proc code proc description...date of service as audiologic function testing ... recording,...

Proc Code Proc Description

29240 Strapping; shoulder (eg, Velpeau)

29530 Strapping; knee

29540 Strapping; ankle and/or foot

87481 Infectious agent detection by nucleic acid (DNA or RNA); Candida species,

amplified probe technique

83516 Immunoassay for analyte other than infectious agent antibody or

infectious agent antigen; qualitative or semiquantitative, multiple step

method 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed

97597 Debridement (eg, high pressure waterjet with/without suction, sharp

selective debridement with scissors, scalpel and forceps), open wound,

(eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm),

including topical application(s), wound assessment, use of a whirlpool,

when performed and instruction(s) for ongoing care, per session, total

wound(s) surface area; first 20 sq cm or less

G0268 Removal of impacted cerumen (one or both ears) by physician on same

date of service as audiologic function testing

87592 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria

gonorrhoeae, quantification

84270 Sex hormone binding globulin (SHBG)

87507 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal

pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus,

Giardia), includes multiplex reverse transcription, when performed, and

multiplex amplified probe technique, multiple types or subtypes, 12-25

targets

88172 Cytopathology, evaluation of fine needle aspirate; immediate

cytohistologic study to determine adequacy for diagnosis, first evaluation

episode, each site 92582 Conditioning play audiometry

84445 Thyroid stimulating immune globulins (TSI)

A9581 Injection, gadoxetate disodium, 1 ml

87512 Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella

vaginalis, quantification

87517 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus,

quantification

87633 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus

(eg, adenovirus, influenza virus, coronavirus, metapneumovirus,

parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex

reverse transcription and amplified probe technique, multiple types or

subtypes, 12-25 targets

87799 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise

specified; quantification, each organism

83014 Helicobacter pylori; drug administration

88377 Morphometric analysis, in situ hybridization (quantitative or semi-

quantitative), manual, per specimen; each multiplex probe stain procedure

36473 Endovenous ablation therapy of incompetent vein, extremity, inclusive of

all imaging guidance and monitoring, percutaneous, mechanochemical;

first vein treated 87912 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis

B virus

81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine

needle aspirate, algorithm reported as a categorical result (eg, benign or

suspicious) 83883 Nephelometry, each analyte not elsewhere specified

84432 Thyroglobulin

87147 Culture, typing; immunologic method, other than immunofluoresence (eg,

agglutination grouping), per antiserum

82962 Glucose, blood by glucose monitoring device(s) cleared by the FDA

specifically for home use

51701 Insertion of non-indwelling bladder catheter (eg, straight catheterization

for residual urine)

95957 Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike

analysis)

81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome);

sequence analysis, each comparator exome (eg, parents, siblings) (List

separately in addition to code for primary procedure)

95027 Intracutaneous (intradermal) tests, sequential and incremental, with

allergenic extracts for airborne allergens, immediate type reaction,

including test interpretation and report, specify number of tests

92520 Laryngeal function studies (ie, aerodynamic testing and acoustic testing)

99140 Anesthesia complicated by emergency conditions (specify) (List separately

in addition to code for primary anesthesia procedure)

54235 Injection of corpora cavernosa with pharmacologic agent(s) (eg,

papaverine, phentolamine)

87150 Culture, typing; identification by nucleic acid (DNA or RNA) probe,

amplified probe technique, per culture or isolate, each organism probed

94667 Manipulation chest wall, such as cupping, percussing, and vibration to

facilitate lung function; initial demonstration and/or evaluation

92512 Nasal function studies (eg, rhinomanometry)

87511 Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella

vaginalis, amplified probe technique

83992 Phencyclidine (PCP)

G0453 Continuous intraoperative neurophysiology monitoring, from outside the

operating room (remote or nearby), per patient, (attention directed

exclusively to one patient) each 15 minutes (list in addition to primary

procedure) 29130 Application of finger splint; static


cytohistologic study to determine adequacy for diagnosis, each separate

additional evaluation episode, same site (List separately in addition to

code for primary procedure)

82397 Chemiluminescent assay

87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium

difficile, toxin gene(s), amplified probe technique

80372 Tapentadol


infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)

