632 238 Spine fusion, extra segment22633 14 Lumbar spine fusion combined 22634 238 Spine fusion extra segment 22800 14 Fusion of spine22802 14 Fusion of spine22804 45 Fusion of spine22808 14 Fusion of spine22810 45 Fusion of spine22812 45 Fusion of spine22818 3 Kyphectomy, 1-2 segments22819 34 Kyphectomy, 3 or more22830 14 Exploration of spinal fusion22840 225 Insert spine fixation device22842 225 Insert spine fixation device22843 238 Insert spine fixation device22844 238 Insert spine fixation device22845 225 Insert spine fixation device22846 225 Insert spine fixation device22847 225 Insert spine fixation device22848 225 Insert pelv fixation device22849 45 Reinsert spinal fixation22850 14 Remove spine fixation device22851 225 Apply spine prosth device22852 14 Remove spine fixation device22855 14 Remove spine fixation device22856 45 Cerv artific diskectomy22857 45 Lumbar artif diskectomy22858 45 Second level cer diskectomy22861 45 Revise cerv artific disc22862 34 Revise lumbar artif disc22864 14 Remove cerv artif disc22865 3 Remove lumb artif disc22899 198 Spine surgery procedure, unlisted22900 8 Remove abdominal wall lesion22901 8 Exc abdl tum deep 5 cm/>22902 8 Excise abd lesion sc < 3 cm22903 8 Exc abd les sc 3 cm/>22904 1 Radical resect abd tumor<5cm 22905 32 Rad resect abd tumor 5 cm/>


CPT/HCPCS MOD MOD LEV DESCRIPTION22999 198 Abdomen surgery procedure, unlisted23000 8 Removal of calcium deposits23020 52 Release shoulder joint23030 24 Drain shoulder lesion23031 25 Drain shoulder bursa23035 21 Drain shoulder bone lesion23040 9 Exploratory shoulder surgery23044 11 Exploratory shoulder surgery23065 25 Biopsy shoulder tissues23066 25 Biopsy shoulder tissues23071 21 Exc shoulder les sc 3 cm/>23073 21 Exc shoulder tum deep 5 cm/>23075 25 Removal of shoulder lesion23076 25 Removal of shoulder lesion23077 9 Resect shoulder tumor < 5 cm 23078 9 Resect shoulder tumor 5 cm/> 23100 9 Biopsy of shoulder joint23101 11 Shoulder joint surgery23105 9 Remove shoulder joint lining23106 11 Incision of collarbone joint23107 9 Explore treat shoulder joint23120 8 Partial removal, collar bone23125 9 Removal of collar bone23130 11 Remove shoulder bone, part23140 25 Removal of bone lesion23145 9 Removal of bone lesion23146 21 Removal of bone lesion23150 9 Removal of humerus lesion23155 9 Removal of humerus lesion23156 21 Removal of humerus lesion23170 25 Remove collar bone lesion23172 21 Remove shoulder blade lesion23174 9 Remove humerus lesion23180 11 Remove collar bone lesion23182 21 Remove shoulder blade lesion23184 9 Remove humerus lesion23190 9 Partial removal of scapula23195 9 Removal of head of humerus23200 46 Removal of collar bone23210 46 Removal of shoulder blade23220 46 Partial removal of humerus23330 21 Remove shoulder foreign body23331 21 Remove shoulder foreign body end-dated 12/31/201323332 46 Remove shoulder foreign body end-dated 12/31/201323333 021 Remove shoulder fb deep 23334 021 Shoulder prosthesis removal 23335 015 Shoulder prosthesis removal 23350 140 Injection for shoulder x-ray23395 8 Muscle transfer,shoulder/arm23397 39 Muscle transfers23400 40 Fixation of shoulder blade23405 8 Incision of tendon & muscle23406 50 Incise tendon(s) & muscle(s)23410 9 Repair of tendon(s)23412 9 Repair of tendon(s)23415 11 Release of shoulder ligament23420 9 Repair of shoulder23430 9 Repair biceps tendon23440 9 Remove/transplant tendon23450 9 Repair shoulder capsule23455 40 Repair shoulder capsule23460 40 Repair shoulder capsule23462 40 Repair shoulder capsule23465 40 Repair shoulder capsule23466 40 Repair shoulder capsule23470 15 Reconstruct shoulder joint


CPT/HCPCS MOD MOD LEV DESCRIPTION23472 46 Reconstruct shoulder joint23473 46 Revis reconst shoulder joint 23474 46 Revis reconst shoulder joint 23480 11 Revision of collar bone23485 9 Revision of collar bone23490 52 Reinforce clavicle23491 40 Reinforce shoulder bones23500 25 Treat clavicle fracture23505 25 Treat clavicle fracture23515 40 Treat clavicle fracture23520 21 Treat clavicle dislocation23525 21 Treat clavicle dislocation23530 21 Treat clavicle dislocation23532 52 Treat clavicle dislocation23540 25 Treat clavicle dislocation23545 21 Treat clavicle dislocation23550 9 Treat clavicle dislocation23552 40 Treat clavicle dislocation23570 25 Treat shoulder blade fx23575 21 Treat shoulder blade fx23585 40 Treat scapula fracture23600 25 Treat humerus fracture23605 25 Treat humerus fracture23615 9 Treat humerus fracture23616 40 Treat humerus fracture23620 25 Treat humerus fracture23625 25 Treat humerus fracture23630 9 Treat humerus fracture23650 25 Treat shoulder dislocation23655 25 Treat shoulder dislocation23660 9 Treat shoulder dislocation23665 25 Treat dislocation/fracture23670 40 Treat dislocation/fracture23675 25 Treat dislocation/fracture23680 40 Treat dislocation/fracture23700 24 Fixation of shoulder23800 40 Fusion of shoulder joint23802 39 Fusion of shoulder joint23900 59 Amputation of arm & girdle23920 14 Amputation at shoulder joint23921 55 Amputation follow-up surgery23929 198 Shoulder surgery procedure23930 25 Drainage of arm lesion23931 25 Drainage of arm bursa23935 21 Drain arm/elbow bone lesion24000 9 Exploratory elbow surgery24006 9 Release elbow joint24065 25 Biopsy arm/elbow soft tissue24066 25 Biopsy arm/elbow soft tissue24071 21 Exc arm/elbow les sc 3 cm/>24073 21 Ex arm/elbow tum deep 5 cm/>24075 25 Remove arm/elbow lesion24076 25 Remove arm/elbow lesion24077 11 Resect arm/elbow tum < 5 cm 24079 9 Resect arm/elbow tum 5 cm/> 24100 9 Biopsy elbow joint lining24101 21 Explore/treat elbow joint24102 9 Remove elbow joint lining24105 25 Removal of elbow bursa24110 11 Remove humerus lesion24115 9 Remove/graft bone lesion24116 21 Remove/graft bone lesion24120 21 Remove elbow lesion24125 9 Remove/graft bone lesion24126 21 Remove/graft bone lesion24130 11 Removal of head of radius


CPT/HCPCS MOD MOD LEV DESCRIPTION24134 21 Removal of arm bone lesion24136 25 Remove radius bone lesion24138 21 Remove elbow bone lesion24140 21 Partial removal of arm bone24145 11 Partial removal of radius24147 11 Partial removal of elbow24149 9 Radical resection of elbow24150 46 Extensive humerus surgery24152 9 Extensive radius surgery24155 9 Removal of elbow joint24160 43 Remove elbow joint implant 24164 43 Remove radius head implant24200 21 Removal of arm foreign body24201 25 Removal of arm foreign body24220 135 Injection for elbow x-ray24300 25 Manipulate elbow w/anesth24301 8 Muscle/tendon transfer24305 20 Arm tendon lengthening24310 20 Revision of arm tendon24320 8 Repair of arm tendon24330 21 Revision of arm muscles24331 52 Revision of arm muscles24332 25 Tenolysis, triceps24340 9 Repair of biceps tendon24341 9 Repair arm tendon/muscle24342 40 Repair of ruptured tendon24343 9 Repr elbow lat ligmnt w/tiss24344 9 Reconstruct elbow lat ligmnt24345 9 Repr elbw med ligmnt w/tiss24346 9 Reconstruct elbow med ligmnt24357 21 Repair elbow, perc24358 21 Repair elbow w/deb. open24359 21 Repair elbow deb/attch open24360 40 Reconstruct elbow joint24361 40 Reconstruct elbow joint24362 52 Reconstruct elbow joint24363 52 Replace elbow joint24365 9 Reconstruct head of radius24366 40 Reconstruct head of radius24370 52 Revise reconst elbow joint 24371 52 Revise reconst elbow joint 24400 9 Revision of humerus24410 9 Revision of humerus24420 40 Revision of humerus24430 9 Repair of humerus24435 40 Repair humerus with graft24470 52 Revision of elbow joint24495 21 Decompression of forearm24498 40 Reinforce humerus24500 25 Treat humerus fracture24505 25 Treat humerus fracture24515 9 Treat humerus fracture24516 40 Treat humerus fracture24530 25 Treat humerus fracture24535 25 Treat humerus fracture24538 57 Treat humerus fracture24545 9 Treat humerus fracture24546 40 Treat humerus fracture24560 25 Treat humerus fracture24565 25 Treat humerus fracture24566 57 Treat humerus fracture24575 40 Treat humerus fracture24576 25 Treat humerus fracture24577 25 Treat humerus fracture24579 40 Treat humerus fracture24582 57 Treat humerus fracture


CPT/HCPCS MOD MOD LEV DESCRIPTION24586 9 Treat elbow fracture24587 40 Treat elbow fracture24600 25 Treat elbow dislocation24605 25 Treat elbow dislocation24615 40 Treat elbow dislocation24620 21 Treat elbow fracture24635 40 Treat elbow fracture24640 21 Treat elbow dislocation24650 25 Treat radius fracture24655 25 Treat radius fracture24665 9 Treat radius fracture24666 40 Treat radius fracture24670 25 Treat ulnar fracture24675 25 Treat ulnar fracture24685 40 Treat ulnar fracture24800 40 Fusion of elbow joint24802 52 Fusion/graft of elbow joint24900 46 Amputation of upper arm24920 46 Amputation of upper arm24925 52 Amputation follow-up surgery24930 60 Amputation follow-up surgery24931 60 Amputate upper arm & implant24935 60 Revision of amputation24940 60 Revision of upper arm24999 199 Upper arm/elbow surgery, unlisted25000 25 Incision of tendon sheath25001 25 Incise flexor carpi radialis25020 25 Decompress forearm 1 space25023 21 Decompress forearm 1 space25024 25 Decompress forearm 2 spaces25025 21 Decompress forarm 2 spaces25028 25 Drainage of forearm lesion25031 21 Drainage of forearm bursa25035 21 Treat forearm bone lesion25040 21 Explore/treat wrist joint25065 25 Biopsy forearm soft tissues25066 25 Biopsy forearm soft tissues25071 21 Exc forearm les sc 3 cm/>25073 21 Exc forearm tum deep 3 cm/>25075 25 Remove forearm lesion subcut25076 25 Remove forearm lesion deep25077 25 Resect forearm/wrist tum<3cm 25078 21 Resect forarm/wrist tum 3cm> 25085 21 Incision of wrist capsule25100 21 Biopsy of wrist joint25101 21 Explore/treat wrist joint25105 9 Remove wrist joint lining25107 9 Remove wrist joint cartilage25109 25 Excise tendon forearm/wrist25110 25 Remove wrist tendon lesion25111 25 Remove wrist tendon lesion25112 25 Reremove wrist tendon lesion25115 25 Remove wrist/forearm lesion25116 9 Remove wrist/forearm lesion25118 25 Excise wrist tendon sheath25119 9 Partial removal of ulna25120 9 Removal of forearm lesion25125 21 Remove/graft forearm lesion25126 21 Remove/graft forearm lesion25130 21 Removal of wrist lesion25135 9 Remove & graft wrist lesion25136 9 Remove & graft wrist lesion25145 21 Remove forearm bone lesion25150 11 Partial removal of ulna25151 9 Partial removal of radius25170 46 Extensive forearm surgery


CPT/HCPCS MOD MOD LEV DESCRIPTION25210 8 Removal of wrist bone25215 8 Removal of wrist bones25230 11 Partial removal of radius25240 9 Partial removal of ulna25246 140 Injection for wrist x-ray25248 25 Remove forearm foreign body25250 21 Removal of wrist prosthesis25251 50 Removal of wrist prosthesis25259 25 Manipulate wrist w/anesthes25260 24 Repair forearm tendon/muscle25263 20 Repair forearm tendon/muscle25265 20 Repair forearm tendon/muscle25270 20 Repair forearm tendon/muscle25272 20 Repair forearm tendon/muscle25274 8 Repair forearm tendon/muscle25275 9 Repair forearm tendon sheath25280 8 Revise wrist/forearm tendon25290 24 Incise wrist/forearm tendon25295 24 Release wrist/forearm tendon25300 21 Fusion of tendons at wrist25301 21 Fusion of tendons at wrist25310 8 Transplant forearm tendon25312 8 Transplant forearm tendon25315 21 Revise palsy hand tendon(s)25316 21 Revise palsy hand tendon(s)25320 21 Repair/revise wrist joint25332 52 Revise wrist joint25335 52 Realignment of hand25337 57 Reconstruct ulna/radioulnar25350 21 Revision of radius25355 21 Revision of radius25360 9 Revision of ulna25365 21 Revise radius & ulna25370 21 Revise radius or ulna25375 9 Revise radius & ulna25390 9 Shorten radius or ulna25391 40 Lengthen radius or ulna25392 52 Shorten radius & ulna25393 52 Lengthen radius & ulna25394 9 Repair carpal bone, shorten25400 9 Repair radius or ulna25405 40 Repair/graft radius or ulna25415 9 Repair radius & ulna25420 40 Repair/graft radius & ulna25425 9 Repair/graft radius or ulna25426 40 Repair/graft radius & ulna25430 25 Vasc graft into carpal bone25431 40 Repair nonunion carpal bone25440 40 Repair/graft wrist bone25441 40 Reconstruct wrist joint25442 40 Reconstruct wrist joint25443 40 Reconstruct wrist joint25444 52 Reconstruct wrist joint25445 43 Reconstruct wrist joint25446 40 Wrist replacement25447 40 Repair wrist joints25449 40 Remove wrist joint implant25450 57 Revision of wrist joint25455 57 Revision of wrist joint25490 52 Reinforce radius25491 52 Reinforce ulna25492 52 Reinforce radius and ulna25500 25 Treat fracture of radius25505 25 Treat fracture of radius25515 40 Treat fracture of radius25520 25 Treat fracture of radius


CPT/HCPCS MOD MOD LEV DESCRIPTION25525 40 Treat fracture of radius25526 40 Treat fracture of radius25530 25 Treat fracture of ulna25535 25 Treat fracture of ulna25545 40 Treat fracture of ulna25560 25 Treat fracture radius & ulna25565 25 Treat fracture radius & ulna25574 9 Treat fracture radius & ulna25575 40 Treat fracture radius/ulna25600 25 Treat fracture radius/ulna25605 25 Treat fracture radius/ulna25606 25 Treat fx distal radial25607 21 Treat fx rad extra-articul25608 21 Treat fx rad intra-articul25609 21 Treat fx radial 3+ frag25622 25 Treat wrist bone fracture25624 21 Treat wrist bone fracture25628 21 Treat wrist bone fracture25630 25 Treat wrist bone fracture25635 21 Treat wrist bone fracture25645 21 Treat wrist bone fracture25650 25 Treat wrist bone fracture25651 21 Pin ulnar styloid fracture25652 11 Treat fracture ulnar styloid25660 21 Treat wrist dislocation25670 9 Treat wrist dislocation25671 25 Pin radioulnar dislocation25675 21 Treat wrist dislocation25676 52 Treat wrist dislocation25680 21 Treat wrist fracture25685 21 Treat wrist fracture25690 21 Treat wrist dislocation25695 9 Treat wrist dislocation25800 9 Fusion of wrist joint25805 9 Fusion/graft of wrist joint25810 9 Fusion/graft of wrist joint25820 9 Fusion of hand bones25825 40 Fuse hand bones with graft25830 40 Fusion, radioulnar jnt/ulna25900 29 Amputation of forearm25905 60 Amputation of forearm25907 52 Amputation follow-up surgery25909 60 Amputation follow-up surgery25915 60 Amputation of forearm25920 29 Amputate hand at wrist25922 52 Amputate hand at wrist25924 60 Amputation follow-up surgery25927 29 Amputation of hand25929 52 Amputation follow-up surgery25931 57 Amputation follow-up surgery25999 199 Forearm or wrist surgery, unlisted26010 24 Drainage of finger abscess26011 24 Drainage of finger abscess26020 24 Drain hand tendon sheath26025 20 Drainage of palm bursa26030 20 Drainage of palm bursas26034 24 Treat hand bone lesion26035 50 Decompress fingers/hand26037 50 Decompress fingers/hand26040 25 Release palm contracture26045 57 Release palm contracture26055 24 Incise finger tendon sheath26060 20 Incision of finger tendon26070 25 Explore/treat hand joint26075 25 Explore/treat finger joint26080 24 Explore/treat finger joint


CPT/HCPCS MOD MOD LEV DESCRIPTION26100 21 Biopsy hand joint lining26105 21 Biopsy finger joint lining26110 24 Biopsy finger joint lining26111 20 Exc hand les sc 1.5 cm/>26113 20 Exc hand tum deep 1.5 cm/>26115 24 Remove hand lesion subcut26116 24 Remove hand lesion, deep26117 24 Rad resect hand tumor < 3 cm 26118 20 Rad resect hand tumor 3 cm/> 26121 25 Release palm contracture26123 57 Release palm contracture26125 244 Release palm contracture26130 25 Remove wrist joint lining26135 20 Revise finger joint, each26140 24 Revise finger joint, each26145 24 Tendon excision, palm/finger26160 24 Remove tendon sheath lesion26170 20 Removal of palm tendon, each26180 20 Removal of finger tendon26185 9 Remove finger bone26200 20 Remove hand bone lesion26205 24 Remove/graft bone lesion26210 24 Removal of finger lesion26215 24 Remove/graft finger lesion26230 20 Partial removal of hand bone26235 20 Partial removal, finger bone26236 24 Partial removal, finger bone26250 50 Extensive hand surgery26260 20 Extensive finger surgery26262 20 Partial removal of finger26320 24 Removal of implant from hand26340 25 Manipulate finger w/anesth26341 25 Manipulat palm cord post inj 26350 24 Repair finger/hand tendon26352 8 Repair/graft hand tendon26356 24 Repair finger/hand tendon26357 20 Repair finger/hand tendon26358 20 Repair/graft hand tendon26370 20 Repair finger/hand tendon26372 50 Repair/graft hand tendon26373 20 Repair finger/hand tendon26390 39 Revise hand/finger tendon26392 39 Repair/graft hand tendon26410 24 Repair hand tendon26412 20 Repair/graft hand tendon26415 50 Excision, hand/finger tendon26416 55 Graft hand or finger tendon26418 24 Repair finger tendon26420 20 Repair/graft finger tendon26426 24 Repair finger/hand tendon26428 20 Repair/graft finger tendon26432 24 Repair finger tendon26433 24 Repair finger tendon26434 20 Repair/graft finger tendon26437 24 Realignment of tendons26440 24 Release palm/finger tendon26442 24 Release palm & finger tendon26445 24 Release hand/finger tendon26449 20 Release forearm/hand tendon26450 20 Incision of palm tendon26455 20 Incision of finger tendon26460 24 Incise hand/finger tendon26471 50 Fusion of finger tendons26474 50 Fusion of finger tendons26476 24 Tendon lengthening26477 10 Tendon shortening


CPT/HCPCS MOD MOD LEV DESCRIPTION26478 20 Lengthening of hand tendon26479 20 Shortening of hand tendon26480 20 Transplant hand tendon26483 39 Transplant/graft hand tendon26485 8 Transplant palm tendon26489 50 Transplant/graft palm tendon26490 50 Revise thumb tendon26492 39 Tendon transfer with graft26494 39 Hand tendon/muscle transfer26496 50 Revise thumb tendon26497 50 Finger tendon transfer26498 8 Finger tendon transfer26499 39 Revision of finger26500 20 Hand tendon reconstruction26502 20 Hand tendon reconstruction26508 50 Release thumb contracture26510 50 Thumb tendon transfer26516 20 Fusion of knuckle joint26517 20 Fusion of knuckle joints26518 8 Fusion of knuckle joints26520 24 Release knuckle contracture26525 10 Release finger contracture26530 20 Revise knuckle joint26531 8 Revise knuckle with implant26535 24 Revise finger joint26536 50 Revise/implant finger joint26540 8 Repair hand joint26541 39 Repair hand joint with graft26542 20 Repair hand joint with graft26545 20 Reconstruct finger joint26546 21 Repair nonunion hand26548 20 Reconstruct finger joint26550 50 Construct thumb replacement26551 59 Great toe-hand transfer26553 45 Single transfer, toe-hand26554 45 Double transfer, toe-hand26555 50 Positional change of finger26556 45 Toe joint transfer26560 20 Repair of web finger26561 39 Repair of web finger26562 50 Repair of web finger26565 20 Correct metacarpal flaw26567 20 Correct finger deformity26568 50 Lengthen metacarpal/finger26580 50 Repair hand deformity26587 50 Reconstruct poly digit, tissue, bone26590 50 Repair finger deformity26591 50 Repair muscles of hand26593 24 Release muscles of hand26596 50 Excision constricting tissue26600 24 Treat metacarpal fracture26605 24 Treat metacarpal fracture26607 20 Treat metacarpal fracture26608 20 Treat metacarpal fracture26615 24 Treat metacarpal fracture26641 20 Treat thumb dislocation26645 20 Treat thumb fracture26650 24 Treat thumb fracture26665 10 Treat thumb fracture26670 20 Treat hand dislocation26675 20 Treat hand dislocation26676 24 Pin hand dislocation26685 10 Treat hand dislocation26686 20 Treat hand dislocation26700 24 Treat knuckle dislocation26705 20 Treat knuckle dislocation


CPT/HCPCS MOD MOD LEV DESCRIPTION26706 24 Pin knuckle dislocation26715 20 Treat knuckle dislocation26720 24 Treat finger fracture, each26725 24 Treat finger fracture, each26727 24 Treat finger fracture, each26735 24 Treat finger fracture, each26740 24 Treat finger fracture, each26742 24 Treat finger fracture, each26746 24 Treat finger fracture, each26750 24 Treat finger fracture, each26755 24 Treat finger fracture, each26756 20 Pin finger fracture, each26765 24 Treat finger fracture, each26770 24 Treat finger dislocation26775 24 Treat finger dislocation26776 24 Pin finger dislocation26785 24 Treat finger dislocation26820 39 Thumb fusion with graft26841 8 Fusion of thumb26842 39 Thumb fusion with graft26843 8 Fusion of hand joint26844 39 Fusion/graft of hand joint26850 20 Fusion of knuckle26852 39 Fusion of knuckle with graft26860 24 Fusion of finger joint26861 244 Fusion of finger jnt, add-on26862 39 Fusion/graft of finger joint26863 241 Fuse/graft added joint26910 24 Amputate metacarpal bone26951 24 Amputation of finger/thumb26952 24 Amputation of finger/thumb26989 204 Hand/finger surgery, unlisted26990 24 Drainage of pelvis lesion26991 20 Drainage of pelvis bursa26992 27 Drainage of bone lesion27000 11 Incision of hip tendon27001 9 Incision of hip tendon27003 40 Incision of hip tendon27005 15 Incision of hip tendon27006 15 Incision of hip tendons27025 15 Incision of hip/thigh fascia27027 29 Buttock fasciotomy27030 15 Drainage of hip joint27033 9 Exploration of hip joint27035 40 Denervation of hip joint27036 15 Excision of hip joint/muscle27040 25 Biopsy of soft tissues27041 25 Biopsy of soft tissues27043 25 Exc hip pelvis les sc 3 cm/>27045 9 Exc hip/pelv tum deep 5 cm/>27047 25 Remove hip/pelvis lesion27048 9 Remove hip/pelvis lesion27049 9 Resect hip/pelv tum < 5 cm 27050 9 Biopsy of sacroiliac joint27052 9 Biopsy of hip joint27054 15 Removal of hip joint lining27057 29 Buttock fasciotomy w/dbrdmt27059 9 Resect hip/pelv tum 5 cm/> 27060 25 Removal of ischial bursa27062 11 Remove femur lesion/bursa27065 9 Removal of hip bone lesion27066 9 Removal of hip bone lesion27067 21 Remove/graft hip bone lesion27070 15 Partial removal of hip bone27071 15 Partial removal of hip bone


CPT/HCPCS MOD MOD LEV DESCRIPTION27075 45 Extensive hip surgery27076 45 Extensive hip surgery27077 45 Extensive hip surgery27078 14 Extensive hip surgery27080 39 Removal of tail bone27086 21 Remove hip foreign body27087 9 Remove hip foreign body27090 15 Removal of hip prosthesis27091 15 Removal of hip prosthesis27093 140 Injection for hip x-ray27095 140 Injection for hip x-ray27096 140 Inject sacroiliac joint27097 52 Revision of hip tendon27098 52 Transfer tendon to pelvis27100 40 Transfer of abdominal muscle27105 52 Transfer of spinal muscle27110 40 Transfer of iliopsoas muscle27111 40 Transfer of iliopsoas muscle27120 15 Reconstruction of hip socket27122 15 Reconstruction of hip socket27125 15 Partial hip replacement27130 15 Total hip arthroplasty27132 15 Total hip arthroplasty27134 15 Revise hip joint replacement27137 15 Revise hip joint replacement27138 15 Revise hip joint replacement27140 15 Transplant femur ridge27146 15 Incision of hip bone27147 15 Revision of hip bone27151 15 Incision of hip bones27156 15 Revision of hip bones27158 26 Revision of pelvis27161 15 Incision of neck of femur27165 15 Incision/fixation of femur27170 15 Repair/graft femur head/neck27175 60 Treat slipped epiphysis27176 46 Treat slipped epiphysis27177 46 Treat slipped epiphysis27178 46 Treat slipped epiphysis27179 29 Revise head/neck of femur27181 60 Treat slipped epiphysis27185 48 Revision of femur epiphysis27187 15 Reinforce hip bones27193 24 Treat pelvic ring fracture27194 8 Treat pelvic ring fracture27200 24 Treat tail bone fracture27202 50 Treat tail bone fracture27215 70 Treat pelvic fracture(s)27216 70 Treat pelvic ring fracture27217 70 Treat pelvic ring fracture27218 70 Treat pelvic ring fracture27220 25 Treat hip socket fracture27222 31 Treat hip socket fracture27226 15 Treat hip wall fracture27227 15 Treat hip fracture(s)27228 15 Treat hip fracture(s)27230 25 Treat thigh fracture27232 31 Treat thigh fracture27235 17 Treat thigh fracture27236 15 Treat thigh fracture27238 25 Treat thigh fracture27240 31 Treat thigh fracture27244 15 Treat thigh fracture27245 15 Treat thigh fracture27246 25 Treat thigh fracture27248 15 Treat thigh fracture


CPT/HCPCS MOD MOD LEV DESCRIPTION27250 106 Treat hip dislocation27252 25 Treat hip dislocation27253 15 Treat hip dislocation27254 15 Treat hip dislocation27256 21 Treat hip dislocation27257 21 Treat hip dislocation27258 15 Treat hip dislocation27259 29 Treat hip dislocation27265 25 Treat hip dislocation27266 25 Treat hip dislocation27267 9 Close tx, femor fx, prox end, head27268 15 Close tx, femor fx, w/mnpg27269 46 Open tx, femor fx, w/internal fixation27275 24 Manipulation of hip joint27279 70 Arthrodesis sacroiliac joing27280 46 Fusion of sacroiliac joint27282 45 Fusion of pubic bones27284 15 Fusion of hip joint27286 46 Fusion of hip joint27290 14 Amputation of leg at hip27295 14 Amputation of leg at hip27299 199 Pelvis/hip joint surgery, unlisted27301 25 Drain thigh/knee lesion27303 15 Drainage of bone lesion27305 40 Incise thigh tendon & fascia27306 21 Incision of thigh tendon27307 9 Incision of thigh tendons27310 9 Exploration of knee joint27323 25 Biopsy, thigh soft tissues27324 25 Biopsy, thigh soft tissues27325 21 Neurectomy, hamstring27326 9 Neurectomy, popliteal27327 25 Removal of thigh lesion27328 25 Removal of thigh lesion27329 9 Resect thigh/knee tum < 5 cm 27330 11 Biopsy, knee joint lining27331 9 Explore/treat knee joint27332 9 Removal of knee cartilage27333 9 Removal of knee cartilage27334 9 Remove knee joint lining27335 9 Remove knee joint lining27337 21 Exc thigh/knee les sc 3 cm/>27339 21 Exc thigh/knee tum dep 5cm/>27340 25 Removal of kneecap bursa27345 9 Removal of knee cyst27347 9 Remove knee cyst27350 9 Removal of kneecap27355 9 Remove femur lesion27356 9 Remove femur lesion/graft27357 9 Remove femur lesion/graft27358 227 Remove femur lesion/fixation27360 9 Partial removal, leg bone(s)27364 9 Resect thigh/knee tum 5 cm/> 27365 15 Extensive leg surgery27370 140 Injection for knee x-ray27372 21 Removal of foreign body27380 9 Repair of kneecap tendon27381 40 Repair/graft kneecap tendon27385 9 Repair of thigh muscle27386 9 Repair/graft of thigh muscle27390 20 Incision of thigh tendon27391 8 Incision of thigh tendons27392 38 Incision of thigh tendons27393 8 Lengthening of thigh tendon27394 20 Lengthening of thigh tendons27395 38 Lengthening of thigh tendons


CPT/HCPCS MOD MOD LEV DESCRIPTION27396 8 Transplant of thigh tendon27397 50 Transplants of thigh tendons27400 40 Revise thigh muscles/tendons27403 9 Repair of knee cartilage27405 9 Repair of knee ligament27407 9 Repair of knee ligament27409 9 Repair of knee ligaments27412 46 Autochondrocyte implant knee27415 46 Osteochondral knee allograft27416 21 Osteochondral knee autograft27418 9 Repair degenerated kneecap27420 9 Revision of unstable kneecap27422 9 Revision of unstable kneecap27424 9 Revision/removal of kneecap27425 11 Lateral retinacular release27427 9 Reconstruction, knee27428 9 Reconstruction, knee27429 9 Reconstruction, knee27430 9 Revision of thigh muscles27435 9 Incision of knee joint27437 11 Revise kneecap27438 9 Revise kneecap with implant27440 9 Revision of knee joint27441 9 Revision of knee joint27442 9 Revision of knee joint27443 9 Revision of knee joint27445 15 Revision of knee joint27446 9 Revision of knee joint27447 15 Total knee arthroplasty27448 15 Incision of thigh27450 15 Incision of thigh27454 15 Realignment of thigh bone27455 15 Realignment of knee27457 15 Realignment of knee27465 15 Shortening of thigh bone27466 15 Lengthening of thigh bone27468 15 Shorten/lengthen thighs27470 15 Repair of thigh27472 46 Repair/graft of thigh27475 11 Surgery to stop leg growth27477 17 Surgery to stop leg growth27479 52 Surgery to stop leg growth27485 62 Surgery to stop leg growth27486 15 Revise/replace knee joint27487 15 Revise/replace knee joint27488 15 Removal of knee prosthesis27495 15 Reinforce thigh27496 25 Decompression of thigh/knee27497 9 Decompression of thigh/knee27498 9 Decompression of thigh/knee27499 40 Decompression of thigh/knee27500 25 Treatment of thigh fracture27501 21 Treatment of thigh fracture27502 25 Treatment of thigh fracture27503 21 Treatment of thigh fracture27506 15 Treatment of thigh fracture27507 15 Treatment of thigh fracture27508 25 Treatment of thigh fracture27509 21 Treatment of thigh fracture27510 25 Treatment of thigh fracture27511 15 Treatment of thigh fracture27513 15 Treatment of thigh fracture27514 15 Treatment of thigh fracture27516 25 Treat thigh fx growth plate27517 21 Treat thigh fx growth plate27519 46 Treat thigh fx growth plate


CPT/HCPCS MOD MOD LEV DESCRIPTION27520 25 Treat kneecap fracture27524 15 Treat kneecap fracture27530 25 Treat knee fracture27532 25 Treat knee fracture27535 15 Treat knee fracture27536 15 Treat knee fracture27538 21 Treat knee fracture(s)27540 15 Treat knee fracture27550 21 Treat knee dislocation27552 21 Treat knee dislocation27556 15 Treat knee dislocation27557 15 Treat knee dislocation27558 15 Treat knee dislocation27560 25 Treat kneecap dislocation27562 21 Treat kneecap dislocation27566 9 Treat kneecap dislocation27570 24 Fixation of knee joint27580 15 Fusion of knee27590 15 Amputate leg at thigh27591 46 Amputate leg at thigh27592 46 Amputate leg at thigh27594 57 Amputation follow-up surgery27596 48 Amputation follow-up surgery27598 46 Amputate lower leg at knee27599 199 Leg surgery procedure, unlisted27600 11 Decompression of lower leg27601 25 Decompression of lower leg27602 9 Decompression of lower leg27603 25 Drain lower leg lesion27604 21 Drain lower leg bursa27605 21 Incision of achilles tendon27606 11 Incision of achilles tendon27607 25 Treat lower leg bone lesion27610 25 Explore/treat ankle joint27612 9 Exploration of ankle joint27613 25 Biopsy lower leg soft tissue27614 25 Biopsy lower leg soft tissue27615 9 Resect leg/ankle tum < 5 cm 27616 9 Resect leg/ankle tum 5 cm/> 27618 25 Remove lower leg lesion27619 25 Remove lower leg lesion27620 9 Explore/treat ankle joint27625 9 Remove ankle joint lining27626 21 Remove ankle joint lining27630 25 Removal of tendon lesion27632 21 Exc leg/ankle les sc 3 cm/>27634 21 Exc leg/ankle tum dep 5 cm/>27635 11 Remove lower leg bone lesion27637 9 Remove/graft leg bone lesion27638 9 Remove/graft leg bone lesion27640 11 Partial removal of tibia27641 11 Partial removal of fibula27645 15 Extensive lower leg surgery27646 15 Extensive lower leg surgery27647 21 Extensive ankle/heel surgery27648 135 Injection for ankle x-ray27650 9 Repair achilles tendon27652 11 Repair/graft achilles tendon27654 9 Repair of achilles tendon27656 52 Repair leg fascia defect27658 39 Repair of leg tendon, each27659 39 Repair of leg tendon, each27664 50 Repair of leg tendon, each27665 39 Repair of leg tendon, each27675 9 Repair lower leg tendons27676 21 Repair lower leg tendons


CPT/HCPCS MOD MOD LEV DESCRIPTION27680 10 Release of lower leg tendon27681 10 Release of lower leg tendons27685 8 Revision of lower leg tendon27686 10 Revise lower leg tendons27687 9 Revision of calf tendon27690 9 Revise lower leg tendon27691 9 Revise lower leg tendon27692 234 Revise additional leg tendon27695 11 Repair of ankle ligament27696 11 Repair of ankle ligaments27698 9 Repair of ankle ligament27700 9 Revision of ankle joint27702 15 Reconstruct ankle joint27703 29 Reconstruction, ankle joint27704 11 Removal of ankle implant27705 9 Incision of tibia27707 11 Incision of fibula27709 9 Incision of tibia & fibula27712 15 Realignment of lower leg27715 15 Revision of lower leg27720 9 Repair of tibia27722 15 Repair/graft of tibia27724 15 Repair/graft of tibia27725 15 Repair of lower leg27726 11 Repair fibula nonunion27727 15 Repair of lower leg27730 11 Repair of tibia epiphysis27732 25 Repair of fibula epiphysis27734 25 Repair lower leg epiphyses27740 21 Repair of leg epiphyses27742 9 Repair of leg epiphyses27745 9 Reinforce tibia27750 25 Treatment of tibia fracture27752 25 Treatment of tibia fracture27756 9 Treatment of tibia fracture27758 9 Treatment of tibia fracture27759 9 Treatment of tibia fracture27760 25 Treatment of ankle fracture27762 25 Treatment of ankle fracture27766 11 Treatment of ankle fracture27767 25 Closed tx posterior ankle fx 27768 25 Closed tx posterior ankle vs w/ mnpj27769 25 Open tx posterior ankle fx27780 25 Treatment of fibula fracture27781 25 Treatment of fibula fracture27784 11 Treatment of fibula fracture27786 25 Treatment of ankle fracture27788 25 Treatment of ankle fracture27792 11 Treatment of ankle fracture27808 25 Treatment of ankle fracture27810 25 Treatment of ankle fracture27814 9 Treatment of ankle fracture27816 25 Treatment of ankle fracture27818 25 Treatment of ankle fracture27822 9 Treatment of ankle fracture27823 9 Treatment of ankle fracture27824 25 Treat lower leg fracture27825 21 Treat lower leg fracture27826 9 Treat lower leg fracture27827 9 Treat lower leg fracture27828 9 Treat lower leg fracture27829 9 Treat lower leg joint27830 21 Treat lower leg dislocation27831 21 Treat lower leg dislocation27832 9 Treat lower leg dislocation27840 25 Treat ankle dislocation


CPT/HCPCS MOD MOD LEV DESCRIPTION27842 25 Treat ankle dislocation27846 9 Treat ankle dislocation27848 9 Treat ankle dislocation27860 20 Fixation of ankle joint27870 9 Fusion of ankle joint27871 9 Fusion of tibiofibular joint27880 15 Amputation of lower leg27881 15 Amputation of lower leg27882 15 Amputation of lower leg27884 25 Amputation follow-up surgery27886 17 Amputation follow-up surgery27888 46 Amputation of foot at ankle27889 43 Amputation of foot at ankle27892 52 Decompression of leg27893 52 Decompression of leg27894 52 Decompression of leg27899 199 Leg/ankle surgery procedure, unlisted28001 24 Drainage of bursa of foot28002 24 Treatment of foot infection28003 24 Treatment of foot infection28005 24 Treat foot bone lesion28008 25 Incision of foot fascia28010 24 Incision of toe tendon28011 24 Incision of toe tendons28020 10 Exploration of foot joint28022 24 Exploration of foot joint28024 24 Exploration of toe joint28035 10 Decompression of tibia nerve28039 21 Exc foot/toe tum sc 1.5 cm/>28041 21 Exc foot/toe tum dep 1.5cm/>28043 25 Excision of foot lesion28045 21 Excision of foot lesion28046 11 Resect foot/toe tumor < 3 cm 28047 9 Resect foot/toe tumor 3 cm/> 28050 11 Biopsy of foot joint lining28052 11 Biopsy of foot joint lining28054 21 Biopsy of toe joint lining28055 20 Neurectomy, foot28060 25 Partial removal, foot fascia28062 10 Removal of foot fascia28070 24 Removal of foot joint lining28072 24 Removal of foot joint lining28080 20 Removal of foot lesion28086 9 Excise foot tendon sheath28088 21 Excise foot tendon sheath28090 25 Removal of foot lesion28092 24 Removal of toe lesions28100 9 Removal of ankle/heel lesion28102 21 Remove/graft foot lesion28103 21 Remove/graft foot lesion28104 8 Removal of foot lesion28106 8 Remove/graft foot lesion28107 20 Remove/graft foot lesion28108 24 Removal of toe lesions28110 11 Part removal of metatarsal28111 11 Part removal of metatarsal28112 11 Part removal of metatarsal28113 21 Part removal of metatarsal28114 9 Removal of metatarsal heads28116 25 Revision of foot28118 9 Removal of heel bone28119 11 Removal of heel spur28120 11 Part removal of ankle/heel28122 9 Partial removal of foot bone28124 25 Partial removal of toe28126 24 Partial removal of toe


CPT/HCPCS MOD MOD LEV DESCRIPTION28130 9 Removal of ankle bone28140 10 Removal of metatarsal28150 24 Removal of toe28153 24 Partial removal of toe28160 24 Partial removal of toe28171 20 Extensive foot surgery28173 10 Extensive foot surgery28175 10 Extensive foot surgery28190 25 Removal of foot foreign body28192 25 Removal of foot foreign body28193 25 Removal of foot foreign body28200 10 Repair of foot tendon28202 39 Repair/graft of foot tendon28208 10 Repair of foot tendon28210 50 Repair/graft of foot tendon28220 24 Release of foot tendon28222 24 Release of foot tendons28225 10 Release of foot tendon28226 24 Release of foot tendons28230 24 Incision of foot tendon(s)28232 24 Incision of toe tendon28234 24 Incision of foot tendon28238 9 Revision of foot tendon28240 25 Release of big toe28250 9 Revision of foot fascia28260 9 Release of midfoot joint28261 21 Revision of foot tendon28262 9 Revision of foot and ankle28264 21 Release of midfoot joint28270 25 Release of foot contracture28272 25 Release of toe joint, each28280 21 Fusion of toes28285 11 Repair of hammertoe28286 24 Repair of hammertoe28288 24 Partial removal of foot bone28289 40 Repair hallux rigidus28290 25 Correction of bunion28292 9 Correction of bunion28293 9 Correction of bunion28294 9 Correction of bunion28296 9 Correction of bunion28297 40 Correction of bunion28298 9 Correction of bunion28299 9 Correction of bunion28300 9 Incision of heel bone28302 9 Incision of ankle bone28304 9 Incision of midfoot bones28305 9 Incise/graft midfoot bones28306 9 Incision of metatarsal28307 21 Incision of metatarsal28308 9 Incision of metatarsal28309 21 Incision of metatarsals28310 10 Revision of big toe28312 10 Revision of toe28313 24 Repair deformity of toe28315 11 Removal of sesamoid bone28320 8 Repair of foot bones28322 8 Repair of metatarsals28340 55 Resect enlarged toe tissue28341 55 Resect enlarged toe28344 42 Repair extra toe(s)28345 50 Repair webbed toe(s)28360 59 Reconstruct cleft foot28400 25 Treatment of heel fracture28405 21 Treatment of heel fracture28406 21 Treatment of heel fracture


CPT/HCPCS MOD MOD LEV DESCRIPTION28415 9 Treat heel fracture28420 40 Treat/graft heel fracture28430 25 Treatment of ankle fracture28435 21 Treatment of ankle fracture28436 57 Treatment of ankle fracture28445 40 Treat ankle fracture28446 9 Osteochondral talus autograft28450 24 Treat midfoot fracture, each28455 20 Treat midfoot fracture, each28456 24 Treat midfoot fracture28465 55 Treat midfoot fracture, each28470 24 Treat metatarsal fracture28475 24 Treat metatarsal fracture28476 20 Treat metatarsal fracture28485 10 Treat metatarsal fracture28490 24 Treat big toe fracture28495 24 Treat big toe fracture28496 24 Treat big toe fracture28505 55 Treat big toe fracture28510 24 Treatment of toe fracture28515 24 Treatment of toe fracture28525 50 Treat toe fracture28530 20 Treat sesamoid bone fracture28531 42 Treat sesamoid bone fracture28540 20 Treat foot dislocation28545 20 Treat foot dislocation28546 20 Treat foot dislocation28555 39 Repair foot dislocation28570 20 Treat foot dislocation28575 20 Treat foot dislocation28576 20 Treat foot dislocation28585 39 Repair foot dislocation28600 20 Treat foot dislocation28605 20 Treat foot dislocation28606 24 Treat foot dislocation28615 39 Repair foot dislocation28630 20 Treat toe dislocation28635 20 Treat toe dislocation28636 10 Treat toe dislocation28645 10 Repair toe dislocation28660 24 Treat toe dislocation28665 20 Treat toe dislocation28666 10 Treat toe dislocation28675 55 Repair of toe dislocation28705 39 Fusion of foot bones28715 8 Fusion of foot bones28725 8 Fusion of foot bones28730 8 Fusion of foot bones28735 39 Fusion of foot bones28737 39 Revision of foot bones28740 8 Fusion of foot bones28750 52 Fusion of big toe joint28755 11 Fusion of big toe joint28760 40 Fusion of big toe joint28800 15 Amputation of midfoot28805 29 Amputation thru metatarsal28810 20 Amputation toe & metatarsal28820 24 Amputation of toe28825 24 Partial amputation of toe28890 43 High energy eswt, plantar f28899 198 Foot/toes surgery procedure, unlisted29000 81 Application of body cast29010 81 Application of body cast29015 81 Application of body cast29020 81 Application of body cast end-dated 12/31/201429025 81 Application of body cast end-dated 12/31/2014


CPT/HCPCS MOD MOD LEV DESCRIPTION29035 81 Application of body cast29040 81 Application of body cast29044 81 Application of body cast29046 81 Application of body cast29049 80 Application of figure eight29055 80 Application of shoulder cast29058 80 Application of shoulder cast29065 84 Application of long arm cast29075 84 Application of forearm cast29085 84 Apply hand/wrist cast29086 84 Apply finger cast29105 84 Apply long arm splint29125 84 Apply forearm splint29126 84 Apply forearm splint29130 84 Application of finger splint29131 84 Application of finger splint29200 83 Strapping of chest29240 83 Strapping of shoulder29260 84 Strapping of elbow or wrist29280 84 Strapping of hand or finger29305 80 Application of hip cast29325 80 Application of hip casts29345 84 Application of long leg cast29355 84 Application of long leg cast29358 84 Apply long leg cast brace29365 84 Application of long leg cast29405 84 Apply short leg cast29425 84 Apply short leg cast29435 84 Apply short leg cast29440 84 Addition of walker to cast29445 84 Apply rigid leg cast29450 84 Application of leg cast29505 84 Application, long leg splint29515 84 Application lower leg splint29520 80 Strapping of hip29530 83 Strapping of knee29540 83 Strapping of ankle29550 83 Strapping of toes29580 84 Application of paste boot29581 82 Application of multlay comprs lwr leg29582 82 Apply multlay comprs upr leg 29583 82 Apply multlay comprs upr arm 29584 82 Appl multlay comprs arm/hand 29700 100 Removal/revision of cast29705 102 Removal/revision of cast29710 94 Removal/revision of cast29715 93 Removal/revision of cast end-dated 12/31/201429720 100 Repair of body cast29730 100 Windowing of cast29740 100 Wedging of cast29750 94 Wedging of clubfoot cast29799 198 Casting/strapping procedure, unlisted29800 21 Jaw arthroscopy/surgery29804 9 Jaw arthroscopy/surgery29805 11 Shoulder arthroscopy, dx29806 11 Shoulder arthroscopy/surgery29807 11 Shoulder arthroscopy/surgery29819 11 Shoulder arthroscopy/surgery29820 9 Shoulder arthroscopy/surgery29821 9 Shoulder arthroscopy/surgery29822 21 Shoulder arthroscopy/surgery29823 9 Shoulder arthroscopy/surgery29824 9 Shoulder arthroscopy/surgery29825 9 Shoulder arthroscopy/surgery29826 9 Shoulder arthroscopy/surgery29827 9 Arthroscopy rotator cuff repair


CPT/HCPCS MOD MOD LEV DESCRIPTION29828 9 Arthroscopy biceps tenodesis29830 25 Elbow arthroscopy29834 9 Elbow arthroscopy/surgery29835 9 Elbow arthroscopy/surgery29836 9 Elbow arthroscopy/surgery29837 9 Elbow arthroscopy/surgery29838 21 Elbow arthroscopy/surgery29840 21 Wrist arthroscopy29843 9 Wrist arthroscopy/surgery29844 21 Wrist arthroscopy/surgery29845 9 Wrist arthroscopy/surgery29846 21 Wrist arthroscopy/surgery29847 21 Wrist arthroscopy/surgery29848 25 Wrist endoscopy/surgery29850 9 Knee arthroscopy/surgery29851 40 Knee arthroscopy/surgery29855 9 Tibial arthroscopy/surgery29856 40 Tibial arthroscopy/surgery29860 9 Hip arthroscopy, dx29861 40 Hip arthroscopy/surgery29862 40 Hip arthroscopy/surgery29863 9 Hip arthroscopy/surgery29866 21 Autgrft implnt, knee w/scope29867 29 Allgrft implnt, knee w/scope29868 60 Meniscal trnspl, knee w/scpe29870 11 Knee arthroscopy, dx29871 25 Knee arthroscopy/drainage29873 11 Knee arthroscopy/surgery29874 21 Knee arthroscopy/surgery29875 21 Knee arthroscopy/surgery29876 25 Knee arthroscopy/surgery29877 21 Knee arthroscopy/surgery29879 21 Knee arthroscopy/surgery29880 9 Knee arthroscopy/surgery29881 21 Knee arthroscopy/surgery29882 25 Knee arthroscopy/surgery29883 21 Knee arthroscopy/surgery29884 9 Knee arthroscopy/surgery29885 9 Knee arthroscopy/surgery29886 25 Knee arthroscopy/surgery29887 9 Knee arthroscopy/surgery29888 9 Knee arthroscopy/surgery29889 9 Knee arthroscopy/surgery29891 52 Ankle arthroscopy/surgery29892 52 Ankle arthroscopy/surgery29893 11 Scope, plantar fasciotomy29894 9 Ankle arthroscopy/surgery29895 9 Ankle arthroscopy/surgery29897 21 Ankle arthroscopy/surgery29898 40 Ankle arthroscopy/surgery29899 9 Ankle arthroscopy/surgery29900 21 Mcp joint arthroscopy, dx29901 21 Mcp joint arthroscopy, surg29902 21 Mcp joint arthroscopy, surg29904 21 Subtalar arthro w/ fb removal29905 21 Subtalar arthro w/ exc29906 21 Subtalar arthro w/ deb29907 21 Subtalar arthro w/ fusion29914 40 Hip arthro w/femoroplasty 29915 40 Hip arthro acetabuloplasty 29916 40 Hip arthro w/labral repair 29999 202 Arthroscopy of joint, unlisted30000 20 Drainage of nose lesion30020 24 Drainage of nose lesion30100 104 Intranasal biopsy30110 25 Removal of nose polyp(s)


CPT/HCPCS MOD MOD LEV DESCRIPTION30115 25 Removal of nose polyp(s)30117 24 Removal of intranasal lesion30118 10 Removal of intranasal lesion30120 24 Revision of nose30124 24 Removal of nose lesion30125 20 Removal of nose lesion30130 25 Removal of turbinate bones30140 25 Removal of turbinate bones30150 10 Partial removal of nose30160 39 Removal of nose30200 104 Injection treatment of nose30210 55 Nasal sinus therapy30220 24 Insert nasal septal button30300 22 Remove nasal foreign body30310 20 Remove nasal foreign body30320 50 Remove nasal foreign body30400 50 Reconstruction of nose30410 50 Reconstruction of nose30420 55 Reconstruction of nose30430 50 Revision of nose30435 50 Revision of nose30450 50 Revision of nose30460 39 Revision of nose30462 39 Revision of nose30465 20 Repair nasal stenosis30520 55 Repair of nasal septum30540 50 Repair nasal defect30545 50 Repair nasal defect30560 24 Release of nasal adhesions30580 55 Repair upper jaw fistula30600 50 Repair mouth/nose fistula30620 55 Intranasal reconstruction30630 50 Repair nasal septum defect30801 23 Cauterization, inner nose30802 23 Cauterization, inner nose30901 102 Control of nosebleed30903 102 Control of nosebleed30905 99 Control of nosebleed30906 99 Repeat control of nosebleed30915 55 Ligation, nasal sinus artery30920 24 Ligation, upper jaw artery30930 25 Therapy, fracture of nose30999 198 Nasal surgery procedure, unlisted31000 25 Irrigation, maxillary sinus31002 21 Irrigation, sphenoid sinus31020 25 Exploration, maxillary sinus31030 25 Exploration, maxillary sinus31032 25 Explore sinus,remove polyps31040 42 Exploration behind upper jaw31050 25 Exploration, sphenoid sinus31051 57 Sphenoid sinus surgery31070 25 Exploration of frontal sinus31075 9 Exploration of frontal sinus31080 21 Removal of frontal sinus31081 9 Removal of frontal sinus31084 9 Removal of frontal sinus31085 9 Removal of frontal sinus31086 21 Removal of frontal sinus31087 9 Removal of frontal sinus31090 25 Exploration of sinuses31200 25 Removal of ethmoid sinus31201 25 Removal of ethmoid sinus31205 9 Removal of ethmoid sinus31225 15 Removal of upper jaw31230 15 Removal of upper jaw31231 103 Nasal endoscopy, dx


CPT/HCPCS MOD MOD LEV DESCRIPTION31233 106 Nasal/sinus endoscopy, dx31235 106 Nasal/sinus endoscopy, dx31237 106 Nasal/sinus endoscopy, surg31238 98 Nasal/sinus endoscopy, surg31239 52 Nasal/sinus endoscopy, surg31240 125 Nasal/sinus endoscopy, surg31254 106 Revision of ethmoid sinus31255 106 Removal of ethmoid sinus31256 106 Exploration maxillary sinus31267 106 Endoscopy, maxillary sinus31276 131 Sinus endoscopy, surgical31287 98 Nasal/sinus endoscopy, surg31288 125 Nasal/sinus endoscopy, surg31290 60 Nasal/sinus endoscopy, surg31291 60 Nasal/sinus endoscopy, surg31292 29 Nasal/sinus endoscopy, surg31293 60 Nasal/sinus endoscopy, surg31294 60 Nasal/sinus endoscopy, surg31295 106 Sinus endo w/balloon dil 31296 106 Sinus endo w/balloon dil 31297 106 Sinus endo w/balloon dil 31299 198 Sinus surgery procedure, unlisted31300 8 Removal of larynx lesion31320 20 Diagnostic incision, larynx31360 14 Removal of larynx31365 45 Removal of larynx31367 14 Partial removal of larynx31368 14 Partial removal of larynx31370 14 Partial removal of larynx31375 14 Partial removal of larynx31380 14 Partial removal of larynx31382 14 Partial removal of larynx31390 14 Removal of larynx & pharynx31395 45 Reconstruct larynx & pharynx31400 20 Revision of larynx31420 8 Removal of epiglottis31500 101 Insert emergency airway31502 129 Change of windpipe airway31505 104 Diagnostic laryngoscopy31510 96 Laryngoscopy with biopsy31511 104 Remove foreign body, larynx31512 96 Removal of larynx lesion31513 96 Injection into vocal cord31515 104 Laryngoscopy for aspiration31520 107 Diagnostic laryngoscopy31525 104 Diagnostic laryngoscopy31526 104 Diagnostic laryngoscopy31527 96 Laryngoscopy for treatment31528 96 Laryngoscopy and dilation31529 96 Laryngoscopy and dilation31530 104 Operative laryngoscopy31531 96 Operative laryngoscopy31535 104 Operative laryngoscopy31536 104 Operative laryngoscopy31540 104 Operative laryngoscopy31541 104 Operative laryngoscopy31545 131 Remove vc lesion w/scope31546 131 Remove vc lesion scope/graft31560 96 Operative laryngoscopy31561 96 Operative laryngoscopy31570 104 Laryngoscopy with injection31571 104 Laryngoscopy with injection31575 104 Diagnostic laryngoscopy31576 104 Laryngoscopy with biopsy31577 96 Remove foreign body, larynx31578 96 Removal of larynx lesion


CPT/HCPCS MOD MOD LEV DESCRIPTION31579 104 Diagnostic laryngoscopy31580 39 Revision of larynx31582 10 Revision of larynx31584 45 Treat larynx fracture31587 45 Revision of larynx31588 50 Revision of larynx31590 39 Reinnervate larynx31595 8 Larynx nerve surgery31599 198 Larynx surgery procedure, unlisted31600 113 Incision of windpipe31601 90 Incision of windpipe31603 104 Incision of windpipe31605 104 Incision of windpipe31610 30 Incision of windpipe31611 8 Surgery/speech prosthesis31612 96 Puncture/clear windpipe31613 24 Repair windpipe opening31614 55 Repair windpipe opening31615 129 Visualization of windpipe31620 249 Endobronchial us add-on31622 104 Dx bronchoscope/wash31623 104 Dx bronchoscope/brush31624 104 Dx bronchoscope/lavage31625 104 Bronchoscopy with biopsy31626 96 Bronchoscopy w/markers31627 246 Navigational bronchoscopy31628 104 Bronchoscopy with biopsy31629 104 Bronchoscopy with biopsy31630 104 Bronchoscopy w/ trach/bronch dilation31631 104 Bronchoscopy w/ placement of trach stent31632 244 Bronchoscopy/lung bx, add’l31633 244 Bronchoscopy/needle bx add’l31634 104 Bronch w/balloon occlusion 31635 104 Bronchoscopy w/fb removal31636 129 Bronchoscopy, bronch stents31637 244 Bronchoscopy, stent add-on31638 129 Bronchoscopy, revise stent31640 104 Bronchoscopy w/tumor excise31641 129 Bronchoscopy, treat blockage31643 104 Diag bronchoscope/catheter31645 104 Bronchoscopy, clear airways31646 104 Bronchoscopy, reclear airway31647 129 Bronchial valve init insert 31648 129 Bronchial valve remov init 31649 129 Bronchial valve remov addl 31651 129 Bronchial valve addl insert 31660 104 Bronch thermoplsty 1 lobe 31661 104 Bronch thermoplsty 2/> lobes 31717 104 Bronchial brush biopsy31720 104 Clearance of airways31725 113 Clearance of airways31730 129 Intro, windpipe wire/tube31750 39 Repair of windpipe31755 39 Repair of windpipe31760 45 Repair of windpipe31766 45 Reconstruction of windpipe31770 45 Repair/graft of bronchus31775 59 Reconstruct bronchus31780 45 Reconstruct windpipe31781 45 Reconstruct windpipe31785 45 Remove windpipe lesion31786 45 Remove windpipe lesion31800 27 Repair of windpipe injury31805 14 Repair of windpipe injury31820 20 Closure of windpipe lesion31825 20 Repair of windpipe defect


CPT/HCPCS MOD MOD LEV DESCRIPTION31830 20 Revise windpipe scar31899 198 Airways surgical procedure, unlisted32035 14 Thoracostomy w/rib resection32036 14 Thoracostomy w/flap drainage32096 12 Open wedge/bx lung infiltr 32097 12 Open wedge/bx lung nodule 32098 12 Open biopsy of lung pleura 32100 14 Exploration of chest32110 14 Explore/repair chest32120 14 Re-exploration of chest32124 14 Explore chest free adhesions32140 14 Removal of lung lesion(s)32141 45 Remove/treat lung lesions32150 45 Removal of lung lesion(s)32151 45 Remove lung foreign body32160 45 Open chest heart massage32200 14 Drain open lung lesion 32201 137 Drain percut lung lesion 32215 14 Treat chest lining32220 14 Release of lung32225 14 Partial release of lung32310 14 Removal of chest lining32320 14 Free/remove chest lining32400 104 Needle biopsy chest lining32405 129 Percut bx lung/mediastinum32440 14 Remove lung pneumonectomy32442 45 Sleeve pneumonectomy32445 45 Removal of lung extrapleural32480 14 Partial removal of lung32482 14 Bilobectomy32484 14 Segmentectomy32486 45 Sleeve lobectomy32488 45 Completion pneumonectomy32491 15 Lung volume reduction32501 238 Repair bronchus add-on32503 45 Resect apical lung tumor32504 45 Resect apical lung tum/chest32505 12 Wedge resect of lung initial 32506 12 Wedge resect of lung add-on 32507 12 Wedge resect of lung diag 32540 45 Removal of lung lesion32550 130 Insert pleural catheter32551 116 Insertion of chest tube32552 50 Remove lung catheter32553 124 Ins mark thor for rad tx perq, single/mult32554 130 Aspirate pleura w/o imaging 32555 130 Aspirate pleura w/ imaging 32556 130 Insert cath pleura w/o image 32557 130 Insert cath pleura w/ image 32560 113 Treat lung lining chemically32561 107 Lyse chest fibrin initial day32562 107 Lyse chest fibrin subsequent day32601 107 Thoracoscopy, diagnostic32604 107 Thoracoscopy wbx sac32606 107 Thoracoscopy w/bx med space32607 107 Thoracoscopy w/bx infiltrate 32608 107 Thoracoscopy w/bx nodule 32609 107 Thoracoscopy w/bx pleura 32650 14 Thoracoscopy w/pleurodesis32651 14 Thoracoscopy remove cortex32652 14 Thoracoscopy rem totl cortex32653 14 Thoracoscopy remov fb/fibrin32654 14 Thoracoscopy contrl bleeding32655 14 Thoracoscopy resect bullae32656 14 Thoracoscopy w/pleurectomy32658 45 Thoracoscopy w/sac fb remove


CPT/HCPCS MOD MOD LEV DESCRIPTION32659 14 Thoracoscopy w/sac drainage32661 45 Thoracoscopy w/pericard exc32662 45 Thoracoscopy w/mediast exc32663 45 Thoracoscopy w/lobectomy32664 46 Thoracoscopy w/ th nrv exc32665 45 Thoracoscop w/esoph musc exc32666 45 Thoracoscopy w/wedge resect 32667 45 Thoracoscopy w/w resect addl 32668 45 Thoracoscopy w/w resect diag 32669 45 Thoracoscopy remove segment 32670 45 Thoracoscopy bilobectomy 32671 45 Thoracoscopy pneumonectomy 32672 45 Thoracoscopy for LVRS 32673 45 Thoracoscopy w/thymus resect 32674 45 Thoracoscopy lumph node exc 32701 14 Thorax stereo rad targetw/tx 32800 45 Repair lung hernia32810 27 Close chest after drainage32815 14 Close bronchial fistula32820 14 Reconstruct injured chest32850 270 Donor pneumonectomy fr cadaver donor32851 3 Lung transplant, single32852 3 Lung transplant with bypass32853 2 Lung transplant, double32854 33 Lung transplant with bypass32855 175 Prepare donor lung, single32856 175 Prepare donor lung, double32900 14 Removal of rib(s)32905 14 Revise & repair chest wall32906 45 Revise & repair chest wall32940 14 Revision of lung32960 104 Therapeutic pneumothorax32997 113 Total lung lavage32998 96 Perq rf ablate tx, pul tumor32999 200 Chest surgery procedure, unlisted33010 104 Drainage of heart sac33011 96 Repeat drainage of heart sac33015 30 Incision of heart sac33020 14 Incision of heart sac33025 14 Incision of heart sac33030 14 Partial removal of heart sac33031 45 Partial removal of heart sac33050 45 Resect heart sac lesion33120 45 Removal of heart lesion33130 45 Removal of heart lesion33140 27 Heart revascularize (tmr)33141 225 Heart tmr w/other procedure33202 61 Insert epicard eltrd, open33203 61 Insert epicard eltrd, endo33206 10 Insert heart pm atrial33207 42 Insert heart pm ventricular33208 42 Insrt heart pm atrial & vent33210 104 Insert electrd/pm cath sngl33211 104 Insert card electrodes dual33212 24 Insert pulse gen sngl lead33213 24 Insert pulse gen dual leads33214 39 Upgrade of pacemaker system33215 24 Reposition pacing-defib lead33216 55 Revise eltrd pacing-defib33217 24 Revise eltrd pacing-defib33218 55 Revise eltrd pacing-defib33220 55 Revise eltrd pacing-defib33221 24 Insert pulse gen mult leads 33222 24 Relocation pocket pacemaker 33223 20 Relocate pocket for defib 33224 129 Insert pacing lead & connect


CPT/HCPCS MOD MOD LEV DESCRIPTION33225 228 L ventric pacing lead add-on33226 129 Reposition L ventric lead33227 129 Remove&replace pm gen singl 33228 129 Remv&replc pm gen dual lead 33229 129 Remv&replc pm gen mult leads 33230 24 Insrt pulse gen w/dual leads 33231 24 Insrt pulse gen w/mult leads 33233 24 Removal of pm generator33234 55 Removal of pacemaker system33235 55 Removal pacemaker electrode33236 45 Remove electrode/thoracotomy33237 45 Remove electrode/thoracotomy33238 45 Remove electrode/thoracotomy33240 24 Insrt pulse gen w/singl lead33241 8 Remove pulse generator33243 45 Remove eltrd/thoracotomy33244 47 Remove eltrd, transven33249 42 Insert pace-defib w/lead33250 14 Ablate heart dysrhythm focus33251 45 Ablate heart dysrhythm focus33254 14 Ablate atria, lmtd33255 14 Ablate atria w/o bypass, ext33256 14 Ablate atria w/bypass, exten33257 230 Ablate atria, lmtd, add-on33258 230 Ablate atria, x10sv, add-on33259 230 Ablate atria w/ bypass, add-on33261 45 Ablate heart dysrhythm focus33262 24 Remv&replc cvd gen sing lead 33263 24 Remv&replc cvd gen dual lead 33264 24 Remv&replc cvd gen mult lead 33265 45 Ablate atria w/bypass, endo33266 45 Ablate atria w/o bypass endo33270 45 Ins/rep subq defibrillator33271 45 Insj subq impltbl dfb elctrd33272 45 Rmvl of subq defibrillator33273 45 Repose prev impltbl subq dfb33282 55 Implant pat-active ht record33284 55 Remove pat-active ht record33300 14 Repair of heart wound33305 45 Repair of heart wound33310 14 Exploratory heart surgery33315 14 Exploratory heart surgery33320 14 Repair major blood vessel(s)33321 14 Repair major vessel33322 14 Repair major blood vessel(s)33330 14 Insert major vessel graft33332 14 Insert major vessel graft end-dated 12/31/201433335 14 Insert major vessel graft33361 14 Replace aortic valve perq 33362 14 Replace aortic vlave open 33363 14 Replace aortic valve open 33364 14 Replace aortic valve open 33365 14 Replace aortic valve open 33366 14 Trcath replace aortic valve 33367 14 Replace aortic valve w/byp 33368 14 Replace aortic valve w/byp 33369 14 Replace aortic valve w/byp 33400 14 Repair of aortic valve33401 14 Valvuloplasty, open33403 14 Valvuloplasty, w/cp bypass33404 45 Prepare heart-aorta conduit33405 45 Replacement of aortic valve33406 14 Replacement of aortic valve33410 14 Replacement of aortic valve33411 59 Replacement of aortic valve33412 14 Replacement of aortic valve


CPT/HCPCS MOD MOD LEV DESCRIPTION33413 14 Replacement of aortic valve33414 45 Repair of aortic valve33415 45 Revision, subvalvular tissue33416 14 Revise ventricle muscle33417 45 Repair of aortic valve33418 45 Repair Tcat mitral valve33419 45 Repair Tcat mitral valve33420 47 Revision of mitral valve33422 45 Revision of mitral valve33425 14 Repair of mitral valve33426 45 Repair of mitral valve33427 45 Repair of mitral valve33430 45 Replacement of mitral valve33460 14 Revision of tricuspid valve33463 14 Valvuloplasty, tricuspid33464 45 Valvuloplasty, tricuspid33465 45 Replace tricuspid valve33468 45 Revision of tricuspid valve33470 59 Revision of pulmonary valve33471 14 Valvotomy, pulmonary valve33472 27 Revision of pulmonary valve end-dated 12/31/201433474 14 Revision of pulmonary valve33475 45 Replacement, pulmonary valve33476 45 Revision of heart chamber33478 45 Revision of heart chamber33496 45 Repair, prosth valve clot33500 45 Repair heart vessel fistula33501 14 Repair heart vessel fistula33502 45 Coronary artery correction33503 14 Coronary artery graft33504 45 Coronary artery graft33505 45 Repair artery w/tunnel33506 45 Repair artery, translocation33507 45 Repair art, intramural33508 238 Endoscopic vein harvest33510 27 CABG, vein, single33511 27 CABG, vein, two33512 27 CABG, vein, three33513 27 CABG, vein, four33514 27 CABG, vein, five33516 59 Cabg, vein, six or more33517 230 CABG, artery-vein, single33518 230 CABG, artery-vein, two33519 230 CABG, artery-vein, three33521 230 CABG, artery-vein, four33522 230 CABG, artery-vein, five33523 246 Cabg, art-vein, six or more33530 230 Coronary artery, bypass/reop33533 27 CABG, arterial, single33534 27 CABG, arterial, two33535 27 CABG, arterial, three33536 59 Cabg, arterial, four or more33542 14 Removal of heart lesion33545 14 Repair of heart damage33548 45 Restore/remodel, ventricle33572 246 Open coronary endarterectomy33600 45 Closure of valve33602 45 Closure of valve33606 45 Anastomosis/artery-aorta33608 14 Repair anomaly w/conduit33610 45 Repair by enlargement33611 14 Repair double ventricle33612 45 Repair double ventricle33615 45 Repair, modified fontan33617 45 Repair single ventricle33619 45 Repair single ventricle


CPT/HCPCS MOD MOD LEV DESCRIPTION33641 45 Repair heart septum defect33645 14 Revision of heart veins33647 45 Repair heart septum defects33660 45 Repair of heart defects33665 45 Repair of heart defects33670 45 Repair of heart chambers33675 14 Close mult vsd33676 45 Close mult vsd w/resection33677 45 Cl mult vsd w/rem pul band33681 14 Repair heart septum defect33684 14 Repair heart septum defect33688 14 Repair heart septum defect33690 45 Reinforce pulmonary artery33692 14 Repair of heart defects33694 45 Repair of heart defects33697 45 Repair of heart defects33702 14 Repair of heart defects33710 59 Repair of heart defects33720 45 Repair of heart defect33722 45 Repair of heart defect33724 14 Repair venous anomaly33726 14 Repair pul venous stenosis33730 45 Repair heart-vein defect(s)33732 45 Repair heart-vein defect33735 27 Revision of heart chamber33736 14 Revision of heart chamber33737 45 Revision of heart chamber33750 45 Major vessel shunt33755 45 Major vessel shunt33762 45 Major vessel shunt33764 45 Major vessel shunt & graft33766 14 Major vessel shunt33767 45 Major vessel shunt33768 238 Cavopulmonary shunting33770 14 Repair great vessels defect33771 14 Repair great vessels defect33774 14 Repair great vessels defect33775 59 Repair great vessels defect33776 45 Repair great vessels defect33777 59 Repair great vessels defect33778 14 Repair great vessels defect33779 45 Repair great vessels defect33780 14 Repair great vessels defect33781 59 Repair great vessels defect33782 45 Nikaidoh proc, w/o ostia implt33783 45 Nikaidoh proc, w/ ostia implt(s)33786 45 Repair arterial trunk33788 45 Revision of pulmonary artery33800 45 Aortic suspension33802 14 Repair vessel defect33803 45 Repair vessel defect33813 14 Repair septal defect33814 45 Repair septal defect33820 59 Revise major vessel33822 45 Revise major vessel, <18yr33824 45 Revise major vessel33840 45 Remove aorta constriction33845 45 Remove aorta constriction33851 45 Remove aorta constriction33852 27 Repair septal defect33853 45 Repair septal defect33860 45 Ascending aortic graft33863 45 Ascending aortic graft33864 14 Ascending aortic graft33870 45 Transverse aortic arch graft33875 45 Thoracic aortic graft


CPT/HCPCS MOD MOD LEV DESCRIPTION33877 14 Thoracoabdominal graft33880 44 Endovasc taa repr incl subcl33881 44 Endovasc taa repr w/o subcl33883 45 Insert endovasc prosth, taa33884 238 Endovasc prosth, taa, add-on33886 45 Endovasc prosth, delayed33889 91 Artery transpose/endovas taa33891 122 Car-car bp grft/endovas taa33910 45 Remove lung artery emboli33915 14 Remove lung artery emboli33916 45 Surgery of great vessel33917 45 Repair pulmonary artery33920 14 Repair pulmonary atresia33922 45 Transect pulmonary artery33924 238 Remove pulmonary shunt33925 14 Rpr pul art unifocal w/o cpb33926 45 Repr pul art, unifocal w/cpb33930 270 Removal of donor heart/lung33933 201 Prepare donor heart/lung33935 34 Transplantation, heart/lung33940 270 Removal of donor heart33944 201 Prepare donor heart33945 34 Transplantation of heart33946 201 Ecmo/ecls initiation venous33948 201 Ecmo/ecls daily mgmt-venous33949 201 Ecmo/ecls daily mgmt artery33952 201 Ecmo/ecls insj prph cannula33954 201 Ecmo/ecls insj prph cannula33956 201 Ecmo/ecls insj ctr cannula33958 201 Ecmo/ecls repos perph cnula33960 121 External circulation assist end-dated 12/31/201433961 240 External circulation assist end-dated 12/31/201433962 201 Ecmo/ecls repos perph cnula33964 201 Ecmo/ecls repos perph cnula33966 201 Ecmo/ecls rmvl prph cannula33967 107 Insert ia percut device33968 138 Remove aortic assist device33970 90 Aortic circulation assist33971 61 Aortic circulation assist33973 120 Insert balloon device33974 61 Remove intra-aortic balloon33975 183 Implant ventricular device33976 182 Implant ventricular device33977 27 Remove ventricular device33978 26 Remove ventricular device33979 211 Insert intracorporeal device33980 59 Remove intracorporeal device33981 211 Replace VAD pump, single or bivent, ea.33982 211 Replace VAD intra W/O cardio bypass33983 211 Replace VAD intra w/ cardio bypass33984 211 Ecmo/ecls rmvl prph cannula33986 211 Ecmo/ecls rmvl ctr cannula33987 211 Artery expos rmvl ctr cannula33988 211 insertion of left heart vent33989 211 removal of left heart vent33990 211 Insert vad artery access 33991 211 Insert vad art&vein access 33992 211 Remove vad different session 33993 211 Reposition vad diff session 33999 198 Cardiac surgery procedure, unlisted34001 15 Removal of artery clot34051 15 Removal of artery clot34101 15 Removal of artery clot34111 15 Removal of arm artery clot34151 15 Removal of artery clot34201 15 Removal of artery clot


CPT/HCPCS MOD MOD LEV DESCRIPTION34203 15 Removal of leg artery clot34401 15 Removal of vein clot34421 15 Removal of vein clot34451 15 Removal of vein clot34471 48 Removal of vein clot34490 25 Removal of vein clot34501 46 Repair valve, femoral vein34502 59 Reconstruct vena cava34510 46 Transposition of vein valve34520 46 Cross-over vein graft34530 46 Leg vein fusion34800 14 Endovasc abdo repair w/tube34802 14 Endovasc abdo repr w/device34803 13 Endovas aaa repr w/3-p part34804 14 Endovasc abdo repr w/device34805 14 Endovasc abdo repair w/pros34806 238 Aneurysm press sensor, add-on34808 238 Endovasc abdo occlud device34812 91 Xpose for endoprosth, aortic34813 225 Xpose for endoprosth, femorl34820 91 Xpose for endoprosth, iliac34825 45 Endovasc extend prosth, init34826 238 Endovasc exten prosth, addl34830 45 Open aortic tube prosth repr34831 45 Open aortoiliac prosth repr34832 45 Open aortofemor prosth repr34833 91 Xpose for endoprosth, iliac34834 91 Xpose, endoposth, brachial34839 211 Plnning pt spec fenest graft34841 185 Endocasc visc aorta 1 graft 34842 185 Endovasc visc aorta 2 graft 34843 185 Endovasc visc aorta 3 graft 34844 185 Endovasc visc aorta 4 graft 34845 185 Visc & infraren abd 1 prosth 34846 185 Visc & infraren abd 2 prosth 34847 185 Visc & infraren abd 3 prosth 34848 185 Visc & infraren abd 4+ prost 34900 46 Endovasc iliac repr w/graft35001 46 Repair defect of artery35002 46 Repair artery rupture, neck35005 46 Repair defect of artery35011 46 Repair defect of artery35013 46 Repair artery rupture, arm35021 46 Repair defect of artery35022 46 Repair artery rupture, chest35045 46 Repair defect of arm artery35081 14 Repair defect of artery35082 14 Repair artery rupture, aorta35091 46 Repair defect of artery35092 46 Repair artery rupture, aorta35102 46 Repair defect of artery35103 46 Repair artery rupture aorta 35111 46 Repair defect of artery35112 46 Repair artery rupture,spleen35121 60 Repair defect of artery35122 46 Repair artery rupture, belly35131 46 Repair defect of artery35132 15 Repair artery rupture, groin35141 46 Repair defect of artery35142 46 Repair artery rupture, thigh35151 46 Repair defect of artery35152 46 Repair artery rupture, knee35180 45 Repair blood vessel lesion35182 45 Repair blood vessel lesion35184 45 Repair blood vessel lesion35188 39 Repair blood vessel lesion


CPT/HCPCS MOD MOD LEV DESCRIPTION35189 45 Repair blood vessel lesion35190 45 Repair blood vessel lesion35201 15 Repair blood vessel lesion35206 15 Repair blood vessel lesion35207 11 Repair blood vessel lesion35211 15 Repair blood vessel lesion35216 15 Repair blood vessel lesion35221 15 Repair blood vessel lesion35226 15 Repair blood vessel lesion35231 15 Repair blood vessel lesion35236 15 Repair blood vessel lesion35241 15 Repair blood vessel lesion35246 15 Repair blood vessel lesion35251 15 Repair blood vessel lesion35256 15 Repair blood vessel lesion35261 15 Repair blood vessel lesion35266 15 Repair blood vessel lesion35271 15 Repair blood vessel lesion35276 15 Repair blood vessel lesion35281 15 Repair blood vessel lesion35286 15 Repair blood vessel lesion35301 15 Rechanneling of artery35302 15 Rechanneling of artery35303 15 Rechanneling of artery35304 15 Rechanneling of artery35305 15 Rechanneling of artery35306 238 Rechanneling of artery35311 15 Rechanneling of artery35321 15 Rechanneling of artery35331 15 Rechanneling of artery35341 15 Rechanneling of artery35351 15 Rechanneling of artery35355 15 Rechanneling of artery35361 15 Rechanneling of artery35363 15 Rechanneling of artery35371 15 Rechanneling of artery35372 15 Rechanneling of artery35390 238 Reoperation, carotid add-on35400 238 Angioscopy35450 91 Repair arterial blockage35452 91 Repair arterial blockage35458 91 Repair arterial blockage35460 119 Repair venous blockage35471 116 Repair arterial blockage35472 91 Repair arterial blockage35475 106 Repair arterial blockage35476 131 Repair venous blockage35500 225 Harvest vein for bypass35501 46 Artery bypass graft35506 15 Artery bypass graft35508 15 Artery bypass graft35509 15 Artery bypass graft35510 15 Artery bypass graft35511 15 Artery bypass graft35512 15 Artery bypass graft35515 15 Artery bypass graft35516 15 Artery bypass graft35518 15 Artery bypass graft35521 15 Artery bypass graft35522 15 Artery bypass graft35523 46 Artery bypass graft35525 15 Artery bypass graft35526 15 Artery bypass graft35531 15 Artery bypass graft35533 46 Artery bypass graft35535 46 Artery bypass graft


CPT/HCPCS MOD MOD LEV DESCRIPTION35536 15 Artery bypass graft35537 14 Artery bypass graft35538 14 Artery bypass graft35539 15 Artery bypass graft35540 17 Artery bypass graft35556 15 Artery bypass graft35558 15 Artery bypass graft35560 15 Artery bypass graft35563 15 Artery bypass graft35565 15 Artery bypass graft35566 46 Artery bypass graft35570 46 Artery bypass graft35571 46 Artery bypass graft35572 246 Harvest femoropopliteal vein35583 46 Vein bypass graft35585 46 Vein bypass graft35587 46 Vein bypass graft35600 238 Harvest artery for cabg35601 15 Artery bypass graft35606 15 Artery bypass graft35612 15 Artery bypass graft35616 15 Artery bypass graft35621 46 Artery bypass graft35623 46 Bypass graft, not vein35626 15 Artery bypass graft35631 15 Artery bypass graft35632 15 Artery bypass graft35633 46 Artery bypass graft35634 46 Artery bypass graft35636 15 Artery bypass graft35637 45 Artery bypass graft35638 45 Artery bypass graft35642 46 Artery bypass graft35645 15 Artery bypass graft35646 14 Artery bypass graft35647 15 Aortofemoral bypass graft35650 15 Artery bypass graft35654 45 Artery bypass graft35656 15 Artery bypass graft35661 15 Artery bypass graft35663 15 Artery bypass graft35665 15 Artery bypass graft35666 46 Artery bypass graft35671 15 Artery bypass graft35681 225 Composite bypass graft35682 225 Composite bypass graft35683 225 Composite bypass graft35685 225 Bypass graft patency/patch35686 238 Bypass graft/av fist patency35691 46 Arterial transposition35693 46 Arterial transposition35694 15 Arterial transposition35695 46 Arterial transposition35697 238 Reimplant artery each35700 225 Reoperation, bypass graft35701 15 Exploration, carotid artery35721 15 Exploration, femoral artery35741 15 Exploration popliteal artery35761 9 Exploration of artery/vein35800 14 Explore neck vessels35820 14 Explore chest vessels35840 14 Explore abdominal vessels35860 14 Explore limb vessels35870 45 Repair vessel graft defect35875 10 Removal of clot in graft35876 8 Removal of clot in graft


CPT/HCPCS MOD MOD LEV DESCRIPTION35879 46 Revise graft w/vein35881 46 Revise graft w/vein35883 15 Revise graft w/nonauto graft35884 46 Revise graft w/vein35901 45 Excision, graft, neck35903 45 Excision, graft, extremity35905 45 Excision, graft, thorax35907 45 Excision, graft, abdomen36000 191 Place needle in vein36002 106 Pseudoaneurysm injection trt36005 110 Injection ext venography36010 196 Place catheter in vein36011 196 Place catheter in vein36012 196 Place catheter in vein36013 192 Place catheter in artery36014 196 Place catheter in artery36015 196 Place catheter in artery36100 196 Establish access to artery36120 192 Establish access to artery36140 192 Establish access to artery36147 176 Access av dial grft for eval36148 246 Access av dial grft for proc36160 192 Establish access to aorta36200 196 Place catheter in aorta36215 192 Place catheter in artery36216 192 Place catheter in artery36217 192 Place catheter in artery36218 232 Place catheter in artery36221 192 Place cath thoracic aorta 36222 192 Place cath carotid/inom art 36223 192 Place cath carotid/inom art 36224 192 Place cath carotd art 36225 192 Place cath subclavian art 36226 192 Place cath vertebral art 36227 192 Place cath xtrnl carotid 36228 192 Place cath intracranial art 36245 196 Ins cath abd/l ext art 1ST36246 196 Ins cath abd/l ext art 2ND36247 196 Ins cath abd/l ext art 3RD36248 232 Ins cath abd/l ext art addl36251 14 Ins cath ren art 1st unilat 36252 14 Ins cath ren art 1st bilat 36253 14 Ins cath ren art 2nd+ unilat 36254 14 Ins cath ren art 2nd+ bilat 36260 55 Insertion of infusion pump36261 20 Revision of infusion pump36262 55 Removal of infusion pump36299 198 Vessel injection procedure, unlisted36410 192 Non-routine bl draw, > 3 yrs36415 266 Routine venipuncture36425 179 Establish access to vein36430 180 Blood transfusion service36455 208 Exchange transfusion service36468 124 Injection(s), spider veins36469 124 Injection(s), spider veins36470 25 Injection therapy of vein36471 57 Injection therapy of veins36475 131 Endovenous rf, 1st vein36476 245 Endovenous rf, vein add-on36478 131 Endovenous laser, 1st vein36479 245 Endovenous laser vein addon36481 113 Insertion of catheter, vein36500 113 Insertion of catheter, vein36511 129 Apheresis wbc36512 129 Apheresis rbc36513 129 Apheresis platelets


CPT/HCPCS MOD MOD LEV DESCRIPTION36514 129 Apheresis plasma36515 129 Apheresis, adsorp/reinfuse36516 129 Apheresis, selective36522 129 Photopheresis36556 105 Insert non-tunnel cv cath36558 21 Insert tunneled cv cath36561 21 Insert tunneled cv cath36563 20 Insert tunneled cv cath36565 21 Insert tunneled cv cath36566 21 Insert tunneled cv cath36569 105 Insert tunneled cv cath36571 21 Insert tunneled cv cath36575 96 Repair tunneled cv cath36576 20 Repair tunneled cv cath36578 20 Replace tunneled cv cath36580 130 Replace tunneled cv cath36581 50 Replace tunneled cv cath36582 50 Replace tunneled cv cath36583 50 Replace tunneled cv cath36584 130 Replace tunneled cv cath36585 50 Replace tunneled cv cath36589 52 Removal tunneled cv cath36590 50 Removal tunneled cv cath36591 213 Draw blood off venous device36592 213 Collect blood from PICC36593 177 Declot vascular device36595 129 Mech remov tunneled cv cath36596 104 Mech remov tunneled cv cath36597 104 Reposition venous catheter36598 125 Inj w/fluor, eval cv device36600 192 Withdrawal of arterial blood36620 114 Insertion catheter, artery36625 114 Insertion catheter, artery36640 104 Insertion catheter, artery36680 124 Insert needle, bone cavity36800 104 Insertion of cannula36810 104 Insertion of cannula36815 104 Insertion of cannula36818 8 Av fuse, uppr arm, cephalic36819 8 Av fusion/uppr arm vein36820 40 Av fusion/forearm vein36821 8 Av fusion direct any site36822 30 Insertion of cannula(s) end-dated 12/31/201436823 61 Insertion of cannula(s)36825 8 Artery-vein graft36830 8 Artery-vein graft36831 8 Open thrombect av fistula36832 8 Av fistula revision, open36833 8 Av fistula revision36835 24 Artery to vein shunt36838 15 Dist revas ligation, hemo36860 104 External cannula declotting36861 104 Cannula declotting36870 43 Percut thrombect av fistula37140 47 Revision of circulation37145 59 Revision of circulation37160 45 Revision of circulation37180 45 Revision of circulation37181 45 Splice spleen/kidney veins37182 133 Insert hepatic shunt (tips)37183 133 Remove hepatic shunt (tips)37184 89 Prim art mech thrombectomy37185 235 Prim art m-thrombect add-on37186 235 Sec art m-thrombect add-on37187 119 Venous mech thrombectomy37188 119 Venous m-thrombectomy add-on


CPT/HCPCS MOD MOD LEV DESCRIPTION37191 74 Ins endovas vena cava filtr 37192 74 Redo endovas vena cava filtr 37193 74 Rem endovas vena cava filter 37195 213 Thrombolytic therapy, stroke37197 251 Remove intrvas froeign body 37200 104 Transcatheter biopsy37202 113 Transcatheter therapy infuse37204 113 Transcatheter occlusion end-dated 12/31/201337205 107 Transcath iv stent percut end-dated 12/31/201337206 246 Transcath iv stent/perc addl end-dated 12/31/201337207 91 Transcath iv stent open end-dated 12/31/201337208 238 Transcath iv stent/open addl end-dated 12/31/201337210 137 Embolization uterine fibroid end-dated 12/31/201337211 104 Thrombolytic art therapy 37212 104 Thrombolytic venous therapy 37213 104 Thromblytic art/ven therapy 37214 104 Cessj therapy cath removal 37215 27 Transcath stent, cca w/eps37216 70 Transcath stent, cca w/o eps37217 230 Stent placemt retro carotid 37218 119 Stene placemt ante carotid37220 119 Iliac revasc 37221 119 Iliac revasc w/stent 37222 119 Iliac revasc add-on 37223 119 Iliac revasc w/stent add-on 37224 90 Fem/popl revas w/tla 37225 90 Fem/popl revas w/ather 37226 90 Fem/popl revasc w/stent 37227 90 Fem/popl revasc stnt & ather 37228 90 Tib/per revasc w/tla 37229 90 Tib/per revasc w/ather 37230 90 Tib/per revasc w/stent 37231 90 Tib/per revasc stent & ather 37232 133 Tib/per revasc add-on 37233 133 Tib/per revasc w/ather add-on 37234 133 Revsc opn/prq tib/pero stent 37235 133 Tib/per revasc stnt & ather 37236 89 Open perq place stent 1st 37237 241 Open/perq place stent ea add 37238 89 Open/perq place stent same 37239 241 Open/perq place stent ea add 37241 113 Vasc embolize/occlude venous 37242 113 Vasc embolize/occlude artery 37243 113 Vasc embolize/occlude organ 37244 113 Vasc embolize/occlude bleed 37250 238 Iv us first vessel add-on37251 238 Iv us each add vessel add-on37500 11 Endoscopy ligate perf veins37501 203 Vascular endoscopy procedure37565 45 Ligation of neck vein37600 45 Ligation of neck artery37605 45 Ligation of neck artery37606 59 Ligation of neck artery37607 10 Ligation of a-v fistula37609 57 Temporal artery procedure37615 14 Ligation of neck artery37616 14 Ligation of chest artery37617 14 Ligation of abdomen artery37618 14 Ligation of extremity artery37619 47 Ligation of inf vena cava 37650 43 Revision of major vein37660 45 Revision of major vein37700 25 Revise leg vein37718 11 Ligate/strip short leg vein37722 11 Ligate/strip long leg vein37735 11 Removal of leg veins/lesion


CPT/HCPCS MOD MOD LEV DESCRIPTION37760 42 Revision of leg veins37761 40 Ligation leg vein(s), open w/ ultrasound, 1 leg37765 11 Phleb veins - extrem - to 2037766 11 Phleb veins - extrem 20+37780 11 Revision of leg vein37785 25 Revise secondary varicosity37788 45 Revascularization, penis37790 50 Penile venous occlusion37799 198 Vascular surgery procedure, unlisted38100 14 Removal of spleen, total38101 14 Removal of spleen, partial38102 225 Removal of spleen, total38115 45 Repair of ruptured spleen38120 14 Laparoscopy, splenectomy38129 211 Laparoscope proc, spleen38200 133 Injection for spleen x-ray38204 270 Bl donor search management38205 133 Harvest allogeneic stem cell38206 124 Harvest auto stem cells38207 270 Cryopreserve stem cells38208 270 Thaw preserved stem cells38209 270 Wash harvest stem cells38210 270 T-cell depletion of harvest38211 270 Tumor cell deplete of harvst38212 270 Rbc depletion of harvest38213 270 Platelet deplete of harvest38214 270 Volume deplete of harvest38215 270 Harvest stem cell concentrte38220 178 Bone marrow aspiration38221 178 Biopsy, needle/trocar38230 50 Bone marrow harvest allogen38232 50 Bone marrow harvest autolog 38240 211 Bn marrow/stm transplt allo38241 205 Bn marrow/stm transplt auto38242 133 Lymphocyte infuse transplant38243 131 Transplj hematopoietic boost 38300 24 Drainage, lymph node lesion38305 55 Drainage, lymph node lesion38308 8 Incision of lymph channels38380 45 Thoracic duct procedure38381 45 Thoracic duct procedure38382 45 Thoracic duct procedure38500 25 Biopsy/removal, lymph nodes38505 106 Needle biopsy, lymph nodes38510 25 Biopsy/removal, lymph nodes38520 25 Biopsy/removal, lymph nodes38525 25 Biopsy/removal, lymph nodes38530 9 Biopsy/removal, lymph nodes38542 9 Explore deep node(s), neck38550 20 Removal, neck/armpit lesion38555 39 Removal, neck/armpit lesion38562 13 Removal, pelvic lymph nodes38564 14 Removal, abdomen lymph nodes38570 8 Laparoscopy, lymph node biop38571 7 Laparoscopy, lymphadenectomy38572 7 Laparoscopy, lymphadenectomy38589 214 Laparoscope proc, lymphatic, unlisted38700 9 Removal of lymph nodes, neck38720 15 Removal of lymph nodes, neck38724 15 Removal of lymph nodes, neck38740 9 Remove armpit lymph nodes38745 40 Remove armpit lymph nodes38746 238 Remove thoracic lymph nodes38747 225 Remove abdominal lymph nodes38760 9 Remove groin lymph nodes38765 15 Remove groin lymph nodes


