2015 clinician utilization data available for preview...page 1 of 41 physician compare py 2015...

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Physician Compare PY 2015 Clinician Utilization Data Available for Preview

The Centers for Medicare & Medicaid Services (CMS) provides official datasets for the Medicare.gov Physician Compare website to give you useful information about groups, physicians, and other clinicians currently enrolled in Medicare and what they’re doing to improve the care they provide. Physician Compare will begin publicly reporting utilization data for clinicians, starting with a subset of the 2015 Healthcare Common Procedure Coding System (HCPCS) codes.

The goal was to define a subset of codes that would provide more information about the scope of care of the clinicians included on Physician Compare. The subset of publicly reported HCPCS codes will be based on the top 5 codes reported by each available Medicare specialty, excluding evaluation and management codes. The evaluation and management codes do not provide descriptive information regarding care and were, therefore, excluded from the available subset. To define the universe of available HCPCS codes for the Physician Compare Downloadable Database, the top 5 codes for each specialty represented on the website were identified. However, the information available for any given clinician is not limited to their specific specialty. This just defines the subset of codes available for inclusion in the Downloadable Database. As a result, clinicians may have data publicly reported for more than 5 HCPCS codes. Below is a list of the 2015 HCPCS codes targeted for public reporting in the Physician Compare Downloadable Database to be released with the performance information finalized in the 2016 Physician Fee Schedule final rule (80 FR 71130 through 71131).

The Physician Compare 30-day preview period gives clinicians a chance to review their utilization data prior to it being publicly reported on Physician Compare. Any clinician who provided services in 2015, and is still providing services, should preview their utilization data prior to it being publicly reported in the Physician Compare Downloadable Database. To preview this data, go to the Medicare Provider Utilization and Payment Data1 file on Data.CMS.gov. Clinicians should then review the information for the HCPCS codes listed below before preview ends on November 17, 2017.

If you have any questions about this information, please contact the Physician Compare support team at [email protected].

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https://www.medicare.gov/physiciancompare/search.html

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HCPCS Codes by Specialty

The 2015 HCPCS codes targeted for public reporting are organized under the following specialties:

A-F Addiction MedicineAllergy/Immunology

AnesthesiologyAnesthesiology AssistantAudiologist

Cardiac ElectrophysiologyCardiac Surgery

Cardiovascular Disease (Cardiology)Certified Nurse MidwifeCertified Registered Nurse AnesthetistChiropracticClinical Nurse Specialist Clinical Psychologist

Clinical Social WorkerColorectal Surgery (Proctology)Critical Care (Intensivists)

DentistDermatologyDiagnostic RadiologyEmergency MedicineEndocrinologyFamily Practice

G-NGastroenterologyGeneral Practice

General SurgeryGeriatric MedicineGeriatric Psychiatry

Gynecological OncologyHand Surgery

Hematology

Hematology/OncologyHospice/Palliative Care

HospitalistInfectious DiseaseInternal Medicine

Interventional CardiologyInterventional Pain ManagementInterventional Radiology

Maxillofacial SurgeryMedical OncologyNephrologyNeurologyNeuropsychiatryNeurosurgeryNuclear MedicineNurse Practitioner

O-P Obstetrics/GynecologyOccupational Therapy

OphthalmologyOptometryOral Surgery

Orthopedic SurgeryOsteopathic Manipulative MedicineOtolaryngology

Pain ManagementPathology

Pediatric MedicinePeripheral Vascular DiseasePhysical Medicine And RehabilitationPhysical TherapyPhysician Assistant

Plastic And Reconstructive SurgeryPodiatryPreventative MedicinePsychiatryPulmonary Disease

Q-Z Radiation OncologyRegistered Dietitian Or Nutrition ProfessionalRheumatologySleep MedicineSpeech Language PathologistSports MedicineSurgical Oncology

Thoracic Surgery

UrologyVascular Surgery

Numerical List of HCPCS Codes

In addition, you can view the complete list of the 2015 HCPCS codes targeted for public reporting in numerical order.