85660 Sickling of RBC, reduction

95941 Continuous intraoperative neurophysiology monitoring, from outside the

operating room (remote or nearby) or for monitoring of more than one

case while in the operating room, per hour (List separately in addition to


77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more

sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture

assessment 29260 Strapping; elbow or wrist

84252 Riboflavin (Vitamin B-2)

83861 Microfluidic analysis utilizing an integrated collection and analysis device,

tear osmolarity

86774 Antibody; tetanus

12021 Treatment of superficial wound dehiscence; with packing

83861 Microfluidic analysis utilizing an integrated collection and analysis device,

tear osmolarity

80368 Sedative hypnotics (non-benzodiazepines)

88264 Chromosome analysis; analyze 20-25 cells

80371 Stimulants, synthetic

29520 Strapping; hip


quantitative), using computer-assisted technology, per specimen; each

multiplex probe stain procedure 93229 External mobile cardiovascular telemetry with electrocardiographic

recording, concurrent computerized real time data analysis and greater

than 24 hours of accessible ECG data storage (retrievable with query) with

ECG triggered and patient selected events transmitted to a remote

attended surveillance center for up to 30 days; technical support for

connection and patient instructions for use, attended surveillance, analysis

and transmission of daily and emergent data reports as prescribed by a

phy

95992 Canalith repositioning procedure(s) (eg, Epley maneuver, Semont

maneuver), per day

95957 Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike

analysis)

80373 Tramadol

88365 In situ hybridization (eg, FISH), each probe

29550 Strapping; toes

29131 Application of finger splint; dynamic

93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or

multiple lead pacemaker system or implantable cardioverter-defibrillator

system, remote data acquisition(s), receipt of transmissions and technician

review, technical support and distribution of results

86812 HLA typing; A, B, or C (eg, A10, B7, B27), single antigen

80360 Methylphenidate

29280 Strapping; hand or finger



29200 Strapping; thorax

81422 Fetal chromosomal microdeletion(s) genomic sequence analysis (eg,

DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA

in maternal blood 99100 Anesthesia for patient of extreme age, younger than 1 year and older than

70 (List separately in addition to code for primary anesthesia procedure)

L5848 Addition to endoskeletal knee-shin system, fluid stance extension,

dampening feature, with or without adjustability

86648 Antibody; Diphtheria

99498 Advance care planning including the explanation and discussion of advance

directives such as standard forms (with completion of such forms, when

performed), by the physician or other qualified health care professional;

each additional 30 minutes (List separately in addition to code for primary

procedure)

R0075 Transportation of portable x-ray equipment and personnel to home or

nursing home, per trip to facility or location, more than one patient seen

84235 Receptor assay; endocrine, other than estrogen or progesterone (specify

hormone)

84255 Selenium

80357 Ketamine and norketamine

81382 HLA Class II typing, high resolution (ie, alleles or allele groups); 1 locus (eg,

HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each

E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating

system

81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome);

sequence analysis

88348 Electron microscopy; diagnostic

80338 Antidepressants, not otherwise specified

88738 Hemoglobin (Hgb), quantitative, transcutaneous

88364 In situ hybridization (eg, FISH), per specimen; each additional single probe

stain procedure (List separately in addition to code for primary procedure)

92547 Use of vertical electrodes (List separately in addition to code for primary

procedure)

Q2035 Influenza virus vaccine, split virus, when administered to individuals 3

years of age and older, for intramuscular use (AFLURIA)

80370 Skeletal muscle relaxants; 3 or more

80321 Alcohol biomarkers; 1 or 2

V5254 Hearing aid, digital, monaural, CIC

87802 Infectious agent antigen detection by immunoassay with direct optical

observation; Streptococcus, group B

87400 Infectious agent antigen detection by enzyme immunoassay technique,

qualitative or semiquantitative, multiple-step method; Influenza, A or B,

each

95079 Ingestion challenge test (sequential and incremental ingestion of test

items, eg, food, drug or other substance); each additional 60 minutes of

testing (List separately in addition to code for primary procedure)

81376 HLA Class II typing, low resolution (eg, antigen equivalents); 1 locus (eg,

HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each

86021 Antibody identification; leukocyte antibodies

87496 Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus,


84244 Renin

78268 Urea breath test, C-14 (isotopic); analysis

80366 Pregabalin

94762 Noninvasive ear or pulse oximetry for oxygen saturation; by continuous

overnight monitoring (separate procedure)

51702 Insertion of temporary indwelling bladder catheter; simple (eg, Foley)

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

E0731 Form-fitting conductive garment for delivery of TENS or NMES (with

conductive fibers separated from the patient's skin by layers of fabric)

82272 Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3

simultaneous determinations, performed for other than colorectal

neoplasm screening 80355 Gabapentin, non-blood

80331 Analgesics, non-opioid; 6 or more

83986 pH; body fluid, not otherwise specified


quantitative) each probe; manual

81225 CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg,

drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17)