CPT/HCPCS MOD MOD LEV DESCRIPTION38770 15 Remove pelvis lymph nodes38780 14 Remove abdomen lymph nodes38790 140 Inject for lymphatic x-ray38792 140 Ra tracer id of sentinl node38794 59 Access thoracic lymph duct38900 140 Io map of sent lymph node 38999 200 Blood/lymph system procedure, unlisted39000 14 Exploration of chest39010 14 Exploration of chest39200 45 Resect mediastinal cyst39220 14 Resect mediastinal tumor39400 61 Mediastinoscopy incl biospy39499 198 Chest procedure, unlisted39501 14 Repair diaphragm laceration39503 45 Repair of diaphragm hernia39540 14 Repair of diaphragm hernia39541 14 Repair of diaphragm hernia39545 14 Revision of diaphragm39560 14 Resect diaphragm, simple39561 14 Resect diaphragm, complex39599 198 Diaphragm surgery procedure, unlisted40490 129 Biopsy of lip40500 24 Partial excision of lip40510 24 Partial excision of lip40520 24 Partial excision of lip40525 55 Reconstruct lip with flap40527 50 Reconstruct lip with flap40530 55 Partial removal of lip40650 50 Repair lip40652 50 Repair lip40654 55 Repair lip40700 20 Repair cleft lip/nasal40701 49 Repair cleft lip/nasal40702 49 Repair cleft lip/nasal40720 52 Repair cleft lip/nasal40761 55 Repair cleft lip/nasal40799 198 Lip surgery procedure, unlisted40800 24 Drainage of mouth lesion40801 55 Drainage of mouth lesion40804 20 Removal, foreign body, mouth40805 50 Removal, foreign body, mouth40806 96 Incision of lip fold40808 24 Biopsy of mouth lesion40810 24 Excision of mouth lesion40812 24 Excise/repair mouth lesion40814 55 Excise/repair mouth lesion40816 55 Excision of mouth lesion40818 50 Excise oral mucosa for graft40819 50 Excise lip or cheek fold40820 55 Treatment of mouth lesion40830 50 Repair mouth laceration40831 50 Repair mouth laceration40840 20 Reconstruction of mouth40842 20 Reconstruction of mouth40843 19 Reconstruction of mouth40844 20 Reconstruction of mouth40845 50 Reconstruction of mouth40899 198 Mouth surgery procedure, unlisted41000 24 Drainage of mouth lesion41005 20 Drainage of mouth lesion41006 50 Drainage of mouth lesion41007 50 Drainage of mouth lesion41008 50 Drainage of mouth lesion41009 50 Drainage of mouth lesion41010 20 Incision of tongue fold41015 50 Drainage of mouth lesion


CPT/HCPCS MOD MOD LEV DESCRIPTION41016 50 Drainage of mouth lesion41017 50 Drainage of mouth lesion41018 50 Drainage of mouth lesion41019 117 Place needles, head/neck for rt41100 24 Biopsy of tongue41105 24 Biopsy of tongue41108 24 Biopsy of floor of mouth41110 24 Excision of tongue lesion41112 24 Excision of tongue lesion41113 24 Excision of tongue lesion41114 20 Excision of tongue lesion41115 20 Excision of tongue fold41116 24 Excision of mouth lesion41120 8 Partial removal of tongue41130 14 Partial removal of tongue41135 14 Tongue and neck surgery41140 14 Removal of tongue41145 14 Tongue removal, neck surgery41150 14 Tongue, mouth, jaw surgery41153 14 Tongue, mouth, neck surgery41155 45 Tongue, jaw, & neck surgery41250 20 Repair tongue laceration41251 20 Repair tongue laceration41252 50 Repair tongue laceration41500 20 Fixation of tongue41510 20 Tongue to lip surgery41512 50 Tongue suspension41520 20 Reconstruction, tongue fold41530 50 Tongue base vol reduction41599 198 Tongue and mouth surgery, unlisted41800 24 Drainage of gum lesion41805 20 Removal foreign body, gum41806 50 Removal foreign body,jawbone41820 124 Excision, gum, each quadrant41821 124 Excision of gum flap41822 50 Excision of gum lesion41823 50 Excision of gum lesion41825 24 Excision of gum lesion41826 24 Excision of gum lesion41827 55 Excision of gum lesion41828 50 Excision of gum lesion41830 50 Removal of gum tissue41850 124 Treatment of gum lesion41870 124 Gum graft41872 50 Repair gum41874 50 Repair tooth socket41899 198 Dental surgery procedure, unlisted42000 20 Drainage mouth roof lesion42100 24 Biopsy roof of mouth42104 24 Excision lesion, mouth roof42106 24 Excision lesion, mouth roof42107 55 Excision lesion, mouth roof42120 39 Remove palate/lesion42140 24 Excision of uvula42145 55 Repair palate, pharynx/uvula42160 20 Treatment mouth roof lesion42180 50 Repair palate42182 50 Repair palate42200 50 Reconstruct cleft palate42205 20 Reconstruct cleft palate42210 50 Reconstruct cleft palate42215 20 Reconstruct cleft palate42220 20 Reconstruct cleft palate42225 20 Reconstruct cleft palate42226 50 Lengthening of palate42227 50 Lengthening of palate


CPT/HCPCS MOD MOD LEV DESCRIPTION42235 50 Repair palate42260 50 Repair nose to lip fistula42280 50 Preparation, palate mold42281 50 Insertion, palate prosthesis42299 198 Palate/uvula surgery, unlisted42300 24 Drainage of salivary gland42305 20 Drainage of salivary gland42310 20 Drainage of salivary gland42320 20 Drainage of salivary gland42330 24 Removal of salivary stone42335 24 Removal of salivary stone42340 50 Removal of salivary stone42400 104 Biopsy of salivary gland42405 55 Biopsy of salivary gland42408 50 Excision of salivary cyst42409 50 Drainage of salivary cyst42410 8 Excise parotid gland/lesion42415 8 Excise parotid gland/lesion42420 8 Excise parotid gland/lesion42425 8 Excise parotid gland/lesion42426 45 Excise parotid gland/lesion42440 8 Excise submaxillary gland42450 50 Excise sublingual gland42500 50 Repair salivary duct42505 55 Repair salivary duct42507 19 Parotid duct diversion42508 19 Parotid duct diversion end-dated 12/31/201442509 49 Parotid duct diversion42510 38 Parotid duct diversion42550 137 Injection for salivary x-ray42600 50 Closure of salivary fistula42650 104 Dilation of salivary duct42660 124 Dilation of salivary duct42665 20 Ligation of salivary duct42699 198 Salivary surgery procedure, unlisted42700 55 Drainage of tonsil abscess42720 50 Drainage of throat abscess42725 39 Drainage of throat abscess42800 24 Biopsy of throat42802 24 Biopsy of throat end-dated 12/31/201342804 24 Biopsy of upper nose/throat42806 24 Biopsy of upper nose/throat42808 24 Excise pharynx lesion42809 55 Remove pharynx foreign body42810 20 Excision of neck cyst42815 39 Excision of neck cyst42821 20 Remove tonsils and adenoids42826 24 Removal of tonsils42831 20 Removal of adenoids42836 20 Removal of adenoids42842 27 Extensive surgery of throat42844 45 Extensive surgery of throat42845 45 Extensive surgery of throat42860 20 Excision of tonsil tags42870 50 Excision of lingual tonsil42890 39 Partial removal of pharynx42892 39 Revision of pharyngeal walls42894 45 Revision of pharyngeal walls 42900 20 Repair throat wound42950 39 Reconstruction of throat42953 59 Repair throat, esophagus42955 50 Surgical opening of throat42960 20 Control throat bleeding42961 27 Control throat bleeding42962 24 Control throat bleeding42970 24 Control nose/throat bleeding


CPT/HCPCS MOD MOD LEV DESCRIPTION42971 27 Control nose/throat bleeding42972 20 Control nose/throat bleeding42999 198 Throat surgery procedure, unlisted43020 45 Incision of esophagus43030 8 Throat muscle surgery43045 45 Incision of esophagus43100 14 Excision of esophagus lesion43101 14 Excision of esophagus lesion43107 14 Removal of esophagus43108 45 Removal of esophagus43112 14 Removal of esophagus43113 45 Removal of esophagus43116 14 Partial removal of esophagus43117 14 Partial removal of esophagus43118 14 Partial removal of esophagus43121 14 Partial removal of esophagus43122 14 Partial removal of esophagus43123 14 Partial removal of esophagus43124 45 Removal of esophagus43130 8 Removal of esophagus pouch43135 14 Removal of esophagus pouch43180 104 Esophagoscopy rigid trnso43191 104 Esophagoscopy rigid trnso dx 43192 104 Esophagoscp rig trnso inject 43193 104 Esophagoscp rig trnso biopsy 43194 104 Esophagoscp rig trnso rem fb 43195 104 Esophagoscopy rigid balloon 43196 104 Esophagoscp guide wire dilat 43197 104 Esophagoscopy flex dx brush 43198 104 Esophagosc flex trnsn biopsy 43200 104 Esophagoscopy flexible brush 43201 104 Esoph scope w/submusous inj 43202 104 Esophagoscopy flex biopsy 43204 104 Esoph scope w/sclerosis inj 43205 96 Esophagus endoscopy/ligation 43206 104 Esoph optical endomicroscopy 43211 104 Esophagoscop mucosal resect 43212 104 Esophagoscop stent placement 43213 104 Esophagoscopy retro balloon 43214 104 Esophagosc dilate balloon 30 43215 104 Esophagoscopy flex remove fb 43216 96 Esophagoscopy lesion removal 43217 104 Esophagoscopy snare les remv 43219 104 Esophagus endoscopy end-dated 12/31/201343220 104 Esophagoscopy balloon <30mm 43226 104 Esoph endoscopy dilation 43227 104 Esophagoscopy control bleed 43228 104 Esoph endoscopy ablation end-dated 12/31/201343229 104 Esophagoscopy lesion ablate 43231 87 Esophagoscop ultrasound exam 43232 87 Esophagoscopy w/us needle bx 43233 104 Egd balloon dil esoph30 mm/> 43235 104 Egd diagnostic brush wash 43236 104 Uppr gi scope w/submuc inj 43237 96 Endoscopic us exam esoph 43238 96 Egd us fine needle bx/aspir 43239 104 Egd biopsy single/multiple 43240 104 Egd w/transmural drain cyst 43241 104 Egd tube/cath insertion 43242 96 Egd us fine needle bx/aspir 43243 104 Egd injection varices 43244 96 Egd varices ligation 43245 104 Egd dilate stricture 43246 87 Egd place gastrostomy tube 43247 104 Egd remove foreign body 43248 104 Egd guide wire insertion


CPT/HCPCS MOD MOD LEV DESCRIPTION43249 104 Esoph egd dilation <30 mm 43250 104 Egd cautery tumor polyp 43251 104 Egd remove lesion snare 43252 104 Egd optical endomicroscopy 43253 104 Egd us transmural injxn/mark 43254 104 Egd endo mucosal resection 43255 104 Egd control bleeding any 43256 104 Uppr gi endoscopy w/stent end-dated 12/31/201343257 104 Egd w/thrml txmnt gerd 43258 104 Operative upper gi endoscopy end-dated 12/31/201343259 96 Egd us exam duodenum/jejunum 43260 104 Ercp w/specimen collection 43261 129 Endo cholangiopancreatograph43262 129 Endo cholangiopancreatograph43263 129 Ercp sphincter pressure meas 43264 104 Ercp remove duct calculi 43265 104 Ercp lithotripsy calculi 43266 104 Egd endoscopic stent place 43267 129 Endo cholangiopancreatograph end-dated 12/31/201343268 129 Endo cholangiopancreatograph end-dated 12/31/201343269 129 Endo cholangiopancreatograph end-dated 12/31/201343270 104 Egd lesion ablation 43271 129 Endo cholangiopancreatograph end-dated 12/31/201343272 124 Endo cholangiopancreatograph end-dated 12/31/201343273 241 Endoscopic pancreatoscopy 43274 129 ERCP duct stent placement 43275 129 ERCP remove forgn body duct 43276 129 ERCP stent exchange w/dilate 43277 129 ERCP ea duct/ampulla dilate 43278 124 ERCP lesion ablate w/dilate 43279 45 Lap myotomy, heller43280 14 Laparoscopy, fundoplasty43281 14 Lap paraesophag hern repair43282 45 Lap paraesoph hern repair w/mesh43283 120 Lap esoph lengthening 43289 214 Laparoscope proc, esoph43300 14 Repair of esophagus43305 45 Repair esophagus and fistula43310 14 Repair of esophagus43312 45 Repair esophagus and fistula43313 14 Esophagoplasty congential43314 45 Tracheo-esophagoplasty cong43320 45 Fuse esophagus & stomach43324 45 Revise esophagus & stomach43325 45 Revise esophagus & stomach43326 45 Revise esophagus & stomach43330 45 Repair of esophagus43331 45 Repair of esophagus43332 45 Transab esoph hiat hern rpr 43333 45 Transab esoph hiat hern rpr 43334 45 Transthor diaphrag hern rpr 43335 45 Transthor diaphrag hern rpr 43336 45 Thorabd diaphr hern repair 43337 45 Thorabd diaphr hern repair 43338 120 Esoph lengthening 43340 45 Fuse esophagus & intestine43341 45 Fuse esophagus & intestine43350 45 Surgical opening, esophagus end-dated 12/31/201443351 45 Surgical opening, esophagus43352 45 Surgical opening, esophagus43360 45 Gastrointestinal repair43361 45 Gastrointestinal repair43400 14 Ligate esophagus veins43401 45 Esophagus surgery for veins43405 45 Ligate/staple esophagus43410 45 Repair esophagus wound


CPT/HCPCS MOD MOD LEV DESCRIPTION43415 14 Repair esophagus wound43420 45 Repair esophagus opening43425 45 Repair esophagus opening43450 104 Dilate esophagus 1/mult pass 43453 104 Dilate esophagus43456 104 Dilate esophagus end-dated 12/31/201343458 104 Dilate esophagus end-dated 12/31/201343460 137 Pressure treatment esophagus43496 14 Free jejunum flap, microvasc43499 200 Esophagus surgery procedure, unlisted43500 14 Surgical opening of stomach43501 14 Surgical repair of stomach43502 14 Surgical repair of stomach43510 45 Surgical opening of stomach43520 14 Incision of pyloric muscle43605 14 Biopsy of stomach43610 14 Excision of stomach lesion43611 14 Excision of stomach lesion43620 45 Removal of stomach43621 45 Removal of stomach43622 45 Removal of stomach43631 45 Removal of stomach, partial43632 45 Removal of stomach, partial43633 14 Removal of stomach, partial43634 45 Removal of stomach, partial43635 238 Removal of stomach, partial43640 14 Vagotomy & pylorus repair43641 45 Vagotomy & pylorus repair43644 14 Lap gastric bypass/roux-en-y43645 14 Lap gastr bypass incl smll i43647 175 Lap impl electrode, antrum43648 175 Lap revise/remv eltrd antrum43651 45 Laparoscopy, vagus nerve43652 45 Laparoscopy, vagus nerve43653 8 Laparoscopy, gastrostomy43659 214 Laparoscope proc, stom43752 105 Nasal/orogastric w/stent43753 105 Tx gastro intub w/asp 43754 105 Dx gastr intub w/asp spec 43755 105 Dx gastr intub w/asp specs 43756 105 Dx duod intub w/asp spec 43757 105 Dx duod intub w/asp specs 43760 104 Change gastrostomy tube43761 104 Reposition gastrostomy tube43770 8 Lap, place gastr adjust band43771 14 Lap, revise adjust gast band43772 14 Lap, remove adjust gast band43773 14 Lap, change adjust gast band43774 14 Lap remov adj gast band/port43775 45 Lap sleeve gastrectomy43800 14 Reconstruction of pylorus43810 14 Fusion of stomach and bowel43820 14 Fusion of stomach and bowel43825 14 Fusion of stomach and bowel43830 14 Place gastrostomy tube43831 14 Place gastrostomy tube43832 14 Place gastrostomy tube43840 14 Repair of stomach lesion43842 70 Gastroplasty for obesity43843 45 Gastroplasty for obesity43845 14 Gastroplasty duodenal switch43846 14 Gastric bypass for obesity43847 45 Gastric bypass for obesity43848 14 Revision gastroplasty43850 14 Revise stomach-bowel fusion43855 45 Revise stomach-bowel fusion


CPT/HCPCS MOD MOD LEV DESCRIPTION43860 14 Revise stomach-bowel fusion43865 14 Revise stomach-bowel fusion43870 45 Repair stomach opening43880 45 Repair stomach-bowel fistula43881 201 Impl/redo electrd, antrum43882 175 Revise/remove electrd antrum43886 8 Revise gastric port, open43887 8 Remove gastric port, open43888 8 Change gastric port, open43999 198 Stomach surgery procedure, unlisted44005 14 Freeing of bowel adhesion44010 14 Incision of small bowel44015 225 Insert needle cath bowel44020 14 Explore small intestine44021 14 Decompress small bowel44025 14 Incision of large bowel44050 14 Reduce bowel obstruction44055 45 Correct malrotation of bowel44100 104 Biopsy of bowel44110 14 Excise intestine lesion(s)44111 45 Excision of bowel lesion(s)44120 14 Removal of small intestine44121 238 Removal of small intestine44125 45 Removal of small intestine44126 14 Enterectomy w/taper, cong44127 14 Enterectomy w/o taper, cong44128 238 Enterectomy cong, add-on44130 14 Bowel to bowel fusion44132 185 Enterectomy, cadaver donor44133 185 Enterectomy, live donor44135 185 Intestine transplnt, cadaver44136 185 Intestine transplant, live44137 201 Remove intestinal allograft44139 238 Mobilization of colon44140 14 Partial removal of colon44141 14 Partial removal of colon44143 14 Partial removal of colon44144 14 Partial removal of colon44145 14 Partial removal of colon44146 14 Partial removal of colon44147 14 Partial removal of colon44150 14 Removal of colon44151 14 Removal of colon/ileostomy44155 14 Removal of colon/ileostomy44156 14 Removal of colon/ileostomy44157 14 Colectomy w/ileoanal anast44158 14 Colectomy w/neo-rectum pouch44160 14 Removal of colon44180 14 Lap, enterolysis44186 14 Lap, jejunostomy44187 14 Lap, ileo/jejuno-stomy44188 14 Lap, colostomy44202 14 Lap resect s/intestine singl44203 238 Lap resect s/intestine, addl44204 14 Laparo partial colectomy44205 14 Lap colectomy part w/ileum44206 14 Lap part colectomy w/stoma44207 14 L colectomy/coloproctostomy44208 14 L colectomy/coloproctostomy44210 14 Laparo total proctocolectomy44211 14 Laparo total proctocolectomy44212 14 Laparo total proctocolectomy44213 238 Lap, mobil splenic fl add-on44227 14 Lap, close enterostomy44238 214 Laparoscope proc, intestine44300 14 Open bowel to skin


CPT/HCPCS MOD MOD LEV DESCRIPTION44310 14 Ileostomy/jejunostomy44312 20 Revision of ileostomy44314 14 Revision of ileostomy44316 14 Devise bowel pouch44320 14 Colostomy44322 14 Colostomy with biopsies44340 10 Revision of colostomy44345 14 Revision of colostomy44346 14 Revision of colostomy44360 104 Small bowel endoscopy44361 104 Small bowel endoscopy/biopsy44363 124 Small bowel endoscopy44364 96 Small bowel endoscopy44365 96 Small bowel endoscopy44366 104 Small bowel endoscopy44369 96 Small bowel endoscopy44370 96 Small bowel endoscopy/stent44372 129 Small bowel endoscopy44373 129 Small bowel endoscopy44376 96 Small bowel endoscopy44377 124 Small bowel endoscopy/biopsy44378 96 Small bowel endoscopy44379 124 S bowel endoscope w/stent44380 104 Small bowel endoscopy44381 129 Small bowel endoscopy br/wa44382 129 Small bowel endoscopy44383 129 Ileoscopy w/stent44384 129 Small bowel endoscopy44385 129 Endoscopy of bowel pouch44386 124 Endoscopy, bowel pouch/biop44388 104 Colon endoscopy44389 104 Colonoscopy with biopsy44390 124 Colonoscopy for foreign body44391 96 Colonoscopy for bleeding44392 129 Colonoscopy & polypectomy44393 129 Colonoscopy, lesion removal44394 129 Colonoscopy w/snare44397 129 Colonoscopy w/stent end-dated 12/31/201444401 97 Colonoscopy w/ablation44402 97 Colonoscopy w/stent plcmt44403 97 Colonoscopy w/resection44404 97 Colonoscopy w/injection44406 97 Colonoscopy w/dilation44407 97 Colonoscopy w/ultrasound44408 97 Colonoscopy w/aspir/bx44500 97 Intro, gastrointestinal tube44602 14 Suture, small intestine44603 14 Suture, small intestine44604 14 Suture, large intestine44605 45 Repair of bowel lesion44615 45 Intestinal stricturoplasty44620 14 Repair bowel opening44625 14 Repair bowel opening44626 14 Repair bowel opening44640 45 Repair bowel-skin fistula44650 45 Repair bowel fistula44660 45 Repair bowel-bladder fistula44661 14 Repair bowel-bladder fistula44680 45 Surgical revision, intestine44700 45 Suspend bowel w/prosthesis44701 225 Intraop colon lavage add-on44705 201 Prepare fecal microbiota 44715 201 Prepare donor intestine44720 201 Prep donor intestine/venous44721 201 Prep donor intestine/artery44799 200 Intestine surgery procedure, unlisted


CPT/HCPCS MOD MOD LEV DESCRIPTION44800 45 Excision of bowel pouch44820 14 Excision of mesentery lesion44850 14 Repair of mesentery44899 198 Bowel surgery procedure, unlisted44900 14 Drain appendix abscess open 44901 137 Drain app abscess percut end-dated 12/31/201344950 14 Appendectomy44955 238 Appendectomy add-on44960 14 Appendectomy44970 14 Laparoscopy, appendectomy44979 214 Laparoscope proc, app45000 55 Drainage of pelvic abscess45005 24 Drainage of rectal abscess45020 55 Drainage of rectal abscess45100 24 Biopsy of rectum45108 10 Removal of anorectal lesion45110 14 Removal of rectum45111 14 Partial removal of rectum45112 14 Removal of rectum45113 14 Partial proctectomy45114 14 Partial removal of rectum45116 14 Partial removal of rectum45119 14 Remove rectum w/reservoir45120 14 Removal of rectum45121 14 Removal of rectum and colon45123 14 Partial proctectomy45126 45 Pelvic exenteration45130 14 Excision of rectal prolapse45135 14 Excision of rectal prolapse45136 45 Excise ileoanal reservoir45150 20 Excision of rectal stricture45160 8 Excision of rectal lesion45171 8 Excise rect tumor, transanal, part45172 8 Excise rect tumor, transanal, full45190 10 Destruction, rectal tumor45300 104 Proctosigmoidoscopy dx45303 104 Proctosigmoidoscopy dilate45305 104 Protosigmoidoscopy w/bx45307 96 Protosigmoidoscopy fb45308 104 Protosigmoidoscopy removal45309 104 Protosigmoidoscopy removal45315 104 Protosigmoidoscopy removal45317 104 Protosigmoidoscopy bleed45320 104 Protosigmoidoscopy ablate45321 104 Protosigmoidoscopy volvul45327 104 Proctosigmoidoscopy w/stent45330 104 Diagnostic sigmoidoscopy45331 104 Sigmoidoscopy and biopsy45332 104 Sigmoidoscopy w/fb removal45333 104 Sigmoidoscopy & polypectomy45334 104 Sigmoidoscopy for bleeding45335 104 Sigmoidoscope w/submuc inj45337 104 Sigmoidoscopy & decompress45338 104 Sigmoidoscpy w/tumr remove45339 104 Sigmoidoscopy w/ablate tumr45340 104 Sig w/balloon dilation45341 104 Sigmoidoscopy w/ultrasound45342 104 Sigmoidoscopy w/us guide bx45345 104 Sigmodoscopy w/stent45346 104 Colonoscopy w/decompression45347 104 Sigmoidoscopy w/ablation45349 104 Sigmoidoscopy w/plcmt stent45350 104 Sigmoidoscopy w/resection45355 104 Surgical colonoscopy45378 104 Diagnostic colonoscopy45378 53 113 Diagnostic colonoscopy


CPT/HCPCS MOD MOD LEV DESCRIPTION45379 129 Colonoscopy w/fb removal45380 104 Colonoscopy and biopsy45381 104 Colonoscope, submucous inj45382 104 Colonoscopy/control bleeding45383 129 Lesion removal colonoscopy45384 129 Lesion remove colonoscopy45385 104 Lesion removal colonoscopy45386 129 Colonoscope dilate stricture45387 129 Colonoscopy w/stent end-dated 12/31/201445388 129 Sgmdsc w/band ligation45389 129 Colonoscopy w/ablation45390 129 Colonoscopy w/stent plcmt45391 129 Colonoscopy w/endoscope us45392 129 Colonoscopy w/endoscopic fnb45393 129 Colonosscopy w/resection45395 45 Lap, removal of rectum45397 14 Lap, remove rectum w/pouch45398 129 Colonoscopy w/decompression45399 129 Colonoscopy w/band ligation45400 14 Laparoscopic proctopexy45402 14 Lap proctopexy w/sig resect45499 211 Laparoscope proc, rectum45500 20 Repair of rectum45505 24 Repair of rectum45520 104 Treatment of rectal prolapse45540 14 Correct rectal prolapse45541 8 Correct rectal prolapse45550 14 Repair rectum/remove sigmoid45560 8 Repair of rectocele45562 14 Exploration/repair of rectum45563 45 Exploration/repair of rectum45800 14 Repair rect/bladder fistula45805 14 Repair fistula w/colostomy45820 14 Repair rectourethral fistula45825 14 Repair fistula w/colostomy45900 20 Reduction of rectal prolapse45905 24 Dilation of anal sphincter45910 24 Dilation of rectal narrowing45915 24 Remove rectal obstruction45990 85 Surg dx exam, anorectal45999 198 Rectum surgery procedure, unlisted46601 104 Unlisted procedure colon46607 104 Diagnostic anoscopy46020 24 Placement of seton46030 50 Removal of rectal marker46040 55 Incision of rectal abscess46045 24 Incision of rectal abscess46050 24 Incision of anal abscess46060 24 Incision of rectal abscess46070 50 Incision of anal septum46080 24 Incision of anal sphincter46083 24 Incise external hemorrhoid46200 24 Removal of anal fissure46220 24 Removal of anal tab46221 24 Ligation of hemorrhoid(s)46230 24 Removal of anal tabs46250 24 Hemorrhoidectomy46255 24 Hemorrhoidectomy46257 24 Remove hemorrhoids & fissure46258 20 Remove hemorrhoids & fistula46260 24 Hemorrhoidectomy46261 24 Remove hemorrhoids & fissure46262 24 Remove hemorrhoids & fistula46270 24 Removal of anal fistula46275 24 Removal of anal fistula46280 24 Removal of anal fistula


CPT/HCPCS MOD MOD LEV DESCRIPTION46285 24 Removal of anal fistula46288 24 Repair anal fistula46320 55 Removal of hemorrhoid clot46500 24 Injection into hemorrhoid(s)46505 57 Chemodenervation anal musc46600 104 Diagnostic anoscopy46604 104 Anoscopy and dilation46606 104 Anoscopy and biopsy46608 124 Anoscopy/ remove for body46610 129 Anoscopy/remove lesion46611 124 Anoscopy46612 124 Anoscopy/ remove lesions46614 104 Anoscopy/control bleeding46615 124 Anoscopy46700 24 Repair of anal stricture46705 45 Repair of anal stricture46706 24 Repr of anal fistula w/glue46707 20 Repair anorectal fist w/plug46710 45 Repr per/vag pouch sngl proc46712 45 Repr per/vag pouch dbl proc46715 59 Repair of anovaginal fistula46716 45 Repair of anovaginal fistula46730 45 Construction of absent anus46735 45 Construction of absent anus46740 45 Construction of absent anus46742 45 Repair of imperforated anus46744 45 Repair of cloacal anomaly46746 14 Repair of cloacal anomaly46748 45 Repair of cloacal anomaly46750 39 Repair of anal sphincter46751 45 Repair of anal sphincter46753 55 Reconstruction of anus46754 50 Removal of suture from anus46760 39 Repair of anal sphincter46761 8 Repair of anal sphincter46762 39 Implant artificial sphincter46900 55 Destruction, anal lesion(s)46910 55 Destruction, anal lesion(s)46916 55 Cryosurgery, anal lesion(s)46917 55 Laser surgery, anal lesions46922 55 Excision of anal lesion(s)46924 55 Destruction, anal lesion(s)46930 20 Destroy internal hemorrhoids46940 24 Treatment of anal fissure46942 20 Treatment of anal fissure46945 24 Ligation of hemorrhoids46946 55 Ligation of hemorrhoids46947 24 Hemorrhoidopexy by stapling46999 198 Anus surgery procedure, unlisted47000 104 Needle biopsy of liver47001 226 Needle biopsy, liver add-on47010 14 Open drainage liver lesion 47011 113 Percut drain liver lesion end-dated 12/31/201347015 14 Inject/aspirate liver cyst47100 14 Wedge biopsy of liver47120 14 Partial removal of liver47122 14 Extensive removal of liver47125 14 Partial removal of liver47130 45 Partial removal of liver47133 270 Removal of donor liver47135 34 Transplantation of liver47136 34 Transplantation of liver47140 34 Partial removal, donor liver47141 34 Partial removal, donor liver47142 45 Partial removal, donor liver47143 175 Prep donor liver, whole


CPT/HCPCS MOD MOD LEV DESCRIPTION47144 45 Prep donor liver, 3-segment47145 201 Prep donor liver, lobe split47146 201 Prep donor liver/venous47147 201 Prep donor liver/arterial47300 14 Surgery for liver lesion47350 14 Repair liver wound47360 14 Repair liver wound47361 14 Repair liver wound47362 14 Repair liver wound47370 14 Laparo ablate liver tumor rf47371 14 Laparo ablate liver cryosug47379 211 Laparoscope procedure, liver47380 14 Open ablate liver tumor rf47381 14 Open ablate liver tumor cryo47382 24 Percut ablate liver rf47383 104 Diagnostic anoscopy & biopsy47399 200 Liver surgery procedure, unlisted47400 45 Incision of liver duct47420 14 Incision of bile duct47425 45 Incision of bile duct47460 14 Incise bile duct sphincter47480 14 Incision of gallbladder47490 30 Incision of gallbladder47500 113 Injection for liver x-rays47505 107 Injection for liver x-rays47510 24 Insert catheter, bile duct47511 25 Insert bile duct drain47525 25 Change bile duct catheter47530 24 Revise/reinsert bile tube47550 225 Bile duct endoscopy add-on47552 88 Biliary endo perq dx w/speci 47553 104 Biliary endoscopy thru skin47554 88 Biliary endoscopy thru skin47555 104 Biliary endoscopy thru skin47556 104 Biliary endoscopy thru skin47560 96 Laparoscopy w/cholangio47561 96 Laparo w/cholangio/biopsy47562 39 Laparoscopic cholecystectomy47563 39 Laparo cholecystectomy/graph47564 39 Laparo cholecystectomy/explr47570 45 Laparo cholecystoenterostomy47579 214 Laparoscope proc, biliary47600 14 Removal of gallbladder47605 14 Removal of gallbladder47610 14 Removal of gallbladder47612 14 Removal of gallbladder47620 14 Removal of gallbladder47630 10 Remove bile duct stone47700 45 Exploration of bile ducts47701 59 Bile duct revision47711 45 Excision of bile duct tumor47712 14 Excision of bile duct tumor47715 14 Excision of bile duct cyst47720 14 Fuse gallbladder & bowel47721 14 Fuse upper gi structures47740 14 Fuse gallbladder & bowel47741 45 Fuse gallbladder & bowel47760 14 Fuse bile ducts and bowel47765 14 Fuse liver ducts & bowel47780 14 Fuse bile ducts and bowel47785 45 Fuse bile ducts and bowel47800 45 Reconstruction of bile ducts47801 14 Placement, bile duct support47802 39 Fuse liver duct & intestine47900 14 Suture bile duct injury47999 200 Bile tract surgery procedure, unlisted


CPT/HCPCS MOD MOD LEV DESCRIPTION48000 14 Drainage of abdomen48001 45 Placement of drain, pancreas48020 14 Removal of pancreatic stone48100 14 Biopsy of pancreas, open48102 30 Needle biopsy, pancreas48105 45 Resect/debride pancreas48120 14 Removal of pancreas lesion48140 45 Partial removal of pancreas48145 45 Partial removal of pancreas48146 45 Pancreatectomy48148 14 Removal of pancreatic duct48150 45 Partial removal of pancreas48152 45 Pancreatectomy48153 45 Pancreatectomy48154 45 Pancreatectomy48155 45 Removal of pancreas48160 270 Pancreas removal/transplant48400 246 Injection, intraop add-on48500 45 Surgery of pancreatic cyst48510 45 Drain pancreatic pseudocyst 48511 137 Drain pancreatic pseudocyst end-dated 12/31/201348520 45 Fuse pancreas cyst and bowel48540 45 Fuse pancreas cyst and bowel48545 14 Pancreatorrhaphy48547 45 Duodenal exclusion48548 14 Fuse pancreas and bowel48550 270 Donor pancreatectomy48551 201 Prep donor pancreas48552 201 Prep donor pancreas/venous48554 34 Transpl allograft pancreas48556 34 Removal, allograft pancreas48999 198 Pancreas surgery procedure, unlisted49000 14 Exploration of abdomen49002 14 Reopening of abdomen49010 14 Exploration behind abdomen49020 27 Drainage abdom abscess open 49021 113 Drain abdominal abscess end-dated 12/31/201349040 14 Drain open abdom abscess 49041 137 Drain percut abdom abscess end-dated 12/31/201349060 16 Drain open retroperi abscess 49061 137 Drain percut retroper absc end-dated 12/31/201349062 45 Drain to peritoneal cavity49082 68 Abd paracentesis 49083 68 Abd paracentesis w/imaging 49084 68 Peritoneal lavage 49180 104 Biopsy, abdominal mass49203 14 Exc abd tumor 5 cm or less49204 14 Exc abd tumor over 5 cm49205 14 Exc abd tumor over 10 cm49215 14 Excise sacral spine tumor49220 45 Multiple surgery, abdomen49250 42 Excision of umbilicus49255 14 Removal of omentum49320 20 Diag laparo separate proc49321 39 Laparoscopy, biopsy49322 8 Laparoscopy, aspiration49323 14 Laparo drain lymphocele49324 39 Lap insertion perm ip cath49325 39 Lap revision perm ip cath49326 234 Lap w/omentopexy add-on49327 39 Lap ins device for rt49329 214 Laparo proc, abdm/per/oment, unlisted49400 113 Air injection into abdomen49402 10 Remove foreign body, adbomen49405 113 Image cath fluid colxn visc 49406 113 Image cath fluid peri/retro


CPT/HCPCS MOD MOD LEV DESCRIPTION49407 27 Image cath fluid trns/vgnl 49411 124 Ins mark abd/pel for rt perq, ea or mult49412 236 Ins device for rt guide open49418 24 Insert tun ip cath perc49419 55 Insrt abdom cath for chemotx49421 24 Insert abdominal drain49422 55 Remove perm cannula/catheter49423 96 Exchange drainage catheter49424 107 Assess cyst, contrast inject49425 45 Insert abdomen-venous drain49426 55 Revise abdomen-venous shunt49427 133 Injection, abdominal shunt49428 61 Ligation of shunt49429 24 Removal of shunt49435 234 Insert subq exten to ip cath49436 8 Embedded ip cath exit-site49440 50 Place gastrostomy tube perc49441 50 Place duod/jej tube perc49442 50 Place cecostomy tube perc49446 96 Change g-tube to g-j perc49450 96 Replace g/c tube perc49451 96 Replace duod/jej tube perc49452 96 Replace g-j tube perc49460 96 Fix g/colon tube w/ device49465 107 Fluoro exam of g/colon tube49505 40 Rpr i/hern init reduc>5 yr49507 9 Rpr i/hern init block>5 yr49520 40 Rerepair ing hernia, reduce49521 40 Rerepair ing hernia, blocked49525 40 Repair ing hernia, sliding49540 40 Repair lumbar hernia49550 9 Rpr fem hernia, init, reduce49553 40 Rpr fem hernia, init blocked49555 40 Rerepair fem hernia, reduce49557 40 Rerepair fem hernia, blocked49560 9 Rpr ventral hern init, reduc49561 9 Rpr ventral hern init, block49565 9 Rerepair ventrl hern, reduce49566 9 Rerepair ventrl hern, block49568 222 Hernia repair w/mesh49570 9 Rpr epigastric hern, reduce49572 9 Rpr epigastric hern, blocked49585 8 Rpr umbil hern, reduc > 5 yr49587 8 Rpr umbil hern, block > 5 yr49590 40 Repair spigelian hernia49600 39 Repair umbilical lesion49605 45 Repair umbilical lesion49606 45 Repair umbilical lesion49610 45 Repair umbilical lesion49611 45 Repair umbilical lesion49650 9 Laparo hernia repair initial49651 9 Laparo hernia repair recur49652 40 Lap vent/abd hernia repair49653 40 Lap vent/abd hern proc comp49654 40 Lap inc hernia repair49655 40 Lap inc hern repair comp49656 40 Lap inc hernia repair recur49657 40 Lap inc hern recur comp49659 214 Laparo proc, hernia repair49900 45 Repair of abdominal wall49904 36 Omental flap, extra-abdom49905 225 Omental flap, intra-abdom49906 47 Free omental flap, microvasc49999 200 Abdomen surgery procedure, unlisted50010 14 Exploration of kidney50020 16 Renal abscess open drain


CPT/HCPCS MOD MOD LEV DESCRIPTION50021 113 Renal abscess percut drain end-dated 12/31/201350040 16 Drainage of kidney50045 14 Exploration of kidney50060 14 Removal of kidney stone50065 27 Incision of kidney50070 14 Incision of kidney50075 14 Removal of kidney stone50080 25 Removal of kidney stone50081 9 Removal of kidney stone50100 14 Revise kidney blood vessels50120 15 Exploration of kidney50125 15 Explore and drain kidney50130 15 Removal of kidney stone50135 46 Exploration of kidney50200 106 Biopsy of kidney50205 15 Biopsy of kidney50220 15 Remove kidney, open50225 15 Removal kidney open, complex50230 15 Removal kidney open, radical50234 14 Removal of kidney & ureter50236 14 Removal of kidney & ureter50240 14 Partial removal of kidney50250 14 Cryoablate renal mass open50280 14 Removal of kidney lesion50290 14 Removal of kidney lesion50300 270 Removal of donor kidney50320 46 Removal of donor kidney50323 201 Prep cadaver renal allograft50325 201 Prep donor renal graft50327 201 Prep renal graft/venous50328 201 Prep renal graft/arterial50329 201 Prep renal graft/ureteral50340 15 Removal of kidney50360 34 Transplantation of kidney50365 35 Transplantation of kidney50370 45 Remove transplanted kidney50380 45 Reimplantation of kidney50382 106 Change ureter stent, percut50384 106 Remove ureter stent, percut50385 125 Change stent via transureth50386 98 Remove stent via transureth50387 98 Change ext/int ureter stent50389 131 Remove renal tube w/fluoro50390 106 Drainage of kidney lesion50391 104 Instll rx agnt into rnal tub50392 106 Insert kidney drain50393 106 Insert ureteral tube50394 116 Injection for kidney x-ray50395 106 Create passage to kidney50396 125 Measure kidney pressure50398 106 Change kidney tube50400 14 Revision of kidney/ureter50405 14 Revision of kidney/ureter50500 14 Repair of kidney wound50520 14 Close kidney-skin fistula50525 45 Repair renal-abdomen fistula50526 27 Repair renal-abdomen fistula50540 44 Revision of horseshoe kidney50541 14 Laparo ablate renal cyst50542 14 Laparo ablate renal mass50543 14 Laparo partial nephrectomy50544 14 Laparoscopy, pyeloplasty50545 15 Laparo radical nephrectomy50546 15 Laparoscopic nephrectomy50547 15 Laparo removal donor kidney50548 14 Laparo remove k/ureter


CPT/HCPCS MOD MOD LEV DESCRIPTION50549 214 Laparoscope proc, renal50551 98 Kidney endoscopy50553 131 Kidney endoscopy50555 98 Kidney endoscopy & biopsy50557 98 Kidney endoscopy & treatment50561 125 Kidney endoscopy & treatment50562 39 Renal scope w/tumor resect50570 98 Kidney endoscopy50572 125 Kidney endoscopy50574 98 Kidney endoscopy & biopsy50575 131 Kidney endoscopy50576 125 Kidney endoscopy & treatment50580 125 Kidney endoscopy & treatment50590 57 Fragmenting of kidney stone50592 25 Perc rf ablate renal tumor50593 27 Perc cryo ablate renal tumor50600 15 Exploration of ureter50605 15 Insert ureteral support50610 46 Removal of ureter stone50620 46 Removal of ureter stone50630 46 Removal of ureter stone50650 14 Removal of ureter50660 14 Removal of ureter50684 116 Injection for ureter x-ray50686 124 Measure ureter pressure50688 24 Change of ureter tube50690 137 Injection for ureter x-ray50700 45 Revision of ureter50715 15 Release of ureter50722 14 Release of ureter50725 45 Release/revise ureter50727 8 Revise ureter50728 45 Revise ureter50740 45 Fusion of ureter & kidney50750 59 Fusion of ureter & kidney50760 45 Fusion of ureters50770 45 Splicing of ureters50780 46 Reimplant ureter in bladder50782 46 Reimplant ureter in bladder50783 46 Reimplant ureter in bladder50785 46 Reimplant ureter in bladder50800 15 Implant ureter in bowel50810 14 Fusion of ureter & bowel50815 15 Urine shunt to intestine50820 46 Construct bowel bladder50825 14 Construct bowel bladder50830 45 Revise urine flow50840 46 Replace ureter by bowel50845 45 Appendico-vesicostomy50860 46 Transplant ureter to skin50900 14 Repair of ureter50920 45 Closure ureter/skin fistula50930 45 Closure ureter/bowel fistula50940 46 Release of ureter50945 15 Laparoscopy ureterolithotomy50947 9 Laparo new ureter/bladder50948 9 Laparo new ureter/bladder50949 202 Laparoscope proc, ureter50951 98 Endoscopy of ureter50953 125 Endoscopy of ureter50955 98 Ureter endoscopy & biopsy50957 125 Ureter endoscopy & treatment50961 125 Ureter endoscopy & treatment50970 98 Ureter endoscopy50972 125 Ureter endoscopy & catheter50974 98 Ureter endoscopy & biopsy


CPT/HCPCS MOD MOD LEV DESCRIPTION50976 125 Ureter endoscopy & treatment50980 125 Ureter endoscopy & treatment51020 39 Incise & treat bladder51030 50 Incise & treat bladder51040 8 Incise & drain bladder51045 20 Incise bladder/drain ureter51050 8 Removal of bladder stone51060 45 Removal of ureter stone51065 50 Remove ureter calculus51080 39 Drainage of bladder abscess51100 104 Drain bladder by needle51101 104 Drain bladder by trocar/cath51102 104 Drain bladder w/ cath insertion51500 39 Removal of bladder cyst51520 8 Removal of bladder lesion51525 8 Removal of bladder lesion51530 45 Removal of bladder lesion51535 46 Repair of ureter lesion51550 14 Partial removal of bladder51555 14 Partial removal of bladder51565 14 Revise bladder & ureter(s)51570 14 Removal of bladder51575 13 Removal of bladder & nodes51580 14 Remove bladder/revise tract51585 13 Removal of bladder & nodes51590 14 Remove bladder/revise tract51595 13 Remove bladder/revise tract51596 14 Remove bladder/create pouch51597 45 Removal of pelvic structures51600 113 Injection for bladder x-ray51605 113 Preparation for bladder xray51610 113 Injection for bladder x-ray51700 104 Irrigation of bladder51701 104 Insert bladder catheter51702 104 Insert temp bladder cath51703 104 Insert bladder cath, complex51705 24 Change of bladder tube51710 55 Change of bladder tube51715 96 Endoscopic injection/implant51720 104 Treatment of bladder lesion51725 124 Simple cystometrogram51725 TC 134 Simple cystometrogram51725 26 133 Simple cystometrogram51726 129 Complex cystometrogram51726 TC 139 Complex cystometrogram51726 26 137 Complex cystometrogram51727 133 Cystometrogram w/up51727 TC 134 Cystometrogram w/up51727 26 133 Cystometrogram w/up51728 107 Cystometrogram w/vp51728 TC 109 Cystometrogram w/vp51728 26 107 Cystometrogram w/vp51729 107 Cystometrogram w/vp&up51729 TC 109 Cystometrogram w/vp&up51729 26 107 Cystometrogram w/vp&up51736 124 Urine flow measurement51736 TC 134 Urine flow measurement51736 26 133 Urine flow measurement51741 129 Electro-uroflowmetry, first51741 TC 139 Electro-uroflowmetry, first51741 26 137 Electro-uroflowmetry, first51784 104 Anal/urinary muscle study51784 TC 115 Anal/urinary muscle study51784 26 113 Anal/urinary muscle study51785 96 Anal/urinary muscle study51785 TC 109 Anal/urinary muscle study


CPT/HCPCS MOD MOD LEV DESCRIPTION51785 26 107 Anal/urinary muscle study51792 124 Urinary reflex study51792 TC 134 Urinary reflex study51792 26 133 Urinary reflex study51797 241 Intraabdominal pressure test51797 TC 246 Intraabdominal pressure test51797 26 246 Intraabdominal pressure test51798 177 Us urine capacity measure51800 14 Revision of bladder/urethra51820 44 Revision of urinary tract51840 14 Attach bladder/urethra51841 14 Attach bladder/urethra51845 14 Repair bladder neck51860 14 Repair of bladder wound51865 14 Repair of bladder wound51880 39 Repair of bladder opening51900 45 Repair bladder/vagina lesion51920 14 Close bladder-uterus fistula51925 45 Hysterectomy/bladder repair51940 14 Correction of bladder defect51960 45 Revision of bladder & bowel51980 45 Construct bladder opening51990 14 Laparo urethral suspension51992 8 Laparo sling operation51999 213 Laparoscope proc, bladder52000 104 Cystourethroscopy52001 104 Cystourethroscopy, removal of clots52005 104 Cystourethroscopy & ureter catheter52007 106 Cystourethroscopy and biopsy52010 104 Cystourethroscopy & duct catheter52204 104 Cystourethroscopy52214 104 Cystourethroscopy and treatment52224 104 Cystourethroscopy and treatment52234 104 Cystourethroscopy and treatment52235 104 Cystourethroscopy and treatment52240 104 Cystourethroscopy and treatment52250 129 Cystourethroscopy and radiotracer52260 104 Cystourethroscopy and treatment52265 104 Cystourethroscopy and treatment52270 104 Cystourethroscopy & revise urethra52275 104 Cystourethroscopy & revise urethra52276 104 Cystourethroscopy and treatment52277 124 Cystourethroscopy and treatment52281 104 Cystourethroscopy and treatment52282 129 Cystourethroscopy, implant stent52283 104 Cystourethroscopy and treatment52285 104 Cystourethroscopy and treatment52287 104 Cystoscopy chemodenervation 52290 103 Cystourethroscopy and treatment52300 95 Cystourethroscopy and treatment52301 95 Cystourethroscopy and treatment52305 104 Cystourethroscopy and treatment52310 104 Cystourethroscopy and treatment52315 104 Cystourethroscopy and treatment52317 104 Remove bladder stone52318 104 Remove bladder stone52320 106 Cystourethroscopy and treatment52325 106 Cystourethroscopy, stone removal52327 131 Cystourethroscopy, inject material52330 106 Cystourethroscopy and treatment52332 106 Cystourethroscopy and treatment52334 131 Create passage to kidney52341 106 Cysto w/ureter stricture tx52342 106 Cysto w/up stricture tx52343 106 Cysto w/renal stricture tx52344 106 Cysto/uretero, stone remove


CPT/HCPCS MOD MOD LEV DESCRIPTION52345 96 Cysto/uretero w/up stricture52346 124 Cystouretero w/renal strict52351 104 Cystouretro & or pyeloscope52352 106 Cystouretro w/stone remove52353 131 Cystouretero w/lithotripsy52354 106 Cystouretero w/biopsy52355 131 Cystouretero w/excise tumor52356 127 Cysto/uretero w/lithotripsy 52400 55 Cystouretero w/congen repr52402 124 Cystourethro cut ejacul duct52441 24 Perq abltj lvr cryoablation52442 24 Cystourethro w/implant52450 24 Incision of prostate52500 24 Revision of bladder neck52601 55 Prostatectomy (TURP)52630 55 Remove prostate regrowth52640 24 Relieve bladder contracture52647 55 Laser surgery of prostate52648 55 Laser surgery of prostate52649 59 Prostate laser enucleation52700 20 Drainage of prostate abscess53000 24 Incision of urethra53010 24 Incision of urethra53020 104 Incision of urethra53025 96 Incision of urethra53040 20 Drainage of urethra abscess53060 24 Drainage of urethra abscess53080 24 Drainage of urinary leakage53085 39 Drainage of urinary leakage53200 104 Biopsy of urethra53210 8 Removal of urethra53215 39 Removal of urethra53220 20 Treatment of urethra lesion53230 39 Removal of urethra lesion53235 8 Removal of urethra lesion53240 55 Surgery for urethra pouch53250 24 Removal of urethra gland53260 24 Treatment of urethra lesion53265 24 Treatment of urethra lesion53270 24 Removal of urethra gland53275 24 Repair of urethra defect53400 39 Revise urethra, stage 153405 39 Revise urethra, stage 253410 39 Reconstruction of urethra53415 45 Reconstruction of urethra53420 42 Reconstruct urethra, stage 153425 39 Reconstruct urethra, stage 253430 39 Reconstruction of urethra53431 39 Reconstruct urethra/bladder53440 39 Correct bladder function53442 50 Remove perineal prosthesis53444 39 Insert tandem cuff53445 39 Insert uro/ves nck sphincter53446 39 Remove uro sphincter53447 39 Remove/replace ur sphincter53448 45 Remov/replc ur sphinctr comp53449 39 Repair uro sphincter53450 24 Revision of urethra53460 20 Revision of urethra53500 45 Urethrlys, transvag w/ scope53502 24 Repair of urethra injury53505 20 Repair of urethra injury53510 8 Repair of urethra injury53515 8 Repair of urethra injury53520 24 Repair of urethra defect53600 104 Dilate urethra stricture


CPT/HCPCS MOD MOD LEV DESCRIPTION53601 104 Dilate urethra stricture53605 104 Dilate urethra stricture53620 104 Dilate urethra stricture53621 104 Dilate urethra stricture53660 104 Dilation of urethra53661 104 Dilation of urethra53665 104 Dilation of urethra53850 55 Prostatic microwave thermotx53852 55 Prostatic rf thermotx53855 96 Insert prost urethral stent53860 55 Transurethral rf treatment53899 198 Urology surgery procedure, unlisted54001 24 Slitting of prepuce54015 50 Drain penis lesion54050 24 Destruction, penis lesion(s)54055 24 Destruction, penis lesion(s)54056 24 Cryosurgery, penis lesion(s)54057 24 Laser surg, penis lesion(s)54060 24 Excision of penis lesion(s)54065 55 Destruction, penis lesion(s)54100 104 Biopsy of penis54105 24 Biopsy of penis54110 20 Treatment of penis lesion54111 8 Treat penis lesion, graft54112 8 Treat penis lesion, graft54115 20 Treatment of penis lesion54120 8 Partial removal of penis54125 45 Removal of penis54130 44 Remove penis & nodes54135 58 Remove penis & nodes54164 24 Frenulotomy of penis54200 24 Treatment of penis lesion54205 20 Treatment of penis lesion54220 129 Treatment of penis lesion54230 137 Prepare penis study54231 129 Dynamic cavernosometry54235 104 Penile injection54240 96 Penis study54240 TC 109 Penis study54240 26 107 Penis study54250 96 Penis study54250 TC 109 Penis study54250 26 107 Penis study54300 8 Revision of penis54304 50 Revision of penis54308 39 Reconstruction of urethra54312 39 Reconstruction of urethra54316 39 Reconstruction of urethra54318 39 Reconstruction of urethra54322 50 Reconstruction of urethra54324 8 Reconstruction of urethra54326 39 Reconstruction of urethra54328 39 Revise penis/urethra54332 45 Revise penis/urethra54336 45 Revise penis/urethra54340 39 Secondary urethral surgery54344 39 Secondary urethral surgery54348 39 Secondary urethral surgery54352 39 Reconstruct urethra/penis54360 39 Penis plastic surgery54380 8 Repair penis54385 39 Repair penis54390 45 Repair penis and bladder54400 42 Insert semi-rigid prosthesis54401 42 Insert self-contd prosthesis54405 39 Insert multi-comp penis pros


CPT/HCPCS MOD MOD LEV DESCRIPTION54406 39 Remove multi-comp penis pros54408 39 Repair multi-comp penis pros54410 39 Remove/replace penis prosth54411 45 Remv/replc penis pros, comp54415 39 Remove self-contd penis pros54416 39 Remv/repl penis contain pros54417 45 Remv/replc penis pros, compl54420 50 Revision of penis54430 58 Revision of penis54435 55 Revision of penis54440 39 Repair of penis54450 104 Preputial stretching54500 98 Biopsy of testis54505 21 Biopsy of testis54512 11 Excise lesion testis54520 25 Removal of testis54522 9 Orchiectomy, partial54530 40 Removal of testis54535 60 Extensive testis surgery54550 21 Exploration for testis54560 9 Exploration for testis54600 57 Reduce testis torsion54620 25 Suspension of testis54640 52 Suspension of testis54650 60 Orchiopexy (Fowler-Stephens)54660 21 Revision of testis54670 21 Repair testis injury54680 40 Relocation of testis(es)54690 9 Laparoscopy, orchiectomy54692 25 Laparoscopy, orchiopexy54699 214 Laparoscope proc, testis, unlisted54700 24 Drainage of scrotum54800 124 Biopsy of epididymis54830 50 Remove epididymis lesion54840 24 Remove epididymis lesion54860 24 Removal of epididymis54861 50 Removal of epididymis54865 50 Explore epididymis54900 20 Fusion of spermatic ducts54901 49 Fusion of spermatic ducts55000 104 Drainage of hydrocele55040 24 Removal of hydrocele55041 23 Removal of hydroceles55060 52 Repair of hydrocele55100 24 Drainage of scrotum abscess55110 24 Explore scrotum55120 50 Removal of scrotum lesion55150 39 Removal of scrotum55175 20 Revision of scrotum55180 50 Revision of scrotum55200 19 Incision of sperm duct55250 23 Removal of sperm duct(s)55300 132 Prepare, sperm duct x-ray55400 40 Repair of sperm duct55450 49 Ligation of sperm duct55500 20 Removal of hydrocele55520 8 Removal of sperm cord lesion55530 11 Revise spermatic cord veins55535 40 Revise spermatic cord veins55540 43 Revise hernia & sperm veins55550 9 Laparo ligate spermatic vein55559 214 Laparo proc, spermatic cord55600 21 Incise sperm duct pouch55605 29 Incise sperm duct pouch55650 15 Remove sperm duct pouch55680 50 Remove sperm pouch lesion


CPT/HCPCS MOD MOD LEV DESCRIPTION55700 104 Biopsy of prostate55705 10 Biopsy of prostate55706 39 Prostate saturation sampling55720 39 Drainage of prostate abscess55725 39 Drainage of prostate abscess55801 45 Removal of prostate55810 45 Extensive prostate surgery55812 45 Extensive prostate surgery55815 44 Extensive prostate surgery55821 45 Removal of prostate55831 45 Removal of prostate55840 45 Extensive prostate surgery55842 45 Extensive prostate surgery55845 44 Extensive prostate surgery55860 10 Surgical exposure, prostate55862 14 Extensive prostate surgery55865 44 Extensive prostate surgery55866 45 Laparo radical prostatectomy55870 118 Electroejaculation55873 24 Cryoablate prostate55875 20 Transperi needle place, pros55876 86 Place rt device/marker, pros55899 200 Genital surgery procedure, unlisted55920 124 Place needles pelvic for rt56405 10 I & D of vulva/perineum56420 24 Drainage of gland abscess56440 24 Surgery for vulva lesion56441 20 Lysis of labial lesion(s)56501 24 Destroy, vulva lesions, simp56515 55 Destroy vulva lesion/s compl56605 88 Biopsy of vulva/perineum56606 223 Biopsy of vulva/perineum56620 8 Partial removal of vulva56625 39 Complete removal of vulva56630 14 Extensive vulva surgery56631 45 Extensive vulva surgery56632 44 Extensive vulva surgery56633 14 Extensive vulva surgery56634 45 Extensive vulva surgery56637 45 Extensive vulva surgery56640 46 Extensive vulva surgery56740 24 Remove vagina gland lesion56800 8 Repair of vagina56810 39 Repair of perineum56820 104 Exam of vulva w/scope56821 104 Exam/biopsy of vulva w/scope57000 20 Exploration of vagina57010 50 Drainage of pelvic abscess57020 96 Drainage of pelvic fluid57022 20 I & d vaginal hematoma, pp57023 50 I & d vag hematoma, non-ob57061 24 Destroy vag lesions, simple57065 24 Destroy vag lesions, complex57100 104 Biopsy of vagina57105 24 Biopsy of vagina57106 14 Remove vagina wall, partial57107 14 Remove vagina tissue, part57109 13 Vaginectomy partial w/nodes57110 14 Remove vagina wall, complete57111 13 Remove vagina tissue, compl57112 13 Vaginectomy w/nodes, compl57120 14 Closure of vagina57130 8 Remove vagina lesion57135 24 Remove vagina lesion57150 100 Treat vagina infection57155 24 Insert uteri tandem/ovoids


CPT/HCPCS MOD MOD LEV DESCRIPTION57156 126 Ins vag brachytx device57160 126 Insert pessary/other device57170 123 Fitting of diaphragm/cap57180 24 Treat vaginal bleeding57200 8 Repair of vagina57210 8 Repair vagina/perineum57220 8 Revision of urethra57230 8 Repair of urethral lesion57240 8 Repair bladder & vagina57250 8 Repair rectum & vagina57260 8 Repair of vagina57265 8 Extensive repair of vagina57267 234 Insert mesh/pelvic flr addon57268 8 Repair of bowel bulge57270 14 Repair of bowel pouch57280 45 Suspension of vagina57282 45 Repair of vaginal prolapse57283 14 Colpopexy, intraperitoneal57284 45 Repair paravaginal defect57285 14 Repair paravag defect, vag57287 39 Revise/remove sling repair57288 39 Repair bladder defect57289 8 Repair bladder & vagina57291 20 Construction of vagina57292 45 Construct vagina with graft57295 8 Change vaginal graft57296 45 Revise vag graft, open abd57300 39 Repair rectum-vagina fistula57305 14 Repair rectum-vagina fistula57307 45 Fistula repair & colostomy57308 45 Fistula repair, transperine57310 14 Repair urethrovaginal lesion57311 45 Repair urethrovaginal lesion57320 8 Repair bladder-vagina lesion57330 14 Repair bladder-vagina lesion57400 96 Dilation of vagina57410 104 Pelvic examination57415 20 Remove vaginal foreign body57420 104 Exam of vagina w/scope57421 104 Exam/biopsy of vag w/scope57423 14 Repair paravag defect, laparoscopic57425 45 Laparoscopy, surg, colpopexy57426 8 Revise prosth vag graft, lap57452 104 Examination of vagina57454 104 Vagina examination & biopsy57455 104 Biopsy of cervix w/scope57456 104 Endocerv curettage w/scope57460 104 Cervix excision57461 104 Conz of cervix w/scope, leep57500 104 Biopsy of cervix57505 55 Endocervical curettage57510 24 Cauterization of cervix57511 24 Cryocautery of cervix57513 24 Laser surgery of cervix57520 55 Conization of cervix57522 24 Conization of cervix57530 8 Removal of cervix57531 13 Removal of cervix, radical57540 14 Removal of residual cervix57545 14 Remove cervix/repair pelvis57550 8 Removal of residual cervix57555 14 Remove cervix/repair vagina57556 8 Remove cervix, repair bowel57558 24 D&c of cervical stump57700 50 Revision of cervix57720 20 Revision of cervix


CPT/HCPCS MOD MOD LEV DESCRIPTION57800 104 Dilation of cervical canal58100 104 Biopsy of uterus lining58110 246 Bx done w/colposcopy add-on58120 24 Dilation and curettage58140 14 Removal of uterus lesion58145 8 Removal of uterus lesion58146 14 Myomectomy abdom complex58150 14 Total hysterectomy58152 14 Total hysterectomy58180 14 Partial hysterectomy58200 14 Extensive hysterectomy58210 13 Extensive hysterectomy58240 45 Removal of pelvis contents58260 14 Vaginal hysterectomy58262 14 Vaginal hysterectomy58263 14 Vaginal hysterectomy58267 14 Hysterectomy & vagina repair58270 14 Hysterectomy & vagina repair58275 14 Hysterectomy/revise vagina58280 14 Hysterectomy/revise vagina58285 14 Extensive hysterectomy58290 14 Vag hyst complex58291 14 Vag hyst incl t/o, complex58292 14 Vag hyst t/o & repair, compl58293 14 Vag hyst w/uro repair, compl58294 14 Vag hyst w/enterocele, compl58340 113 Catheter for hysterography58346 24 Insert heyman uteri capsule58353 10 Endometr ablate, thermal58356 39 Endometrial cryoablation58400 45 Suspension of uterus58410 45 Suspension of uterus58520 14 Repair of ruptured uterus58540 59 Revision of uterus58541 14 Lsh, uterus 250 g or less58542 14 Lsh w/t/o ut 250 g or less58543 14 Lsh uterus above 250 g58544 14 Lsh w/t/o uterus above 250 g58545 8 Laparoscopic myomectomy58546 8 Laparo-myomectomy, complex58548 13 Lap radical hyst58550 8 Laparo-asst vag hysterectomy58552 8 Laparo-vag hyst incl t/o58553 14 Laparo-vag hyst, complex58554 14 Laparo-vag hyst w/t/o, compl58555 87 Hysteroscopy, dx, sep proc58558 88 Hysteroscopy, biopsy58559 88 Hysteroscopy, lysis58560 87 Hysteroscopy, resect septum58561 87 Hysteroscopy, remove myoma58562 88 Hysteroscopy, remove fb58563 87 Hysteroscopy, ablation58565 41 Hysteroscopy, sterilization58570 14 TLH, Uterus 250 g or less58571 14 TLH w/t/o 250 g or less58572 14 TLH, uterus over 250 g58573 14 TLH w/t/o uterus over 250 g58578 214 Laparo proc, uterus58579 214 Hysteroscope procedure58600 38 Division of fallopian tube58605 26 Division of fallopian tube58611 246 Ligate oviduct(s) add-on58615 50 Occlude fallopian tube(s)58660 8 Laparoscopy, lysis58661 8 Laparoscopy, remove adnexa58662 8 Laparoscopy, excise lesions


CPT/HCPCS MOD MOD LEV DESCRIPTION58670 10 Laparoscopy, tubal cautery58671 10 Laparoscopy, tubal block58672 21 Laparoscopy, fimbrioplasty58673 21 Laparoscopy, salpingostomy58679 214 Laparo proc, oviduct-ovary58700 13 Removal of fallopian tube58720 13 Removal of ovary/tube(s)58740 14 Revise fallopian tube(s)58750 45 Repair oviduct58752 59 Revise ovarian tube(s)58760 46 Remove tubal obstruction58770 60 Create new tubal opening58800 23 Drainage of ovarian cyst(s)58805 7 Drainage of ovarian cyst(s)58820 20 Drain ovary abscess, open58822 14 Drain ovary abscess, percut58823 137 Drain pelvic abscess percut end-dated 12/31/201358825 45 Transposition, ovary(s)58900 7 Biopsy of ovary(s)58920 13 Partial removal of ovary(s)58925 13 Removal of ovarian cyst(s)58940 13 Removal of ovary(s)58943 14 Removal of ovary(s)58950 13 Resect ovarian malignancy58951 13 Resect ovarian malignancy58952 13 Resect ovarian malignancy58953 13 Tah, rad dissect for debulk58954 13 Tah rad debulk/lymph remove58956 13 Bso, omentectomy w/tah58957 13 Resect recurrent gyn mal58958 13 Resect recur gyn mal w/lym58960 14 Exploration of abdomen58999 200 Genital surgery procedure, unlisted59000 104 Amniocentesis, diagnostic59001 129 Amniocentesis, therapeutic59012 124 Fetal cord puncture,prenatal59015 124 Chorion biopsy59020 96 Fetal contract stress test59020 TC 109 Fetal contract stress test59020 26 107 Fetal contract stress test59025 96 Fetal non-stress test59025 TC 109 Fetal non-stress test59025 26 107 Fetal non-stress test59030 133 Fetal scalp blood sample59050 213 Fetal monitor w/report59051 185 Fetal monitor/interpret only59070 124 Transabdom amnioinfus w/ us59072 129 Umbilical cord occlud w/ us59074 133 Fetal fluid drainage w/ us59076 124 Fetal shunt placement, w/ us59100 65 Remove uterus lesion59120 66 Treat ectopic pregnancy59121 66 Treat ectopic pregnancy59130 69 Treat ectopic pregnancy59135 69 Treat ectopic pregnancy59136 69 Treat ectopic pregnancy59140 69 Treat ectopic pregnancy59150 63 Treat ectopic pregnancy59151 67 Treat ectopic pregnancy59160 50 D & c after delivery59200 129 Insert cervical dilator59300 93 Episiotomy or vaginal repair59320 124 Revision of cervix59325 133 Revision of cervix59350 133 Repair of uterus59400 192 Obstetrical care


CPT/HCPCS MOD MOD LEV DESCRIPTION59409 183 Obstetrical care59410 192 Obstetrical care59412 210 Antepartum manipulation59414 209 Deliver placenta59425 185 Antepartum care only59426 185 Antepartum care only59430 192 Care after delivery59510 192 Cesarean delivery59514 175 Cesarean delivery only59515 192 Cesarean delivery59525 225 Remove uterus after cesarean59610 211 Vbac delivery59612 183 Vbac delivery only59614 183 Vbac care after delivery59618 211 Attempted vbac delivery59620 183 Attempted vbac delivery only59622 183 Attempted vbac after care59812 68 Treatment of miscarriage59820 68 Care of miscarriage59821 67 Treatment of miscarriage59830 69 Treat uterus infection59870 67 Evacuate mole of uterus59871 124 Remove cerclage suture59897 217 Fetal invas px w/ us60000 20 Drain thyroid/tongue cyst60100 104 Biopsy of thyroid60200 8 Remove thyroid lesion60210 8 Partial thyroid excision60212 8 Parital thyroid excision60220 8 Partial removal of thyroid60225 8 Partial removal of thyroid60240 14 Removal of thyroid60252 14 Removal of thyroid60254 45 Extensive thyroid surgery60260 15 Repeat thyroid surgery60270 45 Removal of thyroid60271 45 Removal of thyroid60280 8 Remove thyroid duct lesion60281 8 Remove thyroid duct lesion60300 104 Aspir/inj thyroid cyst60500 14 Explore parathyroid glands60502 14 Re-explore parathyroids60505 14 Explore parathyroid glands60512 238 Autotransplant parathyroid60520 45 Removal of thymus gland60521 14 Removal of thymus gland60522 14 Removal of thymus gland60540 15 Explore adrenal gland60545 14 Explore adrenal gland60600 14 Remove carotid body lesion60605 45 Remove carotid body lesion60650 15 Laparoscopy adrenalectomy60659 214 Laparo proc, endocrine60699 198 Endocrine surgery procedure, unlisted61020 104 Remove brain cavity fluid61026 104 Injection into brain canal61050 96 Remove brain canal fluid61055 105 Injection into brain canal61070 104 Brain canal shunt procedure61105 27 Twist drill hole61107 114 Drill skull for implantation61108 30 Drill skull for drainage61120 27 Burr hole for puncture61140 27 Pierce skull for biopsy61150 16 Pierce skull for drainage61151 30 Pierce skull for drainage


CPT/HCPCS MOD MOD LEV DESCRIPTION61154 15 Pierce skull & remove clot61156 14 Pierce skull for drainage61210 113 Pierce skull, implant device61215 10 Insert brain-fluid device61250 15 Pierce skull & explore61253 26 Pierce skull & explore61304 14 Open skull for exploration61305 14 Open skull for exploration61312 14 Open skull for drainage61313 14 Open skull for drainage61314 14 Open skull for drainage61315 14 Open skull for drainage61316 249 Implant cran bone flap to abdo61320 14 Open skull for drainage61321 14 Open skull for drainage61322 14 Decompressive craniotomy61323 47 Decompressive lobectomy61330 9 Decompress eye socket61332 14 Explore/biopsy eye socket61333 45 Explore orbit/remove lesion61334 39 Explore orbit/remove object end-dated 12/31/201461340 15 Relieve cranial pressure61343 45 Incise skull (press relief)61345 14 Relieve cranial pressure61440 45 Incise skull for surgery end-dated 12/31/201461450 45 Incise skull for surgery61458 14 Incise skull for brain wound61460 45 Incise skull for surgery61470 45 Incise skull for surgery end-dated 12/31/201461480 45 Incise skull for surgery61490 15 Incise skull for surgery end-dated 12/31/201461500 45 Removal of skull lesion61501 45 Remove infected skull bone61510 45 Removal of brain lesion61512 45 Remove brain lining lesion61514 45 Removal of brain abscess61516 45 Removal of brain lesion61517 249 Implant brain chemotx add-on61518 45 Removal of brain lesion61519 45 Remove brain lining lesion61520 45 Removal of brain lesion61521 45 Removal of brain lesion61522 14 Removal of brain abscess61524 45 Removal of brain lesion61526 16 Removal of brain lesion61530 47 Removal of brain lesion61531 14 Implant brain electrodes61533 14 Implant brain electrodes61534 14 Removal of brain lesion61535 14 Remove brain electrodes61536 14 Removal of brain lesion61537 14 Removal of brain tissue61538 14 Removal of brain tissue61539 14 Removal of brain tissue61540 14 Removal of brain tissue61541 14 Incision of brain tissue end-dated 12/31/201461542 14 Removal of brain tissue61543 14 Removal of brain tissue61544 27 Remove & treat brain lesion61545 14 Excision of brain tumor61546 45 Removal of pituitary gland61548 45 Removal of pituitary gland61550 14 Release of skull seams61552 45 Release of skull seams61556 27 Incise skull/sutures61557 59 Incise skull/sutures


CPT/HCPCS MOD MOD LEV DESCRIPTION61558 27 Excision of skull/sutures61559 45 Excision of skull/sutures61563 14 Excision of skull tumor61564 45 Excision of skull tumor61566 14 Removal of brain tissue61567 14 Incision of brain tissue61570 14 Remove foreign body, brain61571 45 Incise skull for brain wound61575 14 Skull base/brainstem surgery61576 45 Skull base/brainstem surgery61580 5 Craniofacial approach, skull61581 37 Craniofacial approach, skull61582 34 Craniofacial approach, skull61583 34 Craniofacial approach, skull61584 4 Orbitocranial approach/skull61585 35 Orbitocranial approach/skull61586 34 Resect nasopharynx, skull61590 35 Infratemporal approach/skull61591 35 Infratemporal approach/skull61592 35 Orbitocranial approach/skull61595 37 Transtemporal approach/skull61596 35 Transcochlear approach/skull61597 35 Transcondylar approach/skull61598 34 Transpetrosal approach/skull61600 34 Resect/excise cranial lesion61601 34 Resect/excise cranial lesion61605 34 Resect/excise cranial lesion61606 34 Resect/excise cranial lesion61607 3 Resect/excise cranial lesion61608 3 Resect/excise cranial lesion61609 233 Transect artery, sinus end-dated 12/31/201461610 233 Transect artery, sinus61611 233 Transect artery, sinus61612 233 Transect artery, sinus61613 35 Remove aneurysm, sinus61615 34 Resect/excise lesion, skull61616 34 Resect/excise lesion, skull61618 34 Repair dura61619 34 Repair dura61623 137 Endovasc tempory vessel occl61624 137 Occlusion/embolization cath61626 137 Occlusion/embolization cath61630 201 Intracranial angioplasty61635 201 Intracran angioplsty w/stent61640 257 Dilate ic vasospasm, init61641 290 Dilate ic vasospasm add-on61642 290 Dilate ic vasospasm add-on61680 14 Intracranial vessel surgery61682 45 Intracranial vessel surgery61684 14 Intracranial vessel surgery61686 45 Intracranial vessel surgery61690 14 Intracranial vessel surgery61692 45 Intracranial vessel surgery61697 45 Brain aneurysm repr, complx61698 45 Brain aneurysm repr, complx61700 45 Brain aneurysm repr , simple61702 45 Inner skull vessel surgery61703 45 Clamp neck artery61705 45 Revise circulation to head61708 59 Revise circulation to head61710 59 Revise circulation to head61711 45 Fusion of skull arteries61720 61 Incise skull/brain surgery61735 47 Incise skull/brain surgery61750 16 Incise skull/brain biopsy61751 16 Brain biopsy w/ ct/mr guide


CPT/HCPCS MOD MOD LEV DESCRIPTION61760 16 Implant brain electrodes61770 42 Incise skull for treatment61781 232 Scan proc cranial intra 61782 232 Scan proc cranial extra 61783 232 Scan proc spinal 61790 55 Treat trigeminal nerve61791 50 Treat trigeminal tract61796 28 Srs, cranial lesion simple61797 246 Srs, cran les simple, addl61798 28 Srs, cranial lesion complex61799 246 Srs, cran les complex, addl61800 246 Apply srs headframe add-on61850 59 Implant neuroelectrodes61860 59 Implant neuroelectrodes61863 46 Implant neuroelectrode61864 238 Implant neuroelectrde, add’l61867 46 Implant neuroelectrode61868 238 Implant neuroelectrde, add’l61870 45 Implant neuroelectrodes61875 59 Implant neuroelectrodes end-dated 12/31/201461880 40 Revise/remove neuroelectrode61885 52 Implant neurostim one array61886 20 Implant neurostim arrays61888 25 Revise/remove neuroreceiver62000 30 Treat skull fracture62005 14 Treat skull fracture62010 45 Treatment of head injury62100 14 Repair brain fluid leakage62115 14 Reduction of skull defect62116 27 Reduction of skull defect end-dated 12/31/201462117 14 Reduction of skull defect62120 45 Repair skull cavity lesion62121 14 Incise skull repair62140 14 Repair of skull defect62141 14 Repair of skull defect62142 59 Remove skull plate/flap62143 45 Replace skull plate/flap62145 45 Repair of skull & brain62146 14 Repair of skull with graft62147 45 Repair of skull with graft62148 249 Retr bone flap to fix skull62160 232 Neuroendoscopy add-on62161 45 Dissect brain w/scope62162 45 Remove colloid cyst w/scope62163 45 Zneuroendoscopy w/fb removal62164 45 Remove brain tumor w/scope62165 45 Remove pituit tumor w/scope62180 59 Establish brain cavity shunt62190 47 Establish brain cavity shunt62192 45 Establish brain cavity shunt62194 50 Replace/irrigate catheter62200 14 Establish brain cavity shunt62201 30 Establish brain cavity shunt62220 14 Establish brain cavity shunt62223 14 Establish brain cavity shunt62225 24 Replace/irrigate catheter62230 8 Replace/revise brain shunt62252 177 Csf shunt reprogram62252 TC 185 Csf shunt reprogram62252 26 185 Csf shunt reprogram62256 27 Remove brain cavity shunt62258 14 Replace brain cavity shunt62263 55 Lysis epidural adhesions62264 55 Epidural lysis on single day62267 96 Interdiscal perq aspir, dx62268 104 Drain spinal cord cyst


CPT/HCPCS MOD MOD LEV DESCRIPTION62269 124 Needle biopsy, spinal cord62270 104 Spinal fluid tap, diagnostic62272 104 Drain cerebro spinal fluid62273 104 Treat epidural spine lesion62280 24 Treat spinal cord lesion62281 24 Treat spinal cord lesion62282 24 Treat spinal canal lesion62284 113 Injection for myelogram62287 24 Percutaneous diskectomy62290 113 Inject for spine disk x-ray62291 113 Inject for spine disk x-ray62292 20 Injection into disk lesion62294 55 Injection into spinal artery62304 104 Cystourethro w/addl implant62305 104 Myelography lumbar injection62310 104 Inject spine c/t62311 104 Inject spine l/s (cd)62318 104 Inject spine w/cath, c/t62319 104 Inject spine w/cath l/s (cd)62350 10 Implant spinal canal cath62351 45 Implant spinal canal cath62355 50 Remove spinal canal catheter62360 39 Insert spine infusion device62361 8 Implant spine infusion pump62362 39 Implant spine infusion pump62365 50 Remove spine infusion device62367 177 Analyze spine infus pump62368 177 Analyze sp inf pump w/reprog62369 177 Anal sp inf pmp w/reprg&fill 62370 177 Anl sp inf pmp w/mdreprg&fil 63001 14 Removal of spinal lamina63003 14 Removal of spinal lamina63005 14 Removal of spinal lamina63011 14 Removal of spinal lamina63012 14 Removal of spinal lamina63015 14 Removal of spinal lamina63016 14 Removal of spinal lamina63017 14 Removal of spinal lamina63020 15 Neck spine disk surgery63030 15 Low back disk surgery63035 239 Spinal disk surgery add-on63040 15 Laminotomy, single cervical63042 15 Laminotomy, single lumbar63043 239 Laminotomy, addl cervical63044 239 Laminotomy, addl lumbar63045 13 Removal of spinal lamina63046 13 Removal of spinal lamina63047 13 Removal of spinal lamina63048 225 Remove spinal lamina add-on63050 14 Cervical laminoplasty63051 45 C-laminoplasty w/graft/plate63055 14 Decompress spinal cord63056 14 Decompress spinal cord63057 238 Decompress spine cord add-on63064 14 Decompress spinal cord63066 238 Decompress spine cord add-on63075 14 Neck spine disk surgery63076 238 Neck spine disk surgery63077 14 Spine disk surgery, thorax63078 238 Spine disk surgery, thorax63081 3 Removal of vertebral body63082 233 Remove vertebral body add-on63085 3 Removal of vertebral body63086 233 Remove vertebral body add-on63087 3 Removal of vertebral body63088 233 Remove vertebral body add-on


CPT/HCPCS MOD MOD LEV DESCRIPTION63090 3 Removal of vertebral body63091 233 Remove vertebral body add-on63101 14 Removal of vertebral body63102 14 Removal of vertebral body63103 238 Remove vertebral body add-on63170 14 Incise spinal cord tract(s)63172 45 Drainage of spinal cyst63173 45 Drainage of spinal cyst63180 45 Revise spinal cord ligaments63182 45 Revise spinal cord ligaments63185 14 Incise spinal column/nerves63190 14 Incise spinal column/nerves63191 15 Incise spinal column/nerves63194 14 Incise spinal column & cord63195 14 Incise spinal column & cord63196 14 Incise spinal column & cord63197 14 Incise spinal column & cord63198 45 Incise spinal column & cord, cerv.63199 45 Incise spinal column & cord, thor.63200 27 Release of spinal cord, lumbar63250 45 Revise spinal cord vessels63251 45 Revise spinal cord vessels63252 45 Revise spinal cord vessels63265 14 Excise intraspinal lesion63266 14 Excise intraspinal lesion63267 14 Excise intraspinal lesion63268 14 Excise intraspinal lesion63270 45 Excise intraspinal lesion63271 45 Excise intraspinal lesion63272 45 Excise intraspinal lesion63273 59 Excise intraspinal lesion63275 14 Biopsy/excise spinal tumor63276 14 Biopsy/excise spinal tumor63277 14 Biopsy/excise spinal tumor63278 14 Biopsy/excise spinal tumor63280 14 Biopsy/excise spinal tumor63281 14 Biopsy/excise spinal tumor63282 14 Biopsy/excise spinal tumor63283 14 Biopsy/excise spinal tumor63285 14 Biopsy/excise spinal tumor63286 14 Biopsy/excise spinal tumor63287 14 Biopsy/excise spinal tumor63290 45 Biopsy/excise spinal tumor63295 224 Repair of laminectomy defect63300 14 Removal of vertebral body63301 14 Removal of vertebral body63302 14 Removal of vertebral body63303 14 Removal of vertebral body63304 45 Removal of vertebral body63305 45 Removal of vertebral body63306 45 Removal of vertebral body63307 45 Removal of vertebral body63308 238 Remove vertebral body add-on63600 50 Remove spinal cord lesion63610 124 Stimulation of spinal cord63615 42 Remove lesion of spinal cord63620 28 Srs, spinal lesion63621 246 Srs, spinal lesion, addl63650 24 Implant neuroelectrodes63655 39 Implant neuroelectrodes63661 8 Remove spine eltrd perq array, inc flourscpy63662 8 Remove spine eltrd plate, inc flourscpy63663 8 Revisespine eltrd perq array,inc flourscpy63664 8 Revise spine eltrd plate, inc flourscpy63685 39 Implant neuroreceiver63688 24 Revise/remove neuroreceiver


CPT/HCPCS MOD MOD LEV DESCRIPTION63700 14 Repair of spinal herniation63702 14 Repair of spinal herniation63704 14 Repair of spinal herniation63706 14 Repair of spinal herniation63707 14 Repair spinal fluid leakage63709 14 Repair spinal fluid leakage63710 14 Graft repair of spine defect63740 45 Install spinal shunt63741 14 Install spinal shunt63744 39 Revision of spinal shunt63746 50 Removal of spinal shunt64400 106 Injection for nerve block64402 106 Injection for nerve block64405 106 Injection for nerve block64408 98 Injection for nerve block64410 98 Injection for nerve block64412 106 Injection for nerve block64413 106 Injection for nerve block64415 106 Injection for nerve block64416 106 N block cont infuse, b plex64417 106 Injection for nerve block64418 106 Injection for nerve block64420 104 Injection for nerve block64421 106 Injection for nerve block64425 106 Injection for nerve block64430 106 Injection for nerve block64435 106 Injection for nerve block64445 106 Injection for nerve block64446 106 N blk inj, sciatic, cont inf64447 106 N block inj fem, single64448 106 N block inj fem, cont inf64449 106 N block inj, lumbar plexus64450 106 N block, other peripheral64455 98 N block inj, plantar digit64479 106 Inj foramen epidural c/t64480 229 Inj foramen epidural add-on64483 106 Inj foramen epidural l/s64484 229 Inj foramen epidural add-on64486 106 Myelography lumbar injection64487 106 Tap block unil by injection64488 106 Tap block uni by infusion64489 106 Tap block bl injection64490 98 Inj paravert f jnt c/t 1 lev, w/image guid64491 242 Inj paravert f jnt c/t 2nd lev, w/image guid64492 242 Inj paravert f jnt c/t 3rd+ lev, w/image guid64493 98 Inj paravert f fnt l/s 1 lev64494 242 Inj paravert f jnt l/s 2nd lev64495 242 Inj paravert f jnt l/s 3rd+ lev64505 104 Injection for nerve block64508 96 Injection for nerve block64510 104 Injection for nerve block64517 104 N block inj, hypogas plxs64520 104 Injection for nerve block64530 104 Injection for nerve block64550 114 Apply neurostimulator64553 20 Implant neuroelectrodes64555 24 Implant neuroelectrodes64561 55 Implant neuroelectrodes64565 24 Implant neuroelectrodes64566 24 Neuroeltrd stim post tibial 64568 20 Inc for vagus n elect impl 64569 20 Revise/repl vagus n eltrd 64570 20 Remove vagus n eltrd 64575 24 Implant neuroelectrodes64580 20 Implant neuroelectrodes64581 55 Implant neuroelectrodes


CPT/HCPCS MOD MOD LEV DESCRIPTION64585 24 Revise/remove neuroelectrode64590 10 Implant neuroreceiver64595 24 Revise/remove neuroreceiver64600 54 Injection treatment of nerve64605 20 Injection treatment of nerve64610 55 Injection treatment of nerve64611 56 Chemodenerv saliv glands64612 57 Destroy nerve, face muscle64613 57 Destroy nerve neck muscle end-dated 12/31/201364614 57 Destroy nerve extrem musc end-dated 12/31/201364615 57 Chemodenerv musc migraine 64616 57 Chemodenerv musc neck dyston 64617 267 Chemodener muscle larynx emg 64620 24 Injection treatment of nerve64630 50 Injection treatment of nerve64632 52 N block inj, common digit64633 25 Destroy cerv/thor facet jnt 64634 25 Destroy c/th facet jnt addl 64635 25 Destroy lumb/sac facet jnt 64636 25 Destroy l/s facet jnt addl 64640 57 Injection treatment of nerve64642 63 Chemodenerv 1 extremity 1-4 64643 57 Chemodenerv 1 extrem 1-4 ea 64644 63 Chemodenerv 1 extrem 5/> mus 64645 57 Chemodenerv 1 extrem 5/> ea 64646 57 Chemodenerv trunk musc 1-5 64647 57 Chemodenerv trunk musc 6/> 64650 124 Chemodenerv eccrine glands64653 124 Chemodenerv eccrine glands64680 55 Injection treatment of nerve64681 55 Injection treatment of nerve64702 24 Revise finger/toe nerve64704 8 Revise hand/foot nerve64708 8 Revise arm/leg nerve64712 8 Revision of sciatic nerve64713 8 Revision of arm nerve(s)64714 8 Revise low back nerve(s)64716 8 Revision of cranial nerve64718 20 Revise ulnar nerve at elbow64719 24 Revise ulnar nerve at wrist64721 25 Carpal tunnel surgery64722 8 Relieve pressure on nerve(s)64726 24 Release foot/toe nerve64727 244 Internal nerve revision64732 50 Incision of brow nerve64734 50 Incision of cheek nerve64736 50 Incision of chin nerve64738 50 Incision of jaw nerve64740 50 Incision of tongue nerve64742 50 Incision of facial nerve64744 52 Incise nerve, back of head64746 39 Incise diaphragm nerve64752 45 Incision of vagus nerve end-dated 12/31/201464755 45 Incision of stomach nerves64760 45 Incision of vagus nerve64761 52 Incision of pelvis nerve end-dated 12/31/201464763 40 Incise hip/thigh nerve64766 52 Incise hip/thigh nerve64771 50 Sever cranial nerve64772 39 Incision of spinal nerve64774 24 Remove skin nerve lesion64776 20 Remove digit nerve lesion64778 244 Digit nerve surgery add-on64782 10 Remove limb nerve lesion64783 244 Limb nerve surgery add-on64784 20 Remove nerve lesion


CPT/HCPCS MOD MOD LEV DESCRIPTION64786 20 Remove sciatic nerve lesion64787 241 Implant nerve end64788 55 Remove skin nerve lesion64790 39 Removal of nerve lesion64792 39 Removal of nerve lesion64795 104 Biopsy of nerve64802 40 Remove sympathetic nerves64804 46 Remove sympathetic nerves64809 46 Remove sympathetic nerves64818 46 Remove sympathetic nerves64820 55 Remove sympathetic nerves64821 57 Remove sympathetic nerves64822 57 Remove sympathetic nerves64823 57 Remove sympathetic nerves64831 24 Repair of digit nerve64832 241 Repair nerve add-on64834 20 Repair of hand or foot nerve64835 20 Repair of hand or foot nerve64836 20 Repair of hand or foot nerve64837 241 Repair nerve add-on64840 20 Repair of leg nerve64856 10 Repair/transpose nerve64857 8 Repair arm/leg nerve64858 8 Repair sciatic nerve64859 234 Nerve surgery64861 8 Repair of arm nerves64862 20 Repair of low back nerves64864 8 Repair of facial nerve64865 8 Repair of facial nerve64866 14 Fusion of facial/other nerve64868 14 Fusion of facial/other nerve64870 8 Fusion of facial/other nerve end-dated 12/31/201464872 234 Subsequent repair of nerve64874 222 Repair & revise nerve add-on64876 222 Repair nerve/shorten bone64885 8 Nerve graft, head or neck64886 8 Nerve graft, head or neck64890 20 Nerve graft, hand or foot64891 20 Nerve graft, hand or foot64892 8 Nerve graft, arm or leg64893 20 Nerve graft, arm or leg64895 8 Nerve graft, hand or foot64896 8 Nerve graft, hand or foot64897 20 Nerve graft, arm or leg64898 8 Nerve graft, arm or leg64901 234 Nerve graft add-on64902 241 Nerve graft add-on64905 8 Nerve pedicle transfer64907 8 Nerve pedicle transfer64910 39 Nerve repair w/allograft64911 45 Neurorraphy w/vein autograft64999 198 Nervous system surgery, unlisted65091 9 Revise eye65093 11 Revise eye with implant65101 25 Removal of eye65103 11 Remove eye/insert implant65105 9 Remove eye/attach implant65110 9 Removal of eye65112 9 Remove eye/revise socket65114 9 Remove eye/revise socket65125 11 Revise ocular implant65130 11 Insert ocular implant65135 25 Insert ocular implant65140 25 Attach ocular implant65150 52 Revise ocular implant65155 57 Reinsert ocular implant


CPT/HCPCS MOD MOD LEV DESCRIPTION65175 11 Removal of ocular implant65205 102 Remove foreign body from eye65210 128 Remove foreign body from eye65220 106 Remove foreign body from eye65222 131 Remove foreign body from eye65235 21 Remove foreign body from eye65260 21 Remove foreign body from eye65265 9 Remove foreign body from eye65270 21 Repair of eye wound65272 25 Repair of eye wound65273 17 Repair of eye wound65275 21 Repair of eye wound65280 21 Repair of eye wound65285 57 Repair of eye wound65286 57 Repair of eye wound65290 43 Repair of eye socket wound65400 25 Removal of eye lesion65410 98 Biopsy of cornea65420 25 Removal of eye lesion65426 25 Removal of eye lesion65430 106 Corneal smear65435 106 Curette/treat cornea65436 57 Curette/treat cornea65450 57 Treatment of corneal lesion65600 57 Revision of cornea65710 40 Corneal transplant65730 40 Corneal transplant65750 9 Corneal transplant65755 9 Corneal transplant65756 40 Corneal trnspl, endothelial65757 246 Prep corneal endo allograft65760 270 Revision of cornea65765 270 Revision of cornea65767 270 Corneal tissue transplant65770 52 Revise cornea with implant65771 270 Radial keratotomy65772 25 Correction of astigmatism65775 25 Correction of astigmatism65778 11 Cover eye w/membrane 65779 9 Cover eye w/membrane suture 65780 11 Ocular reconst, transplant65781 9 Ocular reconst, transplant65782 11 Ocular reconst, transplant65800 106 Drainage of eye65810 25 Drainage of eye65815 25 Drainage of eye65820 21 Relieve inner eye pressure65850 11 Incision of eye65855 25 Laser surgery of eye65860 21 Incise inner eye adhesions65865 11 Incise inner eye adhesions65870 11 Incise inner eye adhesions65875 11 Incise inner eye adhesions65880 25 Incise inner eye adhesions65900 52 Remove eye lesion65920 11 Remove implant of eye65930 11 Remove blood clot from eye66020 25 Injection treatment of eye66030 25 Injection treatment of eye66130 21 Remove eye lesion66150 43 Glaucoma surgery66155 57 Glaucoma surgery66160 43 Glaucoma surgery66165 52 Glaucoma surgery end-dated 12/31/201466170 40 Glaucoma surgery66172 40 Incision of eye


CPT/HCPCS MOD MOD LEV DESCRIPTION66174 40 Translum dil eye canal 66175 40 Trnslum dil eye canal w/stnt 66179 40 Tap block bl by infusion66180 40 Implant eye shunt66183 40 Insert ant drainage device 66184 40 Tap block bl by infusion66185 52 Revise eye shunt66220 9 Repair eye lesion66225 43 Repair/graft eye lesion66250 25 Follow-up surgery of eye66500 11 Incision of iris66505 25 Incision of iris66600 25 Remove iris and lesion66605 25 Removal of iris66625 25 Removal of iris66630 25 Removal of iris66635 25 Removal of iris66680 11 Repair iris & ciliary body66682 25 Repair iris & ciliary body66700 21 Destruction, ciliary body66710 57 Destruction, ciliary body66711 57 Ciliary endoscopic ablation66720 25 Destruction, ciliary body66740 25 Destruction, ciliary body66761 25 Revision of iris66762 25 Revision of iris66770 25 Removal of inner eye lesion66820 25 Incision, secondary cataract66821 25 After cataract laser surgery66825 21 Reposition intraocular lens66830 25 Removal of lens lesion66840 25 Removal of lens material66850 25 Removal of lens material66852 9 Removal of lens material66920 9 Extraction of lens66930 21 Extraction of lens66940 9 Extraction of lens66982 25 Cataract surgery, complex66983 25 Cataract surg w/iol, 1 stage66984 25 Cataract surg w/iol, i stage66985 11 Insert lens prosthesis66986 11 Exchange lens prosthesis66990 232 Ophthalmic endoscope add-on66999 199 Eye surgery procedure, unlisted67005 11 Partial removal of eye fluid67010 11 Partial removal of eye fluid67015 11 Release of eye fluid67025 11 Replace eye fluid67027 9 Implant eye drug system67028 106 Injection eye drug67030 11 Incise inner eye strands67031 25 Laser surgery, eye strands67036 9 Removal of inner eye fluid67039 9 Laser treatment of retina67040 9 Laser treatment of retina67041 9 Vit for macular pucker67042 9 Vit for macular hole67043 9 Vit for membrane dissect67101 25 Repair detached retina67105 25 Repair detached retina67107 9 Repair detached retina67108 9 Repair detached retina67110 25 Repair detached retina67112 9 Rerepair detached retina67113 40 Repair retinal detach, clpx67115 57 Release encircling material