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HCPCS Codes by Specialty

Addiction Medicine

Rank HCPCS Code Code Description

1 G0434 Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

2 95117 Injection of incremental dosages of allergen, 2 or more injections

3 36620 Insertion of arterial catheter for blood sampling or infusion, accessed through the skin

4 00790 Anesthesia for procedure in upper abdomen including use of an endoscope

5 92540 Observation, testing, and recording of abnormal eye movement

Allergy/Immunology


1 95004 Injection of allergenic extracts into skin, accessed through the skin

2 95117 Injection of incremental dosages of allergen, 2 or more injections

3 95165 Preparation and provision of single or multiple antigens for allergen immunotherapy

4 94010 Measurement and graphic recording of total and timed exhaled air capacity

5 95024 Injection of allergenic extracts into skin for immediate reaction analysis

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Anesthesiology


1 00740 Anesthesia for procedure on gastrointestinal tract using an endoscope

2 00810 Anesthesia for procedure on lower intestine using an endoscope


4 00142 Anesthesia for lens surgery


Anesthesiology Assistant






5 01402 Anesthesia for open or endoscopic total knee joint replacement

Audiologist


1 92557 Air and bone conduction assessment of hearing loss and speech recognition

2 92567 Eardrum testing using ear probe

3 92550 Assessment of eardrum and muscle function

4 92543 Assessment and recording of balance system during irrigation of both ears

5 92540 Observation, testing, and recording of abnormal eye movement

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Cardiac Electrophysiology


1 93280 Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report

2 33208 Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes

3 93284 Evaluation, testing and programming adjustment of defibrillator with analysis, review and report

4 93000 Routine EKG using at least 12 leads including interpretation and report

5 93283 Evaluation, testing and programming adjustment of defibrillator with analysis, review and report

Cardiac Surgery


1 33533 Heart artery bypass to repair one artery

2 33508 Harvest of veins for coronary artery bypass procedure using an endoscope

3 33518 Combined multiple vein and artery heart artery bypasses

4 33405 Replacement of aortic valve using artificial valve on heart-lung machine, open procedure


Cardiovascular Disease (Cardiology)


1 93306 Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function


3 93010 Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report

4 93018 Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician interpretation and report

5 78452 Nuclear medicine study of vessels of heart using drugs or exercise multiple studies

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Certified Nurse Midwife


1 G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination

2 Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

3 81002 Urinalysis, manual test

4 36415 Insertion of needle into vein for collection of blood sample

5 82270 Stool analysis for blood to screen for colon tumors

Certified Registered Nurse Anesthetist






5 01402 Anesthesia for open or endoscopic total knee joint replacement

Chiropractic


1 98941 Chiropractic manipulative treatment, 3 to 4 spinal regions

2 98940 Chiropractic manipulative treatment, 1 to2 spinal regions

3 98942 Chiropractic manipulative treatment, 5 spinal regions

4 97001 Physical therapy evaluation

5 97110 Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes

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Clinical Nurse Specialist


1 90792 Psychiatric diagnostic evaluation with medical services

2 90833 Psychotherapy, 30 minutes



5 90791 Psychiatric diagnostic evaluation

Clinical Psychologist






5 96118 Neuropsychological testing, interpretation, and report by psychologist or physician per hour

Clinical Social Worker






5 90853 Group psychotherapy

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Colorectal Surgery (Proctology)


1 46600 Diagnostic examination of the anus using an endoscope

2 45385 Removal of polyps or growths of large bowel using an endoscope

3 45380 Biopsy of large bowel using an endoscope

4 45378 Diagnostic examination of large bowel using an endoscope

5 46221 Removal of hemorrhoid by rubber banding

Critical Care (Intensivists)


1 36556 Insertion of central venous catheter for infusion, patient 5 years or older

2 31500 Emergent insertion of breathing tube into windpipe cartilage using an endoscope

3 94729 Measurement of lung diffusing capacity

4 94060 Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration


Dentist


1 70355 X-ray imaging of teeth

2 40808 Biopsy of mouth

3 70100 X-ray of mandible, less than 4 views

4 70350 Imaging of jaws and skull for orthodontic purposes

5 76102 Complex motion imaging procedure on both sides of body

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Dermatology


1 17000 Destruction of skin growth

2 11100 Biopsy of single growth of skin and/or tissue

3 17003 Destruction of 2-14 skin growths

4 17110 Destruction of up to 14 skin growths

5 11101 Biopsy of each additional growth of skin and/or tissue

Diagnostic Radiology


1 71020 X-ray of chest, 2 views, front and side

2 71010 X-ray of chest, 1 view, front

3 74177 CT scan of abdomen and pelvis with contrast

4 74176 CT scan of abdomen and pelvis

5 74000 X-ray of abdomen, single view

Emergency Medicine




3 96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention

4 31500 Emergent insertion of breathing tube into windpipe cartilage using an endoscope