80342 Antipsychotics, not otherwise specified; 1-3

80334 Antidepressants, serotonergic class; 6 or more

A7526 Tracheostomy tube collar/holder, each

86353 Lymphocyte transformation, mitogen (phytomitogen) or antigen induced

blastogenesis

81539 Oncology (high-grade prostate cancer), biochemical assay of four proteins

(Total PSA, Free PSA, Intact PSA, and human kallikrein-2 [hK2]), utilizing

plasma or serum, prognostic algorithm reported as a probability score

87084 Culture, presumptive, pathogenic organisms, screening only; with colony

estimation from density chart

G0500 Moderate sedation services provided by the same physician or other

qualified health care professional performing a gastrointestinal endoscopic

service that sedation supports, requiring the presence of an independent

trained observer to assist in the monitoring of the patient's level of

consciousness and physiological status; initial 15 minutes of intra-service

time; patient age 5 years or older (additional time may be reported with

99153, as appropriate)

E0983 Manual wheelchair accessory, power add-on to convert manual

wheelchair to motorized wheelchair, joystick control

80369 Skeletal muscle relaxants; 1 or 2

87220 Tissue examination by KOH slide of samples from skin, hair, or nails for

fungi or ectoparasite ova or mites (eg, scabies)

L6704 Terminal device, sport/recreational/work attachment, any material, any

size

88311 Decalcification procedure (List separately in addition to code for surgical

pathology examination)


quantitative) each probe; manual

86886 Antihuman globulin test (Coombs test); indirect, each antibody titer

81374 HLA Class I typing, low resolution (eg, antigen equivalents); 1 antigen

equivalent (eg, B*27), each

81261 IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas,

B-cell), gene rearrangement analysis to detect abnormal clonal

population(s); amplified methodology (eg, polymerase chain reaction)

A9576 Injection, gadoteridol, (ProHance multipack), per ml




cytohistologic study to determine adequacy for diagnosis, each separate

additional evaluation episode, same site (List separately in addition to


V5265 Ear mold/insert, disposable, any type

G0168 Wound closure utilizing tissue adhesive(s) only

80344 Antipsychotics, not otherwise specified; 7 or more

83789 Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte

not elsewhere specified; quantitative, each specimen

81372 HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie,

HLA-A, -B, and -C)

82671 Estrogens; fractionated

27412 Autologous chondrocyte implantation, knee

0387T Transcatheter insertion or replacement of permanent leadless pacemaker,

ventricular

A7048 Vacuum drainage collection unit and tubing kit, including all supplies

needed for collection unit change, for use with implanted catheter, each

80341 Antiepileptics, not otherwise specified; 7 or more



multiplex probe stain procedure 80333 Antidepressants, serotonergic class; 3-5



87071 Culture, bacterial; quantitative, aerobic with isolation and presumptive

identification of isolates, any source except urine, blood or stool

V5259 Hearing aid, digital, binaural, ITC



81230 CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug

metabolism), gene analysis, common variant(s) (eg, *2, *22)

82085 Aldolase

88366 In situ hybridization (eg, FISH), per specimen; each multiplex probe stain

procedure

70554 Magnetic resonance imaging, brain, functional MRI; including test

selection and administration of repetitive body part movement and/or

visual stimulation, not requiring physician or psychologist administration

E0720 Transcutaneous electrical nerve stimulation (TENS) device, 2 lead,

localized stimulation

81383 HLA Class II typing, high resolution (ie, alleles or allele groups); 1 allele or

allele group (eg, HLA-DQB1*06:02P), each

81455 Targeted genomic sequence analysis panel, solid organ or

hematolymphoid neoplasm, DNA analysis, and RNA analysis when

performed, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A,

EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS,

MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation

for sequence variants and copy number variants or rearrangements, if

performed

85598 Phospholipid neutralization; hexagonal phospholipid

81264 IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia and

lymphoma, B-cell), gene rearrangement analysis, evaluation to detect

abnormal clonal population(s)