CPT/HCPCS MOD MOD LEV DESCRIPTION67120 11 Remove eye implant material67121 9 Remove eye implant material67141 25 Treatment of retina67145 25 Treatment of retina67208 25 Treatment of retinal lesion67210 25 Treatment of retinal lesion67218 25 Treatment of retinal lesion67220 25 Treatment of choroid lesion67221 104 Ocular photodynamic ther67225 228 Eye photodynamic ther add-on67227 25 Treatment of retinal lesion67228 25 Treatment of retinal lesion67250 11 Reinforce eye wall67255 9 Reinforce/graft eye wall67299 199 Eye surgery procedure, unlisted67311 25 Revise eye muscle67312 11 Revise two eye muscles67314 25 Revise eye muscle67316 52 Revise two eye muscles67318 43 Revise eye muscle(s)67320 244 Revise eye muscle(s) add-on67331 236 Eye surgery follow-up add-on67332 236 Rerevise eye muscles add-on67334 236 Revise eye muscle w/suture67335 236 Eye suture during surgery67340 241 Revise eye muscle add-on67343 11 Release eye tissue67345 57 Destroy nerve of eye muscle67346 125 Biopsy, eye muscle67399 199 Eye muscle surgery procedure, unlisted67400 11 Explore/biopsy eye socket67405 25 Explore/drain eye socket67412 11 Explore/treat eye socket67413 21 Explore/treat eye socket67414 9 Explr/decompress eye socket67415 98 Aspiration, orbital contents67420 40 Explore/treat eye socket67430 21 Explore/treat eye socket67440 9 Explore/drain eye socket67445 9 Explr/decompress eye socket67450 9 Explore/biopsy eye socket67500 106 Inject/treat eye socket67505 106 Inject/treat eye socket67515 106 Inject/treat eye socket67550 43 Insert eye socket implant67560 52 Revise eye socket implant67570 40 Decompress optic nerve67599 199 Orbit surgery procedure, unlisted67700 25 Drainage of eyelid abscess67710 25 Incision of eyelid67715 25 Incision of eyelid fold67800 24 Remove eyelid lesion67801 24 Remove eyelid lesions67805 24 Remove eyelid lesions67808 55 Remove eyelid lesion(s)67810 106 Biopsy of eyelid67820 106 Revise eyelashes67825 25 Revise eyelashes67830 25 Revise eyelashes67835 52 Revise eyelashes67840 25 Remove eyelid lesion67850 25 Treat eyelid lesion67875 106 Closure of eyelid by suture67880 25 Revision of eyelid67882 25 Revision of eyelid67900 57 Repair brow defect


CPT/HCPCS MOD MOD LEV DESCRIPTION67901 57 Repair eyelid defect67902 43 Repair eyelid defect67903 43 Repair eyelid defect67904 11 Repair eyelid defect67906 57 Repair eyelid defect67908 25 Repair eyelid defect67909 57 Revise eyelid defect67911 25 Revise eyelid defect67912 57 Correction eyelid w/ implant67914 25 Repair eyelid defect67915 25 Repair eyelid defect67916 25 Repair eyelid defect67917 57 Repair eyelid defect67921 25 Repair eyelid defect67922 25 Repair eyelid defect67923 25 Repair eyelid defect67924 57 Repair eyelid defect67930 25 Repair eyelid wound67935 25 Repair eyelid wound67938 25 Remove eyelid foreign body67950 11 Revision of eyelid67961 52 Revision of eyelid67966 57 Revision of eyelid67971 11 Reconstruction of eyelid67973 40 Reconstruction of eyelid67974 40 Reconstruction of eyelid67975 57 Reconstruction of eyelid67999 199 Revision of eyelid, unlisted68020 25 Incise/drain eyelid lining68040 106 Treatment of eyelid lesions68100 106 Biopsy of eyelid lining68110 25 Remove eyelid lining lesion68115 25 Remove eyelid lining lesion68130 25 Remove eyelid lining lesion68135 25 Remove eyelid lining lesion68200 106 Treat eyelid by injection68320 11 Revise/graft eyelid lining68325 43 Revise/graft eyelid lining68326 25 Revise/graft eyelid lining68328 52 Revise/graft eyelid lining68330 21 Revise eyelid lining68335 43 Revise/graft eyelid lining68340 52 Separate eyelid adhesions68360 25 Revise eyelid lining68362 11 Revise eyelid lining68371 25 Harvest eye tissue, alograft68399 199 Eyelid lining surgery, unlisted68400 25 Incise/drain tear gland68420 25 Incise/drain tear sac68440 25 Incise tear duct opening68500 57 Removal of tear gland68505 25 Partial removal, tear gland68510 98 Biopsy of tear gland68520 52 Removal of tear sac68525 89 Biopsy of tear sac68530 25 Clearance of tear duct68540 43 Remove tear gland lesion68550 57 Remove tear gland lesion68700 57 Repair tear ducts68705 25 Revise tear duct opening68720 40 Create tear sac drain68745 40 Create tear duct drain68750 40 Create tear duct drain68760 57 Close tear duct opening68761 52 Close tear duct opening68770 21 Close tear system fistula


CPT/HCPCS MOD MOD LEV DESCRIPTION68801 25 Dilate tear duct opening68810 25 Probe nasolacrimal duct68811 25 Probe nasolacrimal duct68815 57 Probe nasolacrimal duct68816 25 Probe nasolacrimal duct w/ balloon68840 25 Explore/irrigate tear ducts68850 140 Injection for tear sac x-ray68899 199 Tear duct system surgery, unlisted69000 24 Drain external ear lesion69005 24 Drain external ear lesion69020 24 Drain outer ear canal lesion69100 129 Biopsy of external ear69105 129 Biopsy of external ear canal69110 24 Remove external ear, partial69120 55 Removal of external ear69140 20 Remove ear canal lesion(s)69145 24 Remove ear canal lesion(s)69150 10 Extensive ear canal surgery69155 45 Extensive ear/neck surgery69200 100 Clear outer ear canal69205 55 Clear outer ear canal69210 99 Remove impacted ear wax uni 69220 106 Clean out mastoid cavity69222 57 Clean out mastoid cavity69300 207 Revise external ear69310 24 Rebuild outer ear canal69320 50 Rebuild outer ear canal69399 198 Outer ear surgery procedure, unlisted69400 104 Inflate middle ear canal end-dated 12/31/201469401 104 Inflate middle ear canal end-dated 12/31/201469405 20 Catheterize middle ear canal end-dated 12/31/201469420 25 Incision of eardrum69421 25 Incision of eardrum69424 131 Remove ventilating tube69433 25 Create eardrum opening69436 25 Create eardrum opening69440 25 Exploration of middle ear69450 52 Eardrum revision69501 25 Mastoidectomy69502 21 Mastoidectomy69505 21 Remove mastoid structures69511 21 Extensive mastoid surgery69530 21 Extensive mastoid surgery69535 17 Remove part of temporal bone69540 25 Remove ear lesion69550 52 Remove ear lesion69552 52 Remove ear lesion69554 46 Remove ear lesion69601 21 Mastoid surgery revision69602 21 Mastoid surgery revision69603 21 Mastoid surgery revision69604 25 Mastoid surgery revision69605 21 Mastoid surgery revision69610 25 Repair of eardrum69620 25 Repair of eardrum69631 25 Repair eardrum structures69632 57 Rebuild eardrum structures69633 57 Rebuild eardrum structures69635 25 Repair eardrum structures69636 52 Rebuild eardrum structures69637 52 Rebuild eardrum structures69641 25 Revise middle ear & mastoid69642 25 Revise middle ear & mastoid69643 25 Revise middle ear & mastoid69644 25 Revise middle ear & mastoid69645 25 Revise middle ear & mastoid


CPT/HCPCS MOD MOD LEV DESCRIPTION69646 52 Revise middle ear & mastoid69650 25 Release middle ear bone69660 25 Revise middle ear bone69661 52 Revise middle ear bone69662 57 Revise middle ear bone69666 52 Repair middle ear structures69667 52 Repair middle ear structures69670 21 Remove mastoid air cells69676 57 Remove middle ear nerve69700 25 Close mastoid fistula69710 270 Implant/replace hearing aid69711 21 Remove/repair hearing aid69714 25 Implant temple bone w/stimul69715 57 Temple bne implnt w/stimulat69717 25 Temple bone implant revision69718 57 Revise temple bone implant69720 9 Release facial nerve69725 29 Release facial nerve69740 52 Repair facial nerve69745 52 Repair facial nerve69799 199 Middle ear surgery procedure, unlisted69801 21 Incise inner ear69805 21 Explore inner ear69806 57 Explore inner ear69820 52 Establish inner ear window69840 52 Revise inner ear window69905 25 Remove inner ear69910 52 Remove inner ear & mastoid69915 40 Incise inner ear nerve69930 52 Implant cochlear device69949 199 Inner ear surgery procedure, unlisted69950 46 Incise inner ear nerve69955 46 Release facial nerve69960 15 Release inner ear canal69970 46 Remove inner ear lesion69979 199 Temporal bone surgery, unlisted69990 230 Microsurgery add-on70010 219 Contrast x-ray of brain70015 219 Contrast x-ray of brain70015 TC 219 Contrast x-ray of brain70015 26 219 Contrast x-ray of brain70030 220 X-ray eye for foreign body70030 TC 220 X-ray eye for foreign body70030 26 220 X-ray eye for foreign body70100 219 X-ray exam of jaw70100 TC 219 X-ray exam of jaw70100 26 219 X-ray exam of jaw70110 219 X-ray exam of jaw70110 TC 219 X-ray exam of jaw70110 26 219 X-ray exam of jaw70120 197 X-ray exam of mastoids70120 TC 197 X-ray exam of mastoids70120 26 197 X-ray exam of mastoids70130 220 X-ray exam of mastoids70130 TC 220 X-ray exam of mastoids70130 26 220 X-ray exam of mastoids70134 219 X-ray exam of middle ear70134 TC 219 X-ray exam of middle ear70134 26 219 X-ray exam of middle ear70140 219 X-ray exam of facial bones70140 TC 219 X-ray exam of facial bones70140 26 219 X-ray exam of facial bones70150 219 X-ray exam of facial bones70150 TC 219 X-ray exam of facial bones70150 26 219 X-ray exam of facial bones70160 219 X-ray exam of nasal bones


CPT/HCPCS MOD MOD LEV DESCRIPTION70160 TC 219 X-ray exam of nasal bones70160 26 219 X-ray exam of nasal bones70170 219 X-ray exam of tear duct70170 TC 219 X-ray exam of tear duct70170 26 219 X-ray exam of tear duct70190 220 X-ray exam of eye sockets70190 TC 220 X-ray exam of eye sockets70190 26 220 X-ray exam of eye sockets70200 219 X-ray exam of eye sockets70200 TC 219 X-ray exam of eye sockets70200 26 219 X-ray exam of eye sockets70210 219 X-ray exam of sinuses70210 TC 219 X-ray exam of sinuses70210 26 219 X-ray exam of sinuses70220 219 X-ray exam of sinuses70220 TC 219 X-ray exam of sinuses70220 26 219 X-ray exam of sinuses70240 219 X-ray exam, pituitary saddle70240 TC 219 X-ray exam, pituitary saddle70240 26 219 X-ray exam, pituitary saddle70250 219 X-ray exam of skull70250 TC 219 X-ray exam of skull70250 26 219 X-ray exam of skull70260 195 X-ray exam of skull70260 TC 195 X-ray exam of skull70260 26 195 X-ray exam of skull70300 195 X-ray exam of teeth70300 TC 195 X-ray exam of teeth70300 26 195 X-ray exam of teeth70310 195 X-ray exam of teeth70310 TC 195 X-ray exam of teeth70310 26 195 X-ray exam of teeth70320 219 Full mouth x-ray of teeth70320 TC 219 Full mouth x-ray of teeth70320 26 219 Full mouth x-ray of teeth70328 195 X-ray exam of jaw joint70328 TC 195 X-ray exam of jaw joint70328 26 195 X-ray exam of jaw joint70330 218 X-ray exam of jaw joints70330 TC 218 X-ray exam of jaw joints70330 26 218 X-ray exam of jaw joints70332 220 X-ray exam of jaw joint70332 TC 220 X-ray exam of jaw joint70332 26 220 X-ray exam of jaw joint70336 172 Magnetic image, jaw joint70336 TC 171 Magnetic image, jaw joint70336 26 172 Magnetic image, jaw joint70350 219 X-ray head for orthodontia70350 TC 219 X-ray head for orthodontia70350 26 219 X-ray head for orthodontia70355 195 Panoramic x-ray of jaws70355 TC 195 Panoramic x-ray of jaws70355 26 195 Panoramic x-ray of jaws70360 219 X-ray exam of neck70360 TC 219 X-ray exam of neck70360 26 219 X-ray exam of neck70370 219 Throat x-ray & fluoroscopy70370 TC 219 Throat x-ray & fluoroscopy70370 26 219 Throat x-ray & fluoroscopy70371 151 Speech evaluation, complex70371 TC 153 Speech evaluation, complex70371 26 151 Speech evaluation, complex70373 219 Contrast x-ray of larynx70373 TC 219 Contrast x-ray of larynx70373 26 219 Contrast x-ray of larynx70380 219 X-ray exam of salivary gland


CPT/HCPCS MOD MOD LEV DESCRIPTION70380 TC 219 X-ray exam of salivary gland70380 26 219 X-ray exam of salivary gland70390 219 X-ray exam of salivary duct70390 TC 219 X-ray exam of salivary duct70390 26 219 X-ray exam of salivary duct70450 151 Ct head/brain w/o dye70450 TC 149 Ct head/brain w/o dye70450 26 151 Ct head/brain w/o dye70460 151 Ct head/brain w/dye70460 TC 149 Ct head/brain w/dye70460 26 151 Ct head/brain w/dye70470 151 Ct head/brain w/o&w dye70470 TC 149 Ct head/brain w/o&w dye70470 26 151 Ct head/brain w/o&w dye70480 151 Ct orbit/ear/fossa w/o dye70480 TC 149 Ct orbit/ear/fossa w/o dye70480 26 151 Ct orbit/ear/fossa w/o dye70481 151 Ct orbit/ear/fossa w/dye70481 TC 149 Ct orbit/ear/fossa w/dye70481 26 151 Ct orbit/ear/fossa w/dye70482 151 Ct orbit/ear/fossa w/o&w dye70482 TC 149 Ct orbit/ear/fossa w/o&w dye70482 26 151 Ct orbit/ear/fossa w/o&w dye70486 151 Ct maxillofacial w/o dye70486 TC 149 Ct maxillofacial w/o dye70486 26 151 Ct maxillofacial w/o dye70487 151 Ct maxillofacial w/dye70487 TC 149 Ct maxillofacial w/dye70487 26 151 Ct maxillofacial w/dye70488 151 Ct maxillofacial w/o&w dye70488 TC 149 Ct maxillofacial w/o&w dye70488 26 151 Ct maxillofacial w/o&w dye70490 151 Ct soft tissue neck w/o dye70490 TC 149 Ct soft tissue neck w/o dye70490 26 151 Ct soft tissue neck w/o dye70491 151 Ct soft tissue neck w/dye70491 TC 149 Ct soft tissue neck w/dye70491 26 151 Ct soft tissue neck w/dye70492 151 Ct sft tsue nck w/o & w/dye70492 TC 149 Ct sft tsue nck w/o & w/dye70492 26 151 Ct sft tsue nck w/o & w/dye70496 151 Ct angiography, head70496 TC 149 Ct angiography, head70496 26 151 Ct angiography, head70498 151 Ct angiography, neck70498 TC 149 Ct angiography, neck70498 26 151 Ct angiography, neck70540 151 Mri orbit/face/neck w/o dye70540 TC 149 Mri orbit/face/neck w/o dye70540 26 151 Mri orbit/face/neck w/o dye70542 151 Mri orbit/face/neck w/dye70542 TC 149 Mri orbit/face/neck w/dye70542 26 151 Mri orbit/face/neck w/dye70543 168 Mri orbt/fac/nck w/o&w dye70543 TC 166 Mri orbt/fac/nck w/o&w dye70543 26 168 Mri orbt/fac/nck w/o&w dye70544 151 Mr angiography head w/o dye70544 TC 149 Mr angiography head w/o dye70544 26 151 Mr angiography head w/o dye70545 151 Mr angiography head w/dye70545 TC 149 Mr angiography head w/dye70545 26 151 Mr angiography head w/dye70546 151 Mr angiograph head w/o&w dye70546 TC 149 Mr angiograph head w/o&w dye70546 26 151 Mr angiograph head w/o&w dye70547 151 Mr angiography neck w/o dye


CPT/HCPCS MOD MOD LEV DESCRIPTION70547 TC 149 Mr angiography neck w/o dye70547 26 151 Mr angiography neck w/o dye70548 151 Mr angiography neck w/dye70548 TC 149 Mr angiography neck w/dye70548 26 151 Mr angiography neck w/dye70549 168 Mr angiograph neck w/o&w dye70549 TC 166 Mr angiograph neck w/o&w dye70549 26 168 Mr angiograph neck w/o&w dye70551 151 Mri brain w/o dye70551 TC 149 Mri brain w/o dye70551 26 151 Mri brain w/o dye70552 151 Mri brain w/dye70552 TC 149 Mri brain w/dye70552 26 151 Mri brain w/dye70553 168 Mri brain w/o&w dye70553 TC 166 Mri brain w/o&w dye70553 26 168 Mri brain w/o&w dye70554 157 Fmri brain by tech70554 TC 156 Fmri brain by tech70554 26 157 Fmri brain by tech70555 157 Fmri brain by phys/psych70555 TC 158 Fmri brain by phys/psych70555 26 157 Fmri brain by phys/psych70557 151 Mri brain w/o dye70557 TC 153 Mri brain w/o dye70557 26 151 Mri brain w/o dye70558 151 Mri brain w/ dye70558 TC 153 Mri brain w/ dye70558 26 151 Mri brain w/ dye70559 151 Mri brain w/o & w/ dye70559 TC 153 Mri brain w/o & w/ dye70559 26 151 Mri brain w/o & w/ dye71010 195 Chest x-ray71010 TC 195 Chest x-ray71010 26 195 Chest x-ray71015 195 Chest x-ray71015 TC 195 Chest x-ray71015 26 195 Chest x-ray71020 195 Chest x-ray71020 TC 195 Chest x-ray71020 26 195 Chest x-ray71021 195 Chest x-ray71021 TC 195 Chest x-ray71021 26 195 Chest x-ray71022 195 Chest x-ray71022 TC 195 Chest x-ray71022 26 195 Chest x-ray71023 195 Chest x-ray and fluoroscopy71023 TC 195 Chest x-ray and fluoroscopy71023 26 195 Chest x-ray and fluoroscopy71030 195 Chest x-ray71030 TC 195 Chest x-ray71030 26 195 Chest x-ray71034 195 Chest x-ray and fluoroscopy71034 TC 195 Chest x-ray and fluoroscopy71034 26 195 Chest x-ray and fluoroscopy71035 195 Chest x-ray71035 TC 195 Chest x-ray71035 26 195 Chest x-ray71100 195 X-ray exam of ribs71100 TC 195 X-ray exam of ribs71100 26 195 X-ray exam of ribs71101 219 X-ray exam of ribs/chest71101 TC 219 X-ray exam of ribs/chest71101 26 219 X-ray exam of ribs/chest71110 194 X-ray exam of ribs


CPT/HCPCS MOD MOD LEV DESCRIPTION71110 TC 194 X-ray exam of ribs71110 26 194 X-ray exam of ribs71111 218 X-ray exam of ribs/ chest71111 TC 218 X-ray exam of ribs/ chest71111 26 218 X-ray exam of ribs/ chest71120 219 X-ray exam of breastbone71120 TC 219 X-ray exam of breastbone71120 26 219 X-ray exam of breastbone71130 219 X-ray exam of breastbone71130 TC 219 X-ray exam of breastbone71130 26 219 X-ray exam of breastbone71250 151 Ct thorax w/o dye71250 TC 149 Ct thorax w/o dye71250 26 151 Ct thorax w/o dye71260 151 Ct thorax w/dye71260 TC 149 Ct thorax w/dye71260 26 151 Ct thorax w/dye71270 151 Ct thorax w/o&w dye71270 TC 149 Ct thorax w/o&w dye71270 26 151 Ct thorax w/o&w dye71275 151 Ct angiography, chest71275 TC 149 Ct angiography, chest71275 26 151 Ct angiography, chest71550 151 Mri chest w/o dye71550 TC 149 Mri chest w/o dye71550 26 151 Mri chest w/o dye71551 151 Mri chest w/dye71551 TC 149 Mri chest w/dye71551 26 151 Mri chest w/dye71552 168 Mri chest w/o&w dye71552 TC 166 Mri chest w/o&w dye71552 26 168 Mri chest w/o&w dye71555 151 Mra, chest w or w/o dye71555 TC 149 Mra, chest w or w/o dye71555 26 151 Mra, chest w or w/o dye72010 219 X-ray exam of spine72010 TC 219 X-ray exam of spine72010 26 219 X-ray exam of spine72020 195 X-ray exam of spine72020 TC 195 X-ray exam of spine72020 26 195 X-ray exam of spine72040 195 X-ray exam neck spine 2-3 vw 72040 TC 195 X-ray exam neck spine 2-3 vw 72040 26 195 X-ray exam neck spine 2-3 vw 72050 195 X-ray exam of neck spine72050 TC 195 X-ray exam of neck spine72050 26 195 X-ray exam of neck spine72052 195 X-ray exam of neck spine72052 TC 195 X-ray exam of neck spine72052 26 195 X-ray exam of neck spine72069 195 X-ray exam of trunk spine72069 TC 195 X-ray exam of trunk spine72069 26 195 X-ray exam of trunk spine72070 195 X-ray exam of thoracic spine72070 TC 195 X-ray exam of thoracic spine72070 26 195 X-ray exam of thoracic spine72072 195 X-ray exam of thoracic spine72072 TC 195 X-ray exam of thoracic spine72072 26 195 X-ray exam of thoracic spine72074 195 X-ray exam of thoracic spine72074 TC 195 X-ray exam of thoracic spine72074 26 195 X-ray exam of thoracic spine72080 195 X-ray exam of trunk spine72080 TC 195 X-ray exam of trunk spine72080 26 195 X-ray exam of trunk spine72090 195 X-ray exam of trunk spine


CPT/HCPCS MOD MOD LEV DESCRIPTION72090 TC 195 X-ray exam of trunk spine72090 26 195 X-ray exam of trunk spine72100 195 X-ray exam of lower spine72100 TC 195 X-ray exam of lower spine72100 26 195 X-ray exam of lower spine72110 195 X-ray exam of lower spine72110 TC 195 X-ray exam of lower spine72110 26 195 X-ray exam of lower spine72114 195 X-ray exam of lower spine72114 TC 195 X-ray exam of lower spine72114 26 195 X-ray exam of lower spine72120 195 X-ray exam of lower spine72120 TC 195 X-ray exam of lower spine72120 26 195 X-ray exam of lower spine72125 151 Ct neck spine w/o dye72125 TC 149 Ct neck spine w/o dye72125 26 151 Ct neck spine w/o dye72126 151 Ct neck spine w/dye72126 TC 149 Ct neck spine w/dye72126 26 151 Ct neck spine w/dye72127 151 Ct neck spine w/o&w dye72127 TC 149 Ct neck spine w/o&w dye72127 26 151 Ct neck spine w/o&w dye72128 151 Ct chest spine w/o dye72128 TC 149 Ct chest spine w/o dye72128 26 151 Ct chest spine w/o dye72129 151 Ct chest spine w/dye72129 TC 149 Ct chest spine w/dye72129 26 151 Ct chest spine w/dye72130 151 Ct chest spine w/o&w dye72130 TC 149 Ct chest spine w/o&w dye72130 26 151 Ct chest spine w/o&w dye72131 151 Ct lumbar spine w/o dye72131 TC 149 Ct lumbar spine w/o dye72131 26 151 Ct lumbar spine w/o dye72132 151 Ct lumbar spine w/dye72132 TC 149 Ct lumbar spine w/dye72132 26 151 Ct lumbar spine w/dye72133 151 Ct lumbar spine w/o&w dye72133 TC 149 Ct lumbar spine w/o&w dye72133 26 151 Ct lumbar spine w/o&w dye72141 168 Mri neck spine w/o dye72141 TC 166 Mri neck spine w/o dye72141 26 168 Mri neck spine w/o dye72142 151 Mri neck spine w/dye72142 TC 149 Mri neck spine w/dye72142 26 151 Mri neck spine w/dye72146 168 Mri chest spine w/o dye72146 TC 166 Mri chest spine w/o dye72146 26 168 Mri chest spine w/o dye72147 151 Mri chest spine w/dye72147 TC 149 Mri chest spine w/dye72147 26 151 Mri chest spine w/dye72148 168 Mri lumbar spine w/o dye72148 TC 166 Mri lumbar spine w/o dye72148 26 168 Mri lumbar spine w/o dye72149 168 Mri lumbar spine w/dye72149 TC 166 Mri lumbar spine w/dye72149 26 168 Mri lumbar spine w/dye72156 168 Mri neck spine w/o&w dye72156 TC 166 Mri neck spine w/o&w dye72156 26 168 Mri neck spine w/o&w dye72157 168 Mri chest spine w/o&w dye72157 TC 166 Mri chest spine w/o&w dye72157 26 168 Mri chest spine w/o&w dye72158 168 Mri lumbar spine w/o&w dye


CPT/HCPCS MOD MOD LEV DESCRIPTION72158 TC 166 Mri lumbar spine w/o&w dye72158 26 168 Mri lumbar spine w/o&w dye72159 277 Mr angio spine w/o&w dye72159 TC 278 Mr angio spine w/o&w dye72159 26 277 Mr angio spine w/o&w dye72170 195 X-ray exam of pelvis72170 TC 195 X-ray exam of pelvis72170 26 195 X-ray exam of pelvis72190 219 X-ray exam of pelvis72190 TC 219 X-ray exam of pelvis72190 26 219 X-ray exam of pelvis72191 151 Ct angiograph pelv w/o&w dye72191 TC 149 Ct angiograph pelv w/o&w dye72191 26 151 Ct angiograph pelv w/o&w dye72192 151 Ct pelvis w/o dye72192 TC 149 Ct pelvis w/o dye72192 26 151 Ct pelvis w/o dye72193 151 Ct pelvis w/dye72193 TC 149 Ct pelvis w/dye72193 26 151 Ct pelvis w/dye72194 151 Ct pelvis w/o&w dye72194 TC 149 Ct pelvis w/o&w dye72194 26 151 Ct pelvis w/o&w dye72195 151 Mri pelvis w/o dye72195 TC 149 Mri pelvis w/o dye72195 26 151 Mri pelvis w/o dye72196 151 Mri pelvis w/dye72196 TC 149 Mri pelvis w/dye72196 26 151 Mri pelvis w/dye72197 168 Mri pelvis w/o & w dye72197 TC 166 Mri pelvis w/o & w dye72197 26 168 Mri pelvis w/o & w dye72198 151 Mra, pelvis w/o&w dye72198 TC 149 Mra, pelvis w/o&w dye72198 26 151 Mra, pelvis w/o&w dye72200 195 X-ray exam sacroiliac joints72200 TC 195 X-ray exam sacroiliac joints72200 26 195 X-ray exam sacroiliac joints72202 195 X-ray exam sacroiliac joints72202 TC 195 X-ray exam sacroiliac joints72202 26 195 X-ray exam sacroiliac joints72220 195 X-ray exam of tailbone72220 TC 195 X-ray exam of tailbone72220 26 195 X-ray exam of tailbone72240 195 Contrast x-ray of neck spine72240 TC 195 Contrast x-ray of neck spine72240 26 195 Contrast x-ray of neck spine72255 195 Contrast x-ray, thorax spine72255 TC 195 Contrast x-ray, thorax spine72255 26 195 Contrast x-ray, thorax spine72265 195 Contrast x-ray, lower spine72265 TC 195 Contrast x-ray, lower spine72265 26 195 Contrast x-ray, lower spine72270 219 Contrast x-ray of spine72270 TC 219 Contrast x-ray of spine72270 26 219 Contrast x-ray of spine72275 282 Epidurography72275 TC 282 Epidurography72275 26 282 Epidurography72285 195 X-ray c/t spine disk72285 TC 195 X-ray c/t spine disk72285 26 195 X-ray c/t spine disk72291 168 Perq vertebroplasty, fluor end-dated 12/31/201472291 TC 170 Perq vertebroplasty, fluor end-dated 12/31/201472291 26 168 Perq vertebroplasty, fluor end-dated 12/31/201472292 168 Perq vertebroplasty, ct end-dated 12/31/2014


CPT/HCPCS MOD MOD LEV DESCRIPTION72292 TC 170 Perq vertebroplasty, ct end-dated 12/31/201472292 26 168 Perq vertebroplasty, ct end-dated 12/31/201472295 195 X-ray of lower spine disk72295 TC 195 X-ray of lower spine disk72295 26 195 X-ray of lower spine disk73000 197 X-ray exam of collar bone73000 TC 197 X-ray exam of collar bone73000 26 197 X-ray exam of collar bone73010 197 X-ray exam of shoulder blade73010 TC 197 X-ray exam of shoulder blade73010 26 197 X-ray exam of shoulder blade73020 197 X-ray exam of shoulder73020 TC 197 X-ray exam of shoulder73020 26 197 X-ray exam of shoulder73030 197 X-ray exam of shoulder73030 TC 197 X-ray exam of shoulder73030 26 197 X-ray exam of shoulder73040 197 Contrast x-ray of shoulder73040 TC 197 Contrast x-ray of shoulder73040 26 197 Contrast x-ray of shoulder73050 194 X-ray exam of shoulders73050 TC 194 X-ray exam of shoulders73050 26 194 X-ray exam of shoulders73060 197 X-ray exam of humerus73060 TC 197 X-ray exam of humerus73060 26 197 X-ray exam of humerus73070 197 X-ray exam of elbow73070 TC 197 X-ray exam of elbow73070 26 197 X-ray exam of elbow73080 197 X-ray exam of elbow73080 TC 197 X-ray exam of elbow73080 26 197 X-ray exam of elbow73085 197 Contrast x-ray of elbow73085 TC 197 Contrast x-ray of elbow73085 26 197 Contrast x-ray of elbow73090 197 X-ray exam of forearm73090 TC 197 X-ray exam of forearm73090 26 197 X-ray exam of forearm73100 197 X-ray exam of wrist73100 TC 197 X-ray exam of wrist73100 26 197 X-ray exam of wrist73110 197 X-ray exam of wrist73110 TC 197 X-ray exam of wrist73110 26 197 X-ray exam of wrist73115 197 Contrast x-ray of wrist73115 TC 197 Contrast x-ray of wrist73115 26 197 Contrast x-ray of wrist73120 197 X-ray exam of hand73120 TC 197 X-ray exam of hand73120 26 197 X-ray exam of hand73130 197 X-ray exam of hand73130 TC 197 X-ray exam of hand73130 26 197 X-ray exam of hand73140 197 X-ray exam of finger(s)73140 TC 197 X-ray exam of finger(s)73140 26 197 X-ray exam of finger(s)73200 157 Ct upper extremity w/o dye73200 TC 156 Ct upper extremity w/o dye73200 26 157 Ct upper extremity w/o dye73201 157 Ct upper extremity w/dye73201 TC 156 Ct upper extremity w/dye73201 26 157 Ct upper extremity w/dye73202 157 Ct uppr extremity w/o&w dye73202 TC 156 Ct uppr extremity w/o&w dye73202 26 157 Ct uppr extremity w/o&w dye73206 151 Ct angio upr extrm w/o&w dye


CPT/HCPCS MOD MOD LEV DESCRIPTION73206 TC 149 Ct angio upr extrm w/o&w dye73206 26 151 Ct angio upr extrm w/o&w dye73218 157 Mri upper extremity w/o dye73218 TC 156 Mri upper extremity w/o dye73218 26 157 Mri upper extremity w/o dye73219 157 Mri upper extremity w/dye73219 TC 156 Mri upper extremity w/dye73219 26 157 Mri upper extremity w/dye73220 157 Mri uppr extremity w/o&w dye73220 TC 156 Mri uppr extremity w/o&w dye73220 26 157 Mri uppr extremity w/o&w dye73221 157 Mri joint upr extrem w/o dye73221 TC 156 Mri joint upr extrem w/o dye73221 26 157 Mri joint upr extrem w/o dye73222 157 Mri joint upr extrem w/ dye73222 TC 156 Mri joint upr extrem w/ dye73222 26 157 Mri joint upr extrem w/ dye73223 157 Mri joint upr extr w/o&w dye73223 TC 156 Mri joint upr extr w/o&w dye73223 26 157 Mri joint upr extr w/o&w dye73225 277 Mr angio upr extr w/o&w dye73225 TC 278 Mr angio upr extr w/o&w dye73225 26 277 Mr angio upr extr w/o&w dye73500 195 X-ray exam of hip73500 TC 195 X-ray exam of hip73500 26 195 X-ray exam of hip73510 195 X-ray exam of hip73510 TC 195 X-ray exam of hip73510 26 195 X-ray exam of hip73520 194 X-ray exam of hips73520 TC 194 X-ray exam of hips73520 26 194 X-ray exam of hips73525 197 Contrast x-ray of hip73525 TC 197 Contrast x-ray of hip73525 26 197 Contrast x-ray of hip73530 197 X-ray exam of hip73530 TC 197 X-ray exam of hip73530 26 197 X-ray exam of hip73540 195 X-ray exam of pelvis & hips73540 TC 195 X-ray exam of pelvis & hips73540 26 195 X-ray exam of pelvis & hips73550 197 X-ray exam of thigh73550 TC 197 X-ray exam of thigh73550 26 197 X-ray exam of thigh73560 197 X-ray exam of knee, 1 or 273560 TC 197 X-ray exam of knee, 1 or 273560 26 197 X-ray exam of knee, 1 or 273562 197 X-ray exam of knee, 373562 TC 197 X-ray exam of knee, 373562 26 197 X-ray exam of knee, 373564 197 X-ray exam, knee, 4 or more73564 TC 197 X-ray exam, knee, 4 or more73564 26 197 X-ray exam, knee, 4 or more73565 194 X-ray exam of knees73565 TC 194 X-ray exam of knees73565 26 194 X-ray exam of knees73580 197 Contrast x-ray of knee joint73580 TC 197 Contrast x-ray of knee joint73580 26 197 Contrast x-ray of knee joint73590 197 X-ray exam of lower leg73590 TC 197 X-ray exam of lower leg73590 26 197 X-ray exam of lower leg73600 197 X-ray exam of ankle73600 TC 197 X-ray exam of ankle73600 26 197 X-ray exam of ankle73610 197 X-ray exam of ankle


CPT/HCPCS MOD MOD LEV DESCRIPTION73610 TC 197 X-ray exam of ankle73610 26 197 X-ray exam of ankle73615 197 Contrast x-ray of ankle73615 TC 197 Contrast x-ray of ankle73615 26 197 Contrast x-ray of ankle73620 197 X-ray exam of foot73620 TC 197 X-ray exam of foot73620 26 197 X-ray exam of foot73630 197 X-ray exam of foot73630 TC 197 X-ray exam of foot73630 26 197 X-ray exam of foot73650 197 X-ray exam of heel73650 TC 197 X-ray exam of heel73650 26 197 X-ray exam of heel73660 197 X-ray exam of toe(s)73660 TC 197 X-ray exam of toe(s)73660 26 197 X-ray exam of toe(s)73700 157 Ct lower extremity w/o dye73700 TC 156 Ct lower extremity w/o dye73700 26 157 Ct lower extremity w/o dye73701 157 Ct lower extremity w/dye73701 TC 156 Ct lower extremity w/dye73701 26 157 Ct lower extremity w/dye73702 157 Ct lwr extremity w/o&w dye73702 TC 156 Ct lwr extremity w/o&w dye73702 26 157 Ct lwr extremity w/o&w dye73706 157 Ct angio lwr extr w/o&w dye73706 TC 156 Ct angio lwr extr w/o&w dye73706 26 157 Ct angio lwr extr w/o&w dye73718 157 Mri lower extremity w/o dye73718 TC 156 Mri lower extremity w/o dye73718 26 157 Mri lower extremity w/o dye73719 157 Mri lower extremity w/dye73719 TC 156 Mri lower extremity w/dye73719 26 157 Mri lower extremity w/dye73720 157 Mri lwr extremity w/o&w dye73720 TC 156 Mri lwr extremity w/o&w dye73720 26 157 Mri lwr extremity w/o&w dye73721 157 Mri joint of lwr extre w/o d73721 TC 156 Mri joint of lwr extre w/o d73721 26 157 Mri joint of lwr extre w/o d73722 157 Mri joint of lwr extr w/dye73722 TC 156 Mri joint of lwr extr w/dye73722 26 157 Mri joint of lwr extr w/dye73723 157 Mri joint lwr extr w/o&w dye73723 TC 156 Mri joint lwr extr w/o&w dye73723 26 157 Mri joint lwr extr w/o&w dye73725 157 Mra, lwr ext w or w/o dye73725 TC 156 Mra, lwr ext w or w/o dye73725 26 157 Mra, lwr ext w or w/o dye74000 195 X-ray exam of abdomen74000 TC 195 X-ray exam of abdomen74000 26 195 X-ray exam of abdomen74010 195 X-ray exam of abdomen74010 TC 195 X-ray exam of abdomen74010 26 195 X-ray exam of abdomen74020 195 X-ray exam of abdomen74020 TC 195 X-ray exam of abdomen74020 26 195 X-ray exam of abdomen74022 195 X-ray exam series, abdomen74022 TC 195 X-ray exam series, abdomen74022 26 195 X-ray exam series, abdomen74150 151 Ct abdomen w/o dye74150 TC 149 Ct abdomen w/o dye74150 26 151 Ct abdomen w/o dye74160 151 Ct abdomen w/dye


CPT/HCPCS MOD MOD LEV DESCRIPTION74160 TC 149 Ct abdomen w/dye74160 26 151 Ct abdomen w/dye74170 151 Ct abdomen w/o&w dye74170 TC 149 Ct abdomen w/o&w dye74170 26 151 Ct abdomen w/o&w dye74174 151 Ct angio abd&pelv w/o&w/dye 74174 TC 149 Ct angio abd&pelv w/o&w/dye 74174 26 151 Ct angio abd&pelv w/o&w/dye 74175 151 Ct angio abdom w/o&w dye74175 TC 149 Ct angio abdom w/o&w dye74175 26 151 Ct angio abdom w/o&w dye74176 151 Ct abd & pelvis w/o contrast 74176 TC 149 Ct abd & pelvis w/o contrast 74176 26 151 Ct abd & pelvis w/o contrast 74177 151 Ct abd & pelv w/contrast74177 TC 149 Ct abd & pelv w/contrast74177 26 151 Ct abd & pelv w/contrast74178 151 Ct anio abd & pelv 1 + regns74178 TC 149 Ct anio abd & pelv 1 + regns74178 26 151 Ct anio abd & pelv 1 + regns74181 151 Mri abdomen w/o dye74181 TC 149 Mri abdomen w/o dye74181 26 151 Mri abdomen w/o dye74182 151 Mri abdomen w/dye74182 TC 149 Mri abdomen w/dye74182 26 151 Mri abdomen w/dye74183 168 Mri abdomen w/o&w dye74183 TC 166 Mri abdomen w/o&w dye74183 26 168 Mri abdomen w/o&w dye74185 151 Mra, abdom w or w/o dy74185 TC 149 Mra, abdom w or w/o dy74185 26 151 Mra, abdom w or w/o dy74190 219 X-ray exam of peritoneum74190 TC 219 X-ray exam of peritoneum74190 26 219 X-ray exam of peritoneum74210 195 Contrst x-ray exam of throat74210 TC 195 Contrst x-ray exam of throat74210 26 195 Contrst x-ray exam of throat74220 219 Contrast x-ray, esophagus74220 TC 219 Contrast x-ray, esophagus74220 26 219 Contrast x-ray, esophagus74230 219 Cine/video x-ray, throat/eso74230 TC 219 Cine/video x-ray, throat/eso74230 26 219 Cine/video x-ray, throat/eso74235 219 Remove esophagus obstruction74235 TC 219 Remove esophagus obstruction74235 26 219 Remove esophagus obstruction74240 195 X-ray exam, upper gi tract74240 TC 195 X-ray exam, upper gi tract74240 26 195 X-ray exam, upper gi tract74241 219 X-ray exam, upper gi tract74241 TC 219 X-ray exam, upper gi tract74241 26 219 X-ray exam, upper gi tract74245 195 X-ray exam, upper gi tract74245 TC 195 X-ray exam, upper gi tract74245 26 195 X-ray exam, upper gi tract74246 195 Contrst x-ray uppr gi tract74246 TC 195 Contrst x-ray uppr gi tract74246 26 195 Contrst x-ray uppr gi tract74247 219 Contrst x-ray uppr gi tract74247 TC 219 Contrst x-ray uppr gi tract74247 26 219 Contrst x-ray uppr gi tract74249 219 Contrst x-ray uppr gi tract74249 TC 219 Contrst x-ray uppr gi tract74249 26 219 Contrst x-ray uppr gi tract74250 195 X-ray exam of small bowel


CPT/HCPCS MOD MOD LEV DESCRIPTION74250 TC 195 X-ray exam of small bowel74250 26 195 X-ray exam of small bowel74251 219 X-ray exam of small bowel74251 TC 219 X-ray exam of small bowel74251 26 219 X-ray exam of small bowel74260 219 X-ray exam of small bowel74260 TC 219 X-ray exam of small bowel74260 26 219 X-ray exam of small bowel74261 168 CT colonography, w/o dye74261 TC 170 CT colonography, w/o dye74261 26 168 CT colonography, w/o dye74262 168 CT colonography, w/ dye74262 TC 170 CT colonography, w/ dye74262 26 168 CT colonography, w/ dye74263 277 CT colonography, screening74263 TC 278 CT colonography, screening74263 26 277 CT colonography, screening74270 219 Contrast x-ray exam of colon74270 TC 219 Contrast x-ray exam of colon74270 26 219 Contrast x-ray exam of colon74280 219 Contrast x-ray exam of colon74280 TC 219 Contrast x-ray exam of colon74280 26 219 Contrast x-ray exam of colon74283 195 Contrast x-ray exam of colon74283 TC 195 Contrast x-ray exam of colon74283 26 195 Contrast x-ray exam of colon74290 195 Contrast x-ray, gallbladder74290 TC 195 Contrast x-ray, gallbladder74290 26 195 Contrast x-ray, gallbladder74291 195 Contrast x-rays, gallbladder end-dated 12/31/201474291 TC 195 Contrast x-rays, gallbladder end-dated 12/31/201474291 26 195 Contrast x-rays, gallbladder end-dated 12/31/201474300 195 X-ray bile ducts/pancreas74300 TC 195 X-ray bile ducts/pancreas74300 26 195 X-ray bile ducts/pancreas74301 232 X-rays at surgery add-on74301 TC 232 X-rays at surgery add-on74301 26 232 X-rays at surgery add-on74305 195 X-ray bile ducts/pancreas74305 TC 195 X-ray bile ducts/pancreas74305 26 195 X-ray bile ducts/pancreas74320 195 Contrast x-ray of bile ducts74320 TC 195 Contrast x-ray of bile ducts74320 26 195 Contrast x-ray of bile ducts74327 219 X-ray bile stone removal74327 TC 219 X-ray bile stone removal74327 26 219 X-ray bile stone removal74328 219 Xray bile duct endoscopy74328 TC 219 Xray bile duct endoscopy74328 26 219 Xray bile duct endoscopy74329 195 X-ray for pancreas endoscopy74329 TC 195 X-ray for pancreas endoscopy74329 26 195 X-ray for pancreas endoscopy74330 219 X-ray bile/panc endoscopy74330 TC 219 X-ray bile/panc endoscopy74330 26 219 X-ray bile/panc endoscopy74340 219 X-ray guide for GI tube74340 TC 219 X-ray guide for GI tube74340 26 219 X-ray guide for GI tube74355 219 X-ray guide, intestinal tube74355 TC 219 X-ray guide, intestinal tube74355 26 219 X-ray guide, intestinal tube74360 219 X-ray guide, GI dilation74360 TC 219 X-ray guide, GI dilation74360 26 219 X-ray guide, GI dilation74363 219 X-ray, bile duct dilation


CPT/HCPCS MOD MOD LEV DESCRIPTION74363 TC 219 X-ray, bile duct dilation74363 26 219 X-ray, bile duct dilation74400 195 Contrst x-ray, urinary tract74400 TC 195 Contrst x-ray, urinary tract74400 26 195 Contrst x-ray, urinary tract74410 195 Contrst x-ray, urinary tract74410 TC 195 Contrst x-ray, urinary tract74410 26 195 Contrst x-ray, urinary tract74415 195 Contrst x-ray, urinary tract74415 TC 195 Contrst x-ray, urinary tract74415 26 195 Contrst x-ray, urinary tract74420 195 Contrst x-ray, urinary tract74420 TC 195 Contrst x-ray, urinary tract74420 26 195 Contrst x-ray, urinary tract74425 195 Contrst x-ray, urinary tract74425 TC 195 Contrst x-ray, urinary tract74425 26 195 Contrst x-ray, urinary tract74430 219 Contrast x-ray, bladder74430 TC 219 Contrast x-ray, bladder74430 26 219 Contrast x-ray, bladder74440 219 X-ray, male genital tract74440 TC 219 X-ray, male genital tract74440 26 219 X-ray, male genital tract74445 219 X-ray exam of penis74445 TC 219 X-ray exam of penis74445 26 219 X-ray exam of penis74450 195 X-ray, urethra/bladder74450 TC 195 X-ray, urethra/bladder74450 26 195 X-ray, urethra/bladder74455 195 X-ray, urethra/bladder74455 TC 195 X-ray, urethra/bladder74455 26 195 X-ray, urethra/bladder74470 219 X-ray exam of kidney lesion74470 TC 219 X-ray exam of kidney lesion74470 26 219 X-ray exam of kidney lesion74475 195 X-ray control, cath insert74475 TC 195 X-ray control, cath insert74475 26 195 X-ray control, cath insert74480 195 X-ray control, cath insert74480 TC 195 X-ray control, cath insert74480 26 195 X-ray control, cath insert74485 195 X-ray guide, GU dilation74485 TC 195 X-ray guide, GU dilation74485 26 195 X-ray guide, GU dilation74710 219 X-ray measurement of pelvis74710 TC 219 X-ray measurement of pelvis74710 26 219 X-ray measurement of pelvis74740 195 X-ray, female genital tract74740 TC 195 X-ray, female genital tract74740 26 195 X-ray, female genital tract74742 219 X-ray, fallopian tube74742 TC 219 X-ray, fallopian tube74742 26 219 X-ray, fallopian tube74775 219 X-ray exam of perineum74775 TC 219 X-ray exam of perineum74775 26 219 X-ray exam of perineum75557 172 Cardiac MRI for morph75557 TC 166 Cardiac MRI for morph75557 26 168 Cardiac MRI for morph75559 168 Cardiac MRI w/ stress img75559 TC 166 Cardiac MRI w/ stress img75559 26 168 Cardiac MRI w/ stress img75561 168 Cardiac MRI for morph w/ dye75561 TC 166 Cardiac MRI for morph w/ dye75561 26 168 Cardiac MRI for morph w/ dye75563 168 Card MRI w/stress img & dye


CPT/HCPCS MOD MOD LEV DESCRIPTION75563 TC 166 Card MRI w/stress img & dye75563 26 168 Card MRI w/stress img & dye75565 249 Card MRI vel flw map, add-on75565 TC 249 Card MRI vel flw map, add-on75565 26 249 Card MRI vel flw map, add-on75571 151 CT HRT w/o dye w/CA test75571 TC 153 CT HRT w/o dye w/CA test75571 26 151 CT HRT w/o dye w/CA test75572 151 CT HRT w/3D image 75572 TC 153 CT HRT w/3D image 75572 26 151 CT HRT w/3D image 75573 168 CT HRT W/3D image, congenital75573 TC 170 CT HRT W/3D image, congenital75573 26 168 CT HRT W/3D image, congenital75574 151 CT angio HRT w/3D image75574 TC 153 CT angio HRT w/3D image75574 26 151 CT angio HRT w/3D image75600 195 Contrast x-ray exam of aorta75600 TC 195 Contrast x-ray exam of aorta75600 26 195 Contrast x-ray exam of aorta75605 195 Contrast x-ray exam of aorta75605 TC 195 Contrast x-ray exam of aorta75605 26 195 Contrast x-ray exam of aorta75625 195 Contrast x-ray exam of aorta75625 TC 195 Contrast x-ray exam of aorta75625 26 195 Contrast x-ray exam of aorta75630 195 X-ray aorta, leg arteries75630 TC 195 X-ray aorta, leg arteries75630 26 195 X-ray aorta, leg arteries75635 151 Ct angio abdominal arteries75635 TC 149 Ct angio abdominal arteries75635 26 151 Ct angio abdominal arteries75658 195 Artery x-rays, arm75658 TC 195 Artery x-rays, arm75658 26 195 Artery x-rays, arm75705 195 Artery x-rays, spine75705 TC 195 Artery x-rays, spine75705 26 195 Artery x-rays, spine75710 195 Artery x-rays, arm/leg75710 TC 195 Artery x-rays, arm/leg75710 26 195 Artery x-rays, arm/leg75716 194 Artery x-rays, arms/legs75716 TC 194 Artery x-rays, arms/legs75716 26 194 Artery x-rays, arms/legs75726 195 Artery x-rays, abdomen75726 TC 195 Artery x-rays, abdomen75726 26 195 Artery x-rays, abdomen75731 195 Artery x-rays, adrenal gland75731 TC 195 Artery x-rays, adrenal gland75731 26 195 Artery x-rays, adrenal gland75733 194 Artery x-rays, adrenals75733 TC 194 Artery x-rays, adrenals75733 26 194 Artery x-rays, adrenals75736 195 Artery x-rays, pelvis75736 TC 195 Artery x-rays, pelvis75736 26 195 Artery x-rays, pelvis75741 195 Artery x-rays, lung75741 TC 195 Artery x-rays, lung75741 26 195 Artery x-rays, lung75743 194 Artery x-rays, lungs75743 TC 194 Artery x-rays, lungs75743 26 194 Artery x-rays, lungs75746 195 Artery x-rays, lung75746 TC 195 Artery x-rays, lung75746 26 195 Artery x-rays, lung75756 195 Artery x-rays, chest


CPT/HCPCS MOD MOD LEV DESCRIPTION75756 TC 195 Artery x-rays, chest75756 26 195 Artery x-rays, chest75774 232 Artery x-ray, each vessel75774 TC 232 Artery x-ray, each vessel75774 26 232 Artery x-ray, each vessel75791 195 AV dialysis shunt imaging75791 TC 153 AV dialysis shunt imaging75791 26 151 AV dialysis shunt imaging75801 195 Lymph vessel x-ray, arm/leg75801 TC 195 Lymph vessel x-ray, arm/leg75801 26 195 Lymph vessel x-ray, arm/leg75803 218 Lymph vessel x-ray,arms/legs75803 TC 218 Lymph vessel x-ray,arms/legs75803 26 218 Lymph vessel x-ray,arms/legs75805 195 Lymph vessel x-ray, trunk75805 TC 195 Lymph vessel x-ray, trunk75805 26 195 Lymph vessel x-ray, trunk75807 218 Lymph vessel x-ray, trunk75807 TC 218 Lymph vessel x-ray, trunk75807 26 218 Lymph vessel x-ray, trunk75809 219 Nonvascular shunt, x-ray75809 TC 219 Nonvascular shunt, x-ray75809 26 219 Nonvascular shunt, x-ray75810 195 Vein x-ray, spleen/liver75810 TC 195 Vein x-ray, spleen/liver75810 26 195 Vein x-ray, spleen/liver75820 195 Vein x-ray, arm/leg75820 TC 195 Vein x-ray, arm/leg75820 26 195 Vein x-ray, arm/leg75822 194 Vein x-ray, arms/legs75822 TC 194 Vein x-ray, arms/legs75822 26 194 Vein x-ray, arms/legs75825 195 Vein x-ray, trunk75825 TC 195 Vein x-ray, trunk75825 26 195 Vein x-ray, trunk75827 195 Vein x-ray, chest75827 TC 195 Vein x-ray, chest75827 26 195 Vein x-ray, chest75831 195 Vein x-ray, kidney75831 TC 195 Vein x-ray, kidney75831 26 195 Vein x-ray, kidney75833 194 Vein x-ray, kidneys75833 TC 194 Vein x-ray, kidneys75833 26 194 Vein x-ray, kidneys75840 195 Vein x-ray, adrenal gland75840 TC 195 Vein x-ray, adrenal gland75840 26 195 Vein x-ray, adrenal gland75842 194 Vein x-ray, adrenal glands75842 TC 194 Vein x-ray, adrenal glands75842 26 194 Vein x-ray, adrenal glands75860 195 Vein x-ray, neck75860 TC 195 Vein x-ray, neck75860 26 195 Vein x-ray, neck75870 195 Vein x-ray, skull75870 TC 195 Vein x-ray, skull75870 26 195 Vein x-ray, skull75872 195 Vein x-ray, skull75872 TC 195 Vein x-ray, skull75872 26 195 Vein x-ray, skull75880 195 Vein x-ray, eye socket75880 TC 195 Vein x-ray, eye socket75880 26 195 Vein x-ray, eye socket75885 195 Vein x-ray, liver75885 TC 195 Vein x-ray, liver75885 26 195 Vein x-ray, liver75887 195 Vein x-ray, liver


CPT/HCPCS MOD MOD LEV DESCRIPTION75887 TC 195 Vein x-ray, liver75887 26 195 Vein x-ray, liver75889 195 Vein x-ray, liver75889 TC 195 Vein x-ray, liver75889 26 195 Vein x-ray, liver75891 195 Vein x-ray, liver75891 TC 195 Vein x-ray, liver75891 26 195 Vein x-ray, liver75893 195 Venous sampling by catheter75893 TC 195 Venous sampling by catheter75893 26 195 Venous sampling by catheter75894 195 X-rays, transcath therapy75894 TC 195 X-rays, transcath therapy75894 26 195 X-rays, transcath therapy75896 195 X-rays, transcath therapy75896 TC 195 X-rays, transcath therapy75896 26 195 X-rays, transcath therapy75898 195 Follow-up angiography75898 TC 195 Follow-up angiography75898 26 195 Follow-up angiography75901 168 Remove cva device obstruct75901 TC 170 Remove cva device obstruct75901 26 168 Remove cva device obstruct75902 168 Remove cva lumen obstruct75902 TC 170 Remove cva lumen obstruct75902 26 168 Remove cva lumen obstruct75945 168 Intravascular us75945 TC 170 Intravascular us75945 26 168 Intravascular us75946 249 Intravascular us add-on75946 TC 249 Intravascular us add-on75946 26 249 Intravascular us add-on75952 151 Endovasc repair abdom aorta75952 TC 153 Endovasc repair abdom aorta75952 26 151 Endovasc repair abdom aorta75953 168 Abdom aneurysm endovas rpr75953 TC 170 Abdom aneurysm endovas rpr75953 26 168 Abdom aneurysm endovas rpr75954 168 Iliac aneurysm endovas rpr75954 TC 170 Iliac aneurysm endovas rpr75954 26 168 Iliac aneurysm endovas rpr75956 195 Xray, endovasc thor ao repr75956 TC 195 Xray, endovasc thor ao repr75956 26 195 Xray, endovasc thor ao repr75957 195 Xray, endovasc thor ao repr75957 TC 195 Xray, endovasc thor ao repr75957 26 195 Xray, endovasc thor ao repr75958 219 Xray, place prox ext thor ao75958 TC 219 Xray, place prox ext thor ao75958 26 219 Xray, place prox ext thor ao75959 195 Xray, place dist ext thor ao75959 TC 195 Xray, place dist ext thor ao75959 26 195 Xray, place dist ext thor ao75960 195 Transcath iv stent rs&I end-dated 12/31/201375962 151 Repair arterial blockage75962 TC 153 Repair arterial blockage75962 26 151 Repair arterial blockage75964 249 Repair artery blockage, each75964 TC 249 Repair artery blockage, each75964 26 249 Repair artery blockage, each75966 151 Repair arterial blockage75966 TC 153 Repair arterial blockage75966 26 151 Repair arterial blockage75968 249 Repair artery blockage, each75968 TC 249 Repair artery blockage, each75968 26 249 Repair artery blockage, each


CPT/HCPCS MOD MOD LEV DESCRIPTION75970 168 Vascular biopsy75970 TC 170 Vascular biopsy75970 26 168 Vascular biopsy75978 168 Repair venous blockage75978 TC 170 Repair venous blockage75978 26 168 Repair venous blockage75980 195 Contrast xray exam bile duct75980 TC 195 Contrast xray exam bile duct75980 26 195 Contrast xray exam bile duct75982 195 Contrast xray exam bile duct75982 TC 195 Contrast xray exam bile duct75982 26 195 Contrast xray exam bile duct75984 195 Xray control catheter change75984 TC 195 Xray control catheter change75984 26 195 Xray control catheter change75989 195 Abscess drainage under x-ray75989 TC 195 Abscess drainage under x-ray75989 26 195 Abscess drainage under x-ray76000 151 Fluoroscope examination76000 TC 153 Fluoroscope examination76000 26 151 Fluoroscope examination76001 151 Fluoroscope exam, extensive76001 TC 153 Fluoroscope exam, extensive76001 26 151 Fluoroscope exam, extensive76080 195 X-ray exam of fistula76080 TC 195 X-ray exam of fistula76080 26 195 X-ray exam of fistula76098 219 X-ray exam, breast specimen76098 TC 219 X-ray exam, breast specimen76098 26 219 X-ray exam, breast specimen76100 195 X-ray exam of body section76100 TC 195 X-ray exam of body section76100 26 195 X-ray exam of body section76101 195 Complex body section x-ray76101 TC 195 Complex body section x-ray76101 26 195 Complex body section x-ray76102 218 Complex body section x-rays76102 TC 218 Complex body section x-rays76102 26 218 Complex body section x-rays76120 195 Cine/video x-rays76120 TC 195 Cine/video x-rays76120 26 195 Cine/video x-rays76125 232 Cine/ video x-rays add-on76125 TC 232 Cine/ video x-rays add-on76125 26 232 Cine/ video x-rays add-on76140 290 X-ray consultation76376 195 3d render w/o postprocess76376 TC 195 3d render w/o postprocess76376 26 195 3d render w/o postprocess76377 195 3d rendering w/postprocess76377 TC 195 3d rendering w/postprocess76377 26 195 3d rendering w/postprocess76380 195 CAT scan follow-up study76380 TC 195 CAT scan follow-up study76380 26 195 CAT scan follow-up study76390 277 Mr spectroscopy76390 TC 278 Mr spectroscopy76390 26 277 Mr spectroscopy76506 151 Echo exam of head76506 TC 153 Echo exam of head76506 26 151 Echo exam of head76510 172 Ophth us, b scan & quant a76510 TC 173 Ophth us, b scan & quant a76510 26 172 Ophth us, b scan & quant a76511 157 Ophth us, quant a only76511 TC 158 Ophth us, quant a only


CPT/HCPCS MOD MOD LEV DESCRIPTION76511 26 157 Ophth us, quant a only76512 157 Ophth us, b scan w/ or w/out quant a76512 TC 158 Ophth us, b scan w/ or w/out quant a76512 26 157 Ophth us, b scan w/ or w/out quant a76513 157 Echo exam of eye, water bath76513 TC 158 Echo exam of eye, water bath76513 26 157 Echo exam of eye, water bath76514 167 Echo exam of eye, thickness76514 TC 169 Echo exam of eye, thickness76514 26 167 Echo exam of eye, thickness76516 150 Echo exam of eye76516 TC 152 Echo exam of eye76516 26 150 Echo exam of eye76519 150 Echo exam of eye76519 TC 152 Echo exam of eye76519 26 157 Echo exam of eye76529 157 Echo exam of eye76529 TC 158 Echo exam of eye76529 26 157 Echo exam of eye76536 151 Us exam of head and neck76536 TC 153 Us exam of head and neck76536 26 151 Us exam of head and neck76604 151 Us exam, chest, b-scan76604 TC 149 Us exam, chest, b-scan76604 26 151 Us exam, chest, b-scan76641 150 Ultrasound breast complete76641 TC 152 Ultrasound breast complete76641 26 150 Ultrasound breast complete76642 150 Ultrasound breat limited76642 TC 152 Ultrasound breat limited76642 26 150 Ultrasound breat limited76645 150 Us exam, breast(s) end-dated 12/31/201476645 TC 152 Us exam, breast(s) end-dated 12/31/201476645 26 150 Us exam, breast(s) end-dated 12/31/201476700 151 Us exam, abdom, complete76700 TC 149 Us exam, abdom, complete76700 26 151 Us exam, abdom, complete76705 151 Us exam, abdom, limited76705 TC 149 Us exam, abdom, limited76705 26 151 Us exam, abdom, limited76770 151 Us exam abdo back wall, comp76770 TC 149 Us exam abdo back wall, comp76770 26 151 Us exam abdo back wall, comp76775 151 Us exam abdo back wall, lim76775 TC 149 Us exam abdo back wall, lim76775 26 151 Us exam abdo back wall, lim76776 168 Us exam k transpl w/doppler76776 TC 166 Us exam k transpl w/doppler76776 26 168 Us exam k transpl w/doppler76800 151 Us exam, spinal canal76800 TC 153 Us exam, spinal canal76800 26 151 Us exam, spinal canal76801 151 Ob us < 14 wks, single fetus76801 TC 153 Ob us < 14 wks, single fetus76801 26 151 Ob us < 14 wks, single fetus76802 249 Ob us < 14 wks, addl fetus76802 TC 249 Ob us < 14 wks, addl fetus76802 26 249 Ob us < 14 wks, addl fetus76805 151 Us exam, pg uterus, compl76805 TC 153 Us exam, pg uterus, compl76805 26 151 Us exam, pg uterus, compl76810 232 Us exam, pg uterus, mult76810 TC 232 Us exam, pg uterus, mult76810 26 232 Us exam, pg uterus, mult76811 168 Ob us, detailed, sngl fetus76811 TC 170 Ob us, detailed, sngl fetus


CPT/HCPCS MOD MOD LEV DESCRIPTION76811 26 168 Ob us, detailed, sngl fetus76812 249 Ob us, detailed, addl fetus76812 TC 249 Ob us, detailed, addl fetus76812 26 249 Ob us, detailed, addl fetus76813 168 Ob us nuchal meas, 1 gest76813 TC 170 Ob us nuchal meas, 1 gest76813 26 168 Ob us nuchal meas, 1 gest76814 249 Ob us nuchal meas, add-on76814 TC 249 Ob us nuchal meas, add-on76814 26 249 Ob us nuchal meas, add-on76815 151 Us exam, pg uterus limit76815 TC 153 Us exam, pg uterus limit76815 26 151 Us exam, pg uterus limit76816 151 Us exam pg uterus repeat76816 TC 153 Us exam pg uterus repeat76816 26 151 Us exam pg uterus repeat76817 168 Transvaginal us, obstetric76817 TC 170 Transvaginal us, obstetric76817 26 168 Transvaginal us, obstetric76818 151 Fetal biophy profile w/nst76818 TC 153 Fetal biophy profile w/nst76818 26 151 Fetal biophy profile w/nst76819 151 Fetal biophys profil w/o nst76819 TC 153 Fetal biophys profil w/o nst76819 26 151 Fetal biophys profil w/o nst76820 168 Umbilical artery echo76820 TC 170 Umbilical artery echo76820 26 168 Umbilical artery echo76821 168 Middle cerebral artery echo76821 TC 170 Middle cerebral artery echo76821 26 168 Middle cerebral artery echo76825 151 Echo exam of fetal heart76825 TC 153 Echo exam of fetal heart76825 26 151 Echo exam of fetal heart76826 151 Echo exam of fetal heart76826 TC 153 Echo exam of fetal heart76826 26 151 Echo exam of fetal heart76827 151 Echo exam of fetal heart76827 TC 153 Echo exam of fetal heart76827 26 151 Echo exam of fetal heart76828 151 Echo exam of fetal heart76828 TC 153 Echo exam of fetal heart76828 26 151 Echo exam of fetal heart76830 151 Us exam, transvaginal76830 TC 153 Us exam, transvaginal76830 26 151 Us exam, transvaginal76831 151 Echo exam, uterus76831 TC 149 Echo exam, uterus76831 26 151 Echo exam, uterus76856 151 Us exam, pelvic, complete76856 TC 149 Us exam, pelvic, complete76856 26 151 Us exam, pelvic, complete76857 195 Us exam, pelvic, limited76857 TC 193 Us exam, pelvic, limited76857 26 195 Us exam, pelvic, limited76870 151 Us exam, scrotum76870 TC 149 Us exam, scrotum76870 26 151 Us exam, scrotum76872 151 Echo exam, transrectal76872 TC 153 Echo exam, transrectal76872 26 151 Echo exam, transrectal76873 273 Echograp trans r, pros study76873 TC 274 Echograp trans r, pros study76873 26 273 Echograp trans r, pros study76881 157 Us xtr non-vasc complete76881 TC 156 Us xtr non-vasc complete


CPT/HCPCS MOD MOD LEV DESCRIPTION76881 26 157 Us xtr non-vasc complete76882 157 Us xtr non-vasc lmtd76882 TC 156 Us xtr non-vasc lmtd76882 26 157 Us xtr non-vasc lmtd76930 151 Echo guide, cardiocentesis76930 TC 153 Echo guide, cardiocentesis76930 26 151 Echo guide, cardiocentesis76932 151 Echo guide for heart biopsy76932 TC 153 Echo guide for heart biopsy76932 26 151 Echo guide for heart biopsy76936 151 Echo guide for artery repair76936 TC 153 Echo guide for artery repair76936 26 151 Echo guide for artery repair76937 232 Us guide, vascular access76937 TC 232 Us guide, vascular access76937 26 232 Us guide, vascular access76940 151 Us guide, tissue ablation76940 TC 153 Us guide, tissue ablation76940 26 151 Us guide, tissue ablation76941 151 Echo guide for transfusion76941 TC 153 Echo guide for transfusion76941 26 151 Echo guide for transfusion76942 195 Echo guide for biopsy76942 TC 195 Echo guide for biopsy76942 26 195 Echo guide for biopsy76945 151 Echo guide, villus sampling76945 TC 153 Echo guide, villus sampling76945 26 151 Echo guide, villus sampling76946 151 Echo guide for amniocentesis76946 TC 153 Echo guide for amniocentesis76946 26 151 Echo guide for amniocentesis76950 151 Echo guidance radiotherapy end-dated 12/31/201476950 TC 153 Echo guidance radiotherapy end-dated 12/31/201476950 26 151 Echo guidance radiotherapy end-dated 12/31/201476965 151 Echo guidance radiotherapy76965 TC 153 Echo guidance radiotherapy76965 26 151 Echo guidance radiotherapy76970 195 Ultrasound exam follow-up76970 TC 195 Ultrasound exam follow-up76970 26 195 Ultrasound exam follow-up76975 151 GI endoscopic ultrasound76975 TC 153 GI endoscopic ultrasound76975 26 151 GI endoscopic ultrasound76977 151 Us bone density measure76977 TC 153 Us bone density measure76977 26 151 Us bone density measure76998 195 Us guide, intraop76998 TC 195 Us guide, intraop76998 26 195 Us guide, intraop77001 232 Fluoroguide for vein device77001 TC 232 Fluoroguide for vein device77001 26 232 Fluoroguide for vein device77002 195 Needle localization by xray77002 TC 195 Needle localization by xray77002 26 195 Needle localization by xray77003 282 Fluoroguide for spine inject77003 TC 282 Fluoroguide for spine inject77003 26 282 Fluoroguide for spine inject77061 168 Breast tomosynthesis uni77061 TC 170 Breast tomosynthesis uni77061 26 168 Breast tomosynthesis uni77062 168 Breast tomosynthesis bl77062 TC 170 Breast tomosynthesis bl77062 26 168 Breast tomosynthesis bl77063 168 Breast tomosynthesis bl77063 TC 170 Breast tomosynthesis bl


CPT/HCPCS MOD MOD LEV DESCRIPTION77063 26 168 Breast tomosynthesis bl77085 168 DXA bone density study77085 TC 170 DXA bone density study77085 26 168 DXA bone density study77086 168 Fracture assessment via DXA77086 TC 170 Fracture assessment via DXA77086 26 168 Fracture assessment via DXA77011 151 Ct scan for localization77011 TC 153 Ct scan for localization77011 26 151 Ct scan for localization77012 151 Ct scan for needle biopsy77012 TC 153 Ct scan for needle biopsy77012 26 151 Ct scan for needle biopsy77013 151 Ct guide for tissue ablation77013 TC 153 Ct guide for tissue ablation77013 26 151 Ct guide for tissue ablation77014 151 Ct scan for therapy guide77014 TC 153 Ct scan for therapy guide77014 26 151 Ct scan for therapy guide77021 151 Mr guidance for needle place77021 TC 153 Mr guidance for needle place77021 26 151 Mr guidance for needle place77022 151 Mri for tissue ablation77022 TC 153 Mri for tissue ablation77022 26 151 Mri for tissue ablation77031 168 Stereotact guide for brst bx end-dated 12/31/201377032 168 Guidance for needle breast end-dated 12/31/201377051 249 Computer dx mammogram add-on77051 TC 249 Computer dx mammogram add-on77051 26 249 Computer dx mammogram add-on77052 249 Comp screen mammogram add-on77052 TC 249 Comp screen mammogram add-on77052 26 249 Comp screen mammogram add-on77053 195 X-ray of mammary duct77053 TC 195 X-ray of mammary duct77053 26 195 X-ray of mammary duct77054 219 X-ray of mammary ducts77054 TC 219 X-ray of mammary ducts77054 26 219 X-ray of mammary ducts77055 168 Mammogram, one breast77055 TC 170 Mammogram, one breast77055 26 168 Mammogram, one breast77056 168 Mammogram, both breasts77056 TC 170 Mammogram, both breasts77056 26 168 Mammogram, both breasts77057 167 Mammogram, screening77057 TC 169 Mammogram, screening77057 26 167 Mammogram, screening77058 151 Mri, one breast77058 TC 149 Mri, one breast77058 26 151 Mri, one breast77059 168 Mri, both breasts77059 TC 166 Mri, both breasts77059 26 167 Mri, both breasts77071 220 X-ray stress view77072 219 X-rays for bone age77072 TC 219 X-rays for bone age77072 26 219 X-rays for bone age77073 219 X-rays, bone length studies77073 TC 219 X-rays, bone length studies77073 26 219 X-rays, bone length studies77074 219 X-rays, bone survey, limited77074 TC 219 X-rays, bone survey, limited77074 26 219 X-rays, bone survey, limited77075 219 X-rays, bone survey complete77075 TC 219 X-rays, bone survey complete


CPT/HCPCS MOD MOD LEV DESCRIPTION77075 26 219 X-rays, bone survey complete77077 168 Joint survey, single view77077 TC 170 Joint survey, single view77077 26 168 Joint survey, single view77078 168 Ct bone density, axial77078 TC 170 Ct bone density, axial77078 26 168 Ct bone density, axial77080 168 Dxa bone density, axial77080 TC 170 Dxa bone density, axial77080 26 168 Dxa bone density, axial77081 168 Dxa bone density/peripheral77081 TC 170 Dxa bone density/peripheral77081 26 168 Dxa bone density/peripheral77082 168 Dxa bone density, vert fx end-dated 12/31/201477082 TC 170 Dxa bone density, vert fx end-dated 12/31/201477082 26 168 Dxa bone density, vert fx end-dated 12/31/201477084 168 Magnetic image, bone marrow77084 TC 170 Magnetic image, bone marrow77084 26 168 Magnetic image, bone marrow77261 195 Radiation therapy planning77262 195 Radiation therapy planning77263 195 Radiation therapy planning77280 168 Set radiation therapy field77280 TC 170 Set radiation therapy field77280 26 168 Set radiation therapy field77285 168 Set radiation therapy field77285 TC 170 Set radiation therapy field77285 26 168 Set radiation therapy field77290 168 Set radiation therapy field77290 TC 170 Set radiation therapy field77290 26 168 Set radiation therapy field77293 168 Respirator motion mgmt simul 77293 TC 168 Respirator motion mgmt simul 77293 26 168 Respirator motion mgmt simul 77295 168 3-d radiotherapy plan 77295 TC 170 3-d radiotherapy plan 77295 26 168 3-d radiotherapy plan 77300 151 Radiation therapy dose plan77300 TC 153 Radiation therapy dose plan77300 26 151 Radiation therapy dose plan77301 168 Radioltherapy dos plan, imrt77301 TC 170 Radioltherapy dos plan, imrt77301 26 168 Radioltherapy dos plan, imrt77305 151 Radiation therapy dose plan end-dated 12/31/201477305 TC 153 Radiation therapy dose plan end-dated 12/31/201477305 26 151 Radiation therapy dose plan end-dated 12/31/201477306 151 Telethx isodose plan simple77306 TC 153 Telethx isodose plan simple77306 26 151 Telethx isodose plan simple77307 151 Telethx isodose plan cplx77307 TC 153 Telethx isodose plan cplx77307 26 151 Telethx isodose plan cplx77310 151 Radiation therapy dose plan end-dated 12/31/201477310 TC 153 Radiation therapy dose plan end-dated 12/31/201477310 26 151 Radiation therapy dose plan end-dated 12/31/201477315 151 Radiation therapy dose plan end-dated 12/31/201477315 TC 153 Radiation therapy dose plan end-dated 12/31/201477315 26 151 Radiation therapy dose plan end-dated 12/31/201477316 151 Brachytx isodose plan simple77316 TC 153 Brachytx isodose plan simple77316 26 151 Brachytx isodose plan simple77317 151 Brachytx isodose intermed77317 TC 153 Brachytx isodose intermed77317 26 151 Brachytx isodose intermed77318 151 Brachytx isodose complex77318 TC 153 Brachytx isodose complex


CPT/HCPCS MOD MOD LEV DESCRIPTION77318 26 151 Brachytx isodose complex77321 151 Radiation therapy port plan77321 TC 153 Radiation therapy port plan77321 26 151 Radiation therapy port plan77326 151 Radiation therapy dose plan end-dated 12/31/201477326 TC 153 Radiation therapy dose plan end-dated 12/31/201477326 26 151 Radiation therapy dose plan end-dated 12/31/201477327 151 Radiation therapy dose plan end-dated 12/31/201477327 TC 153 Radiation therapy dose plan end-dated 12/31/201477327 26 151 Radiation therapy dose plan end-dated 12/31/201477328 151 Radiation therapy dose plan end-dated 12/31/201477328 TC 153 Radiation therapy dose plan end-dated 12/31/201477328 26 151 Radiation therapy dose plan end-dated 12/31/201477331 151 Special radiation dosimetry77331 TC 153 Special radiation dosimetry77331 26 151 Special radiation dosimetry77332 151 Radiation treatment aid(s)77332 TC 153 Radiation treatment aid(s)77332 26 151 Radiation treatment aid(s)77333 151 Radiation treatment aid(s)77333 TC 153 Radiation treatment aid(s)77333 26 151 Radiation treatment aid(s)77334 151 Radiation treatment aid(s)77334 TC 153 Radiation treatment aid(s)77334 26 151 Radiation treatment aid(s)77336 195 Radiation physics consult77338 168 Design MLC device for IMRT77338 TC 170 Design MLC device for IMRT77338 26 168 Design MLC device for IMRT77370 195 Radiation physics consult77371 151 Srs, multisource77372 151 Srs, linear based77373 151 Sbrt delivery77385 151 Intsty modul rad tx dlvr smpl77386 151 Intsty modul rad tx dlvr cplx77387 151 Guidance for radioj tx dlvr77401 151 Radiation treatment delivery77402 151 Radiation treatment delivery77403 151 Radiation treatment delivery end-dated 12/31/201477404 151 Radiation treatment delivery end-dated 12/31/201477406 151 Radiation treatment delivery end-dated 12/31/201477407 151 Radiation treatment delivery77408 151 Radiation treatment delivery end-dated 12/31/201477409 151 Radiation treatment delivery end-dated 12/31/201477411 151 Radiation treatment delivery end-dated 12/31/201477412 151 Radiation treatment delivery77413 151 Radiation treatment delivery end-dated 12/31/201477414 151 Radiation treatment delivery end-dated 12/31/201477416 151 Radiation treatment delivery end-dated 12/31/201477417 219 Radiology port film(s)77418 151 Radiation tx delivery, imrt end-dated 12/31/201477421 168 Stereoscopic x-ray guidance end-dated 12/31/201477421 TC 170 Stereoscopic x-ray guidance end-dated 12/31/201477421 26 168 Stereoscopic x-ray guidance end-dated 12/31/201477422 151 Neutron beam tx, simple77423 151 Neutron beam tx, complex77424 168 Io rad tx delivery by x-ray 77425 168 Io rad tx deliver by elctrns 77427 273 Radiation tx management, x577431 151 Radiation therapy management77432 151 Stereotactic radiation trmt77435 151 Sbrt management77469 151 Io radiation tx management 77470 151 Special radiation treatment77470 TC 153 Special radiation treatment77470 26 151 Special radiation treatment


CPT/HCPCS MOD MOD LEV DESCRIPTION77520 195 Proton trmt, simple w/o comp77522 195 Proton trmt, simple w/comp77523 195 Proton trmt, intermediate77525 219 Proton treatment, complex77600 151 Hyperthermia treatment77600 TC 153 Hyperthermia treatment77600 26 151 Hyperthermia treatment77605 151 Hyperthermia treatment77605 TC 153 Hyperthermia treatment77605 26 151 Hyperthermia treatment77610 151 Hyperthermia treatment77610 TC 153 Hyperthermia treatment77610 26 151 Hyperthermia treatment77615 151 Hyperthermia treatment77615 TC 153 Hyperthermia treatment77615 26 151 Hyperthermia treatment77620 151 Hyperthermia treatment77620 TC 153 Hyperthermia treatment77620 26 151 Hyperthermia treatment77750 151 Infuse radioactive materials77750 TC 153 Infuse radioactive materials77750 26 151 Infuse radioactive materials77761 151 Apply intrcav radiat simple77761 TC 153 Apply intrcav radiat simple77761 26 151 Apply intrcav radiat simple77762 151 Apply intrcav radiat interm77762 TC 153 Apply intrcav radiat interm77762 26 151 Apply intrcav radiat interm77763 151 Apply intrcav radiat compl77763 TC 153 Apply intrcav radiat compl77763 26 151 Apply intrcav radiat compl77776 151 Apply interstit radiat simpl77776 TC 153 Apply interstit radiat simpl77776 26 141 Apply interstit radiat simpl77777 151 Apply interstit radiat inter77777 TC 153 Apply interstit radiat inter77777 26 141 Apply interstit radiat inter77778 168 Apply iterstit radiat compl77778 TC 170 Apply iterstit radiat compl77778 26 159 Apply iterstit radiat compl77785 195 Hdr brachytx, 1 channel77785 TC 195 Hdr brachytx, 1 channel77785 26 195 Hdr brachytx, 1 channel77786 195 Hdr brachytx, 2-12 channel77786 TC 195 Hdr brachytx, 2-12 channel77786 26 195 Hdr brachytx, 2-12 channel77787 195 Hdr brachytx over 12 chan77787 TC 195 Hdr brachytx over 12 chan77787 26 195 Hdr brachytx over 12 chan77789 114 Apply surface radiation77789 TC 115 Apply surface radiation77789 26 114 Apply surface radiation77790 195 Radiation handling77790 TC 195 Radiation handling77790 26 195 Radiation handling77799 219 Radium/radioisotope therapy, unlisted77799 219 Radium/radioisotope therapy, unlisted77799 219 Radium/radioisotope therapy, unlisted78012 168 Thyroid uptake measurement 78012 TC 168 Thyroid uptake measurement 78012 26 168 Thyroid uptake measurement 78013 168 Thyroid imaging w/blood flow 78013 TC 168 Thyroid imaging w/blood flow 78013 26 168 Thyroid imaging w/blood flow 78014 168 Thyroid imaging w/blood flow 78014 TC 168 Thyroid imaging w/blood flow


CPT/HCPCS MOD MOD LEV DESCRIPTION78014 26 168 Thyroid imaging w/blood flow 78015 151 Thyroid met imaging78015 TC 153 Thyroid met imaging78015 26 151 Thyroid met imaging78016 168 Thyroid met imaging/studies78016 TC 170 Thyroid met imaging/studies78016 26 168 Thyroid met imaging/studies78018 168 Thyroid met imaging, body78018 TC 170 Thyroid met imaging, body78018 26 168 Thyroid met imaging, body78020 249 Thyroid met uptake78020 TC 249 Thyroid met uptake78020 26 249 Thyroid met uptake78070 168 Parathyroid nuclear imaging78070 TC 170 Parathyroid nuclear imaging78070 26 168 Parathyroid nuclear imaging78071 168 Parathyrd planar w/wo subtrj 78071 TC 168 Parathyrd planar w/wo subtrj 78071 26 168 Parathyrd planar w/wo subtrj 78072 168 Parathyrd planar w/spect&CT 78072 TC 168 Parathyrd planar w/spect&CT 78072 26 168 Parathyrd planar w/spect&CT 78075 168 Adrenal nuclear imaging78075 TC 170 Adrenal nuclear imaging78075 26 168 Adrenal nuclear imaging78102 151 Bone marrow imaging, ltd78102 TC 153 Bone marrow imaging, ltd78102 26 151 Bone marrow imaging, ltd78103 151 Bone marrow imaging, mult78103 TC 153 Bone marrow imaging, mult78103 26 151 Bone marrow imaging, mult78104 168 Bone marrow imaging, body78104 TC 170 Bone marrow imaging, body78104 26 168 Bone marrow imaging, body78110 195 Plasma volume, single78110 TC 195 Plasma volume, single78110 26 195 Plasma volume, single78111 219 Plasma volume, multiple78111 TC 219 Plasma volume, multiple78111 26 219 Plasma volume, multiple78120 195 Red cell mass, single78120 TC 195 Red cell mass, single78120 26 195 Red cell mass, single78121 219 Red cell mass, multiple78121 TC 219 Red cell mass, multiple78121 26 219 Red cell mass, multiple78122 219 Blood volume78122 TC 219 Blood volume78122 26 219 Blood volume78130 195 Red cell survival study78130 TC 195 Red cell survival study78130 26 195 Red cell survival study78135 219 Red cell survival kinetics78135 TC 219 Red cell survival kinetics78135 26 219 Red cell survival kinetics78140 195 Red cell sequestration78140 TC 195 Red cell sequestration78140 26 195 Red cell sequestration78185 151 Spleen imaging78185 TC 153 Spleen imaging78185 26 151 Spleen imaging78190 219 Platelet survival, kinetics78190 TC 219 Platelet survival, kinetics78190 26 219 Platelet survival, kinetics78191 195 Platelet survival78191 TC 195 Platelet survival


CPT/HCPCS MOD MOD LEV DESCRIPTION78191 26 195 Platelet survival78195 151 Lymph system imaging78195 TC 153 Lymph system imaging78195 26 151 Lymph system imaging78201 151 Liver imaging78201 TC 153 Liver imaging78201 26 151 Liver imaging78202 151 Liver imaging with flow78202 TC 153 Liver imaging with flow78202 26 151 Liver imaging with flow78205 151 Liver imaging (3D)78205 TC 153 Liver imaging (3D)78205 26 151 Liver imaging (3D)78206 168 Liver image (3d) w/flow78206 TC 170 Liver image (3d) w/flow78206 26 168 Liver image (3d) w/flow78215 151 Liver and spleen imaging78215 TC 153 Liver and spleen imaging78215 26 151 Liver and spleen imaging78216 168 Liver & spleen image/flow78216 TC 170 Liver & spleen image/flow78216 26 168 Liver & spleen image/flow78226 151 Hepatobiliary system imaging 78226 TC 149 Hepatobiliary system imaging 78226 26 151 Hepatobiliary system imaging 78227 168 Hepatobil syst image w/drug 78227 TC 149 Hepatobil syst image w/drug 78227 26 168 Hepatobil syst image w/drug 78230 151 Salivary gland imaging78230 TC 153 Salivary gland imaging78230 26 151 Salivary gland imaging78231 168 Serial salivary imaging78231 TC 170 Serial salivary imaging78231 26 168 Serial salivary imaging78232 168 Salivary gland function exam78232 TC 170 Salivary gland function exam78232 26 168 Salivary gland function exam78258 168 Esophageal motility study78258 TC 170 Esophageal motility study78258 26 168 Esophageal motility study78261 168 Gastric mucosa imaging78261 TC 170 Gastric mucosa imaging78261 26 168 Gastric mucosa imaging78262 168 Gastroesophageal reflux exam78262 TC 170 Gastroesophageal reflux exam78262 26 168 Gastroesophageal reflux exam78264 168 Gastric emptying study78264 TC 170 Gastric emptying study78264 26 168 Gastric emptying study78267 282 Breath tst attain/anal c-1478268 290 Breath test analysis, c-1478270 151 Vit B-12 absorption exam78270 TC 153 Vit B-12 absorption exam78270 26 151 Vit B-12 absorption exam78271 151 Vit B-12 absorp exam, IF78271 TC 153 Vit B-12 absorp exam, IF78271 26 151 Vit B-12 absorp exam, IF78272 168 Vit B-12 absorp, combined78272 TC 170 Vit B-12 absorp, combined78272 26 168 Vit B-12 absorp, combined78278 168 Acute GI blood loss imaging78278 TC 170 Acute GI blood loss imaging78278 26 168 Acute GI blood loss imaging78282 168 GI protein loss exam78282 TC 170 GI protein loss exam78282 26 168 GI protein loss exam


CPT/HCPCS MOD MOD LEV DESCRIPTION78290 168 Meckel’s divert exam78290 TC 170 Meckel’s divert exam78290 26 168 Meckel’s divert exam78291 168 Leveen/shunt patency exam78291 TC 170 Leveen/shunt patency exam78291 26 168 Leveen/shunt patency exam78300 151 Bone imaging, limited area78300 TC 153 Bone imaging, limited area78300 26 151 Bone imaging, limited area78305 151 Bone imaging, multiple areas78305 TC 153 Bone imaging, multiple areas78305 26 151 Bone imaging, multiple areas78306 151 Bone imaging, whole body78306 TC 153 Bone imaging, whole body78306 26 151 Bone imaging, whole body78315 151 Bone imaging, 3 phase78315 TC 153 Bone imaging, 3 phase78315 26 151 Bone imaging, 3 phase78320 168 Bone imaging (3D)78320 TC 170 Bone imaging (3D)78320 26 168 Bone imaging (3D)78350 277 Bone mineral, single photon78350 TC 278 Bone mineral, single photon78350 26 277 Bone mineral, single photon78351 277 Bone mineral, dual photon78414 168 Non-imaging heart function78414 TC 170 Non-imaging heart function78414 26 168 Non-imaging heart function78428 168 Cardiac shunt imaging78428 TC 170 Cardiac shunt imaging78428 26 168 Cardiac shunt imaging78445 151 Vascular flow imaging78445 TC 153 Vascular flow imaging78445 26 151 Vascular flow imaging78451 168 HT muscle image spect, single78451 TC 170 HT muscle image spect, single78451 26 168 HT muscle image spect, single78452 168 HT muscle image spect, mult78452 TC 170 HT muscle image spect, mult78452 26 168 HT muscle image spect, mult78453 168 HT muscle image, planar, single78453 TC 170 HT muscle image, planar, single78453 26 168 HT muscle image, planar, single78454 168 HT muscle image, planar, mult78454 TC 170 HT muscle image, planar, mult78454 26 168 HT muscle image, planar, mult78456 277 Acute venous thrombus image78456 TC 278 Acute venous thrombus image78456 26 277 Acute venous thrombus image78457 151 Venous thrombosis imaging78457 TC 153 Venous thrombosis imaging78457 26 151 Venous thrombosis imaging78458 167 Ven thrombosis images, bilat78458 TC 169 Ven thrombosis images, bilat78458 26 167 Ven thrombosis images, bilat78459 168 Heart muscle imaging (PET)78459 TC 170 Heart muscle imaging (PET)78459 26 168 Heart muscle imaging (PET)78466 168 Heart infarct image78466 TC 170 Heart infarct image78466 26 168 Heart infarct image78468 151 Heart infarct image (ef)78468 TC 153 Heart infarct image (ef)78468 26 151 Heart infarct image (ef)78469 168 Heart infarct image (3D)78469 TC 170 Heart infarct image (3D)


CPT/HCPCS MOD MOD LEV DESCRIPTION78469 26 168 Heart infarct image (3D)78472 168 Gated heart, planar, single78472 TC 170 Gated heart, planar, single78472 26 168 Gated heart, planar, single78473 168 Gated heart, multiple78473 TC 170 Gated heart, multiple78473 26 168 Gated heart, multiple78481 168 Heart first pass, single78481 TC 170 Heart first pass, single78481 26 168 Heart first pass, single78483 168 Heart first pass, multiple78483 TC 170 Heart first pass, multiple78483 26 168 Heart first pass, multiple78491 168 Heart image (pet), single78491 TC 170 Heart image (pet), single78491 26 168 Heart image (pet), single78492 168 Heart image (pet), multiple78492 TC 170 Heart image (pet), multiple78492 26 168 Heart image (pet), multiple78494 168 Heart image, spect78494 TC 170 Heart image, spect78494 26 168 Heart image, spect78496 249 Heart first pass add-on78496 TC 249 Heart first pass add-on78496 26 249 Heart first pass add-on78499 219 Cardiovascular nuclear exam, unlisted78499 TC 219 Cardiovascular nuclear exam, unlisted78499 26 219 Cardiovascular nuclear exam, unlisted78579 151 Lung ventilation imaging 78579 TC 153 Lung ventilation imaging 78579 26 151 Lung ventilation imaging 78580 151 Lung perfusion imaging78580 TC 153 Lung perfusion imaging78580 26 151 Lung perfusion imaging78582 151 Lung ventilat&perfus imaging 78582 TC 153 Lung ventilat&perfus imaging 78582 26 151 Lung ventilat&perfus imaging 78597 151 Lung perfusion differential 78597 TC 153 Lung perfusion differential 78597 26 151 Lung perfusion differential 78598 151 Lung perf&ventilat diferentl 78598 153 Lung perf&ventilat diferentl 78598 151 Lung perf&ventilat diferentl 78599 219 Respiratory nuclear exam, unlisted78599 TC 219 Respiratory nuclear exam, unlisted78599 26 219 Respiratory nuclear exam, unlisted78600 151 Brain imaging, ltd static78600 TC 153 Brain imaging, ltd static78600 26 151 Brain imaging, ltd static78601 151 Brain imaging, ltd w/ flow78601 TC 153 Brain imaging, ltd w/ flow78601 26 151 Brain imaging, ltd w/ flow78605 151 Brain imaging, complete78605 TC 153 Brain imaging, complete78605 26 151 Brain imaging, complete78606 151 Brain imaging, compl w/flow78606 TC 153 Brain imaging, compl w/flow78606 26 151 Brain imaging, compl w/flow78607 168 Brain imaging (3D)78607 TC 170 Brain imaging (3D)78607 26 168 Brain imaging (3D)78608 168 Brain imaging (PET)78608 TC 170 Brain imaging (PET)78608 26 168 Brain imaging (PET)78609 277 Brain imaging (PET)78609 TC 278 Brain imaging (PET)