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Endocrinology


1 83036 Hemoglobin A1C level


3 76536 Ultrasound of head and neck

4 82962 Blood glucose (sugar) test performed by hand-held instrument

5 10022 Fine needle aspiration using imaging guidance

Family Practice


1 G0008 Administration of influenza virus vaccine


3 G0009 Administration of pneumococcal vaccine

4 G0439 Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit


Gastroenterology


1 43239 Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope


3 45385 Removal of polyps or growths of large bowel using an endoscope


5 43235 Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope

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General Practice







General Surgery


1 47562 Removal of gallbladder using an endoscope

2 43239 Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope



5 36561 Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older

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Geriatric Medicine


1 G0180

Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per certification period



4 G0179

Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per re-certification period


Geriatric Psychiatry





4 90870 Shock treatment and monitoring


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Gynecological Oncology


1 58571 Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope


3 96413 Infusion of chemotherapy into a vein up to 1 hour

4 J1100 Injection, dexamethasone sodium phosphate, 1 mg

5 96367 Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour

Hand Surgery


1 20550 Injections of tendon sheath, ligament, or muscle membrane

2 73140 X-ray of fingers, minimum of 2 views

3 73110 X-ray of wrist, minimum of 3 views

4 73130 X-ray of hand, minimum of 3 views

5 64721 Release and/or relocation of median nerve of hand

Hematology





4 96365 Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour

5 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test

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Hematology/Oncology







Hospice/Palliative Care




3 G0180




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Hospitalist


1 G0180






Infectious Disease




3 96365 Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour


5 90670 Pneumococcal vaccine for injection into muscle

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Internal Medicine







Interventional Cardiology


1 93458 Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart

2 93306 Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function


4 92928 Catheter insertion of stents in major coronary artery or branch, accessed through the skin


Interventional Pain Management


1 64493 Injections of lower or sacral spine facet joint using imaging guidance

2 64483 Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance


4 62311 Injections of substances into lower or sacral spine

5 20610 Aspiration and/or injection of large joint or joint capsule

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Interventional Radiology


1 77001 Fluoroscopic guidance for insertion, replacement or removal of central venous access device

2 76937 Ultrasound guidance for accessing into blood vessel

3 71010 X-ray of chest, 1 view, front

4 77012 Radiological supervision and interpretation of CT guidance for needle insertion


Maxillofacial Surgery



2 99144 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 30 minutes

3 40808 Biopsy of mouth

4 40812 Removal of growth of mouth

5 70330 X-ray of jaw joints on both sides of the face

Medical Oncology







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Nephrology


1 90935 Hemodialysis procedure with one physician evaluation

2 90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older

3 90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older

4 90962 Dialysis services (1 physician visit per month), patient 20 years of age and older

5 90966 Home dialysis services per month, patient 20 years of age or older

Neurology


1 95886 Needle measurement and recording of electrical activity of muscles of arm or leg complete study

2 95816 Measurement and recording of brain wave (EEG) activity, awake and drowsy

3 95819 Measurement and recording of brain wave (EEG) activity, awake and asleep

4 95910 Nerve transmission studies, 7-8 studies


Neuropsychiatry



2 95816 Measurement and recording of brain wave (EEG) activity, awake and drowsy



5 95819 Measurement and recording of brain wave (EEG) activity, awake and asleep

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Neurosurgery


1 63047 Partial removal of middle spine bone with release of spinal cord and/or nerves

2 22851 Insertion of spinal instrumentation for spinal stabilization

3 63048 Partial removal of spine bone with release of spinal cord and/or nerves

4 22842 Insertion of posterior spinal instrumentation for spinal stabilization, 3 to 6 vertebral segments

5 22551 Fusion of spine bones with removal of disc at upper spinal column, anterior approach

Nuclear Medicine


1 78306 Bone and/or joint imaging, whole body

2 78452 Nuclear medicine study of vessels of heart using drugs or exercise multiple studies