97602 Removal of devitalized tissue from wound(s), non-selective debridement,

without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion),

including topical application(s), wound assessment, and instruction(s) for

ongoing care, per session

G0424 Pulmonary rehabilitation, including exercise (includes monitoring), one

hour, per session, up to 2 sessions per day

77370 Special medical radiation physics consultation

64550 Application of surface (transcutaneous) neurostimulator

95874 Needle electromyography for guidance in conjunction with

chemodenervation (List separately in addition to code for primary

procedure) 81525 Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of

12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-

embedded tissue, algorithm reported as a recurrence score

83874 Myoglobin

94780 Car seat/bed testing for airway integrity, neonate, with continual nursing

observation and continuous recording of pulse oximetry, heart rate and

respiratory rate, with interpretation and report; 60 minutes

83018 Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury);

quantitative, each

L2200 Addition to lower extremity, limited ankle motion, each joint

81375 HLA Class II typing, low resolution (eg, antigen equivalents); HLA-

DRB1/3/4/5 and -DQB1

94668 Manipulation chest wall, such as cupping, percussing, and vibration to

facilitate lung function; subsequent

81381 HLA Class I typing, high resolution (ie, alleles or allele groups); 1 allele or

allele group (eg, B*57:01P), each


quantitative) each probe; using computer-assisted technology

99492 Initial psychiatric collaborative care management, first 70 minutes in the

first calendar month of behavioral health care manager activities, in

consultation with a psychiatric consultant, and directed by the treating

physician or other qualified health care professional, with the following

required elements: outreach to and engagement in treatment of a patient

directed by the treating physician or other qualified health care

professional; initial assessment of the patient, including administrat

92584 Electrocochleography

88348 Electron microscopy; diagnostic

51705 Change of cystostomy tube; simple

58672 Laparoscopy, surgical; with fimbrioplasty

76390 Magnetic resonance spectroscopy

78267 Urea breath test, C-14 (isotopic); acquisition for analysis

81377 HLA Class II typing, low resolution (eg, antigen equivalents); 1 antigen

equivalent, each

81380 HLA Class I typing, high resolution (ie, alleles or allele groups); 1 locus (eg,

HLA-A, -B, or -C), each

82380 Carotene

82657 Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere

specified; nonradioactive substrate, each specimen

83037 Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use


infectious agent antigen; quantitative, not otherwise specified

84182 Protein; Western Blot, with interpretation and report, blood or other body

fluid, immunological probe for band identification, each

84238 Receptor assay; non-endocrine (specify receptor)

84260 Serotonin

84392 Sulfate, urine

85390 Fibrinolysins or coagulopathy screen, interpretation and report

85597 Phospholipid neutralization; platelet

86005 Allergen specific IgE; qualitative, multiallergen screen (dipstick, paddle, or

disk)

86356 Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise

specified, each antigen

87497 Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus,

quantification

88182 Flow cytometry, cell cycle or DNA analysis

88363 Examination and selection of retrieved archival (ie, previously diagnosed)

tissue(s) for molecular analysis (eg, KRAS mutational analysis)

88381 Microdissection (ie, sample preparation of microscopically identified

target); manual

88720 Bilirubin, total, transcutaneous

90887 Interpretation or explanation of results of psychiatric, other medical

examinations and procedures, or other accumulated data to family or

other responsible persons, or advising them how to assist patient

92558 Evoked otoacoustic emissions, screening (qualitative measurement of

distortion product or transient evoked otoacoustic emissions), automated

analysis 93352 Use of echocardiographic contrast agent during stress echocardiography

(List separately in addition to code for primary procedure)

94761 Noninvasive ear or pulse oximetry for oxygen saturation; multiple

determinations (eg, during exercise)

95070 Inhalation bronchial challenge testing (not including necessary pulmonary

function tests); with histamine, methacholine, or similar compounds

96912 Photochemotherapy; psoralens and ultraviolet A (PUVA)

97598 Debridement (eg, high pressure waterjet with/without suction, sharp

selective debridement with scissors, scalpel and forceps), open wound,

(eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm),

including topical application(s), wound assessment, use of a whirlpool,

when performed and instruction(s) for ongoing care, per session, total

wound(s) surface area; each additional 20 sq cm, or part thereof (List


0159T Computer-aided detection, including computer algorithm analysis of MRI

image data for lesion detection/characterization, pharmacokinetic

analysis, with further physician review for interpretation, breast MRI (List


0399T Myocardial strain imaging (quantitative assessment of myocardial

mechanics using image-based analysis of local myocardial dynamics) (List


81231 CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug

metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7)

81411 Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz

syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome);

duplication/deletion analysis panel, must include analyses for TGFBR1,

TGFBR2, MYH11, and COL3A1

81412 Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan

disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C,

Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel,

must include sequencing of at least 9 genes, including ASPA, BLM, CFTR,

FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1

81460 Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial

encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS],

myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia,

and retinitis pigmentosa [NARP], Leber hereditary optic neuropathy

[LHON]), genomic sequence, must include sequence analysis of entire

mitochondrial genome with heteroplasmy detection

81490 Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using

immunoassays, utilizing serum, prognostic algorithm reported as a disease

activity score 88369 Morphometric analysis, in situ hybridization (quantitative or semi-

quantitative), manual, per specimen; each additional single probe stain

procedure (List separately in addition to code for primary procedure)


quantitative), manual, per specimen; each additional single probe stain

procedure (List separately in addition to code for primary procedure)