CPT/HCPCS MOD MOD LEV DESCRIPTION78609 26 277 Brain imaging (PET)78610 151 Brain flow imaging only78610 TC 153 Brain flow imaging only78610 26 151 Brain flow imaging only78630 168 Cerebrospinal fluid scan78630 TC 170 Cerebrospinal fluid scan78630 26 168 Cerebrospinal fluid scan78635 168 CSF ventriculography78635 TC 170 CSF ventriculography78635 26 168 CSF ventriculography78645 168 CSF shunt evaluation78645 TC 170 CSF shunt evaluation78645 26 168 CSF shunt evaluation78647 168 Cerebrospinal fluid scan78647 TC 170 Cerebrospinal fluid scan78647 26 168 Cerebrospinal fluid scan78650 168 CSF leakage imaging78650 TC 170 CSF leakage imaging78650 26 168 CSF leakage imaging78660 168 Nuclear exam of tear flow78660 TC 170 Nuclear exam of tear flow78660 26 168 Nuclear exam of tear flow78699 219 Nervous system nuclear exam, unlisted78699 TC 219 Nervous system nuclear exam, unlisted78699 26 219 Nervous system nuclear exam, unlisted78700 151 Kidney imaging, static78700 TC 153 Kidney imaging, static78700 26 151 Kidney imaging, static78701 151 Kidney imaging with flow78701 TC 153 Kidney imaging with flow78701 26 151 Kidney imaging with flow78707 151 Kidney flow/function image78707 TC 153 Kidney flow/function image78707 26 151 Kidney flow/function image78708 151 Kidney flow/function image78708 TC 153 Kidney flow/function image78708 26 151 Kidney flow/function image78709 168 Kidney flow/function image78709 TC 170 Kidney flow/function image78709 26 168 Kidney flow/function image78710 168 Kidney imaging (3D)78710 TC 170 Kidney imaging (3D)78710 26 168 Kidney imaging (3D)78725 151 Kidney function study78725 TC 153 Kidney function study78725 26 151 Kidney function study78730 249 Urinary bladder retention78730 TC 249 Urinary bladder retention78730 26 249 Urinary bladder retention78740 168 Ureteral reflux study78740 TC 170 Ureteral reflux study78740 26 168 Ureteral reflux study78761 168 Testicular imaging/flow78761 TC 170 Testicular imaging/flow78761 26 168 Testicular imaging/flow78799 219 Genitourinary nuclear exam, unlisted78799 TC 219 Genitourinary nuclear exam, unlisted78799 26 219 Genitourinary nuclear exam, unlisted78800 151 Tumor imaging, limited area78800 TC 153 Tumor imaging, limited area78800 26 151 Tumor imaging, limited area78801 151 Tumor imaging, mult areas78801 TC 153 Tumor imaging, mult areas78801 26 151 Tumor imaging, mult areas78802 147 Tumor imaging, whole body78802 TC 148 Tumor imaging, whole body


CPT/HCPCS MOD MOD LEV DESCRIPTION78802 26 147 Tumor imaging, whole body78803 164 Tumor imaging (3D)78803 TC 165 Tumor imaging (3D)78803 26 164 Tumor imaging (3D)78804 168 Tumor imaging, whole body78804 TC 170 Tumor imaging, whole body78804 26 168 Tumor imaging, whole body78805 151 Abscess imaging, ltd area78805 TC 153 Abscess imaging, ltd area78805 26 151 Abscess imaging, ltd area78806 164 Abscess imaging, whole body78806 TC 165 Abscess imaging, whole body78806 26 164 Abscess imaging, whole body78807 164 Nuclear localization/abscess78807 TC 165 Nuclear localization/abscess78807 26 164 Nuclear localization/abscess78808 219 Iv inj ra drug dx study78811 168 Tumor imaging (pet), limited78811 TC 170 Tumor imaging (pet), limited78811 26 168 Tumor imaging (pet), limited78812 168 Tumor image (pet)/skul-thigh78812 TC 170 Tumor image (pet)/skul-thigh78812 26 168 Tumor image (pet)/skul-thigh78813 168 Tumor image (pet) full body78813 TC 170 Tumor image (pet) full body78813 26 168 Tumor image (pet) full body78814 168 Tumor image pet/ct, limited78814 TC 170 Tumor image pet/ct, limited78814 26 168 Tumor image pet/ct, limited78815 168 Tumorimage pet/ct skul-thigh78815 TC 170 Tumorimage pet/ct skul-thigh78815 26 168 Tumorimage pet/ct skul-thigh78816 168 Tumor image pet/ct full body78816 TC 170 Tumor image pet/ct full body78816 26 168 Tumor image pet/ct full body78999 219 Nuclear diagnostic exam, unlisted78999 TC 219 Nuclear diagnostic exam, unlisted78999 26 219 Nuclear diagnostic exam, unlisted79005 219 Nuclear rx, oral admin79005 TC 219 Nuclear rx, oral admin79005 26 219 Nuclear rx, oral admin79101 195 Nuclear rx, iv admin79101 TC 195 Nuclear rx, iv admin79101 26 195 Nuclear rx, iv admin79200 219 Intracavitary nuclear trmt79200 TC 219 Intracavitary nuclear trmt79200 26 219 Intracavitary nuclear trmt79300 219 Interstitial nuclear therapy79300 TC 219 Interstitial nuclear therapy79300 26 219 Interstitial nuclear therapy79403 219 Hematopoetic nuclear therapy79403 TC 219 Hematopoetic nuclear therapy79403 26 219 Hematopoetic nuclear therapy79440 219 Nuclear joint therapy79440 TC 219 Nuclear joint therapy79440 26 219 Nuclear joint therapy79445 219 Nuclear rx, intra-arterial79445 TC 219 Nuclear rx, intra-arterial79445 26 219 Nuclear rx, intra-arterial80047 282 Metabolic panel ionized ca80047 QW 282 Metabolic panel ionized ca80048 290 Basic metabolic panel80048 QW 290 Basic metabolic panel80050 290 General health panel80051 282 Electrolyte panel80051 QW 282 Electrolyte panel


CPT/HCPCS MOD MOD LEV DESCRIPTION80053 290 Comprehen metabolic panel80053 QW 290 Comprehen metabolic panel80055 290 Obstetric panel80061 290 Lipid panel80061 QW 290 Lipid panel80069 290 Renal function panel80069 QW 290 Renal function panel80074 290 Acute hepatitis panel80076 282 Hepatic function panel80100 290 Drug screen, qualitate/multi end-dated 12/31/201480101 282 Drug screen, single end-dated 12/31/201480101 QW 282 Drug screen, single end-dated 12/31/201480102 290 Drug confirmation end-dated 12/31/201480103 290 Drug analysis, tissue prep end-dated 12/31/201480104 290 Drug scrn 1+ class nonchromo end-dated 12/31/201480150 290 Assay of amikacin80152 290 Assay of amitriptyline end-dated 12/31/201480154 290 Assay of benzodiazepines end-dated 12/31/201480155 290 Drug screen quant caffeine 80156 290 Assay, carbamazepine, total80157 290 Assay, carbamazepine, free80158 290 Assay of cyclosporine80159 290 Drug screen quant clozapine 80160 290 Assay of desipramine end-dated 12/31/201480162 290 Assay of digoxin80163 290 Assay of digoxin free80164 290 Assay, dipropylacetic acid80165 290 Dipropylacetic acid free80166 290 Assay of doxepin end-dated 12/31/201480168 290 Assay of ethosuximide80169 290 Drug screen quant everolimus 80170 290 Assay of gentamicin80171 290 Drug screen quant gabapentin 80172 290 Assay of gold end-dated 12/31/201480173 290 Assay of haloperidol80174 290 Assay of imipramine end-dated 12/31/201480175 290 Drug screen quan lamotrigine 80176 290 Assay of lidocaine80177 290 Drug scrn quan levetiracetam 80178 290 Assay of lithium80178 QW 290 Assay of lithium80180 290 Drug scrn quan mycophenolate 80182 290 Assay of nortriptyline end-dated 12/31/201480183 290 Drug scrn quant oxcarbazepin 80184 290 Assay of phenobarbital80185 290 Assay of phenytoin, total80186 290 Assay of phenytoin, free80188 290 Assay of primidone80190 282 Assay of procainamide80192 290 Assay of procainamide80194 290 Assay of quinidine80195 290 Assay of sirolimus80196 290 Assay of salicylate end-dated 12/31/201480197 290 Assay of tacrolimus80198 290 Assay of theophylline80199 290 Drug screen quant tiagabine 80200 290 Assay of tobramycin80201 290 Assay of topiramate80202 290 Assay of vancomycin80203 290 Drug screen quant zonisamide 80299 290 Quantitative assay, drug80300 290 Drug screen non tlc devices80301 290 Drug screen class list A80302 290 Drug screen prsmpty 1 class80303 290 Drug screen one/mult class80304 290 Drug screen one/mult class


CPT/HCPCS MOD MOD LEV DESCRIPTION80320 290 Drug screen quantal cohols80321 290 Alcohols biomarkers 1 or 280322 290 Alcohols biomarkers 3/more80323 290 Alkaloids nos80324 290 Drug screen amphetamines 1/280325 290 Amphetamine 3 or 480326 290 Amphetamine 5 or more80327 290 Anabolic steriod 1 or 280328 290 Anabolic steriod 3 or more80329 290 Analgesics non-opiod 1 or 380330 290 Analgesics non-opiod 3-580331 290 Analgesics non-opiod 6/more80332 290 Antidepressants class 1 or 280333 290 Antidepressants class 3-580334 290 Antidepressants class 6/more80335 290 Antidepressants tricyclic 1/280336 290 Antidepressants tricyclic 3-580337 290 Tricyclic & cyclicals 6/more80338 290 Antidepressant not specified80339 290 Antiepileptics nos 1-380340 290 Antiepileptics nos 4-680341 290 Antiepileptics nos 7/more80342 290 Antipsychotics nos 1-380343 290 Antipsychotics nos 4-680344 290 Antipsychotics nos 7/more80345 290 Drug screening barbiturates80346 290 Benzodiazepines 1-1280347 290 Benzodiazepines 13 or more80348 290 Drug screening buprenorphine80349 290 Cannabinoids natural80350 290 Cannabinoids synthetic 1-380351 290 Cannabinoids synthetic 4-680352 290 Cannabinoids synthetic 7/more80353 290 Drug screening cocaine80354 290 Drug screening fentanyl80355 290 Gabapentin non-blood80356 290 Heroin metabolite80357 290 Ketamine and Norketamine80358 290 Drug screening methadone80359 290 Methylenedioxyamphetamines80360 290 Methylphenidate80361 290 Opiates 1 or more80362 290 Opioids & opiate analogs 1/280363 290 Opiods & opiate analogs 3/480364 290 Opioid & opiate analog 5/more80365 290 Drug screening oxycodone80366 290 Drug screening pregabalin80367 290 Drug screening propoxyphene80368 290 Sedative hypnotics80369 290 Skeletal muscle relaxant 1/280370 290 Skel musc relaxant 3 or more80371 290 Stimulants synthetic80372 290 Drug screening tapentadol80373 290 Drug screening tramadol80374 290 Stereiosomer analysis80375 290 Drug/substance nos 1-380376 290 Drug/substance nos 4-680377 290 Drug/substance nos 7/more80400 290 Acth stimulation panel80402 290 Acth stimulation panel80406 290 Acth stimulation panel80408 290 Aldosterone suppression eval80410 290 Calcitonin stimul panel80412 290 CRH stimulation panel80414 290 Testosterone response80415 290 Estradiol response panel


CPT/HCPCS MOD MOD LEV DESCRIPTION80416 290 Renin stimulation panel80417 290 Renin stimulation panel80418 290 Pituitary evaluation panel80420 290 Dexamethasone panel80422 290 Glucagon tolerance panel80424 290 Glucagon tolerance panel80426 290 Gonadotropin hormone panel80428 290 Growth hormone panel80430 290 Growth hormone panel80432 290 Insulin suppression panel80434 290 Insulin tolerance panel80435 290 Insulin tolerance panel80436 290 Metyrapone panel80438 290 TRH stimulation panel80439 290 TRH stimulation panel80440 290 TRH stimulation panel end-dated 12/31/201480500 266 Lab pathology consultation80502 266 Lab pathology consultation81000 281 Urinalysis, nonauto w/scope81001 286 Urinalysis, auto w/scope81002 281 Urinalysis nonauto w/o scope81003 281 Urinalysis, auto, w/o scope81003 QW 281 Urinalysis, auto, w/o scope81005 281 Urinalysis81007 290 Urine screen for bacteria81007 QW 290 Urine screen for bacteria81015 282 Microscopic exam of urine81020 290 Urinalysis, glass test81025 286 Urine pregnancy test81050 281 Urinalysis, volume measure81099 290 Urinalysis test procedure, unlisted81161 290 DMD dup/delet analysis 81200 290 ASPA gene 81205 290 Bckdhb gene 81206 290 Bcr/abl1 gene major bp 81207 290 Bcr/abl1 gene minor bp 81208 290 Bcr/abl1 gene other bp 81209 290 Blm gene 81210 290 Braf gene 81211 290 Brca1&2 seq & com dup/del 81212 290 Brca1&2 185&5385&6174 var 81213 290 Brca1&2 uncom dup/del var 81214 290 Brca1 full seq & com dup/del 81215 290 Brca1 gene known fam variant 81216 290 Brca2 gene full sequence 81217 290 Brca2 gene known fam variant 81220 290 Cftr gene com variants 81221 290 Cftr gene known fam variants 81222 290 Cftr gene dup/delet variants 81223 290 Cftr gene full sequence 81224 290 Cftr gene intron poly T 81225 290 CYP2C19 gene com variants 81226 290 CYP2D6 gene com variants 81227 290 CYP2C9 gene com variants 81228 290 Cytogen micrarray copy nmbr 81229 290 Cytogen M array copy no&snp 81240 290 F2 gene 81241 290 F5 gene 81242 290 FANCC gene 81243 290 FMR1 gene detection 81244 290 FMR1 gene characterization 81245 290 FLT3 gene 81246 290 FLT3 gene analysis 81250 290 G6PC gene 81251 290 GBA gene 81255 290 HEXA gene


CPT/HCPCS MOD MOD LEV DESCRIPTION81256 290 HFE gene 81257 290 HBA1/HBA2 gene 81260 290 IKBKAP gene 81261 290 IGH gene rearrange amp meth 81262 290 IGH gene rearrang dir probe 81263 290 IGH vari regional mutation 81264 290 IGK rearrangeabn clonal pop 81265 290 STR markers specimen anal 81266 290 STR markers spec anal addl 81267 290 Chimerism anal no cell selec 81268 290 Chimerism anal w/cell select 81270 290 JAK2 gene 81275 290 KRAS gene 81280 290 Long qt synd gene full seq 81281 290 Long qt synd known fam var 81282 290 Long qt syn gene dup/dlt var 81287 290 Mgmt gene methylation anal 81288 290 MLH1 gene81290 290 MCOLN1 gene 81291 290 MTHFR gene 81292 290 MLH1 gene full seq 81293 290 MLH1 gene known variants 81294 290 MLH1 gene dup/delete variant 81295 290 MSH2 gene full seq 81296 290 MSH2 gene known variants 81297 290 MSH2 gene dup/delete variant 81298 290 MSH6 gene full seq 81299 290 MSH6 gene known variants 81300 290 MSH6 gene dup/delete variant 81301 290 Microsatellite instability 81302 290 MECP2 gene full seq 81303 290 MECP2 gene known variant 81304 290 MECP2 gene dup/delet variant 81310 290 NPM1 gene 81313 290 PCA3/KLK3 antigen81315 290 Pml/raralpha com breakpoints 81316 290 Pml/raralpha 1 breakpoint 81317 290 PMS2 gene full seq analysis 81318 290 PMS2 known familial variants 81319 290 PMS2 gene dup/delet variants 81330 290 SMPD1 gene common variants 81331 290 SNRPN/UBE3A gene 81332 290 SERPINA1 gene 81340 290 TRB@ gene rearrange amplify 81341 290 TRB@ gene rearrange dirprobe 81342 290 TRG gene rearrangement anal 81350 290 UGT1A1 gene 81355 290 VKORC1 gene 81370 290 HLA I & II typing lr 81371 290 HLA I & II type verify lr 81372 290 HLA I typing complete lr 81373 290 HLA I typing 1 locus lr 81374 290 HLA I typing 1 antigen lr 81375 290 HLA II typing ag equiv lr 81376 290 HLA II typing 1 locus lr 81377 290 HLA II type 1 ag equiv lr 81378 290 HLA I & II typing hr 81379 290 HLA I typing complete hr 81380 290 HLA I typing 1 locus hr 81381 290 HLA I typing 1 allele hr 81382 290 HLA II typing 1 loc hr 81383 290 HLA II typing 1 allele hr 81400 290 Mopath procedure level 1 81401 290 Mopath procedure level 2 81402 290 Mopath procedure level 3 81403 290 Mopath procedure level 4


CPT/HCPCS MOD MOD LEV DESCRIPTION81404 290 Mopath procedure level 5 81405 290 Mopath procedure level 6 81406 290 Mopath procedure level 7 81407 290 Mopath procedure level 8 81408 290 Mopath procedure level 9 81410 290 Aortic dysfunction/dilation81411 290 Aortic dysfunction/dilation81415 290 Exome sequence analysis81416 290 Exome sequence analysis81417 290 Exome re-evaluation81420 290 Fetal chrmoml aneuploidy81425 290 Genome sequence analysis81426 290 Genome sequence analysis81427 290 Genome re-evaluation81430 290 Hearing loss sequence analysis81431 290 Hearing loss dup/del analysis81435 290 Hereditary colon cancer81436 290 Hereditary colon ca snyd81440 290 Mitochondrial gene81445 290 Targeted genomic seq analys81450 290 Targeted genomic seq analys81455 290 Targeted genomic seq analys81460 290 Whole mitochondrial genome81465 290 Whole mitochondrial genome81470 290 X-linked intellectual dblt81471 290 X-linked intellectual dblt81504 290 Oncology tissue of origin 81507 290 Fetal aneuploidy trisom risk 81519 290 Oncology breast mrna82000 290 Assay of blood acetaldehyde end-dated 12/31/201482003 290 Assay of acetaminophen end-dated 12/31/201482009 290 Test for acetone/ketones82010 290 Acetone assay82010 QW 290 Acetone assay82013 282 Acetylcholinesterase assay82016 282 Acylcarnitines, qual82017 290 Acylcarnitines, quant82024 282 Assay of acth82030 290 Assay of adp & amp82040 282 Assay of serum albumin82040 QW 282 Assay of serum albumin82042 290 Assay of urine albumin82042 QW 290 Assay of urine albumin82043 290 Microalbumin, quantitative82043 QW 290 Microalbumin, quantitative82044 290 Microalbumin, semiquant82044 QW 290 Microalbumin, semiquant82045 290 Albumin, ischemia modified82055 290 Assay of ethanol end-dated 12/31/201482055 QW 290 Assay of ethanol end-dated 12/31/201482075 290 Assay of breath ethanol82085 290 Assay of aldolase82088 282 Assay of aldosterone82101 290 Assay of urine alkaloids end-dated 12/31/201482103 290 Alpha-1-antitrypsin, total82104 290 Alpha-1-antitrypsin, pheno82105 290 Alpha-fetoprotein, serum82106 290 Alpha-fetoprotein, amniotic82107 290 Alpha-fetoprotein l382108 290 Assay of aluminum82120 290 Amines, vaginal fluid qual82120 QW 290 Amines, vaginal fluid qual82127 282 Amino acid, single qual82128 282 Amino acids, mult qual82131 282 Amino acids, single quant82135 290 Assay, aminolevulinic acid


CPT/HCPCS MOD MOD LEV DESCRIPTION82136 290 Amino acids, quant, 2-582139 290 Amino acids, quan, 6 or more82140 290 Assay of ammonia82143 290 Amniotic fluid scan end-dated 12/31/201482145 290 Assay of amphetamines82150 290 Assay of amylase82150 QW 290 Assay of amylase82154 290 Androstanediol glucuronide82157 290 Assay of androstenedione82160 290 Assay of androsterone82163 290 Assay of angiotensin II82164 290 Angiotensin I enzyme test82172 290 Assay of apolipoprotein82175 290 Assay of arsenic82180 290 Assay of ascorbic acid82190 290 Atomic absorption82205 282 Assay of barbiturates end-dated 12/31/201482232 290 Assay of beta-2 protein82239 290 Bile acids, total82240 290 Bile acids, cholylglycine82247 282 Bilirubin, total82247 QW 282 Bilirubin, total82248 282 Bilirubin, direct82252 290 Fecal bilirubin test82261 290 Assay of biotinidase82270 290 Test for blood, feces82271 290 Occult blood, feces, single82271 QW 290 Occult blood, feces, single82272 282 Blood occult peroxidase82274 290 Assay test for blood, fecal82274 QW 290 Assay test for blood, fecal82286 290 Assay of bradykinin82300 290 Assay of cadmium82306 290 Assay of vitamin D82308 282 Assay of calcitonin82310 282 Assay of calcium82310 QW 282 Assay of calcium82330 282 Assay of calcium82330 QW 282 Assay of calcium82331 290 Calcium infusion test82340 290 Assay of calcium in urine82355 290 Calculus analysis, qual82360 290 Calculus assay, quant82365 290 Calculus spectroscopy82370 290 X-ray assay, calculus82373 290 Assay, c-d transfer measure82374 282 Assay, blood carbon dioxide82374 QW 282 Assay, blood carbon dioxide82375 290 Assay, blood carbon monoxide82376 290 Test for carbon monoxide82378 290 Carcinoembryonic antigen82379 290 Assay of carnitine82380 290 Assay of carotene82382 290 Assay, urine catecholamines82383 290 Assay, blood catecholamines82384 282 Assay, three catecholamines82387 290 Assay of cathepsin-d82390 290 Assay of ceruloplasmin82397 290 Chemiluminescent assay82415 290 Assay of chloramphenicol82435 282 Assay of blood chloride82435 QW 282 Assay of blood chloride82436 290 Assay of urine chloride82438 290 Assay, other fluid chlorides82441 290 Test for chlorohydrocarbons82465 290 Assay, bld/serum cholesterol


CPT/HCPCS MOD MOD LEV DESCRIPTION82465 QW 290 Assay, bld/serum cholesterol82480 290 Assay, serum cholinesterase82482 290 Assay, rbc cholinesterase82485 290 Assay, chondroitin sulfate82486 282 Gas/liquid chromatography82487 282 Paper chromatography82488 282 Paper chromatography82489 282 Thin layer chromatography82491 282 Chromotography, quant, sing82492 282 Chromotography, quant, mult82495 290 Assay of chromium82507 290 Assay of citrate82520 290 Assay of cocaine end-dated 12/31/201482523 290 Collagen crosslinks82523 QW 290 Collagen crosslinks82525 290 Assay of copper82528 290 Assay of corticosterone82530 282 Cortisol, free82533 282 Total cortisol82540 290 Assay of creatine82541 290 Column chromotography, qual82542 290 Column chromotography, quant82543 290 Column chromotograph/isotope82544 290 Column chromotograph/isotope82550 290 Assay of ck (cpk)82550 QW 290 Assay of ck (cpk)82552 290 Assay of cpk in blood82553 282 Creatine, MB fraction82554 290 Creatine, isoforms82565 282 Assay of creatinine82565 QW 282 Assay of creatinine82570 282 Assay of urine creatinine82570 QW 282 Assay of urine creatinine82575 290 Creatinine clearance test82585 290 Assay of cryofibrinogen82595 290 Assay of cryoglobulin82600 290 Assay of cyanide82607 290 Vitamin B-1282608 290 B-12 binding capacity82610 290 Cystatin C 82615 290 Test for urine cystines82626 290 Dehydroepiandrosterone82627 290 Dehydroepiandrosterone82633 290 Desoxycorticosterone82634 282 Deoxycortisol82638 290 Assay of dibucaine number82646 290 Assay of dihydrocodeinone end-dated 12/31/201482649 290 Assay of dihydromorphinone end-dated 12/31/201482651 290 Assay of dihydrotestosterone end-dated 12/31/201482652 290 Assay of dihydroxyvitamin d82654 290 Assay of dimethadione end-dated 12/31/201482656 290 Pancreatic elastase, fecal82657 290 Enzyme cell activity82658 290 Enzyme cell activity, ra82664 290 Electrophoretic test82666 290 Assay of epiandrosterone end-dated 12/31/201482668 290 Assay of erythropoietin82670 282 Assay of estradiol82671 290 Assay of estrogens82672 290 Assay of estrogen82677 290 Assay of estriol82679 290 Assay of estrone82679 QW 290 Assay of estrone82690 290 Assay of ethchlorvynol end-dated 12/31/201482693 290 Assay of ethylene glycol82696 290 Assay of etiocholanolone


CPT/HCPCS MOD MOD LEV DESCRIPTION82705 290 Fats/lipids, feces, qual82710 290 Fats/lipids, feces, quant82715 290 Assay of fecal fat82725 290 Assay of blood fatty acids82726 290 Long chain fatty acids82728 290 Assay of ferritin82731 290 Assay of fetal fibronectin82735 290 Assay of fluoride82735 290 Assay of flurazepam end-dated 12/31/201482746 290 Blood folic acid serum82747 290 Assay of folic acid, rbc82757 290 Assay of semen fructose82759 290 Assay of rbc galactokinase82760 290 Assay of galactose82775 290 Assay galactose transferase82776 290 Galactose transferase test82777 274 Galectin-3 82784 290 Assay of gammaglobulin igm82785 290 Assay of gammaglobulin ige82787 290 Igg 1, 2, 3 or 4, each82800 282 Blood pH82803 282 Blood gases: pH, pO2 & pCO282805 290 Blood gases W/02 saturation82810 290 Blood gases, O2 sat only82820 290 Hemoglobin-oxygen affinity82930 290 Gastric analy w/ph ea spec82938 290 Gastrin test82941 290 Assay of gastrin82943 290 Assay of glucagon82945 282 Glucose other fluid82946 290 Glucagon tolerance test82947 282 Assay, glucose, blood quant82947 QW 282 Assay, glucose, blood quant82948 282 Reagent strip/blood glucose82950 290 Glucose test82950 QW 290 Glucose test82951 290 Glucose tolerance test (GTT)82951 QW 290 Glucose tolerance test (GTT)82952 290 GTT-added samples82952 QW 290 GTT-added samples82953 290 Glucose-tolbutamide test end-dated 12/31/201482955 290 Assay of g6pd enzyme82960 290 Test for G6PD enzyme82962 290 Glucose blood test82963 290 Assay of glucosidase82965 290 Assay of gdh enzyme82975 290 Assay of glutamine end-dated 12/31/201482977 290 Assay of GGT82977 QW 290 Assay of GGT82978 290 Assay of glutathione82979 290 Assay, rbc glutathione82980 290 Assay of glutethimide end-dated 12/31/201482985 290 Glycated protein82985 QW 290 Glycated protein83001 282 Gonadotropin (FSH)83001 QW 282 Gonadotropin (FSH)83002 282 Gonadotropin (LH)83002 QW 282 Gonadotropin (LH)83003 282 Assay, growth hormone (hgh)83006 290 Growth stimulatino gene 283008 290 Assay of guanosine end-dated 12/31/201483009 290 H pylori (c-13), blood83010 290 Assay of haptoglobin, quant83012 290 Assay of haptoglobins83013 282 H pylori analysis83014 282 H pylori drug admin/collect


CPT/HCPCS MOD MOD LEV DESCRIPTION83015 290 Heavy metal screen83018 290 Quantitative screen, metals83020 290 Hemoglobin electrophoresis83020 26 290 Hemoglobin electrophoresis83021 290 Hemoglobin chromotography83026 282 Hemoglobin, copper sulfate83030 290 Fetal hemoglobin, chemical83033 282 Fetal hemoglobin assay, qual83036 282 Glycated hemoglobin test83036 QW 282 Glycated hemoglobin test83037 282 Glycosylated hb, home device83037 QW 282 Glycosylated hb, home device83045 290 Blood methemoglobin test83050 290 Blood methemoglobin assay83051 290 Assay of plasma hemoglobin83055 290 Blood sulfhemoglobin test end-dated 12/31/201483060 290 Blood sulfhemoglobin assay83065 290 Assay of hemoglobin heat83068 290 Hemoglobin stability screen83069 290 Assay of urine hemoglobin83070 290 Assay of hemosiderin, qual83071 290 Assay of hemosiderin, quant end-dated 12/31/201483080 290 Assay of b hexosaminidase83088 290 Assay of histamine83090 282 Assay of homocystine83150 290 Assay of for hva83491 290 Assay of corticosteroids83497 290 Assay of 5-hiaa83498 282 Assay of progesterone83499 290 Assay of progesterone83500 290 Assay, free hydroxyproline83505 290 Assay, total hydroxyproline83516 282 Immunoassay, nonantibody83518 282 Immunoassay, dipstick83518 QW 282 Immunoassay, dipstick83519 282 Immunoassay, nonantibody83520 282 Immunoassay, RIA83520 QW 282 Immunoassay, RIA83525 282 Assay of insulin83527 290 Assay of insulin83528 290 Assay of intrinsic factor83540 290 Assay of iron83550 290 Iron binding test83570 290 Assay of idh enzyme83582 290 Assay of ketogenic steroids83586 290 Assay 17- ketosteroids83593 290 Fractionation, ketosteroids83605 290 Assay of lactic acid83605 QW 290 Assay of lactic acid83615 290 Lactate (LD) (LDH) enzyme83625 290 Assay of ldh enzymes83630 282 Lactoferrin, fecal (qual)83631 290 Lactoferrin, fecal (quant)83632 290 Placental lactogen83633 290 Test urine for lactose83634 290 Assay of urine for lactose end-dated 12/31/201483655 290 Assay of lead83655 QW 290 Assay of lead83661 290 L/s ratio, fetal lung83662 290 Foam stability, fetal lung83663 290 Fluoro polarize, fetal lung83664 290 Lamellar bdy, fetal lung83670 290 Assay of lap enzyme83690 290 Assay of lipase83695 290 Assay of lipoprotein(a)83698 290 Assay lipoprotein pla2


CPT/HCPCS MOD MOD LEV DESCRIPTION83700 290 Lipopro bld, electrophoretic83701 290 Lipoprotein bld, hr fraction83704 290 Lipoprotein, bld, by nmr83718 290 Assay of lipoprotein83718 QW 290 Assay of lipoprotein83719 290 Assay of blood lipoprotein83721 282 Assay of blood lipoprotein83721 QW 282 Assay of blood lipoprotein83727 290 Assay of lrh hormone83735 290 Assay of magnesium83775 290 Assay of md enzyme83785 290 Assay of manganese83788 282 Mass spectrometry qual83789 282 Mass spectrometry quant83805 290 Assay of meprobamate end-dated 12/31/201483825 290 Assay of mercury83835 290 Assay of metanephrines83840 290 Assay of methadone end-dated 12/31/201483857 290 Assay of methemalbumin83858 290 Assay of methsuximide end-dated 12/31/201483861 290 Microfluid analy tears83864 290 Mucopolysaccharides83866 290 Mucopolysaccharides screen end-dated 12/31/201483872 290 Assay synovial fluid mucin83873 290 Assay of csf protein83874 290 Assay of myoglobin83876 290 Assay, myeloperoxidase83880 290 Natriuretic peptide83880 QW 290 Natriuretic peptide83883 290 Assay, nephelometry not spec83885 290 Assay of nickel83887 290 Assay of nicotine end-dated 12/31/201483915 290 Assay of nucleotidase83916 290 Oligoclonal bands83918 290 Organic acids, total, quant83919 282 Organic acids, qual, each83921 290 Organic acid, single, quant83925 290 Assay of opiates end-dated 12/31/201483930 290 Assay of blood osmolality83935 290 Assay of urine osmolality83937 290 Assay of osteocalcin83945 290 Assay of oxalate83950 290 Oncorprotein, her-2/neu83951 290 Oncoprotein, dcp83970 290 Assay of parathormone83986 282 Assay of body fluid acidity83986 QW 282 Assay of body fluid acidity83987 290 Exhaled breath condensate83992 290 Assay for phencyclidine83993 290 Assay for calprotectin fecal84022 290 Assay of phenothiazine end-dated 12/31/201484030 290 Assay of blood pku84035 290 Assay of phenylketones84060 290 Assay acid phosphatase84061 290 Phosphatase, forensic exam84066 290 Assay prostate phosphatase84075 282 Assay alkaline phosphatase84075 QW 282 Assay alkaline phosphatase84078 290 Assay alkaline phosphatase84080 290 Assay alkaline phosphatases84081 290 Amniotic fluid enzyme test84085 290 Assay of rbc pg6d enzyme84087 290 Assay phosphohexose enzymes84100 282 Assay of phosphorus84105 290 Assay of urine phosphorus84106 290 Test for porphobilinogen


CPT/HCPCS MOD MOD LEV DESCRIPTION84110 290 Assay of porphobilinogen84112 290 Eval amniotic fluid protein 84119 290 Test urine for porphyrins84120 290 Assay of urine porphyrins84126 290 Assay of feces porphyrins end-dated 12/31/201484127 290 Assay of feces porphyrins84132 282 Assay of serum potassium84132 QW 282 Assay of serum potassium84133 290 Assay of urine potassium84134 290 Assay of prealbumin84135 290 Assay of pregnanediol84138 290 Assay of pregnanetriol84140 290 Assay of pregnenolone84143 282 Assay of 17-hydroxypregneno84144 290 Assay of progesterone84145 290 Procalcitonin (PCT)84146 282 Assay of prolactin84150 290 Assay of prostaglandin84152 290 Assay of psa, complexed84153 290 Assay of psa, total84154 290 Assay of psa, free84155 282 Assay of protein84156 290 Assay of protein, urine84157 290 Assay of protein, other84157 QW 290 Assay of protein, other84160 290 Assay of serum protein84163 290 Pappa, serum84165 290 Assay of serum proteins84165 26 290 Assay of serum proteins84166 290 Protein e-phoresis/urine/csf84166 26 290 Protein e-phoresis/urine/csf84181 282 Western blot test84181 26 282 Western blot test84182 290 Protein, western blot test84182 26 290 Protein, western blot test84202 290 Assay RBC protoporphyrin84203 290 Test RBC protoporphyrin84206 290 Assay of proinsulin84207 290 Assay of vitamin b-684210 290 Assay of pyruvate84220 290 Assay of pyruvate kinase84228 290 Assay of quinine84233 290 Assay of estrogen84234 290 Assay of progesterone84235 290 Assay of endocrine hormone84238 290 Assay, nonendocrine receptor84244 282 Assay of renin84252 290 Assay of vitamin b-284255 290 Assay of selenium84260 290 Assay of serotonin84270 290 Assay of sex hormone globul84275 290 Assay of sialic acid84285 290 Assay of silica84295 282 Assay of serum sodium84295 QW 282 Assay of serum sodium84300 290 Assay of urine sodium84302 290 Assay of sweat sodium84305 290 Assay of somatomedin84307 290 Assay of somatostatin84311 290 Spectrophotometry84315 290 Body fluid specific gravity84375 290 Chromatogram assay, sugars84376 282 Sugars, single, qual84377 282 Sugars, multiple, qual84378 282 Sugars single quant84379 290 Sugars multiple quant


CPT/HCPCS MOD MOD LEV DESCRIPTION84392 290 Assay of urine sulfate84402 290 Assay of testosterone84403 282 Assay of total testosterone84425 290 Assay of vitamin b-184430 290 Assay of thiocyanate84431 290 Thromboxane, urine84432 290 Assay of thyroglobulin84436 290 Assay of total thyroxine84437 290 Assay of neonatal thyroxine84439 290 Assay of free thyroxine84442 290 Assay of thyroid activity84443 282 Assay thyroid stim hormone84443 QW 282 Assay thyroid stim hormone84445 290 Assay of tsi84446 290 Assay of vitamin e84449 290 Assay of transcortin84450 282 Transferase (AST) (SGOT)84450 QW 282 Transferase (AST) (SGOT)84460 282 Alanine amino (ALT) (SGPT)84460 QW 282 Alanine amino (ALT) (SGPT)84466 290 Assay of transferrin84478 290 Assay of triglycerides84478 QW 290 Assay of triglycerides84479 290 Assay of thyroid (t3 or t4)84480 290 Assay, triiodothyronine (t3)84481 290 Free assay (FT-3)84482 290 Reverse assay (t3)84484 290 Assay of troponin, quant84485 290 Assay duodenal fluid trypsin84488 290 Test feces for trypsin84490 290 Assay of feces for trypsin84510 290 Assay of tyrosine84512 290 Assay of troponin, qual84520 282 Assay of urea nitrogen84520 QW 282 Assay of urea nitrogen84525 290 Urea nitrogen semi-quant84540 290 Assay of urine/urea-n84545 290 Urea-N clearance test84550 290 Assay of blood/uric acid84550 QW 290 Assay of blood/uric acid84560 290 Assay of urine/uric acid84577 290 Assay of feces/urobilinogen84578 290 Test urine urobilinogen84580 290 Assay of urine urobilinogen84583 282 Assay of urine urobilinogen84585 290 Assay of urine vma84586 290 Assay of vip84588 290 Assay of vasopressin84590 290 Assay of vitamin a84591 282 Assay of nos vitamin84597 290 Assay of vitamin k84600 290 Assay of volatiles84620 290 Xylose tolerance test84630 290 Assay of zinc84681 282 Assay of c-peptide84702 290 Chorionic gonadotropin test84703 290 Chorionic gonadotropin assay84703 QW 290 Chorionic gonadotropin assay84704 290 HCG, free betachain test84830 290 Ovulation tests84999 290 Clinical chemistry test, unlisted85002 290 Bleeding time test85004 282 Automated diff wbc count85007 290 Differential WBC count85008 290 Nondifferential WBC count85009 290 Differential WBC count


CPT/HCPCS MOD MOD LEV DESCRIPTION85013 282 Hematocrit85014 282 Hematocrit85014 QW 282 Hematocrit85018 282 Hemoglobin85018 QW 282 Hemoglobin85025 290 Automated hemogram85027 282 Automated hemogram85032 290 Manual cell count, each85041 282 Red blood cell (RBC) count85044 290 Reticulocyte count85045 290 Reticulocyte count85046 290 Reticyte/hgb concentrate85048 282 White blood cell (WBC) count85049 282 Automated platelet count85055 290 Reticulated platelet assay85060 270 Blood smear interpretation85097 266 Bone marrow interpretation85130 290 Chromogenic substrate assay85170 290 Blood clot retraction85175 290 Blood clot lysis time85210 290 Blood clot factor II test85220 290 Blood clot factor V test85230 290 Blood clot factor VII test85240 290 Blood clot factor VIII test85244 290 Blood clot factor VIII test85245 290 Blood clot factor VIII test85246 290 Blood clot factor VIII test85247 290 Blood clot factor VIII test85250 290 Blood clot factor IX test85260 290 Blood clot factor X test85270 290 Blood clot factor XI test85280 290 Blood clot factor XII test85290 290 Blood clot factor XIII test85291 290 Blood clot factor XIII test85292 290 Blood clot factor assay85293 290 Blood clot factor assay85300 290 Antithrombin III test85301 290 Antithrombin III test85302 290 Blood clot inhibitor antigen85303 290 Blood clot inhibitor test85305 290 Blood clot inhibitor assay85306 290 Blood clot inhibitor test85307 290 Assay activated protein c85335 290 Factor inhibitor test85337 290 Thrombomodulin85345 290 Coagulation time85347 290 Coagulation time85348 290 Coagulation time85360 290 Euglobulin lysis85362 290 Fibrin degradation products85366 290 Fibrinogen test85370 290 Fibrinogen test85378 282 Fibrin degradation, semiquant85379 282 Fibrin degradation, quant85380 290 Fibrin degradation, vte85384 290 Fibrinogen85385 290 Fibrinogen85390 290 Fibrinolysins screen85390 26 290 Fibrinolysins screen85396 290 Clotting assay, whole blood85397 290 Clotting funct activity85400 290 Fibrinolytic plasmin85410 290 Fibrinolytic antiplasmin85415 290 Fibrinolytic plasminogen85420 290 Fibrinolytic plasminogen85421 290 Fibrinolytic plasminogen


CPT/HCPCS MOD MOD LEV DESCRIPTION85441 290 Heinz bodies, direct85445 290 Heinz bodies, induced85460 290 Hemoglobin, fetal85461 290 Hemoglobin, fetal85475 290 Hemolysin85520 290 Heparin assay85525 290 Heparin85530 290 Heparin-protamine tolerance85536 282 Iron stain peripheral blood85540 290 Wbc alkaline phosphatase85547 290 RBC mechanical fragility85549 290 Muramidase85555 282 RBC osmotic fragility85557 290 RBC osmotic fragility85576 290 Blood platelet aggregation85576 26 290 Blood platelet aggregation85576 QW 290 Blood platelet aggregation85597 290 Platelet neutralization85598 290 Hexagnal phosph pltlt neutrl85610 290 Prothrombin time85610 QW 290 Prothrombin time85611 290 Prothrombin test85612 290 Viper venom prothrombin time85613 290 Russell viper venom, diluted85635 290 Reptilase test85651 282 Rbc sed rate, nonautomated85652 290 Rbc sed rate, automated85660 290 RBC sickle cell test85670 290 Thrombin time, plasma85675 290 Thrombin time, titer85705 290 Thromboplastin inhibition85730 290 Thromboplastin time, partial85732 290 Thromboplastin time, partial85810 290 Blood viscosity examination85999 290 Hematology procedure, unlisted85999 TC 290 Hematology procedure, unlisted85999 26 290 Hematology procedure, unlisted86000 290 Agglutinins, febrile86001 290 Allergen specific igg86003 290 Allergen specific IgE86005 282 Allergen specific IgE86021 290 WBC antibody identification86022 290 Platelet antibodies86023 290 Immunoglobulin assay86038 290 Antinuclear antibodies86039 290 Antinuclear antibodies (ANA)86060 290 Antistreptolysin o, titer86063 282 Antistreptolysin o, screen86077 219 Physician blood bank service86078 219 Physician blood bank service86079 219 Physician blood bank service86140 290 C-reactive protein86141 290 C-reactive protein, hs86146 290 Glycoprotein antibody86147 290 Cardiolipin antibody86148 290 Phospholipid antibody86152 274 Cell enumeration & ID 86153 00 Cell enumeration phys interp 86155 290 Chemotaxis assay86156 282 Cold agglutinin, screen86157 290 Cold agglutinin, titer86160 290 Complement, antigen86161 290 Complement/function activity86162 290 Complement, total (CH50)86171 290 Complement fixation, each86185 290 Counterimmunoelectrophoresis


CPT/HCPCS MOD MOD LEV DESCRIPTION86200 290 Ccp antibody86215 290 Deoxyribonuclease, antibody86225 290 DNA antibody86226 290 DNA antibody, single strand86235 290 Nuclear antigen antibody86243 290 Fc receptor86255 290 Fluorescent antibody, screen86255 26 290 Fluorescent antibody, screen86256 290 Fluorescent antibody, titer86256 26 290 Fluorescent antibody, titer86277 290 Growth hormone antibody86280 290 Hemagglutination inhibition86294 282 Immunoassay, tumor qual86294 QW 282 Immunoassay, tumor qual86300 290 Immunoassay, tumor ca 15-386301 290 Immunoassay, tumor ca 19-986304 290 Immunoassay, tumor, ca 12586305 290 Human epididymis protein 486308 290 Heterophile antibodies86308 QW 290 Heterophile antibodies86309 290 Heterophile antibodies86310 290 Heterophile antibodies86316 282 Immunoassay, tumor other86317 290 Immunoassay,infectious agent86318 282 Immunoassay,infectious agent86318 QW 282 Immunoassay,infectious agent86320 290 Serum immunoelectrophoresis86320 26 290 Serum immunoelectrophoresis86325 290 Other immunoelectrophoresis86325 26 290 Other immunoelectrophoresis86327 290 Immunoelectrophoresis assay86327 26 290 Immunoelectrophoresis assay86329 282 Immunodiffusion86331 282 Immunodiffusion ouchterlony86332 290 Immune complex assay86334 290 Immunofixation procedure86334 26 290 Immunofixation procedure86335 290 Immunfix e-phorsis/urine/csf86335 26 290 Immunfix e-phorsis/urine/csf86336 290 Inhibin A86337 290 Insulin antibodies86340 290 Intrinsic factor antibody86341 290 Islet cell antibody86343 290 Leukocyte histamine release86344 290 Leukocyte phagocytosis86352 290 Cell function assay w/stim86353 290 Lymphocyte transformation86355 282 B cells, total count86356 282 Mononuclear cell antigen86357 282 Nk cells, total count86359 282 T cells, total count86360 282 T cell, absolute count/ratio86361 282 T cell, absolute count86367 282 Stem cells, total count86376 290 Microsomal antibody86378 290 Migration inhibitory factor86382 290 Neutralization test, viral86384 290 Nitroblue tetrazolium dye86386 190 Nuclear matrix protein 22 86403 290 Particle agglutination test86406 290 Particle agglutination test86430 290 Rheumatoid factor test86431 290 Rheumatoid factor, quant86480 290 Tb test, cell immun measure86481 290 Tb ag response t-cell susp86485 270 Skin test, candida


CPT/HCPCS MOD MOD LEV DESCRIPTION86486 270 Skin test, nos antigen86490 270 Coccidioidomycosis skin test86510 270 Histoplasmosis skin test86580 270 TB intradermal test86590 290 Streptokinase, antibody86592 290 Blood serology, qualitative86593 290 Blood serology, quantitative86602 290 Antinomyces antibody86603 290 Adenovirus antibody86606 290 Aspergillus antibody86609 290 Bacterium antibody86611 290 Bartonella antibody86612 290 Blastomyces antibody86615 290 Bordetella antibody86617 290 Lyme disease antibody86618 290 Lyme disease antibody86618 QW 290 Lyme disease antibody86619 290 Borrelia antibody86622 290 Brucella antibody86625 290 Campylobacter antibody86628 290 Candida antibody86631 290 Chlamydia antibody86632 290 Chlamydia igm antibody86635 290 Coccidioides antibody86638 290 Q fever antibody86641 290 Cryptococcus antibody86644 290 CMV antibody86645 290 CMV antibody, IgM86648 290 Diphtheria antibody86651 290 Encephalitis antibody86652 290 Encephalitis antibody86653 290 Encephalitis antibody86654 290 Encephalitis antibody86658 290 Enterovirus antibody86663 290 Epstein-barr antibody86664 290 Epstein-barr antibody86665 290 Epstein-barr antibody86666 290 Ehrlichia antibody86668 290 Francisella tularensis86671 290 Fungus antibody86674 290 Giardia lamblia antibody86677 290 Helicobacter pylori86682 290 Helminth antibody86684 290 Hemophilus influenza86687 290 Htlv-i antibody86688 290 Htlv-ii antibody86689 290 HTLV/HIV confirmatory test86692 290 Hepatitis, delta agent86694 290 Herpes simplex test86695 290 Herpes simplex test86696 290 Herpes simplex type 286698 290 Histoplasma86701 290 HIV-186701 QW 290 HIV-186702 290 HIV-286703 290 HIV-1/HIV-2 single result86703 QW 290 HIV-1/HIV-2 single result86704 290 Hep b core antibody, total86705 290 Hep b core antibody, igm86706 290 Hep b surface antibody86707 290 Hep be antibody86708 290 Hep a antibody, total86709 290 Hep a antibody, igm86710 290 Influenza virus antibody86711 274 John Cunningham antibody 86713 290 Legionella antibody


CPT/HCPCS MOD MOD LEV DESCRIPTION86717 290 Leishmania antibody86720 290 Leptospira antibody86723 290 Listeria monocytogenes ab86727 290 Lymph choriomeningitis ab86729 290 Lympho venereum antibody86732 290 Mucormycosis antibody86735 290 Mumps antibody86738 290 Mycoplasma antibody86741 290 Neisseria meningitidis86744 290 Nocardia antibody86747 290 Parvovirus antibody86750 290 Malaria antibody86753 290 Protozoa antibody nos86756 290 Respiratory virus antibody86757 290 Rickettsia antibody86759 290 Rotavirus antibody86762 290 Rubella antibody86765 290 Rubeola antibody86768 290 Salmonella antibody86771 290 Shigella antibody86774 290 Tetanus antibody86777 290 Toxoplasma antibody86778 290 Toxoplasma antibody, igm86780 290 Treponema pallidum86784 290 Trichinella antibody86787 290 Varicella-zoster antibody86788 290 West nile virus ab, igm86789 290 West nile virus antibody86790 290 Virus antibody nos86793 290 Yersinia antibody86800 290 Thyroglobulin antibody86803 290 Hepatitis c ab test86804 290 Hep c ab test, confirm86805 290 Lymphocytotoxicity assay86806 282 Lymphocytotoxicity assay86807 290 Cytotoxic antibody screening86808 290 Cytotoxic antibody screening86812 282 HLA typing, A, B, or C86813 290 HLA typing, A, B, or C86816 282 HLA typing, DR/DQ86817 290 HLA typing, DR/DQ86821 290 Lymphocyte culture, mixed86822 290 Lymphocyte culture, primed86825 290 HLA x-match, non-cytotoxic86826 290 HLA x-match, non-cyt, add-on86828 274 HLA class I&II antibody qual 86829 274 HLA class I/II antibody qual 86830 274 HLA class I phenotype qual 86831 274 HLA class II phenotype qual 86832 274 HLA class I high defin qual 86833 274 HLA class II high defin qual 86834 274 HLA class I semiquant panel 86835 274 HLA class II semiquant panel 86849 290 Immunology procedure86850 290 RBC antibody screen86860 290 RBC antibody elution86870 290 RBC antibody identification86880 290 Coombs test86885 290 Coombs test86886 290 Coombs test86890 290 Autologous blood process86891 290 Autologous blood, op salvage86900 290 Blood typing, ABO86901 290 Blood typing, Rh (D)86902 290 Blood type antigen donor ea86904 290 Blood typing, patient serum


CPT/HCPCS MOD MOD LEV DESCRIPTION86905 290 Blood typing, RBC antigens86906 290 Blood typing, Rh phenotype86920 290 Compatibility test86921 290 Compatibility test86922 290 Compatibility test86923 282 Compatibility test, electric86927 290 Plasma, fresh frozen86930 282 Frozen blood prep86931 282 Frozen blood thaw86932 290 Frozen blood freeze/thaw86940 290 Hemolysins/agglutinins, auto86941 290 Hemolysins/agglutinins86945 290 Blood product/irradiation86950 282 Leukacyte transfusion86960 290 Vol reduction of blood/prod86965 290 Pooling blood platelets86970 290 RBC pretreatment86971 290 RBC pretreatment86972 290 RBC pretreatment86975 290 RBC pretreatment, serum86976 290 RBC pretreatment, serum86977 290 RBC pretreatment, serum86978 290 RBC pretreatment, serum86985 282 Split blood or products86999 290 Transfusion procedure, unlisted87001 290 Small animal inoculation end-dated 12/31/201487003 290 Small animal inoculation87015 282 Specimen concentration87040 290 Blood culture for bacteria87045 290 Feces culture, bacteria87046 290 Stool cultr, bacteria, each87070 282 Culture, bacteria, other87071 282 Culture bacteri aerobic othr87073 282 Culture bacteria anaerobic87075 282 Culture bacteria anaerobic87076 282 Culture anaerobe ident, each87077 282 Culture aerobic identify87077 QW 282 Culture aerobic identify87081 282 Culture screen only87084 290 Culture of specimen by kit87086 282 Urine culture/colony count87088 282 Urine bacteria culture87101 290 Skin fungi culture87102 282 Fungus isolation culture87103 290 Blood fungus culture87106 290 Fungi identification, yeast87107 290 Fungi identification, mold87109 290 Mycoplasma87110 290 Chlamydia culture87116 290 Mycobacteria culture87118 290 Mycobacteric identification87140 290 Cultur type immunofluoresc87143 290 Culture typing, glc/hplc87147 290 Culture type, immunologic87149 282 Culture type, nucleic acid87150 282 DNA/RNA, amplified probe87152 290 Culture type pulse field gel87153 282 DNA/RNA sequencing87158 290 Culture typing, added method87164 290 Dark field examination87164 26 290 Dark field examination87166 282 Dark field examination87168 290 Macroscopic exam arthropod87169 290 Macacroscopic exam parasite87172 290 Pinworm exam87176 290 Tissue homogenization, cultr


CPT/HCPCS MOD MOD LEV DESCRIPTION87177 290 Ova and parasites smears87181 290 Microbe susceptible, diffuse87184 290 Microbe susceptible, disk87185 290 Microbe susceptible, enzyme87186 290 Microbe susceptible, mic87187 290 Microbe susceptible, mlc87188 290 Microbe suscept, macrobroth87190 290 Microbe suscept, mycobacteri87197 290 Bactericidal level, serum87205 290 Smear, gram stain87206 282 Smear, fluorescent/acid stai87207 290 Smear, special stain87207 26 290 Smear, special stain87209 282 Smear, complex stain87210 290 Smear, wet mount, saline/ink87210 QW 290 Smear, wet mount, saline/ink87220 290 Tissue exam for fungi87230 290 Assay, toxin or antitoxin87250 290 Virus inoculate, eggs/animal87252 290 Virus inoculation, tissue87253 282 Virus inoculate tissue, addl87254 290 Virus inoculation, shell via87255 290 Genet virus isolate, hsv87260 282 Adenovirus ag, if87265 282 Pertussis ag, if87267 282 Enterovirus anitbody, dfa87269 282 Giardia ag, if87270 282 Chlamydia trachomatis ag, if87271 282 Cytomegalovirus, (DFA)87272 282 Cryptosporidum/gardia ag, if87273 290 Herpes simplex 2, ag, if87274 282 Herpes simplex 1, ag, if87275 290 Influenza b, ag, if87276 282 Influenza a, ag, if87277 290 Legionella micdadei, ag, if87278 282 Legion pneumophilia ag, if87279 290 Parainfluenza, ag, if87280 282 Respiratory syncytial ag, if87281 290 Pneumocystis carinii, ag, if87283 290 Rubeola, ag, if87285 282 Treponema pallidum, ag, if87290 282 Varicella zoster, ag, if87299 282 Antibody detection, nos, if87300 290 Ag detection, polyval, if87301 282 Adenovirus ag, eia87305 282 Aspergillus ag, eia87320 282 Chylmd trach ag, eia87324 282 Clostridium ag, eia87327 290 Cryptococcus neoform ag, eia87328 282 Cryptospor ag, eia87329 282 Giardia ag, eia87332 282 Cytomegalovirus ag, eia87335 282 E coli 0157 ag, eia87336 290 Entamoeb hist dispr, ag, eia87337 290 Entamoeb hist group, ag, eia87338 282 Hpylori, stool, eia87339 290 H pylori ag, eia87340 282 Hepatitis b surface ag, eia87341 290 Hepatitis b surface, ag, eia87350 282 Hepatitis be ag, eia87380 282 Hepatitis delta ag, eia87385 282 Histoplasma capsul ag, eia87389 282 HIV-1 ag w/HIV-1 & HIV-2 ab 87390 282 Hiv-1 ag, eia87391 282 Hiv-2 ag, eia87400 290 Influenza a/b, ag, eia


CPT/HCPCS MOD MOD LEV DESCRIPTION87420 282 Resp syncytial ag, eia87425 282 Rotavirus ag, eia87427 290 Shiga-like toxin ag, eia87430 282 Strep a ag, eia87449 282 Ag detect nos, eia, mult87449 QW 282 Ag detect nos, eia, mult87450 282 Ag detect nos, eia, single87451 290 Ag detect polyval, eia, mult87470 282 Bartonella, dna, dir probe87471 282 Bartonella, dna, amp probe87472 290 Bartonella, dna, quant87475 282 Lyme dis, dna, dir probe87476 282 Lyme dis, dna, amp probe87477 290 Lyme dis, dna, quant87480 282 Candida, dna, dir probe87481 282 Candida, dna, amp probe87482 290 Candida, dna, quant87485 282 Chylmd pneum, dna, dir probe87486 282 Chylmd pneum, dna, amp probe87487 290 Chylmd pneum, dna, quant87490 282 Chylmd trach, dna, dir probe87491 282 Chylmd trach, dna, amp probe87492 290 Chylmd trach, dna, quant87493 290 C. difficile, amplified probe87495 282 Cytomeg, dna, dir probe87496 282 Cytomeg, dna, amp probe87497 282 Cytomeg, dna, quant87498 282 Enterovirus probe&revrs trns 87500 290 Vanomycin, DNA, amp probe87501 290 Influenza dna amp prob 1+87502 290 Influenza dna amp probe87503 290 Influenza dna amp prob addl87505 290 NFCT agent detection Gl87506 290 IADNA-DN/RNA probe TQ 6-1187507 290 IADNA-DN/RNA probe TQ 12-2587510 282 Gardner vag, dna, dir probe87511 282 Gardner vag, dna, amp probe87512 290 Gardner vag, dna, quant87515 282 Hepatitis b, dna, dir probe87516 282 Hepatitis b, dna, amp probe87517 282 Hepatitis b, dna, quant87520 282 Hepatitis c, rna, dir probe87521 282 Hepatitis c probe&rvrs trnsc 87522 282 Hepatitis c revrs trnscrpj 87525 282 Hepatitis g, dna, dir probe87526 282 Hepatitis g, dna, amp probe87527 282 Hepatitis g, dna, quant87528 282 Hsv, dna, dir probe87529 282 Hsv, dna, amp probe87530 282 Hsv, dna, quant87531 282 Hhv-6, dna, dir probe87532 282 Hhv-6, dna, amp probe87533 282 Hhv-6, dna, quant87534 282 Hiv-1, dna, dir probe87535 282 Hiv-1 probe&reverse trnscrpj 87536 282 Hiv-1 quant&revrse trnscrpj 87537 282 Hiv-2, dna, dir probe87538 282 Hiv-2 probe&revrse trnscripj 87539 282 Hiv-2 quant&revrse trnscripj 87540 282 Legion pneumo, dna, dir prob87541 282 Legion pneumo, dna, amp prob87542 290 Legion pneumo, dna, quant87550 282 Mycobacteria, dna, dir probe87551 282 Mycobacteria, dna, amp probe87552 290 Mycobacteria, dna, quant87555 282 M.tuberculo, dna, dir probe


CPT/HCPCS MOD MOD LEV DESCRIPTION87556 282 M.tuberculo, dna, amp probe87557 290 M.tuberculo, dna, quant87560 282 M.avium-intra, dna, dir prob87561 282 M.avium-intra, dna, amp prob87562 290 M.avium-intra, dna, quant87580 282 M.pneumon, dna, dir probe87581 282 M.pneumon, dna, amp probe87582 290 M.pneumon, dna, quant87590 282 N.gonorrhoeae, dna, dir prob87591 282 N.gonorrhoeae, dna, amp prob87592 290 N.gonorrhoeae, dna, quant87620 282 Hpv, dna, dir probe end-dated 12/31/201487621 282 Hpv, dna, amp probe end-dated 12/31/201487622 282 Hpv, dna, quant end-dated 12/31/201487623 290 Hpv low-risk types87624 290 Hpv high-risk types87625 290 Hpv types 16 & 18 only87631 274 Resp virus 3-5 targets 87632 274 Resp virus 6-11 targets 87633 274 Resp virus 12-25 targets 87640 282 Staph a, dna, amp probe87641 290 Mr-staph, dna, amp probe87650 282 Strep a, dna, dir probe87651 282 Strep a, dna, amp probe87652 290 Strep a, dna, quant87653 282 Strep b, dna, amp probe87660 282 Trichomonas vagin, dir probe87661 282 Trichomonas vaginalis amplif 87797 282 Detect agent nos, dna, dir87798 282 Detect agent nos, dna, amp87799 290 Detect agent nos, dna, quant87800 290 Detect agnt mult, dna, direc87801 290 Detect agnt mult, dna, ampli87802 290 Strep b assay w/optic87803 290 Clostridium toxin a w/optic87804 290 Influenza assay w/optic87804 QW 290 Influenza assay w/optic87806 290 HIV antigen w/hiv antibodies87807 282 Rsv assay w/optic87807 QW 282 Rsv assay w/optic87808 290 Trichomonas assay w/optic87808 QW 290 Trichomonas assay w/optic87809 290 Adenovirus assay w/optic87810 282 Chylmd trach assay w/optic87850 282 N. gonorrhoeae assay w/optic87880 282 Strep a assay w/optic87880 QW 282 Strep a assay w/optic87899 282 Agent nos assay w/optic87899 QW 282 Agent nos assay w/optic87900 282 Phenotype, infect agent drug87901 290 Genotype, dna, hiv reverse t87902 290 Genotype, dna, hepatitis C87903 290 Phenotype, dna hiv w/culture87904 290 Phenotype, dna hiv w/clt add87905 290 Sialidase enzyme assay87905 QW 290 Sialidase enzyme assay87906 290 Genotype dna hiv reverse t87999 290 Microbiology procedure, unlisted88000 290 Autopsy (necropsy), gross88005 290 Autopsy (necropsy), gross88007 290 Autopsy (necropsy), gross88020 290 Autopsy (necropsy), complete88025 290 Autopsy (necropsy), complete88027 290 Autopsy (necropsy), complete88036 290 Limited autopsy88037 290 Limited autopsy


CPT/HCPCS MOD MOD LEV DESCRIPTION88040 290 Forensic autopsy (necropsy)88045 290 Coroner’s autopsy (necropsy)88099 290 Necropsy (autopsy) procedure, unlisted88104 260 Cytopathology, fluids88104 TC 261 Cytopathology, fluids88104 26 260 Cytopathology, fluids88106 260 Cytopathology, fluids88106 TC 261 Cytopathology, fluids88106 26 260 Cytopathology, fluids88108 260 Cytopath, concentrate tech88108 TC 261 Cytopath, concentrate tech88108 26 260 Cytopath, concentrate tech88112 260 Cytopath, cell enhance tech88112 TC 261 Cytopath, cell enhance tech88112 26 260 Cytopath, cell enhance tech88120 260 Cytp urne 3-5 probes ea spec88120 TC 261 Cytp urne 3-5 probes ea spec88120 26 260 Cytp urne 3-5 probes ea spec88121 260 Cytp urine 3-5 probes cmptr88121 TC 261 Cytp urine 3-5 probes cmptr88121 26 260 Cytp urine 3-5 probes cmptr88125 260 Forensic cytopathology88125 TC 261 Forensic cytopathology88125 26 260 Forensic cytopathology88130 282 Sex chromatin identification88140 282 Sex chromatin identification88141 282 Cytopath, c/v, interpret88142 290 Cytopath, c/v, thin layer88143 290 Cytopath, c/v, thin lyr redo88147 290 Cytopath, c/v, automated88148 290 Cytopath, c/v, auto rescreen88150 290 Cytopath, c/v, manual88152 290 Cytopath, c/v, auto redo88153 290 Cytopath, c/v, redo88154 290 Cytopath, c/v, select88155 290 Cytopath, c/v, index add-on88160 260 Cytopath smear, other source88160 TC 261 Cytopath smear, other source88160 26 260 Cytopath smear, other source88161 260 Cytopath smear, other source88161 TC 261 Cytopath smear, other source88161 26 260 Cytopath smear, other source88162 260 Cytopath smear, other source88162 TC 261 Cytopath smear, other source88162 26 260 Cytopath smear, other source88164 290 Cytopath tbs, c/v, manual88165 290 Cytopath tbs, c/v, redo88166 290 Cytopath tbs, c/v, auto redo88167 290 Cytopath tbs, c/v, select88172 260 Cytopathology eval of fna88172 TC 261 Cytopathology eval of fna88172 26 260 Cytopathology eval of fna88173 260 Cytopath eval, fna, report88173 TC 261 Cytopath eval, fna, report88173 26 260 Cytopath eval, fna, report88174 290 Cytopath, c/v auto, in fluid88175 290 Cytopath, c/v auto fluid redo88177 260 Cytp c/v auto thin lyr addl88177 TC 261 Cytp c/v auto thin lyr addl88177 26 260 Cytp c/v auto thin lyr addl88182 260 Cell marker study88182 TC 261 Cell marker study88182 26 260 Cell marker study88184 266 Flowcytometry/ tc, 1 marker88185 282 Flowcytometry/tc, add-on88187 266 Flowcytometry/read, 2-8


CPT/HCPCS MOD MOD LEV DESCRIPTION88188 266 Flowcytometry/read, 9-1588189 266 Flowcytometry/read, 16 & >88199 270 Cytopathology procedure, unlisted88230 290 Tissue culture, lymphocyte88233 290 Tissue culture, skin/biopsy88235 290 Tissue culture, placenta88237 290 Tissue culture, bone marrow88239 290 Tissue culture, tumor88240 290 Cell cryopreserve/storage88241 290 Frozen cell preparation88245 282 Chromosome analysis, 20-2588248 290 Chromosome analysis, 50-10088249 290 Chromosome analysis, 10088261 282 Chromosome analysis, 588262 282 Chromosome analysis, 15-2088263 290 Chromosome analysis, 4588264 290 Chromosome analysis, 20-2588267 290 Chromosome analys, placenta88269 290 Chromosome analys, amniotic88271 282 Cytogenetics, dna probe88272 282 Cytogenetics, 3-588273 282 Cytogenetics, 10-3088274 282 Cytogenetics, 25-9988275 282 Cytogenetics, 100-30088280 290 Chromosome karyotype study88283 290 Chromosome banding study88285 290 Chromosome count, additional88289 290 Chromosome study, additional88291 270 Cyto/molecular report88299 270 Cytogenetic study, unlisted88300 168 Surgical path, gross88300 TC 170 Surgical path, gross88300 26 168 Surgical path, gross88302 151 Tissue exam by pathologist88302 TC 153 Tissue exam by pathologist88302 26 151 Tissue exam by pathologist88304 151 Tissue exam by pathologist88304 TC 153 Tissue exam by pathologist88304 26 151 Tissue exam by pathologist88305 151 Tissue exam by pathologist88305 TC 153 Tissue exam by pathologist88305 26 151 Tissue exam by pathologist88307 151 Tissue exam by pathologist88307 TC 153 Tissue exam by pathologist88307 26 151 Tissue exam by pathologist88309 151 Tissue exam by pathologist88309 TC 153 Tissue exam by pathologist88309 26 151 Tissue exam by pathologist88311 249 Decalcify tissue88311 TC 249 Decalcify tissue88311 26 249 Decalcify tissue88312 195 Special stains88312 TC 195 Special stains88312 26 195 Special stains88313 195 Special stains88313 TC 195 Special stains88313 26 195 Special stains88314 232 Histochemical stain88314 TC 232 Histochemical stain88314 26 232 Histochemical stain88319 151 Enzyme histochemistry88319 TC 153 Enzyme histochemistry88319 26 151 Enzyme histochemistry88321 195 Microslide consultation88323 195 Microslide consultation88323 TC 195 Microslide consultation


CPT/HCPCS MOD MOD LEV DESCRIPTION88323 26 195 Microslide consultation88325 195 Comprehensive review of data88329 195 Path consult introp88331 219 Path consult intraop, 1 bloc88331 TC 219 Path consult intraop, 1 bloc88331 26 219 Path consult intraop, 1 bloc88332 219 Path consult intraop, addl88332 TC 219 Path consult intraop, addl88332 26 219 Path consult intraop, addl88333 195 Intraop cyto path consult, 188333 TC 195 Intraop cyto path consult, 188333 26 195 Intraop cyto path consult, 188334 195 Intraop cyto path consult, 288334 TC 195 Intraop cyto path consult, 288334 26 195 Intraop cyto path consult, 288341 151 Immunohisto antibody slide 88341 TC 153 Immunohisto antibody slide 88341 26 151 Immunohisto antibody slide 88342 151 Immunohisto antibody slide 88342 TC 153 Immunohisto antibody slide 88342 26 151 Immunohisto antibody slide 88343 151 Immunohisto antibod add slid 88343 TC 153 Immunohisto antibod add slid 88343 26 151 Immunohisto antibod add slid 88344 151 Immunohisto antibody slide 88344 TC 153 Immunohisto antibody slide 88344 26 151 Immunohisto antibody slide 88346 151 Immunofluorescent study88346 TC 153 Immunofluorescent study88346 26 151 Immunofluorescent study88347 151 Immunofluorescent study88347 TC 153 Immunofluorescent study88347 26 151 Immunofluorescent study88348 151 Electron microscopy88348 TC 153 Electron microscopy88348 26 151 Electron microscopy88349 151 Scanning electron microscopy end-dated 12/31/201488349 TC 153 Scanning electron microscopy end-dated 12/31/201488349 26 151 Scanning electron microscopy end-dated 12/31/201488355 151 Analysis, skeletal muscle88355 TC 153 Analysis, skeletal muscle88355 26 151 Analysis, skeletal muscle88356 151 Analysis, nerve88356 TC 153 Analysis, nerve88356 26 151 Analysis, nerve88358 151 Analysis, tumor88358 TC 153 Analysis, tumor88358 26 151 Analysis, tumor88360 151 Tumor immunohistochem/manual88360 TC 153 Tumor immunohistochem/manual88360 26 151 Tumor immunohistochem/manual88361 151 Immunohistochemistry, tumor88361 TC 153 Immunohistochemistry, tumor88361 26 151 Immunohistochemistry, tumor88362 168 Nerve teasing preparations88362 TC 170 Nerve teasing preparations88362 26 168 Nerve teasing preparations88363 170 Xm archive tissue molec anal88364 151 Immunohisto antibody slide 88364 TC 153 Immunohisto antibody slide 88364 26 151 Immunohisto antibody slide 88365 151 Tissue hybridization88365 TC 153 Tissue hybridization88365 26 151 Tissue hybridization88366 151 Insitu hybridizatino (FISH)88366 TC 153 Insitu hybridizatino (FISH)


CPT/HCPCS MOD MOD LEV DESCRIPTION88366 26 151 Insitu hybridizatino (FISH)88367 151 Insitu hybridization, auto88367 TC 153 Insitu hybridization, auto88367 26 151 Insitu hybridization, auto88368 151 Insitu hybridization, manual88368 TC 153 Insitu hybridization, manual88368 26 151 Insitu hybridization, manual88369 151 Insitu hybridization (FISH)88369 TC 153 Insitu hybridization (FISH)88369 26 151 Insitu hybridization (FISH)88371 273 Protein, western blot tissue88371 26 151 Protein, western blot tissue88372 273 Protein analysis w/probe88372 26 151 Protein analysis w/probe88373 273 M/phmtrc alys ishquant/semiq88373 TC 153 M/phmtrc alys ishquant/semiq88373 26 151 M/phmtrc alys ishquant/semiq88374 273 M/phmtrc alys ishquant/semiq88374 TC 153 M/phmtrc alys ishquant/semiq88374 26 151 M/phmtrc alys ishquant/semiq88375 274 Optical endomicroscpy interp 88377 273 M/phmtrc alys ishquant/semiq88377 TC 153 M/phmtrc alys ishquant/semiq88377 26 151 M/phmtrc alys ishquant/semiq88380 151 Microdissection88380 TC 153 Microdissection88380 26 151 Microdissection88381 151 Microdissection, manual88381 TC 153 Microdissection, manual88381 26 151 Microdissection, manual88387 168 Tiss exam molecular study88387 TC 170 Tiss exam molecular study88387 26 168 Tiss exam molecular study88388 232 Tiss exam molecular study, add-on88388 TC 232 Tiss exam molecular study, add-on88388 26 232 Tiss exam molecular study, add-on88399 219 Surgical pathology procedure, unlisted88399 TC 219 Surgical pathology procedure, unlisted88399 26 219 Surgical pathology procedure, unlisted88720 290 Bilirubin total transcut88738 290 HGB, wuant transcutaneous88740 290 Transcutaneous carboxyhb88741 290 Transcutaneous methb89049 219 Chct for mal hyperthermia89050 282 Body fluid cell count89051 290 Body fluid cell count89055 290 Leukocyte count, fecal89060 282 Exam synovial fluid crystals89060 26 195 Exam synovial fluid crystals89125 290 Specimen fat stain89160 290 Exam feces for meat fibers89190 290 Nasal smear for eosinophils89220 219 Sputum specimen collection89230 219 Collect sweat for test89240 219 Pathology lab procedure89257 282 Sperm identification89260 290 Sperm isolation, simple89261 290 Sperm isolation, complex89264 290 Identify sperm tissue89300 290 Semen analysis89300 QW 290 Semen analysis89310 290 Semen analysis89320 290 Semen analysis89321 282 Semen analysis89321 QW 282 Semen analysis89322 290 Semen analysis, strict criteria


CPT/HCPCS MOD MOD LEV DESCRIPTION89325 290 Sperm antibody test89330 290 Evaluation, cervical mucus89331 290 Retrograde ejeculation analysis89337 290 Cryopreservation oocyte(s)90281 290 Human ig, im90283 290 Human ig, iv90284 290 Human ig, sc90287 290 Botulinum antitoxin90288 290 Botulism ig, iv90291 290 Cmv ig, iv90296 290 Diphtheria antitoxin90371 290 Hep b ig, im, 1ml90375 290 Rabies ig, im/sc, 150IU90376 290 Rabies ig, heat treated, 150IU90378 290 Rsv ig, im, 50mg90384 290 Rh ig, full-dose, im90385 282 Rh ig, minidose, im, 50mcg90386 290 Rh ig, iv90389 290 Tetanus ig, im90393 290 Vaccina ig, im90396 290 Varicella-zoster ig, im, 125 units90399 290 Immune globulin, unlisted90460 269 Im admin 1st/only component90471 269 Immunization admin90472 286 Immunization admin, each add90473 269 Immune admin oral/nasal90474 286 Immune admin oral/nasal addl90476 290 Adenovirus vaccine, type 490477 290 Adenovirus vaccine, type 790581 290 Anthrax vaccine, sc90585 290 Bcg vaccine, percut, 50mg90586 290 Bcg vaccine, intravesical, 1ea90632 290 Hep a vaccine, adult im, 1ml90636 290 Hep a/hep b vacc, adult im90645 290 Hib vaccine, hboc, im, 1ea90646 290 Hib vaccine, prp-d, im90647 290 Hib vaccine, prp-omp, im, 0.5ml90648 290 Hib vaccine, prp-t, im,0.5ml90653 271 Flu vaccine adjuvant im 90654 290 Flu vaccine no preserv id90656 290 Flu vaccine no preserv 3 & >, 0.5ml90658 290 Flu vaccine, >3 yrs, im, 0.50ml90660 290 Flu vaccine, nasal90661 290 Flu vaccine, cell culture, prsv free, im90662 290 Flu vaccine, prsv free, inc antig, im90665 290 Lyme disease vaccine, im90670 290 Pneumo conj vacc, 13 val, im90672 271 Flu vaccine 4 valent nasal 90673 290 Flu vacc riv3 no preserv 90675 290 Rabies vaccine, im, 1ml90676 290 Rabies vaccine, id90680 290 Rotovirus vaccine, 3dose oral90681 290 Rotovirus vaccine, 2dose oral90686 290 Flu vac no prsv 4 val 3 yrs+ 90688 290 Flu vacc 4 val 3 yrs plus im 90690 290 Typhoid vaccine, oral90691 290 Typhoid vaccine, im, 0.5ml90692 290 Typhoid vaccine, h-p, sc/id90693 290 Typhoid vaccine, akd, sc90698 290 Dtap-hib-ip vaccine, im90701 290 Dtp vaccine, im90703 290 Tetanus vaccine, im, 0.5ml90704 290 Mumps vaccine, sc, 0.5ml90705 290 Measles vaccine, sc, 0.5ml90706 290 Rubella vaccine, sc, 0.5ml90707 290 Mmr vaccine, sc, 0.5ml


CPT/HCPCS MOD MOD LEV DESCRIPTION90708 290 Measles-rubella vaccine, sc90710 290 Mmrv vaccine, sc90712 290 Oral poliovirus vaccine90713 290 Poliovirus, ipv, sc/im, 0.5ml90714 290 Td vaccine no prsrv > 7, im90715 290 Tdap vaccine >7 im90716 290 Chicken pox vaccine, sc, 0.5ml90717 290 Yellow fever vaccine, sc, 0.5ml90718 290 Td vaccine > 7, im, 0.5ml90719 290 Diphtheria vaccine, im90720 290 Dtp/hib vaccine, im, 0.5ml90721 290 Dtap/hib vaccine, im, 1ea90723 290 Dtap-hep b-ipv vaccine, im90725 290 Cholera vaccine, injectable90727 290 Plague vaccine, im90732 290 Pneumococcal vacc 23 val im 90733 290 Meningococcal vaccine, sc, 0.5ml90734 290 Meningococcal vaccine, im90735 290 Encephalitis vaccine, sc, 1ml90736 290 Zoster vaccine, sc90738 290 Inactivated je vacc im90739 271 Hep B vacc adult 2 dose IM 90740 290 Hep b vacc, ill pat 3 dose im, 40mcg90746 290 Hep b vaccine, adult, im, 1ea90747 290 Hep b vacc, ill pat 4 dose im, 40mcg90748 290 Hep b/hib vaccine, im90749 290 Vaccine toxoid90785 271 Psytx complex interactive 90791 271 Psych diagnostic evaluation 90792 271 Psych diag eval w/med srvcs 90832 271 Psytx pt&/family 30 minutes 90833 271 Psytx pt&/fam w/E&M 30 min 90834 271 Psytx pt&/family 45 minutes 90836 271 Psytx pt&/fam w/E&M 45 min 90837 271 Psytx pt&/family 60 minutes 90838 271 Psytx pt&/fam w/E&M 60 min 90839 271 Psytx crisis initial 60 min 90840 271 Psytx crisis ea addl 30 min 90845 279 Psychoanalysis90846 279 Family psytx w/o patient90847 279 Family psytx w/patient90849 279 Multiple family group psytx90853 279 Group psychotherapy90863 271 Pharmacologic mgmt w/psytx 90865 282 Narcosynthesis90867 271 Tcranial magn stim tx plan90868 271 Tcranial magn stim tx deli90869 271 Tcran magn stim redetemine 90870 271 Electroconvulsive therapy90875 290 Psychophysiological therapy90876 290 Psychophysiological therapy90880 282 Hypnotherapy90882 286 Environmental manipulation90885 290 Psy evaluation of records90887 286 Consultation with family90889 290 Preparation of report, psych, ins90899 290 Psychiatric service/therapy, unlisted90901 271 Biofeedback train, any meth90911 272 Biofeedback peri/uro/rectal90935 114 Hemodialysis, one evaluation90937 114 Hemodialysis, repeated eval90940 282 Hemodialysis access study90945 114 Dialysis, one evaluation90947 114 Dialysis repeated eval 90957 219 Esrd srv, 4 visits p mo, 12-1990958 219 Esrd srv, 2-3 vsts p mo, 12-19


CPT/HCPCS MOD MOD LEV DESCRIPTION90959 219 Esrd serv, 1 visit p mo, 12-1990960 219 Esrd srv, 4 visits p mo, 20+90961 219 Esrd srv, 2-3 vsts p mo, 20+90962 219 Esrd serv, 1 visit p mo, 20+90965 219 Esrd home pt, serv p mo, 12-1990966 219 Esrd home pt, serv p mo, 20+90969 219 Esrd home pt serv p day, 12-1990970 219 Esrd home pt serv p day, 20+90989 290 Dialysis training, complete90993 290 Dialysis training, incomplete90997 114 Hemoperfusion90999 219 Dialysis procedure, unlisted91010 138 Esophagus motility study91010 TC 139 Esophagus motility study91010 26 138 Esophagus motility study91013 138 Esophgl motil w/stim/perfus91013 TC 139 Esophgl motil w/stim/perfus91013 26 138 Esophgl motil w/stim/perfus91020 138 Gastric motility91020 TC 139 Gastric motility91020 26 138 Gastric motility91022 138 Duodenal motility study91022 TC 139 Duodenal motility study91022 26 138 Duodenal motility study91030 138 Acid perfusion of esophagus91030 TC 139 Acid perfusion of esophagus91030 26 138 Acid perfusion of esophagus91034 138 Gastroesophageal reflux test91034 TC 139 Gastroesophageal reflux test91034 26 138 Gastroesophageal reflux test91035 138 G-esoph reflx tst w/electrod91035 TC 139 G-esoph reflx tst w/electrod91035 26 138 G-esoph reflx tst w/electrod91037 138 Esoph imped function test91037 TC 139 Esoph imped function test91037 26 138 Esoph imped function test91038 138 Esoph imped funct test > 1h91038 TC 139 Esoph imped funct test > 1h91038 26 138 Esoph imped funct test > 1h91040 138 Esoph balloon distension tst91040 TC 139 Esoph balloon distension tst91040 26 138 Esoph balloon distension tst91065 138 Breath hydrogen/methane test 91065 TC 139 Breath hydrogen/methane test 91065 26 138 Breath hydrogen/methane test 91110 168 Gi tract capsule endoscopy91110 TC 170 Gi tract capsule endoscopy91110 26 168 Gi tract capsule endoscopy91111 168 Esophageal capsule endoscopy91111 TC 170 Esophageal capsule endoscopy91111 26 168 Esophageal capsule endoscopy91117 114 Colon motility 6 hr study91120 168 Rectal sensation test91120 TC 170 Rectal sensation test91120 26 168 Rectal sensation test91122 114 Anal pressure record91122 TC 115 Anal pressure record91122 26 114 Anal pressure record91132 151 Electrogastrography91132 TC 153 Electrogastrography91132 26 151 Electrogastrography91133 168 Electrogastrography w/test91133 TC 170 Electrogastrography w/test91133 26 168 Electrogastrography w/test91200 219 HPV vaccine non valent im91200 TC 219 HPV vaccine non valent im


CPT/HCPCS MOD MOD LEV DESCRIPTION91200 26 219 HPV vaccine non valent im91299 219 Gastroenterology procedure, unlisted91299 TC 219 Gastroenterology procedure, unlisted91299 26 219 Gastroenterology procedure, unlisted92002 78 Eye exam, new patient92004 78 Eye exam, new patient92012 78 Eye exam established pat92014 78 Eye exam & treatment92015 290 Refraction92018 195 New eye exam & treatment92019 195 Eye exam & treatment92020 194 Special eye evaluation92025 151 Corneal topography92025 TC 153 Corneal topography92025 26 151 Corneal topography92060 167 Special eye evaluation92060 TC 169 Special eye evaluation92060 26 167 Special eye evaluation92065 167 Orthoptic/pleoptic training92065 TC 169 Orthoptic/pleoptic training92065 26 167 Orthoptic/pleoptic training92071 195 Contact lens fitting for tx 92072 195 Fit contac lens for managmnt 92081 167 Visual field examination(s)92081 TC 169 Visual field examination(s)92081 26 167 Visual field examination(s)92082 167 Visual field examination(s)92082 TC 169 Visual field examination(s)92082 26 167 Visual field examination(s)92083 167 Visual field examination(s)92083 TC 169 Visual field examination(s)92083 26 167 Visual field examination(s)92100 194 Serial tonometry exam(s)92132 172 Cmptr ophth dx img ant segmt92132 TC 173 Cmptr ophth dx img ant segmt92132 26 172 Cmptr ophth dx img ant segmt92133 172 Cmptr ophth img optic nerve92133 TC 173 Cmptr ophth img optic nerve92133 26 172 Cmptr ophth img optic nerve92134 172 Cptr ophth dx img post segmt92134 TC 173 Cptr ophth dx img post segmt92134 26 172 Cptr ophth dx img post segmt92136 167 Ophthalmic biometry92136 TC 169 Ophthalmic biometry92136 26 172 Ophthalmic biometry92140 194 Glaucoma provocative tests92145 194 Liver elastography92145 TC 194 Liver elastography92145 26 194 Liver elastography92225 220 Special eye exam, initial92226 220 Special eye exam, subsequent92227 150 Remote dx retinal imaging92228 150 Remote retinal imaging mgmt92228 TC 152 Remote retinal imaging mgmt92228 26 150 Remote retinal imaging mgmt92230 197 Eye exam with photos92235 172 Eye exam with photos92235 TC 173 Eye exam with photos92235 26 172 Eye exam with photos92240 172 Icg angiography92240 TC 173 Icg angiography92240 26 172 Icg angiography92250 150 Eye exam with photos92250 TC 152 Eye exam with photos92250 26 150 Eye exam with photos92260 194 Ophthalmoscopy/dynamometry


CPT/HCPCS MOD MOD LEV DESCRIPTION92265 150 Eye muscle evaluation92265 TC 152 Eye muscle evaluation92265 26 150 Eye muscle evaluation92270 150 Electro-oculography92270 TC 152 Electro-oculography92270 26 150 Electro-oculography92275 167 Electroretinography92275 TC 169 Electroretinography92275 26 167 Electroretinography92283 167 Color vision examination92283 TC 169 Color vision examination92283 26 167 Color vision examination92284 167 Dark adaptation eye exam92284 TC 169 Dark adaptation eye exam92284 26 167 Dark adaptation eye exam92285 167 Eye photography92285 TC 169 Eye photography92285 26 167 Eye photography92286 167 Internal eye photography92286 TC 169 Internal eye photography92286 26 167 Internal eye photography92287 167 Internal eye photography92310 290 Contact lens fitting92311 219 Contact lens fitting92312 218 Contact lens fitting92313 219 Contact lens fitting92314 290 Prescription of contact lens92315 219 Prescription of contact lens92316 218 Prescription of contact lens92317 219 Prescription of contact lens92325 195 Modification of contact lens92326 219 Replacement of contact lens92340 290 Fitting of spectacles92341 290 Fitting of spectacles92342 290 Fitting of spectacles92352 290 Special spectacles fitting92353 290 Special spectacles fitting92354 290 Special spectacles fitting92355 290 Special spectacles fitting92358 290 Eye prosthesis service92370 290 Repair & adjust spectacles92371 290 Repair & adjust spectacles92499 219 Eye service or procedure, unlisted92499 TC 219 Eye service or procedure, unlisted92499 26 219 Eye service or procedure, unlisted92502 114 Ear and throat examination92504 195 Ear microscopy examination92506 195 Speech/hearing evaluation end-dated 12/31/201392507 195 Speech/hearing therapy92508 195 Speech/hearing therapy92511 114 Nasopharyngoscopy92512 195 Nasal function studies92516 195 Facial nerve function test92520 195 Laryngeal function studies92521 195 Evaluation of speech fluency 92522 195 Evaluate speech production 92523 195 Speech sound lang comprehen 92524 195 Behavral qualit analys voice 92526 195 Oral function therapy92540 151 Basic vestibular evaluation92540 TC 153 Basic vestibular evaluation92540 26 151 Basic vestibular evaluation92541 151 Spontaneous nystagmus test92541 TC 153 Spontaneous nystagmus test92541 26 151 Spontaneous nystagmus test92542 151 Positional nystagmus test


CPT/HCPCS MOD MOD LEV DESCRIPTION92542 TC 153 Positional nystagmus test92542 26 151 Positional nystagmus test92543 151 Caloric vestibular test92543 TC 153 Caloric vestibular test92543 26 151 Caloric vestibular test92544 151 Optokinetic nystagmus test92544 TC 153 Optokinetic nystagmus test92544 26 151 Optokinetic nystagmus test92545 151 Oscillating tracking test92545 TC 153 Oscillating tracking test92545 26 151 Oscillating tracking test92546 151 Sinusoidal rotational test92546 TC 153 Sinusoidal rotational test92546 26 151 Sinusoidal rotational test92547 249 Use of vertical electrodes92548 168 Posturography92548 TC 170 Posturography92548 26 168 Posturography92550 194 Tympanometry & refles thresh92551 286 Pure tone hearing test, air92552 189 Pure tone audiometry, air92553 194 Audiometry, air & bone92555 194 Speech threshold audiometry92556 194 Speech audiometry, complete92557 194 Comprehensive hearing test92558 150 Evoked auditory test qual 92561 194 Bekesy audiometry, diagnosis92562 194 Loudness balance test92563 194 Tone decay hearing test92564 194 Sisi hearing test92565 194 Stenger test, pure tone92567 194 Tympanometry92568 194 Acoustic reflex testing92570 194 Acoustic immittance testing92571 194 Filtered speech hearing test92572 194 Staggered spondaic word test92575 194 Sensorineural acuity test92576 194 Synthetic sentence test92577 194 Stenger test, speech92579 194 Visual audiometry (vra)92582 194 Conditioning play audiometry92583 194 Select picture audiometry92584 194 Electrocochleography92585 150 Auditor evoke potent, compre92585 TC 152 Auditor evoke potent, compre92585 26 150 Auditor evoke potent, compre92586 194 Auditor evoke potent, limit92587 150 Evoked auditory test limited92587 TC 152 Evoked auditory test limited92587 26 150 Evoked auditory test limited92588 150 Evoked auditory tst complete92588 TC 152 Evoked auditory tst complete92588 26 150 Evoked auditory tst complete92590 290 Hearing aid exam, one ear92591 290 Hearing aid exam, both ears92592 290 Hearing aid check, one ear92593 290 Hearing aid check, both ears92594 290 Electro hearng aid test, one92595 290 Electro hearng aid tst, both92596 194 Ear protector evaluation92597 219 Oral speech device eval92603 219 Cochlear implant f/up exam, >7yr92604 195 Reprogram cochlear implant 7 >92607 219 Ex for speech device rx, 1hr92608 249 Ex for speech device rx addl92609 195 Use of speech device service


CPT/HCPCS MOD MOD LEV DESCRIPTION92610 195 Evaluate swallowing function92611 195 Motion fluoroscopy/swallow92612 219 Endoscopy swallow tst (fees)92613 219 Endoscopy swallow tst (fees)92614 219 Laryngoscopic sensory test92615 219 Eval laryngoscopy sense tst92616 219 Fees w/laryngeal sense test92617 219 Interprt fees/laryngeal test92618 249 Ex for nonspeech dev rx add 92620 194 Auditory function, 60 min92621 232 Auditory function, + 15 min92625 218 Tinnitus assessment92626 194 Eval aud rehab status92627 249 Eval aud status rehab add-on92630 290 Aud rehab pre-ling hear loss92633 290 Aud rehab postling hear loss92640 218 Aud brainstem implant programg92700 219 Ent procedure/service92920 113 Prq cardiac angioplast 1 art 92921 232 Prq cardiac angio addl art 92924 113 Prq card angio/athrect 1 art 92925 232 Prq card angio/athrect addl 92928 137 Prq card stent w/angio 1 vsl 92929 232 Prq card stent w/angio addl 92933 137 Prq card stent/ath/angio 92934 232 Prq card stent/ath/angio 92937 137 Prq revasc byp graft 1 vsl 92938 232 Prq revasc byp graft addl 92941 113 Prq card revasc mi 1 vsl 92943 113 Prq card revasc chronic 1vsl 92944 232 Prq card revasc chronic addl 92950 190 Heart/lung resuscitation cpr92953 114 Temporary external pacing92960 114 Cardioversion electric, ext92961 271 Cardioversion, electric, int92970 114 Cardioassist, internal92971 114 Cardioassist, external92973 249 Percut coronary thrombectomy92974 249 Cath place, cardio brachytx92975 113 Dissolve clot, heart vessel92977 219 Dissolve clot, heart vessel92978 249 Intravasc us, heart add-on92978 TC 249 Intravasc us, heart add-on92978 26 249 Intravasc us, heart add-on92979 249 Intravasc us, heart add-on92979 TC 249 Intravasc us, heart add-on92979 26 249 Intravasc us, heart add-on92986 30 Revision of aortic valve92987 30 Revision of mitral valve92990 61 Revision of pulmonary valve92992 61 Revision of heart chamber92993 61 Revision of heart chamber92997 137 Pul art balloon repr, percut92998 249 Pul art balloon repr, percut93000 195 Electrocardiogram, complete93005 190 Electrocardiogram, tracing93010 195 Electrocardiogram report93015 195 Cardiovascular stress test93016 195 Cardiovascular stress test93017 195 Cardiovascular stress test93018 195 Cardiovascular stress test93024 168 Cardiac drug stress test93024 TC 170 Cardiac drug stress test93024 26 168 Cardiac drug stress test93025 168 Microvolt t-wave assess93025 TC 170 Microvolt t-wave assess