3 78815 Nuclear medicine study with CT imaging skull base to mid-thigh

4 78582 Nuclear medicine study of lung ventilation and blood circulation in the lungs

5 78816 Nuclear medicine study with CT imaging whole body

Nurse Practitioner







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Obstetrics/Gynecology


1 G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination

2 Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

3 76830 Ultrasound pelvis through vagina


5 G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous

Occupational Therapy



2 97003 Occupational therapy evaluation

3 97140 Manual (physical) therapy techniques to 1 or more regions, each 15 minutes

4 97530 Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes

5 97035 Application of ultrasound to 1 or more areas, each 15 minutes

Ophthalmology


1 92014 Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits

2 92012 Eye and medical examination for diagnosis and treatment, established patient

3 92083 Measurement of field of vision during daylight conditions

4 92004 Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits

5 92134 Diagnostic imaging of retina

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Optometry


1 92014 Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits

2 92004 Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits

3 92250 Photography of the retina

4 92083 Measurement of field of vision during daylight conditions

5 92133 Diagnostic imaging of optic nerve of eye

Oral Surgery



2 88305 Pathology examination of tissue using a microscope, intermediate complexity

3 21085 Impression and custom preparation of outer ear prosthesis

4 21210 Repair of nasal or cheek bone with bone graft

5 70350 Imaging of jaws and skull for orthodontic purposes

Orthopedic Surgery



2 73030 X-ray of shoulder, minimum of 2 views

3 73510 X-ray of hip of one side of body, minimum of 2 views

4 73562 X-ray of knee, 3 views

5 27447 Repair of knee joint

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Osteopathic Manipulative Medicine


1 98927 Osteopathic manipulative treatment to 5-6 body regions





Otolaryngology


1 31575 Diagnostic examination of voice box using flexible endoscope

2 69210 Removal of impact ear wax, one ear

3 31231 Diagnostic examination of nasal passages using an endoscope

4 92557 Air and bone conduction assessment of hearing loss and speech recognition

5 92567 Eardrum testing using ear probe

Pain Management



2 62311 Injections of substances into lower or sacral spine




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Pathology


1 88305 Pathology examination of tissue using a microscope, intermediate complexity

2 88342 Tissue or cell analysis by immunologic technique

3 88341 Special stained specimen slides to examine tissue

4 88307 Pathology examination of tissue using a microscope, moderately high complexity

5 88304 Pathology examination of tissue using a microscope, moderately low complexity

Pediatric Medicine






5 90670 Pneumococcal vaccine for injection into muscle

Peripheral Vascular Disease


1 93970 Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers

2 93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers

3 93880 Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck

4 93922 Ultrasound study of arteries of both arms and legs

5 93925 Ultrasound study of arteries and arterial grafts of both legs

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Physical Medicine And Rehabilitation


1 95886 Needle measurement and recording of electrical activity of muscles of arm or leg complete study





Physical Therapy



2 97001 Physical therapy evaluation

3 97140 Manual (physical) therapy techniques to 1 or more regions, each 15 minutes

4 97112 Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes

5 G0283 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care

Physician Assistant






5 81003 Automated urinalysis test

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Plastic And Reconstructive Surgery


1 11100 Biopsy of single growth of skin and/or tissue

2 14060 Tissue transfer repair of wound (10 sq. centimeters or less) of eyelids, nose, ears, and/or lips

3 11642 Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips

4 13132 Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet

5 11042 Removal of skin and tissue first 20 sq. cm or less

Podiatry


1 11721 Removal of tissue from 6 or more finger or toe nails

2 11056 Removal of 2 to 4 thickened skin growths

3 73630 X-ray of foot, minimum of 3 views

4 11720 Removal of tissue from 1 to 5 finger or toe nails

5 11055 Removal of single thickened skin growth

Preventative Medicine



2 99183 Management and supervision of oxygen chamber therapy per session

3 11042 Removal of skin and tissue first 20 sq. cm or less

4 97597 Removal of tissue from wounds per session


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Psychiatry







Pulmonary Disease




3 94726 Determination of lung volumes using plethysmography

4 94010 Measurement and graphic recording of total and timed exhaled air capacity