99493 Subsequent psychiatric collaborative care management, first 60 minutes in

a subsequent month of behavioral health care manager activities, in

consultation with a psychiatric consultant, and directed by the treating

physician or other qualified health care professional, with the following

required elements: tracking patient follow-up and progress using the

registry, with appropriate documentation; participation in weekly caseload

consultation with the psychiatric consultant; ongoing collaboration

A4617 Mouthpiece

A7507 Filter holder and integrated filter without adhesive, for use in a

tracheostoma heat and moisture exchange system, each

A7508 Housing and integrated adhesive, for use in a tracheostoma heat and

moisture exchange system and/or with a tracheostoma valve, each

A9577 Injection, gadobenate dimeglumine (MultiHance), per ml

E1800 Dynamic adjustable elbow extension/flexion device, includes soft interface

material

E1805 Dynamic adjustable wrist extension/flexion device, includes soft interface

material

G0296 Counseling visit to discuss need for lung cancer screening using low dose

CT scan (LDCT) (service is for eligibility determination and shared decision

making) J2805 Injection, sincalide, 5 mcg

J7626 Budesonide, inhalation solution, FDA-approved final product,

noncompounded, administered through DME, unit dose form, up to 0.5

mg K0195 Elevating legrests, pair (for use with capped rental wheelchair base)

K0195 Elevating legrests, pair (for use with capped rental wheelchair base)


years of age and older, for intramuscular use (FLULAVAL)

S0020 Injection, bupivicaine HCl, 30 ml

S0073 Injection, aztreonam, 500 mg

V5275 Ear impression, each

59866 Multifetal pregnancy reduction(s) (MPR)

75573 Computed tomography, heart, with contrast material, for evaluation of

cardiac structure and morphology in the setting of congenital heart

disease (including 3D image postprocessing, assessment of LV cardiac

function, RV structure and function and evaluation of venous structures, if

performed)

81050 Volume measurement for timed collection, each

82540 Creatine

82610 Cystatin C

83719 Lipoprotein, direct measurement; VLDL cholesterol

83986 pH; body fluid, not otherwise specified

84181 Protein; Western Blot, with interpretation and report, blood or other body

fluid

86079 Blood bank physician services; authorization for deviation from standard

blood banking procedures (eg, use of outdated blood, transfusion of Rh

incompatible units), with written report

86816 HLA typing; DR/DQ, single antigen

86832 Antibody to human leukocyte antigens (HLA), solid phase assays (eg,

microspheres or beads, ELISA, Flow cytometry); high definition qualitative

panel for identification of antibody specificities (eg, individual antigen per

bead methodology), HLA Class I

87140 Culture, typing; immunofluorescent method, each antiserum

87149 Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct

probe technique, per culture or isolate, each organism probed

87530 Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex

virus, quantification

87538 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified

probe technique, includes reverse transcription when performed

92620 Evaluation of central auditory function, with report; initial 60 minutes

92625 Assessment of tinnitus (includes pitch, loudness matching, and masking)

93042 Rhythm ECG, 1-3 leads; interpretation and report only

96001 Comprehensive computer-based motion analysis by video-taping and 3D

kinematics; with dynamic plantar pressure measurements during walking

81327 SEPT9 (Septin9) (eg, colorectal cancer) methylation analysis

81432 Hereditary breast cancer-related disorders (eg, hereditary breast cancer,

hereditary ovarian cancer, hereditary endometrial cancer); genomic

sequence analysis panel, must include sequencing of at least 10 genes,

always including BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN,

STK11, and TP53

87505 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal

pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus,

Giardia), includes multiplex reverse transcription, when performed, and

multiplex amplified probe technique, multiple types or subtypes, 3-5

targets



additional single probe stain procedure (List separately in addition to code

for primary procedure)