CPT/HCPCS MOD MOD LEV DESCRIPTION93025 26 168 Microvolt t-wave assess93040 195 Rhythm ECG with report93041 195 Rhythm ECG, tracing93042 195 Rhythm ECG, report93224 195 ECG monitor/report, 24 hrs93225 195 ECG monitor/record, 24 hrs93226 195 ECG monitor/report, 24 hrs93227 195 ECG monitor/review, 24 hrs93228 195 Remote 30 day ecg rev/report93229 195 Remote 30 day ecg tech supp93260 195 Corneal hysteresis deter93260 TC 153 Corneal hysteresis deter93260 26 151 Corneal hysteresis deter93261 195 Prgmg dev eval impltbl sys93261 TC 153 Prgmg dev eval impltbl sys93261 26 151 Prgmg dev eval impltbl sys93268 195 ECG record/review93270 195 ECG recording93271 195 Ecg/monitoring and analysis93272 195 Ecg/review, interpret only93278 151 ECG/signal-averaged93278 TC 153 ECG/signal-averaged93278 26 151 ECG/signal-averaged93279 151 Pm device progr eval, sngl93279 TC 153 Pm device progr eval, sngl93279 26 151 Pm device progr eval, sngl93280 151 Pm device progr eval, dual93280 TC 153 Pm device progr eval, dual93280 26 151 Pm device progr eval, dual93281 151 Pm device progr eval, multi93281 TC 153 Pm device progr eval, multi93281 26 151 Pm device progr eval, multi93282 151 Icd device prog eval, 1 sngl93282 TC 153 Icd device prog eval, 1 sngl93282 26 151 Icd device prog eval, 1 sngl93283 151 Icd device progr eval, dual93283 TC 153 Icd device progr eval, dual93283 26 151 Icd device progr eval, dual93284 151 Icd device progr eval, mult93284 TC 153 Icd device progr eval, mult93284 26 151 Icd device progr eval, mult93285 151 Ilr device eval progr93285 TC 153 Ilr device eval progr93285 26 151 Ilr device eval progr93286 151 Pre-op pm device eval93286 TC 153 Pre-op pm device eval93286 26 151 Pre-op pm device eval93287 151 Pre-op icd device eval93287 TC 153 Pre-op icd device eval93287 26 151 Pre-op icd device eval93288 151 Pm device eval in person93288 TC 153 Pm device eval in person93288 26 151 Pm device eval in person93289 151 Icd device interrogate93289 TC 153 Icd device interrogate93289 26 151 Icd device interrogate93290 151 Icm device eval93290 TC 153 Icm device eval93290 26 151 Icm device eval93291 151 Ilr device interrogate93291 TC 153 Ilr device interrogate93291 26 151 Ilr device interrogate93292 151 Wcd device interrogate93292 TC 153 Wcd device interrogate93292 26 151 Wcd device interrogate93293 151 Pm phone r-strip device eval


CPT/HCPCS MOD MOD LEV DESCRIPTION93293 TC 153 Pm phone r-strip device eval93293 26 151 Pm phone r-strip device eval93294 195 Pm device interrogate remote93295 195 Icd device interrogat remote93296 195 Pm/icd remote tech serv93297 195 Icm device interrogat remote93298 195 Ilr device interrogat remote93299 195 Icm/ilr remote tech serv93303 151 Echo transthoracic93303 TC 153 Echo transthoracic93303 26 151 Echo transthoracic93304 151 Echo transthoracic93304 TC 153 Echo transthoracic93304 26 151 Echo transthoracic93306 151 Tte w/doppler, complete93306 TC 153 Tte w/doppler, complete93306 26 151 Tte w/doppler, complete93307 151 Echo exam of heart93307 TC 153 Echo exam of heart93307 26 151 Echo exam of heart93308 151 Echo exam of heart93308 TC 153 Echo exam of heart93308 26 151 Echo exam of heart93312 151 Echo transesophageal93312 TC 153 Echo transesophageal93312 26 151 Echo transesophageal93313 195 Echo transesophageal93314 151 Echo transesophageal93314 TC 153 Echo transesophageal93314 26 151 Echo transesophageal93315 151 Echo transesophageal93315 TC 153 Echo transesophageal93315 26 151 Echo transesophageal93316 195 Echo transesophageal93317 151 Echo transesophageal93317 TC 153 Echo transesophageal93317 26 151 Echo transesophageal93318 151 Echo transesophageal intraop93318 TC 153 Echo transesophageal intraop93318 26 151 Echo transesophageal intraop93320 232 Doppler echo exam, heart93320 TC 232 Doppler echo exam, heart93320 26 232 Doppler echo exam, heart93321 232 Doppler echo exam, heart93321 TC 232 Doppler echo exam, heart93321 26 232 Doppler echo exam, heart93325 232 Doppler color flow add-on93325 TC 232 Doppler color flow add-on93325 26 232 Doppler color flow add-on93350 168 Echo transthoracic93350 TC 170 Echo transthoracic93350 26 168 Echo transthoracic93351 195 Stress tte complete93351 TC 195 Stress tte complete93351 26 195 Stress tte complete93352 249 Admin ecg contrast agent93355 249 Interrogate subq defib93451 268 Right heart cath 93451 TC 268 Right heart cath 93451 26 268 Right heart cath 93452 268 Left hrt caht w/ventrclgrphy 93452 TC 268 Left hrt caht w/ventrclgrphy 93452 26 268 Left hrt caht w/ventrclgrphy 93453 268 R&l hrt cath w/ventriclgrphy 93453 TC 268 R&l hrt cath w/ventriclgrphy 93453 26 268 R&l hrt cath w/ventriclgrphy


CPT/HCPCS MOD MOD LEV DESCRIPTION93454 268 Coronary artery angio S&I 93454 TC 268 Coronary artery angio S&I 93454 26 268 Coronary artery angio S&I 93455 268 Coronary art/grft anion S&L 93455 TC 268 Coronary art/grft anion S&L 93455 26 268 Coronary art/grft anion S&L 93456 268 R hrt coronary arthery angio 93456 TC 268 R hrt coronary arthery angio 93456 26 268 R hrt coronary arthery angio 93457 268 R hrt art/grft angio 93457 TC 268 R hrt art/grft angio 93457 26 268 R hrt art/grft angio 93458 268 L hrt artery/ventricle angio 93458 TC 268 L hrt artery/ventricle angio 93458 26 268 L hrt artery/ventricle angio 93459 268 L hrt art/grft angio 93459 TC 268 L hrt art/grft angio 93459 26 268 L hrt art/grft angio 93460 268 R&L hrt art/ventricle angio 93460 TC 268 R&L hrt art/ventricle angio93460 26 268 R&L hrt art/ventricle angio93461 268 R&L hrt art/ventricle angio 93461 TC 268 R&L hrt art/ventricle angio93461 26 268 R&L hrt art/ventricle angio93462 150 L hrt cath trnsptl puncture 93463 150 Drug admin & hemodynmic meas 93464 268 Exercise w/hemodynamic meas 93464 TC 268 Exercise w/hemodynamic meas 93464 26 268 Exercise w/hemodynamic meas 93503 114 Insert/place heart catheter93505 113 Biopsy of heart lining93505 TC 115 Biopsy of heart lining93505 26 113 Biopsy of heart lining93530 113 Rt heart cath, congenital93530 TC 115 Rt heart cath, congenital93530 26 113 Rt heart cath, congenital93531 113 R & l heart cath, congenital93531 TC 115 R & l heart cath, congenital93531 26 113 R & l heart cath, congenital93532 113 R & l heart cath, congenital93532 TC 115 R & l heart cath, congenital93532 26 113 R & l heart cath, congenital93533 113 R & l heart cath, congenital93533 TC 115 R & l heart cath, congenital93533 26 113 R & l heart cath, congenital93561 114 Cardiac output measurement93561 TC 115 Cardiac output measurement93561 26 114 Cardiac output measurement93562 114 Card output measure subsq93562 TC 115 Card output measure subsq93562 26 114 Card output measure subsq93563 160 Inject congenital card cath 93564 160 Inject hrt congntl art/grft 93565 160 Inject L ventr/atrial angio 93566 160 Inject R ventr/atrial angio 93567 160 Inject suprvlv aortography 93568 160 Inject pulm art hrt cath 93571 249 Heart flow reserve measure93571 TC 249 Heart flow reserve measure93571 26 249 Heart flow reserve measure93572 249 Heart flow reserve measure93572 TC 249 Heart flow reserve measure93572 26 249 Heart flow reserve measure93580 113 Transcath closure of asd93581 113 Transcath closure of vsd93582 113 Perq transcath closure pda


CPT/HCPCS MOD MOD LEV DESCRIPTION93583 113 Perq transcath septal reduxn 93600 114 Bundle of His recording93600 TC 115 Bundle of His recording93600 26 114 Bundle of His recording93602 114 Intra-atrial recording93602 TC 115 Intra-atrial recording93602 26 114 Intra-atrial recording93603 114 Right ventricular recording93603 TC 115 Right ventricular recording93603 26 114 Right ventricular recording93609 249 Map tachycardia, add-on93609 TC 249 Map tachycardia, add-on93609 26 249 Map tachycardia, add-on93610 114 Intra-atrial pacing93610 TC 115 Intra-atrial pacing93610 26 114 Intra-atrial pacing93612 114 Intraventricular pacing93612 TC 115 Intraventricular pacing93612 26 114 Intraventricular pacing93613 249 Electrophys map, 3d, add-on93615 138 Esophageal recording93615 TC 139 Esophageal recording93615 26 138 Esophageal recording93616 138 Esophageal recording93616 TC 139 Esophageal recording93616 26 138 Esophageal recording93618 114 Heart rhythm pacing93618 TC 115 Heart rhythm pacing93618 26 114 Heart rhythm pacing93619 137 Electrophysiology evaluation93619 TC 139 Electrophysiology evaluation93619 26 137 Electrophysiology evaluation93620 137 Electrophysiology evaluation93620 TC 139 Electrophysiology evaluation93620 26 137 Electrophysiology evaluation93621 249 Electrophysiology evaluation93621 TC 249 Electrophysiology evaluation93621 26 249 Electrophysiology evaluation93622 249 Electrophysiology evaluation93622 TC 249 Electrophysiology evaluation93622 26 249 Electrophysiology evaluation93623 249 Stimulation, pacing heart93623 TC 249 Stimulation, pacing heart93623 26 249 Stimulation, pacing heart93624 113 Electrophysiologic study93624 TC 115 Electrophysiologic study93624 26 113 Electrophysiologic study93631 138 Heart pacing, mapping93631 TC 139 Heart pacing, mapping93631 26 138 Heart pacing, mapping93640 137 Evaluation heart device93640 TC 139 Evaluation heart device93640 26 137 Evaluation heart device93641 137 Electrophysiology evaluation93641 TC 139 Electrophysiology evaluation93641 26 137 Electrophysiology evaluation93642 137 Electrophysiology evaluation93642 TC 139 Electrophysiology evaluation93642 26 137 Electrophysiology evaluation93644 137 Echo transesophageal (tee)93644 TC 139 Echo transesophageal (tee)93644 26 137 Echo transesophageal (tee)93650 137 Ablate heart dysrhythm focus93653 137 Ep & ablate supravent arrhyt 93654 137 Ep & ab;ate vemtroc tachy 93655 137 Ablate arrhythmia add on


CPT/HCPCS MOD MOD LEV DESCRIPTION93656 137 Tx atrial fib pulm vein isol 93657 137 Tx l/r atrial fib addl 93660 137 Tilt table evaluation93660 TC 139 Tilt table evaluation93660 26 137 Tilt table evaluation93662 232 Intracardiac ecg (ice)93662 TC 232 Intracardiac ecg (ice)93662 26 232 Intracardiac ecg (ice)93668 290 Peripheral vascular rehab, per session93701 168 Bioimpedance, thoracic93702 168 Electrophysiology evaluation93724 138 Analyze pacemaker system93724 TC 139 Analyze pacemaker system93724 26 138 Analyze pacemaker system93740 277 Temperature gradient studies93745 151 Set-up cardiovert-defibrill93745 TC 153 Set-up cardiovert-defibrill93745 26 151 Set-up cardiovert-defibrill93750 195 Interrogation vad, in person93770 277 Measure venous pressure93784 219 Ambulatory BP monitoring93786 219 Ambulatory BP recording93788 219 Ambulatory BP analysis93790 219 Review/report BP recording93797 114 Cardiac rehab93798 138 Cardiac rehab/monitor93799 219 Cardiovascular procedure, unlisted93799 TC 219 Cardiovascular procedure, unlisted93799 26 219 Cardiovascular procedure, unlisted93880 167 Extracranial study93880 TC 169 Extracranial study93880 26 167 Extracranial study93882 168 Extracranial study93882 TC 170 Extracranial study93882 26 168 Extracranial study93886 168 Intracranial study93886 TC 170 Intracranial study93886 26 168 Intracranial study93888 151 Intracranial study93888 TC 153 Intracranial study93888 26 151 Intracranial study93890 168 Tcd, vasoreactivity study93890 TC 170 Tcd, vasoreactivity study93890 26 168 Tcd, vasoreactivity study93892 151 Tcd, emboli detect w/o inj93892 TC 153 Tcd, emboli detect w/o inj93892 26 151 Tcd, emboli detect w/o inj93893 168 Tcd, emboli detect w/inj93893 TC 170 Tcd, emboli detect w/inj93893 26 168 Tcd, emboli detect w/inj93895 168 Bis xtracell fluid analysis93895 TC 170 Bis xtracell fluid analysis93895 26 168 Bis xtracell fluid analysis93922 150 Extremity study93922 TC 152 Extremity study93922 26 150 Extremity study93923 150 Extremity study93923 TC 152 Extremity study93923 26 150 Extremity study93924 150 Extremity study93924 TC 152 Extremity study93924 26 150 Extremity study93925 150 Lower extremity study93925 TC 152 Lower extremity study93925 26 150 Lower extremity study93926 151 Lower extremity study


CPT/HCPCS MOD MOD LEV DESCRIPTION93926 TC 153 Lower extremity study93926 26 151 Lower extremity study93930 150 Upper extremity study93930 TC 152 Upper extremity study93930 26 150 Upper extremity study93931 151 Upper extremity study93931 TC 153 Upper extremity study93931 26 151 Upper extremity study93965 150 Extremity study93965 TC 152 Extremity study93965 26 150 Extremity study93970 150 Extremity study93970 TC 152 Extremity study93970 26 150 Extremity study93971 151 Extremity study93971 TC 153 Extremity study93971 26 151 Extremity study93975 151 Vascular study93975 TC 153 Vascular study93975 26 151 Vascular study93976 151 Vascular study93976 TC 153 Vascular study93976 26 151 Vascular study93978 151 Vascular study93978 TC 153 Vascular study93978 26 151 Vascular study93979 151 Vascular study93979 TC 153 Vascular study93979 26 151 Vascular study93980 151 Penile vascular study93980 TC 153 Penile vascular study93980 26 151 Penile vascular study93981 151 Penile vascular study93981 TC 153 Penile vascular study93981 26 151 Penile vascular study93982 195 Aneurysm pressure sens study93990 151 Doppler flow testing93990 TC 153 Doppler flow testing93990 26 151 Doppler flow testing93998 195 Noninvas vasc dx study proc 94002 195 Vent mgmt inpat, init day94003 195 Vent mgmt inpat, subq day94004 195 Vent mgmt nf per day94005 290 Home vent mgmt supervision94010 151 Breathing capacity test94010 TC 153 Breathing capacity test94010 26 151 Breathing capacity test94014 219 Patient recorded spirometry94015 195 Patient recorded spirometry94016 195 Review patient spirometry94060 151 Evaluation of wheezing94060 TC 153 Evaluation of wheezing94060 26 151 Evaluation of wheezing94070 168 Evaluation of wheezing94070 TC 170 Evaluation of wheezing94070 26 168 Evaluation of wheezing94150 277 Vital capacity test94150 TC 278 Vital capacity test94150 26 277 Vital capacity test94200 151 Lung function test (MBC/MVV)94200 TC 153 Lung function test (MBC/MVV)94200 26 151 Lung function test (MBC/MVV)94250 151 Expired gas collection94250 TC 153 Expired gas collection94250 26 151 Expired gas collection94375 151 Respiratory flow volume loop


CPT/HCPCS MOD MOD LEV DESCRIPTION94375 TC 153 Respiratory flow volume loop94375 26 151 Respiratory flow volume loop94400 168 CO2 breathing response curve94400 TC 170 CO2 breathing response curve94400 26 168 CO2 breathing response curve94450 168 Hypoxia response curve94450 TC 170 Hypoxia response curve94450 26 168 Hypoxia response curve94452 151 Hast w/report94452 TC 153 Hast w/report94452 26 151 Hast w/report94453 168 Hast w/oxygen titrate94453 TC 170 Hast w/oxygen titrate94453 26 168 Hast w/oxygen titrate94610 195 Surfactant admin thru tube94620 151 Pulmonary stress test/simple94620 TC 153 Pulmonary stress test/simple94620 26 151 Pulmonary stress test/simple94621 168 Pulm stress test/complex94621 TC 170 Pulm stress test/complex94621 26 168 Pulm stress test/complex94640 195 Airway inhalation treatment94642 219 Aerosol inhalation treatment94644 190 Cbt, 1st hour94645 249 Cbt, each addl hour94660 195 Pos airway pressure, CPAP94662 195 Neg press ventilation, cnp94664 195 Aerosol or vapor inhalations94667 216 Chest wall manipulation94668 216 Chest wall manipulation94669 216 Mechanical chest wall oscill 94680 151 Exhaled air analysis, o294680 TC 153 Exhaled air analysis, o294680 26 151 Exhaled air analysis, o294681 151 Exhaled air analysis, o2/co294681 TC 153 Exhaled air analysis, o2/co294681 26 151 Exhaled air analysis, o2/co294690 151 Exhaled air analysis94690 TC 153 Exhaled air analysis94690 26 151 Exhaled air analysis94726 151 Pulm funct tst plethysmograp 94726 TC 153 Pulm funct tst plethysmograp 94726 26 151 Pulm funct tst plethysmograp 94727 151 Pulm function test by gas 94727 TC 153 Pulm function test by gas 94727 26 151 Pulm function test by gas 94728 151 Pulm funct test oscillometry 94728 TC 153 Pulm funct test oscillometry 94728 26 151 Pulm funct test oscillometry 94729 151 C02/membrane diffuse capacity 94729 TC 153 C02/membrane diffuse capacity 94729 26 151 C02/membrane diffuse capacity 94750 151 Pulmonary compliance study94750 TC 153 Pulmonary compliance study94750 26 151 Pulmonary compliance study94760 219 Measure blood oxygen level94761 219 Measure blood oxygen level94762 195 Measure blood oxygen level94770 151 Exhaled carbon dioxide test94799 219 Pulmonary service/procedure, unlisted94799 TC 219 Pulmonary service/procedure, unlisted94799 26 219 Pulmonary service/procedure, unlisted95004 216 Allergy skin tests95012 219 Exhaled nitric oxide meas95017 190 Perq & icut allg test venoms 95018 190 Perq&ic allg test drugs/biol


CPT/HCPCS MOD MOD LEV DESCRIPTION95024 190 Allergy skin tests95027 190 Skin end point titration95028 190 Allergy skin tests95044 216 Allergy patch tests95052 216 Photo patch test95056 216 Photosensitivity tests95060 190 Eye allergy tests95065 216 Nose allergy test95070 190 Bronchial allergy tests95071 216 Bronchial allergy tests95076 216 Ingest challenge ini 120 min 95079 216 Ingest challenge addl 60 min 95115 216 Immunotherapy, one injection95117 216 Immunotherapy injections95120 286 Immunotherapy, one injection95125 286 Immunotherapy, many antigens95130 286 Immunotherapy, insect venom95131 286 Immunotherapy, insect venoms95132 286 Immunotherapy, insect venoms95133 286 Immunotherapy, insect venoms95134 286 Immunotherapy, insect venoms95144 195 Antigen therapy services95145 195 Antigen therapy services95146 195 Antigen therapy services95147 195 Antigen therapy services95148 195 Antigen therapy services95149 219 Antigen therapy services95165 219 Antigen therapy services95170 219 Antigen therapy services95180 219 Rapid desensitization95199 219 Allergy immunology services, unlisted95250 219 Glucose monitoring, cont95251 219 Gluc monitor, cont, phys i&r95800 190 Slp stdy unattended95800 TC 190 Slp stdy unattended95800 26 190 Slp stdy unattended95801 190 Slp stdy unatnd w/anal95801 TC 190 Slp stdy unatnd w/anal95801 26 190 Slp stdy unatnd w/anal95803 168 Actigraphy testing95803 TC 170 Actigraphy testing95803 26 168 Actigraphy testing95805 145 Multiple sleep latency test95805 TC 146 Multiple sleep latency test95805 26 145 Multiple sleep latency test95806 190 Sleep study, unattended95806 TC 190 Sleep study, unattended95806 26 190 Sleep study, unattended95807 145 Sleep study, attended95807 TC 146 Sleep study, attended95807 26 145 Sleep study, attended95808 162 Polysomnography, 1-395808 TC 163 Polysomnography, 1-395808 26 162 Polysomnography, 1-395810 162 Polysomnography, 4 or more95810 TC 163 Polysomnography, 4 or more95810 26 162 Polysomnography, 4 or more95811 162 Polysomnography w/cpap95811 TC 163 Polysomnography w/cpap95811 26 162 Polysomnography w/cpap95812 145 Electroencephalogram (EEG)95812 TC 146 Electroencephalogram (EEG)95812 26 145 Electroencephalogram (EEG)95813 145 Electroencephalogram (EEG)95813 TC 146 Electroencephalogram (EEG)95813 26 145 Electroencephalogram (EEG)


CPT/HCPCS MOD MOD LEV DESCRIPTION95816 145 Electroencephalogram (EEG)95816 TC 146 Electroencephalogram (EEG)95816 26 145 Electroencephalogram (EEG)95819 145 Electroencephalogram (EEG)95819 TC 146 Electroencephalogram (EEG)95819 26 145 Electroencephalogram (EEG)95822 145 Sleep electroencephalogram95822 TC 146 Sleep electroencephalogram95822 26 145 Sleep electroencephalogram95824 151 Electroencephalography95824 TC 153 Electroencephalography95824 26 151 Electroencephalography95827 145 Night electroencephalogram95827 TC 146 Night electroencephalogram95827 26 145 Night electroencephalogram95829 151 Surgery electrocorticogram95829 TC 153 Surgery electrocorticogram95829 26 151 Surgery electrocorticogram95830 219 Insert electrodes for EEG95831 190 Limb muscle testing, manual95832 190 Hand muscle testing, manual95833 190 Body muscle testing, manual95834 190 Body muscle testing, manual95851 190 Range of motion measurements95852 190 Range of motion measurements95857 216 Tensilon test95860 151 Muscle test, one limb95860 TC 153 Muscle test, one limb95860 26 151 Muscle test, one limb95861 151 Muscle test, two limbs95861 TC 153 Muscle test, two limbs95861 26 151 Muscle test, two limbs95863 151 Muscle test, 3 limbs95863 TC 153 Muscle test, 3 limbs95863 26 151 Muscle test, 3 limbs95864 151 Muscle test, 4 limbs95864 TC 153 Muscle test, 4 limbs95864 26 151 Muscle test, 4 limbs95865 150 Muscle test, larynx95865 TC 152 Muscle test, larynx95865 26 150 Muscle test, larynx95866 154 Muscle test, hemidiaphragm95866 TC 155 Muscle test, hemidiaphragm95866 26 154 Muscle test, hemidiaphragm95867 151 Muscle test, head or neck95867 TC 153 Muscle test, head or neck95867 26 151 Muscle test, head or neck95868 150 Muscle test, head or neck95868 TC 152 Muscle test, head or neck95868 26 150 Muscle test, head or neck95869 151 Muscle test, thor paraspinal95869 TC 153 Muscle test, thor paraspinal95869 26 151 Muscle test, thor paraspinal95870 151 Muscle test, nonparaspinal95870 TC 153 Muscle test, nonparaspinal95870 26 151 Muscle test, nonparaspinal95872 151 Muscle test, one fiber95872 TC 153 Muscle test, one fiber95872 26 151 Muscle test, one fiber95873 232 Guide nerv destr, elec stim95873 TC 232 Guide nerv destr, elec stim95873 26 232 Guide nerv destr, elec stim95874 232 Guide nerv destr, needle emg95874 TC 232 Guide nerv destr, needle emg95874 26 232 Guide nerv destr, needle emg95875 151 Limb exercise test


CPT/HCPCS MOD MOD LEV DESCRIPTION95875 TC 153 Limb exercise test95875 26 151 Limb exercise test95885 151 Musc tst done w/nerv tst lim 95885 TC 153 Musc tst done w/nerv tst lim 95885 26 151 Musc tst done w/nerv tst lim 95886 151 Musc test done w/N test comp 95886 TC 153 Musc test done w/N test comp 95886 26 151 Musc test done w/N test comp 95887 151 Musc tst done w/N tst nonext 95887 TC 153 Musc tst done w/N tst nonext 95887 26 151 Musc tst done w/N tst nonext 95905 151 Motor/sens nrve conduct test95905 TC 153 Motor/sens nrve conduct test95905 26 151 Motor/sens nrve conduct test95907 154 Nvr cndj tst 1-2 studies 95907 TC 154 Nvr cndj tst 1-2 studies 95907 26 154 Nvr cndj tst 1-2 studies 95908 154 Nrv cndj tst 3-4 studies 95908 TC 154 Nrv cndj tst 3-4 studies 95908 26 154 Nrv cndj tst 3-4 studies 95909 154 Nrv cndj tst 5-6 studies 95909 TC 154 Nrv cndj tst 5-6 studies 95909 26 154 Nrv cndj tst 5-6 studies 95910 154 Nrv cndj test 7-8 studies 95910 TC 154 Nrv cndj test 7-8 studies 95910 26 154 Nrv cndj test 7-8 studies 95911 154 Nrv cndj test 9-10 studies 95911 TC 154 Nrv cndj test 9-10 studies 95911 26 154 Nrv cndj test 9-10 studies 95912 154 Nrv cndj test 11-12 studies 95912 TC 154 Nrv cndj test 11-12 studies 95912 26 154 Nrv cndj test 11-12 studies 95913 154 Nrv cndj test 13/> studies 95913 TC 154 Nrv cndj test 13/> studies 95913 26 154 Nrv cndj test 13/> studies 95921 168 Autonomic nerv function test95921 TC 170 Autonomic nerv function test95921 26 168 Autonomic nerv function test95922 151 Autonomic nerv function test95922 TC 153 Autonomic nerv function test95922 26 151 Autonomic nerv function test95923 168 Autonomic nerv function test95923 TC 170 Autonomic nerv function test95923 26 168 Autonomic nerv function test95924 232 Ans parasymp & symp w/tilt 95924 TC 232 Ans parasymp & symp w/tilt 95924 26 232 Ans parasymp & symp w/tilt 95925 150 Somatosensory testing95925 TC 152 Somatosensory testing95925 26 150 Somatosensory testing95926 150 Somatosensory testing95926 TC 152 Somatosensory testing95926 26 150 Somatosensory testing95927 151 Somatosensory testing95927 TC 153 Somatosensory testing95927 26 151 Somatosensory testing95928 151 C motor evoked, uppr limbs95928 TC 153 C motor evoked, uppr limbs95928 26 151 C motor evoked, uppr limbs95929 151 C motor evoked, lwr limbs95929 TC 153 C motor evoked, lwr limbs95929 26 151 C motor evoked, lwr limbs95930 150 Visual evoked potential test95930 TC 152 Visual evoked potential test95930 26 150 Visual evoked potential test95933 151 Blink reflex test


CPT/HCPCS MOD MOD LEV DESCRIPTION95933 TC 153 Blink reflex test95933 26 151 Blink reflex test95937 151 Neuromuscular junction test95937 TC 153 Neuromuscular junction test95937 26 151 Neuromuscular junction test95938 150 Somatosensory testing 95938 TC 152 Somatosensory testing 95938 26 150 Somatosensory testing 95939 150 C motor evoked upr&lwr limbs 95939 TC 152 C motor evoked upr&lwr limbs 95939 26 150 C motor evoked upr&lwr limbs 95940 232 Ionm in operating room15 min 95941 232 Ionm remote/>1 pt or per hr 95943 168 Parasymp&symp hrt rate test 95943 TC 168 Parasymp&symp hrt rate test 95943 26 168 Parasymp&symp hrt rate test 95950 151 Ambulatory eeg monitoring95950 TC 153 Ambulatory eeg monitoring95950 26 151 Ambulatory eeg monitoring95951 151 EEG monitoring/videorecord95951 TC 153 EEG monitoring/videorecord95951 26 151 EEG monitoring/videorecord95953 151 EEG monitoring/computer95953 TC 153 EEG monitoring/computer95953 26 151 EEG monitoring/computer95954 151 EEG monitoring/giving drugs95954 TC 153 EEG monitoring/giving drugs95954 26 151 EEG monitoring/giving drugs95955 151 EEG during surgery95955 TC 153 EEG during surgery95955 26 151 EEG during surgery95956 151 Eeg monitoring, cable/radio95956 TC 153 Eeg monitoring, cable/radio95956 26 151 Eeg monitoring, cable/radio95957 151 EEG digital analysis95957 TC 153 EEG digital analysis95957 26 151 EEG digital analysis95958 151 EEG monitoring/function test95958 TC 153 EEG monitoring/function test95958 26 151 EEG monitoring/function test95961 151 Electrode stimulation, brain95961 TC 153 Electrode stimulation, brain95961 26 151 Electrode stimulation, brain95962 232 Electrode stim, brain add-on95962 TC 232 Electrode stim, brain add-on95962 26 232 Electrode stim, brain add-on95965 168 Meg, spontaneous95965 TC 170 Meg, spontaneous95965 26 168 Meg, spontaneous95966 168 Meg, evoked, single95966 TC 170 Meg, evoked, single95966 26 168 Meg, evoked, single95967 249 Meg, evoked, each addl95967 TC 249 Meg, evoked, each addl95967 26 249 Meg, evoked, each addl95970 195 Analyze neurostim, no prog95971 219 Analyze neurostim, simple95972 219 Analyze neurostim, complex95973 249 Analyze neurostim, complex95974 195 Cranial neurostim, complex95975 249 Cranial neurostim, complex95978 219 Analyze neurostim brain/1h95979 249 Analyz neurostim brain addon95980 219 IO analysis, gast, n-stim init95981 195 IO analysis, gast, n-stim subsq95982 195 IO ga n-stim subsq w/ reprog


CPT/HCPCS MOD MOD LEV DESCRIPTION95990 195 Spin/brain pump refil & main95991 195 Spin/brain pump refil & main95992 290 Canalith repositioning proc95999 219 Neurological procedure, unlisted96000 218 Motion analysis, video/3d96001 218 Motion test w/ft press meas96002 218 Dynamic surface emg96003 218 Dynamic fine wire emg96004 218 Phys review of motion tests96020 151 Functional brain mapping96020 TC 153 Functional brain mapping96020 26 151 Functional brain mapping96101 195 Psycho testing by psych/phys96102 188 Psycho testing by technician96103 188 Psycho testing admin by comp96105 187 Assessment of aphasia96110 195 Developmental screen96111 195 Developmental test, extend96116 195 Neurobehavioral status exam96118 195 Neuropsych tst by psych/phys96119 188 Neuropsych testing by tech96120 188 Neuropsych tst admin w/comp96125 188 Cognitive test by hc professional96127 188 Carotid intima atheroma eval96150 186 Assess hlth/behave, init96151 186 Assess hlth/behave, subseq96152 186 Intervene hlth/behave, indiv96153 186 Intervene hlth/behave, group96154 186 Interv hlth/behav, fam w/pt96155 284 Interv hlth/behav fam no pt96360 195 Hydration iv infusion, init96361 249 Hydrate iv infusion, add-on96365 195 Ther/proph/diag iv inf, init96366 249 Ther/proph/diag iv inf add-on96367 249 Tx/proph/dg addl seq iv inf96368 249 Ther/diag concurrent inf96369 195 Sc ther infusion, up to 1 hr96370 249 Sc ther infusion, addl hr96371 249 Sc ther infusion, reset pump96372 195 Ther/proph/diag inj, sc/im96373 195 Ther/proph/diag inj, ia96374 195 Ther/proph/diag inj, iv push96375 232 Tx/pro/dx inj new drug add-on96376 282 Tx/pro/dx inj new drug add-on96401 190 Chemo, anti-neopl, sq/im96402 190 Chemo hormon antineopl sq/im96405 111 Intralesional chemo admin96406 111 Intralesional chemo admin96409 190 Chemo, iv push, sngl drug96411 248 Chemo, iv push, addl drug96413 190 Chemo, iv infusion, 1 hr96415 248 Chemo, iv infusion, addl hr96416 190 Chemo prolong infuse w/pump96417 248 Chemo iv infus each addl seq96420 190 Chemotherapy, push technique96422 190 Chemotherapy infusion method96423 231 Chemo, infuse method add-on96425 190 Chemotherapy infusion method96440 114 Chemotherapy, intracavitary96446 114 Chemotx admn prtl cavity96450 112 Chemotherapy, into CNS96521 190 Refil/maint, portable pump96522 195 Refil/main pump/resvr syst96523 195 Irrig drug delivery device96542 219 Chemotherapy injection96549 219 Chemotherapy, unspecified


CPT/HCPCS MOD MOD LEV DESCRIPTION96567 219 Photodynamic tx, skin96570 232 Photodynamic tx, 30 min96571 232 Photodynamic tx, addl 15 min96900 219 Ultraviolet light therapy96904 219 Whole body photography96910 219 Photochemotherapy with UV-B96912 219 Photochemotherapy with UV-A96913 219 Photochemotherapy, UV-A or B96920 113 Laser tx, skin < 250 sq cm96921 113 Laser tx, skin 250-500 sq cm96922 137 Laser tx, skin > 500 sq cm96999 219 Dermatological procedure, unlisted97001 190 Pt evaluation97002 190 Pt re-evaluation97003 190 Ot evaluation97004 190 Ot re-evaluation97012 190 Mechanical traction therapy97014 286 Electric stimulation therapy97016 190 Vasopneumatic device therapy97018 190 Paraffin bath therapy97022 190 Whirlpool therapy97024 190 Diathermy treatment97026 190 Infrared therapy97028 190 Ultraviolet therapy97032 190 Electrical stimulation97033 190 Electric current therapy97034 190 Contrast bath therapy97035 190 Ultrasound therapy97036 190 Hydrotherapy97039 216 Physical therapy treatment97110 190 Therapeutic exercises97112 190 Neuromuscular reeducation97113 190 Aquatic therapy/exercises97116 190 Gait training therapy97124 190 Massage therapy97139 216 Physical medicine procedure97140 190 Manual therapy97150 190 Group therapeutic procedures97530 190 Therapeutic activities97532 190 Cognitive skills development97533 190 Sensory integration97535 190 Self care mngment training97537 190 Community/work reintegration97542 190 Wheelchair mngment training97545 190 Work hardening, initial 2 hrs97546 231 Work hardening add-on, each add'l hr97597 190 Active wound care/20 cm or <97598 190 Active wound care > 20 cm97605 190 Neg press wound tx, < 50 cm97606 190 Neg press wound tx, > 50 cm97607 190 Brief emotional/behav assmt97608 190 Neg press wnd tx</=50 sq cm97610 190 Low frequency non-thermal us 97750 190 Physical performance test97755 190 Assistive technology assess97760 190 Orthotic mgmt and training97761 190 Prosthetic training97762 190 C/o for orthotic/prosth use97799 219 Physical medicine procedure, nos97802 190 Medical nutrition, indiv, in97803 190 Med nutrition, indiv, subseq97804 190 Medical nutrition, group97810 290 Acupunct w/o stimul 15 min97811 290 Acupunct w/o stimul addl 15m97813 290 Acupunct w/stimul 15 min97814 290 Acupunct w/stimul addl 15m


CPT/HCPCS MOD MOD LEV DESCRIPTION98925 114 Osteopathic manipulation98926 114 Osteopathic manipulation98927 114 Osteopathic manipulation98928 114 Osteopathic manipulation98929 114 Osteopathic manipulation98940 138 Chiropractic manipulation, spinal, 1-2 reg98941 138 Chiropractic manipulation, spinal, 3-4 reg98942 138 Chiropractic manipulation, spinal, 5 reg98960 290 Self-mgmt educ & train, 1 pt98961 290 Self-mgmt educ/train, 2-4 pt98962 290 Self-mgmt educ/train, 5-8 pt98966 290 HC prof phone call, 5-10 min98967 290 HC prof phone call, 11-20 min98968 290 HC prof phone call, 21-30 min98969 290 Online service by HC prof99070 290 Special supplies99071 290 Patient education materials99080 290 Special reports or forms99082 219 Unusual physician travel99091 290 Collect/review data from pt99144 195 Mod cs by same phys, 5 yrs +99145 232 Mod cs by same phys add-on99149 195 Mod cs diff phys 5 yrs +99150 232 Mod cs diff phys add-on99175 219 Induction of vomiting99183 219 Hyperbaric oxygen therapy99188 219 Hypothermia ill neonate99190 290 Special pump services, ea hr99191 290 Special pump services, 3/4 hr99192 290 Special pump services, 1/2 hr99195 195 Phlebotomy99199 219 Special service/proc/report, unlisted99201 79 Office/outpatient visit new 99202 79 Office/outpatient visit new 99203 79 Office/outpatient visit new 99204 79 Office/outpatient visit new 99205 79 Office/outpatient visit new 99211 71 Office/outpatient visit, est99212 71 Office/outpatient visit est 99213 71 Office/outpatient visit est 99214 71 Office/outpatient visit est 99215 71 Office/outpatient visit est 99217 75 Observation care discharge99218 72 Initial observation care 99219 72 Initial observation care 99220 72 Initial observation care 99221 72 Initial hospital care 99222 72 Initial hospital care 99223 72 Initial hospital care 99224 72 Subsequent observation care 99225 72 Subsequent observation care 99226 72 Subsequent observation care 99231 72 Subsequent hospital care 99232 72 Subsequent hospital care 99233 72 Subsequent hospital care 99234 75 Observ/hosp same date 99235 75 Observ/hosp same date 99236 75 Observ/hosp same date 99238 75 Hospital discharge day99239 75 Hospital discharge day99281 72 Emergency dept visit99282 72 Emergency dept visit99283 72 Emergency dept visit99284 72 Emergency dept visit99285 72 Emergency dept visit99288 73 Direct advanced life support


CPT/HCPCS MOD MOD LEV DESCRIPTION99291 72 Critical care, first hour99292 74 Critical care, addl 30 min99304 266 Nursing facility care init 99305 266 Nursing facility care init 99306 266 Nursing facility care init 99307 266 Nursing fac care subseq 99308 266 Nursing fac care subseq 99309 266 Nursing fac care subseq 99310 266 Nursing fac care subseq 99315 266 Nursing fac discharge day99316 266 Nursing fac discharge day99318 266 Annual nursing fac assessmnt99324 265 Domicil/r-home visit new pat99325 265 Domicil/r-home visit new pat99326 265 Domicil/r-home visit new pat99327 265 Domicil/r-home visit new pat99328 265 Domicil/r-home visit new pat99334 265 Domicil/r-home visit est pat99335 265 Domicil/r-home visit est pat99336 265 Domicil/r-home visit est pat99337 265 Domicil/r-home visit est pat99339 290 Domicil/r-home care supervis99340 290 Domicil/r-home care supervis99341 79 Home visit new patient 99342 79 Home visit new patient 99343 79 Home visit new patient 99344 79 Home visit new patient 99345 79 Home visit new patient 99347 79 Home visit est patient 99348 79 Home visit est patient 99349 79 Home visit est patient 99350 79 Home visit est patient 99354 76 Prolonged service, office99355 76 Prolonged service, office99356 76 Prolonged service, inpatient99357 76 Prolonged service, inpatient99358 290 Prolonged serv, w/o contact99359 290 Prolonged serv, w/o contact99360 282 Physician standby services99363 290 Anticoag mgmt, init99364 290 Anticoag mgmt, subseq99366 290 Team conf w/ pat by HC prof99367 290 Team conf w/o pat by phys99368 290 Team conf w/o pat by HC prof99374 290 Home health care supervision, 15-29 min99375 290 Home health care supervision, 30+ min99377 290 Hospice care supervision99378 290 Hospice care supervision99379 290 Nursing fac care supervision99380 290 Nursing fac care supervision99406 266 Behav chng smoking, 3-10 min99407 266 Behav chng smoking, gt 10 min99408 290 Audit/dast, 15-30 min99409 290 Audit/dast, over 30 min99441 77 Phone E/M by phys, 5-10 min99442 77 Phone E/M by phys, 11-20 min99443 77 Phone E/M by phys, 21-30 min99444 77 Online e/m by phys/qhp 99446 77 Interprof phone/online 5-10 99447 77 Interprof phone/online 11-20 99448 77 Interprof phone/online 21-30 99449 77 Interprof phone/online 31/> 99455 75 Work related disability exam 99456 266 Disability examination 99487 79 Cmplx chron care w/o pt vsit 99488 79 Cmplx chron care w/ pt vsit end-dated 12/31/2014


CPT/HCPCS MOD MOD LEV DESCRIPTION99489 79 Complx chron care addl30 min 99490 79 App topical flouride varnish99495 76 Trans care mgmt 14 day disch 99496 76 Trans care mgmt 7 day disch 99497 79 Chron care mgmt srvc 20 min99498 270 Advncd care plan 30 min99499 270 Unlisted e&m service99500 290 Home visit, prenatal99501 290 Home visit, postnatal99503 290 Home visit, resp therapy99504 290 Home visit mech ventilator99505 290 Home visit, stoma care99506 290 Home visit, im injection99507 290 Home visit, cath maintain99509 290 Home visit day life activity99510 290 Home visit, sing/m/fam couns99511 290 Home visit, fecal/enema mgmt99512 290 Home visit, hemodialysis99600 290 Home visit nos99601 290 Home infusion/visit, 2 hrs99602 290 Home infusion, each addtl hr99605 282 Mtms by pharm, new pat, 15 min99606 282 Mtms by pharm, est pat, 15 min99607 290 Mtms by pharm, addl 15 min0016T 207 Thermotx choroid vasc lesion0017T 207 Photocoagulat macular drusen0375T 267 Total disc arthrp ant appr0376T 267 Insert ant segment drain int0377T 267 Anoscpy inj agent for incont0378T 267 Visual field assmnt rev/rprt0379T 267 Vis field assmnt tech support0380T 267 Comp animat ret imag series0042T 219 Ct perfusion w/contrast, cbf0051T 185 Implant total heart system0052T 213 Replace thrc unit hrt syst 0053T 213 Replace implantable hrt syst 0054T 230 Bone srgry cmptr fluor image 0055T 230 Bone srgry cmptr ct/mri imag 0071T 213 U/s leiomyomata ablate <2000072T 213 U/s leiomyomata ablate >2000075T 143 Perq stent/chest vert art0075T TC 144 Perq stent/chest vert art0075T 26 143 Perq stent/chest vert art0076T 246 S&i stent/chest vert art0076T TC 246 S&i stent/chest vert art0076T 26 246 S&i stent/chest vert art0078T 185 Endovasc aort repr w/device end-dated 12/31/20130079T 230 Endovasc visc extnsn repr end-dated 12/31/20130080T 185 Endovasc aort repr rad s&I end-dated 12/31/20130081T 230 Endovasc visc extnsn s&I end-dated 12/31/20130085T 219 Breath test heart reject0092T 246 Artific disc addl cervical 0095T 230 Rmvl artific disc addl crvcl 0098T 246 Revise, cervical artif disc, ea add'l intersp0099T 177 Implant corneal ring0100T 206 Prosth retina receive & gen0101T 206 Extracorp shockwv tx, hi energy0102T 206 Extracorp shockwv tx, anesth0103T 219 Holotranscobalamin, quant0104T 219 At rest cardio gas rebreathe0105T 219 Exerc cardio gas rebreathe0106T 219 Touch quant sensory test0107T 219 Vibrate quant sensory test0108T 219 Cool quant sensory test0109T 219 Heat quant sensory test0110T 219 NOW quant sensory test


CPT/HCPCS MOD MOD LEV DESCRIPTION0111T 219 RBC membranes fatty acids0123T 177 Scleral fistulization0124T 177 Conjunctival drug placement end-dated 12/31/20130126T 213 Chd risk imt study0159T 232 Computer breast MRI add-on0159T TC 232 Computer breast MRI add-on0159T 26 232 Computer breast MRI add-on0160T 213 Transcran mag stim planning0161T 213 Transcran mag stim delivery0163T 246 Lumb artif diskectomy addl0164T 246 Remove lumb artif disc addl0165T 246 Revise lumb artif disc addl0169T 185 Place stereo cath brain0171T 213 Lumbar spine proces distract0172T 246 Lumbar spine proces addl0173T 246 Iop monit io pressure0174T 249 Cad cxr with interp0175T 195 Cad cxr remote0176T 177 Aqu canal dilat w/o retent0177T 206 Aqu canal dilat w retent0178T 195 64 Lead ECG w I&R0179T 195 64 Lead ECG w tracing only0180T 195 64 Lead ECG w I&R only0181T 184 Corneal hysteresis0182T 151 HDR elec brachytherapy0182T TC 153 HDR elec brachytherapy0182T 26 151 HDR elec brachytherapy0183T 219 Wound ultrasound end-dated 12/31/20130184T 213 Excise rectal tumor, TEMS0185T 219 Comptr probability analysis end-dated 12/31/20130186T 177 Suprachoroidal drug delivery end-dated 12/31/20130187T 195 Scan computer ophthalmid dx imag0188T 290 Videoconf crit care 74 min0189T 290 Videoconf crit care addl 300190T 241 Place intraoc radiation src0191T 206 Insert ant segment drain int0192T 206 Insert ant segment drain ext end-dated 12/31/20130193T 213 Rf bladder neck microremodel0195T 185 Prescrl fuse w/o instr l5/s1 0196T 246 Prescrl fuse w/o instr l4/l5 0197T 185 Intrafraction track motion0198T 213 Ocular blood flow measure0199T 270 Physiologic tremor record w/report0200T 213 Perq sacral augmt, unilat inject, 1+ needles, uni0201T 212 Perq sacral augmt, bilat inject, 2+ needles, bilat0202T 185 Post vert arthrplst, lumbar, 1 level w/ flouroscop0205T 246 Inirs each vessel add-on0206T 290 Cptr dbs alys car elec dta 0207T 185 Clear eyelid gland w/heat, unilateral0208T 219 Automated audiometry air0209T 219 Auto audiometry air/bone0210T 219 Auto audiometry sp thresh0211T 219 Auto audiometry sp thresh0212T 219 Comprehen auto audiometry0213T 215 Us facet jt inj cerv/t 1 lev0214T 247 Us facet jt inj cerv/t 2 lev0215T 247 Us facet jt inj cerv/t 3 lev0216T 215 Us facet jt inj ls 1 level0217T 247 Us facet jt inj ls 2 level0218T 247 Us facet jt inj ls 3 level0219T 213 Fuse spine facet jt cerv, uni or bilateral0220T 213 Fuse spine facet jt thor, uni or bilateral0221T 213 Fuse spine facet jt lumbar, uni or bilateral0222T 246 Fuse spine facet jt add seg0223T 213 Acoustic ECG W/I&R


CPT/HCPCS MOD MOD LEV DESCRIPTION0224T 213 Acoustic ECG 1+ Analysis0225T 213 Acoustic ECG Analy & Reprog0226T 213 Anocopy HRA W/Spec Collect0227T 213 Anooscopy HRA W/Biopsy 0228T 215 NJX TFRML EPRL W/US Cer/Thor0229T 247 NJX TFRML EPRL W/US Cer/Thor0230T 213 NJX TFRML EPRL W/US Lumb/Sac0231T 247 NJX TFRML EPRL W/US Lumb/Sac0232T 213 NJX Platelet Plasma0233T 213 Skin Glycation Spectroscopy0234T 90 Trluml perip athrc renal art 0235T 90 Trluml perip athrc visceral 0236T 90 Trluml perip athrc abd aorta 0237T 90 Trluml perip athrc brchiocph 0238T 90 Trluml perip athrc iliac art 0239T 281 Bioimpedance spectroscopy 0240T 151 Esoph motility 3D topography 0240T TC 153 Esoph motility 3D topography 0240T 26 151 Esoph motility 3D topography 0241T 151 Esoph motility w/stim/perf 0241T TC 153 Esoph motility w/stim/perf 0241T 26 151 Esoph motility w/stim/perf 0243T 282 Intm msr bronchodil wheeze 0243T TC 282 Intm msr bronchodil wheeze 0243T 26 282 Intm msr bronchodil wheeze 0244T 282 Cont msr bronchodil wheeze 0244T TC 282 Cont msr bronchodil wheeze 0244T 26 282 Cont msr bronchodil wheeze 0245T 246 Opn tx rib fx 1-2 ribs0246T 246 Opn tx rib fx 3-4 ribs0247T 246 Opn tx rib fx 5-6 ribs0248T 246 Open tx rib fx 7/> ribs0249T 129 Ligation hemorrhoid w/us 0253T 206 Insert aqueous drain device 0254T 46 Evasc rpr iliac art bifur 0255T 46 Evasc Rpr iliac art bifr d&i 0255T TC 149 Evasc Rpr iliac art bifr d&i 0255T 26 151 Evasc Rpr iliac art bifr d&i 0262T 264 Impltj pulm vlv evasc appr 0263T 264 Im B1 mrw cel ther cmpl 0264T 264 Im B1 mrw cel ther xcl hrvst 0265T 264 Im B1 mrw cel ther hrvst onl 0266T 264 Implt/rpl crtd sns dev total 0267T 264 Implt/rpt crtd sns dev lead 0268T 264 Implt/rpl crtd sns dev gen 0269T 264 Rev/remvl crtd sns dev total 0270T 264 Rev/remvl crtd sns dev lead 0271T 264 Rev/remvl crtd sns dev gen 0272T 268 Interrogate crtd sns dev0273T 268 Interrogate crtd sns w/pgrmg0274T 264 Perq lamot/lam crv/thrc 0275T 264 Perq lamot/lam lumbar 0278T 290 Tempr 0281T 268 LAA closure w/implant 0282T 209 Periph field stimul trial 0283T 209 Periph field stimul perm 0284T 210 Periph field stimul revise 0285T 268 Periph field stimul analys 0286T 268 Near IFR spectrsc of wounds 0287T 268 Near IFR guide of vasc site 0288T 210 Anoscopy w/RF delivery 0289T 268 Laser inc for PKP/LKP donor 0290T 268 Laser inc for PKP/LKP recip 0291T 268 Iv oct for proc init vessel0292T 268 Iv oct for proc addl vessel0293T 268 Ins lt atrl press monitor


CPT/HCPCS MOD MOD LEV DESCRIPTION0293T 268 Ins lt atrl press monitor0294T 268 Ins lt atrl press mont addon0295T 268 Ext ecg complete0296T 268 Ext ecg recording0297T 268 Ext ecg scan w/report0298T 268 Ext ecg review and interp0299T 268 Esw wound healing init wound0300T 268 Esw wound healing addl wound0301T 210 Mw therapy for breast tumor0309T 238 Prescrl fuse w/ instr L4/L5 0310T 290 Motor function mapping ntms 0318T 14 Replace aortic valve tthorac 0319T 254 Insert subq defib w/eltrd 0320T 254 Insert subq defib electrode 0321T 254 Insert subq defib pls gen 0322T 254 Rmvl subq defib pls gen 0323T 254 Rmvl & replc subq pls gen 0324T 254 Rmvl subq defib electrode 0325T 254 Repos subq defib eltrd &/gen 0327T 290 Implt subq defib interogat 0328T 290 Implt subq defib sys dev evl 0329T 290 Mntr io press 24hrs/> uni/bi 0330T 290 Tear film img uni/bi w/i&r 0331T 290 Heart symp image plnr 0332T 290 Heart symp image plnr spect 0333T 290 Visual ep acuity screen auto 0334T 213 Perq stablj sacroiliac joint 0335T 021 Extraosseous joint stblztion 0336T 063 Lap ablat uterine fibroids 0337T 151 Endothel fxnassmnt non-invas 0338T 021 Trnscth renal symp denrv unl 0339T 052 Trnscth renal symp denrv bil 0340T 096 Ablate pulm tumors + extnsn0341T 150 Quant pupillometry w/ rprt0342T 129 Thxp apheresis w/hdl delip0343T 014 Transcath mtral vlve repair0344T 014 Transcath mtral vlve repair0345T 014 Transcath mtral vlve repair0346T 151 Ultrasound elastography0347T 124 Ins bone device for rsa0348T 197 Rsa spine exam0349T 197 Rsa upper extr exam0350T 197 Rsa lower extr exam0351T 268 Intraop oct brst/node spec0352T 268 Oct brst/node spec0353T 268 Intraop oct breast cavity0354T 268 Oct breast surg cavity i&r0355T 168 GI tract capsule endoscopy0356T 205 Insrt drug device for iop0358T 151 Bia whole body0359T 186 Behavioral id assessment0360T 186 Observ behav assessment0361T 186 Observ behav assess addl0362T 186 Expose behav assessment0363T 186 Expose behav assess addl0364T 186 Behavior treatment0365T 186 Behavior treatment addl0366T 186 Group behavior treatment0367T 186 Group behav treatment addl0368T 186 Behavior treatment modified0369T 186 Behav treatment modify addl0370T 186 Fam behav treatment guidance0371T 186 Mult fam behav treat guide0372T 186 Social skills training group0373T 186 Exposure behavior treatment0374T 186 Expose behav treatment addl


CPT/HCPCS MOD MOD LEV DESCRIPTIONA0080 290 Noninterest escort in non er, per miA0090 290 Interest escort in non er, per miA0100 290 Nonemergency transport taxiA0110 290 Nonemergency transport bus, etc.A0120 290 Noner transport mini-busA0130 290 Noner transport wheelch vanA0140 290 Nonemergency transport airA0170 290 Noner transport parking feesA0180 290 Noner transport lodgng recipA0190 290 Noner transport meals recipA0200 290 Noner transport lodgng escrtA0210 290 Noner transport meals escortA0380 290 BLS mileage, per mileA0382 290 Basic support routine supplsA0384 290 Bls defibrillation suppliesA0390 290 ALS mileage, per mileA0392 290 Als defibrillation suppliesA0394 290 Als IV drug therapy suppliesA0396 290 Als esophageal intub supplsA0398 290 Als routine disposble supplsA0420 290 Ambulance waiting 1/2 hrA0422 290 Ambulance 02 life sustainingA0424 290 Extra ambulance attendantA0425 290 Ground mileageA0426 290 Als 1A0427 290 ALS1-emergencyA0428 290 blsA0429 290 BLS-emergencyA0430 290 Fixed wing air transportA0431 290 Rotary wing air transportA0432 290 PI volunteer ambulance coA0433 290 ALS 2A0434 290 Specialty care transportA0435 290 Fixed wing air mileageA0436 290 Rotary wing air mileageA0998 290 Ambulance response/tx, no transportA0999 290 Unlisted ambulance serviceA4206 290 1 CC sterile syringe&needleA4207 290 2 CC sterile syringe&needleA4208 290 3 CC sterile syringe&needleA4209 290 5+ CC sterile syringe&needleA4210 290 Non needle injection deviceA4211 290 Supp for self-adm injectionsA4212 290 Non coring needle or styletA4213 290 20+ CC syringe onlyA4215 290 Sterile needleA4216 290 Sterile water/saline, 10 mlA4217 290 Sterile water/saline, 500 mlA4217 AU 290 Sterile water/saline, 500 mlA4218 290 Sterile saline or water, metered dose dispenser, 10 mlA4220 290 Infusion pump refill kitA4221 290 Maint drug infus cath per wkA4222 290 Infusion supplies, ext pump, per unitA4223 290 Infusion supplies w/o pumpA4230 290 Infus insulin pump non needlA4231 290 Infusion insulin pump needleA4232 290 Syringe w/needle insulin 3ccA4233 290 Alkalin batt for glucose monA4233 NU 290 Alkalin batt for glucose monA4234 290 J-cell batt for glucose monA4234 NU 290 J-cell batt for glucose monA4235 290 Lithium batt for glucose monA4235 NU 290 Lithium batt for glucose monA4236 290 Silvr oxide batt glucose monA4236 NU 290 Silvr oxide batt glucose monA4244 290 Alcohol or peroxide per pint


CPT/HCPCS MOD MOD LEV DESCRIPTIONA4245 290 Alcohol wipes per boxA4246 290 Betadine/phisohex solutionA4247 290 Betadine/iodine swabs/wipesA4248 290 Chlorhexidine antiseptA4250 290 Urine reagent strips/tabletsA4252 290 Blood ketone test or stripA4253 290 Blood glucose/reagent stripsA4253 NU 290 Blood glucose/reagent stripsA4255 290 Glucose monitor platformsA4256 290 Calibrator solution/chipsA4257 290 Replace Lensshield CartridgeA4258 290 Lancet device eachA4259 290 Lancets per boxA4265 290 ParaffinA4280 290 Brst prsths adhsv attchmntA4290 290 Sacral nerve stim test leadA4300 290 Cath impl vasc access portalA4301 290 Implantable access syst percA4305 290 Drug delivery system >=50 MLA4306 290 Drug delivery system <=5 MLA4310 290 Insert tray w/o bag/cathA4311 290 Catheter w/o bag 2-way latexA4312 290 Cath w/o bag 2-way siliconeA4313 290 Catheter w/bag 3-wayA4314 290 Cath w/drainage 2-way latexA4315 290 Cath w/drainage 2-way silcneA4316 290 Cath w/drainage 3-wayA4320 290 Irrigation trayA4321 290 Cath therapeutic irrig agentA4322 290 Irrigation syringeA4326 290 Male external catheterA4327 290 Fem urinary collect dev cupA4328 290 Fem urinary collect pouchA4330 290 Stool collection pouchA4331 290 Extension drainage tubingA4332 290 Lubricant, ind sterile pkt, eachA4333 290 Urinary cath anchor deviceA4334 290 Urinary cath leg strapA4335 290 Incontinence supply, misc, eaA4336 290 Urethral insert, incont supplyA4338 290 Indwelling catheter latexA4340 290 Indwelling catheter specialA4344 290 Cath indw foley 2 way silicnA4346 290 Cath indw foley 3 wayA4349 290 Male external cat, disposableA4351 290 Straight tip urine catheterA4352 290 Coude tip urinary catheterA4353 290 Intermittent urinary cathA4354 290 Cath insertion tray w/bagA4355 290 Bladder irrigation tubingA4356 290 Ext ureth clmp or compr dvcA4357 290 Bedside drainage bagA4358 290 Urinary leg or abdomen bagA4360 290 Disposable ext urethral deviceA4361 290 Ostomy face plateA4362 290 Solid skin barrierA4363 290 Ostomy clamp, replacementA4364 290 AdhesiveA4366 290 Ostomy ventA4367 290 Ostomy beltA4368 290 Ostomy filterA4369 290 Skin barrier liquid per ozA4371 290 Skin barrier powder per ozA4372 290 Skin barrier solid 4x4 equivA4373 290 Skin barrier with flangeA4375 290 Drainable plastic pch w fcpl


CPT/HCPCS MOD MOD LEV DESCRIPTIONA4376 290 Drainable rubber pch w fcpltA4377 290 Drainable plstic pch w/o fpA4378 290 Drainable rubber pch w/o fpA4379 290 Urinary plastic pouch w fcplA4380 290 Urinary rubber pouch w fcpltA4381 290 Urinary plastic pouch w/o fpA4382 290 Urinary hvy plstc pch w/o fpA4383 290 Urinary rubber pouch w/o fpA4384 290 Ostomy faceplt/silicone ringA4385 290 Ost skn barrier sld ext wearA4387 290 Ost clsd pouch w att st barrA4388 290 Drainable pch w ex wear barrA4389 290 Drainable pch w st wear barrA4390 290 Drainable pch ex wear convexA4391 290 Urinary pouch w ex wear barrA4392 290 Urinary pouch w st wear barrA4393 290 Urine pch w ex wear bar convA4394 290 Ostomy pouch liq deodorantA4395 290 Ostomy pouch solid deodorantA4396 290 Peristomal hernia supprt bltA4397 290 Irrigation supply sleeveA4398 290 Ostomy irrigation bagA4399 290 Ostomy irrig cone/cath w brsA4400 290 Ostomy irrigation setA4402 290 Lubricant per ounceA4404 290 Ostomy ring eachA4405 290 Nonpectin based ostomy pasteA4406 290 Pectin based ostomy pasteA4407 290 Ext wear ost skn barr <=4sq"A4408 290 Ext wear ost skn barr >4sq"A4409 290 Ost skn barr w flng <=4 sq"A4410 290 Ost skn barr w flng >4sq"A4411 290 Ost skn barr extnd =4sqA4412 290 Ost pouch drain high outputA4413 290 2 pc drainable ost pouchA4414 290 Ostomy sknbarr w flng <=4sq"A4415 290 Ostomy skn barr w flng >4sq"A4416 290 Ost pch clsd w barrier/filtrA4417 290 Ost pch w bar/bltinconv/fltrA4418 290 Ost pch clsd w/o bar w filtrA4419 290 Ost pch for bar w flange/fltA4420 290 Ost pch clsd for bar w lk flA4421 290 Ostomy supply miscA4422 290 Ost pouch absorbent materialA4423 290 Ost pch for bar w lk fl/fltrA4424 290 Ost pch drain w bar & filterA4425 290 Ost pch drain for barrier flA4426 290 Ost pch drain 2 piece systemA4427 290 Ost pch drain/barr lk flng/fA4428 290 Urine ost pouch w faucet/tapA4429 290 Urine ost pouch w bltinconvA4430 290 Ost urine pch w b/bltin convA4431 290 Ost pch urine w barrier/tapvA4432 290 Os pch urine w bar/fange/tapA4433 290 Urine ost pch bar w lock flnA4434 290 Ost pch urine w lock flng/ftA4435 290 1pc ost pch drain high utput A4450 290 Non-waterproof tapeA4450 AU 290 Non-waterproof tapeA4450 AV 290 Non-waterproof tapeA4450 AW 290 Non-waterproof tapeA4452 290 Waterproof tapeA4452 AU 290 Waterproof tapeA4452 AV 290 Waterproof tapeA4452 AW 290 Waterproof tapeA4455 290 Adhesive remover per ounce


CPT/HCPCS MOD MOD LEV DESCRIPTIONA4456 290 Adhesive remover, wipesA4458 290 Reusable enema bagA4459 290 Manual pump enema, reusableA4461 290 Surgical dressing holder, non-reusableA4463 290 Surgical dressing holder, reusableA4465 290 Non-elastic extremity binderA4466 290 Elastic garment coveringA4470 290 Gravlee jet washerA4480 290 Vabra aspiratorA4481 290 Tracheostoma filterA4483 290 Moisture exchangerA4490 290 Above knee surgical stockingA4495 290 Thigh length surg stockingA4500 290 Below knee surgical stockingA4510 290 Full length surg stockingA4520 290 Incontinence garment anytypeA4554 290 Disposable underpadsA4555 290 Ca tx e-stim electr/transducA4556 290 ElectrodesA4557 290 Lead wiresA4558 290 Conductive paste or gelA4559 290 Coupling gel or paste, per ozA4561 290 Pessary rubberA4562 290 PessaryA4565 290 SlingsA4566 290 Should sling/vest/abrestrainA4570 290 SplintA4575 290 Hyperbaric O2 chamber dispsA4580 290 Cast supplies (plaster)A4590 290 Special casting materialA4595 290 TENS suppl 2 lead per monthA4600 290 Sleeve, inter limb comp device, repl only, ea.A4601 290 Lith ion batt, non-pros use, replacement, ea.A4602 290 Replace lithium battery 1.5VA4604 290 Tubing with heating elementA4604 NU 290 Tubing with heating elementA4605 290 Trach suction cath close sysA4605 NU 290 Trach suction cath close sysA4606 290 Oxygen probe used w oximeterA4608 290 Transtracheal oxygen cathA4611 290 Heavy duty batteryA4611 NU 290 Heavy duty batteryA4611 RR 290 Heavy duty batteryA4611 UE 290 Heavy duty batteryA4612 290 Battery cablesA4612 NU 290 Battery cablesA4612 RR 290 Battery cablesA4612 UE 290 Battery cablesA4613 290 Battery chargerA4613 NU 290 Battery chargerA4613 RR 290 Battery chargerA4613 UE 290 Battery chargerA4614 290 Hand-held PEFR meterA4615 290 Cannula nasalA4616 290 Tubing (oxygen) per footA4617 290 Mouth pieceA4618 290 Breathing circuitsA4618 NU 290 Breathing circuitsA4618 RR 290 Breathing circuitsA4618 UE 290 Breathing circuitsA4619 290 Face tentA4619 NU 290 Face tentA4620 290 Variable concentration maskA4623 290 Tracheostomy inner cannulaA4624 290 Tracheal suction tubeA4624 NU 290 Tracheal suction tube


CPT/HCPCS MOD MOD LEV DESCRIPTIONA4625 290 Trach care kit for new trachA4626 290 Tracheostomy cleaning brushA4627 290 Spacer bag/reservoirA4628 290 Oropharyngeal suction cathA4628 NU 290 Oropharyngeal suction cathA4629 290 Tracheostomy care kitA4630 290 Repl bat t.e.n.s. own by ptA4630 NU 290 Repl bat t.e.n.s. own by ptA4633 290 Uvl replacement bulbA4633 NU 290 Uvl replacement bulbA4634 290 Replacement bulb th lightboxA4635 290 Underarm crutch padA4635 NU 290 Underarm crutch padA4635 RR 290 Underarm crutch padA4635 UE 290 Underarm crutch padA4636 290 Handgrip for cane etcA4636 NU 290 Handgrip for cane etcA4636 RR 290 Handgrip for cane etcA4636 UE 290 Handgrip for cane etcA4637 290 Repl tip cane/crutch/walkerA4637 NU 290 Repl tip cane/crutch/walkerA4637 RR 290 Repl tip cane/crutch/walkerA4637 UE 290 Repl tip cane/crutch/walkerA4638 290 Repl batt pulse gen sysA4638 NU 290 Repl batt pulse gen sysA4639 290 Infrared ht sys replcmnt padA4639 NU 290 Infrared ht sys replcmnt padA4640 290 Alternating pressure padA4640 NU 290 Alternating pressure padA4640 RR 290 Alternating pressure padA4640 UE 290 Alternating pressure padA4641 290 Diagnostic imaging agentA4642 290 Satumomab pendetide per doseA4648 290 Implantable tissue markerA4650 290 Implant radiation dosimeterA4651 290 Calibrated microcap tubeA4652 290 Microcapillary tube sealantA4653 290 PD catheter anchor beltA4657 290 Dialysis syringe w/wo needleA4660 290 Esrd blood pressure deviceA4663 290 Esrd blood pressure cuffA4670 290 Auto blood pressure monitorA4671 290 Disposable cycler setA4672 290 Drainage ext line, dialysisA4673 290 Ext line w easy lock connectA4674 290 Chem/antisept solution, 8ozA4680 290 Activated carbon filter, eaA4690 290 Dialyzers, eaA4706 290 Bicarbonate conc sol per galA4707 290 Bicarbonate conc pow per pacA4708 290 Acetate conc sol per gallonA4709 290 Acid conc sol per gallonA4714 290 Treated water for dialysisA4719 290 ”Y set” tubingA4720 290 Dialysat sol fld vol > 249ccA4721 290 Dialysat sol fld vol > 999ccA4722 290 Dialys sol fld vol > 1999ccA4723 290 Dialys sol fld vol > 2999ccA4724 290 Dialys sol fld vol > 3999ccA4725 290 Dialys sol fld vol > 4999ccA4726 290 Dialys sol fld vol > 5999ccA4728 290 Dialysate solution, non-dexA4730 290 Fistula cannulation set dialA4736 290 Topical anesthetic, per gramA4737 290 Inj anesthetic per 10 mlA4740 290 Esrd shunt accessory


CPT/HCPCS MOD MOD LEV DESCRIPTIONA4750 290 Arterial or venous tubingA4755 290 Arterial and venous tubingA4760 290 Standard testing solutionA4765 290 Dialysate concentrateA4766 290 Dialysate conc sol add 10 mlA4770 290 Blood testing suppliesA4771 290 Blood clotting time tubeA4772 290 Dextrostick/glucose stripsA4773 290 HemostixA4774 290 Ammonia test paperA4802 290 Protamine sulfate per 50 mgA4860 290 Disposable catheter capsA4870 290 Plumbing/electrical workA4890 290 Contracts/repair/maintenanceA4911 290 Drain bag/bottleA4913 290 Esrd supplyA4918 290 Venous pressure clampA4927 290 GlovesA4928 290 Surgical maskA4929 290 Tourniquet for dialysis, eaA4930 290 Sterile, gloves per pairA4931 290 Reusable oral thermometerA4932 290 Reusable rectal thermometerA5051 290 Pouch clsd w barr attachedA5052 290 Clsd ostomy pouch w/o barrA5053 290 Clsd ostomy pouch faceplateA5054 290 Clsd ostomy pouch w/flangeA5055 290 Stoma capA5056 290 1 pc ost pouch w filter A5057 290 1 pc ost pou w built-in conv A5061 290 Pouch drainable w barrier atA5062 290 Drnble ostomy pouch w/o barrA5063 290 Drain ostomy pouch w/flangeA5071 290 Urinary pouch w/barrierA5072 290 Urinary pouch w/o barrierA5073 290 Urinary pouch on barr w/flngA5081 290 Stoma plug or seal, any type A5082 290 Continent stoma catheterA5083 290 Stoma absorptive coverA5093 290 Ostomy accessory convex inseA5102 290 Bedside drain btl w/wo tubeA5105 290 Urinary suspensoryA5112 290 Urinary leg bagA5113 290 Latex leg strapA5114 290 Foam/fabric leg strapA5120 290 Skin barrier, wipe or swabA5120 AU 290 Skin barrier, wipe or swabA5120 AV 290 Skin barrier, wipe or swabA5121 290 Solid skin barrier 6x6A5122 290 Solid skin barrier 8x8A5126 290 Disk/foam pad +or- adhesiveA5131 290 Appliance cleanerA5200 290 Percutaneous catheter anchorA5500 290 Diab shoe for density insertA5501 290 Diabetic custom molded shoeA5503 290 Diabetic shoe w/roller/rockrA5504 290 Diabetic shoe with wedgeA5505 290 Diab shoe w/metatarsal barA5506 290 Diabetic shoe w/off set heelA5507 290 Modification diabetic shoeA5508 290 Diabetic deluxe shoeA5510 290 Compression form shoe insertA5512 290 Multi den insert direct formA5513 290 Multi den insert custom moldA6000 290 Wound warming wound coverA6010 290 Collagen based wound filler


CPT/HCPCS MOD MOD LEV DESCRIPTIONA6011 290 Collagen gel/paste wound filA6021 290 Collagen dressing <=16 sq inA6022 290 Collagen drsg>6<=48 sq inA6023 290 Collagen dressing >48 sq inA6024 290 Collagen dsg wound fillerA6025 290 Silicone gel sheet, eachA6154 290 Wound pouch eachA6196 290 Alginate dressing <=16 sq inA6197 290 Alginate drsg >16 <=48 sq inA6198 290 Alginate dressing > 48 sq inA6199 290 Alginate drsg wound fillerA6203 290 Composite drsg <= 16 sq inA6204 290 Composite drsg >16<=48 sq inA6205 290 Composite drsg > 48 sq inA6206 290 Contact layer <= 16 sq inA6207 290 Contact layer >16<= 48 sq inA6208 290 Contact layer > 48 sq inA6209 290 Foam drsg <=16 sq in w/o bdrA6210 290 Foam drg >16<=48 sq in w/o bA6211 290 Foam drg > 48 sq in w/o brdrA6212 290 Foam drg <=16 sq in w/borderA6213 290 Foam drg >16<=48 sq in w/bdrA6214 290 Foam drg > 48 sq in w/borderA6215 290 Foam dressing wound fillerA6216 290 Non-sterile gauze<=16 sq inA6217 290 Non-sterile gauze>16<=48 sqA6218 290 Non-sterile gauze > 48 sq inA6219 290 Gauze <= 16 sq in w/borderA6220 290 Gauze >16 <=48 sq in w/bordrA6221 290 Gauze > 48 sq in w/borderA6222 290 Gauze <=16 in no w/sal w/o bA6223 290 Gauze >16<=48 no w/sal w/o bA6224 290 Gauze > 48 in no w/sal w/o bA6228 290 Gauze <= 16 sq in water/salA6229 290 Gauze >16<=48 sq in watr/salA6230 290 Gauze > 48 sq in water/salneA6231 290 Hydrogel dsg<=16 sq inA6232 290 Hydrogel dsg>16<=48 sq inA6233 290 Hydrogel dressing >48 sq inA6234 290 Hydrocolld drg <=16 w/o bdrA6235 290 Hydrocolld drg >16<=48 w/o bA6236 290 Hydrocolld drg > 48 in w/o bA6237 290 Hydrocolld drg <=16 in w/bdrA6238 290 Hydrocolld drg >16<=48 w/bdrA6239 290 Hydrocolld drg > 48 in w/bdrA6240 290 Hydrocolld drg filler pasteA6241 290 Hydrocolloid drg filler dryA6242 290 Hydrogel drg <=16 in w/o bdrA6243 290 Hydrogel drg >16<=48 w/o bdrA6244 290 Hydrogel drg >48 in w/o bdrA6245 290 Hydrogel drg <= 16 in w/bdrA6246 290 Hydrogel drg >16<=48 in w/bA6247 290 Hydrogel drg > 48 sq in w/bA6248 290 Hydrogel drsg gel fillerA6250 290 Skin seal protect moisturizrA6251 290 Absorpt drg <=16 sq in w/o bA6252 290 Absorpt drg >16 <=48 w/o bdrA6253 290 Absorpt drg > 48 sq in w/o bA6254 290 Absorpt drg <=16 sq in w/bdrA6255 290 Absorpt drg >16<=48 in w/bdrA6256 290 Absorpt drg > 48 sq in w/bdrA6257 290 Transparent film <= 16 sq inA6258 290 Transparent film >16<=48 inA6259 290 Transparent film > 48 sq inA6260 290 Wound cleanser any type/sizeA6261 290 Wound filler gel/paste /oz


CPT/HCPCS MOD MOD LEV DESCRIPTIONA6262 290 Wound filler dry form / gramA6266 290 Impreg gauze no h20/sal/yardA6402 290 Sterile gauze <= 16 sq inA6403 290 Sterile gauze>16 <= 48 sq inA6404 290 Sterile gauze > 48 sq inA6407 290 Packing stripsA6410 290 Sterile eye padA6411 290 Non-sterile eye padA6412 290 Occlusive eye patchA6441 290 Pad band 3"<= w <=5", /ydA6442 290 Conform band n/s w<3"/ydA6443 290 Conform band n/s 3" <= w <= 5", /ydA6444 290 Conform band n/s w>=5", /ydA6445 290 Conform band s w <3", /ydA6446 290 Conform band s 3" <= w <=5", /ydA6447 290 Conform band s w >=5", /ydA6448 290 Lt compres band <3", /ydA6449 290 Lt compres band 3" <= w <= 5", /ydA6450 290 Lt compres band >=5", /ydA6451 290 Mod compres band 3" <= w <= 5", /ydA6452 290 High compres band 3" <= w <= 5", /ydA6453 290 Self-adher band w <3"/ydA6454 290 Self-adher band 3" <= w <= 5", /ydA6455 290 Self-adher band >=5", /ydA6456 290 Zinc paste band 3" <= w <= 5", /ydA6457 290 Tubular dressingA6501 290 Compres burngarment bodysuitA6502 290 Compres burngarment chinstrpA6503 290 Compres burngarment facehoodA6504 290 Cmprsburngarment glove-wristA6505 290 Cmprsburngarment glove-elbowA6506 290 Cmprsburngrmnt glove-axillaA6507 290 Cmprs burngarment foot-kneeA6508 290 Cmprs burngarment foot-thighA6509 290 Compres burn garment jacketA6510 290 Compres burn garment leotardA6511 290 Compres burn garment pantyA6512 290 Compres burn garment, nocA6513 290 Compress burn mask face/neckA6530 290 Compression stocking BK18-30A6531 290 Compression stocking BK30-40A6531 AW 290 Compression stocking BK30-40A6532 290 Compression stocking BK40-50A6532 AW 290 Compression stocking BK40-50A6533 290 Gc stocking thighlngth 18-30A6534 290 Gc stocking thighlngth 30-40A6535 290 Gc stocking thighlngth 40-50A6536 290 Gc stocking full lngth 18-30A6537 290 Gc stocking full lngth 30-40A6538 290 Gc stocking full lngth 40-50A6539 290 Gc stocking waistlngth 18-30A6540 290 Gc stocking waistlngth 30-40A6541 290 Gc stocking waistlngth 40-50A6544 290 Gc stocking garter beltA6545 290 Grad comp non-elastic BKA6545 AW 290 Grad comp non-elastic BKA6549 290 G compression stockingA6550 290 Neg pres wound ther drsg setA7000 290 Disposable canister for pumpA7000 NU 290 Disposable canister for pumpA7001 290 Nondisposable pump canisterA7001 NU 290 Nondisposable pump canisterA7002 290 Tubing used w suction pumpA7002 NU 290 Tubing used w suction pumpA7003 290 Nebulizer administration setA7003 NU 290 Nebulizer administration set


CPT/HCPCS MOD MOD LEV DESCRIPTIONA7004 290 Disposable nebulizer sml volA7004 NU 290 Disposable nebulizer sml volA7005 290 Nondisposable nebulizer setA7005 NU 290 Nondisposable nebulizer setA7006 290 Filtered nebulizer admin setA7006 NU 290 Filtered nebulizer admin setA7007 290 Lg vol nebulizer disposableA7007 NU 290 Lg vol nebulizer disposableA7008 290 Disposable nebulizer prefillA7008 NU 290 Disposable nebulizer prefillA7009 290 Nebulizer reservoir bottleA7009 NU 290 Nebulizer reservoir bottleA7010 290 Disposable corrugated tubingA7010 NU 290 Disposable corrugated tubingA7011 290 Nondispos corrugated tubingA7012 290 Nebulizer water collec devicA7012 NU 290 Nebulizer water collec devicA7013 290 Disposable compressor filterA7013 NU 290 Disposable compressor filterA7014 290 Compressor nondispos filterA7014 NU 290 Compressor nondispos filterA7015 290 Aerosol mask used w nebulizeA7015 NU 290 Aerosol mask used w nebulizeA7016 290 Nebulizer dome & mouthpieceA7016 NU 290 Nebulizer dome & mouthpieceA7017 290 Nebulizer not used w oxygenA7017 NU 290 Nebulizer not used w oxygenA7017 RR 290 Nebulizer not used w oxygenA7017 UE 290 Nebulizer not used w oxygenA7018 290 Water distilled w/nebulizerA7020 290 Interface, cough stim deviceA7025 290 Replace chest compress vestA7025 NU 290 Replace chest compress vestA7026 290 Replace chst cmprss sys hoseA7026 NU 290 Replace chst cmprss sys hoseA7027 290 Combination oral/nasal maskA7027 NU 290 Combination oral/nasal maskA7028 290 Repl oral cushion combo maskA7028 NU 290 Repl oral cushion combo maskA7029 290 Repl nasal pillow comb maskA7029 NU 290 Repl nasal pillow comb maskA7030 290 CPAP full face maskA7030 NU 290 CPAP full face maskA7031 290 Replacement facemask interfaA7031 NU 290 Replacement facemask interfaA7032 290 Replacement nasal cushionA7032 NU 290 Replacement nasal cushionA7033 290 Replacement nasal pillowsA7033 NU 290 Replacement nasal pillowsA7034 290 Nasal application deviceA7034 NU 290 Nasal application deviceA7035 290 Pos airway press headgearA7035 NU 290 Pos airway press headgearA7036 290 Pos airway press chinstrapA7036 NU 290 Pos airway press chinstrapA7037 290 Pos airway pressure tubingA7037 NU 290 Pos airway pressure tubingA7038 290 Pos airway pressure filterA7038 NU 290 Pos airway pressure filterA7039 290 Filter, non disposable w papA7039 NU 290 FilterA7040 290 One way chest drain valveA7041 290 Water seal drain containerA7042 290 Implanted pleural catheter end-dated 12/31/2014A7043 290 Vacuum drainagebottle/tubing end-dated 12/31/2014A7044 290 PAP oral interface


CPT/HCPCS MOD MOD LEV DESCRIPTIONA7044 NU 290 PAP oral interfaceA7045 290 Repl exhalation port for PAPA7045 NU 290 Repl exhalation port for PAPA7045 RR 290 Repl exhalation port for PAPA7045 UE 290 Repl exhalation port for PAPA7046 290 Repl water chamber, PAP devA7046 NU 290 Repl water chamberA7047 290 Resp suction oral interface A7047 NU 290 Resp suction oral interface A7048 290 Vacuum drainagebottle/tubingA7501 290 Tracheostoma valve w diaphraA7502 290 Replacement diaphragm/fplateA7503 290 HMES filter holder or capA7504 290 Tracheostoma HMES filterA7505 290 HMES or trach valve housingA7506 290 HMES/trachvalve adhesivediskA7507 290 Integrated filter & holderA7508 290 Housing & Integrated AdhesivA7509 290 Heat & moisture exchange sysA7520 290 Trach/laryn tube non-cuffedA7521 290 Trach/laryn tube cuffedA7522 290 Trach/laryn tube stainlessA7523 290 Tracheostomy shower protectA7524 290 Tracheostoma stent/stud/bttnA7525 290 Tracheostomy maskA7526 290 Tracheostomy tube collarA7527 290 Trach/laryn tube plug/stopA8000 290 Soft protect helmet prefabA8000 NU 290 Soft protect helmet prefabA8000 RR 290 Soft protect helmet prefabA8000 UE 290 Soft protect helmet prefabA8001 290 Hard protect helmet prefabA8001 NU 290 Hard protect helmet prefabA8001 RR 290 Hard protect helmet prefabA8001 UE 290 Hard protect helmet prefabA8002 290 Soft protect helmet customA8002 NU 290 Soft protect helmet customA8002 RR 290 Soft protect helmet customA8002 UE 290 Soft protect helmet customA8003 290 Hard protect helmet customA8003 NU 290 Hard protect helmet customA8003 RR 290 Hard protect helmet customA8003 UE 290 Hard protect helmet customA8004 290 Repl soft interface, helmetA8004 NU 290 Repl soft interface, helmetA8004 RR 290 Repl soft interface, helmetA8004 UE 290 Repl soft interface, helmetA9150 290 Misc/exper non-prescript drugA9155 290 Artificial salivaA9180 290 Lice treatment, topicalA9272 290 Disp wound suct, drsg/access A9274 290 Ext amb insulin delivery sysA9275 290 Disp home glucose monitorA9276 290 Disposable sensor, CGM sysA9277 290 External transmitter, CGMA9278 290 External receiver, CGM sysA9279 290 Monitoring feature/deviceNOCA9280 290 Alert device, nocA9281 290 Reaching/grabbing deviceA9282 290 Wig any typeA9283 290 Foot press off load supp devA9284 290 Non-electronic spirometerA9300 290 Exercise equipmentA9500 290 Technetium TC 99m sestamibi, per unitA9501 290 Technetium TC-99m teboroximeA9502 290 Technetium TC99M tetrofosmin, per unit


CPT/HCPCS MOD MOD LEV DESCRIPTIONA9503 290 Technetium TC 99m medronate, up to 30mciA9504 290 Technetium tc 99m apcitideA9505 290 Thallous chloride TL 201/mciA9507 290 Indium/111 capromab pendetid, per doseA9508 290 Iobenguane sulfate I-131, 0.5mciA9509 290 Iodine I-123 sod iodide milA9510 290 Technetium TC99m Disofenin, per vialA9512 290 Technetiumtc99mpertechnetateA9516 290 I-123 sodium iodide capsule, eaA9517 290 I-131 sodium iodide capsule, eaA9520 290 Technetiumtc-99m sulfur clld A9521 290 Technetiumtc-99m exametazineA9524 290 Iodinated I-131 serumalbumin, 5microcuriesA9526 290 Ammonia N-13, per doseA9527 290 Iodine I-125 sodium iodide, per millicurieA9528 290 Dx I131 so iodide cap, 1millicurieA9529 290 Dx I131 so iodide sol millicA9530 290 Th I131 so iodide sol millicA9531 290 Dx I131 so iodide microcurieA9532 290 I-125 serum albumin microA9536 290 Tc99m depreotideA9537 290 Tc99m mebrofeninA9538 290 Tc99m pyrophosphateA9539 290 Tc99m pentetateA9540 290 Tc99m MAAA9541 290 Tc99m sulfur colloidA9542 290 In111 ibritumomab, dxA9543 290 Y90 ibritumomab, rxA9544 290 I131 tositumomab, dxA9545 290 I131 tositumomab, rxA9546 290 Co57/58A9547 290 In111 oxyquinolineA9548 290 In111 pentetateA9550 290 Tc99m gluceptateA9551 290 Tc99m succimerA9552 290 F18 fdgA9553 290 Cr51 chromateA9554 290 I125 iothalamate, dxA9555 290 Rb82 rubidiumA9556 290 Ga67 galliumA9557 290 Tc99m bicisateA9558 290 Xe133 xenon 10mciA9559 290 Co57 cyanoA9560 290 Tc99m labeled rbcA9561 290 Tc99m oxidronateA9562 290 Tc99m mertiatideA9563 290 P32 Na phosphateA9564 290 P32 chromic phosphateA9566 290 Tc99m fanolesomabA9567 290 Technetium TC-99m aerosolA9568 290 Technetium TC99m arcitumomab, dx, up to 45 millicuriesA9569 290 Technetium TC-99m auto WBCA9570 290 Indium In-111 auto WBCA9571 290 Indium IN-111 auto plateletA9572 290 Indium In-111 pentetreotideA9575 290 Inj gadoterate meglumi 0.1ml A9576 290 Inj prohance multipackA9577 290 Inj multihanceA9578 290 Inj multihance multipackA9579 290 Gad-base MR contrast NOS,1mlA9580 290 Sodium fluoride F-18, up to 30 mciA9581 290 Inj. Gadoxetate disodium, 1 mlA9582 290 I-123 iobenguane, dx, up to 15 mciA9583 290 Inj. Gadofosveset trisodium, 1 mlA9584 290 Iodine i-123 ioflupaneA9585 290 Gadobutrol injection


CPT/HCPCS MOD MOD LEV DESCRIPTIONA9599 290 Radiopha dx beta amyloid pet A9600 290 Strontium-89 chloride, 1mciA9604 290 SM-153 lexidronam, up to 150 mciA9606 290 Radium RA223 dichloride therA9698 290 Non-rad contrast materialNOCA9699 290 Noc therapeutic radiopharmA9700 290 Echocardiography Contrast, per studyA9900 290 Supply/accessory/serviceA9901 290 Delivery/set up/dispensingA9999 290 DME supply or accessory, nosANIML 290 Animal cost in tx of A.C.ASSTR 290 Assisted Reemployment

ATP02 290 Auto.Test Pane Pricing Code, 1-2 Tests ATP03 290 Auto.Test Pane Pricing Code, 3 Tests ATP04 290 Auto.Test Pane Pricing Code, 4 Tests ATP05 290 Auto.Test Pane Pricing Code, 5 Tests ATP06 290 Auto.Test Pane Pricing Code, 6 Tests

ATP07 290 Auto.Test Pane Pricing Code, 7 Tests ATP08 290 Auto.Test Pane Pricing Code, 8 Tests ATP09 290 Auto.Test Pane Pricing Code, 9 Tests ATP10 290 Auto.Test Pane Pricing Code, 10 Tests

ATP11 290 Auto.Test Pane Pricing Code, 11 Tests ATP12 290 Auto.Test Pane Pricing Code, 12 Tests ATP16 290 Auto.Test Pane Pricing Code, 13 -16 Tests

ATP18 290 Auto.Test Pane Pricing Code, 17-18 Tests ATP19 290 Auto.Test Pane Pricing Code, 19 Tests ATP20 290 Auto.Test Pane Pricing Code, 20 Tests ATP21 290 Auto.Test Pane Pricing Code, 21 Tests

ATP22 290 Auto.Test Pane Pricing Code, 22 Tests ATP23 290 Auto.Test Pane Pricing Code, 23 Tests

ATTMD 290 Attending physician medical report requestB4034 290 Enter feed supkit syr by dayB4035 290 Enteral feed supp pump per dB4036 290 Enteral feed sup kit grav byB4081 290 Enteral ng tubing w/ styletB4082 290 Enteral ng tubing w/o styletB4083 290 Enteral stomach tube levineB4087 290 Gastro/jejuno tube, stdB4088 290 Gastro/jejuno tube, low-proB4100 290 Food thickener oralB4102 290 EF adult fluids and electroB4104 290 Additive for enteral formula (fiber)B4149 290 EF blenderized foodsB4150 290 Enteral formulae category iB4152 290 Enteral formulae category iiB4153 290 Enteral formulae category iiB4154 290 Enteral formulae category ivB4155 290 Enteral formulae category vB4157 290 EF special metabolic inheritB4164 290 Parenteral 50% dextrose soluB4168 290 Parenteral sol amino acid 3.B4172 290 Parenteral sol amino acid 5.B4176 290 Parenteral sol amino acid 7-B4178 290 Parenteral sol amino acid >B4180 290 Parenteral sol carb > 50%B4185 290 Parenteral sol 10 gm lipidsB4189 290 Parenteral sol amino acid &B4193 290 Parenteral sol 52-73 gm protB4197 290 Parenteral sol 74-100 gm proB4199 290 Parenteral sol > 100gm proteB4216 290 Parenteral nutrition additivB4220 290 Parenteral supply kit premixB4222 290 Parenteral supply kit homemiB4224 290 Parenteral administration kiB5000 290 Parenteral sol renal-amirosyB5100 290 Parenteral sol hepatic-fream


CPT/HCPCS MOD MOD LEV DESCRIPTIONB5200 290 Parenteral sol stres-brnch cB9000 290 Enter infusion pump w/o alrmB9000 NU 290 Enter infusion pump w/o alrmB9000 RR 290 Enter infusion pump w/o alrmB9000 UE 290 Enter infusion pump w/o alrmB9002 290 Enteral infusion pump w/ alaB9002 NU 290 Enteral infusion pump w/ alaB9002 RR 290 Enteral infusion pump w/ alaB9002 UE 290 Enteral infusion pump w/ alaB9004 290 Parenteral infus pump portabB9004 NU 290 Parenteral infus pump portabB9004 RR 290 Parenteral infus pump portabB9004 UE 290 Parenteral infus pump portabB9006 290 Parenteral infus pump statioB9006 NU 290 Parenteral infus pump statioB9006 RR 290 Parenteral infus pump statioB9006 UE 290 Parenteral infus pump statioB9998 290 Enteral supply, n.o.c.B9999 290 Parenteral supply, n.o.c.C1300 290 Hyperbaric O2, full body, 30 min end-dated 12/31/2014C1713 290 Anchor screw, implantableC1714 290 Catheter, transluminal atherectomy, direct'lC1716 290 Brachytherapy seed, gold 198C1717 290 Brachytherapy seed, hi dose iridium 192C1719 290 Brachytherapy seed, non-hi dose iridium 192C1724 290 Catheter, transluminal atherectomy, rotat'lC1725 290 Catheter, transluminal angioplasty, non-laserC1730 290 Catheter, electrophysiology, diag, < 20 electC1731 290 Catheter, electrophysiology, diag, > 19 electC1732 290 Catheter, electrophysiology, diag/ablation, 3D mapC1733 290 Catheter, electrophysiology, diag/ablationC1749 290 Endo, colon, retro imagingC1750 290 Catheter, hemodialysis, long-termC1751 290 Catheter, infusionC1752 290 Catheter, hemodialysis, short-termC1758 290 Catheter, ureteralC1760 290 Closure device, vascularC1766 290 Intro cheath, guiding, intracardiacC1767 290 Generator, neurostimulator non-rechargeC1769 290 Guide wireC1772 290 Infusion pump, programmableC1776 290 Joint deviceC1777 290 Lead, cardioverter-defibrillatorC1778 290 Lead, neurostimulatorC1779 290 Lead, pacemaker, transvenous VDDC1781 290 Mesh, implantableC1785 290 Pacemaker, dual chamber, rate responsC1786 290 Pacemaker, single chamber, rate responsC1787 290 Patient programmer, neurostimulatorC1788 290 Port, indwellingC1789 290 Prosthesis, breast, implantableC1819 290 Tissue localization-excision deviceC1820 290 Generator neurostim, implant, rechg bat syC1821 290 Interspinous proces distraction device, implantC1830 290 Powered bone marrow bx needleC1840 290 Telescopic intraocular lensC1874 290 Stent, coated/covered, w/deliv sysC1875 290 Stent, coated/covered, w/out deliv sysC1876 290 Stent, non-coat/cov, w/deliv sysC1877 290 Stent, non-coat/cov, w/out deliv sysC1879 290 Tissue marker, implantable end-dated 6/30/2013C1885 290 Catheter, transluminal angioplasty, laserC1886 290 Catheter, ablation C1887 290 Catheter, guidingC1891 290 Infusion pump, non-program, permanentC1892 290 Introducer/sheath, guiding, intracardiac elec