5 95811 Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube

Radiation Oncology


1 77427 Radiation treatment management, 5 treatments

2 77334 Radiation treatment devices, design and construction, complex

3 77300 Calculation of radiation therapy dose

4 77263 Management of radiation therapy, complex

5 77290 Management of radiation therapy, simulation, complex

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Registered Dietitian Or Nutrition Professional


1 97802 Medical nutrition therapy, assessment and intervention, each 15 minutes

2 97803 Medical nutrition therapy re-assessment and intervention, each 15 minutes

3 G0108 Diabetes outpatient self-management training services, individual, per 30 minutes

4 G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

5 G0270

Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes

Rheumatology




3 J1030 Injection, methylprednisolone acetate, 40 mg



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Sleep Medicine


1 95811 Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube

2 95810 Sleep monitoring of patient (6 years or older) in sleep lab

3 95806 Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort



Speech Language Pathologist


1 92507 Treatment of speech, language, voice, communication, and/or hearing processing disorder

2 92610 Evaluation of swallowing function

3 92526 Treatment of swallowing and/or oral feeding function

4 92523 Evaluation of speech sound production with evaluation of language comprehension and expression

5 92524 Behavioral and qualitative analysis of voice and resonance

Sports Medicine



2 73030 X-ray of shoulder, minimum of 2 views

3 J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg

4 20611 Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance

5 73564 X-ray of knee, 4 or more views

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Surgical Oncology


1 38525 Biopsy or removal of lymph nodes of under the arm, open procedure

2 19301 Partial removal of breast

3 38900 Lymph node imaging during surgery

4 36561 Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older

5 77001 Fluoroscopic guidance for insertion, replacement or removal of central venous access device

Thoracic Surgery


1 33533 Heart artery bypass to repair one artery

2 33508 Harvest of veins for coronary artery bypass procedure using an endoscope


4 33405 Replacement of aortic valve using artificial valve on heart-lung machine, open procedure


Urology


1 52000 Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope

2 51798 Ultrasound measurement of bladder capacity after voiding

3 76872 Ultrasound of rectum

4 55700 Biopsy of prostate gland

5 76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle

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Vascular Surgery


1 93970 Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers

2 93880 Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck

3 93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers

4 93926 Ultrasound study of arteries and arterial grafts of one leg or limited

5 93922 Ultrasound study of arteries of both arms and legs

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Numerical List of HCPC Codes

HCPCS Code Code Description

00142 Anesthesia for lens surgery

00740 Anesthesia for procedure on gastrointestinal tract using an endoscope

00790 Anesthesia for procedure in upper abdomen including use of an endoscope

00810 Anesthesia for procedure on lower intestine using an endoscope

01402 Anesthesia for open or endoscopic total knee joint replacement

10022 Fine needle aspiration using imaging guidance

11042 Removal of skin and tissue first 20 sq. cm or less

11055 Removal of single thickened skin growth

11056 Removal of 2 to 4 thickened skin growths

11100 Biopsy of single growth of skin and/or tissue

11101 Biopsy of each additional growth of skin and/or tissue

11642 Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips

11720 Removal of tissue from 1 to 5 finger or toe nails

11721 Removal of tissue from 6 or more finger or toe nails

13132 Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet

14060 Tissue transfer repair of wound (10 sq. centimeters or less) of eyelids, nose, ears, and/or lips

17000 Destruction of skin growth

17003 Destruction of 2-14 skin growths

17110 Destruction of up to 14 skin growths

19301 Partial removal of breast

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20550 Injections of tendon sheath, ligament, or muscle membrane

20610 Aspiration and/or injection of large joint or joint capsule

20611 Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance

21085 Impression and custom preparation of outer ear prosthesis

21210 Repair of nasal or cheek bone with bone graft

22551 Fusion of spine bones with removal of disc at upper spinal column, anterior approach

22842 Insertion of posterior spinal instrumentation for spinal stabilization, 3 to 6 vertebral segments

22851 Insertion of spinal instrumentation for spinal stabilization

27447 Repair of knee joint

31231 Diagnostic examination of nasal passages using an endoscope

31500 Emergent insertion of breathing tube into windpipe cartilage using an endoscope

31575 Diagnostic examination of voice box using flexible endoscope

33208 Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes

33405 Replacement of aortic valve using artificial valve on heart-lung machine, open procedure

33508 Harvest of veins for coronary artery bypass procedure using an endoscope

33518 Combined multiple vein and artery heart artery bypasses

33519 Combined multiple vein and artery heart artery bypasses

33533 Heart artery bypass to repair one artery

36415 Insertion of needle into vein for collection of blood sample

36556 Insertion of central venous catheter for infusion, patient 5 years or older

36561 Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older

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36620 Insertion of arterial catheter for blood sampling or infusion, accessed through the skin