99484 Care management services for behavioral health conditions, at least 20

minutes of clinical staff time, directed by a physician or other qualified

health care professional, per calendar month, with the following required

elements: initial assessment or follow-up monitoring, including the use of

applicable validated rating scales; behavioral health care planning in

relation to behavioral/psychiatric health problems, including revision for

patients who are not progressing or whose status changes; f

A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile,

each

A9556 Gallium Ga-67 citrate, diagnostic, per millicurie

E1038 Transport chair, adult size, patient weight capacity up to and including 300

pounds

E1802 Dynamic adjustable forearm pronation/supination device, includes soft

interface material

E1810 Dynamic adjustable knee extension/flexion device, includes soft interface

material

G0102 Prostate cancer screening; digital rectal examination

G0181 Physician supervision of a patient receiving Medicare-covered services

provided by a participating home health agency (patient not present)

requiring complex and multidisciplinary care modalities involving regular

physician development and/or revision of care plans, review of

subsequent reports of patient status, review of laboratory and other

studies, communication (including telephone calls) with other health care

professionals involved in the patient's care, integration of new information

int

J2704 Injection, propofol, 10 mg

L1851 Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion

and extension joint (unicentric or polycentric), medial-lateral and rotation

control, with or without varus/valgus adjustment, prefabricated, off-the-

shelf

L7400 Addition to upper extremity prosthesis, below elbow/wrist disarticulation,

ultralight material (titanium, carbon fiber or equal)

L7403 Addition to upper extremity prosthesis, below elbow/wrist disarticulation,

acrylic material


years of age and older, for intramuscular use (Fluzone)

81270 JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis,

p.Val617Phe (V617F) variant

81373 HLA Class I typing, low resolution (eg, antigen equivalents); 1 locus (eg,

HLA-A, -B, or -C), each

83937 Osteocalcin (bone g1a protein)

84206 Proinsulin

84311 Spectrophotometry, analyte not elsewhere specified

84586 Vasoactive intestinal peptide (VIP)

86226 Deoxyribonucleic acid (DNA) antibody; single stranded

86332 Immune complex assay

87168 Macroscopic examination; arthropod

88314 Special stain including interpretation and report; histochemical stain on

frozen tissue block (List separately in addition to code for primary

procedure) 94781 Car seat/bed testing for airway integrity, neonate, with continual nursing

observation and continuous recording of pulse oximetry, heart rate and

respiratory rate, with interpretation and report; each additional full 30

minutes (List separately in addition to code for primary procedure)

95873 Electrical stimulation for guidance in conjunction with chemodenervation


96102 Psychological testing (includes psychodiagnostic assessment of

emotionality, intellectual abilities, personality and psychopathology, eg,

MMPI and WAIS), with qualified health care professional interpretation

and report, administered by technician, per hour of technician time, face-

to-face

96150 Health and behavior assessment (eg, health-focused clinical interview,

behavioral observations, psychophysiological monitoring, health-oriented

questionnaires), each 15 minutes face-to-face with the patient; initial

assessment

96154 Health and behavior intervention, each 15 minutes, face-to-face; family

(with the patient present)

97606 Negative pressure wound therapy (eg, vacuum assisted drainage

collection), including topical application(s), wound assessment, and

instruction(s) for ongoing care, per session; total wound(s) surface area

greater than 50 square centimeters

99358 Prolonged evaluation and management service before and/or after direct

patient care; first hour

81232 DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and

capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A,

*4, *5, *6) 81272 KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg,

gastrointestinal stromal tumor [GIST], acute myeloid leukemia,

melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13,

17, 18) 88373 Morphometric analysis, in situ hybridization (quantitative or semi-


additional single probe stain procedure (List separately in addition to code

for primary procedure)

A4224 Supplies for maintenance of insulin infusion catheter, per week

A4562 Pessary, nonrubber, any type

E1830 Dynamic adjustable toe extension/flexion device, includes soft interface

material

G0120 Colorectal cancer screening; alternative to G0105, screening colonoscopy,

barium enema

G0121 Colorectal cancer screening; colonoscopy on individual not meeting

criteria for high risk

J1245 Injection, dipyridamole, per 10 mg

J3010 Injection, fentanyl citrate, 0.1 mg

L3761 Elbow orthosis (EO), with adjustable position locking joint(s),

prefabricated, off-the-shelf

31502 Tracheotomy tube change prior to establishment of fistula tract

54231 Dynamic cavernosometry, including intracavernosal injection of vasoactive

drugs (eg, papaverine, phentolamine)

76390 Magnetic resonance spectroscopy

80417 Peripheral vein renin stimulation panel (eg, captopril) This panel must

include the following: Renin (84244 x 2)

80424 Glucagon tolerance panel; for pheochromocytoma This panel must include

the following: Catecholamines, fractionated (82384 x 2)