CPT/HCPCS MOD MOD LEV DESCRIPTIONC1893 290 Introducer/sheath, guiding, intracardiac elecC1894 290 Introducer/sheath, not guiding, intracardiac elecC1895 290 Lead, cardiovert-defibr, endocard dual coilC1896 290 Lead, cardiovert-defibr, not endocard dual coilC1897 290 Lead, neurostimulator test kitC1898 290 Lead, pacemaker, not transvenous VDDC1899 290 Lead, pacemaker/cardiovert-defibr combiC1900 290 Lead, coronary venousC2616 290 Brachytherapy seed, Yttrium-90C2617 290 Stent, non-coronary, temp, w/out deliv sysC2618 290 Probe/needle, cryo C2619 290 Pacemaker, dual chamber, non rate-respC2620 290 Pacemaker, single chamber, non rate-respC2624 290 Wireless pressure sensorC2625 290 Stent, non-coronary, temp, w/deliv sysC2626 290 Infusion pump, non-program, tempC2628 290 Catheter, occlusionC2629 290 Introducer/sheath, not guiding, intracardiac elecC2630 290 Catheter, elect, diag/ablation not 3D mapC2634 290 Brachytx source, HA, I-125C2635 290 Brachytx source, HA, P-103C2636 290 Brachytx linear source, P-103C2638 290 Brachytherapy seed, stranded, iodine-125C2639 290 Brachytherapy seed, non-stranded, iodine-125C2640 290 Brachytherapy seed, stranded, palladium-103C2641 290 Brachytherapy seed, non-stranded, palladium-103C2642 290 Brachytx source, stranded, Cesium-131C2643 290 Brachytx source, non-stranded, Cesium-131C2644 290 Brachytx Cesium-131 chlorideC2698 290 Brachytx, stranded, NOSC2699 290 Brachytx, non-stranded, NOSC5271 290 Low cost skin substitute app C5272 290 Low cost skin substitute app C5273 290 Low cost skin substitute app C5274 290 Low cost skin substitute app C5275 290 Low cost skin substitute app C5276 290 Low cost skin substitute app C5277 290 Low cost skin substitute app C5278 290 Low cost skin substitute app C8900 290 MRA w/contrast, abdomenC8901 290 MRA w/out contrast, abdomenC8902 290 MRA w/out + w/contrast, abdomenC8903 280 MRI w/contrast, breast, unilC8904 280 MRI w/out contrast, breast, unilC8905 280 MRI w/out + w/contrast, breast, unilC8906 250 MRI w/contrast, breast, bilC8907 250 MRI w/out contrast, breast, bilC8908 250 MRI w/out + w/contrast, breast, bilC8909 290 MRA w/contrast, chestC8910 290 MRA w/out contrast, chestC8911 290 MRA w/out + w/contrast, chestC8912 285 MRA w/contrast, lower extC8913 285 MRA w/out contrast, lower extC8914 285 MRA w/out + w/contrast, lower extC8918 290 MRA w/ contrast, pelvisC8919 290 MRA w/out contrast, pelvisC8920 290 MRA w/out & w/contrast, pelvisC8921 282 Comp transtho echo w/contrC8922 282 Limit transtho echo w/contrC8923 282 2D com transtho echo w/contrC8924 282 2D lim transtho echo w/contrC8925 282 2D TEE w/contrast, int/reptC8926 282 Cong TEE w/contr, int/reptC8927 282 TEE w/contrast; monitorC8928 290 2D transtho w/contr; stress


CPT/HCPCS MOD MOD LEV DESCRIPTIONC8931 290 MRA, w/dye, spinal canalC8932 290 MRA, w/o dye, spinal canalC8933 290 MRA, w/o&w/dye, spinal canalC8934 290 MRA, w/dye, upper extremity C8935 290 MRA, w/o dye, upper extr C8936 290 MRA, w/o&2/dye, upper extrC8957 282 Prolonged IV inf, req pumpC9022 290 Injection, elosulfate alfaC9025 290 Injection, RamucirumabC9026 290 Injection, VedolizumabC9027 290 Injection, PembrolizumabC9113 290 Injection, Pantoprazole sodium, per vialC9121 290 Injection, argatrobanC9130 290 Injection, ivig bivigam end-dated 12/31/2013C9131 290 Injection, ado-trastuzumab emtansine end-dated 12/31/2013C9133 290 Factor ix recombinant end-dated 12/31/2014C9134 290 Factor xiii recombinant end-dated 12/31/2014C9136 290 Factor VIII (Eloctate)C9248 290 Inj, clevidipine butyrateC9250 290 Artiss, fibrin sealant, 2mlC9254 290 Inj. Lacosamide, 1 mgC9255 290 Inj. Paliperidone palmitate, 1 mgC9256 290 Inj. Dexamethasone intravitreal impl, 0.1 mgC9257 290 Inj. Bevacizumab, 0.25 mgC9259 290 Pralatrexate injectionC9261 290 Ustekinumab injectionC9262 290 Fludarabine phosphate, oralC9275 290 Hexaminolevulinate hclC9285 290 Patch, lidocaine/tetracaineC9292 290 Injection, pertuzumab end-dated 12/31/2013C9293 290 Injection, glucarpidase C9295 290 Injection, carfilzomib end-dated 12/31/2013C9296 290 Injection, ziv-aflibercept end-dated 12/31/2013C9297 290 Omacetaxine mepesuccinate end-dated 12/31/2013C9298 290 Injection, ocriplasmin end-dated 12/31/2013C9349 290 Fortaderm, fortaderm antimicC9352 290 Neuragen nerve guide, per cmC9353 290 Neurawrap nerve protector,cmC9354 290 Veritas collagen matrix, cm2C9355 290 Neuromatrix nerve cuff, cmC9356 290 TendoGlideTendon Prot, cm2C9358 290 SurgiMend, 0.5cm2C9359 290 Implant, bone void fillerC9360 290 SurgiMend, 0.5 sq cmC9361 290 NeuroMend nerve wrap, 0.5 cmC9362 290 Implnt, bone void filler-strip, 0.5 ccC9363 290 Integra Meshed Bil Wound Mat, 1 sq cmC9364 290 Porcine implant, Permacol, 1 sq cmC9367 290 Endoform Dermal TemplateC9441 290 Inj, ferric carboxymaltose end-dated 6/30/2014C9442 290 Injection, BelinostatC9443 290 Injection, DalbavancinC9444 290 Injection, OritavancinC9446 290 Inj, Tedizolid PhosphateC9447 290 Inj, phenylephrine ketorolacC9497 290 Loxapine, inhalation powder C9600 290 Perc drug-el cor stent sing C9601 290 Perc drug-el cor stent bran C9602 290 Perc D-E cor stent ather s C9603 290 Perc D-E cor stent ather br C9604 290 Perc D-E cor revasc T cabg S C9605 290 Perc D-E cor revasc T cabg B C9606 290 Perc D-E cor revasc W ami S C9607 290 Perc D-E cor revasc chro sin


CPT/HCPCS MOD MOD LEV DESCRIPTIONC9608 290 Perc D-E cor revasc chro add C9724 283 EPS gast cardia plicC9725 283 Place endorectal appC9726 283 Rxt breast appl place/removC9727 283 Insert implants, soft palate; min of 3C9728 283 Place device/marker, non pro C9734 290 U/S trtmt, not leiomyomataC9736 008 Lap ablate uteri fibroid rfC9737 290 Lap esoph augmentationC9732 290 Insert ocular telescope pros C9742 290 Laryngoscopy with injectionC9800 290 Dermal filler inj px/supplC9898 290 Inpnt stay radiolabeled itemD0120 290 Periodic oral evaluationD0140 290 Limit oral eval problm focusD0150 270 Comprehensve oral evaluationD0160 290 Extensv oral eval prob focusD0170 290 Re-eval,est pt,problem focusD0180 290 Comp periodontal evaluationD0190 290 Screening of a patient D0191 290 Assessment of a patient D0210 290 Intraor complete film seriesD0220 290 Intraoral periapical first fD0230 290 Intraoral periapical ea addD0240 270 Intraoral occlusal filmD0250 270 Extraoral first filmD0260 270 Extraoral ea additional filmD0270 270 Dental bitewing single filmD0272 270 Dental bitewings two filmsD0273 290 Dental bitewings - three filmsD0274 270 Dental bitewings four filmsD0277 290 Vert bitewings-sev to eightD0290 290 Dental film skull/facial bonD0310 290 Dental saliographyD0320 290 Dental tmj arthrogram incl iD0321 290 Dental other tmj filmsD0322 290 Dental tomographic surveyD0330 290 Dental panoramic filmD0340 290 Dental cephalometric filmD0350 290 Oral/facial imagesD0360 290 Cone beam ctD0362 290 Cone beam, two dimensionalD0363 290 Cone beam, three dimensionalD0364 290 Cone beam ct capture and interpretation D0365 290 Cone beam ct capture and interpretation D0366 290 Cone beam ct capture and interpretation D0367 290 Cone beam ct capture and interpretation D0368 290 Cone beam ct capture and interpretation D0369 290 Maxillofacial MRI capture and interpretaD0370 290 Maxillofacial ultrasound capture and intD0371 290 Sialoendoscopy capture and interpretatioD0380 290 Cone beam CT image capture with limited D0381 290 Cone beam CT image capture with field ofD0382 290 Cone beam CT image capture with field ofD0383 290 Cone beam CT image captue with field of D0384 290 Cone beam CT image capture for TMJ serieD0385 290 Maxillofacial MRI image capture D0386 290 Maxillofacial ultrasound image capture D0391 290 Interpretation of diagnositc image by a D0415 290 Bacteriologic studyD0416 290 Viral cultureD0417 290 Collect & prep saliva sampleD0418 290 Analysis of saliva sampleD0421 290 Gen tst suscept oral diseaseD0425 290 Caries susceptibility test


CPT/HCPCS MOD MOD LEV DESCRIPTIOND0431 290 Diag tst detect mucos abnormD0460 270 Pulp vitality testD0470 290 Diagnostic castsD0472 290 Gross exam, prep & reportD0473 290 Micro exam, prep & reportD0474 290 Micro w exam of surg marginsD0475 290 Decalcification procedureD0476 290 Spec stains for microorganisD0477 290 Spec stains not for microorgD0478 290 Immunohistochemical stainsD0479 290 Tissue in-situ hybridizationD0480 290 Cytopath smear prep & reportD0481 290 Electron microscopy diagnostD0482 290 Direct immunofluorescenceD0483 290 Indirect immunofluorescenceD0484 290 Consult slides prep elsewherD0485 290 Consult inc prep of slidesD0486 290 Accession of brush biopsyD0502 270 Other oral pathology proceduD0999 270 Unspecified diagnostic proceD1110 290 Dental prophylaxis adultD1204 290 Topical fluor w/o prophy aduD1206 290 Topical fluoride varnishD1208 290 Topical application of fluorideD1310 290 Nutri counsel-control cariesD1320 290 Tobacco counselingD1330 290 Oral hygiene instructionD1351 290 Dental sealant per toothD1510 213 Space maintainer fxd unilatD1515 213 Fixed bilat space maintainerD1520 213 Remove unilat space maintainD1525 213 Remove bilat space maintainD1550 213 Recement space maintainerD1555 290 Remove fix space maintainerD2140 290 Amalgam one surface permanenD2150 290 Amalgam two surfaces permaneD2160 290 Amalgam three surfaces permaD2161 290 Amalgam 4 or > surfaces permD2330 290 Resin one surface-anteriorD2331 290 Resin two surfaces-anteriorD2332 290 Resin three surfaces-anterioD2335 290 Resin 4/> surf or w incis anD2390 290 Ant resin-based cmpst crownD2391 290 Post 1 srfc resinbased cmpstD2392 290 Post 2 srfc resinbased cmpstD2393 290 Post 3 srfc resinbased cmpstD2394 290 Post >=4srfc resinbase cmpstD2410 290 Dental gold foil one surfaceD2420 290 Dental gold foil two surfaceD2430 290 Dental gold foil three surfaD2510 290 Dental inlay metalic 1 surfD2520 290 Dental inlay metallic 2 surfD2530 290 Dental inlay metl 3/more surD2542 290 Dental onlay metallic 2 surfD2543 290 Dental onlay metallic 3 surfD2544 290 Dental onlay metl 4/more surD2610 290 Inlay porcelain/ceramic 1 suD2620 290 Inlay porcelain/ceramic 2 suD2630 290 Dental onlay porc 3/more surD2642 290 Dental onlay porcelin 2 surfD2643 290 Dental onlay porcelin 3 surfD2644 290 Dental onlay porc 4/more surD2650 290 Inlay composite/resin one suD2651 290 Inlay composite/resin two suD2652 290 Dental inlay resin 3/mre surD2662 290 Dental onlay resin 2 surface


CPT/HCPCS MOD MOD LEV DESCRIPTIOND2663 290 Dental onlay resin 3 surfaceD2664 290 Dental onlay resin 4/mre surD2710 290 Crown resin laboratoryD2712 290 Crown 3/4 resin-based composD2720 290 Crown resin w/ high noble meD2721 290 Crown resin w/ base metalD2722 290 Crown resin w/ noble metalD2740 290 Crown porcelain/ceramic subsD2750 290 Crown porcelain w/ h noble mD2751 290 Crown porcelain fused base mD2752 290 Crown porcelain w/ noble metD2780 290 Crown 3/4 cast hi noble metD2781 290 Crown 3/4 cast base metalD2782 290 Crown 3/4 cast noble metalD2783 290 Crown 3/4 porcelain/ceramicD2790 290 Crown full cast high noble mD2791 290 Crown full cast base metalD2792 290 Crown full cast noble metalD2794 290 Crown-titaniumD2799 290 Provisional crownD2910 290 Dental recement inlayD2915 290 Recement cast or prefab postD2920 290 Dental recement crownD2929 290 Prefabricated porcelain/ceramic crown D2930 290 Prefab stnlss steel crwn priD2931 290 Prefab stnlss steel crown peD2932 290 Prefabricated resin crownD2933 290 Prefab stainless steel crownD2934 290 Prefab steel crown primaryD2940 290 Dental sedative fillingD2950 290 Core build-up incl any pinsD2951 290 Tooth pin retentionD2952 290 Post and core cast + crownD2953 290 Each addtnl cast postD2954 290 Prefab post/core + crownD2955 290 Post removalD2957 290 Each addtnl prefab postD2960 290 Laminate labial veneerD2961 290 Lab labial veneer resinD2962 290 Lab labial veneer porcelainD2970 290 Temp crown (fractured tooth)D2971 290 Add proc construct new crownD2975 290 CopingD2980 290 Crown repairD2981 290 Inlay repair necessitated by restorativeD2982 290 Onlay repair necessitated by restorativeD2983 290 Veneer repair necessitated by restorativD2990 290 Resin infiltration of incipient smooth sD2999 270 Dental unspec restorative prD3110 290 Pulp cap directD3120 290 Pulp cap indirectD3220 290 Therapeutic pulpotomyD3221 290 Gross pulpal debridementD3222 290 Part pulp for apexogenesisD3230 290 Pulpal therapy anterior primD3240 290 Pulpal therapy posterior priD3310 290 AnteriorD3320 290 Root canal therapy 2 canalsD3330 290 Root canal therapy 3 canalsD3331 290 Non-surg tx root canal obsD3332 290 Incomplete endodontic txD3333 290 Internal root repairD3346 290 Retreat root canal anteriorD3347 290 Retreat root canal bicuspidD3348 290 Retreat root canal molarD3351 290 Apexification/recalc initial


CPT/HCPCS MOD MOD LEV DESCRIPTIOND3352 290 Apexification/recalc interimD3353 290 Apexification/recalc finalD3410 290 Apicoect/perirad surg anterD3421 290 Root surgery bicuspidD3425 290 Root surgery molarD3426 290 Root surgery ea add rootD3430 290 Retrograde fillingD3450 290 Root amputationD3460 213 Endodontic endosseous implanD3470 290 Intentional replantationD3910 290 Isolation- tooth w rubb damD3920 290 Tooth splittingD3950 290 Canal prep/fitting of dowelD3999 219 Endodontic procedure, nosD4210 290 Gingivectomy/plasty per quadD4211 290 Gingivectomy/plasty per tootD4212 290 Gingivectomy or gingivoplasty to allow aD4230 290 Ana crown exp 4 or> per quadD4231 290 Ana crown exp 1-3 per quadD4240 290 Gingival flap proc w/ planinD4241 290 Gngvl flap w rootplan 1-3 thD4245 290 Apically positioned flapD4249 290 Crown lengthen hard tissueD4260 268 Osseous surgery per quadrantD4261 290 Osseous surg, l-3 teeth/quadD4263 268 Bone replce graft first siteD4264 268 Bone replce graft each addD4265 290 Bio mtrls to aid soft/os regD4266 290 Guided tiss regen resorbleD4267 290 Guided tiss regen nonresorbD4268 290 Surgical revision procedureD4270 213 Pedicle soft tissue graft prD4271 213 Free soft tissue graft procD4273 213 Subepithelial tissue graftD4274 290 Distal/proximal wedge procD4275 290 Soft tissue allograftD4276 290 Con tissue w dble ped graftD4277 290 Free soft tissue graft procedure (indludD4278 290 Free soft tissue graft procedure (includeD4320 290 Provision splnt intracoronalD4321 290 Provisional splint extracoroD4341 290 Periodontal scaling & rootD4342 290 Periodontal scaling 1-3teethD4355 268 Full mouth debridementD4381 268 Localized chemo deliveryD4910 290 Periodontal maint proceduresD4920 290 Unscheduled dressing changeD4999 290 Unspecified periodontal procD5110 290 Dentures complete maxillaryD5120 290 Dentures complete mandibleD5130 290 Dentures immediat maxillaryD5140 290 Dentures immediat mandibleD5211 290 Dentures maxill part resinD5212 290 Dentures mand part resinD5213 290 Dentures maxill part metalD5214 290 Dentures mandibl part metalD5225 290 Maxillary part denture flexD5226 290 Mandibular part denture flexD5281 290 Removable partial dentureD5410 290 Dentures adjust cmplt maxilD5411 290 Dentures adjust cmplt mandD5421 290 Dentures adjust part maxillD5422 290 Dentures adjust part mandblD5510 290 Dentur repr broken compl basD5520 290 Replace denture teeth compltD5610 290 Dentures repair resin base


CPT/HCPCS MOD MOD LEV DESCRIPTIOND5620 290 Rep part denture cast frameD5630 290 Rep partial denture claspD5640 290 Replace part denture teethD5650 290 Add tooth to partial dentureD5660 290 Add clasp to partial dentureD5670 290 Replc tth&acrlc on mtl frmwkD5671 290 Replc tth&acrlc mandibularD5710 290 Dentures rebase cmplt maxilD5711 290 Dentures rebase cmplt mandD5720 290 Dentures rebase part maxillD5721 290 Dentures rebase part mandblD5730 290 Denture reln cmplt maxil chD5731 290 Denture reln cmplt mand chrD5740 290 Denture reln part maxil chrD5741 290 Denture reln part mand chrD5750 290 Denture reln cmplt max labD5751 290 Denture reln cmplt mand labD5760 290 Denture reln part maxil labD5761 290 Denture reln part mand labD5810 290 Denture interm cmplt maxillD5811 290 Denture interm cmplt mandblD5820 290 Denture interm part maxillD5821 290 Denture interm part mandblD5850 290 Denture tiss conditn maxillD5851 290 Denture tiss condtin mandblD5860 290 Overdenture completeD5861 290 Overdenture partialD5862 290 Precision attachmentD5867 290 Replacement of precision attD5875 290 Prosthesis modificationD5899 290 Removable prosthodontic procD5911 268 Facial moulage sectionalD5912 268 Facial moulage completeD5913 290 Nasal prosthesisD5914 290 Auricular prosthesisD5915 290 Orbital prosthesisD5916 290 Ocular prosthesisD5919 290 Facial prosthesisD5922 290 Nasal septal prosthesisD5923 290 Ocular prosthesis interimD5924 290 Cranial prosthesisD5925 290 Facial augmentation implantD5926 290 Replacement nasal prosthesisD5927 290 Auricular replacementD5928 290 Orbital replacementD5929 290 Facial replacementD5931 290 Surgical obturatorD5932 290 Postsurgical obturatorD5933 290 Refitting of obturatorD5934 290 Mandibular flange prosthesisD5935 290 Mandibular denture prosthD5936 290 Temp obturator prosthesisD5937 290 Trismus applianceD5951 268 Feeding aidD5953 290 Adult speech aidD5954 290 Superimposed prosthesisD5955 290 Palatal lift prosthesisD5958 290 Intraoral con def inter pltD5959 290 Intraoral con def mod palatD5960 290 Modify speech aid prosthesisD5982 290 Surgical stentD5983 268 Radiation applicatorD5984 268 Radiation shieldD5985 268 Radiation cone locatorD5986 290 Fluoride applicatorD5987 213 Commissure splint


CPT/HCPCS MOD MOD LEV DESCRIPTIOND5988 290 Surgical splintD5991 290 Topical medicament carrierD5999 290 Maxillofacial prosthesisD6010 290 Odontics endosteal implantD6012 290 Surg placement, Endosteal implantD6040 290 Odontics eposteal implantD6050 290 Odontics transosteal implntD6051 290 Interim abutment D6053 290 Implnt/abtmnt spprt remv dntD6054 290 Implnt/abtmnt spprt remvprtlD6055 290 Implant connecting barD6056 290 Prefabricated abutmentD6057 290 Custom abutmentD6058 290 Abutment supported crownD6059 290 Abutment supported mtl crownD6060 290 Abutment supported mtl crownD6061 290 Abutment supported mtl crownD6062 290 Abutment supported mtl crownD6063 290 Abutment supported mtl crownD6064 290 Abutment supported mtl crownD6065 290 Implant supported crownD6066 290 Implant supported mtl crownD6067 290 Implant supported mtl crownD6068 290 Abutment supported retainerD6069 290 Abutment supported retainerD6070 290 Abutment supported retainerD6071 290 Abutment supported retainerD6072 290 Abutment supported retainerD6073 290 Abutment supported retainerD6074 290 Abutment supported retainerD6075 290 Implant supported retainerD6076 290 Implant supported retainerD6077 290 Implant supported retainerD6078 290 Implnt/abut suprtd fixd dentD6079 290 Implnt/abut suprtd fixd dentD6080 290 Implant maintenanceD6090 290 Repair implantD6091 290 Repl semi/precision attachD6092 290 Recement supp crownD6093 290 Recement supp part dentureD6094 290 Abut support crown titaniumD6095 290 Odontics repr abutmentD6100 290 Removal of implantD6101 290 Debridement of a periimplant defect and D6102 290 Debridement and osseous contouring of a D6103 290 Bone graft for repair of periimplant defD6104 290 Bone graft at time of implant placement D6190 290 Radio/surgical implant indexD6194 290 Abut support retainer titaniD6199 290 Implant procedureD6205 290 Pontic-indirect resin basedD6210 290 Prosthodont high noble metalD6211 290 Bridge base metal castD6212 290 Bridge noble metal castD6214 290 Pontic titaniumD6240 290 Bridge porcelain high nobleD6241 290 Bridge porcelain base metalD6242 290 Bridge porcelain nobel metalD6245 290 Bridge porcelain/ceramicD6250 290 Bridge resin w/high nobleD6251 290 Bridge resin base metalD6252 290 Bridge resin w/noble metalD6253 290 Provisional ponticD6545 290 Dental retainr cast metlD6548 290 Porcelain/ceramic retainerD6600 290 Porcelain/ceramic inlay 2srf


CPT/HCPCS MOD MOD LEV DESCRIPTIOND6601 290 Porc/ceram inlay >= 3 surfacD6602 290 Cst hgh nble mtl inlay 2 srfD6603 290 Cst hgh nble mtl inlay >=3srD6604 290 Cst bse mtl inlay 2 surfacesD6605 290 Cst bse mtl inlay >= 3 surfaD6606 290 Cast noble metal inlay 2 surD6607 290 Cst noble mtl inlay >=3 surfD6608 290 Onlay porc/crmc 2 surfacesD6609 290 Onlay porc/crmc >=3 surfacesD6610 290 Onlay cst hgh nbl mtl 2 srfcD6611 290 Onlay cst hgh nbl mtl >=3srfD6612 290 Onlay cst base mtl 2 surfaceD6613 290 Onlay cst base mtl >=3 surfaD6614 290 Onlay cst nbl mtl 2 surfacesD6615 290 Onlay cst nbl mtl >=3 surfacD6624 290 Inlay titaniumD6634 290 Onlay titaniumD6710 290 Crown-indirect resin basedD6720 290 Retain crown resin w hi nbleD6721 290 Crown resin w/base metalD6722 290 Crown resin w/noble metalD6740 290 Crown porcelain/ceramicD6750 290 Crown porcelain high nobleD6751 290 Crown porcelain base metalD6752 290 Crown porcelain noble metalD6780 290 Crown 3/4 high noble metalD6781 290 Crown 3/4 cast based metalD6782 290 Crown 3/4 cast noble metalD6783 290 Crown 3/4 porcelain/ceramicD6790 290 Crown full high noble metalD6791 290 Crown full base metal castD6792 290 Crown full noble metal castD6793 290 Provisional retainer crownD6794 290 Crown titaniumD6920 213 Dental connector barD6930 290 Dental recement bridgeD6940 290 Stress breakerD6950 290 Precision attachmentD6970 290 Post & core plus retainerD6972 290 Prefab post & core plus retaD6973 290 Core build up for retainerD6975 290 Coping metalD6976 290 Each addtnl cast postD6977 290 Each addtl prefab postD6980 290 Bridge repairD6999 290 Fixed prosthodontic procD7111 290 Coronal remnants deciduous tD7140 290 Extraction erupted tooth/exrD7210 213 Rem imp tooth w mucoper flpD7220 213 Impact tooth remov soft tissD7230 213 Impact tooth remov part bonyD7240 213 Impact tooth remov comp bonyD7241 213 Impact tooth rem bony w/compD7250 213 Tooth root removalD7260 213 Oral antral fistula closureD7261 290 Primary closure sinus perfD7270 290 Tooth reimplantationD7272 290 Tooth transplantationD7280 290 Exposure impact tooth orthodD7282 290 Mobilize erupted/malpos tootD7283 290 Place device impacted toothD7285 290 Biopsy of oral tissue hardD7286 290 Biopsy of oral tissue softD7287 290 Cytology sample collectionD7288 290 Brush biopsyD7290 290 Repositioning of teeth


CPT/HCPCS MOD MOD LEV DESCRIPTIOND7291 213 Transseptal fiberotomyD7292 290 Screw retained plate w flapD7293 290 Temp anchorage dev w flapD7294 290 Temp anchorage dev w/o flapD7310 290 Alveoplasty w/ extractionD7311 290 Alveoloplasty w/extract 1-3D7320 290 Alveoplasty w/o extractionD7321 290 Alveoloplasty not w/extractsD7340 290 Vestibuloplasty ridge extensD7350 290 Vestibuloplasty exten graftD7410 290 Rad exc lesion up to 1.25 cmD7411 290 Excision benign lesion>1.25cD7412 290 Excision benign lesion complD7413 290 Excision malig lesion<=1.25cD7414 290 Excision malig lesion>1.25cmD7415 290 Excision malig les complicatD7440 290 Malig tumor exc to 1.25 cmD7441 290 Malig tumor > 1.25 cmD7450 290 Rem odontogen cyst to 1.25cmD7451 290 Rem odontogen cyst > 1.25 cmD7460 290 Rem nonodonto cyst to 1.25cmD7461 290 Rem nonodonto cyst > 1.25 cmD7465 290 Lesion destructionD7471 290 Rem exostosis any siteD7472 290 Removal of torus palatinusD7473 290 Remove torus mandibularisD7485 290 Surg reduct osseoustuberositD7490 290 Mandible resectionD7510 290 I&d absc intraoral soft tissD7511 290 Incision/drain abscess intraD7520 290 I&d abscess extraoralD7521 290 Incision/drain abscess extraD7530 290 Removal fb skin/areolar tissD7540 290 Removal of fb reactionD7550 290 Removal of sloughed off boneD7560 290 Maxillary sinusotomyD7610 290 Maxilla open reduct simpleD7620 290 Clsd reduct simpl maxilla fxD7630 290 Open red simpl mandible fxD7640 290 Clsd red simpl mandible fxD7650 290 Open red simp malar/zygom fxD7660 290 Clsd red simp malar/zygom fxD7670 290 Closd rductn splint alveolusD7671 290 Alveolus open reductionD7680 290 Reduct simple facial bone fxD7710 290 Maxilla open reduct compoundD7720 290 Clsd reduct compd maxilla fxD7730 290 Open reduct compd mandble fxD7740 290 Clsd reduct compd mandble fxD7750 290 Open red comp malar/zygma fxD7760 290 Clsd red comp malar/zygma fxD7770 290 Open reduc compd alveolus fxD7771 290 Alveolus clsd reduc stblz teD7780 290 Reduct compnd facial bone fxD7810 290 Tmj open reduct-dislocationD7820 290 Closed tmp manipulationD7830 290 Tmj manipulation under anestD7840 290 Removal of tmj condyleD7850 290 Tmj meniscectomyD7852 290 Tmj repair of joint discD7854 290 Tmj excisn of joint membraneD7856 290 Tmj cutting of a muscleD7858 290 Tmj reconstructionD7860 290 Tmj cutting into jointD7865 290 Tmj reshaping componentsD7870 290 Tmj aspiration joint fluid


CPT/HCPCS MOD MOD LEV DESCRIPTIOND7871 290 Lysis + lavage w cathetersD7872 290 Tmj diagnostic arthroscopyD7873 290 Tmj arthroscopy lysis adhesnD7874 290 Tmj arthroscopy disc repositD7875 290 Tmj arthroscopy synovectomyD7876 290 Tmj arthroscopy discectomyD7877 290 Tmj arthroscopy debridementD7880 290 Occlusal orthotic applianceD7899 290 Tmj unspecified therapyD7910 290 Dent sutur recent wnd to 5cmD7911 290 Dental suture wound to 5 cmD7912 290 Suture complicate wnd > 5 cmD7920 290 Dental skin graftD7921 290 Collection and application of autologousD7940 213 Reshaping bone orthognathicD7941 290 Bone cutting ramus closedD7943 290 Cutting ramus open w/graftD7944 290 Bone cutting segmentedD7945 290 Bone cutting body mandibleD7946 290 Reconstruction maxilla totalD7947 290 Reconstruct maxilla segmentD7948 290 Reconstruct midface no graftD7949 290 Reconstruct midface w/graftD7950 290 Mandible graftD7951 290 Sinus aug w bone/bone supD7952 290 Sinus augmentation via a vertical approaD7953 290 Bone replacement graftD7955 290 Repair maxillofacial defectsD7960 290 Frenulectomy/frenulotomyD7963 290 FrenuloplastyD7970 290 Excision hyperplastic tissueD7971 290 Excision pericoronal gingivaD7972 290 Surg redct fibrous tuberositD7980 290 SialolithotomyD7981 290 Excision of salivary glandD7982 290 SialodochoplastyD7983 290 Closure of salivary fistulaD7990 290 Emergency tracheotomyD7991 290 Dental coronoidectomyD7995 290 Synthetic graft facial bonesD7996 290 Implant mandible for augmentD7997 290 Appliance removalD7998 290 Intraoral place of fix devD7999 290 Oral surgery procedure, nosD8010 290 Limited dental tx primaryD8020 290 Limited dental tx transitionD8030 290 Limited dental tx adolescentD8040 290 Limited dental tx adultD8050 290 Intercep dental tx primaryD8060 290 Intercep dental tx transitnD8070 290 Compre dental tx transitionD8080 290 Compre dental tx adolescentD8090 290 Compre dental tx adultD8210 290 Orthodontic rem appliance txD8220 290 Fixed appliance therapy habtD8660 290 Preorthodontic tx visitD8670 290 Periodic orthodontc tx visitD8680 290 Orthodontic retentionD8690 290 Orthodontic treatmentD8691 290 Repair ortho applianceD8692 290 Replacement retainerD8693 290 Rebond/cement/repair retainD8999 290 Orthodontic procedure, nosD9110 213 Tx dental pain minor procD9120 290 Fix partial denture sectionD9210 290 Dent anesthesia w/o surgery


CPT/HCPCS MOD MOD LEV DESCRIPTIOND9211 290 Regional block anesthesiaD9212 290 Trigeminal block anesthesiaD9215 290 Local anesthesiaD9220 290 General anesthesiaD9221 290 General anesthesia ea ad 15mD9230 219 AnalgesiaD9241 290 Intravenous sedationD9242 290 IV sedation ea ad 30 mD9248 290 Sedation (non-iv)D9310 290 Dental consultationD9410 290 Dental house callD9420 290 Hospital callD9430 290 Office visit during hoursD9440 290 Office visit after hoursD9450 290 Case presentation tx planD9610 290 Dent therapeutic drug injectD9612 290 Thera par drugs 2 or > adminD9630 219 Other drugs/medicamentsD9910 290 Dent appl desensitizing medD9911 290 Appl desensitizing resinD9920 290 Behavior managementD9930 213 Treatment of complicationsD9940 213 Dental occlusal guardD9941 290 Fabrication athletic guardD9942 290 Repair/reline occlusal guardD9950 213 Occlusion analysisD9951 213 Limited occlusal adjustmentD9952 213 Complete occlusal adjustmentD9970 290 Enamel microabrasionD9971 290 Odontoplasty 1-2 teethD9972 290 Extrnl bleaching per archD9973 290 Extrnl bleaching per toothD9974 290 Intrnl bleaching per toothD9999 290 Adjunctive procedure, nosE0100 290 Cane adjust/fixed with tipE0100 NU 290 Cane adjust/fixed with tipE0100 RR 290 Cane adjust/fixed with tipE0100 UE 290 Cane adjust/fixed with tipE0105 290 Cane adjust/fixed quad/3 proE0105 NU 290 Cane adjust/fixed quad/3 proE0105 RR 290 Cane adjust/fixed quad/3 proE0105 UE 290 Cane adjust/fixed quad/3 proE0110 290 Crutch forearm pairE0110 NU 290 Crutch forearm pairE0110 RR 290 Crutch forearm pairE0110 UE 290 Crutch forearm pairE0111 290 Crutch forearm eachE0111 NU 290 Crutch forearm eachE0111 RR 290 Crutch forearm eachE0111 UE 290 Crutch forearm eachE0112 290 Crutch underarm pair woodE0112 NU 290 Crutch underarm pair woodE0112 RR 290 Crutch underarm pair woodE0112 UE 290 Crutch underarm pair woodE0113 290 Crutch underarm each woodE0113 NU 290 Crutch underarm each woodE0113 RR 290 Crutch underarm each woodE0113 UE 290 Crutch underarm each woodE0114 290 Crutch underarm pair no woodE0114 NU 290 Crutch underarm pair no woodE0114 RR 290 Crutch underarm pair no woodE0114 UE 290 Crutch underarm pair no woodE0116 290 Crutch underarm each no woodE0116 NU 290 Crutch underarm each no woodE0116 RR 290 Crutch underarm each no woodE0116 UE 290 Crutch underarm each no wood


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0117 290 Underarm springassist crutchE0117 NU 290 Underarm springassist crutchE0117 RR 290 Underarm springassist crutchE0117 UE 290 Underarm springassist crutchE0118 290 Cruth substitute, lwr leg platformE0118 NU 290 Cruth substitute, lwr leg platformE0118 RR 290 Cruth substitute, lwr leg platformE0118 UE 290 Cruth substitute, lwr leg platformE0130 290 Walker rigid adjust/fixed htE0130 NU 290 Walker rigid adjust/fixed htE0130 RR 290 Walker rigid adjust/fixed htE0130 UE 290 Walker rigid adjust/fixed htE0135 290 Walker folding adjust/fixedE0135 NU 290 Walker folding adjust/fixedE0135 RR 290 Walker folding adjust/fixedE0135 UE 290 Walker folding adjust/fixedE0140 290 Walker w trunk supportE0140 NU 290 Walker w trunk supportE0140 RR 290 Walker w trunk supportE0140 UE 290 Walker w trunk supportE0141 290 Rigid walker wheeled wo seatE0141 NU 290 Rigid wheeled walker adj/fixE0141 RR 290 Rigid wheeled walker adj/fixE0141 UE 290 Rigid wheeled walker adj/fixE0143 290 Walker folding wheeled w/o sE0143 NU 290 Walker folding wheeled w/o sE0143 RR 290 Walker folding wheeled w/o sE0143 UE 290 Walker folding wheeled w/o sE0144 290 Enclosed walker w rear seatE0144 NU 290 Enclosed walker w rear seatE0144 RR 290 Enclosed walker w rear seatE0144 UE 290 Enclosed walker w rear seatE0147 290 Walker variable wheel resistE0147 NU 290 Walker variable wheel resistE0147 RR 290 Walker variable wheel resistE0147 UE 290 Walker variable wheel resistE0148 290 Heavyduty walker no wheelsE0148 NU 290 Heavyduty walker no wheelsE0148 RR 290 Heavyduty walker no wheelsE0148 UE 290 Heavyduty walker no wheelsE0149 290 Heavy duty wheeled walkerE0149 NU 290 Heavy duty wheeled walkerE0149 RR 290 Heavy duty wheeled walkerE0149 UE 290 Heavy duty wheeled walkerE0153 290 Forearm crutch platform attaE0153 NU 290 Forearm crutch platform attaE0153 RR 290 Forearm crutch platform attaE0153 UE 290 Forearm crutch platform attaE0154 290 Walker platform attachmentE0154 NU 290 Walker platform attachmentE0154 RR 290 Walker platform attachmentE0154 UE 290 Walker platform attachmentE0155 290 Walker wheel attachmentE0155 NU 290 Walker wheel attachmentE0155 RR 290 Walker wheel attachmentE0155 UE 290 Walker wheel attachmentE0156 290 Walker seat attachmentE0156 NU 290 Walker seat attachmentE0156 RR 290 Walker seat attachmentE0156 UE 290 Walker seat attachmentE0157 290 Walker crutch attachmentE0157 NU 290 Walker crutch attachmentE0157 RR 290 Walker crutch attachmentE0157 UE 290 Walker crutch attachmentE0158 290 Walker leg extenders set of4E0158 NU 290 Walker leg extenders set of4


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0158 RR 290 Walker leg extenders set of4E0158 UE 290 Walker leg extenders set of4E0159 290 Brake for wheeled walkerE0159 NU 290 Brake for wheeled walkerE0159 RR 290 Brake for wheeled walkerE0159 UE 290 Brake for wheeled walkerE0160 290 Sitz type bath or equipmentE0160 NU 290 Sitz type bath or equipmentE0160 RR 290 Sitz type bath or equipmentE0160 UE 290 Sitz type bath or equipmentE0161 290 Sitz bath/equipment w/faucetE0161 NU 290 Sitz bath/equipment w/faucetE0161 RR 290 Sitz bath/equipment w/faucetE0161 UE 290 Sitz bath/equipment w/faucetE0162 290 Sitz bath chairE0162 NU 290 Sitz bath chairE0162 RR 290 Sitz bath chairE0162 UE 290 Sitz bath chairE0163 290 Commode chair stationry fxdE0163 NU 290 Commode chair stationry fxdE0163 RR 290 Commode chair stationry fxdE0163 UE 290 Commode chair stationry fxdE0165 290 Commode chair stationry detE0165 NU 290 Commode chair stationry detE0165 RR 290 Commode chair stationry detE0165 UE 290 Commode chair stationry detE0167 290 Commode chair pail or panE0167 NU 290 Commode chair pail or panE0167 RR 290 Commode chair pail or panE0167 UE 290 Commode chair pail or panE0168 290 Heavyduty/wide commode chairE0168 NU 290 Heavyduty/wide commode chairE0168 RR 290 Heavyduty/wide commode chairE0168 UE 290 Heavyduty/wide commode chairE0170 290 Commode chair electricE0170 NU 290 Commode chair electricE0170 RR 290 Commode chair electricE0170 UE 290 Commode chair electricE0171 290 Commode chair non-electricE0171 NU 290 Commode chair non-electricE0171 RR 290 Commode chair non-electricE0171 UE 290 Commode chair non-electricE0172 290 Seat lift mechanism toiletE0175 290 Commode chair foot restE0175 NU 290 Commode chair foot restE0175 RR 290 Commode chair foot restE0175 UE 290 Commode chair foot restE0181 290 Press pad alternating w/ pumE0181 NU 290 Press pad alternating w/ pumE0181 RR 290 Press pad alternating w/ pumE0181 UE 290 Press pad alternating w/ pumE0182 290 Pressure pad alternating pumE0182 NU 290 Pressure pad alternating pumE0182 RR 290 Pressure pad alternating pumE0182 UE 290 Pressure pad alternating pumE0184 290 Dry pressure mattressE0184 NU 290 Dry pressure mattressE0184 RR 290 Dry pressure mattressE0184 UE 290 Dry pressure mattressE0185 290 Gel pressure mattress padE0185 NU 290 Gel pressure mattress padE0185 RR 290 Gel pressure mattress padE0185 UE 290 Gel pressure mattress padE0186 290 Air pressure mattressE0186 NU 290 Air pressure mattressE0186 RR 290 Air pressure mattress


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0186 UE 290 Air pressure mattressE0187 290 Water pressure mattressE0187 NU 290 Water pressure mattressE0187 RR 290 Water pressure mattressE0187 UE 290 Water pressure mattressE0188 290 Synthetic sheepskin padE0188 NU 290 Synthetic sheepskin padE0188 RR 290 Synthetic sheepskin padE0188 UE 290 Synthetic sheepskin padE0189 290 Lambswool sheepskin pad, any sizeE0189 NU 290 Lambswool sheepskin padE0189 RR 290 Lambswool sheepskin padE0189 UE 290 Lambswool sheepskin padE0190 290 Positioning cushionE0190 NU 290 Positioning cushionE0191 290 Protector heel or elbowE0191 NU 290 Protector heel or elbowE0191 RR 290 Protector heel or elbowE0191 UE 290 Protector heel or elbowE0193 290 Powered air flotation bedE0193 NU 290 Powered air flotation bedE0193 RR 290 Powered air flotation bedE0193 UE 290 Powered air flotation bedE0194 290 Air fluidized bedE0194 NU 290 Air fluidized bedE0194 RR 290 Air fluidized bedE0194 UE 290 Air fluidized bedE0196 290 Gel pressure mattressE0196 NU 290 Gel pressure mattressE0196 RR 290 Gel pressure mattressE0196 UE 290 Gel pressure mattressE0197 290 Air pressure pad for mattresE0197 NU 290 Air pressure pad for mattresE0197 RR 290 Air pressure pad for mattresE0197 UE 290 Air pressure pad for mattresE0198 290 Water pressure pad for mattrE0198 NU 290 Water pressure pad for mattrE0198 RR 290 Water pressure pad for mattrE0198 UE 290 Water pressure pad for mattrE0199 290 Dry pressure pad for mattresE0199 NU 290 Dry pressure pad for mattresE0199 RR 290 Dry pressure pad for mattresE0199 UE 290 Dry pressure pad for mattresE0200 290 Heat lamp without standE0200 NU 290 Heat lamp without standE0200 RR 290 Heat lamp without standE0200 UE 290 Heat lamp without standE0202 290 Phototherapy light w/ photomE0202 NU 290 Phototherapy light w/ photomE0202 RR 290 Phototherapy light w/ photomE0202 UE 290 Phototherapy light w/ photomE0203 290 Therapeutic lightbox tabletpE0203 NU 290 Therapeutic lightbox tabletpE0203 RR 290 Therapeutic lightbox tabletpE0203 UE 290 Therapeutic lightbox tabletpE0205 290 Heat lamp with standE0205 NU 290 Heat lamp with standE0205 RR 290 Heat lamp with standE0205 UE 290 Heat lamp with standE0210 290 Electric heat pad standardE0210 NU 290 Electric heat pad standardE0210 RR 290 Electric heat pad standardE0210 UE 290 Electric heat pad standardE0215 290 Electric heat pad moistE0215 NU 290 Electric heat pad moistE0215 RR 290 Electric heat pad moist


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0215 UE 290 Electric heat pad moistE0217 290 Water circ heat pad w pumpE0217 NU 290 Water circ heat pad w pumpE0217 RR 290 Water circ heat pad w pumpE0217 UE 290 Water circ heat pad w pumpE0218 290 H20 circulating cold pad w/pumpE0218 NU 290 H20 circulating cold pad w/pumpE0220 290 Hot water bottleE0220 NU 290 Hot water bottleE0220 RR 290 Hot water bottleE0220 UE 290 Hot water bottleE0221 290 Infrared heating pad sysE0221 NU 290 Infrared heating pad systemE0221 RR 290 Infrared heating pad systemE0221 UE 290 Infrared heating pad systemE0225 290 Hydrocollator unitE0225 NU 290 Hydrocollator unitE0225 RR 290 Hydrocollator unitE0225 UE 290 Hydrocollator unitE0230 290 Ice cap or collarE0230 NU 290 Ice cap or collarE0230 RR 290 Ice cap or collarE0230 UE 290 Ice cap or collarE0231 290 Non-contact wound warm deviceE0231 NU 290 Non-contact wound warm deviceE0231 RR 290 Non-contact wound warm deviceE0231 UE 290 Non-contact wound warm deviceE0232 290 Warming card for use w/E0231E0232 NU 290 Warming card for use w/E0231E0232 RR 290 Warming card for use w/E0231E0232 UE 290 Warming card for use w/E0231E0235 290 Paraffin bath unit portableE0235 NU 290 Paraffin bath unit portableE0235 RR 290 Paraffin bath unit portableE0235 UE 290 Paraffin bath unit portableE0236 290 Pump for water circulating pE0236 NU 290 Pump for water circulating pE0236 RR 290 Pump for water circulating pE0236 UE 290 Pump for water circulating pE0238 290 Heat pad non-electric moistE0238 NU 290 Heat pad non-electric moistE0238 RR 290 Heat pad non-electric moistE0238 UE 290 Heat pad non-electric moistE0239 290 Hydrocollator unit portableE0239 NU 290 Hydrocollator unit portableE0239 RR 290 Hydrocollator unit portableE0239 UE 290 Hydrocollator unit portableE0240 290 Bath/shower chairE0240 NU 290 Bath/shower chairE0240 RR 290 Bath/shower chairE0240 UE 290 Bath/shower chairE0241 290 Bathtub wall rail, eachE0241 NU 290 Bathtub wall rail, eachE0242 290 Bathtub rail, floor baseE0242 NU 290 Bathtub rail, floor baseE0243 290 Toilet rail, eachE0243 NU 290 Toilet rail, eachE0244 290 Raised toilet seatE0244 NU 290 Raised toilet seatE0245 290 Tub stool or benchE0245 NU 290 Tub stool or benchE0246 290 Transfer tub rail attachmentE0246 NU 290 Transfer tub rail attachmentE0247 290 Trans bench w/wo comm openE0247 NU 290 Trans bench w/wo comm openE0247 RR 290 Trans bench w/wo comm open


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0247 UE 290 Trans bench w/wo comm openE0248 290 HDtrans bench w/wo comm openE0248 NU 290 HDtrans bench w/wo comm openE0248 RR 290 HDtrans bench w/wo comm openE0248 UE 290 HDtrans bench w/wo comm openE0249 290 Pad water circulating heat uE0249 NU 290 Pad water circulating heat uE0249 RR 290 Pad water circulating heat uE0249 UE 290 Pad water circulating heat uE0250 290 Hosp bed fixed ht w/ mattresE0250 NU 290 Hosp bed fixed ht w/ mattresE0250 RR 290 Hosp bed fixed ht w/ mattresE0250 UE 290 Hosp bed fixed ht w/ mattresE0251 290 Hosp bed fixd ht w/o mattresE0251 NU 290 Hosp bed fixd ht w/o mattresE0251 RR 290 Hosp bed fixd ht w/o mattresE0251 UE 290 Hosp bed fixd ht w/o mattresE0255 290 Hospital bed var ht w/ mattrE0255 NU 290 Hospital bed var ht w/ mattrE0255 RR 290 Hospital bed var ht w/ mattrE0255 UE 290 Hospital bed var ht w/ mattrE0256 290 Hospital bed var ht w/o mattE0256 NU 290 Hospital bed var ht w/o mattE0256 RR 290 Hospital bed var ht w/o mattE0256 UE 290 Hospital bed var ht w/o mattE0260 290 Hosp bed semi-electr w/ mattE0260 NU 290 Hosp bed semi-electr w/ mattE0260 RR 290 Hosp bed semi-electr w/ mattE0260 UE 290 Hosp bed semi-electr w/ mattE0261 290 Hosp bed semi-electr w/o matE0261 NU 290 Hosp bed semi-electr w/o matE0261 RR 290 Hosp bed semi-electr w/o matE0261 UE 290 Hosp bed semi-electr w/o matE0265 290 Hosp bed total electr w/ matE0265 NU 290 Hosp bed total electr w/ matE0265 RR 290 Hosp bed total electr w/ matE0265 UE 290 Hosp bed total electr w/ matE0266 290 Hosp bed total elec w/o mattE0266 NU 290 Hosp bed total elec w/o mattE0266 RR 290 Hosp bed total elec w/o mattE0266 UE 290 Hosp bed total elec w/o mattE0270 290 Hosp bed institu type w/matE0271 290 Mattress innerspringE0271 NU 290 Mattress innerspringE0271 RR 290 Mattress innerspringE0271 UE 290 Mattress innerspringE0272 290 Mattress foam rubberE0272 NU 290 Mattress foam rubberE0272 RR 290 Mattress foam rubberE0272 UE 290 Mattress foam rubberE0273 290 Bed boardE0273 NU 290 Bed boardE0273 RR 290 Bed boardE0273 UE 290 Bed boardE0274 290 Over-bed tableE0274 NU 290 Over-bed tableE0274 RR 290 Over-bed tableE0274 UE 290 Over-bed tableE0275 290 Bed pan standardE0275 NU 290 Bed pan standardE0275 RR 290 Bed pan standardE0275 UE 290 Bed pan standardE0276 290 Bed pan fractureE0276 NU 290 Bed pan fractureE0276 RR 290 Bed pan fractureE0276 UE 290 Bed pan fracture


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0277 290 Powered pres-redu air mattrsE0277 NU 290 Powered pres-redu air mattrsE0277 RR 290 Powered pres-redu air mattrsE0277 UE 290 Powered pres-redu air mattrsE0280 290 Bed cradleE0280 NU 290 Bed cradleE0280 RR 290 Bed cradleE0280 UE 290 Bed cradleE0290 290 Hosp bed fx ht w/o rails w/mE0290 NU 290 Hosp bed fx ht w/o rails w/mE0290 RR 290 Hosp bed fx ht w/o rails w/mE0290 UE 290 Hosp bed fx ht w/o rails w/mE0291 290 Hosp bed fx ht w/o rail w/oE0291 NU 290 Hosp bed fx ht w/o rail w/oE0291 RR 290 Hosp bed fx ht w/o rail w/oE0291 UE 290 Hosp bed fx ht w/o rail w/oE0292 290 Hosp bed var ht w/o rail w/oE0292 NU 290 Hosp bed var ht w/o rail w/oE0292 RR 290 Hosp bed var ht w/o rail w/oE0292 UE 290 Hosp bed var ht w/o rail w/oE0293 290 Hosp bed var ht w/o rail w/E0293 NU 290 Hosp bed var ht w/o rail w/E0293 RR 290 Hosp bed var ht w/o rail w/E0293 UE 290 Hosp bed var ht w/o rail w/E0294 290 Hosp bed semi-elect w/ mattrE0294 NU 290 Hosp bed semi-elect w/ mattrE0294 RR 290 Hosp bed semi-elect w/ mattrE0294 UE 290 Hosp bed semi-elect w/ mattrE0295 290 Hosp bed semi-elect w/o mattE0295 NU 290 Hosp bed semi-elect w/o mattE0295 RR 290 Hosp bed semi-elect w/o mattE0295 UE 290 Hosp bed semi-elect w/o mattE0296 290 Hosp bed total elect w/ mattE0296 NU 290 Hosp bed total elect w/ mattE0296 RR 290 Hosp bed total elect w/ mattE0296 UE 290 Hosp bed total elect w/ mattE0297 290 Hosp bed total elect w/o matE0297 NU 290 Hosp bed total elect w/o matE0297 RR 290 Hosp bed total elect w/o matE0297 UE 290 Hosp bed total elect w/o matE0301 290 HD hosp bedE0301 NU 290 HD hosp bedE0301 RR 290 HD hosp bedE0301 UE 290 HD hosp bedE0302 290 Ex hd hosp bed > 600 lbsE0302 NU 290 Ex hd hosp bed > 600 lbsE0302 RR 290 Ex hd hosp bed > 600 lbsE0302 UE 290 Ex hd hosp bed > 600 lbsE0303 290 Hosp bed hvy dty xtra wideE0303 NU 290 Hosp bed hvy dty xtra wideE0303 RR 290 Hosp bed hvy dty xtra wideE0303 UE 290 Hosp bed hvy dty xtra wideE0304 290 Hosp bed xtra hvy dty x wideE0304 NU 290 Hosp bed xtra hvy dty x wideE0304 RR 290 Hosp bed xtra hvy dty x wideE0304 UE 290 Hosp bed xtra hvy dty x wideE0305 290 Rails bed side half lengthE0305 NU 290 Rails bed side half lengthE0305 RR 290 Rails bed side half lengthE0305 UE 290 Rails bed side half lengthE0310 290 Rails bed side full lengthE0310 NU 290 Rails bed side full lengthE0310 RR 290 Rails bed side full lengthE0310 UE 290 Rails bed side full lengthE0315 290 Bed accessory; board/table/supportE0316 290 Safety enclos frame/canopy for hosp bed


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0316 NU 290 Safety enclos frame/canopy for hosp bedE0316 RR 290 Bed safety enclosureE0316 UE 290 Safety enclos frame/canopy for hosp bedE0325 290 Urinal male jug-typeE0325 NU 290 Urinal male jug-typeE0325 RR 290 Urinal male jug-typeE0325 UE 290 Urinal male jug-typeE0326 290 Urinal female jug-typeE0326 NU 290 Urinal female jug-typeE0326 RR 290 Urinal female jug-typeE0326 UE 290 Urinal female jug-typeE0350 290 Cont unit, electronic bowel irrigaE0352 290 Dispos pack, use w/electronic irrigaE0370 290 Air elevator for heelE0370 NU 290 Air elevator for heelE0370 RR 290 Air elevator for heelE0370 UE 290 Air elevator for heelE0371 290 Nonpower mattress overlayE0371 NU 290 Nonpower mattress overlayE0371 RR 290 Nonpower mattress overlayE0371 UE 290 Nonpower mattress overlayE0372 290 Powered air mattress overlayE0372 NU 290 Powered air mattress overlayE0372 RR 290 Powered air mattress overlayE0372 UE 290 Powered air mattress overlayE0373 290 Nonpowered pressure mattressE0373 NU 290 Nonpowered pressure mattressE0373 RR 290 Nonpowered pressure mattressE0373 UE 290 Nonpowered pressure mattressE0424 290 Stationary compressed gas 02, rentalE0424 RR 290 Stationary compressed gas 02, rentalE0425 290 Stationary compressed gas 02, purchaseE0425 NU 290 Stationary compressed gas 02, purchaseE0425 UE 290 Stationary compressed gas 02, purchaseE0430 290 Portable gaseous 02, purchaseE0430 NU 290 Portable gaseous 02, purchaseE0430 UE 290 Portable gaseous 02, purchaseE0431 290 Portable gaseous 02, rentalE0431 RR 290 Portable gaseous 02, rentalE0433 290 Portable liquid O2 system, rentalE0433 RR 290 Portable liquid O2 system, rentalE0434 290 Portable liquid 02, rentalE0434 RR 290 Portable liquid 02, rentalE0435 290 Portable liquid 02, purchaseE0435 NU 290 Portable liquid 02, purchaseE0435 UE 290 Portable liquid 02, purchaseE0439 290 Stationary liquid 02, rentalE0439 RR 290 Stationary liquid 02, rentalE0440 290 Stationary liquid 02, purchaseE0440 NU 290 Stationary liquid 02, purchaseE0440 UE 290 Stationary liquid 02, purchaseE0441 290 Oxygen contents, gaseousE0442 290 Oxygen contents, liquidE0443 290 Portable 02 contentsE0444 290 Portable 02 contentsE0445 290 Oximeter non-invasiveE0445 NU 290 Oximeter non-invasiveE0445 RR 290 Oximeter non-invasiveE0445 UE 290 Oximeter non-invasiveE0446 290 Topical ox deliver sys, nosE0450 290 Volume vent stationary/portaE0450 NU 290 Volume vent stationary/portaE0450 RR 290 Volume vent stationary/portaE0450 UE 290 Volume vent stationary/portaE0455 290 O2 tent, excl croup/pediatric tentsE0457 290 Chest shell


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0457 NU 290 Chest shellE0457 RR 290 Chest shellE0457 UE 290 Chest shellE0459 290 Chest wrapE0459 NU 290 Chest wrapE0459 RR 290 Chest wrapE0459 UE 290 Chest wrapE0460 290 Neg press vent portabl/statnE0460 NU 290 Neg press vent portabl/statnE0460 RR 290 Neg press vent portabl/statnE0460 UE 290 Neg press vent portabl/statnE0461 290 Vol vent noninvasive interfaE0461 NU 290 Vol vent noninvasive interfaE0461 RR 290 Vol vent noninvasive interfaE0461 UE 290 Vol vent noninvasive interfaE0462 290 Rocking bed w/ or w/o side rE0462 NU 290 Rocking bed w/ or w/o side rE0462 RR 290 Rocking bed w/ or w/o side rE0462 UE 290 Rocking bed w/ or w/o side rE0463 290 Press supp vent invasive intE0463 RR 290 Press supp vent invasive intE0464 290 Press supp vent invasive intE0464 RR 290 Press supp vent invasive intE0470 290 RAD w/o backup non-inv intfcE0470 NU 290 RAD w/o backup non-inv intfcE0470 RR 290 RAD w/o backup non-inv intfcE0470 UE 290 RAD w/o backup non-inv intfcE0471 290 RAD w/backup non inv intrfcE0471 NU 290 RAD w/backup non inv intrfcE0471 RR 290 RAD w/backup non inv intrfcE0471 UE 290 RAD w/backup non inv intrfcE0472 290 RAD w backup invasive intrfcE0472 NU 290 RAD w backup invasive intrfcE0472 RR 290 RAD w backup invasive intrfcE0472 UE 290 RAD w backup invasive intrfcE0480 290 Percussor elect/pneum home mE0480 NU 290 Percussor elect/pneum home mE0480 RR 290 Percussor elect/pneum home mE0480 UE 290 Percussor elect/pneum home mE0481 290 Intrapulmonary perc vent sys + accessE0481 NU 290 Intrapulmonary perc vent sys + accessE0481 RR 290 Intrapulmonary perc vent sys + accessE0481 UE 290 Intrapulmonary perc vent sys + accessE0482 290 Cough stimulat device, alt +/- air pressE0482 NU 290 Cough stimulat device, alt +/- air pressE0482 RR 290 Cough stimulating deviceE0482 UE 290 Cough stimulat device, alt +/- air pressE0483 290 Chest compression gen systemE0483 NU 290 Chest compression gen systemE0483 RR 290 Chest compression gen systemE0483 UE 290 Chest compression gen systemE0484 290 Non-elec oscillatory pep dvcE0484 NU 290 Non-elec oscillatory pep dvcE0484 RR 290 Non-elec oscillatory pep dvcE0484 UE 290 Non-elec oscillatory pep dvcE0485 290 Oral device/appliance prefabE0485 NU 290 Oral device/appliance prefabE0485 RR 290 Oral device/appliance prefabE0485 UE 290 Oral device/appliance prefabE0486 290 Oral device/appliance cusfabE0486 NU 290 Oral device/appliance cusfabE0487 290 Electronic spirometerE0500 290 Ippb all typesE0500 NU 290 Ippb all typesE0500 RR 290 Ippb all typesE0500 UE 290 Ippb all types


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0550 290 Humidif extens supple w ippbE0550 NU 290 Humidif extens supple w ippbE0550 RR 290 Humidif extens supple w ippbE0550 UE 290 Humidif extens supple w ippbE0555 290 Humidifier for use w/ regulaE0555 NU 290 Humidifier for use w/ regulaE0560 290 Humidifier supplemental w/ iE0560 NU 290 Humidifier supplemental w/ iE0560 RR 290 Humidifier supplemental w/ iE0560 UE 290 Humidifier supplemental w/ iE0561 290 Humidifier nonheated w PAPE0561 NU 290 Humidifier nonheated w PAPE0561 RR 290 Humidifier nonheated w PAPE0561 UE 290 Humidifier nonheated w PAPE0562 290 Humidifier heated used w PAPE0562 NU 290 Humidifier heated used w PAPE0562 RR 290 Humidifier heated used w PAPE0562 UE 290 Humidifier heated used w PAPE0565 290 Compressor air power sourceE0565 NU 290 Compressor air power sourceE0565 RR 290 Compressor air power sourceE0565 UE 290 Compressor air power sourceE0570 290 Nebulizer with compressionE0570 NU 290 Nebulizer with compressionE0570 RR 290 Nebulizer with compressionE0570 UE 290 Nebulizer with compressionE0572 290 Aerosol compressor adjust prE0572 NU 290 Aerosol compressor adjust prE0572 RR 290 Aerosol compressor adjust prE0572 UE 290 Aerosol compressor adjust prE0574 290 Ultrasonic generator w svnebE0574 NU 290 Ultrasonic generator w svnebE0574 RR 290 Ultrasonic generator w svnebE0574 UE 290 Ultrasonic generator w svnebE0575 290 Nebulizer ultrasonicE0575 NU 290 Nebulizer ultrasonicE0575 RR 290 Nebulizer ultrasonicE0575 UE 290 Nebulizer ultrasonicE0580 290 Nebulizer for use w/ regulatE0580 NU 290 Nebulizer for use w/ regulatE0580 RR 290 Nebulizer for use w/ regulatE0580 UE 290 Nebulizer for use w/ regulatE0585 290 Nebulizer w/ compressor & heE0585 NU 290 Nebulizer w/ compressor & heE0585 RR 290 Nebulizer w/ compressor & heE0585 UE 290 Nebulizer w/ compressor & heE0600 290 Suction pump portab hom modlE0600 NU 290 Suction pump portab hom modlE0600 RR 290 Suction pump portab hom modlE0600 UE 290 Suction pump portab hom modlE0601 290 Cont airway pressure deviceE0601 NU 290 Cont airway pressure deviceE0601 RR 290 Cont airway pressure deviceE0601 UE 290 Cont airway pressure deviceE0602 290 Breast pump, all typesE0602 NU 290 Manual breast pumpE0602 RR 290 Manual breast pumpE0602 UE 290 Manual breast pumpE0605 290 Vaporizer room typeE0605 NU 290 Vaporizer room typeE0605 RR 290 Vaporizer room typeE0605 UE 290 Vaporizer room typeE0606 290 Drainage board posturalE0606 NU 290 Drainage board posturalE0606 RR 290 Drainage board posturalE0606 UE 290 Drainage board postural


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0607 290 Blood glucose monitor homeE0607 NU 290 Blood glucose monitor homeE0607 RR 290 Blood glucose monitor homeE0607 UE 290 Blood glucose monitor homeE0610 290 Pacemaker monitr audible/visE0610 NU 290 Pacemaker monitr audible/visE0610 RR 290 Pacemaker monitr audible/visE0610 UE 290 Pacemaker monitr audible/visE0615 290 Pacemaker monitr digital/visE0615 NU 290 Pacemaker monitr digital/visE0615 RR 290 Pacemaker monitr digital/visE0615 UE 290 Pacemaker monitr digital/visE0616 290 Cardiac event recorderE0617 290 Ext defrib w/ integ EKG analysisE0617 NU 290 Ext defrib w/ integ EKG analysisE0617 RR 290 Automatic ext defibrillatorE0617 UE 290 Ext defrib w/ integ EKG analysisE0618 290 Apnea monitorE0618 NU 290 Apnea monitorE0618 RR 290 Apnea monitorE0618 UE 290 Apnea monitorE0619 290 Apnea monitor w recorderE0619 RR 290 Apnea monitor w recorderE0620 290 Cap bld skin piercing laserE0620 NU 290 Cap bld skin piercing laserE0620 RR 290 Cap bld skin piercing laserE0620 UE 290 Cap bld skin piercing laserE0621 290 Patient lift sling or seatE0621 NU 290 Patient lift sling or seatE0621 RR 290 Patient lift sling or seatE0621 UE 290 Patient lift sling or seatE0625 290 Patient lift; kartop/bath/toilet, NOSE0627 290 Seat lift incorp lift-chairE0627 NU 290 Seat lift incorp lift-chairE0627 RR 290 Seat lift incorp lift-chairE0627 UE 290 Seat lift incorp lift-chairE0628 290 Seat lift for pt furn-electrE0628 NU 290 Seat lift for pt furn-electrE0628 RR 290 Seat lift for pt furn-electrE0628 UE 290 Seat lift for pt furn-electrE0629 290 Seat lift for pt furn-non-elE0629 NU 290 Seat lift for pt furn-non-elE0629 RR 290 Seat lift for pt furn-non-elE0629 UE 290 Seat lift for pt furn-non-elE0630 290 Patient lift hydraulicE0630 NU 290 Patient lift hydraulicE0630 RR 290 Patient lift hydraulicE0630 UE 290 Patient lift hydraulicE0635 290 Patient lift electricE0635 NU 290 Patient lift electricE0635 RR 290 Patient lift electricE0635 UE 290 Patient lift electricE0636 290 PT support & positioning sysE0636 NU 290 PT support & positioning sysE0636 RR 290 PT support & positioning sysE0636 UE 290 PT support & positioning sysE0637 290 Sit-stand w seatliftE0637 NU 290 Sit-stand w seatliftE0637 RR 290 Sit-stand w seatliftE0637 UE 290 Sit-stand w seatliftE0638 290 Standing frame sysE0638 NU 290 Standing frame sysE0638 RR 290 Standing frame sysE0638 UE 290 Standing frame sysE0639 290 Moveable patient lift systemE0640 290 Fixed patient lift system


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0641 290 Multi-position stnd fram sysE0642 290 Dynamic standing frameE0650 290 Pneuma compresor non-segmentE0650 NU 290 Pneuma compresor non-segmentE0650 RR 290 Pneuma compresor non-segmentE0650 UE 290 Pneuma compresor non-segmentE0651 290 Pneum compressor segmentalE0651 NU 290 Pneum compressor segmentalE0651 RR 290 Pneum compressor segmentalE0651 UE 290 Pneum compressor segmentalE0652 290 Pneum compres w/cal pressureE0652 NU 290 Pneum compres w/cal pressureE0652 RR 290 Pneum compres w/cal pressureE0652 UE 290 Pneum compres w/cal pressureE0655 290 Pneumatic appliance half armE0655 NU 290 Pneumatic appliance half armE0655 RR 290 Pneumatic appliance half armE0655 UE 290 Pneumatic appliance half armE0656 290 Segmental pneumatic trunkE0656 NU 290 Segmental pneumatic trunkE0656 RR 290 Segmental pneumatic trunkE0656 UE 290 Segmental pneumatic trunkE0657 290 Segmental pneumatic chestE0657 NU 290 Segmental pneumatic chestE0657 RR 290 Segmental pneumatic chestE0657 UE 290 Segmental pneumatic chestE0660 290 Pneumatic appliance full legE0660 NU 290 Pneumatic appliance full legE0660 RR 290 Pneumatic appliance full legE0660 UE 290 Pneumatic appliance full legE0665 290 Pneumatic appliance full armE0665 NU 290 Pneumatic appliance full armE0665 RR 290 Pneumatic appliance full armE0665 UE 290 Pneumatic appliance full armE0666 290 Pneumatic appliance half legE0666 NU 290 Pneumatic appliance half legE0666 RR 290 Pneumatic appliance half legE0666 UE 290 Pneumatic appliance half legE0667 290 Seg pneumatic appl full legE0667 NU 290 Seg pneumatic appl full legE0667 RR 290 Seg pneumatic appl full legE0667 UE 290 Seg pneumatic appl full legE0668 290 Seg pneumatic appl full armE0668 NU 290 Seg pneumatic appl full armE0668 RR 290 Seg pneumatic appl full armE0668 UE 290 Seg pneumatic appl full armE0669 290 Seg pneumatic appli half legE0669 NU 290 Seg pneumatic appli half legE0669 RR 290 Seg pneumatic appli half legE0669 UE 290 Seg pneumatic appli half legE0670 290 Seg pneum int legs/trunk E0670 NU 290 Seg pneum int legs/trunk E0670 RR 290 Seg pneum int legs/trunk E0670 UE 290 Seg pneum int legs/trunk E0671 290 Pressure pneum appl full legE0671 NU 290 Pressure pneum appl full legE0671 RR 290 Pressure pneum appl full legE0671 UE 290 Pressure pneum appl full legE0672 290 Pressure pneum appl full armE0672 NU 290 Pressure pneum appl full armE0672 RR 290 Pressure pneum appl full armE0672 UE 290 Pressure pneum appl full armE0673 290 Pressure pneum appl half legE0673 NU 290 Pressure pneum appl half legE0673 RR 290 Pressure pneum appl half legE0673 UE 290 Pressure pneum appl half leg


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0675 290 Pneumatic compression deviceE0675 NU 290 Pneumatic compression deviceE0675 RR 290 Pneumatic compression deviceE0675 UE 290 Pneumatic compression deviceE0676 290 Inter limb compress dev NOSE0691 290 Uvl pnl 2 sq ft or lessE0691 NU 290 Uvl pnl 2 sq ft or lessE0691 RR 290 Uvl pnl 2 sq ft or lessE0691 UE 290 Uvl pnl 2 sq ft or lessE0692 290 Uvl sys panel 4 ftE0692 NU 290 Uvl sys panel 4 ftE0692 RR 290 Uvl sys panel 4 ftE0692 UE 290 Uvl sys panel 4 ftE0693 290 Uvl sys panel 6 ftE0693 NU 290 Uvl sys panel 6 ftE0693 RR 290 Uvl sys panel 6 ftE0693 UE 290 Uvl sys panel 6 ftE0694 290 Uvl md cabinet sys 6 ftE0694 NU 290 Uvl md cabinet sys 6 ftE0694 RR 290 Uvl md cabinet sys 6 ftE0694 UE 290 Uvl md cabinet sys 6 ftE0700 290 Safety eqip.-belt/harness/vestE0705 290 Transfer board or deviceE0705 NU 290 Transfer board or deviceE0705 RR 290 Transfer board or deviceE0705 UE 290 Transfer board or deviceE0710 290 Restraint, any type-body/chest/wrist/ankleE0720 290 Tens two leadE0720 NU 290 Tens two leadE0720 RR 290 Tens two leadE0720 UE 290 Tens two leadE0730 290 Tens four leadE0730 NU 290 Tens four leadE0730 RR 290 Tens four leadE0730 UE 290 Tens four leadE0731 290 Conductive garment for tens/E0731 NU 290 Conductive garment for tens/E0731 RR 290 Conductive garment for tens/E0731 UE 290 Conductive garment for tens/E0740 290 Incontinence treatment systemE0740 NU 290 Incontinence treatment systmE0740 RR 290 Incontinence treatment systmE0740 UE 290 Incontinence treatment systmE0744 290 Neuromuscular stim for scoliE0744 NU 290 Neuromuscular stim for scoliE0744 RR 290 Neuromuscular stim for scoliE0744 UE 290 Neuromuscular stim for scoliE0745 290 Neuromuscular stim for shockE0745 NU 290 Neuromuscular stim for shockE0745 RR 290 Neuromuscular stim for shockE0745 UE 290 Neuromuscular stim for shockE0746 290 EMG biofeedback deviceE0747 290 Elec osteogen stim not spineE0747 NU 290 Elec osteogen stim not spineE0747 RR 290 Elec osteogen stim not spineE0747 UE 290 Elec osteogen stim not spineE0748 290 Elec osteogen stim spinalE0748 NU 290 Elec osteogen stim spinalE0748 RR 290 Elec osteogen stim spinalE0748 UE 290 Elec osteogen stim spinalE0749 290 Elec osteogen stim implantedE0749 NU 290 Elec osteogen stim implantedE0749 RR 290 Elec osteogen stim implantedE0749 UE 290 Elec osteogen stim implantedE0755 290 Electronic salivary reflex stimulatorE0760 290 Osteogen ultrasound stimltor


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0760 NU 290 Osteogen ultrasound stimltorE0760 RR 290 Osteogen ultrasound stimltorE0760 UE 290 Osteogen ultrasound stimltorE0761 290 Nontherm electromgntc deviceE0762 290 Trans elec jt stim dev sysE0762 NU 290 Trans elec jt stim dev sysE0762 RR 290 Trans elec jt stim dev sysE0762 UE 290 Trans elec jt stim dev sysE0764 290 Functional neuromuscularstimE0764 NU 290 Functional neuromuscularstimE0764 RR 290 Functional neuromuscularstimE0764 UE 290 Functional neuromuscularstimE0765 290 Nerve stimulator for tx n&vE0765 NU 290 Nerve stimulator for tx n&vE0765 RR 290 Nerve stimulator for tx n&vE0765 UE 290 Nerve stimulator for tx n&vE0766 290 Elec stim cancer treatment E0769 290 Elect/electromag wound tx device NOSE0770 290 Functional electric stim NOSE0776 290 Iv poleE0776 NU 290 Iv poleE0776 RR 290 Iv poleE0776 UE 290 Iv poleE0779 290 Amb infusion pump mechanicalE0779 NU 290 Amb infusion pump mechanicalE0779 RR 290 Amb infusion pump mechanicalE0779 UE 290 Amb infusion pump mechanicalE0780 290 Mech amb infusion pump <8hrsE0780 NU 290 Mech amb infusion pump <8hrsE0780 RR 290 Mech amb infusion pump <8hrsE0780 UE 290 Mech amb infusion pump <8hrsE0781 290 External ambulatory infus puE0781 NU 290 External ambulatory infus puE0781 RR 290 External ambulatory infus puE0781 UE 290 External ambulatory infus puE0782 290 Non-programble infusion pumpE0782 NU 290 Non-programble infusion pumpE0782 RR 290 Non-programble infusion pumpE0782 UE 290 Non-programble infusion pumpE0783 290 Programmable infusion pumpE0783 NU 290 Programmable infusion pumpE0783 RR 290 Programmable infusion pumpE0783 UE 290 Programmable infusion pumpE0784 290 Ext amb infusn pump insulinE0784 NU 290 Ext amb infusn pump insulinE0784 RR 290 Ext amb infusn pump insulinE0784 UE 290 Ext amb infusn pump insulinE0785 290 Replacement impl pump cathetE0785 KF 290 Replacement impl pump cathetE0785 NU 290 Replacement impl pump cathetE0786 290 Implantable pump replacementE0786 NU 290 Implantable pump replacementE0786 RR 290 Implantable pump replacementE0786 UE 290 Implantable pump replacementE0791 290 Parenteral infusion pump staE0791 NU 290 Parenteral infusion pump staE0791 RR 290 Parenteral infusion pump staE0791 UE 290 Parenteral infusion pump staE0830 290 Ambulatory traction deviceE0840 290 Tract frame attach headboardE0840 NU 290 Tract frame attach headboardE0840 RR 290 Tract frame attach headboardE0840 UE 290 Tract frame attach headboardE0849 290 Cervical pneum trac equipE0849 NU 290 Cervical pneum trac equipE0849 RR 290 Cervical pneum trac equip


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0849 UE 290 Cervical pneum trac equipE0850 290 Traction stand free standingE0850 NU 290 Traction stand free standingE0850 RR 290 Traction stand free standingE0850 UE 290 Traction stand free standingE0855 290 Cervical traction equipmentE0855 NU 290 Cervical traction equipmentE0855 RR 290 Cervical traction equipmentE0855 UE 290 Cervical traction equipmentE0856 290 Cervic collar w air bladderE0856 NU 290 Cervic collar w air bladderE0856 RR 290 Cervic collar w air bladderE0856 UE 290 Cervic collar w air bladderE0860 290 Tract equip cervical tractE0860 NU 290 Tract equip cervical tractE0860 RR 290 Tract equip cervical tractE0860 UE 290 Tract equip cervical tractE0870 290 Tract frame attach footboardE0870 NU 290 Tract frame attach footboardE0870 RR 290 Tract frame attach footboardE0870 UE 290 Tract frame attach footboardE0880 290 Trac stand free stand extremE0880 NU 290 Trac stand free stand extremE0880 RR 290 Trac stand free stand extremE0880 UE 290 Trac stand free stand extremE0890 290 Traction frame attach pelvicE0890 NU 290 Traction frame attach pelvicE0890 RR 290 Traction frame attach pelvicE0890 UE 290 Traction frame attach pelvicE0900 290 Trac stand free stand pelvicE0900 NU 290 Trac stand free stand pelvicE0900 RR 290 Trac stand free stand pelvicE0900 UE 290 Trac stand free stand pelvicE0910 290 Trapeze bar attached to bedE0910 NU 290 Trapeze bar attached to bedE0910 RR 290 Trapeze bar attached to bedE0910 UE 290 Trapeze bar attached to bedE0911 290 HD trapeze bar attach to bedE0911 NU 290 HD trapeze bar attach to bedE0911 RR 290 HD trapeze bar attach to bedE0911 UE 290 HD trapeze bar attach to bedE0912 290 HD trapeze bar free standingE0912 NU 290 HD trapeze bar free standingE0912 RR 290 HD trapeze bar free standingE0912 UE 290 HD trapeze bar free standingE0920 290 Fracture frame attached to bedE0920 NU 290 Fracture frame attached to bedE0920 RR 290 Fracture frame attached to bE0920 UE 290 Fracture frame attached to bedE0930 290 Fracture frame free standingE0930 NU 290 Fracture frame free standingE0930 RR 290 Fracture frame free standingE0930 UE 290 Fracture frame free standingE0935 290 Exercise device passive motiE0935 RR 290 Exercise device passive motiE0936 290 CPM device, other than kneeE0936 RR 290 CPM device, other than kneeE0940 290 Trapeze bar free standingE0940 NU 290 Trapeze bar free standingE0940 RR 290 Trapeze bar free standingE0940 UE 290 Trapeze bar free standingE0941 290 Gravity assisted traction deE0941 NU 290 Gravity assisted traction deE0941 RR 290 Gravity assisted traction deE0941 UE 290 Gravity assisted traction deE0942 290 Cervical head harness/halter


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0942 NU 290 Cervical head harness/halterE0942 RR 290 Cervical head harness/halterE0942 UE 290 Cervical head harness/halterE0944 290 Pelvic belt/harness/bootE0944 NU 290 Pelvic belt/harness/bootE0944 RR 290 Pelvic belt/harness/bootE0944 UE 290 Pelvic belt/harness/bootE0945 290 Belt/harness extremityE0945 NU 290 Belt/harness extremityE0945 RR 290 Belt/harness extremityE0945 UE 290 Belt/harness extremityE0946 290 Fracture frame dual w crossE0946 NU 290 Fracture frame dual w crossE0946 RR 290 Fracture frame dual w crossE0946 UE 290 Fracture frame dual w crossE0947 290 Fracture frame attachmnts peE0947 NU 290 Fracture frame attachmnts peE0947 RR 290 Fracture frame attachmnts peE0947 UE 290 Fracture frame attachmnts peE0948 290 Fracture frame attachmnts ceE0948 NU 290 Fracture frame attachmnts ceE0948 RR 290 Fracture frame attachmnts ceE0948 UE 290 Fracture frame attachmnts ceE0950 290 Tray, wheelchair accessoryE0950 NU 290 Tray, wheelchair accessoryE0950 RR 290 Tray, wheelchair accessoryE0950 UE 290 Tray, wheelchair accessoryE0951 290 Loop heelE0951 NU 290 Loop heelE0951 RR 290 Loop heelE0951 UE 290 Loop heelE0952 290 Toe loop/holder, eachE0952 NU 290 Toe loop/holder, eachE0952 RR 290 Toe loop/holder, eachE0952 UE 290 Toe loop/holder, eachE0955 290 Cushioned headrestE0955 NU 290 Cushioned headrestE0955 RR 290 Cushioned headrestE0955 UE 290 Cushioned headrestE0956 290 W/c lateral trunk/hip supporE0956 NU 290 W/c lateral trunk/hip supporE0956 RR 290 W/c lateral trunk/hip supporE0956 UE 290 W/c lateral trunk/hip supporE0957 290 W/c medial thigh supportE0957 NU 290 W/c medial thigh supportE0957 RR 290 W/c medial thigh supportE0957 UE 290 W/c medial thigh supportE0958 290 Whlchr att- conv 1 arm driveE0958 NU 290 Whlchr att- conv 1 arm driveE0958 RR 290 Whlchr att- conv 1 arm driveE0958 UE 290 Whlchr att- conv 1 arm driveE0959 290 Amputee adapterE0959 NU 290 Amputee adapterE0959 RR 290 Amputee adapterE0959 UE 290 Amputee adapterE0960 290 W/c shoulder harness/strapsE0960 NU 290 W/c shoulder harness/strapsE0960 RR 290 W/c shoulder harness/strapsE0960 UE 290 W/c shoulder harness/strapsE0961 290 Wheelchair brake extensionE0961 NU 290 Wheelchair brake extensionE0961 RR 290 Wheelchair brake extensionE0961 UE 290 Wheelchair brake extensionE0966 290 Wheelchair head rest extensiE0966 NU 290 Wheelchair head rest extensiE0966 RR 290 Wheelchair head rest extensi


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0966 UE 290 Wheelchair head rest extensiE0967 290 Wheelchair hand rimsE0967 NU 290 Wheelchair hand rimsE0967 RR 290 Wheelchair hand rimsE0967 UE 290 Wheelchair hand rimsE0968 290 Wheelchair commode seatE0968 NU 290 Wheelchair commode seatE0968 RR 290 Wheelchair commode seatE0968 UE 290 Wheelchair commode seatE0969 290 Wheelchair narrowing deviceE0969 NU 290 Wheelchair narrowing deviceE0969 RR 290 Wheelchair narrowing deviceE0969 UE 290 Wheelchair narrowing deviceE0970 290 Wheelchair no. 2 footplatesE0970 NU 290 Wheelchair no. 2 footplatesE0970 RR 290 Wheelchair no. 2 footplatesE0970 UE 290 Wheelchair no. 2 footplatesE0971 290 Wheelchair anti-tipping deviE0971 NU 290 Wheelchair anti-tipping deviE0971 RR 290 Wheelchair anti-tipping deviE0971 UE 290 Wheelchair anti-tipping deviE0973 290 Wheelchair adjustabl heightE0973 NU 290 W/Ch access det adj armrestE0973 RR 290 W/Ch access det adj armrestE0973 UE 290 W/Ch access det adj armrestE0974 290 Wheelchair grade-aidE0974 NU 290 W/Ch access anti-rollbackE0974 RR 290 W/Ch access anti-rollbackE0974 UE 290 W/Ch access anti-rollbackE0978 290 W/C acc,saf belt pelv strapE0978 NU 290 W/C acc,saf belt pelv strapE0978 RR 290 W/C acc,saf belt pelv strapE0978 UE 290 W/C acc,saf belt pelv strapE0980 290 Wheelchair safety vestE0980 NU 290 Wheelchair safety vestE0980 RR 290 Wheelchair safety vestE0980 UE 290 Wheelchair safety vestE0981 290 Seat upholsteryE0981 NU 290 Seat upholsteryE0981 RR 290 Seat upholsteryE0981 UE 290 Seat upholsteryE0982 290 Back upholsteryE0982 NU 290 Back upholsteryE0982 RR 290 Back upholsteryE0982 UE 290 Back upholsteryE0983 290 Add pwr joystickE0983 NU 290 Add pwr joystickE0983 RR 290 Add pwr joystickE0983 UE 290 Add pwr joystickE0984 290 Add pwr tillerE0984 NU 290 Add pwr tillerE0984 RR 290 Add pwr tillerE0984 UE 290 Add pwr tillerE0985 290 W/c seat lift mechanismE0985 NU 290 W/c seat lift mechanismE0985 RR 290 W/c seat lift mechanismE0985 UE 290 W/c seat lift mechanismE0986 290 Man w/c push-rim pow assistE0986 NU 290 Man w/c push-rim pow assistE0986 RR 290 Man w/c push-rim pow assistE0986 UE 290 Man w/c push-rim pow assistE0988 Lever-activated wheel drive E0988 RR Lever-activated wheel drive E0990 290 Whellchair elevating leg resE0990 NU 290 Whellchair elevating leg resE0990 RR 290 Whellchair elevating leg res


CPT/HCPCS MOD MOD LEV DESCRIPTIONE0990 UE 290 Whellchair elevating leg resE0992 290 Wheelchair solid seat insertE0992 NU 290 Wheelchair solid seat insertE0992 RR 290 Wheelchair solid seat insertE0992 UE 290 Wheelchair solid seat insertE0994 290 Wheelchair arm restE0994 NU 290 Wheelchair arm restE0994 RR 290 Wheelchair arm restE0994 UE 290 Wheelchair arm restE0995 290 Wheelchair calf restE0995 NU 290 Wheelchair calf restE0995 RR 290 Wheelchair calf restE0995 UE 290 Wheelchair calf restE1002 290 Pwr seat tiltE1002 NU 290 Pwr seat tiltE1002 RR 290 Pwr seat tiltE1002 UE 290 Pwr seat tiltE1003 290 Pwr seat reclineE1003 NU 290 Pwr seat reclineE1003 RR 290 Pwr seat reclineE1003 UE 290 Pwr seat reclineE1004 290 Pwr seat recline mechE1004 NU 290 Pwr seat recline mechE1004 RR 290 Pwr seat recline mechE1004 UE 290 Pwr seat recline mechE1005 290 Pwr seat recline pwrE1005 NU 290 Pwr seat recline pwrE1005 RR 290 Pwr seat recline pwrE1005 UE 290 Pwr seat recline pwrE1006 290 Pwr seat combo w/o shearE1006 NU 290 Pwr seat combo w/o shearE1006 RR 290 Pwr seat combo w/o shearE1006 UE 290 Pwr seat combo w/o shearE1007 290 Pwr seat combo w/shearE1007 NU 290 Pwr seat combo w/shearE1007 RR 290 Pwr seat combo w/shearE1007 UE 290 Pwr seat combo w/shearE1008 290 Pwr seat combo pwr shearE1008 NU 290 Pwr seat combo pwr shearE1008 RR 290 Pwr seat combo pwr shearE1008 UE 290 Pwr seat combo pwr shearE1009 290 Add mech leg elevationE1009 NU 290 Add mech leg elevationE1009 RR 290 Add mech leg elevationE1009 UE 290 Add mech leg elevationE1010 290 Add pwr leg elevationE1010 NU 290 Add pwr leg elevationE1010 RR 290 Add pwr leg elevationE1010 UE 290 Add pwr leg elevationE1015 290 Shock absorber for man w/cE1015 NU 290 Shock absorber for man w/cE1015 RR 290 Shock absorber for man w/cE1015 UE 290 Shock absorber for man w/cE1016 290 Shock absorber for power w/cE1016 NU 290 Shock absorber for power w/cE1016 RR 290 Shock absorber for power w/cE1016 UE 290 Shock absorber for power w/cE1017 290 HD shck absrbr for hd man wcE1017 NU 290 HD shck absrbr for hd man wcE1017 RR 290 HD shck absrbr for hd man wcE1017 UE 290 HD shck absrbr for hd man wcE1018 290 HD shck absrber for hd powwcE1018 NU 290 HD shck absrber for hd powwcE1018 RR 290 HD shck absrber for hd powwcE1018 UE 290 HD shck absrber for hd powwcE1020 290 Residual limb support system


CPT/HCPCS MOD MOD LEV DESCRIPTIONE1020 NU 290 Residual limb support systemE1020 RR 290 Residual limb support systemE1020 UE 290 Residual limb support systemE1028 290 W/c manual swingawayE1028 NU 290 W/c manual swingawayE1028 RR 290 W/c manual swingawayE1028 UE 290 W/c manual swingawayE1029 290 W/c vent tray fixedE1029 NU 290 W/c vent tray fixedE1029 RR 290 W/c vent tray fixedE1029 UE 290 W/c vent tray fixedE1030 290 W/c vent tray gimbaledE1030 NU 290 W/c vent tray gimbaledE1030 RR 290 W/c vent tray gimbaledE1030 UE 290 W/c vent tray gimbaledE1031 290 Rollabout chair with castersE1031 NU 290 Rollabout chair with castersE1031 RR 290 Rollabout chair with castersE1031 UE 290 Rollabout chair with castersE1035 290 Patient transfer systemE1035 NU 290 Patient transfer systemE1035 RR 290 Patient transfer systemE1035 UE 290 Patient transfer systemE1036 290 Patient transfer system, >300lbE1036 RR 290 Patient transfer system, >300lbE1038 290 Transport chair, adult sizeE1038 NU 290 Transport chair, adult sizeE1038 RR 290 Transport chair, adult sizeE1038 UE 290 Transport chair, adult sizeE1039 290 Transport chair pt wt>=250lbE1039 NU 290 Transport chair pt wt>=250lbE1039 RR 290 Transport chair pt wt>=250lbE1039 UE 290 Transport chair pt wt>=250lbE1050 290 Whelchr fxd full length armsE1050 NU 290 Whelchr fxd full length armsE1050 RR 290 Whelchr fxd full length armsE1050 UE 290 Whelchr fxd full length armsE1060 290 Wheelchair detachable armsE1060 NU 290 Wheelchair detachable armsE1060 RR 290 Wheelchair detachable armsE1060 UE 290 Wheelchair detachable armsE1070 290 Wheelchair detachable foot rE1070 NU 290 Wheelchair detachable foot rE1070 RR 290 Wheelchair detachable foot rE1070 UE 290 Wheelchair detachable foot rE1083 290 Hemi-wheelchair fixed armsE1083 NU 290 Hemi-wheelchair fixed armsE1083 RR 290 Hemi-wheelchair fixed armsE1083 UE 290 Hemi-wheelchair fixed armsE1084 290 Hemi-wheelchair detachable aE1084 NU 290 Hemi-wheelchair detachable aE1084 RR 290 Hemi-wheelchair detachable aE1084 UE 290 Hemi-wheelchair detachable aE1085 290 Hemi-wheelchair fixed armsE1085 NU 290 Hemi-wheelchair fixed armsE1085 RR 290 Hemi-wheelchair fixed armsE1085 UE 290 Hemi-wheelchair fixed armsE1086 290 Hemi-wheelchair detachable aE1086 NU 290 Hemi-wheelchair detachable aE1086 RR 290 Hemi-wheelchair detachable aE1086 UE 290 Hemi-wheelchair detachable aE1087 290 Wheelchair lightwt fixed armE1087 NU 290 Wheelchair lightwt fixed armE1087 RR 290 Wheelchair lightwt fixed armE1087 UE 290 Wheelchair lightwt fixed armE1088 290 Wheelchair lightweight det a