38525 Biopsy or removal of lymph nodes of under the arm, open procedure

38900 Lymph node imaging during surgery

40808 Biopsy of mouth

40812 Removal of growth of mouth

43235 Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope

43239 Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope

45378 Diagnostic examination of large bowel using an endoscope

45380 Biopsy of large bowel using an endoscope

45385 Removal of polyps or growths of large bowel using an endoscope

46221 Removal of hemorrhoid by rubber banding

46600 Diagnostic examination of the anus using an endoscope

47562 Removal of gallbladder using an endoscope

51798 Ultrasound measurement of bladder capacity after voiding

52000 Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope

55700 Biopsy of prostate gland

58571 Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope

62311 Injections of substances into lower or sacral spine

63047 Partial removal of middle spine bone with release of spinal cord and/or nerves

63048 Partial removal of spine bone with release of spinal cord and/or nerves

64483 Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance

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64493 Injections of lower or sacral spine facet joint using imaging guidance

64494 Injections of lower or sacral spine facet joint using imaging guidance

64721 Release and/or relocation of median nerve of hand

69210 Removal of impact ear wax, one ear

70100 X-ray of mandible, less than 4 views

70330 X-ray of jaw joints on both sides of the face

70350 Imaging of jaws and skull for orthodontic purposes

70355 X-ray imaging of teeth

71010 X-ray of chest, 1 view, front

71020 X-ray of chest, 2 views, front and side

73030 X-ray of shoulder, minimum of 2 views

73110 X-ray of wrist, minimum of 3 views

73130 X-ray of hand, minimum of 3 views

73140 X-ray of fingers, minimum of 2 views

73510 X-ray of hip of one side of body, minimum of 2 views

73562 X-ray of knee, 3 views

73564 X-ray of knee, 4 or more views

73630 X-ray of foot, minimum of 3 views

74000 X-ray of abdomen, single view

74176 CT scan of abdomen and pelvis

74177 CT scan of abdomen and pelvis with contrast

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76102 Complex motion imaging procedure on both sides of body

76536 Ultrasound of head and neck

76830 Ultrasound pelvis through vagina

76872 Ultrasound of rectum

76937 Ultrasound guidance for accessing into blood vessel

76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle

77001 Fluoroscopic guidance for insertion, replacement or removal of central venous access device

77012 Radiological supervision and interpretation of CT guidance for needle insertion

77263 Management of radiation therapy, complex

77290 Management of radiation therapy, simulation, complex

77300 Calculation of radiation therapy dose

77334 Radiation treatment devices, design and construction, complex

77427 Radiation treatment management, 5 treatments

78306 Bone and/or joint imaging, whole body

78452 Nuclear medicine study of vessels of heart using drugs or exercise multiple studies

78582 Nuclear medicine study of lung ventilation and blood circulation in the lungs

78815 Nuclear medicine study with CT imaging skull base to mid-thigh

78816 Nuclear medicine study with CT imaging whole body

81002 Urinalysis, manual test

81003 Automated urinalysis test

82270 Stool analysis for blood to screen for colon tumors

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82962 Blood glucose (sugar) test performed by hand-held instrument

83036 Hemoglobin A1C level

85025 Complete blood cell count (red cells, white blood cell, platelets), automated test

88304 Pathology examination of tissue using a microscope, moderately low complexity

88305 Pathology examination of tissue using a microscope, intermediate complexity

88307 Pathology examination of tissue using a microscope, moderately high complexity

88341 Special stained specimen slides to examine tissue

88342 Tissue or cell analysis by immunologic technique

90670 Pneumococcal vaccine for injection into muscle

90791 Psychiatric diagnostic evaluation

90792 Psychiatric diagnostic evaluation with medical services

90832 Psychotherapy, 30 minutes





90853 Group psychotherapy

90870 Shock treatment and monitoring

90935 Hemodialysis procedure with one physician evaluation

90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older

90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older

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90962 Dialysis services (1 physician visit per month), patient 20 years of age and older