81161 DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion

analysis, and duplication analysis, if performed

81256 HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis,

common variants (eg, C282Y, H63D)

81291 MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary

hypercoagulability) gene analysis, common variants (eg, 677T, 1298C)

82010 Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate);

quantitative

82010 Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate);

quantitative

82135 Aminolevulinic acid, delta (ALA)

82271 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources

82271 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources

82376 Carboxyhemoglobin; qualitative

82441 Chlorinated hydrocarbons, screen

82482 Cholinesterase; RBC

82528 Corticosterone

82585 Cryofibrinogen

82600 Cyanide

82633 Desoxycorticosterone, 11-

82638 Dibucaine number

82735 Fluoride

82930 Gastric acid analysis, includes pH if performed, each specimen

82946 Glucagon tolerance test

82978 Glutathione

83026 Hemoglobin; by copper sulfate method, non-automated

83070 Hemosiderin; qualitative

83491 Hydroxycorticosteroids, 17- (17-OHCS)

83721 Lipoprotein, direct measurement; LDL cholesterol

83872 Mucin, synovial fluid (Ropes test)

83873 Myelin basic protein, cerebrospinal fluid

83885 Nickel

83915 Nucleotidase 5'-

83916 Oligoclonal immune (oligoclonal bands)

84210 Pyruvate

84307 Somatostatin

84315 Specific gravity (except urine)

84431 Thromboxane metabolite(s), including thromboxane if performed, urine

85008 Blood count; blood smear, microscopic examination without manual

differential WBC count

85130 Chromogenic substrate assay

85410 Fibrinolytic factors and inhibitors; alpha-2 antiplasmin

85415 Fibrinolytic factors and inhibitors; plasminogen activator

85420 Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay

85421 Fibrinolytic factors and inhibitors; plasminogen, antigenic assay

85611 Prothrombin time; substitution, plasma fractions, each

86001 Allergen specific IgG quantitative or semiquantitative, each allergen

86022 Antibody identification; platelet antibodies

86156 Cold agglutinin; screen

86277 Growth hormone, human (HGH), antibody

86406 Particle agglutination; titer, each antibody

86590 Streptokinase, antibody

86628 Antibody; Candida

86711 Antibody; JC (John Cunningham) virus

86805 Lymphocytotoxicity assay, visual crossmatch; with titration

86906 Blood typing; Rh phenotyping, complete

87073 Culture, bacterial; quantitative, anaerobic with isolation and presumptive

identification of isolates, any source except urine, blood or stool

87176 Homogenization, tissue, for culture

87300 Infectious agent antigen detection by immunofluorescent technique,

polyvalent for multiple organisms, each polyvalent antiserum

87391 Infectious agent antigen detection by enzyme immunoassay technique,

qualitative or semiquantitative, multiple-step method; HIV-2

87471 Infectious agent detection by nucleic acid (DNA or RNA); Bartonella

henselae and Bartonella quintana, amplified probe technique

87482 Infectious agent detection by nucleic acid (DNA or RNA); Candida species,

quantification

87492 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia

trachomatis, quantification

87532 Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6,


87533 Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6,

quantification

87541 Infectious agent detection by nucleic acid (DNA or RNA); Legionella

pneumophila, amplified probe technique

87632 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus

(eg, adenovirus, influenza virus, coronavirus, metapneumovirus,

parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex

reverse transcription and amplified probe technique, multiple types or

subtypes, 6-11 targets

87652 Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus,

group A, quantification

87810 Infectious agent antigen detection by immunoassay with direct optical

observation; Chlamydia trachomatis

87905 Infectious agent enzymatic activity other than virus (eg, sialidase activity in

vaginal fluid)

88314 Special stain including interpretation and report; histochemical stain on

frozen tissue block (List separately in addition to code for primary

procedure) 88381 Microdissection (ie, sample preparation of microscopically identified

target); manual

88381 Microdissection (ie, sample preparation of microscopically identified

target); manual

89160 Meat fibers, feces

89220 Sputum, obtaining specimen, aerosol induced technique (separate

procedure)

90634 Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for

intramuscular use

92508 Treatment of speech, language, voice, communication, and/or auditory

processing disorder; group, 2 or more individuals

92516 Facial nerve function studies (eg, electroneuronography)

92534 Optokinetic nystagmus test

92575 Sensorineural acuity level test

92577 Stenger test, speech

92593 Hearing aid check; binaural

92621 Evaluation of central auditory function, with report; each additional 15

minutes (List separately in addition to code for primary procedure)