CPT/HCPCS MOD MOD LEV DESCRIPTIONE1088 NU 290 Wheelchair lightweight det aE1088 RR 290 Wheelchair lightweight det aE1088 UE 290 Wheelchair lightweight det aE1089 290 Wheelchair lightwt fixed armE1089 NU 290 Wheelchair lightwt fixed armE1089 RR 290 Wheelchair lightwt fixed armE1089 UE 290 Wheelchair lightwt fixed armE1090 290 Wheelchair lightweight det aE1090 NU 290 Wheelchair lightweight det aE1090 RR 290 Wheelchair lightweight det aE1090 UE 290 Wheelchair lightweight det aE1092 290 Wheelchair wide w/ leg restsE1092 NU 290 Wheelchair wide w/ leg restsE1092 RR 290 Wheelchair wide w/ leg restsE1092 UE 290 Wheelchair wide w/ leg restsE1093 290 Wheelchair wide w/ foot restE1093 NU 290 Wheelchair wide w/ foot restE1093 RR 290 Wheelchair wide w/ foot restE1093 UE 290 Wheelchair wide w/ foot restE1100 290 Whchr s-recl fxd arm leg resE1100 NU 290 Whchr s-recl fxd arm leg resE1100 RR 290 Whchr s-recl fxd arm leg resE1100 UE 290 Whchr s-recl fxd arm leg resE1110 290 Wheelchair semi-recl detachE1110 NU 290 Wheelchair semi-recl detachE1110 RR 290 Wheelchair semi-recl detachE1110 UE 290 Wheelchair semi-recl detachE1130 290 Whlchr std. fxd arm ft restE1130 NU 290 Whlchr std. fxd arm ft restE1130 RR 290 Whlchr std. fxd arm ft restE1130 UE 290 Whlchr std. fxd arm ft restE1140 290 Wheelchair standard detach aE1140 NU 290 Wheelchair standard detach aE1140 RR 290 Wheelchair standard detach aE1140 UE 290 Wheelchair standard detach aE1150 290 Wheelchair standard w/ leg rE1150 NU 290 Wheelchair standard w/ leg rE1150 RR 290 Wheelchair standard w/ leg rE1150 UE 290 Wheelchair standard w/ leg rE1160 290 Wheelchair fixed armsE1160 NU 290 Wheelchair fixed armsE1160 RR 290 Wheelchair fixed armsE1160 UE 290 Wheelchair fixed armsE1161 290 Manual adult wc w tiltinspacE1161 NU 290 Manual adult wc w tiltinspacE1161 RR 290 Manual adult wc w tiltinspacE1161 UE 290 Manual adult wc w tiltinspacE1170 290 Whlchr ampu fxd arm leg restE1170 NU 290 Whlchr ampu fxd arm leg restE1170 RR 290 Whlchr ampu fxd arm leg restE1170 UE 290 Whlchr ampu fxd arm leg restE1171 290 Wheelchair amputee w/o leg rE1171 NU 290 Wheelchair amputee w/o leg rE1171 RR 290 Wheelchair amputee w/o leg rE1171 UE 290 Wheelchair amputee w/o leg rE1172 290 Wheelchair amputee detach arE1172 NU 290 Wheelchair amputee detach arE1172 RR 290 Wheelchair amputee detach arE1172 UE 290 Wheelchair amputee detach arE1180 290 Wheelchair amputee w/ foot rE1180 NU 290 Wheelchair amputee w/ foot rE1180 RR 290 Wheelchair amputee w/ foot rE1180 UE 290 Wheelchair amputee w/ foot rE1190 290 Wheelchair amputee w/ leg reE1190 NU 290 Wheelchair amputee w/ leg reE1190 RR 290 Wheelchair amputee w/ leg re


CPT/HCPCS MOD MOD LEV DESCRIPTIONE1190 UE 290 Wheelchair amputee w/ leg reE1195 290 Wheelchair amputee heavy dutE1195 NU 290 Wheelchair amputee heavy dutE1195 RR 290 Wheelchair amputee heavy dutE1195 UE 290 Wheelchair amputee heavy dutE1200 290 Wheelchair amputee fixed armE1200 NU 290 Wheelchair amputee fixed armE1200 RR 290 Wheelchair amputee fixed armE1200 UE 290 Wheelchair amputee fixed armE1220 290 Wheelchair; specially sized/constrE1221 290 Wheelchair spec size w footE1221 NU 290 Wheelchair spec size w footE1221 RR 290 Wheelchair spec size w footE1221 UE 290 Wheelchair spec size w footE1222 290 Wheelchair spec size w/ legE1222 NU 290 Wheelchair spec size w/ legE1222 RR 290 Wheelchair spec size w/ legE1222 UE 290 Wheelchair spec size w/ legE1223 290 Wheelchair spec size w footE1223 NU 290 Wheelchair spec size w footE1223 RR 290 Wheelchair spec size w footE1223 UE 290 Wheelchair spec size w footE1224 290 Wheelchair spec size w/ legE1224 NU 290 Wheelchair spec size w/ legE1224 RR 290 Wheelchair spec size w/ legE1224 UE 290 Wheelchair spec size w/ legE1225 290 Wheelchair spec sz semi-reclE1225 NU 290 Wheelchair spec sz semi-reclE1225 RR 290 Wheelchair spec sz semi-reclE1225 UE 290 Wheelchair spec sz semi-reclE1226 290 Wheelchair spec sz full-reclE1226 NU 290 W/C access fully reclinebackE1226 RR 290 W/C access fully reclinebackE1226 UE 290 W/C access fully reclinebackE1227 290 Wheelchair spec sz spec ht aE1227 NU 290 Wheelchair spec sz spec ht aE1227 RR 290 Wheelchair spec sz spec ht aE1227 UE 290 Wheelchair spec sz spec ht aE1228 290 Wheelchair spec sz spec ht bE1228 NU 290 Wheelchair spec sz spec ht bE1228 RR 290 Wheelchair spec sz spec ht bE1228 UE 290 Wheelchair spec sz spec ht bE1230 290 Power operated vehicleE1230 NU 290 Power operated vehicleE1230 RR 290 Power operated vehicleE1230 UE 290 Power operated vehicleE1240 290 Whchr litwt det arm leg restE1240 NU 290 Whchr litwt det arm leg restE1240 RR 290 Whchr litwt det arm leg restE1240 UE 290 Whchr litwt det arm leg restE1250 290 Wheelchair lightwt fixed armE1250 NU 290 Wheelchair lightwt fixed armE1250 RR 290 Wheelchair lightwt fixed armE1250 UE 290 Wheelchair lightwt fixed armE1260 290 Wheelchair lightwt foot restE1260 NU 290 Wheelchair lightwt foot restE1260 RR 290 Wheelchair lightwt foot restE1260 UE 290 Wheelchair lightwt foot restE1270 290 Wheelchair lightweight leg rE1270 NU 290 Wheelchair lightweight leg rE1270 RR 290 Wheelchair lightweight leg rE1270 UE 290 Wheelchair lightweight leg rE1280 290 Whchr h-duty det arm leg resE1280 NU 290 Whchr h-duty det arm leg resE1280 RR 290 Whchr h-duty det arm leg resE1280 UE 290 Whchr h-duty det arm leg res


CPT/HCPCS MOD MOD LEV DESCRIPTIONE1285 290 Wheelchair heavy duty fixedE1285 NU 290 Wheelchair heavy duty fixedE1285 RR 290 Wheelchair heavy duty fixedE1285 UE 290 Wheelchair heavy duty fixedE1290 290 Wheelchair hvy duty detach aE1290 NU 290 Wheelchair hvy duty detach aE1290 RR 290 Wheelchair hvy duty detach aE1290 UE 290 Wheelchair hvy duty detach aE1295 290 Wheelchair heavy duty fixedE1295 NU 290 Wheelchair heavy duty fixedE1295 RR 290 Wheelchair heavy duty fixedE1295 UE 290 Wheelchair heavy duty fixedE1296 290 Wheelchair special seat heigE1296 NU 290 Wheelchair special seat heigE1296 RR 290 Wheelchair special seat heigE1296 UE 290 Wheelchair special seat heigE1297 290 Wheelchair special seat deptE1297 NU 290 Wheelchair special seat deptE1297 RR 290 Wheelchair special seat deptE1297 UE 290 Wheelchair special seat deptE1298 290 Wheelchair spec seat depth/wE1298 NU 290 Wheelchair spec seat depth/wE1298 RR 290 Wheelchair spec seat depth/wE1298 UE 290 Wheelchair spec seat depth/wE1300 290 Whirlpool, portable (overtub)E1300 NU 290 Whirlpool, portable (overtub)E1300 RR 290 Whirlpool, portable (overtub)E1310 290 Whirlpool non-portableE1310 NU 290 Whirlpool non-portableE1310 RR 290 Whirlpool non-portableE1310 UE 290 Whirlpool non-portableE1352 290 O2 flow reg pos inspir pressE1353 290 RegulatorE1353 RR 290 RegulatorE1354 290 Wheeled cart, port cyl/concE1355 290 Stand/rackE1355 RR 290 Stand/rackE1356 290 Batt pack/cart, port concE1357 290 Battery charger, port concE1358 290 DC power adapter, port concE1372 290 Oxy suppl heater for nebulizE1372 NU 290 Oxy suppl heater for nebulizE1372 RR 290 Oxy suppl heater for nebulizE1372 UE 290 Oxy suppl heater for nebulizE1390 290 Oxygen concentratorE1390 NU 290 Oxygen concentratorE1390 RR 290 Oxygen concentratorE1390 UE 290 Oxygen concentratorE1391 290 Oxygen concentratorE1391 NU 290 Oxygen concentratorE1391 RR 290 Oxygen concentratorE1391 UE 290 Oxygen concentratorE1392 290 Portable oxygen concentratorE1392 RR 290 Portable oxygen concentratorE1399 290 Durable medical equip. miscE1405 290 O2/water vapor enrich w/heatE1405 NU 290 O2/water vapor enrich w/heatE1405 RR 290 O2/water vapor enrich w/heatE1405 UE 290 O2/water vapor enrich w/heatE1406 290 O2/water vapor enrich w/o heE1406 NU 290 O2/water vapor enrich w/o heE1406 RR 290 O2/water vapor enrich w/o heE1406 UE 290 O2/water vapor enrich w/o heE1500 290 Centrifuge, for dialysisE1510 290 Kidney dialysate del sys kidney machineE1510 RR 290 Kidney dialysate del sys kidney machine


CPT/HCPCS MOD MOD LEV DESCRIPTIONE1520 290 Heparin infus pump-dialysisE1530 290 Air bubble detector for dialysisE1540 290 Pressure alarm for dialysisE1550 290 Bath conductivity meter for dialysisE1560 290 Blood leak detector for dialysisE1570 290 Adjust chair for ESRD patientsE1575 290 Transducer protector/fluid barrier any sizE1580 290 Unipuncture control sys for dialysisE1590 290 Hemodialysis machineE1592 290 Automatic intermittent periotneal dialysisE1594 290 Cycler dialysis mach for peritoneal dialysE1600 290 Deliv &/or installa chgs-renal dialysis eqE1610 290 Reverse osmosis H20 purification sysE1610 RR 290 Reverse osmosis H20 purification sysE1615 290 Deionizer water purification sysE1620 290 Blood pump for dialysisE1625 290 Water softening systemE1630 290 Reciprocating peritoneal dialysis sysE1632 290 Wearable artifical kidneyE1634 290 Peritoneal dialysis clamp, eachE1634 NU 290 Peritoneal dialysis clamp, eachE1635 290 Compact travel hemodialyzer sysE1636 290 Sorbent cartridges, per caseE1637 290 Hemostats for dialysis, eachE1639 290 Scale, for dialysis, eachE1699 290 Dialysis equip, unspecified by rptE1700 290 Jaw motion rehab systemE1700 NU 290 Jaw motion rehab systemE1700 RR 290 Jaw motion rehab systemE1700 UE 290 Jaw motion rehab systemE1701 290 Repl cushions for jaw motionE1702 290 Repl measr scales jaw motionE1800 290 Adjust elbow ext/flex deviceE1800 NU 290 Adjust elbow ext/flex deviceE1800 RR 290 Adjust elbow ext/flex deviceE1800 UE 290 Adjust elbow ext/flex deviceE1801 290 Bi-direct static prog stretch elbow deviceE1801 NU 290 Bi-direct static prog stretch elbow deviceE1801 RR 290 SPS elbow deviceE1801 UE 290 Bi-direct static prog stretch elbow deviceE1802 290 Adjst forearm pro/sup deviceE1802 NU 290 Adjst forearm pro/sup deviceE1802 RR 290 Adjst forearm pro/sup deviceE1802 UE 290 Adjst forearm pro/sup deviceE1805 290 Adjust wrist ext/flex deviceE1805 NU 290 Adjust wrist ext/flex deviceE1805 RR 290 Adjust wrist ext/flex deviceE1805 UE 290 Adjust wrist ext/flex deviceE1806 290 Bi-direct static prog stretch wrist deviceE1806 NU 290 Bi-direct static prog stretch wrist deviceE1806 RR 290 SPS wrist deviceE1806 UE 290 Bi-direct static prog stretch wrist deviceE1810 290 Adjust knee ext/flex deviceE1810 NU 290 Adjust knee ext/flex deviceE1810 RR 290 Adjust knee ext/flex deviceE1810 UE 290 Adjust knee ext/flex deviceE1811 290 Bi-direct static prog stretch knee deviceE1811 NU 290 Bi-direct static prog stretch knee deviceE1811 RR 290 SPS knee deviceE1811 UE 290 Bi-direct static prog stretch knee deviceE1812 290 Knee ext/flex w act res ctrlE1812 NU 290 Knee ext/flex w act res ctrlE1812 RR 290 Knee ext/flex w act res ctrlE1812 UE 290 Knee ext/flex w act res ctrlE1815 290 Adjust ankle ext/flex deviceE1815 NU 290 Adjust ankle ext/flex device


CPT/HCPCS MOD MOD LEV DESCRIPTIONE1815 RR 290 Adjust ankle ext/flex deviceE1815 UE 290 Adjust ankle ext/flex deviceE1816 290 Bi-direct static prog stretch ankle deviceE1816 NU 290 Bi-direct static prog stretch ankle deviceE1816 RR 290 SPS ankle deviceE1816 UE 290 Bi-direct static prog stretch ankle deviceE1818 290 Bi-direct static prog stretch forarm deviceE1818 NU 290 Bi-direct static prog stretch forarm deviceE1818 RR 290 SPS forearm deviceE1818 UE 290 Bi-direct static prog stretch forarm deviceE1820 290 Soft interface materialE1820 NU 290 Soft interface materialE1820 RR 290 Soft interface materialE1820 UE 290 Soft interface materialE1821 290 Replacement, soft interface materialE1821 NU 290 Replacement interface SPSDE1821 RR 290 Replacement interface SPSDE1821 UE 290 Replacement interface SPSDE1825 290 Adjust finger ext/flex devcE1825 NU 290 Adjust finger ext/flex devcE1825 RR 290 Adjust finger ext/flex devcE1825 UE 290 Adjust finger ext/flex devcE1830 290 Adjust toe ext/flex deviceE1830 NU 290 Adjust toe ext/flex deviceE1830 RR 290 Adjust toe ext/flex deviceE1830 UE 290 Adjust toe ext/flex deviceE1831 290 Static str toe dev ext/flexE1840 290 Dynamic adj shouldter flex/abduct/rot deviceE1840 NU 290 Dynamic adj shouldter flex/abduct/rot deviceE1840 RR 290 Adj shoulder ext/flex deviceE1840 UE 290 Dynamic adj shouldter flex/abduct/rot deviceE1841 290 Static str shldr dev rom adjE1841 NU 290 Static str shldr dev rom adjE1841 RR 290 Static str shldr dev rom adjE1841 UE 290 Static str shldr dev rom adjE1902 290 Commun board, non-electE2000 290 Gastric suction pump, home modelE2000 NU 290 Gastric suction pump, home modelE2000 RR 290 Gastric suction pump hme mdlE2000 UE 290 Gastric suction pump, home modelE2100 290 Blood glucose monitor w/int voice synthE2100 NU 290 Bld glucose monitor w voiceE2100 RR 290 Bld glucose monitor w voiceE2100 UE 290 Bld glucose monitor w voiceE2101 290 Blood glucose monitor w/int lancingE2101 NU 290 Bld glucose monitor w lanceE2101 RR 290 Bld glucose monitor w lanceE2101 UE 290 Bld glucose monitor w lanceE2120 290 Pulse gen sys tx endolymp flE2120 NU 290 Pulse gen sys tx endolymp flE2120 RR 290 Pulse gen sys tx endolymp flE2120 UE 290 Pulse gen sys tx endolymp flE2201 290 Man w/ch acc seat w>=20ö<24öE2201 NU 290 Man w/ch acc seat w>=20ö<24öE2201 RR 290 Man w/ch acc seat w>=20ö<24öE2201 UE 290 Man w/ch acc seat w>=20ö<24öE2202 290 Seat width 24-27 inE2202 NU 290 Seat width 24-27 inE2202 RR 290 Seat width 24-27 inE2202 UE 290 Seat width 24-27 inE2203 290 Frame depth less than 22 inE2203 NU 290 Frame depth less than 22 inE2203 RR 290 Frame depth less than 22 inE2203 UE 290 Frame depth less than 22 inE2204 290 Frame depth 22 to 25 inE2204 NU 290 Frame depth 22 to 25 in


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2204 RR 290 Frame depth 22 to 25 inE2204 UE 290 Frame depth 22 to 25 inE2205 290 Manual wc accessory, handrimE2205 NU 290 Manual wc accessory, handrimE2205 RR 290 Manual wc accessory, handrimE2205 UE 290 Manual wc accessory, handrimE2206 290 Complete wheel lock assemblyE2206 NU 290 Complete wheel lock assemblyE2206 RR 290 Complete wheel lock assemblyE2206 UE 290 Complete wheel lock assemblyE2207 290 Crutch and cane holderE2207 NU 290 Crutch and cane holderE2207 RR 290 Crutch and cane holderE2207 UE 290 Crutch and cane holderE2208 290 Cylinder tank carrierE2208 NU 290 Cylinder tank carrierE2208 RR 290 Cylinder tank carrierE2208 UE 290 Cylinder tank carrierE2209 290 Arm trough eachE2209 NU 290 Arm trough eachE2209 RR 290 Arm trough eachE2209 UE 290 Arm trough eachE2210 290 Wheelchair bearingsE2210 NU 290 Wheelchair bearingsE2210 RR 290 Wheelchair bearingsE2210 UE 290 Wheelchair bearingsE2211 290 Pneumatic propulsion tireE2211 NU 290 Pneumatic propulsion tireE2211 RR 290 Pneumatic propulsion tireE2211 UE 290 Pneumatic propulsion tireE2212 290 Pneumatic prop tire tubeE2212 NU 290 Pneumatic prop tire tubeE2212 RR 290 Pneumatic prop tire tubeE2212 UE 290 Pneumatic prop tire tubeE2213 290 Pneumatic prop tire insertE2213 NU 290 Pneumatic prop tire insertE2213 RR 290 Pneumatic prop tire insertE2213 UE 290 Pneumatic prop tire insertE2214 290 Pneumatic caster tire eachE2214 NU 290 Pneumatic caster tire eachE2214 RR 290 Pneumatic caster tire eachE2214 UE 290 Pneumatic caster tire eachE2215 290 Pneumatic caster tire tubeE2215 NU 290 Pneumatic caster tire tubeE2215 RR 290 Pneumatic caster tire tubeE2215 UE 290 Pneumatic caster tire tubeE2216 290 Foam filled propulsion tireE2216 NU 290 Foam filled propulsion tireE2216 RR 290 Foam filled propulsion tireE2216 UE 290 Foam filled propulsion tireE2217 290 Foam filled caster tire eachE2217 NU 290 Foam filled caster tire eachE2217 RR 290 Foam filled caster tire eachE2217 UE 290 Foam filled caster tire eachE2218 290 Foam propulsion tire eachE2218 NU 290 Foam propulsion tire eachE2218 RR 290 Foam propulsion tire eachE2218 UE 290 Foam propulsion tire eachE2219 290 Foam caster tire any size eaE2219 NU 290 Foam caster tire any size eaE2219 RR 290 Foam caster tire any size eaE2219 UE 290 Foam caster tire any size eaE2220 290 Solid propulsion tire eachE2220 NU 290 Solid propulsion tire eachE2220 RR 290 Solid propulsion tire eachE2220 UE 290 Solid propulsion tire each


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2221 290 Solid caster tire eachE2221 NU 290 Solid caster tire eachE2221 RR 290 Solid caster tire eachE2221 UE 290 Solid caster tire eachE2222 290 Solid caster integrated whlE2222 NU 290 Solid caster integrated whlE2222 RR 290 Solid caster integrated whlE2222 UE 290 Solid caster integrated whlE2224 290 Propulsion whl excludes tireE2224 NU 290 Propulsion whl excludes tireE2224 RR 290 Propulsion whl excludes tireE2224 UE 290 Propulsion whl excludes tireE2225 290 Caster wheel excludes tireE2225 NU 290 Caster wheel excludes tireE2225 RR 290 Caster wheel excludes tireE2225 UE 290 Caster wheel excludes tireE2226 290 Caster fork replacement onlyE2226 NU 290 Caster fork replacement onlyE2226 RR 290 Caster fork replacement onlyE2226 UE 290 Caster fork replacement onlyE2227 290 Gear reduction drive wheelE2227 NU 290 Gear reduction drive wheelE2227 RR 290 Gear reduction drive wheelE2227 UE 290 Gear reduction drive wheelE2228 290 Mwc acc, wheelchair brakeE2228 NU 290 Mwc acc, wheelchair brakeE2228 RR 290 Mwc acc, wheelchair brakeE2228 UE 290 Mwc acc, wheelchair brakeE2230 290 Manual standing systemE2231 290 Solid seat support baseE2231 NU 290 Solid seat support baseE2231 RR 290 Solid seat support baseE2231 UE 290 Solid seat support baseE2300 290 Pwr seat elevation sys E2300 NU 290 Pwr seat elevation sys E2300 RR 290 Pwr seat elevation sys E2300 UE 290 Pwr seat elevation sys E2301 290 Pwr standing E2301 NU 290 Pwr standing E2301 RR 290 Pwr standing E2301 UE 290 Pwr standing E2310 290 Electro connect btw controlE2310 NU 290 Electro connect btw controlE2310 RR 290 Electro connect btw controlE2310 UE 290 Electro connect btw controlE2311 290 Electro connect btw 2 sysE2311 NU 290 Electro connect btw 2 sysE2311 RR 290 Electro connect btw 2 sysE2311 UE 290 Electro connect btw 2 sysE2312 290 Mini-prop remote joystickE2312 NU 290 Mini-prop remote joystickE2312 RR 290 Mini-prop remote joystickE2312 UE 290 Mini-prop remote joystickE2313 290 PWC harness, expand controlE2313 NU 290 PWC harness, expand controlE2313 RR 290 PWC harness, expand controlE2313 UE 290 PWC harness, expand controlE2321 290 Hand interface joystickE2321 NU 290 Hand interface joystickE2321 RR 290 Hand interface joystickE2321 UE 290 Hand interface joystickE2322 290 Mult mech switchesE2322 NU 290 Mult mech switchesE2322 RR 290 Mult mech switchesE2322 UE 290 Mult mech switchesE2323 290 Special joystick handle


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2323 NU 290 Special joystick handleE2323 RR 290 Special joystick handleE2323 UE 290 Special joystick handleE2324 290 Chin cup interfaceE2324 NU 290 Chin cup interfaceE2324 RR 290 Chin cup interfaceE2324 UE 290 Chin cup interfaceE2325 290 Sip and puff interfaceE2325 NU 290 Sip and puff interfaceE2325 RR 290 Sip and puff interfaceE2325 UE 290 Sip and puff interfaceE2326 290 Breath tube kitE2326 NU 290 Breath tube kitE2326 RR 290 Breath tube kitE2326 UE 290 Breath tube kitE2327 290 Head control interface mechE2327 NU 290 Head control interface mechE2327 RR 290 Head control interface mechE2327 UE 290 Head control interface mechE2328 290 Head/extremity control interE2328 NU 290 Head/extremity control interE2328 RR 290 Head/extremity control interE2328 UE 290 Head/extremity control interE2329 290 Head control nonproportionalE2329 NU 290 Head control nonproportionalE2329 RR 290 Head control nonproportionalE2329 UE 290 Head control nonproportionalE2330 290 Head control proximity switcE2330 NU 290 Head control proximity switcE2330 RR 290 Head control proximity switcE2330 UE 290 Head control proximity switcE2331 290 Pwr whl chr access, attendant controlE2331 NU 290 Pwr whl chr access, attendant controlE2331 RR 290 Pwr whl chr access, attendant controlE2331 UE 290 Pwr whl chr access, attendant controlE2340 290 W/c wdth 20-23 in seat frameE2340 NU 290 W/c wdth 20-23 in seat frameE2340 RR 290 W/c wdth 20-23 in seat frameE2340 UE 290 W/c wdth 20-23 in seat frameE2341 290 W/c wdth 24-27 in seat frameE2341 NU 290 W/c wdth 24-27 in seat frameE2341 RR 290 W/c wdth 24-27 in seat frameE2341 UE 290 W/c wdth 24-27 in seat frameE2342 290 W/c dpth 20-21 in seat frameE2342 NU 290 W/c dpth 20-21 in seat frameE2342 RR 290 W/c dpth 20-21 in seat frameE2342 UE 290 W/c dpth 20-21 in seat frameE2343 290 W/c dpth 22-25 in seat frameE2343 NU 290 W/c dpth 22-25 in seat frameE2343 RR 290 W/c dpth 22-25 in seat frameE2343 UE 290 W/c dpth 22-25 in seat frameE2351 290 Electronic SGD interfaceE2351 NU 290 Electronic SGD interfaceE2351 RR 290 Electronic SGD interfaceE2351 UE 290 Electronic SGD interfaceE2358 290 Gr 34 nonsealed leadacid E2359 290 Gr 34 sealed leadacid battery E2359 NU 290 Gr 34 sealed leadacid battery E2359 RR 290 Gr 34 sealed leadacid battery E2359 UE 290 Gr 34 sealed leadacid battery E2360 290 22nf nonsealed leadacidE2360 NU 290 22nf nonsealed leadacidE2360 RR 290 22nf nonsealed leadacidE2360 UE 290 22nf nonsealed leadacidE2361 290 22nf sealed leadacid batteryE2361 NU 290 22nf sealed leadacid battery


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2361 RR 290 22nf sealed leadacid batteryE2361 UE 290 22nf sealed leadacid batteryE2362 290 Gr24 nonsealed leadacidE2362 NU 290 Gr24 nonsealed leadacidE2362 RR 290 Gr24 nonsealed leadacidE2362 UE 290 Gr24 nonsealed leadacidE2363 290 Gr24 sealed leadacid batteryE2363 NU 290 Gr24 sealed leadacid batteryE2363 RR 290 Gr24 sealed leadacid batteryE2363 UE 290 Gr24 sealed leadacid batteryE2364 290 U1nonsealed leadacid batteryE2364 NU 290 U1nonsealed leadacid batteryE2364 RR 290 U1nonsealed leadacid batteryE2364 UE 290 U1nonsealed leadacid batteryE2365 290 U1 sealed leadacid batteryE2365 NU 290 U1 sealed leadacid batteryE2365 RR 290 U1 sealed leadacid batteryE2365 UE 290 U1 sealed leadacid batteryE2366 290 Battery chargerE2366 NU 290 Battery chargerE2366 RR 290 Battery chargerE2366 UE 290 Battery chargerE2367 290 Battery chargerE2367 NU 290 Battery chargerE2367 RR 290 Battery chargerE2367 UE 290 Battery chargerE2368 290 Power wc motor replacementE2368 NU 290 Power wc motor replacementE2368 RR 290 Power wc motor replacementE2368 UE 290 Power wc motor replacementE2369 290 Pwr wc gear box replacementE2369 NU 290 Pwr wc gear box replacementE2369 RR 290 Pwr wc gear box replacementE2369 UE 290 Pwr wc gear box replacementE2370 290 Pwr wc motor/gear box comboE2370 NU 290 Pwr wc motor/gear box comboE2370 RR 290 Pwr wc motor/gear box comboE2370 UE 290 Pwr wc motor/gear box comboE2371 290 Gr27 sealed leadacid batteryE2371 NU 290 Gr27 sealed leadacid batteryE2371 RR 290 Gr27 sealed leadacid batteryE2371 UE 290 Gr27 sealed leadacid batteryE2372 290 Gr27 non-sealed leadacidE2372 NU 290 Gr27 non-sealed leadacidE2372 RR 290 Gr27 non-sealed leadacidE2372 UE 290 Gr27 non-sealed leadacidE2373 290 Hand/chin ctrl spec joystickE2373 NU 290 Hand/chin ctrl spec joystickE2373 RR 290 Hand/chin ctrl spec joystickE2373 UE 290 Hand/chin ctrl spec joystickE2374 290 Hand/chin ctrl std joystickE2374 NU 290 Hand/chin ctrl std joystickE2374 RR 290 Hand/chin ctrl std joystickE2374 UE 290 Hand/chin ctrl std joystickE2375 290 Non-expandable controllerE2375 NU 290 Non-expandable controllerE2375 RR 290 Non-expandable controllerE2375 UE 290 Non-expandable controllerE2376 290 Expandable controller, replE2376 NU 290 Expandable controller, replE2376 RR 290 Expandable controller, replE2376 UE 290 Expandable controller, replE2377 290 Expandable controller, initlE2377 NU 290 Expandable controller, initlE2377 RR 290 Expandable controller, initlE2377 UE 290 Expandable controller, initl


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2378 290 Pw actuator replacement E2378 NU 290 Pw actuator replacement E2378 RR 290 Pw actuator replacement E2378 UE 290 Pw actuator replacement E2381 290 Pneum drive wheel tireE2381 NU 290 Pneum drive wheel tireE2381 RR 290 Pneum drive wheel tireE2381 UE 290 Pneum drive wheel tireE2382 290 Tube, pneum wheel drive tireE2382 NU 290 Tube, pneum wheel drive tireE2382 RR 290 Tube, pneum wheel drive tireE2382 UE 290 Tube, pneum wheel drive tireE2383 290 Insert, pneum wheel driveE2383 NU 290 Insert, pneum wheel driveE2383 RR 290 Insert, pneum wheel driveE2383 UE 290 Insert, pneum wheel driveE2384 290 Pneumatic caster tireE2384 NU 290 Pneumatic caster tireE2384 RR 290 Pneumatic caster tireE2384 UE 290 Pneumatic caster tireE2385 290 Tube, pneumatic caster tireE2385 NU 290 Tube, pneumatic caster tireE2385 RR 290 Tube, pneumatic caster tireE2385 UE 290 Tube, pneumatic caster tireE2386 290 Foam filled drive wheel tireE2386 NU 290 Foam filled drive wheel tireE2386 RR 290 Foam filled drive wheel tireE2386 UE 290 Foam filled drive wheel tireE2387 290 Foam filled caster tireE2387 NU 290 Foam filled caster tireE2387 RR 290 Foam filled caster tireE2387 UE 290 Foam filled caster tireE2388 290 Foam drive wheel tireE2388 NU 290 Foam drive wheel tireE2388 RR 290 Foam drive wheel tireE2388 UE 290 Foam drive wheel tireE2389 290 Foam caster tireE2389 NU 290 Foam caster tireE2389 RR 290 Foam caster tireE2389 UE 290 Foam caster tireE2390 290 Solid drive wheel tireE2390 NU 290 Solid drive wheel tireE2390 RR 290 Solid drive wheel tireE2390 UE 290 Solid drive wheel tireE2391 290 Solid caster tireE2391 NU 290 Solid caster tireE2391 RR 290 Solid caster tireE2391 UE 290 Solid caster tireE2392 290 Solid caster tire, integrateE2392 NU 290 Solid caster tire, integrateE2392 RR 290 Solid caster tire, integrateE2392 UE 290 Solid caster tire, integrateE2394 290 Drive wheel excludes tireE2394 NU 290 Drive wheel excludes tireE2394 RR 290 Drive wheel excludes tireE2394 UE 290 Drive wheel excludes tireE2395 290 Caster wheel excludes tireE2395 NU 290 Caster wheel excludes tireE2395 RR 290 Caster wheel excludes tireE2395 UE 290 Caster wheel excludes tireE2396 290 Caster forkE2396 NU 290 Caster forkE2396 RR 290 Caster forkE2396 UE 290 Caster forkE2397 290 Pwc acc, lith-based batteryE2397 NU 290 Pwc acc, lith-based battery


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2397 RR 290 Pwc acc, lith-based batteryE2397 UE 290 Pwc acc, lith-based batteryE2402 290 Neg press wound therapy pumpE2402 NU 290 Neg press wound therapy pumpE2402 RR 290 Neg press wound therapy pumpE2402 UE 290 Neg press wound therapy pumpE2500 290 SGD digitized pre-rec <=8minE2500 NU 290 SGD digitized pre-rec <=8minE2500 RR 290 SGD digitized pre-rec <=8minE2500 UE 290 SGD digitized pre-rec <=8minE2502 290 SGD prerec msg >8min <=20minE2502 NU 290 SGD prerec msg >8min <=20minE2502 RR 290 SGD prerec msg >8min <=20minE2502 UE 290 SGD prerec msg >8min <=20minE2504 290 SGD prerec msg>20min <=40minE2504 NU 290 SGD prerec msg>20min <=40minE2504 RR 290 SGD prerec msg>20min <=40minE2504 UE 290 SGD prerec msg>20min <=40minE2506 290 SGD prerec msg > 40 minE2506 NU 290 SGD prerec msg > 40 minE2506 RR 290 SGD prerec msg > 40 minE2506 UE 290 SGD prerec msg > 40 minE2508 290 SGD spelling phys contactE2508 NU 290 SGD spelling phys contactE2508 RR 290 SGD spelling phys contactE2508 UE 290 SGD spelling phys contactE2510 290 SGD w multi methods msg/accsE2510 NU 290 SGD w multi methods msg/accsE2510 RR 290 SGD w multi methods msg/accsE2510 UE 290 SGD w multi methods msg/accsE2511 290 SGD sftwre prgrm for PC/PDAE2511 NU 290 SGD sftwre prgrm for PC/PDAE2511 RR 290 SGD sftwre prgrm for PC/PDAE2511 UE 290 SGD sftwre prgrm for PC/PDAE2512 290 SGD accessoryE2512 NU 290 SGD accessoryE2512 RR 290 SGD accessoryE2512 UE 290 SGD accessoryE2599 290 SGD accessory, n.o.c.E2601 290 Gen w/c cushion wdth < 22 inE2601 NU 290 Gen w/c cushion wdth < 22 inE2601 RR 290 Gen w/c cushion wdth < 22 inE2601 UE 290 Gen w/c cushion wdth < 22 inE2602 290 Gen w/c cushion wdth >=22 inE2602 NU 290 Gen w/c cushion wdth >=22 inE2602 RR 290 Gen w/c cushion wdth >=22 inE2602 UE 290 Gen w/c cushion wdth >=22 inE2603 290 Skin protect wc cus wd <22inE2603 NU 290 Skin protect wc cus wd <22inE2603 RR 290 Skin protect wc cus wd <22inE2603 UE 290 Skin protect wc cus wd <22inE2604 290 Skin protect wc cus wd>=22inE2604 NU 290 Skin protect wc cus wd>=22inE2604 RR 290 Skin protect wc cus wd>=22inE2604 UE 290 Skin protect wc cus wd>=22inE2605 290 Position wc cush wdth <22 inE2605 NU 290 Position wc cush wdth <22 inE2605 RR 290 Position wc cush wdth <22 inE2605 UE 290 Position wc cush wdth <22 inE2606 290 Position wc cush wdth>=22 inE2606 NU 290 Position wc cush wdth>=22 inE2606 RR 290 Position wc cush wdth>=22 inE2606 UE 290 Position wc cush wdth>=22 inE2607 290 Skin pro/pos wc cus wd <22inE2607 NU 290 Skin pro/pos wc cus wd <22inE2607 RR 290 Skin pro/pos wc cus wd <22in


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2607 UE 290 Skin pro/pos wc cus wd <22inE2608 290 Skin pro/pos wc cus wd>=22inE2608 NU 290 Skin pro/pos wc cus wd>=22inE2608 RR 290 Skin pro/pos wc cus wd>=22inE2608 UE 290 Skin pro/pos wc cus wd>=22inE2609 290 Cus fabricated wc seat cush, any sizeE2610 290 Wc seat cush, poweredE2611 290 Gen use back cush wdth <22inE2611 NU 290 Gen use back cush wdth <22inE2611 RR 290 Gen use back cush wdth <22inE2611 UE 290 Gen use back cush wdth <22inE2612 290 Gen use back cush wdth>=22inE2612 NU 290 Gen use back cush wdth>=22inE2612 RR 290 Gen use back cush wdth>=22inE2612 UE 290 Gen use back cush wdth>=22inE2613 290 Position back cush wd <22inE2613 NU 290 Position back cush wd <22inE2613 RR 290 Position back cush wd <22inE2613 UE 290 Position back cush wd <22inE2614 290 Position back cush wd>=22inE2614 NU 290 Position back cush wd>=22inE2614 RR 290 Position back cush wd>=22inE2614 UE 290 Position back cush wd>=22inE2615 290 Pos back post/lat wdth <22inE2615 NU 290 Pos back post/lat wdth <22inE2615 RR 290 Pos back post/lat wdth <22inE2615 UE 290 Pos back post/lat wdth <22inE2616 290 Pos back post/lat wdth>=22inE2616 NU 290 Pos back post/lat wdth>=22inE2616 RR 290 Pos back post/lat wdth>=22inE2616 UE 290 Pos back post/lat wdth>=22inE2617 290 Cus fabricated wc back cush, any sizeE2619 290 Replace cover w/c seat cushE2619 NU 290 Replace cover w/c seat cushE2619 RR 290 Replace cover w/c seat cushE2619 UE 290 Replace cover w/c seat cushE2620 290 WC planar back cush wd <22inE2620 NU 290 WC planar back cush wd <22inE2620 RR 290 WC planar back cush wd <22inE2620 UE 290 WC planar back cush wd <22inE2621 290 WC planar back cush wd>=22inE2621 NU 290 WC planar back cush wd>=22inE2621 RR 290 WC planar back cush wd>=22inE2621 UE 290 WC planar back cush wd>=22inE2622 290 Adj skin pro/pos cus<22inE2623 290 Adj skin pro wc cus wd>=22inE2624 290 Adj skin pro/pos cus<22inE2625 290 Adj skin pro/pos wc cus>=22E2626 290 Seo mobile arm sup att to wc E2626 NU 290 Seo mobile arm sup att to wc E2626 RR 290 Seo mobile arm sup att to wc E2626 UE 290 Seo mobile arm sup att to wc E2627 290 Arm supp att to wc rancho ty E2627 NU 290 Arm supp att to wc rancho ty E2627 RR 290 Arm supp att to wc rancho ty E2627 UE 290 Arm supp att to wc rancho ty E2628 290 Mobile arm supports reclinin E2628 NU 290 Mobile arm supports reclinin E2628 RR 290 Mobile arm supports reclinin E2628 UE 290 Mobile arm supports reclinin E2629 290 Friction dampening arm supp E2629 NU 290 Friction dampening arm supp E2629 RR 290 Friction dampening arm supp E2629 UE 290 Friction dampening arm supp E2630 290 Monosuspension arm/hand supp E2630 NU 290 Monosuspension arm/hand supp


CPT/HCPCS MOD MOD LEV DESCRIPTIONE2630 RR 290 Monosuspension arm/hand supp E2630 UE 290 Monosuspension arm/hand supp E2631 290 Elevat proximal arm support E2631 NU 290 Elevat proximal arm support E2631 RR 290 Elevat proximal arm support E2631 UE 290 Elevat proximal arm support E2632 290 Offset/lat rocker arm w/ela E2632 NU 290 Offset/lat rocker arm w/ela E2632 RR 290 Offset/lat rocker arm w/ela E2632 UE 290 Offset/lat rocker arm w/ela E2633 290 Mobile arm support supinator E2633 NU 290 Mobile arm support supinator E2633 RR 290 Mobile arm support supinator E2633 UE 290 Mobile arm support supinator EDCAN 290 FECA Dep Dir AuthEXTRA 290 Court costs/collection agency fees/etc-payable on delin billsFOLUP 290 OWCP-requested follow-up report with additional med/other evidenceFORGN 290 Foreign Dummy Procedure CodeFR001 290 Case file review-15 min; EEOICP onlyFR002 290 Supplemental code for file & case review; EEOICP onlyFR003 290 Diagnosis Clarification file review only; EEOICP onlyFR004 290 Impairment Rating file review only; EEOICP onlyFURNI 290 Furniture; non-DMEG0008 281 Admin influenza virus vacG0009 281 Admin pneumococcal vaccineG0010 281 Admin hepatitis b vaccineG0027 286 Semen analysisG0101 181 CA screen;pelvic/breast examG0102 281 Prostate ca screening; dreG0103 286 Psa, total screeningG0104 255 CA screen;flexi sigmoidscopeG0105 255 Colorectal scrn; hi risk indG0105 53 256 Colorectal scrn; hi risk indG0106 262 Colon CA screen;barium enemaG0106 TC 263 Colon CA screen;barium enemaG0106 26 262 Colon CA screen;barium enemaG0108 269 Diab manage trn per indivG0109 269 Diab manage trn ind/groupG0120 262 Colon ca scrn; barium enemaG0120 TC 263 Colon ca scrn; barium enemaG0120 26 262 Colon ca scrn; barium enemaG0121 255 Colon ca scrn not hi rsk indG0121 53 256 Colon ca scrn not hi rsk indG0122 275 Colon ca scrn; barium enemaG0122 TC 276 Colon ca scrn; barium enemaG0122 26 275 Colon ca scrn; barium enemaG0123 286 Screen cerv/vag thin layerG0124 270 Screen c/v thin layer by MDG0127 251 Trim nail(s)G0128 270 CORF skilled nursing service / 10 min.G0129 270 O.T. component of partial hosp serv/dayG0130 270 Single energy x-ray studyG0130 TC 270 Single energy x-ray studyG0130 26 270 Single energy x-ray studyG0141 270 Scr c/v cyto,autosys and mdG0143 290 Scr c/v cyto,thinlayer,rescrG0144 290 Scr c/v cyto,thinlayer,rescrG0145 290 Scr c/v cyto,thinlayer,rescrG0147 290 Scr c/v cyto, automated sysG0148 290 Scr c/v cyto, autosys, rescrG0151 290 HHCP-serv of pt,ea 15 minG0152 290 HHCP-serv of ot,ea 15 minG0153 282 HHCP-svs of s/l path,ea 15mnG0154 290 HHCP-svs of rn,ea 15 minG0155 290 HHCP-svs of csw,ea 15 minG0156 290 HHCP-svs of aide,ea 15 min


CPT/HCPCS MOD MOD LEV DESCRIPTIONG0157 290 HHC pt assistant ea 15G0158 290 HHC ot assistant ea 15G0159 290 HHC pt maint ea 15 minG0160 290 HHC occup therapy ea 15G0161 290 HHC slp ea 15 min G0162 290 HHC rn E&M plan svs, 15 minG0163 290 HHC lpn/rn obs/asses ea 15G0164 290 HHC lis nurse train ea 15G0166 286 Extrnl counterpulse, per txG0168 252 Wound closure by adhesiveG0173 282 Stereo radoisurgery,complete end-dated 12/31/2014G0182 266 Hospice care supervisionG0186 174 Dstry eye lesn,fdr vssl techG0190 269 Immunization administrationG0191 286 Immunization admin, each addG0192 269 Immunization oral/intranasalG0202 218 Screening mammographyG0202 TC 218 Screening mammographyG0202 26 218 Screening mammographyG0204 167 Diagnostic mammography, bilateralG0204 TC 169 Diagnostic mammography, bilateralG0204 26 167 Diagnostic mammography, bilateralG0206 168 Diagnostic mammography, unilateralG0206 TC 170 Diagnostic mammography, unilateralG0206 26 168 Diagnostic mammography, unilateralG0219 277 PET img wholbod melano noncoG0219 TC 278 PET img wholbod melano noncoG0219 26 277 PET img wholbod melano noncoG0237 265 Therapeutic procedures, c 15 minG0238 265 Therapeutic procedures, not G0237, c 15 minG0239 269 Therapeutic proced, not G0236, 2 or moreG0245 195 Initial foot exam pt lopsG0246 195 Followup eval of foot pt lopG0247 244 Routine footcare pt w lopsG0248 264 Demonstrate use home inr monG0249 268 Provide test material,equipmG0250 264 MD review interpret of testG0251 290 Linear acc based stero radio end-dated 12/31/2014G0252 277 PET imaging initial dxG0252 TC 278 PET imaging initial dxG0252 26 277 PET imaging initial dxG0257 290 Unsched dialysis ESRD pt hosG0260 283 Inj for sacroiliac jt anesthG0268 136 Removal of impacted wax mdG0270 266 MNT subs tx for change dxG0271 266 Group MNT 2 or more 30 minsG0275 246 Renal angio, cardiac cath end-dated 12/31/2013G0276 246 Pild/placebo control clin trG0277 246 Hbot, full body chamger, 30mG0278 246 Iliac art angio,cardiac cathG0281 195 Elec stim unattend for pressG0283 195 Elec stim other than woundG0288 213 Recon, CTA for surg planG0289 247 Arthro, loose body + chondroG0306 290 CBC/diffwbc w/o plateletG0307 290 CBC without plateletG0328 286 Fecal blood scrn immunoassayG0328 QW 286 Fecal blood scrn immunoassayG0329 181 Electromagnetic tx for ulcersG0333 290 Dispense fee initial 30 dayG0337 286 Hospice evaluation preelectiG0339 264 Robot lin-radsurg com, first sessionG0340 264 Robot linear steroradio max5G0341 253 Percutaneous islet cell transplantG0342 66 Laparoscopy islet cell transplant


CPT/HCPCS MOD MOD LEV DESCRIPTIONG0343 66 Laparotomy islet cell transplantG0364 227 Bone marrow aspirate &biopsyG0365 258 Vessel mapping hemo accessG0365 TC 259 Vessel mapping hemo accessG0365 26 258 Vessel mapping hemo accessG0372 270 MD service required for PMDG0378 290 Hospital observation per hrG0379 290 Direct admit hospital observG0389 143 Ultrasound exam AAA screenG0389 TC 144 Ultrasound exam AAA screenG0389 26 143 Ultrasound exam AAA screenG0390 140 Trauma Respons w/hosp critiG0396 270 Alcohol/subs interv 15-30mnG0397 270 Alcohol/subs interv >30 minG0403 219 EKG for initial prevent examG0404 219 EKG tracing for initial prevG0405 219 EKG interpret & report preveG0406 221 Inpt/tele follow up 15G0407 221 Inp/tele follow up 25G0408 221 Inpt/tele follow up 35G0409 221 CORF related serv 15 mins eaG0410 282 Grp psych partial hosp 45-50G0411 282 Inter active grp psych partiG0412 45 Open tx iliac spine uni/bilG0413 14 Pelvic ring fracture uni/bilG0414 45 Pelvic ring fx treat int fixG0415 45 Open tx post pelvic fxctureG0416 143 Sat biopsy 10-20 G0416 TC 144 Sat biopsy 10-20 G0416 26 143 Sat biopsy 10-20 G0417 143 Sat biopsy prostate 21-40 end-dated 12/31/2014G0417 TC 144 Sat biopsy prostate 21-40 end-dated 12/31/2014G0417 26 143 Sat biopsy prostate 21-40 end-dated 12/31/2014G0418 143 Sat biopsy prostate 41-60 end-dated 12/31/2014G0418 TC 144 Sat biopsy prostate 41-60 end-dated 12/31/2014G0418 26 143 Sat biopsy prostate 41-60 end-dated 12/31/2014G0419 143 Sat biopsy prostate: >60 end-dated 12/31/2014G0419 TC 144 Sat biopsy prostate: >60 end-dated 12/31/2014G0419 26 143 Sat biopsy prostate: >60 end-dated 12/31/2014G0420 270 Ed svc CKD ind, per hr G0421 270 Ed svc CKD grp per hrG0422 270 Intens cardiac rehab w/exercG0423 270 Intens cardiac rehab no exerG0424 270 Pulmonary rehab w exerG0425 270 Inpt/ed teleconsult 30G0426 270 Inpt/ed teleconsult 50G0427 270 Inpt/ed teleconsult 70G0428 290 Collagen meniscus implantG0429 270 Dermal filler injection(s)G0431 290 Drug screen multiple classG0432 290 Eia hiv-1/hiv-2 screenG0433 290 Elisa hiv-1/hiv-2 screenG0434 290 Drug screen multi drug classG0434 QW 290 Drug screen multi drug classG0435 290 Oral hiv-1/hiv-2 screenG0448 290 Place perm pacing cardiovertG0460 290 Autologous PRP for ulcersG0461 290 Immunohisto/cyto chem 1st st end-dated 12/31/2014G0461 TC 290 Immunohisto/cyto chem 1st st end-dated 12/31/2014G0461 26 290 Immunohisto/cyto chem 1st st end-dated 12/31/2014G0462 290 Immunohisto/cyto chem add G0462 TC 290 Immunohisto/cyto chem add G0462 26 290 Immunohisto/cyto chem add G0463 290 Hospital outpt clinic visitG0464 290 Colorec ca scr, sto bas dna


CPT/HCPCS MOD MOD LEV DESCRIPTIONG0466 290 FQHC visit new patientG0467 290 FQHC visit, estab ptG0468 290 FQHC visit, ippe or awvG0469 290 FQHC visit, mh new ptG0470 290 FQHC visit, mh est ptG0471 290 Ven blood coll snf/hhaG0472 290 Hep C screen high risk/otherG0473 290 Group behav couns 2-10G3001 290 Admin + supply, tositumomab, 450mgG6001 290 Echo guidance radiotherapyG6002 290 Stereoscopic x-ray guidanceG6003 290 Radiation treatment deliveryG6004 290 Radiation treatment deliveryG6005 290 Radiation treatment deliveryG6006 290 Radiation treatment deliveryG6007 290 Radiation treatment deliveryG6008 290 Radiation treatment deliveryG6009 290 Radiation treatment deliveryG6010 290 Radiation treatment deliveryG6011 290 Radiation treatment deliveryG6012 290 Radiation treatment deliveryG6013 290 Radiation treatment deliveryG6014 290 Radiation treatment deliveryG6015 290 Radiation tx delivery imrtG6016 290 Delivery comp imrtG6017 290 Intrafraction track motionG6018 290 Ilioscopy w/stentG6019 290 Colonoscopy lesion removalG6020 290 Colonoscopy w/stentG6022 290 Sigmoidoscopy w/ablate tumrG6023 290 Sigmoidoscopy w/stentG6024 290 Lesion removal colonoscopyG6025 290 Colonoscopy w/stentG6027 290 Anoscopy hra w/spec collectG6028 290 Anoscopy hra w/biopsyG6030 290 Assay of amitriptylineG6031 290 Assay of benzodiazepinesG6032 290 Assay of desipramineG6034 290 Assay of doxepinG6035 290 Assay of goldG6036 290 Assay of imipramineG6037 290 Assay of nortiptylineG6038 290 Assay of salicylateG6039 290 Assay of acetaminophenG6040 290 Assay of ethanolG6041 290 Assay of urine alkaloidsG6042 290 Assay of amphetaminesG6043 290 Assay of barbituratesG6044 290 Assay of cocaineG6045 290 Assay of dihydrocedeinoneG6046 290 Assay of dihydromorphinoneG6047 290 Assay of dihydrotestosteroneG6048 290 Assay of dimethadioneG6049 290 Assay of epiandrosteroneG6050 290 Assay of EthchlorvynolG6051 290 Assay of flurazepam


CPT/HCPCS MOD MOD LEV DESCRIPTION

G6052 290 Assay of meprobamateG6053 290 Assay of methadoneG6054 290 Assay of methsuximideG6055 290 Assay of nicotineG6056 290 Assay of opiatesG6057 290 Assay of phenothiazineG6058 290 Drug confirmationG9035 290 Oseltamivir phosp, brand 75 mgH0001 290 Alcohol and/or drug assessmentH0002 290 Alcohol and/or drug screening, eligibilityH0003 290 Alcohol and/or drug screening, lab analysisH0004 290 Alcohol and/or drug services, ind counselH0005 290 Alcohol and/or drug services, group counselH0006 290 Alcohol and/or drug services, case mgmtH0007 290 Alcohol and/or drug services, crisis intervH0008 290 Alcohol and/or drug serv, sub-acute dtox, ipH0009 290 Alcohol and/or drug serv, acute dtox, ipH0010 290 Alcohol and/or drug serv, sub-acute dtoxH0011 290 Alcohol and/or drug serv, acute dtoxH0012 290 Alcohol and/or drug serv, sub-acute dtox, opH0013 290 Alcohol and/or drug serv, acute dtox, opH0014 290 Alcohol and/or drug serv, ambulatory dtoxH0015 290 Alcohol and/or drug serv, intensive opH0016 290 Alcohol and/or drug serv, medical somaticH0017 290 Alcohol and/or drug serv, residential, hospH0018 290 Alcohol and/or drug serv, s/t residentialH0019 290 Alcohol and/or drug serv, l/t residentialH0020 290 Alcohol and/or drug serv, methadone svcH0022 290 Alcohol and/or drug intervenH0023 290 Alcohol and/or drug outreachH0024 290 Alcohol and/or drug preventiH0025 290 Alcohol and/or drug preventiH0026 290 Alcohol and/or drug preventiH0027 290 Alcohol and/or drug preventiH0028 290 Alcohol and/or drug preventiH0029 290 Alcohol and/or drug preventiH0035 290 MH partial hosp tx under 24hH0036 290 Comm psy face-face per 15minH0043 290 Supported housing, per diemH0044 290 Supported housing, per monthH0049 290 Alcohol/drug screeningH0050 290 Alcohol/drug service 15 minJ0120 290 Tetracyclin inj, 250mgJ0128 290 Abarelix, inj, 10mgJ0129 290 Abatacept injection, 10 mgJ0130 290 Abciximab inj, 10mgJ0131 290 Acetaminophen injectionJ0132 290 Acetylcysteine injection, 100 mgJ0133 290 Acyclovir injection, 5 mgJ0135 290 Adalimumab inj, 20mgJ0150 290 Injection adenosine tx 6mg end-dated 12/31/2014J0151 290 Inj adenosine diag 1mg end-dated 12/31/2014J0152 290 Adenosine inj dx 30mg end-dated 12/31/2013J0153 290 Adenosine inj 1mgJ0170 290 Adrenalin epinephrin inj, 1mlJ0171 290 Adrenalin epinephrine injectJ0178 290 Aflibercept injection J0180 290 Agalsidase beta inj, 1mgJ0190 290 Inj biperiden lactate/5 mgJ0200 290 Alatrofloxacin mesylateJ0205 290 Alglucerase inj, 10unitsJ0207 290 Amifostine inj 500mgJ0210 290 Methyldopate hcl inj, 250mgJ0215 290 Alefacept inj 0.5mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ0220 290 Aglucosidase alfa injectionJ0256 290 Alpha 1 proteinase inhibitor, 10mgJ0257 290 Glassia injectionJ0270 290 Alprostadil for inj, 1.25mcgJ0275 290 Alprostadil urethral suppos, 125mcgJ0278 290 Amikacin sulfate injection, 50mgJ0280 290 Aminophyllin 250 MG injJ0282 290 Amiodarone HCl, 30mgJ0285 290 Amphotericin B, 50mgJ0287 290 Amphotericin b lipid complex, 10mgJ0288 290 Ampho b cholesteryl sulfate, 10mgJ0289 290 Amphotericin b liposome inj, 10mgJ0290 290 Ampicillin 500 MG injJ0295 290 Ampicillin sodium per 1.5 gmJ0300 290 Amobarbital 125 MG injJ0330 290 Succinycholine chloride inj, 20mgJ0348 290 Anadulafungin injection, 1mgJ0350 290 Injection anistreplase 30 uJ0360 290 Hydralazine hcl inj, 20mgJ0364 290 Apomorphine hydrochloride, 1mgJ0365 290 Aprotonin, 10,000 kiuJ0380 290 Inj metaraminol bitartrate, 10mgJ0390 290 Chloroquine injJ0395 290 Arbutamine HCl injJ0400 290 Aripiprazole injectionJ0401 290 Inj aripiprazole ext rel 1mg J0456 290 Azithromycin, 500mgJ0461 290 Atropine sulfate inj, 0.1mgJ0470 290 Dimecaprol inj, 100mgJ0475 290 Baclofen 10 MG injJ0476 290 Baclofen intrathecal trial, 50mcgJ0480 290 Basiliximab, 20mgJ0485 290 Belatacept injection J0490 290 Belimumab injectionJ0500 290 Dicyclomine inj, 20mgJ0515 290 Inj benztropine mesylate, 1mgJ0520 290 Bethanechol chloride injectJ0558 290 Peng benzathine/procaine injJ0559 290 Penicillin g benzathine inj, 2,500unitsJ0560 290 Penicillin g benzathine inj, 600000uJ0561 290 Penicillin G benzathine injJ0570 290 Penicillin g benzathine inj, 1200000uJ0571 290 Buprenorphine oral 1 mgJ0572 290 Buprenorphine/nalox up to 3mgJ0573 290 Buprenorphine/nalox 3.1 to 6mgJ0574 290 Buprenorphine/nalox 6.1 to 10mgJ0575 290 Buprenorphine/nalox over 10 mgJ0580 290 Penicillin g benzathine inj, 2400000uJ0583 290 Bivalirudin, 1mgJ0585 290 Botulinum toxin type A per unitJ0586 290 AbobotulinumtoxinA inj, 5 unitsJ0587 290 Botulinum toxin type B per 100uJ0588 290 Incobotulinumtoxin AJ0592 290 Buprenorphine hydrochloride, 0.1mgJ0594 290 Busulfan injection, 1 mgJ0595 290 Butorphanol tartrate 1 mgJ0597 290 C-1 esterase, berinertJ0598 290 C1 esterase inhibitor inj, 10 unitsJ0600 290 Edetate calcium disodium inj, 1mlJ0610 290 Calcium gluconate inj, 10mlJ0620 290 Calcium glycer & lact/10 MLJ0630 290 Calcitonin salmon inj, 400uJ0636 290 Inj calcitriol per 0.1 mcgJ0637 290 Caspofungin acetate 5mgJ0638 290 Canakinumab injection


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ0640 290 Leucovorin calcium inj/50mgJ0641 290 Levoleucovorin injectionJ0670 290 Inj mepivacaine HCL/10 mlJ0690 290 Cefazolin sodium inj 500mgJ0692 290 Cefepime HCl for inj 500mgJ0694 290 Cefoxitin sodium inj, 1gmJ0696 290 Ceftriaxone sodium inj 250mgJ0697 290 Sterile cefuroxime inj, 750mgJ0698 290 Cefotaxime sodium inj, 1gmJ0702 290 Betamethasone acet&sod phosp, 3mgJ0706 290 Caffeine citrate inj, 5mgJ0710 290 Cephapirin sodium inj, 1gmJ0712 290 Ceftaroline fosamil injJ0713 290 Inj ceftazidime per 500mgJ0715 290 Ceftizoxime sodium / 500mgJ0716 290 Centruroides immune F(AB) J0717 290 Certolizumab pegol inj 1mg J0718 290 Certolizumab pegol inj, 1 mg end-dated 12/31/2013J0720 290 Chloramphenicol sodium injec, 1gmJ0725 290 Chorionic gonadotropin/1000uJ0735 290 Clonidine hydrochloride, 1mgJ0740 290 Cidofovir inj, 375mgJ0743 290 Cilastatin sodium inj, 250mgJ0744 290 Ciprofloxacin iv,200mgJ0745 290 Inj codeine phosphate /30 MGJ0760 290 Colchicine inj, 1mgJ0770 290 Colistimethate sodium inj, 150mgJ0775 290 Collagenase, clost hist injJ0780 290 Prochlorperazine inj, 10mgJ0795 290 Corticorelin ovine triflutal, 1 eaJ0800 290 Corticotropin inj, 40 unitsJ0833 290 Cosyntropin NOS inj, 0.25 mgJ0834 290 Cosyntropin cortrosyn inj, 0.25 mgJ0840 290 Crotalidae poly immune fabJ0850 290 Cytomegalovirus imm IV /vial, 1mlJ0878 290 Daptomycin inj, 1mgJ0881 290 Darbepoetin alfa, non-esrd, 1mcgJ0882 290 Darbepoetin alfa, esrd use, 1mcgJ0885 290 Epoetin alfa, non-esrd, 1000uJ0886 290 Epoetin alfa, esrd, 1000uJ0887 290 Epotetin beta esrd useJ0888 290 Epotetin beta non esrd J0890 290 Peginesatide injection J0894 290 Decitabine injection, 1 mgJ0895 290 Deferoxamine mesylate inj 500mgJ0897 290 Denosumab injectionJ0900 290 Testosterone enanthate inj, 1cc end-dated 12/31/2014J0945 290 Brompheniramine maleate inj, 10mgJ0970 290 Estradiol valerate inj, 40mgJ1000 290 Depo-estradiol cypionate inj 5mgJ1020 290 Methylprednisolone 20mg injJ1030 290 Methylprednisolone 40mg injJ1040 290 Methylprednisolone 80mg injJ1050 290 Medroxyprogesterone acetate J1060 290 Testosterone cypionate 1 ML end-dated 12/31/2014J1070 290 Testosterone cypionat 100mg end-dated 12/31/2014J1071 290 Inj Testosterone cypionateJ1080 290 Testosterone cypionat 200mg end-dated 12/31/2014J1094 290 Inj dexamethasone acetate, 1 mgJ1100 290 Dexamethasone sodium phos 1 mgJ1110 290 Inj dihydroergotamine mesylt, 1mgJ1120 290 Acetazolamid sodium inj, 500mgJ1160 290 Digoxin inj, 0.5mgJ1162 290 Digoxin immune fab (ovine), per vialJ1165 290 Phenytoin sodium inj, 50mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ1170 290 Hydromorphone inj, 4mgJ1180 290 Dyphylline inj, 500mgJ1190 290 Dexrazoxane HCl inj /250mgJ1200 290 Diphenhydramine hcl inj 50mgJ1205 290 Chlorothiazide sodium inj, 500mgJ1212 290 Dimethyl sulfoxide 50%, 50 MLJ1230 290 Methadone inj, 10mgJ1240 290 Dimenhydrinate inj, 50mgJ1245 290 Dipyridamole inj /10mgJ1250 290 Inj dobutamine HCL/250mgJ1260 290 Dolasetron mesylate 10mgJ1265 290 Dopamine inj, 40mgJ1267 290 Doripenem injectionJ1270 290 Injection, doxercalciferol, 1mcgJ1290 290 Ecallantide injecitonJ1300 290 Eculizumab injectionJ1320 290 Amitriptyline inj, 20mgJ1322 290 Elosulfase Alfa, injectionJ1324 290 Enfuvirtide injection, 1 mgJ1325 290 Epoprostenol inj, 0.5mgJ1327 290 Eptifibatide inj, 5mgJ1330 290 Ergonovine maleate inj, 0.2mgJ1335 290 Ertapenem inj, 500mgJ1364 290 Erythro lactobionate /500mgJ1380 290 Estradiol valerate 10mg injJ1410 290 Inj estrogen conjugate 25mgJ1430 290 Ethanolamine oleate 100mgJ1435 290 Injection estrone per 1 mgJ1436 290 Etidronate disodium inj, 300mgJ1438 290 Etanercept inj, 25mgJ1439 290 Inj ferric carboxymaltos 1mgJ1440 290 Filgrastim 300 mcg injeciton end-dated 12/31/2013J1441 290 Filgrastim 480 mcg injection end-dated 12/31/2013J1442 290 Inj, filgrastim g-csf 1mcg J1446 290 Inj, tbo-filgrastim, 5 mcg J1450 290 Fluconazole, 200mgJ1451 290 Fomepizole, 15 mgJ1452 290 Intraocular Fomivirsen na, 1.65mgJ1453 290 Fosaprepitant injectionJ1455 290 Foscarnet sodium inj, 1000mgJ1457 290 Gallium nitrate inj, 1mgJ1458 290 Galsulfase injection, 1 mgJ1459 290 Inj IVIG privigen 500 mgJ1460 290 Gamma globulin 1CC injJ1470 290 Gamma globulin 2 CC injJ1480 290 Gamma globulin 3 CC injJ1490 290 Gamma globulin 4 CC injJ1500 290 Gamma globulin 5 CC injJ1510 290 Gamma globulin 6 CC injJ1520 290 Gamma globulin 7 CC injJ1530 290 Gamma globulin 8 CC injJ1540 290 Gamma globulin 9 CC injJ1550 290 Gamma globulin 10 CC injJ1556 290 Inj. Imm glob bivigam, 500mg J1557 290 Gammaplex injectionJ1559 290 Hizentra injectionJ1560 290 Gamma globulin > 10 CC inj /10mlJ1561 290 Gaminex/gamunex CJ1562 290 Immune globulin subcutaneous, 100 mgJ1566 290 Immune globulin, powder, 500mgJ1568 290 Octagam injection, 500 mgJ1569 290 Gammagard liquid injection, 500 mgJ1570 290 Ganciclovir sodium inj, 500mgJ1571 290 HepaGam B IM injection, 0.5 mlJ1572 290 Flebogamma injection, 500 mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ1573 290 Hepagam B intravenous, injJ1580 290 Garamycin gentamicin inj 80mgJ1590 290 Gatifloxacin inj, 10mgJ1595 290 Inj glatiramer acetate, 20mgJ1599 290 Ivig non-lyophilized, nosJ1600 290 Gold sodium thiomaleate inj 50mgJ1602 290 Golimumab for iv use 1mg J1610 290 Glucagon hydrochloride/1 MGJ1620 290 Gonadorelin hydroch/ 100 mcgJ1626 290 Granisetron HCl injection 100mcgJ1630 290 Haloperidol inj, 5mgJ1631 290 Haloperidol decanoate inj /50mgJ1640 290 Hemin, 1 mgJ1642 290 Inj heparin sodium per 10 uJ1644 290 Inj heparin sodium per 1000 uJ1645 290 Dalteparin sodium per 2500 iuJ1650 290 Inj enoxaparin sodium, 10mgJ1652 290 Fondaparinux sodium, 0.5mgJ1655 290 Tinzaparin sodium injection 1000 iuJ1670 290 Tetanus immune globulin inj, 250uJ1675 290 Histrelin acetateJ1700 290 Hydrocortisone acetate injJ1710 290 Hydrocortisone sodium ph injJ1720 290 Hydrocortisone sodium succ inj 100mgJ1725 290 Hydroxyprogesterone caproateJ1730 290 Diazoxide inj, 300mgJ1740 290 Ibandronate sodium injection, 1 mgJ1741 290 Ibuprofen injection J1742 290 Ibutilide fumarate inj, 1mgJ1743 290 Idursulfase injectionJ1744 290 Icatibant injection J1745 290 Infliximab inj, 10mgJ1750 290 Inj iron dextranJ1756 290 Iron sucrose inj, 1mgJ1786 290 Imuglucerase injectionJ1790 290 Droperidol inj, 1mgJ1800 290 Propranolol inj, 1mgJ1810 290 Droperidol/fentanyl inj, 2mlJ1815 290 Insulin injection, / 5 unitsJ1817 290 Insulin for insulin pump use, 50uJ1825 290 Interferon beta-1a, 33 mcgJ1826 290 Interferon beta-1A inJ1830 290 Interferon beta-1b, 0.25mgJ1835 290 Intraconazole inj, 50mgJ1840 290 Kanamycin sulfate 500mg injJ1850 290 Kanamycin sulfate 75mg injJ1885 290 Ketorolac tromethamine inj 15mgJ1890 290 Cephalothin sodium inj, 1 gramJ1930 290 Lanreotide injectionJ1931 290 Laronidase injection, 0.1mgJ1940 290 Furosemide injection 20mgJ1945 290 Lepirudin, 50mgJ1950 290 Leuprolide acetate, 3.75 MGJ1953 290 Levetiracetam injectionJ1955 290 Inj levocarnitine per 1 gmJ1956 290 Levofloxacin inj, 250mgJ1960 290 Levorphanol tartrate injJ1980 290 Hyoscyamine sulfate inj, 0.25mgJ1990 290 Chlordiazepoxide inj, 100mgJ2001 290 Lidocaine inj, 10mgJ2010 290 Lincomycin inj, 300mgJ2020 290 Linezolid inj, 200mgJ2060 290 Lorazepam inj, 2mgJ2150 290 Mannitol injection 25%, 50mlJ2170 290 Mecasermin injection, 1 mgJ2175 290 Meperidine hydrochl, 100mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ2180 290 Meperidine/promethazine inj, 50mgJ2185 290 Meropenem, 100mgJ2210 290 Methylergonovin maleate inj, 0.2mgJ2212 290 Methylnaltrexone injection J2248 290 Micafungin sodium injection, 1 mgJ2250 290 Inj midazolam hydrochloride, 1mgJ2260 290 Inj milrinone lactate / 5mgJ2265 290 Minocycline hydrochlodide J2270 290 Morphine sulfate inj, 10mgJ2271 290 Morphine so4 inj, 100mg end-dated 12/31/2014J2274 290 Inj morphine preservative freeJ2275 290 Morphine sulfate inj, 10mg end-dated 12/31/2014J2278 290 Ziconotide injection, 1mcgJ2280 290 Inj, moxifloxacin 100 mgJ2300 290 Inj nalbuphine hydrochloride, 10mgJ2310 290 Inj naloxone hydrochloride, 1mgJ2315 290 Naltrexone, depot form, 1 mgJ2320 290 Nandrolone decanoate 50mgJ2321 290 Nandrolone decanoate 100mgJ2322 290 Nandrolone decanoate 200mgJ2323 290 Natalizumab injectionJ2325 290 Nesiritide injection 0.1 mgJ2353 290 Octreotide injection, depot 1mgJ2354 290 Octreotide inj, non-depot 25mcgJ2355 290 Oprelvekin inj, 5mgJ2357 290 Omalizumab injection, 5mgJ2358 290 Olanzapine long-acting injJ2360 290 Orphenadrine inj, 60mgJ2370 290 Phenylephrine hcl inj, 1mlJ2400 290 Chloroprocaine hcl inj, 30mlJ2405 290 Ondansetron hcl inj, 1 mgJ2410 290 Oxymorphone hcl inj, 1mgJ2425 290 Palifermin injection, 50mcgJ2426 290 Paliperidone ;almitate injJ2430 290 Pamidronate disodium, 30mgJ2440 290 Papaverin hcl inj, 60mgJ2460 290 Oxytetracycline inj, 50mgJ2469 290 Palonosetron HCl, 25mcgJ2501 290 Paricalcitol 1mcgJ2503 290 Pegaptanib sodium injection, 0.3mgJ2504 290 Pegademase bovine, 25 iuJ2505 290 Inj, pegfilgrastim, 6mgJ2507 290 Pegloticase injectionJ2510 290 Penicillin g procaine inj, 600000uJ2513 290 Pentastarch 10% solution, 100mlJ2515 290 Pentobarbital sodium inj, 50mgJ2540 290 Penicillin g potassium inj, 600000uJ2543 290 Piperacillin/tazobactam, 1.125gJ2545 290 Pentamidine isethionte/300mgJ2550 290 Promethazine hcl inj, 50mgJ2560 290 Phenobarbital sodium inj, 120mgJ2562 290 Plerixafor inj, 1 mgJ2590 290 Oxytocin inj, 10uJ2597 290 Inj desmopressin acetate, 1mcgJ2650 290 Prednisolone acetate inj, 1mlJ2670 290 Totazoline hcl injectionJ2675 290 Inj progesterone per 50mgJ2680 290 Fluphenazine decanoate 25mgJ2690 290 Procainamide hcl inj, 1gJ2700 290 Oxacillin sodium inj, 250mgJ2704 290 Inj, propofol, 10mgJ2710 290 Neostigmine methylslfte inj, 0.5mgJ2720 290 Inj protamine sulfate/10 MGJ2724 290 Protein C concentrateJ2725 290 Inj protirelin per 250 mcg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ2730 290 Pralidoxime chloride inj, 1gJ2760 290 Phentolaine mesylate inj, 5mgJ2765 290 Metoclopramide hcl inj, 10mgJ2770 290 Quinupristin/dalfopristin, 500mgJ2778 290 Ranibizumab injectionJ2780 290 Ranitidine hydrochloride inj 25mgJ2783 290 Rasburicase 0.5mgJ2785 290 Regadenoson injectionJ2788 290 Rho d immune globulin 50 mcgJ2790 290 Rho d immune globulin inj, 300mcgJ2791 290 Rhophylac injectionJ2792 290 Rho(D) immune globulin h, sd, 100iuJ2793 290 Rilonacept inj, 1 mgJ2794 290 Risperidone, long acting, 0.5mgJ2795 290 Ropivacaine HCl inj, 1mgJ2796 290 Romiplostim inj, 10 mcgJ2800 290 Methocarbamol inj, 10mlJ2805 290 Sincalide injection, 5mcgJ2810 290 Inj theophylline per 40mgJ2820 290 Sargramostim injection 50mcgJ2850 290 Inj secretin synthetic human, 1mcgJ2910 290 Aurothioglucose inj, 50mgJ2916 290 NA Ferric Gluconate Complex 12.5 mgJ2920 290 Methylprednisolone injection 40mgJ2930 290 Methylprednisolone injection 125mgJ2940 290 Somatrem injectionJ2941 290 Somatropin inj, 1mgJ2950 290 Promazine hcl inj, 25mgJ2993 290 Reteplase inj, 18.1mgJ2995 290 Inj streptokinase /250000 IUJ2997 290 Alteplase recombinant, 1 mgJ3000 290 Streptomycin inj, 1gJ3010 290 Fentanyl citrate inj, 0.1mgJ3030 290 Sumatriptan succinate / 6 MGJ3060 290 Inj, taliglucerace alfa 10 uJ3070 290 Pentazocine hcl inj, 30mgJ3095 290 Televancin injectionJ3101 290 Tenecteplase injectionJ3105 290 Terbutaline sulfate inj, 1mgJ3110 290 Teriparatide injection, 10mcgJ3120 290 Testosterone enanthate inj, 100mg end-dated 12/31/2014J3121 290 Inj testostero enanthate 1mgJ3130 290 Testosterone enanthate inj, 200mg end-dated 12/31/2014J3140 290 Testosterone suspension inj, 50mg end-dated 12/31/2014J3145 290 Testosterone undecanoate 1mgJ3150 290 Testosteron propionate inj, 100mg end-dated 12/31/2014J3230 290 Chlorpromazine hcl inj, 50mgJ3240 290 Thyrotropin inj, 0.9mgJ3243 290 Tigecycline injection, 1 mgJ3246 290 Tirofiban hydrochloride, 0.25mgJ3250 290 Trimethobenzamide hcl inj, 200mgJ3260 290 Tobramycin sulfate injection 80mgJ3262 290 Tocilizumab injectionJ3265 290 Injection torsemide 10 mg/mlJ3280 290 Thiethylperazine maleate inj, 10mgJ3285 290 Treprostinil injection, 1mgJ3300 290 Triamcinolone A inj PRS-freeJ3301 290 Triamcinolone acetonide inj 10mgJ3302 290 Triamcinolone diacetate inj 5mgJ3303 290 Triamcinolone hexacetonl inj 5mgJ3305 290 Inj trimetrexate glucoronate, 25mgJ3310 290 Perphenazine injeciton, 5mgJ3315 290 Triptorelin pamoate 3.75mgJ3320 290 Spectinomycn di-hcl inj, 2gJ3350 290 Urea injection, 40mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ3355 290 Urofollitropin, 75 iuJ3357 290 Ustekinumab injectionJ3360 290 Diazepam inj, 5mgJ3364 290 Urokinase 5000 IU injectionJ3365 290 Urokinase 250,000 IU injJ3370 290 Vancomycin hcl injeciton 500mgJ3385 290 Velaglucerase alfaJ3396 290 Verteporfin injection, 0.1mgJ3400 290 Triflupromazine hcl inj, 20mgJ3410 290 Hydroxyzine hcl injeciton 25mgJ3411 290 Thiamine hcl 100 mgJ3415 290 Pyridoxine hcl 100 mgJ3420 290 Vitamin B-12 inj, 1000mcgJ3430 290 Vitamin K phytonadione inj, 1mgJ3465 290 Injection, voriconazole, 10mgJ3470 290 Hyaluronidase inj, 150uJ3471 290 Ovine, up to 999 USP units, per unitJ3472 290 Ovine, 1000 USP unitsJ3473 290 Hyaluronidase recombinant, 1 USP unitJ3475 290 Inj magnesium sulfate 500mgJ3480 290 Inj potassium chloride /2meqJ3485 290 Zidovudine, 10mgJ3486 290 Ziprasidone mesylate, 10mgJ3487 290 Zoledronic acid, 1 mg end-dated 12/31/2013J3488 290 Reclast injection end-dated 12/31/2013J3489 290 Zoledronic acid 1mg J3490 290 Drugs unclassified injectionJ3520 290 Edetate disodium per 150 mgJ3530 290 Nasal vaccine inhalationJ3535 290 Metered dose inhaler drugJ3570 290 Laetrile amygdalin vit B17J3590 290 Unclassified biologicsJ7030 290 Normal saline solution infus 1000ccJ7040 290 Normal saline solution infus 500ml=1unitJ7042 290 5% dextrose/normal saline, 500mlJ7050 290 Normal saline solution infus, 250ccJ7060 290 5% dextrose/water, 500mlJ7070 290 D5w infusion, 1000ccJ7100 290 Dextran 40 infusion, 500mlJ7110 290 Dextran 75 infusion, 500mlJ7120 290 Ringers lactate infusion, 1000ccJ7131 290 Hypertonic saline solJ7178 290 Human fibrinogen conc inj J7180 290 Factor XIII anti-hem factorJ7181 290 Factor XIII recom- a-subunitJ7182 290 Factor Viii recomb novoeightJ7183 290 Wilate injectionJ7185 290 Xyntha inj per IUJ7186 290 Antihemophilic viii/vwf compJ7187 290 Inj Vonwillebrand factor, per IUJ7189 290 Factor viia, 1mcgJ7190 290 Factor VIII, 1iuJ7191 290 Factor VIII (porcine), 1iuJ7192 290 Factor VIII recombinant, 1iuJ7193 290 Factor IX non-recombinant, 1iuJ7194 290 Factor IX complex, 1iuJ7195 290 Factor IX recombinant, 1iuJ7196 290 Antithrombin recombinantJ7197 290 Antithrombin III injection, 1iuJ7198 290 Anti-inhibitor, 1iuJ7199 290 Hemophilia clot factor nocJ7200 290 Factor IX recombinan rixubisJ7201 290 Factor IX FC fusion recombJ7308 290 Aminolevulinic acid hcl top, 354mgJ7309 290 Methyl aminolevulinate, top


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ7310 290 Ganciclovir long act implant, 4.5mgJ7311 290 Fluocinolone acetonide intravitreal implantJ7312 290 Dexamethasone intra implantJ7315 290 Opthalmic mitomycin J7316 290 Inj, ocriplasmin, 0.125 mgJ7321 290 Hyalgan/supartz inj per doseJ7323 290 Euflexxa inj per doseJ7324 290 Orthovisc inj per doseJ7325 290 Synvisc or Synvisc-One inj, 1 mgJ7326 290 Gel-oneJ7327 290 Monovisc inj per doseJ7330 290 Cultured chondrocytes implnt, ea.J7335 290 Cultured chondrocytes implnt end-dated 12/31/2014J7336 290 Capsaicin 8% patchJ7500 290 Azathioprine oral, 50mgJ7501 290 Azathioprine parenteral, 100mgJ7502 290 Cyclosporine oral, 100 mgJ7504 290 Lymphocyte immune globulin, 250mgJ7505 290 Monoclonal antibodies, 5mgJ7506 290 Prednisone oral, 5mgJ7507 290 Tacrolimus imme rel oral 1mg J7508 290 Tacrolimus ex rel oral 0.1mgJ7509 290 Methylprednisolone oral, 4mgJ7510 290 Prednisolone oral per 5 mgJ7511 290 Antithymocyte globuln rabbit, 25mgJ7513 290 Daclizumab, parenteral, 25mgJ7515 290 Cyclosporine oral 25 mgJ7516 290 Cyclosporin parenteral 250mgJ7517 290 Mycophenolate mofetil oral, 250mgJ7518 290 Mycophenolic acid, oral, 180mgJ7520 290 Sirolimus, oral, 1mgJ7525 290 Tacrolimus injection, 5mgJ7527 290 Oral everolimus J7599 290 Immunosuppressive drug nocJ7604 290 Acetylcysteine comp unitJ7605 290 Arformoterol non-comp unitJ7606 290 Formoterol fumarate, inhJ7607 290 Levalbuterol inhal soln, comp, con, via dme, 0.5 mgJ7608 290 Acetylcysteine inh sol u d, 1gJ7609 290 Albuterol comp unit, 1 mgJ7610 290 Albuterol comp con, 1 mgJ7611 290 Albuterol concentrated form, 1mgJ7612 290 Levalbuterol concentrated, 0.5mgJ7613 290 Albuterol unit dose, 1mgJ7614 290 Levalbuterol unit dose, 0.5mgJ7615 290 Levalbuterol comp unit, 0.5 mgJ7620 290 Albuterol non-compounded, 1unitJ7622 290 Beclomethasone inhalatn sol, 1mgJ7624 290 Betamethasone inhalation sol, 1mgJ7626 290 Budesonide inhalation sol, 0.5mgJ7627 290 Budesonide, compoundedJ7628 290 Bitolterol mes inhal sol conJ7629 290 Bitolterol mes inh sol u dJ7631 290 Cromolyn sodium inh sol u d, 10mgJ7632 290 Cromolyn sodium comp unitJ7633 290 Budesonide concentrated sol, 0.25mgJ7634 290 Budesonide inhal soln, comp, con, 0.25mgJ7635 290 Atropine inhal sol con, 1mgJ7636 290 Atropine inhal sol unit dose, 1mgJ7637 290 Dexamethasone inhal sol con, 1mgJ7638 290 Dexamethasone inhal sol u d, 1mgJ7639 290 Dornase alpha inhal sol u d, 1mgJ7640 290 Formoterol injection, 12mcgJ7641 290 Flunisolide, inhalation sol, 1mgJ7642 290 Glycopyrrolate inhal sol con, 1mgJ7643 290 Glycopyrrolate inhal sol u d, 1mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ7644 290 Ipratropium brom inh sol u d, 1mgJ7645 290 Ipratropium bromide comp, via dme, 1mgJ7647 290 Isoetharine HCL, comp, con, via dme 1mgJ7648 290 Isoetharine hcl inh sol conJ7649 290 Isoetharine hcl inh sol u d, 1mgJ7650 290 Isoetharine comp unit dose, 1mgJ7657 290 Isoproterenol HCL, comp, con, 1 mgJ7658 290 Isoproterenolhcl inh sol conJ7659 290 Isoproterenol hcl inh sol udJ7660 290 Isoproterenol comp unit, 1 mgJ7665 290 Mannitol for inhalerJ7667 290 Metaproterenol comp con, 10mgJ7668 290 Metaproterenol inh sol con, 10mgJ7669 290 Metaproterenol inh sol u d, 10mgJ7670 290 Metaproterenol, comp, unit, 10mgJ7674 290 Methacholine chloride, neb, 1mgJ7676 290 Pentamidine comp unit doseJ7680 290 Terbutaline so4 inh sol con, 1mgJ7681 290 Terbutaline so4 inh sol u d, 1mgJ7682 290 Tobramycin inhalation sol, 300mgJ7683 290 Triamcinolone inh sol conJ7684 290 Triamcinolone inh sol u dJ7685 290 Tobramycin, comp, unit, 300mgJ7686 290 Treprostinil, non-comp unitJ7699 290 Inhalation solution for DMEJ7799 290 Non-inhalation drug for DMEJ8498 290 Antiemetic rectal/supp NOSJ8499 290 Oral prescrip drug non chemoJ8501 290 Aprepitant, oral, 5mgJ8510 290 Oral busulfan, 2mgJ8515 290 Cabergoline, oral 0.25mgJ8520 290 Capecitabine, oral, 150 mgJ8521 290 Capecitabine, oral, 500 mgJ8530 290 Cyclophosphamide oral 25mgJ8540 290 Oral dexamethasone, 0.25mgJ8560 290 Etoposide oral 50 MGJ8562 290 Oral fludarabine phosphateJ8565 290 Gefitinib, oral, 250mgJ8597 290 Antiemetic drug oral NOSJ8600 290 Melphalan oral 2 MGJ8610 290 Methotrexate oral 2.5 MGJ8650 290 Nabilone oral, 1mgJ8700 290 Temozolmide, 2.5mgJ8705 290 Topotecan oralJ8999 290 Oral prescription drug chemoJ9000 290 Doxorubic hcl 10 MG vl chemoJ9002 290 Doxil injection end-dated 12/31/2013J9010 290 Alemtuzumab injection 10 mgJ9015 290 Aldesleukin/single use vial, eaJ9017 290 Arsenic trioxide, 1mgJ9019 290 Erwinaze injection J9020 290 Asparaginase inj, 10000uJ9025 290 Azacitidine injection, 1mgJ9027 290 Clofarabine injection, 1mgJ9031 290 Bcg live intravesical vac, eaJ9033 290 Bendamustine injectionJ9035 290 Bevacizumab injection, 10mgJ9040 290 Bleomycin sulfate injection 15uJ9041 290 Bortezomib injection, 0.1mgJ9042 290 Brentuximab vedotin inj J9043 290 Cabazitaxel injectionJ9045 290 Carboplatin injection 50mgJ9047 290 Injection, carfilzomib, 1 mg J9050 290 Carmus bischl nitro inj 100mgJ9055 290 Cetuximab injection, 10mgJ9060 290 Cisplatin 10mg injection


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ9062 290 Cisplatin 50mg injectionJ9065 290 Inj cladribine per 1 MGJ9070 290 Cyclophosphamide 100mg injJ9080 290 Cyclophosphamide 200mg injJ9090 290 Cyclophosphamide 500mg injJ9091 290 Cyclophosphamide 1.0 grm injJ9092 290 Cyclophosphamide 2.0 grm injJ9093 290 Cyclophosphamide lyophilized 100mgJ9094 290 Cyclophosphamide lyophilized 200mgJ9095 290 Cyclophosphamide lyophilized 500mgJ9096 290 Cyclophosphamide lyophilized 1 gJ9097 290 Cyclophosphamide lyophilized 2 gJ9098 290 Cytarabine liposome 10mgJ9100 290 Cytarabine hcl 100mg injJ9110 290 Cytarabine hcl 500mg injJ9120 290 Dactinomycin actinomycin d, 0.5mgJ9130 290 Dacarbazine 100mg injJ9140 290 Dacarbazine 200mg injJ9150 290 Daunorubicin 10mgJ9151 290 Daunorubicin citrate liposom, 10mgJ9155 290 Degarelix inj, 1 mgJ9160 290 Denileukin diftitox, 300 mcgJ9165 290 Diethylstilbestrol injectionJ9171 290 Docetaxel inj, 1mgJ9175 290 Elliotts b solution, 1mlJ9178 290 Inj, epirubicin hcl, 2 mgJ9179 290 Eribulin mesylate injectionJ9181 290 Etoposide 10mg injJ9185 290 Fludarabine phosphate inj 50mgJ9190 290 Fluorouracil inj, 500mgJ9200 290 Floxuridine inj, 500mgJ9201 290 Gemcitabine HCl 200mgJ9202 290 Goserelin acetate implant 3.6mgJ9206 290 Irinotecan inj, 20mgJ9207 290 Ixabepilone injectionJ9208 290 Ifosfamide injectionJ9209 290 Mesna inj, 200mgJ9211 290 Idarubicin hcl inj, 5mgJ9212 290 Interferon alfacon-1, 1mcgJ9213 290 Interferon alfa-2a inj, 3mil uJ9214 290 Interferon alfa-2b inj, 1mil uJ9215 290 Interferon alfa-n3 inj, 250000 IUJ9216 290 Interferon gamma 1-b inj, 3mil uJ9217 290 Leuprolide acetate suspnsion, 7.5mgJ9218 290 Leuprolide acetate inj, 1mgJ9219 290 Leuprolide acetate implant 65mgJ9225 290 Histrelin implant, 50mgJ9226 290 Supprelin LA implantJ9228 290 Ipilimumab injectionJ9230 290 Mechlorethamine hcl inj, 10mgJ9245 290 Inj melphalan hydrochl, 50mgJ9250 290 Methotrexate sodium inj, 5mgJ9260 290 Methotrexate sodium inj, 50mgJ9261 290 Nelarabine injection, 50mgJ9262 290 Inj, omacetaxine mep, 0.01mg J9263 290 Oxaliplatin, 0.5 mgJ9264 290 Paclitaxel injection, 1mgJ9265 290 Paclitaxel inj, 30mg end-dated 12/31/2014J9266 290 Pegaspargase/singl dose vial, eaJ9267 290 Paclitaxel injectionJ9268 290 Pentostatin inj, 10mgJ9270 290 Plicamycin (mithramycin) injJ9280 290 Mitomycin 5mg injJ9290 290 Mitomycin 20mg injJ9291 290 Mitomycin 40mg injJ9293 290 Mitoxantrone hydrochl / 5mg


CPT/HCPCS MOD MOD LEV DESCRIPTIONJ9300 290 Gemtuzumab ozogamicin, 5mgJ9301 290 Obinutuzumab injJ9302 290 Ofatumumab injectionJ9303 290 Panitumumab injectionJ9305 290 Pemetrexed inj, 10mgJ9306 290 Injection, pertuzumab, 1 mg J9307 290 Pralatrexate injectionJ9310 290 Rituximab cancer treatment, 100mgJ9315 290 Romidepsin injectionJ9320 290 Streptozocin inj, 1 gmJ9328 290 Temozolomide inj, 1mgJ9330 290 Temsirolimus injectionJ9340 290 Thiotepa inj, 15mgJ9350 290 Topotecan, 4 mgJ9351 290 Topotecan injcetionJ9354 290 Inj, ado-trastuzumab emt 1mg J9355 290 Trastuzumab, 10mgJ9357 290 Valrubicin, 200 mgJ9360 290 Vinblastine sulfate inj, 1 mgJ9370 290 Vincristine sulfate 1 mg injJ9371 290 Inj, vincristine sul lip 1mg J9375 290 Vincristine sulfate 2 mg injJ9380 290 Vincristine sulfate 5 mg injJ9390 290 Vinorelbine tartrate/10 mgJ9395 290 Injection, Fulvestrant, 25mgJ9400 290 Inj, ziv-aflibercept, 1mg J9600 290 Porfimer sodium, 75mgJ9999 290 Chemotherapy drugK0001 290 Standard wheelchairK0001 NU 290 Standard wheelchairK0001 RR 290 Standard wheelchairK0001 UE 290 Standard wheelchairK0002 290 Stnd hemi (low seat) whlchrK0002 NU 290 Stnd hemi (low seat) whlchrK0002 RR 290 Stnd hemi (low seat) whlchrK0002 UE 290 Stnd hemi (low seat) whlchrK0003 290 Lightweight wheelchairK0003 NU 290 Lightweight wheelchairK0003 RR 290 Lightweight wheelchairK0003 UE 290 Lightweight wheelchairK0004 290 High strength ltwt whlchrK0004 NU 290 High strength ltwt whlchrK0004 RR 290 High strength ltwt whlchrK0004 UE 290 High strength ltwt whlchrK0005 290 Ultralightweight wheelchairK0005 NU 290 Ultralightweight wheelchairK0005 RR 290 Ultralightweight wheelchairK0005 UE 290 Ultralightweight wheelchairK0006 290 Heavy duty wheelchairK0006 NU 290 Heavy duty wheelchairK0006 RR 290 Heavy duty wheelchairK0006 UE 290 Heavy duty wheelchairK0007 290 Extra heavy duty wheelchairK0007 NU 290 Extra heavy duty wheelchairK0007 RR 290 Extra heavy duty wheelchairK0007 UE 290 Extra heavy duty wheelchairK0008 290 Custom manual wheelchair/baseK0009 290 Other manual wheelchair/baseK0010 290 Stnd wt frame power whlchrK0010 NU 290 Stnd wt frame power whlchrK0010 RR 290 Stnd wt frame power whlchrK0010 UE 290 Stnd wt frame power whlchrK0011 290 Stnd wt pwr whlchr w controlK0011 NU 290 Stnd wt pwr whlchr w controlK0011 RR 290 Stnd wt pwr whlchr w controlK0011 UE 290 Stnd wt pwr whlchr w control