90966 Home dialysis services per month, patient 20 years of age or older

92004 Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits

92012 Eye and medical examination for diagnosis and treatment, established patient

92014 Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits

92083 Measurement of field of vision during daylight conditions

92133 Diagnostic imaging of optic nerve of eye

92134 Diagnostic imaging of retina

92250 Photography of the retina

92507 Treatment of speech, language, voice, communication, and/or hearing processing disorder

92523 Evaluation of speech sound production with evaluation of language comprehension and expression

92524 Behavioral and qualitative analysis of voice and resonance

92526 Treatment of swallowing and/or oral feeding function

92540 Observation, testing, and recording of abnormal eye movement

92543 Assessment and recording of balance system during irrigation of both ears

92550 Assessment of eardrum and muscle function

92557 Air and bone conduction assessment of hearing loss and speech recognition

92567 Eardrum testing using ear probe

92610 Evaluation of swallowing function

92928 Catheter insertion of stents in major coronary artery or branch, accessed through the skin

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93000 Routine EKG using at least 12 leads including interpretation and report

93010 Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report

93018 Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician interpretation and report

93280 Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report

93283 Evaluation, testing and programming adjustment of defibrillator with analysis, review and report

93284 Evaluation, testing and programming adjustment of defibrillator with analysis, review and report

93306 Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function

93458 Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart

93880 Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck

93922 Ultrasound study of arteries of both arms and legs

93925 Ultrasound study of arteries and arterial grafts of both legs

93926 Ultrasound study of arteries and arterial grafts of one leg or limited

93970 Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers

93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers

94010 Measurement and graphic recording of total and timed exhaled air capacity

94060 Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration

94726 Determination of lung volumes using plethysmography

94729 Measurement of lung diffusing capacity

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95004 Injection of allergenic extracts into skin, accessed through the skin

95024 Injection of allergenic extracts into skin for immediate reaction analysis

95117 Injection of incremental dosages of allergen, 2 or more injections

95165 Preparation and provision of single or multiple antigens for allergen immunotherapy

95806 Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort

95810 Sleep monitoring of patient (6 years or older) in sleep lab

95811 Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube

95816 Measurement and recording of brain wave (EEG) activity, awake and drowsy

95819 Measurement and recording of brain wave (EEG) activity, awake and asleep

95886 Needle measurement and recording of electrical activity of muscles of arm or leg complete study

95909 Nerve transmission studies, 5-6 studies

95910 Nerve transmission studies, 7-8 studies

96118 Neuropsychological testing, interpretation, and report by psychologist or physician per hour

96365 Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour

96367 Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1hour

96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention

96413 Infusion of chemotherapy into a vein up to 1 hour

97001 Physical therapy evaluation

97003 Occupational therapy evaluation

97035 Application of ultrasound to 1 or more areas, each 15 minutes

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97110 Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes

97112 Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes

97140 Manual (physical) therapy techniques to 1 or more regions, each 15 minutes

97530 Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes

97597 Removal of tissue from wounds per session

97802 Medical nutrition therapy, assessment and intervention, each 15 minutes

97803 Medical nutrition therapy re-assessment and intervention, each 15 minutes

98926 Osteopathic manipulative treatment to 3-4 body regions




98940 Chiropractic manipulative treatment, 1 to2 spinal regions

98941 Chiropractic manipulative treatment, 3 to 4 spinal regions

98942 Chiropractic manipulative treatment, 5 spinal regions

99144 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 30 minutes

99183 Management and supervision of oxygen chamber therapy per session

G0008 Administration of influenza virus vaccine

G0009 Administration of pneumococcal vaccine

G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination

G0108 Diabetes outpatient self-management training services, individual, per 30 minutes

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G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

G0179

Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per re-certification period

G0180


G0270

Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes

G0283 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care

G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous

G0431 Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

G0434 Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

G0439 Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit

J1030 Injection, methylprednisolone acetate, 40 mg

J1100 Injection, dexamethasone sodium phosphate, 1 mg

J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg

Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

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