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0012 290 Ltwt portbl power whlchrK0012 NU 290 Ltwt portbl power whlchrK0012 RR 290 Ltwt portbl power whlchrK0012 UE 290 Ltwt portbl power whlchrK0013 290 Custom motorized/power wheelchair baseK0014 290 Other power whlchr baseK0015 290 Detach non-adjus hght armrstK0015 NU 290 Detach non-adjus hght armrstK0015 RR 290 Detach non-adjus hght armrstK0015 UE 290 Detach non-adjus hght armrstK0017 290 Detach adjust armrest baseK0017 NU 290 Detach adjust armrest baseK0017 RR 290 Detach adjust armrest baseK0017 UE 290 Detach adjust armrest baseK0018 290 Detach adjust armrst upperK0018 NU 290 Detach adjust armrst upperK0018 RR 290 Detach adjust armrst upperK0018 UE 290 Detach adjust armrst upperK0019 290 Arm pad eachK0019 NU 290 Arm pad eachK0019 RR 290 Arm pad eachK0019 UE 290 Arm pad eachK0020 290 Fixed adjust armrest pairK0020 NU 290 Fixed adjust armrest pairK0020 RR 290 Fixed adjust armrest pairK0020 UE 290 Fixed adjust armrest pairK0037 290 High mount flip-up footrestK0037 NU 290 High mount flip-up footrestK0037 RR 290 High mount flip-up footrestK0037 UE 290 High mount flip-up footrestK0038 290 Leg strap eachK0038 NU 290 Leg strap eachK0038 RR 290 Leg strap eachK0038 UE 290 Leg strap eachK0039 290 Leg strap h style eachK0039 NU 290 Leg strap h style eachK0039 RR 290 Leg strap h style eachK0039 UE 290 Leg strap h style eachK0040 290 Adjustable angle footplateK0040 NU 290 Adjustable angle footplateK0040 RR 290 Adjustable angle footplateK0040 UE 290 Adjustable angle footplateK0041 290 Large size footplate eachK0041 NU 290 Large size footplate eachK0041 RR 290 Large size footplate eachK0041 UE 290 Large size footplate eachK0042 290 Standard size footplate eachK0042 NU 290 Standard size footplate eachK0042 RR 290 Standard size footplate eachK0042 UE 290 Standard size footplate eachK0043 290 Ftrst lower extension tubeK0043 NU 290 Ftrst lower extension tubeK0043 RR 290 Ftrst lower extension tubeK0043 UE 290 Ftrst lower extension tubeK0044 290 Ftrst upper hanger bracketK0044 NU 290 Ftrst upper hanger bracketK0044 RR 290 Ftrst upper hanger bracketK0044 UE 290 Ftrst upper hanger bracketK0045 290 Footrest complete assemblyK0045 NU 290 Footrest complete assemblyK0045 RR 290 Footrest complete assemblyK0045 UE 290 Footrest complete assemblyK0046 290 Elevat legrst low extensionK0046 NU 290 Elevat legrst low extensionK0046 RR 290 Elevat legrst low extensionK0046 UE 290 Elevat legrst low extension


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0047 290 Elevat legrst up hangr brackK0047 NU 290 Elevat legrst up hangr brackK0047 RR 290 Elevat legrst up hangr brackK0047 UE 290 Elevat legrst up hangr brackK0050 290 Ratchet assemblyK0050 NU 290 Ratchet assemblyK0050 RR 290 Ratchet assemblyK0050 UE 290 Ratchet assemblyK0051 290 Cam relese assem ftrst/lgrstK0051 NU 290 Cam relese assem ftrst/lgrstK0051 RR 290 Cam relese assem ftrst/lgrstK0051 UE 290 Cam relese assem ftrst/lgrstK0052 290 Swingaway detach footrestK0052 NU 290 Swingaway detach footrestK0052 RR 290 Swingaway detach footrestK0052 UE 290 Swingaway detach footrestK0053 290 Elevate footrest articulateK0053 NU 290 Elevate footrest articulateK0053 RR 290 Elevate footrest articulateK0053 UE 290 Elevate footrest articulateK0056 290 Seat ht <17 or >=21 ltwt wcK0056 NU 290 Seat ht <17 or >=21 ltwt wcK0056 RR 290 Seat ht <17 or >=21 ltwt wcK0056 UE 290 Seat ht <17 or >=21 ltwt wcK0065 290 Spoke protectorsK0065 NU 290 Spoke protectorsK0065 RR 290 Spoke protectorsK0065 UE 290 Spoke protectorsK0069 290 Rear whl complete solid tireK0069 NU 290 Rear whl complete solid tireK0069 RR 290 Rear whl complete solid tireK0069 UE 290 Rear whl complete solid tireK0070 290 Rear whl compl pneum tireK0070 NU 290 Rear whl compl pneum tireK0070 RR 290 Rear whl compl pneum tireK0070 UE 290 Rear whl compl pneum tireK0071 290 Front castr compl pneum tireK0071 NU 290 Front castr compl pneum tireK0071 RR 290 Front castr compl pneum tireK0071 UE 290 Front castr compl pneum tireK0072 290 Frnt cstr cmpl sem-pneum tirK0072 NU 290 Frnt cstr cmpl sem-pneum tirK0072 RR 290 Frnt cstr cmpl sem-pneum tirK0072 UE 290 Frnt cstr cmpl sem-pneum tirK0073 290 Caster pin lock eachK0073 NU 290 Caster pin lock eachK0073 RR 290 Caster pin lock eachK0073 UE 290 Caster pin lock eachK0077 290 Front caster assem completeK0077 NU 290 Front caster assem completeK0077 RR 290 Front caster assem completeK0077 UE 290 Front caster assem completeK0098 290 Drive belt power wheelchairK0098 NU 290 Drive belt power wheelchairK0098 RR 290 Drive belt power wheelchairK0098 UE 290 Drive belt power wheelchairK0105 290 Iv hangerK0105 NU 290 Iv hangerK0105 RR 290 Iv hangerK0105 UE 290 Iv hangerK0108 290 W/c component-accessory NOSK0195 290 Elevating whlchair leg restsK0195 NU 290 Elevating whlchair leg restsK0195 RR 290 Elevating whlchair leg restsK0195 UE 290 Elevating whlchair leg restsK0455 290 Pump uninterrupted infusion


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0455 NU 290 Pump uninterrupted infusionK0455 RR 290 Pump uninterrupted infusionK0455 UE 290 Pump uninterrupted infusionK0462 290 Temporary replacement eqpmntK0552 290 Supply/ext inf pump syr typeK0601 290 Repl batt silver oxide 1.5 vK0601 NU 290 Repl batt silver oxide 1.5 vK0602 290 Repl batt silver oxide 3 vK0602 NU 290 Repl batt silver oxide 3 vK0603 290 Repl batt alkaline 1.5 vK0603 NU 290 Repl batt alkaline 1.5 vK0604 290 Repl batt lithium 3.6 vK0604 NU 290 Repl batt lithium 3.6 vK0605 290 Repl batt lithium 4.5 vK0605 NU 290 Repl batt lithium 4.5 vK0606 290 AED garment w elec analysisK0606 NU 290 AED garment w elec analysisK0606 RR 290 AED garment w elec analysisK0606 UE 290 AED garment w elec analysisK0607 290 Repl batt for AEDK0607 NU 290 Repl batt for AEDK0607 RR 290 Repl batt for AEDK0607 UE 290 Repl batt for AEDK0608 290 Repl garment for AEDK0608 NU 290 Repl garment for AEDK0608 RR 290 Repl garment for AEDK0608 UE 290 Repl garment for AEDK0609 290 Repl electrode for AEDK0609 KF 290 Repl electrode for AEDK0669 290 Seat/back cus no sadmerc verK0672 290 Removable soft interface LEK0730 290 Ctrl dose inh drug deliv sysK0730 NU 290 Ctrl dose inh drug deliv sysK0730 RR 290 Ctrl dose inh drug deliv sysK0730 UE 290 Ctrl dose inh drug deliv sysK0733 290 Pwr wc acc, 12-24 hr sealed lead acid batteryK0733 NU 290 Pwr wc acc, 12-24 hr sealed lead acid batteryK0733 RR 290 Pwr wc acc, 12-24 hr sealed lead acid batteryK0733 UE 290 Pwr wc acc, 12-24 hr sealed lead acid batteryK0734 290 Skin protect wc cus adj wd <22inK0734 NU 290 Skin protect wc cus adj wd <22inK0734 RR 290 Skin protect wc cus adj wd <22inK0734 UE 290 Skin protect wc cus adj wd <22inK0735 290 Skin protect wc cus adj wd>=22inK0735 NU 290 Skin protect wc cus adj wd>=22inK0735 RR 290 Skin protect wc cus adj wd>=22inK0735 UE 290 Skin protect wc cus adj wd>=22inK0736 290 Skin protect&pos wc cus adj wd <22inK0736 NU 290 Skin protect&pos wc cus adj wd <22inK0736 RR 290 Skin protect&pos wc cus adj wd <22inK0736 UE 290 Skin protect&pos wc cus adj wd <22inK0737 290 Skin protect&pos wc cus wd>=22inK0737 NU 290 Skin protect&pos wc cus wd>=22inK0737 RR 290 Skin protect&pos wc cus wd>=22inK0737 UE 290 Skin protect&pos wc cus wd>=22inK0738 290 Portable gas oxygen systemK0738 NU 290 Portable gas oxygen systemK0738 RR 290 Portable gas oxygen systemK0738 UE 290 Portable gas oxygen systemK0739 290 Repair/svc DME non-oxygen equipt per 15 minK0740 290 Repair/svc oxygen equipt per 15 minK0743 290 Portable home suction pumpK0744 290 Absorp drg <=16 suc pumpK0745 290 Absorp drg >16<=48 suc pumpK0746 290 Absorp drg >48 suc pumpK0800 290 POV group 1 std up to 300 lbs


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0800 NU 290 POV group 1 std up to 300 lbsK0800 RR 290 POV group 1 std up to 300 lbsK0800 UE 290 POV group 1 std up to 300 lbsK0801 290 POV group 1 hd 301-450 lbsK0801 NU 290 POV group 1 hd 301-450 lbsK0801 RR 290 POV group 1 hd 301-450 lbsK0801 UE 290 POV group 1 hd 301-450 lbsK0802 290 POV group 1 vhd 451-600 lbsK0802 NU 290 POV group 1 vhd 451-600 lbsK0802 RR 290 POV group 1 vhd 451-600 lbsK0802 UE 290 POV group 1 vhd 451-600 lbsK0806 290 POV group 2 std up to 300lbsK0806 NU 290 POV group 2 std up to 300lbsK0806 RR 290 POV group 2 std up to 300lbsK0806 UE 290 POV group 2 std up to 300lbsK0807 290 POV group 2 hd 301-450 lbsK0807 NU 290 POV group 2 hd 301-450 lbsK0807 RR 290 POV group 2 hd 301-450 lbsK0807 UE 290 POV group 2 hd 301-450 lbsK0808 290 POV group 2 vhd 451-600 lbsK0808 NU 290 POV group 2 vhd 451-600 lbsK0808 RR 290 POV group 2 vhd 451-600 lbsK0808 UE 290 POV group 2 vhd 451-600 lbsK0812 290 Power operated vehicle NOCK0813 290 PWC gp 1 std port seat/backK0813 NU 290 PWC gp 1 std port seat/backK0813 RR 290 PWC gp 1 std port seat/backK0813 UE 290 PWC gp 1 std port seat/backK0814 290 PWC gp 1 std port cap chairK0814 NU 290 PWC gp 1 std port cap chairK0814 RR 290 PWC gp 1 std port cap chairK0814 UE 290 PWC gp 1 std port cap chairK0815 290 PWC gp 1 std seat/backK0815 NU 290 PWC gp 1 std seat/backK0815 RR 290 PWC gp 1 std seat/backK0815 UE 290 PWC gp 1 std seat/backK0816 290 PWC gp 1 std cap chairK0816 NU 290 PWC gp 1 std cap chairK0816 RR 290 PWC gp 1 std cap chairK0816 UE 290 PWC gp 1 std cap chairK0820 290 PWC gp 2 std port seat/backK0820 NU 290 PWC gp 2 std port seat/backK0820 RR 290 PWC gp 2 std port seat/backK0820 UE 290 PWC gp 2 std port seat/backK0821 290 PWC gp 2 std port cap chairK0821 NU 290 PWC gp 2 std port cap chairK0821 RR 290 PWC gp 2 std port cap chairK0821 UE 290 PWC gp 2 std port cap chairK0822 290 PWC gp 2 std seat/backK0822 NU 290 PWC gp 2 std seat/backK0822 RR 290 PWC gp 2 std seat/backK0822 UE 290 PWC gp 2 std seat/backK0823 290 PWC gp 2 std cap chairK0823 NU 290 PWC gp 2 std cap chairK0823 RR 290 PWC gp 2 std cap chairK0823 UE 290 PWC gp 2 std cap chairK0824 290 PWC gp 2 hd seat/backK0824 NU 290 PWC gp 2 hd seat/backK0824 RR 290 PWC gp 2 hd seat/backK0824 UE 290 PWC gp 2 hd seat/backK0825 290 PWC gp 2 hd cap chairK0825 NU 290 PWC gp 2 hd cap chairK0825 RR 290 PWC gp 2 hd cap chairK0825 UE 290 PWC gp 2 hd cap chairK0826 290 PWC gp2 vhd seat/backK0826 NU 290 PWC gp2 vhd seat/back


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0826 RR 290 PWC gp2 vhd seat/backK0826 UE 290 PWC gp2 vhd seat/backK0827 290 PWC gp 2 vhd cap chairK0827 NU 290 PWC gp 2 vhd cap chairK0827 RR 290 PWC gp 2 vhd cap chairK0827 UE 290 PWC gp 2 vhd cap chairK0828 290 PWC gp 2 xtra hd seat/backK0828 NU 290 PWC gp 2 xtra hd seat/backK0828 RR 290 PWC gp 2 xtra hd seat/backK0828 UE 290 PWC gp 2 xtra hd seat/backK0829 290 PWC gp 2 xtra hd cap chairK0829 NU 290 PWC gp 2 xtra hd cap chairK0829 RR 290 PWC gp 2 xtra hd cap chairK0829 UE 290 PWC gp 2 xtra hd cap chairK0830 290 PWC gp2 std seat elevate s/bK0830 NU 290 PWC gp2 std seat elevate s/bK0830 RR 290 PWC gp2 std seat elevate s/bK0830 UE 290 PWC gp2 std seat elevate s/bK0831 290 PWC gp2 std seat elevate capK0831 NU 290 PWC gp2 std seat elevate capK0831 RR 290 PWC gp2 std seat elevate capK0831 UE 290 PWC gp2 std seat elevate capK0835 290 PWC gp2 std sing pow opt s/bK0835 NU 290 PWC gp2 std sing pow opt s/bK0835 RR 290 PWC gp2 std sing pow opt s/bK0835 UE 290 PWC gp2 std sing pow opt s/bK0836 290 PWC gp2 std sing pow opt capK0836 NU 290 PWC gp2 std sing pow opt capK0836 RR 290 PWC gp2 std sing pow opt capK0836 UE 290 PWC gp2 std sing pow opt capK0837 290 PWC gp 2 hd sing pow opt s/bK0837 NU 290 PWC gp 2 hd sing pow opt s/bK0837 RR 290 PWC gp 2 hd sing pow opt s/bK0837 UE 290 PWC gp 2 hd sing pow opt s/bK0838 290 PWC gp 2 hd sing pow opt capK0838 NU 290 PWC gp 2 hd sing pow opt capK0838 RR 290 PWC gp 2 hd sing pow opt capK0838 UE 290 PWC gp 2 hd sing pow opt capK0839 290 PWC gp2 vhd sing pow opt s/bK0839 NU 290 PWC gp2 vhd sing pow opt s/bK0839 RR 290 PWC gp2 vhd sing pow opt s/bK0839 UE 290 PWC gp2 vhd sing pow opt s/bK0840 290 PWC gp2 xhd sing pow opt s/bK0840 NU 290 PWC gp2 xhd sing pow opt s/bK0840 RR 290 PWC gp2 xhd sing pow opt s/bK0840 UE 290 PWC gp2 xhd sing pow opt s/bK0841 290 PWC gp2 std mult pow opt s/bK0841 NU 290 PWC gp2 std mult pow opt s/bK0841 RR 290 PWC gp2 std mult pow opt s/bK0841 UE 290 PWC gp2 std mult pow opt s/bK0842 290 PWC gp2 std mult pow opt capK0842 NU 290 PWC gp2 std mult pow opt capK0842 RR 290 PWC gp2 std mult pow opt capK0842 UE 290 PWC gp2 std mult pow opt capK0843 290 PWC gp2 hd mult pow opt s/bK0843 NU 290 PWC gp2 hd mult pow opt s/bK0843 RR 290 PWC gp2 hd mult pow opt s/bK0843 UE 290 PWC gp2 hd mult pow opt s/bK0848 290 PWC gp 3 std seat/backK0848 NU 290 PWC gp 3 std seat/backK0848 RR 290 PWC gp 3 std seat/backK0848 UE 290 PWC gp 3 std seat/backK0849 290 PWC gp 3 std cap chairK0849 NU 290 PWC gp 3 std cap chairK0849 RR 290 PWC gp 3 std cap chairK0849 UE 290 PWC gp 3 std cap chair


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0850 290 PWC gp 3 hd seat/backK0850 NU 290 PWC gp 3 hd seat/backK0850 RR 290 PWC gp 3 hd seat/backK0850 UE 290 PWC gp 3 hd seat/backK0851 290 PWC gp 3 hd cap chairK0851 NU 290 PWC gp 3 hd cap chairK0851 RR 290 PWC gp 3 hd cap chairK0851 UE 290 PWC gp 3 hd cap chairK0852 290 PWC gp 3 vhd seat/backK0852 NU 290 PWC gp 3 vhd seat/backK0852 RR 290 PWC gp 3 vhd seat/backK0852 UE 290 PWC gp 3 vhd seat/backK0853 290 PWC gp 3 vhd cap chairK0853 NU 290 PWC gp 3 vhd cap chairK0853 RR 290 PWC gp 3 vhd cap chairK0853 UE 290 PWC gp 3 vhd cap chairK0854 290 PWC gp 3 xhd seat/backK0854 NU 290 PWC gp 3 xhd seat/backK0854 RR 290 PWC gp 3 xhd seat/backK0854 UE 290 PWC gp 3 xhd seat/backK0855 290 PWC gp 3 xhd cap chairK0855 NU 290 PWC gp 3 xhd cap chairK0855 RR 290 PWC gp 3 xhd cap chairK0855 UE 290 PWC gp 3 xhd cap chairK0856 290 PWC gp3 std sing pow opt s/bK0856 NU 290 PWC gp3 std sing pow opt s/bK0856 RR 290 PWC gp3 std sing pow opt s/bK0856 UE 290 PWC gp3 std sing pow opt s/bK0857 290 PWC gp3 std sing pow opt capK0857 NU 290 PWC gp3 std sing pow opt capK0857 RR 290 PWC gp3 std sing pow opt capK0857 UE 290 PWC gp3 std sing pow opt capK0858 290 PWC gp3 hd sing pow opt s/bK0858 NU 290 PWC gp3 hd sing pow opt s/bK0858 RR 290 PWC gp3 hd sing pow opt s/bK0858 UE 290 PWC gp3 hd sing pow opt s/bK0859 290 PWC gp3 hd sing pow opt capK0859 NU 290 PWC gp3 hd sing pow opt capK0859 RR 290 PWC gp3 hd sing pow opt capK0859 UE 290 PWC gp3 hd sing pow opt capK0860 290 PWC gp3 vhd sing pow opt s/bK0860 NU 290 PWC gp3 vhd sing pow opt s/bK0860 RR 290 PWC gp3 vhd sing pow opt s/bK0860 UE 290 PWC gp3 vhd sing pow opt s/bK0861 290 PWC gp3 std mult pow opt s/bK0861 NU 290 PWC gp3 std mult pow opt s/bK0861 RR 290 PWC gp3 std mult pow opt s/bK0861 UE 290 PWC gp3 std mult pow opt s/bK0862 290 PWC gp3 hd mult pow opt s/bK0862 NU 290 PWC gp3 hd mult pow opt s/bK0862 RR 290 PWC gp3 hd mult pow opt s/bK0862 UE 290 PWC gp3 hd mult pow opt s/bK0863 290 PWC gp3 vhd mult pow opt s/bK0863 NU 290 PWC gp3 vhd mult pow opt s/bK0863 RR 290 PWC gp3 vhd mult pow opt s/bK0863 UE 290 PWC gp3 vhd mult pow opt s/bK0864 290 PWC gp3 xhd mult pow opt s/bK0864 NU 290 PWC gp3 xhd mult pow opt s/bK0864 RR 290 PWC gp3 xhd mult pow opt s/bK0864 UE 290 PWC gp3 xhd mult pow opt s/bK0868 290 PWC gp 4 std seat/backK0868 NU 290 PWC gp 4 std seat/backK0868 RR 290 PWC gp 4 std seat/backK0868 UE 290 PWC gp 4 std seat/backK0869 290 PWC gp 4 std cap chairK0869 NU 290 PWC gp 4 std cap chair


CPT/HCPCS MOD MOD LEV DESCRIPTIONK0869 RR 290 PWC gp 4 std cap chairK0869 UE 290 PWC gp 4 std cap chairK0870 290 PWC gp 4 hd seat/backK0871 290 PWC gp 4 vhd seat/backK0877 290 PWC gp4 std sing pow opt s/bK0877 NU 290 PWC gp4 std sing pow opt s/bK0877 RR 290 PWC gp4 std sing pow opt s/bK0877 UE 290 PWC gp4 std sing pow opt s/bK0878 290 PWC gp4 std sing pow opt capK0879 290 PWC gp4 hd sing pow opt s/bK0879 NU 290 PWC gp4 hd sing pow opt s/bK0879 RR 290 PWC gp4 hd sing pow opt s/bK0879 UE 290 PWC gp4 hd sing pow opt s/bK0880 290 PWC gp4 vhd sing pow opt s/bK0880 NU 290 PWC gp4 vhd sing pow opt s/bK0880 RR 290 PWC gp4 vhd sing pow opt s/bK0880 UE 290 PWC gp4 vhd sing pow opt s/bK0884 290 PWc gp4 std mult pow opt s/bK0884 NU 290 PWc gp4 std mult pow opt s/bK0884 RR 290 PWc gp4 std mult pow opt s/bK0884 UE 290 PWc gp4 std mult pow opt s/bK0885 290 PWC gp4 std mult pow opt capK0885 NU 290 PWC gp4 std mult pow opt capK0885 RR 290 PWC gp4 std mult pow opt capK0885 UE 290 PWC gp4 std mult pow opt capK0886 290 PWC gp4 hd mult pow s/bK0886 NU 290 PWC gp4 hd mult pow s/bK0886 RR 290 PWC gp4 hd mult pow s/bK0886 UE 290 PWC gp4 hd mult pow s/bK0898 290 Power wheelchair NOCK0899 290 Pow mobility dev no sadmercK0900 290 Custom durable medical equipment, other than wheelchairK0901 290 KO single upright pre ots K0902 290 Ko double upright pre ots L0112 290 Cranial cervical orthosisL0113 290 Cranial cervical torticollisL0120 290 Cerv flex/n/adj foam pre ots L0130 290 Flex thermoplastic collar moL0140 290 Cervical semi-rigid adjustabL0150 290 Cerv semi-rig adj molded chnL0160 290 Cerv sr wire occ/man pre ots L0170 290 Cervical collar molded to ptL0172 290 Cerv col sr foam 2pc pre ots L0174 290 Cerv sr 2pc thor ext pre ots L0180 290 Cer post col occ/man sup adjL0190 290 Cerv collar supp adj cerv baL0200 290 Cerv col supp adj bar & thorL0220 290 Thor rib belt custom fabricaL0430 290 Dewall posture protector end-dated 12/31/2013L0450 290 TLSO flex trunk/thor pre ots L0452 290 TLSO flex custom fab thoraciL0454 290 TLSO trnk sj-t9 pre cst L0455 290 TLSO flex trnk sj-t9 pre ots L0456 290 TLSO flex trnk sj-ss pre cst L0457 290 TLSO flex trnk sj-ss pre ots L0458 290 TLSO 2Mod symphis-xipho preL0460 290 TLSO 2 shl symphys-stern cst L0462 290 TLSO 3Mod sacro-scap preL0464 290 TLSO 4Mod sacro-scap preL0466 290 TLSO r fram soft ant pre cst L0467 290 TLSO r fram soft pre ots L0468 290 TLSO rig fram pelvic pre cst L0469 290 TLSO rig fram pelvic pre ots L0470 290 TLSO rigid frame pre subclavL0472 290 TLSO rigid frame hyperex pre


CPT/HCPCS MOD MOD LEV DESCRIPTIONL0480 290 TLSO rigid plastic custom faL0482 290 TLSO rigid lined custom fabL0484 290 TLSO rigid plastic cust fabL0486 290 TLSO rigidlined cust fab twoL0488 290 TLSO rigid lined pre one pieL0490 290 TLSO rigid plastic pre oneL0491 290 TLSO 2 piece rigid shellL0492 290 TLSO 3 piece rigid shellL0621 290 SIO flex pelvic/sacr pre ots L0622 290 SIO flex pelvisacral customL0623 290 SIO rig pnl pelv/sac pre ots L0624 290 SIO panel customL0625 290 Lo flex l1-below l5 pre ots L0626 290 Lo sag rig pnl stays pre cst L0627 290 Lo sag ri an/pos pnl pre cst L0628 290 Lso flex no ri stays pre ots L0629 290 LSO flex w/rigid stays custL0630 290 Lso r post pnl sj-t9 pre cst L0631 290 Lso sag r an/pos pnl pre cst L0632 290 LSO sag rigid frame custL0633 290 Lso sc r pos/lat pnl pre cst L0634 290 LSO flexion control customL0635 290 LSO sagit rigid panel prefabL0636 290 LSO sagittal rigid panel cusL0637 290 Lso sc r ant/pos pnl pre cst L0638 290 LSO sag-coronal panel customL0639 290 Lso s/c shell/panel prefab L0640 290 LSO s/c shell/panel customL0641 290 LO rig pos pnl l1-l5 pre ots L0642 290 LO sag ri an/pos pnl pre ots L0643 290 LSO sag ctr rigi pos pre ots L0648 290 LSO sag r an/pos pnl pre ots L0649 290 LSO sc r pos/lat pnl pre ots L0650 290 LSO sc r ant/pos pnl pre ots L0651 290 Lumbar-sacral orthosis, sagittal-co L0700 290 Ctlso a-p-l control moldedL0710 290 Ctlso a-p-l control w/ interL0810 290 Halo cervical into jckt vestL0820 290 Halo cervical into body jackL0830 290 Halo cerv into milwaukee typL0859 290 MRI compatible systemL0861 290 Halo repl liner/interfaceL0970 290 Tlso corset frontL0972 290 Lso corset frontL0974 290 Tlso full corsetL0976 290 Lso full corsetL0978 290 Axillary crutch extensionL0980 290 Peroneal straps pair pre ots L0982 290 Stocking sup grips 4 pre ots L0984 290 Protect body sock ea pre ots L0999 290 Add'n to spinal orthosis, NOSL1000 290 Ctlso milwauke initial modelL1005 290 Tension based scoliosis orthL1010 290 Ctlso axilla slingL1020 290 Kyphosis padL1025 290 Kyphosis pad floatingL1030 290 Lumbar bolster padL1040 290 Lumbar or lumbar rib padL1050 290 Sternal padL1060 290 Thoracic padL1070 290 Trapezius slingL1080 290 OutriggerL1085 290 Outrigger bil w/ vert extensL1090 290 Lumbar slingL1100 290 Ring flange plastic/leatherL1110 290 Ring flange plas/leather mol


CPT/HCPCS MOD MOD LEV DESCRIPTIONL1120 290 Covers for upright eachL1200 290 Furnsh initial orthosis onlyL1210 290 Lateral thoracic extensionL1220 290 Anterior thoracic extensionL1230 290 Milwaukee type superstructurL1240 290 Lumbar derotation padL1250 290 Anterior asis padL1260 290 Anterior thoracic derotationL1270 290 Abdominal padL1280 290 Rib gusset (elastic) eachL1290 290 Lateral trochanteric padL1300 290 Body jacket mold to patientL1310 290 Post-operative body jacketL1499 290 Spinal orthosis, NOSL1600 290 Ho flex frejka w/cov pre cst L1610 290 Ho frejka cov only pre cst L1620 290 Ho flex pavlik harns pre cst L1630 290 Abduct control hip semi-flexL1640 290 Pelv band/spread bar thigh cL1650 290 HO abduction hip adjustableL1652 290 HO bi thighcuffs w sprdr barL1660 290 HO abduction static plasticL1680 290 Pelvic & hip control thigh cL1685 290 Post-op hip abduct custom faL1686 290 HO post-op hip abductionL1690 290 Combination bilateral HOL1700 290 Leg perthes orth toronto typL1710 290 Legg perthes orth newingtonL1720 290 Legg perthes orthosis trilatL1730 290 Legg perthes orth scottish rL1755 290 Legg perthes patten bottom tL1810 290 Ko elastic with joints L1812 290 Ko elastic w/joints pre ots L1820 290 Ko elas w/ condyle pads & joL1830 290 Ko immob canvas long pre ots L1831 290 Knee orth pos locking jointL1832 290 Ko adj jnt pos r sup ree cst L1833 290 Ko adj jnt pos r sup pre ots L1834 290 Ko w/0 joint rigid molded toL1836 290 Ko rigid w/0 joints pre ots L1840 290 Ko derot ant cruciate customL1843 290 Ko single upright pre cst L1844 290 Ko w/adj jt rot cntrl moldedL1845 290 Ko double upright pre cst L1846 290 Ko w adj flex/ext rotat moldL1847 290 Ko dbl upright w/air pre cst L1848 290 Ko dbl upright w/air pre ots L1850 290 Ko swedish type pre ots L1860 290 Ko supracondylar socket moldL1900 290 Afo sprng wir drsflx calf bdL1902 290 Afo ankle gauntlet pre ots L1904 290 Afo molded ankle gauntlet L1906 290 Afo multilig ank sup pre ots L1907 290 Afo supramalleolar custom L1910 290 Afo sing bar clasp attach shL1920 290 Afo sing upright w/ adjust sL1930 290 Afo plasticL1932 290 Afo rig ant tib prefab TCF/=L1940 290 Afo molded to patient plastiL1945 290 Afo molded plas rig ant tibL1950 290 Afo spiral molded to pt plasL1951 290 AFO spiral prefabricatedL1960 290 Afo pos solid ank plastic moL1970 290 Afo plastic molded w/ankle jL1971 290 AFO w/ankle jointL1980 290 Afo sing solid stirrup calf


CPT/HCPCS MOD MOD LEV DESCRIPTIONL1990 290 Afo doub solid stirrup calfL2000 290 Kafo sing fre stirr thi/calfL2005 290 KAFO sng/dbl mechanical actL2010 290 Kafo sng solid stirrup w/o jL2020 290 Kafo dbl solid stirrup band/L2030 290 Kafo dbl solid stirrup w/o jL2034 290 KAFO pla sin up w/wo k/a cusL2036 290 Kafo plas doub free knee molL2037 290 Kafo plas sing free knee molL2038 290 Kafo w/o joint multi-axis anL2040 290 Hkafo torsion bil rot strapsL2050 290 Hkafo torsion cable hip pelvL2060 290 Hkafo torsion ball bearing jL2070 290 Hkafo torsion unilat rot strL2080 290 Hkafo unilat torsion cableL2090 290 Hkafo unilat torsion ball brL2106 290 Afo tib fx cast plaster moldL2108 290 Afo tib fx cast molded to ptL2112 290 Afo tibial fracture softL2114 290 Afo tib fx semi-rigidL2116 290 Afo tibial fracture rigidL2126 290 Kafo fem fx cast thermoplasL2128 290 Kafo fem fx cast molded to pL2132 290 Kafo femoral fx cast softL2134 290 Kafo fem fx cast semi-rigidL2136 290 Kafo femoral fx cast rigidL2180 290 Plas shoe insert w ank jointL2182 290 Drop lock kneeL2184 290 Limited motion knee jointL2186 290 Adj motion knee jnt lerman tL2188 290 Quadrilateral brimL2190 290 Waist beltL2192 290 Pelvic band & belt thigh flaL2200 290 Limited ankle motion ea jntL2210 290 Dorsiflexion assist each joiL2220 290 Dorsi & plantar flex ass/resL2230 290 Split flat caliper stirr & pL2232 290 Rocker bottom, contact AFOL2240 290 Round caliper and plate attaL2250 290 Foot plate molded stirrup atL2260 290 Reinforced solid stirrupL2265 290 Long tongue stirrupL2270 290 Varus/valgus strap padded/liL2275 290 Plastic mod low ext pad/lineL2280 290 Molded inner bootL2300 290 Abduction bar jointed adjustL2310 290 Abduction bar-straightL2320 290 Non-molded lacerL2330 290 Lacer molded to patient modeL2335 290 Anterior swing bandL2340 290 Pre-tibial shell molded to pL2350 290 Prosthetic type socket moldeL2360 290 Extended steel shankL2370 290 Patten bottomL2375 290 Torsion ank & half solid stiL2380 290 Torsion straight knee jointL2385 290 Straight knee joint heavy duL2387 290 Add LE poly knee custom KAFOL2390 290 Offset knee joint eachL2395 290 Offset knee joint heavy dutyL2397 290 Suspension sleeve lower extL2405 290 Knee joint drop lock ea jntL2415 290 Knee joint cam lock each joiL2425 290 Knee disc/dial lock/adj flexL2430 290 Knee jnt ratchet lock ea jntL2492 290 Knee lift loop drop lock rin


CPT/HCPCS MOD MOD LEV DESCRIPTIONL2500 290 Thi/glut/ischia wgt bearingL2510 290 Th/wght bear quad-lat brim mL2520 290 Th/wght bear quad-lat brim cL2525 290 Th/wght bear nar m-l brim moL2526 290 Th/wght bear nar m-l brim cuL2530 290 Thigh/wght bear lacer non-moL2540 290 Thigh/wght bear lacer moldedL2550 290 Thigh/wght bear high roll cuL2570 290 Hip clevis type 2 posit jntL2580 290 Pelvic control pelvic slingL2600 290 Hip clevis/thrust bearing frL2610 290 Hip clevis/thrust bearing loL2620 290 Pelvic control hip heavy dutL2622 290 Hip joint adjustable flexionL2624 290 Hip adj flex ext abduct contL2627 290 Plastic mold recipro hip & cL2628 290 Metal frame recipro hip & caL2630 290 Pelvic control band & belt uL2640 290 Pelvic control band & belt bL2650 290 Pelv & thor control glutealL2660 290 Thoracic control thoracic baL2670 290 Thorac cont paraspinal uprigL2680 290 Thorac cont lat support upriL2750 290 Plating chrome/nickel pr barL2755 290 Carbon graphite laminationL2760 290 Extension per extension perL2768 290 Ortho sidebar disconnectL2780 290 Non-corrosive finishL2785 290 Drop lock retainer eachL2795 290 Knee control full kneecapL2800 290 Knee cap medial or lateral pL2810 290 Knee control condylar padL2820 290 Soft interface below knee seL2830 290 Soft interface above knee seL2840 290 Tibial length sock fx or equL2850 290 Femoral lgth sock fx or equaL2861 290 Torsion mechanism knee/ankleL2999 290 Lower extremity orthosis NOSL3000 290 Ft insert ucb berkeley shellL3001 290 Foot insert remov molded speL3002 290 Foot insert plastazote or eqL3003 290 Foot insert silicone gel eacL3010 290 Foot longitudinal arch suppoL3020 290 Foot longitud/metatarsal supL3030 290 Foot arch support remov premL3031 290 Foot, insert/plate, removableL3040 290 Ft arch suprt premold longitL3050 290 Foot arch supp premold metatL3060 290 Foot arch supp longitud/metaL3070 290 Arch suprt att to sho longitL3080 290 Arch supp att to shoe metataL3090 290 Arch supp att to shoe long/mL3100 290 Hallus-valgus nt dyn pre ots L3140 290 Abduction rotation bar shoeL3150 290 Abduct rotation bar w/o shoeL3160 290 Shoe styled positioning devL3170 290 Foot plas heel stabi pre ots L3215 290 Orthopedic ftwear ladies oxfL3216 290 Orthoped ladies shoes dpth iL3217 290 Ladies shoes hightop depth iL3219 290 Orthopedic mens shoes oxfordL3221 290 Orthopedic mens shoes dpth iL3222 290 Mens shoes hightop depth inlL3224 290 Woman's shoe oxford braceL3225 290 Man's shoe oxford braceL3230 290 Ortho footwear, custom shoes, depth inlay


CPT/HCPCS MOD MOD LEV DESCRIPTIONL3250 290 Ortho footwear, custom molded shoeL3251 290 Foot, shoe molded to pat model/silicone eaL3252 290 Foot, shoe molded to pat model/plastazoteL3253 290 Foot, molded shoe Plasttazote eaL3254 290 Footwear, nonstandard size or widthL3255 290 Orth foot non-standard size/L3257 290 Orth foot add charge split sL3260 290 Ambulatory surgical boot eacL3265 290 Plastazote sandal eachL3300 290 Sho lift taper to metatarsalL3310 290 Shoe lift elev heel/sole neoL3320 290 Shoe lift elev heel/sole corL3330 290 Lifts elevation metal extensL3332 290 Shoe lifts tapered to one-haL3334 290 Shoe lifts elevation heel /iL3340 290 Shoe wedge sachL3350 290 Shoe heel wedgeL3360 290 Shoe sole wedge outside soleL3370 290 Shoe sole wedge between soleL3380 290 Shoe clubfoot wedgeL3390 290 Shoe outflare wedgeL3400 290 Shoe metatarsal bar wedge roL3410 290 Shoe metatarsal bar betweenL3420 290 Full sole/heel wedge btweenL3430 290 Sho heel count plast reinforL3440 290 Heel leather reinforcedL3450 290 Shoe heel sach cushion typeL3455 290 Shoe heel new leather standaL3460 290 Shoe heel new rubber standarL3465 290 Shoe heel thomas with wedgeL3470 290 Shoe heel thomas extend to bL3480 290 Shoe heel pad & depress forL3485 290 Shoe heel pad removable forL3500 290 Ortho shoe add leather insolL3510 290 Orthopedic shoe add rub inslL3520 290 O shoe add felt w leath inslL3530 290 Ortho shoe add half soleL3540 290 Ortho shoe add full soleL3550 290 O shoe add standard toe tapL3560 290 O shoe add horseshoe toe tapL3570 290 O shoe add instep extensionL3580 290 O shoe add instep velcro cloL3590 290 O shoe convert to sof counteL3595 290 Ortho shoe add march barL3600 290 Trans shoe calip plate existL3610 290 Trans shoe caliper plate newL3620 290 Trans shoe solid stirrup exiL3630 290 Trans shoe solid stirrup newL3640 290 Shoe dennis browne splint boL3649 290 Orthopedic shoe modifica NOSL3650 290 So 8 abd restraint pre ots L3660 290 So 8 ab rstr can/web pre ots L3670 290 So acro/clav can web pre ots L3671 290 SO cap design w/o jnts CFL3672 290 SO airplane w/o jnts CFL3673 290 SO airplane w/joint CFL3674 290 SO airplane w/wo joint CFL3675 290 So vest canvas/web pre ots L3677 290 So hard plas stabili pre cst L3678 290 So hard plas stabili pre ots L3702 290 EO w/o joints CFL3710 290 Eo elas w/metal jnts pre ots L3720 290 Forearm/arm cuffs free motioL3730 290 Forearm/arm cuffs ext/flex aL3740 290 Cuffs adj lock w/ active conL3760 290 EO withjoint


CPT/HCPCS MOD MOD LEV DESCRIPTIONL3762 290 Eo rigid w/o joints pre ots L3763 290 EWHO rigid w/o jnts CFL3764 290 EWHO w/joint(s) CFL3765 290 EWHFO rigid w/o jnts CFL3766 290 EWHFO w/joint(s) CFL3806 290 WHFO w/joint(s) custom fabL3807 290 Whfo w/o joints pre cst L3808 290 WHFO, rigid w/o jointsL3891 290 Torsion mechanism wrist/elboL3900 290 Hinge extension/flex wrist/fL3901 290 Hinge ext/flex wrist fingerL3904 290 Whfo electric custom fittedL3905 290 WHO w/nontorsion jnt(s) CFL3906 290 Wrist gauntlet molded to ptL3908 290 Who cock-up nonmolde pre ots L3809 290 Whfo w/o joints pre ots L3912 290 Hfo flexion glove pre ots L3913 290 HFO w/o joints CFL3915 290 Who nontorsion jnts pre cst L3916 290 WHO nontorsion jnts pre otsL3917 290 Metacarp fx orthosis pre cst L3918 290 Metacarp fx orthosis pre otsL3919 290 HO w/o joints CFL3921 290 HFO w/joint(s) CFL3923 290 Hfo without joints pre cst L3924 290 HFO without joints pre otsL3925 290 Fo pip dip jnt/sprng pre ots L3927 290 Fo pip dip no jt spr pre ots L3929 290 Hfo nontorsion jnts pre cst L3930 290 HFO nontorsion jnts pre otsL3931 290 WHFO nontorsion joint prefabL3933 290 FO w/o joints CFL3935 290 FO nontorsion joint CFL3956 290 Add joint upper ext orthosisL3960 290 Sewho airplan desig abdu posL3961 290 SEWHO cap design w/o jnts CFL3962 290 Sewho erbs palsey design abdL3967 290 SEWHO airplane w/o jnts CFL3971 290 SEWHO cap design w/jnt(s) CFL3973 290 SEWHO airplane w/jnt(s) CFL3975 290 SEWHFO cap design w/o jnt CFL3976 290 SEWHFO airplane w/o jnts CFL3977 290 SEWHFO cap desgn w/jnt(s) CFL3978 290 SEWHFO airplane w/jnt(s) CFL3980 290 Upp ext fx orthosis humeralL3981 290 UE fx orth shoul cap forearmL3982 290 Upper ext fx orthosis rad/ulL3984 290 Upper ext fx orthosis wristL3995 290 Sock fracture or equal eachL3999 290 Upper limb orthosis, NOSL4000 290 Repl girdle milwaukee orthL4002 290 Replace strap, any orthosisL4010 290 Replace trilateral socket brL4020 290 Replace quadlat socket brimL4030 290 Replace socket brim cust fitL4040 290 Replace molded thigh lacerL4045 290 Replace non-molded thigh lacL4050 290 Replace molded calf lacerL4055 290 Replace non-molded calf laceL4060 290 Replace high roll cuffL4070 290 Replace prox & dist uprightL4080 290 Repl met band kafo-afo proxL4090 290 Repl met band kafo-afo calf/L4100 290 Repl leath cuff kafo prox thL4110 290 Repl leath cuff kafo-afo calL4130 290 Replace pretibial shell


CPT/HCPCS MOD MOD LEV DESCRIPTIONL4205 290 Ortho dvc repair, per 15 minL4210 290 Orth dev, repair/repl minor partsL4350 290 Ankle control ortho pre ots L4360 290 Pneumat walking boot pre cst L4361 290 Pneuma/vac walk boot pre ots L4370 290 Pneum full leg splnt pre ots L4386 290 Non-pneum walk boot pre cst L4387 290 Non-pneum walk boot pre ots L4392 290 Replace AFO soft interfaceL4394 290 Replace foot drop spintL4396 290 Static or dynami afo pre cst L4397 290 Static or dynami afo pre ots L4398 290 Foot drop splint pre ots L4631 290 Afo, walk boot type, cus fabL5000 290 Sho insert w arch toe fillerL5010 290 Mold socket ank hgt w/ toe fL5020 290 Tibial tubercle hgt w/ toe fL5050 290 Ank symes mold sckt sach ftL5060 290 Symes met fr leath socket arL5100 290 Molded socket shin sach footL5105 290 Plast socket jts/thgh lacerL5150 290 Mold sckt ext knee shin sachL5160 290 Mold socket bent knee shin sL5200 290 Kne sing axis fric shin sachL5210 290 No knee/ankle joints w/ ft bL5220 290 No knee joint with artic aliL5230 290 Fem focal defic constant friL5250 290 Hip canad sing axi cons fricL5270 290 Tilt table locking hip singL5280 290 Hemipelvect canad sing axisL5301 290 BK mold socket SACH ft endoL5312 290 Knee disart, sach ft, endo L5321 290 AK open end SACHL5331 290 Hip disart canadian SACH ftL5341 290 Hemipelvectomy canadian SACHL5400 290 Postop dress & 1 cast chg bkL5410 290 Postop dsg bk ea add cast chL5420 290 Postop dsg & 1 cast chg ak/dL5430 290 Postop dsg ak ea add cast chL5450 290 Postop app non-wgt bear dsgL5460 290 Postop app non-wgt bear dsgL5500 290 Init bk ptb plaster directL5505 290 Init ak ischal plstr directL5510 290 Prep BK ptb plaster moldedL5520 290 Perp BK ptb thermopls directL5530 290 Prep BK ptb thermopls moldedL5535 290 Prep BK ptb open end socketL5540 290 Prep BK ptb laminated socketL5560 290 Prep AK ischial plast moldedL5570 290 Prep AK ischial direct formL5580 290 Prep AK ischial thermo moldL5585 290 Prep AK ischial open endL5590 290 Prep AK ischial laminatedL5595 290 Hip disartic sach thermoplsL5600 290 Hip disart sach laminat moldL5610 290 Above knee hydracadenceL5611 290 Ak 4 bar link w/fric swingL5613 290 Ak 4 bar ling w/hydraul swigL5614 290 4-bar link above knee w/swngL5616 290 Ak univ multiplex sys frictL5617 290 AK/BK self-aligning unit eaL5618 290 Test socket symesL5620 290 Test socket below kneeL5622 290 Test socket knee disarticulaL5624 290 Test socket above kneeL5626 290 Test socket hip disarticulat


CPT/HCPCS MOD MOD LEV DESCRIPTIONL5628 290 Test socket hemipelvectomyL5629 290 Below knee acrylic socketL5630 290 Syme typ expandabl wall scktL5631 290 Ak/knee disartic acrylic socL5632 290 Symes type ptb brim design sL5634 290 Symes type poster opening soL5636 290 Symes type medial opening soL5637 290 Below knee total contactL5638 290 Below knee leather socketL5639 290 Below knee wood socketL5640 290 Knee disarticulat leather soL5642 290 Above knee leather socketL5643 290 Hip flex inner socket ext frL5644 290 Above knee wood socketL5645 290 Bk flex inner socket ext fraL5646 290 Below knee cushion socketL5647 290 Below knee suction socketL5648 290 Above knee cushion socketL5649 290 Isch containmt/narrow m-l soL5650 290 Tot contact ak/knee disart sL5651 290 Ak flex inner socket ext fraL5652 290 Suction susp ak/knee disartL5653 290 Knee disart expand wall sockL5654 290 Socket insert symesL5655 290 Socket insert below kneeL5656 290 Socket insert knee articulatL5658 290 Socket insert above kneeL5661 290 Multi-durometer symesL5665 290 Multi-durometer below kneeL5666 290 Below knee cuff suspensionL5668 290 Socket insert w/o lock lowerL5670 290 Bk molded supracondylar suspL5671 290 BK/AK locking mechanismL5672 290 Bk removable medial brim susL5673 290 Socket insert w lock mechL5676 290 Bk knee joints single axis pL5677 290 Bk knee joints polycentric pL5678 290 Bk joint covers pairL5679 290 Socket insert w/o lock mechL5680 290 Bk thigh lacer non-moldedL5681 290 Intl custm cong/latyp insertL5682 290 Bk thigh lacer glut/ischia mL5683 290 Initial custom socket insertL5684 290 Bk fork strapL5685 290 Below knee sus/seal sleeveL5686 290 Bk back checkL5688 290 Bk waist belt webbingL5690 290 Bk waist belt padded and linL5692 290 Ak pelvic control belt lightL5694 290 Ak pelvic control belt pad/lL5695 290 Ak sleeve susp neoprene/equaL5696 290 Ak/knee disartic pelvic joinL5697 290 Ak/knee disartic pelvic bandL5698 290 Ak/knee disartic silesian baL5699 290 Shoulder harnessL5700 290 Replace socket below kneeL5701 290 Replace socket above kneeL5702 290 Replace socket hipL5703 290 Symes ankle w/o (SACH) footL5704 290 Custom shape cover BKL5705 290 Custom shape cover AKL5706 290 Custom shape cvr knee disartL5707 290 Custom shape cvr hip disartL5710 290 Kne-shin exo sng axi mnl locL5711 290 Knee-shin exo mnl lock ultraL5712 290 Knee-shin exo frict swg & st


CPT/HCPCS MOD MOD LEV DESCRIPTIONL5714 290 Knee-shin exo variable frictL5716 290 Knee-shin exo mech stance phL5718 290 Knee-shin exo frct swg & staL5722 290 Knee-shin pneum swg frct exoL5724 290 Knee-shin exo fluid swing phL5726 290 Knee-shin ext jnts fld swg eL5728 290 Knee-shin fluid swg & stanceL5780 290 Knee-shin pneum/hydra pneumL5781 290 Lower limb pros vacuum pumpL5782 290 HD low limb pros vacuum pumpL5785 290 Exoskeletal bk ultralt materL5790 290 Exoskeletal ak ultra-light mL5795 290 Exoskel hip ultra-light mateL5810 290 Endoskel knee-shin mnl lockL5811 290 Endo knee-shin mnl lck ultraL5812 290 Endo knee-shin frct swg & stL5814 290 Endo knee-shin hydral swg phL5816 290 Endo knee-shin polyc mch staL5818 290 Endo knee-shin frct swg & stL5822 290 Endo knee-shin pneum swg frcL5824 290 Endo knee-shin fluid swing pL5826 290 Miniature knee jointL5828 290 Endo knee-shin fluid swg/staL5830 290 Endo knee-shin pneum/swg phaL5840 290 Multi-axial knee/shin systemL5845 290 Knee-shin sys stance flexionL5848 290 Knee-shin sys hydraul stanceL5850 290 Endo ak/hip knee extens assiL5855 290 Mech hip extension assistL5856 290 Elec knee-shin swing/stanceL5857 290 Elec knee-shin swing onlyL5858 290 Stance phase onlyL5859 290 Knee-shin pro flex/ext cont L5910 290 Endo below knee alignable syL5920 290 Endo ak/hip alignable systemL5925 290 Above knee manual lockL5930 290 High activity knee frameL5940 290 Endo bk ultra-light materialL5950 290 Endo ak ultra-light materialL5960 290 Endo hip ultra-light materiaL5961 290 Endo poly hip, pneu/hyd/rotL5962 290 Below knee flex cover systemL5964 290 Above knee flex cover systemL5966 290 Hip flexible cover systemL5968 290 Multiaxial ankle w dorsiflexL5969 290 Ak/ft power asst incl motors L5970 290 Foot external keel sach footL5971 290 SACH foot, replacementL5972 290 Flexible keel footL5973 290 Ank-foot sys dors-plant flexL5974 290 Foot single axis ankle/footL5975 290 Combo ankle/foot prosthesisL5976 290 Energy storing footL5978 290 Ft prosth multiaxial ankl/ftL5979 290 Multi-axial ankle/ft prosthL5980 290 Flex foot systemL5981 290 Flex-walk sys low ext prosthL5982 290 Exoskeletal axial rotation uL5984 290 Endoskeletal axial rotationL5985 290 Lwr ext dynamic prosth pylonL5986 290 Multi-axial rotation unitL5987 290 Shank ft w vert load pylonL5988 290 Vertical shock reducing pyloL5990 290 User adjustable heel heightL5999 290 Lowr extremity prosthes, NOSL6000 290 Part hand thumb rem


CPT/HCPCS MOD MOD LEV DESCRIPTIONL6010 290 Part hand little/ringL6020 290 Part hand no fingersL6025 290 Part hand disart myoelectricL6026 290 Part hand myo exclu term devL6050 290 Wrst MLd sck flx hng tri padL6055 290 Wrst mold sock w/exp interfaL6100 290 Elb mold sock flex hinge padL6110 290 Elbow mold sock suspension tL6120 290 Elbow mold doub splt soc steL6130 290 Elbow stump activated lock hL6200 290 Elbow mold outsid lock hingeL6205 290 Elbow molded w/ expand interL6250 290 Elbow inter loc elbow forarmL6300 290 Shlder disart int lock elbowL6310 290 Shoulder passive restor compL6320 290 Shoulder passive restor capL6350 290 Thoracic intern lock elbowL6360 290 Thoracic passive restor compL6370 290 Thoracic passive restor capL6380 290 Postop dsg cast chg wrst/elbL6382 290 Postop dsg cast chg elb dis/L6384 290 Postop dsg cast chg shlder/tL6386 290 Postop ea cast chg & realignL6388 290 Postop applicat rigid dsg onL6400 290 Below elbow prosth tiss shapL6450 290 Elb disart prosth tiss shapL6500 290 Above elbow prosth tiss shapL6550 290 Shldr disar prosth tiss shapL6570 290 Scap thorac prosth tiss shapL6580 290 Wrist/elbow bowden cable molL6582 290 Wrist/elbow bowden cbl dir fL6584 290 Elbow fair lead cable moldedL6586 290 Elbow fair lead cable dir foL6588 290 Shdr fair lead cable moldedL6590 290 Shdr fair lead cable directL6600 290 Polycentric hinge pairL6605 290 Single pivot hinge pairL6610 290 Flexible metal hinge pairL6611 290 Additional switch, ext powerL6615 290 Disconnect locking wrist uniL6616 290 Disconnect insert locking wrL6620 290 Flexion/extension wrist unitL6621 290 Flex/ext wrist w/wo frictionL6623 290 Spring-ass rot wrst w/ latchL6624 290 Flex/ext/rotation wrist unitL6625 290 Rotation wrst w/ cable lockL6628 290 Quick disconn hook adapter oL6629 290 Lamination collar w/ couplinL6630 290 Stainless steel any wristL6632 290 Latex suspension sleeve eachL6635 290 Lift assist for elbowL6637 290 Nudge control elbow lockL6638 290 Elec lock on manual pw elbowL6640 290 Shoulder abduction joint paiL6641 290 Excursion amplifier pulley tL6642 290 Excursion amplifier lever tyL6645 290 Shoulder flexion-abduction jL6646 290 Multipo locking shoulder jntL6647 290 Shoulder lock actuatorL6648 290 Ext pwrd shlder lock/unlockL6650 290 Shoulder universal jointL6655 290 Standard control cable extraL6660 290 Heavy duty control cableL6665 290 Teflon or equal cable liningL6670 290 Hook to hand cable adapterL6672 290 Harness chest/shlder saddle


CPT/HCPCS MOD MOD LEV DESCRIPTIONL6675 290 Harness figure of 8 sing conL6676 290 Harness figure of 8 dual conL6677 290 UE triple control harnessL6680 290 Test sock wrist disart/bel eL6682 290 Test sock elbw disart/aboveL6684 290 Test socket shldr disart/thoL6686 290 Suction socketL6687 290 Frame typ socket bel elbow/wL6688 290 Frame typ sock above elb/disL6689 290 Frame typ socket shoulder diL6690 290 Frame typ sock interscap-thoL6691 290 Removable insert eachL6692 290 Silicone gel insert or equalL6693 290 Lockingelbow forearm cntrbalL6694 290 Elbow socket ins use w/lockL6695 290 Elbow socket ins use w/o lckL6696 290 Cus elbo skt in for con/atypL6697 290 Cus elbo skt in not con/atypL6698 290 Below/above elbow lock mechL6703 290 Term dev, passive hand mittL6704 290 Term dev, sport/rec/work attL6706 290 Term dev mech hook vol openL6707 290 Term dev mech hook vol closeL6708 290 Term dev mech hand vol openL6709 290 Term dev mech hand vol closeL6715 290 Term device, multi art digit L6721 290 Hook/hand, hvy dty, vol openL6722 290 Hook/hand, hvy dty, vol closL6805 290 Modifier wrist flexion unitL6810 290 Pincher tool otto bock or eqL6880 290 Elec hand ind art digits L6881 290 Autograsp feature ul term dvL6882 290 Microprocessor control uplmbL6883 290 Replc sockt below e/w disaL6884 290 Replc sockt above elbow disaL6885 290 Replc sockt shldr dis/intercL6890 290 Production gloveL6895 290 Custom gloveL6900 290 Hand restorat thumb/1 fingerL6905 290 Hand restoration multiple fiL6910 290 Hand restoration no fingersL6915 290 Hand restoration replacmnt gL6920 290 Wrist disarticul switch ctrlL6925 290 Wrist disart myoelectronic cL6930 290 Below elbow switch controlL6935 290 Below elbow myoelectronic ctL6940 290 Elbow disarticulation switchL6945 290 Elbow disart myoelectronic cL6950 290 Above elbow switch controlL6955 290 Above elbow myoelectronic ctL6960 290 Shldr disartic switch controL6965 290 Shldr disartic myoelectronicL6970 290 Interscapular-thor switch ctL6975 290 Interscap-thor myoelectronicL7007 290 Adult electric handL7009 290 Adult electric hookL7040 290 Prehensile actuator hosmer sL7170 290 Electronic elbow hosmer switL7180 290 Electronic elbow utah myoeleL7181 290 Electronic elbo simultaneousL7259 290 Electronic wrist rotator anyL7260 290 Electron wrist rotator otto end-dated 12/31/2014L7261 290 Electron wrist rotator utah end-dated 12/31/2014L7360 290 Six volt bat otto bock/eq eaL7362 290 Battery chrgr six volt ottoL7364 290 Twelve volt battery utah/equ


CPT/HCPCS MOD MOD LEV DESCRIPTIONL7366 290 Battery chrgr 12 volt utah/eL7367 290 Replacemnt lithium ionbatterL7368 290 Lithium ion battery chargerL7400 290 Add UE prost be/wd, ultliteL7401 290 Add UE prost a/e ultlite matL7402 290 Add UE prost s/d ultlite matL7403 290 Add UE prost b/e acrylicL7404 290 Add UE prost a/e acrylicL7405 290 Add UE prost s/d acrylicL7499 290 Upper extremity prosthes, NOSL7510 290 Repair prosth dvc, rep/repl minor partsL7520 290 Repair prosthetic dvc, per 15 minL7600 290 Prosthetic donning sleeveL7900 290 Male vacuum erection systemL7902 290 Tension ring, vac erect dev L8000 290 Mastectomy braL8001 290 Breast prosthesis bra & formL8002 290 Brst prsth bra & bilat formL8010 290 Mastectomy sleeveL8015 290 Ext breastprosthesis garmentL8020 290 Mastectomy formL8030 290 Breast prosthesis silicone/eL8031 290 Breast prosthesis w adhesiveL8032 290 Reusable nipple prosthesisL8035 290 Custom breast prosthesisL8039 290 Breast prosthesis, NOSL8040 290 Nasal prosthesisL8040 KM 290 Nasal prosthesisL8040 KN 290 Nasal prosthesisL8041 290 Midfacial prosthesisL8041 KM 290 Midfacial prosthesisL8041 KN 290 Midfacial prosthesisL8042 290 Orbital prosthesisL8042 KM 290 Orbital prosthesisL8042 KN 290 Orbital prosthesisL8043 290 Upper facial prosthesisL8043 KM 290 Upper facial prosthesisL8043 KN 290 Upper facial prosthesisL8044 290 Hemi-facial prosthesisL8044 KM 290 Hemi-facial prosthesisL8044 KN 290 Hemi-facial prosthesisL8045 290 Auricular prosthesisL8045 KM 290 Auricular prosthesisL8045 KN 290 Auricular prosthesisL8046 290 Partial facial prosthesisL8046 KM 290 Partial facial prosthesisL8046 KN 290 Partial facial prosthesisL8047 290 Nasal septal prosthesisL8047 KM 290 Nasal septal prosthesisL8047 KN 290 Nasal septal prosthesisL8048 290 Unspec maxillofacial prosthL8049 290 Repair maxillofacial prosthL8300 290 Truss single w/ standard padL8310 290 Truss double w/ standard padL8320 290 Truss addition to std pad waL8330 290 Truss add to std pad scrotalL8400 290 Sheath below kneeL8410 290 Sheath above kneeL8415 290 Sheath upper limbL8417 290 Pros sheath/sock w gel cushnL8420 290 Prosthetic sock multi ply BKL8430 290 Prosthetic sock multi ply AKL8435 290 Pros sock multi ply upper lmL8440 290 Shrinker below kneeL8460 290 Shrinker above kneeL8465 290 Shrinker upper limb


CPT/HCPCS MOD MOD LEV DESCRIPTIONL8470 290 Pros sock single ply BKL8480 290 Pros sock single ply AKL8485 290 Pros sock single ply upper lL8499 290 Unlisted misc prosthetic serL8500 290 Artificial larynxL8501 290 Tracheostomy speaking valveL8505 290 Battery/access, art larynxL8507 290 Trach-esoph voice pros pt inL8509 290 Trach-esoph voice pros md inL8510 290 Voice amplifierL8511 290 Indwelling trach insertL8512 290 Gel cap for trach voice prosL8513 290 Trach pros cleaning deviceL8514 290 Repl trach puncture dilatorL8515 290 Gel cap app device for trachL8600 290 Implant breast silicone/eqL8603 290 Collagen imp urinary 2.5 mlL8604 290 Dextranomer/hyaluronic acid copolymerL8605 290 Inj bulking agent anal canal L8606 290 Synthetic implnt urinary 1mlL8609 290 Artificial corneaL8610 290 Ocular implantL8612 290 Aqueous shunt prosthesisL8613 290 Ossicular implantL8614 290 Cochlear device/systemL8615 290 Coch implant headset replaceL8616 290 Coch implant microphone replL8617 290 Coch implant trans coil replL8618 290 Coch implant tran cable replL8619 290 Replace cochlear processorL8621 290 Repl zinc air batteryL8622 290 Repl alkaline batteryL8623 290 Lith ion batt CID,non-earlvlL8624 290 Lith ion batt CID, ear levelL8627 290 CID ext speech process replL8628 290 CID ext controller replL8629 290 CID transmit coil and cableL8630 290 Metacarpophalangeal implantL8631 290 MCP joint repl 2 pc or moreL8641 290 Metatarsal joint implantL8642 290 Hallux implantL8658 290 Interphalangeal joint spacerL8659 290 Interphalangeal joint replL8670 290 Vascular graftL8679 290 Imp neurosti pls gn any type L8680 290 Implant neurostim elctr eachL8681 290 Pt prgrm for implant neurostimL8682 290 Implant neurostim radiofq recL8683 290 Radiofq trsmtr for implant neuL8684 290 Radiof trsmtr implant scrl neuL8685 290 Implant nrostm pls gen sng recL8686 290 Implant nrostm pls gen sng nonL8687 290 Implant nrostm pls gen dua recL8688 290 Implant nrostm pls gen dua nonL8689 290 External recharging systemL8690 290 Aud osseo dev, int/ext compL8691 290 Aud osseo dev ext snd procesL8692 290 Non-osseointegrated snd procL8693 290 Aud osseo dev, abutmentL8695 290 External recharg sys externL8696 290 Ext antenna phren nerve stimL8699 290 Prosthetic implant, NOSL9900 290 O&P supply/accessory/service, otherM0064 270 Visit for drug monitoring end-dated 12/31/2014MR001 290 Medical recordsP3000 290 Screen pap by tech w md supv


CPT/HCPCS MOD MOD LEV DESCRIPTIONP3001 270 Screening pap smear by physP7001 290 Culture bacterial urineP9010 290 Whole blood for transfusionP9011 290 Blood split unitP9012 290 Cryoprecipitate each unitP9016 290 RBC leukocytes reducedP9017 290 One donor fresh frozn plasmaP9019 290 Platelets, each unitP9020 290 Platelet rich plasma unitP9021 290 Red blood cells unitP9022 290 Washed red blood cells unitP9023 290 Frozen plasma, pooled, sdP9031 290 Platelets leukocytes reducedP9032 290 Platelets, irradiatedP9033 290 Platelets leukoreduced irradP9034 290 Platelets, pheresisP9035 290 Platelet pheres leukoreducedP9036 290 Platelet pheresis irradiatedP9037 290 Plate pheres leukoredu irradP9038 290 RBC irradiatedP9039 290 RBC deglycerolizedP9040 290 RBC leukoreduced irradiatedP9041 290 Albumin(human), 5%, 50mlP9043 290 Plasma protein fraction, 5%, 50mlP9044 290 CryoprecipitatereducedplasmaP9045 290 Albumin (human), 5%, 250 mlP9046 290 Albumin (human), 25%, 20 mlP9047 290 Albumin (human), 25%, 50mlP9048 290 Plasmaprotein fract,5%,250mlP9050 290 Granulocytes, pheresis unitP9051 290 Blood, l/r, cmv-negP9052 290 Platelets, hla-m, l/r, unitP9053 290 Plt, pher, l/r cmv-neg, irrP9054 290 Blood, l/r, froz/degly/washP9055 290 Plt, aph/pher, l/r, cmv-negP9056 290 Blood, l/r, irradiatedP9057 290 RBC, frz/deg/wsh, l/r, irradP9058 290 RBC, l/r, cmv-neg, irradP9059 290 Plasma, frz between 8-24hourP9060 290 Fr frz plasma donor retestedP9603 290 One-way allow prorated milesP9604 290 One-way allow prorated tripP9612 290 Catheterize for urine specP9615 290 Urine specimen collect multPE001 290 Physical exam & other Dx testQ0035 160 CardiokymographyQ0035 TC 161 CardiokymographyQ0035 26 160 CardiokymographyQ0081 290 Infusion therapy oth than chemo drugs / visitQ0091 270 Obtaining screen pap smearQ0092 270 Set up port xray equipmentQ0111 290 Wet mounts/ w preparationsQ0112 290 Potassium hydroxide prepsQ0113 290 Pinworm examinationsQ0114 290 Fern testQ0115 290 Post-coital mucous examQ0138 290 Ferumoxytol inj, 1mg non-esrdQ0139 290 Ferumoxytol inj, 1mg esrd useQ0144 290 Azithromycin dihydrate, oralQ0161 290 Factor IX recombinantQ0162 290 Ondansetron oralQ0163 290 Diphenhydramine HCl 50mgQ0164 290 Prochlorperazine maleate 5mgQ0165 290 Prochlorperazine maleate10mg end-dated 12/31/2013Q0166 290 Granisetron HCl 1 mg oralQ0167 290 Dronabinol 2.5mg oral


CPT/HCPCS MOD MOD LEV DESCRIPTIONQ0168 290 Dronabinol 5mg oral end-dated 12/31/2013Q0169 290 Promethazine HCl 12.5mg oralQ0170 290 Promethazine HCl 25 mg oral end-dated 12/31/2013Q0171 290 Chlorpromazine HCl 10mg oral end-dated 12/31/2013Q0172 290 Chlorpromazine HCl 25mg oral end-dated 12/31/2013Q0173 290 Trimethobenzamide HCl 250mgQ0174 290 Thiethylperazine maleate10mgQ0175 290 Perphenazine 4mg oralQ0176 290 Perphenazine 8mg oral end-dated 12/31/2013Q0177 290 Hydroxyzine pamoate 25mgQ0178 290 Hydroxyzine pamoate 50mg end-dated 12/31/2013Q0180 290 Dolasetron mesylate oral, 100mgQ0181 290 Unspecified oral anti-emeticQ0478 290 Power adapter, combo vadQ0479 290 Power module combo vad, rep Q0480 290 Driver pneumatic vad, repQ0481 290 Microprcsr cu elec vad, repQ0482 290 Microprcsr cu combo vad, repQ0483 290 Monitor elec vad, repQ0484 290 Monitor elec or comb vad, repQ0485 290 Monitor cable elec vad, repQ0486 290 Mon cable elec/pneum vad, repQ0487 290 Leads any type vad, rep onlyQ0488 290 Pwr pack base elec vad, repQ0489 290 Pwr pack base combo vad, repQ0490 290 Emr pwr source elec vad, repQ0491 290 Emr pwr source combo vad, repQ0492 290 Emr pwr cbl elec vad, repQ0493 290 Emr pwr cbl combo vad, repQ0494 290 Emr hd pmp elec/combo, repQ0495 290 Charger elec/combo vad, repQ0496 290 Battery elec/combo vad, repQ0497 290 Bat clps elec/comb vad, repQ0498 290 Holster elec/combo vad, repQ0499 290 Belt/vest elec/combo vad repQ0500 290 Filters elec/combo vad, repQ0501 290 Shwr cov elec/combo vad, repQ0502 290 Mobility cart pneum vad, repQ0503 290 Battery pneum vad, replQ0504 290 Pwr adpt pneum vad, rep vehQ0505 290 Miscl supply/accessory vad end-dated 12/31/2013Q0506 290 Lith-ion batt elec/pneum VAD, replacementQ0510 290 Dispens fee immunosupressiveQ0511 290 Sup fee antiem,antica,immunoQ0512 290 Px sup fee anti-can sub presQ0513 290 Disp fee inhal drugs/30 daysQ0514 290 Disp fee inhal drugs/90 daysQ0515 290 Sermorelin acetate injectionQ1004 290 Ntiol category 4Q1005 290 Ntiol category 5Q2004 290 Bladder calculi irrig sol, 500mlQ2009 290 Fosphenytoin, 50 mgQ2017 290 Teniposide, 50 mgQ2033 290 Influenza vaccine, (Flublok) end-dated 12/31/2013Q2043 290 Sipuleucel-T auto CD54+Q2050 290 Doxorubicin inj 10mgQ2051 290 Zoledronic acid 1mg end-dated 12/31/2013Q2052 290 Ivig demo, services/supplies Q3001 270 Brachytherapy RadioelementsQ3014 290 Telehealth facility feeQ3025 290 IM Inj, interferon beta-1A, 11mcg end-dated 12/31/2013Q3026 290 Injection, interferon beta-1A, subcutaneous end-dated 12/31/2013Q3027 290 Inj beta interferon im 1 mcg Q3028 290 Inj beta interferon sq 1 mcg Q4001 290 Cast sup body cast plasterQ4002 290 Cast sup body cast fiberglas


CPT/HCPCS MOD MOD LEV DESCRIPTIONQ4003 290 Cast sup shoulder cast plstrQ4004 290 Cast sup shoulder cast fbrglQ4005 290 Cast sup long arm adult plstQ4006 290 Cast sup long arm adult fbrgQ4009 290 Cast sup sht arm adult plstrQ4010 290 Cast sup sht arm adult fbrglQ4013 290 Cast sup gauntlet plasterQ4014 290 Cast sup gauntlet fiberglassQ4017 290 Cast sup lng arm splint plstQ4018 290 Cast sup lng arm splint fbrgQ4021 290 Cast sup sht arm splint plstQ4022 290 Cast sup sht arm splint fbrgQ4025 290 Cast sup hip spica plasterQ4026 290 Cast sup hip spica fiberglasQ4029 290 Cast sup long leg plasterQ4030 290 Cast sup long leg fiberglassQ4033 290 Cast sup lng leg cylinder plQ4034 290 Cast sup lng leg cylinder fbQ4037 290 Cast sup shrt leg plasterQ4038 290 Cast sup shrt leg fiberglassQ4041 290 Cast sup lng leg splnt plstrQ4042 290 Cast sup lng leg splnt fbrglQ4045 290 Cast sup sht leg splnt plstrQ4046 290 Cast sup sht leg splnt fbrglQ4049 290 Finger splint, staticQ4050 290 Cast supplies unlistedQ4051 290 Splint supplies miscQ4074 290 Iloprost non-comp unit dose <= 20 mcgQ4081 290 Epo alfa 100 units, ESRDQ4100 290 Skin substitute, NOSQ4101 290 Apligraf skin subQ4102 290 Oasis wound matrix skin subQ4103 290 Oasis burn matrix skin subQ4104 290 Integra BMWD skin subQ4105 290 Integra DRT skin subQ4106 290 Dermagraft skin subQ4107 290 Graftjacket skin subQ4108 290 Integra matrix skin subQ4109 290 Tissuemend skin subQ4110 290 Primatrix skin subQ4111 290 Gammagraft skin subQ4112 290 Cymetra allograftQ4113 290 Graftjacket express allografQ4114 290 Integra flowable wound matriQ4115 290 Alloskin skin sub, 1 sq cmQ4116 290 Alloderm skin sub, 1 sq cmQ4117 290 HyalomatrixQ4119 290 Matristem wound matrixQ4120 290 Matristem burn matrixQ4121 290 TheraskinQ4122 290 DermacellQ4131 290 Epifix Q4132 290 Grafix core Q4133 290 Grafix prime Q4134 290 Hmatrix Q4135 290 Mediskin Q4136 290 Ezderm Q5001 290 Hospice in patient home, 15 minQ4122 290 DermacellQ4123 290 Alloskin Q4124 290 Oasis tri-layer wound matrixQ4125 290 Arthroflex Q4126 290 Memoderm Q4127 290 Talymed Q4128 290 Flexhd or allopatch hd Q4129 290 Unite biomatrix


CPT/HCPCS MOD MOD LEV DESCRIPTIONQ4130 290 Strattice TMQ4134 290 HmatrixQ4137 290 Amnioexcel or biodexcel, 1cm Q4138 290 Biodfence dryflex, 1cm Q4139 290 Amnio or biodmatrix, inj 1cc Q4140 290 Biodfence 1cm Q4141 290 Alloskin ac, 1 cm Q4142 290 Xcm biologic tiss matrix 1c, Q4143 290 Repriza, 1cm Q4145 290 Epifix, inj, 1mg Q4146 290 Tensix, 1cm Q4147 290 Architect ecm, 1cm Q4148 290 Neox 1k, 1cm Q4149 290 Excellagen, 0.1 cc Q4150 290 Allowrap ds or dry 1 sq cmQ4151 290 Amnioband, guardian 1 sq cmQ4152 290 Dermapure 1 sq cmQ4153 290 Dermavest 1 sq cmQ4154 290 Biovance 1 sq cmQ4155 290 Neoxflo or clarixflo 1 mgQ4156 290 Neox 100 1 sq cmQ4157 290 Revitalon 1 sq cmQ4158 290 Marigen 1 sq cmQ4159 290 Affinity 1 sq cmQ4160 290 Nushield 1 sq cmQ5001 290 Hospice or home hlth in home Q5002 290 Hospice/home hlth in asst lv Q5003 290 Hospice in LT/non-skilled NF, 15 minQ5004 290 Hospice in SNF, 15 minQ5005 290 Hospice, inpatient hospital, 15 minQ5006 290 Hospice in hospice facility, 15 minQ5007 290 Hospice in LTCH, 15 minQ5008 290 Hospice in inpatient psych, 15 minQ5010 290 Hospice home care in hospiceQ9951 290 LOCM >= 400 mg/ml iodine,1mlQ9953 290 Inj Fe-based MR contrast,1mlQ9954 290 Oral MR contrast, 100 mlQ9955 290 Inj perflexane lip micros, 1ml Q9956 290 Inj octafluoropropane mic, 1mlQ9957 290 Inj perflutren lip micros, 1ml Q9958 290 HOCM <= 149 mg/ml iodine, 1mlQ9959 290 HOCM 150-199 mg/ml iodine, 1mlQ9960 290 HOCM 200-249 mg/ml iodine, 1mlQ9961 290 HOCM 250-299 mg/ml iodine, 1mlQ9962 290 HOCM 300-349 mg/ml iodine, 1mlQ9963 290 HOCM 350-399 mg/ml iodine, 1mlQ9964 290 HOCM >= 400 mg/ml iodine, 1mlQ9965 290 LOCM 100-199mg/ml iodine,1mlQ9966 290 LOCM 200-299mg/ml iodine,1mlQ9967 290 LOCM 300-399mg/ml iodine,1mlQ9968 290 Visualization adjunct inj, 1mgQ9969 290 Non-heu TC-99M add-on/dose Q9970 290 Inj ferric carboxymaltos 1 mg end-dated 12/31/2014Q9974 290 Morphine epidural/intratheca end-dated 12/31/2014R0070 270 Transport portable x-rayR0075 270 Transport port x-ray multiplS0012 290 Butorphanol tartrate, nasalS0014 290 Tacrine hydrochloride, 10 mgS0017 290 Injection, aminocaproic acid, 250 mgS0020 290 Injection, bupivicaine hydroS0021 290 Injection, cefoperazone sodS0023 290 Injection, cimetidine hydroc, 150mgS0028 290 Injection, famotidine, 20 mgS0030 290 Injection, metronidazole, 500mgS0032 290 Injection, nafcillin sodium, 1gm


CPT/HCPCS MOD MOD LEV DESCRIPTIONS0034 290 Injection, ofloxacin, 400 mgS0039 290 Injection, sulfamethoxazoleS0040 290 Injection, ticarcillin disod, 0.1-3gmS0073 290 Injection, aztreonam, 500 mgS0074 290 Injection, cefotetan disodium, 500 mgS0077 290 Injection, clindamycin phosp, 150mgS0078 290 Injection, fosphenytoin sodiS0080 290 Injection, pentamidine isethS0081 290 Injection, piperacillin sodiS0088 290 Imatinib 100 mgS0090 290 Sildenafil citrate, 25 mgS0091 290 Granisetron 1mgS0092 290 Hydromorphone 250 mgS0093 290 Morphine 500 mgS0104 290 Zidovudine, oral, 100 mgS0106 290 Bupropion HCl, 150 mg, per 60 tabletsS0108 290 Mercaptopurine, oral, 50 mgS0117 290 Tretinoin topical 5 gS0119 290 Ondansetron 4 mg S0122 290 Injection, menotropins, 75 luS0126 290 Injection, follitropin alfa, 75 luS0128 290 Injection, follitropin beta, 75 luS0132 290 Injection, ganirelix acetate, 250 mcg.S0136 290 Clozapine, 25 mgS0137 290 Didanosine, 25 mgS0138 290 Finasteride, 5 mgS0139 290 Minoxidil, 10 mgS0140 290 Saquinavir, 200 mgS0142 290 Colistimethate inh sol mgS0144 290 Inj, propofol, 10 mg end-dated 12/31/2014S0145 290 Peg interferon alfa-2A/180S0146 290 Peg interferon alfa-2b/10S0148 290 Peg interferon alfa-2b/10S0155 290 Epoprostenol dilutantS0156 290 Exemestane, 25 mgS0157 290 Becaplermin gel 1%, 0.5 gmS0160 290 Dextroamphetamine sulfate, 5 mgS0161 290 Calcitrol, 0.25mgS0164 290 Injection pantroprazole sodium, 40mgS0166 290 Inj olanzapine, 2.5mgS0169 290 Calcitrol S0170 290 Anastrozole 1 mgS0171 290 Bumetanide 0.5 mgS0172 290 Chlorambucil 2 mgS0174 290 Dolasetron 50 mgS0175 290 Flutamide 125 mgS0176 290 Hydroxyurea 500 mgS0177 290 Levamisole 50 mgS0178 290 Lomustine 10 mgS0179 290 Megestrol 20 mgS0182 290 Procarbazine 5 mgS0183 290 Prochlorperazine 5 mgS0187 290 Tamoxifen 10 mgS0189 290 Testosterone pellet 75 mgS0190 290 Mifepristone, oral, 200 mgS0191 290 Misoprostol, oral, 200 mcgS0194 290 Vitamin suppl 100 capsS0196 290 Poly-l-lactic acid 1ml faceS0197 290 Prenatal vitamins 30 dayS0255 290 Hospice refer visit non-MDS0265 290 Genetic counsel 15 minsS0270 290 Home std case rate 30 daysS0271 290 Home hospice case 30 daysS0272 290 Home episodic case 30 daysS0595 290 New lenses in pts old frameS1034 290 Art pancreas system


CPT/HCPCS MOD MOD LEV DESCRIPTIONS1035 290 Art pancreas inv disp sensorS1036 290 Art pancreas ext transmitterS1037 290 Art pancreas ext receiverS2066 290 Breast GAP flap reconstruct, unilateralS2067 290 Breast vstackdev diep/gapS2068 290 Breast DIEP flap reconstructS2079 290 Lap esophagomyotomyS2900 290 Robotic surgical systemS3600 290 Stat labS3601 290 Stat lab home/nfS3711 290 Circulating tumor cell testS3713 290 KRAS mutation analysisS3722 290 Dose optimization auc - 5fu+K19463 S3854 290 Gene profile panel breastS3855 290 Gene test presenilin-1 gene end-dated 12/31/2014S5010 290 5% dextrose and 45% salineS5011 290 5% dextrose in lactated ringS5012 290 5% dextrose with potassiumS5013 290 5% dextrose/45%saline,1000mlS5014 290 5% dextrose/45%saline,1500mlS5120 290 Chore services per 15 minS5121 290 Chore services per diemS5125 290 Attendant care service/15 minS5126 290 Attendant care service/diemS5130 290 Homemaker service NOS/15 minS5131 290 Homemaker service NOS/diemS8032 290 Low dose ct lung screeningS8130 290 Interferential stim 2 chan S8131 290 Interferential stim 4 chan S8210 290 Mucus trapS8262 290 Mandib ortho repos device, eaS8270 290 Enuresis alarmS8940 290 Hippotherapy per sessionS9122 290 Home health aide/cert'd nrs asst; per hrS9123 290 Nursing care, in the home, RN; per hrS9124 290 Nursing care, in the home, LPN; per hrS9125 290 Respite care, in the home; per diemS9126 290 Hospice care, in the home; per diemS9127 290 Social work visit, in the home; per diemS9128 290 Speech therapy, in the home; per diemS9129 290 Occup. therapy, in the home; per diemS9131 290 PT in the home per diemS9152 290 Speech therapy, re-evaluationS9475 290 Ambulatory setting substance, per diemS9480 290 Intensive outpatient psychiaS9482 290 Family stabilization 15 minS9485 290 Crisis intervention mental hS9901 290 Christian sci nurse visitS9960 290 Air ambulanc nonemerg fixed S9961 290 Air ambulan nonemerg rotary S9999 290 Sales taxT1000 290 Private duty/independent nsg up to 15 minT1001 290 Nursing assessment/evaluatnT1002 290 RN services up to 15 minutesT1003 290 LPN/LVN services up to 15minT1004 290 Nsg aide service up to 15minT1013 290 Sign Lang/Oral Interpreter/15 minT1017 290 Targeted case mgmt; per 15 minT1019 290 Personal care serv; per 15 minT1020 290 Personal care serv; per diemT1021 290 HH Aide or cn aide per visitT1030 290 Home nursing care, RN; per diemT1031 290 Home nursing care, LPN; per diemT2016 290 Habil res waiver per diemT2030 290 Assist living waiver/monthT2031 290 Assist living waiver/diem


CPT/HCPCS MOD MOD LEV DESCRIPTIONT2032 290 Res care, nos waiver/monthT2033 290 Res, nos waiver per diemT2042 290 Hospice routine home careT2043 290 Hospice continuous home careT2044 290 Hospice respite careT2045 290 Hospice general careT2046 290 Hospice long term care, r&bT4521 290 Adult size brief/diaper smT4522 290 Adult size brief/diaper medT4523 290 Adult size brief/diaper lgT4524 290 Adult size brief/diaper xlT4525 290 Adult size pull-on smT4526 290 Adult size pull-on medT4527 290 Adult size pull-on lgT4528 290 Adult size pull-on xlT4543 290 Adult disp brief/diap abv xl T5999 290 Supply, nosV2020 290 Vision svcs frames purchasesV2100 290 Lens spher single plano 4.00V2101 290 Single visn sphere 4.12-7.00V2102 290 Singl visn sphere 7.12-20.00V2103 290 Spherocylindr 4.00d/12-2.00dV2104 290 Spherocylindr 4.00d/2.12-4dV2105 290 Spherocylinder 4.00d/4.25-6dV2106 290 Spherocylinder 4.00d/>6.00dV2107 290 Spherocylinder 4.25d/12-2dV2108 290 Spherocylinder 4.25d/2.12-4dV2109 290 Spherocylinder 4.25d/4.25-6dV2110 290 Spherocylinder 4.25d/over 6dV2111 290 Spherocylindr 7.25d/.25-2.25V2112 290 Spherocylindr 7.25d/2.25-4dV2113 290 Spherocylindr 7.25d/4.25-6dV2114 290 Spherocylinder over 12.00dV2115 290 Lens lenticular bifocalV2118 290 Lens aniseikonic singleV2121 290 Lenticular lensV2199 290 Lens single vision not oth cV2200 290 Lens spher bifoc plano 4.00dV2201 290 Lens sphere bifocal 4.12-7.0V2202 290 Lens sphere bifocal 7.12-20.V2203 290 Lens sphcyl bifocal 4.00d/.1V2204 290 Lens sphcy bifocal 4.00d/2.1V2205 290 Lens sphcy bifocal 4.00d/4.2V2206 290 Lens sphcy bifocal 4.00d/oveV2207 290 Lens sphcy bifocal 4.25-7d/.V2208 290 Lens sphcy bifocal 4.25-7/2.V2209 290 Lens sphcy bifocal 4.25-7/4.V2210 290 Lens sphcy bifocal 4.25-7/ovV2211 290 Lens sphcy bifo 7.25-12/.25-V2212 290 Lens sphcyl bifo 7.25-12/2.2V2213 290 Lens sphcyl bifo 7.25-12/4.2V2214 290 Lens sphcyl bifocal over 12.V2215 290 Lens lenticular bifocalV2218 290 Lens aniseikonic bifocalV2219 290 Lens bifocal seg width overV2220 290 Lens bifocal add over 3.25dV2221 290 Lenticular lensV2299 290 Lens bifocal specialityV2300 290 Lens sphere trifocal 4.00dV2301 290 Lens sphere trifocal 4.12-7.V2302 290 Lens sphere trifocal 7.12-20V2303 290 Lens sphcy trifocal 4.0/.12-V2304 290 Lens sphcy trifocal 4.0/2.25V2305 290 Lens sphcy trifocal 4.0/4.25V2306 290 Lens sphcyl trifocal 4.00/>6V2307 290 Lens sphcy trifocal 4.25-7/.


CPT/HCPCS MOD MOD LEV DESCRIPTIONV2308 290 Lens sphc trifocal 4.25-7/2.V2309 290 Lens sphc trifocal 4.25-7/4.V2310 290 Lens sphc trifocal 4.25-7/>6V2311 290 Lens sphc trifo 7.25-12/.25-V2312 290 Lens sphc trifo 7.25-12/2.25V2313 290 Lens sphc trifo 7.25-12/4.25V2314 290 Lens sphcyl trifocal over 12V2315 290 Lens lenticular trifocalV2318 290 Lens aniseikonic trifocalV2319 290 Lens trifocal seg width > 28V2320 290 Lens trifocal add over 3.25dV2321 290 Lenticular lensV2399 290 Lens trifocal specialityV2410 290 Lens variab asphericity singV2430 290 Lens variable asphericity biV2499 290 Variable asphericity lensV2500 290 Contact lens pmma sphericalV2501 290 Cntct lens pmma-toric/prismV2502 290 Contact lens pmma bifocalV2503 290 Cntct lens pmma color visionV2510 290 Cntct gas permeable sphericlV2511 290 Cntct toric prism ballastV2512 290 Cntct lens gas permbl bifoclV2513 290 Contact lens extended wearV2520 290 Contact lens hydrophilicV2521 290 Cntct lens hydrophilic toricV2522 290 Cntct lens hydrophil bifoclV2523 290 Cntct lens hydrophil extendV2530 290 Contact lens gas impermeableV2531 290 Contact lens gas permeableV2599 290 Contact lens/es other typeV2600 290 Hand held low vision aidsV2610 290 Single lens spectacle mountV2615 290 Telescop/othr compound lensV2623 290 Plastic eye prosth customV2624 290 Polishing artifical eyeV2625 290 Enlargemnt of eye prosthesisV2626 290 Reduction of eye prosthesisV2627 290 Scleral cover shellV2628 290 Fabrication & fittingV2629 290 Prosthetic eye other typeV2630 290 Anter chamber intraocul lensV2631 290 Iris support intraoclr lensV2632 290 Post chmbr intraocular lensV2700 290 Balance lensV2710 290 Glass/plastic slab off prismV2715 290 Prism lens/esV2718 290 Fresnell prism press-on lensV2730 290 Special base curveV2744 290 Tint photochromatic lens/esV2745 290 TintV2750 290 Anti-reflective coatingV2755 290 UV lens/esV2756 290 Eye glass caseV2760 290 Scratch resistant coatingV2761 290 Mirror coatingV2762 290 PolarizationV2770 290 Occluder lens/esV2780 290 Oversize lens/esV2781 290 Progressive lens per lensV2782 290 LensV2783 290 LensV2784 290 Lens polycarb or equalV2785 290 Corneal tissue processingV2786 290 Occupational multifocal lensV2790 290 Amniotic membrane


CPT/HCPCS MOD MOD LEV DESCRIPTIONV2797 290 Vis item/svc in other codeV2799 290 Miscellaneous vision serviceV5010 290 Assessment for hearing aidV5011 290 Hearing aid fitting/checkingV5014 290 Hearing aid repair/modifyingV5020 290 Conformity evaluationV5030 290 Body-worn hearing aid airV5040 290 Body-worn hearing aid boneV5050 290 Hearing aid monaural in earV5060 290 Behind ear hearing aidV5070 290 Glasses air conductionV5080 290 Glasses bone conductionV5090 290 Hearing aid dispensing feeV5095 290 Semi-implant mid ear prosthesisV5100 290 Body-worn bilat hearing aidV5110 290 Hearing aid dispensing feeV5120 290 Body-worn binaur hearing aidV5130 290 In ear binaural hearing aidV5140 290 Behind ear binaur hearing aiV5150 290 Glasses binaural hearing aidV5160 290 Dispensing fee binauralV5170 290 Within ear cros hearing aidV5180 290 Behind ear cros hearing aidV5190 290 Glasses cros hearing aidV5200 290 Cros hearing aid dispens feeV5210 290 In ear bicros hearing aidV5220 290 Behind ear bicros hearing aiV5230 290 Glasses bicros hearing aidV5240 290 Dispensing fee bicrosV5241 290 Dispensing fee, monauralV5242 290 Hearing aid, monaural, cicV5243 290 Hearing aid, monaural, itcV5244 290 Hearing aid, prog, mon, cicV5245 290 Hearing aid, prog, mon, itcV5246 290 Hearing aid, prog, mon, iteV5247 290 Hearing aid, prog, mon, bteV5248 290 Hearing aid, binaural, cicV5249 290 Hearing aid, binaural, itcV5250 290 Hearing aid, prog, bin, cicV5251 290 Hearing aid, prog, bin, itcV5252 290 Hearing aid, prog, bin, iteV5253 290 Hearing aid, prog, bin, bteV5254 290 Hearing id, digit, mon, cicV5255 290 Hearing aid, digit, mon, itcV5256 290 Hearing aid, digit, mon, iteV5257 290 Hearing aid, digit, mon, bteV5258 290 Hearing aid, digit, bin, cicV5259 290 Hearing aid, digit, bin, itcV5260 290 Hearing aid, digit, bin, iteV5261 290 Hearing aid, digit, bin, bteV5262 290 Hearing aid, disp, monauralV5263 290 Hearing aid, disp, binauralV5264 290 Ear mold/insertV5265 290 Ear mold/insert, dispV5266 290 Battery for hearing deviceV5267 290 Hearing aid supply/accessoryV5268 290 ALD Telephone AmplifierV5269 290 Alerting device, any typeV5270 290 ALD, TV amplifier, any typeV5271 290 ALD, TV caption decoderV5272 290 ALD, TddV5273 290 ALD for cochlear implantV5275 290 Ear impressionV5281 290 Ald fm/dm system, monaural V5282 290 Ald fm/dm system binaural V5283 290 Ald neck, loop ind receiver


CPT/HCPCS MOD MOD LEV DESCRIPTIONV5284 290 Ald fm/dm ear level receiver V5285 290 Ald fm/dm aud input receiver V5286 290 Ald blu tooth fm/dm receiver V5287 290 Ald fm/dm receiver, nos V5288 290 Ald fm/dm transmitter ald V5289 290 Ald fm/dm adapt/boot couplin V5290 290 Ald transmitter microphone V5299 270 Hearing serviceV5336 290 Repair communication deviceV5362 290 Speech screeningV5363 290 Language screeningV5364 290 Dysphagia screening****** ****** ****** ******

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