92627 Evaluation of auditory rehabilitation status; each additional 15 minutes


93041 Rhythm ECG, 1-3 leads; tracing only without interpretation and report

93228 External mobile cardiovascular telemetry with electrocardiographic

recording, concurrent computerized real time data analysis and greater

than 24 hours of accessible ECG data storage (retrievable with query) with

ECG triggered and patient selected events transmitted to a remote

attended surveillance center for up to 30 days; review and interpretation

with report by a physician or other qualified health care professional

94452 High altitude simulation test (HAST), with interpretation and report by a

physician or other qualified health care professional;

94453 High altitude simulation test (HAST), with interpretation and report by a

physician or other qualified health care professional; with supplemental

oxygen titration 95873 Electrical stimulation for guidance in conjunction with chemodenervation


95874 Needle electromyography for guidance in conjunction with

chemodenervation (List separately in addition to code for primary

procedure) 96913 Photochemotherapy (Goeckerman and/or PUVA) for severe

photoresponsive dermatoses requiring at least 4-8 hours of care under

direct supervision of the physician (includes application of medication and

dressings) 99056 Service(s) typically provided in the office, provided out of the office at

request of patient, in addition to basic service

99318 Evaluation and management of a patient involving an annual nursing

facility assessment, which requires these 3 key components: A detailed

interval history; A comprehensive examination; and Medical decision

making that is of low to moderate complexity. Counseling and/or

coordination of care with other physicians, other qualified health care

professionals, or agencies are provided consistent with the nature of the

problem(s) and the patient's and/or family's needs. Usually, the patient is

stable,

99366 Medical team conference with interdisciplinary team of health care

professionals, face-to-face with patient and/or family, 30 minutes or

more, participation by nonphysician qualified health care professional

99374 Supervision of a patient under care of home health agency (patient not

present) in home, domiciliary or equivalent environment (eg, Alzheimer's

facility) requiring complex and multidisciplinary care modalities involving

regular development and/or revision of care plans by that individual,

review of subsequent reports of patient status, review of related

laboratory and other studies, communication (including telephone calls)

for purposes of assessment or care decisions with health care profession

99485 Supervision by a control physician of interfacility transport care of the

critically ill or critically injured pediatric patient, 24 months of age or

younger, includes two-way communication with transport team before

transport, at the referring facility and during the transport, including data

interpretation and report; first 30 minutes

99489 Complex chronic care coordination services; each additional 30 minutes of

clinical staff time directed by a physician or other qualified health care

professional, per calendar month (List separately in addition to code for

primary procedure)

0346T Ultrasound, elastography (List separately in addition to code for primary

procedure)

77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more

sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture

assessment 80374 Stereoisomer (enantiomer) analysis, single drug class

80375 Drug(s) or substance(s), definitive, qualitative or quantitative, not

otherwise specified; 1-3

81247 G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia,

jaundice), gene analysis; common variant(s) (eg, A, A-)

81273 KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg,

mastocytosis), gene analysis, D816 variant(s)

81283 IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis,

rs12979860 variant

81410 Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz

syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome);

genomic sequence analysis panel, must include sequencing of at least 9

genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2,

SLC2A10, SMAD3, and MYLK

97607 Negative pressure wound therapy, (eg, vacuum assisted drainage

collection), utilizing disposable, non-durable medical equipment including

provision of exudate management collection system, topical

application(s), wound assessment, and instructions for ongoing care, per

session; total wound(s) surface area less than or equal to 50 square

centimeters

99415 Prolonged clinical staff service (the service beyond the typical service time)

during an evaluation and management service in the office or outpatient

setting, direct patient contact with physician supervision; first hour (List

separately in addition to code for outpatient Evaluation and Management

service)

99494 Initial or subsequent psychiatric collaborative care management, each

additional 30 minutes in a calendar month of behavioral health care

manager activities, in consultation with a psychiatric consultant, and

directed by the treating physician or other qualified health care

professional (List separately in addition to code for primary procedure)

A4247 Betadine or iodine swabs/wipes, per box

A4332 Lubricant, individual sterile packet, each

A4461 Surgical dressing holder, nonreusable, each

A4483 Moisture exchanger, disposable, for use with invasive mechanical

ventilation

A4558 Conductive gel or paste, for use with electrical device (e.g., TENS, NMES),

per oz

A4559 Coupling gel or paste, for use with ultrasound device, per oz

A4561 Pessary, rubber, any type

A4595 Electrical stimulator supplies, 2 lead, per month, (e.g., TENS, NMES)

A6545 Gradient compression wrap, nonelastic, below knee, 30-50 mm Hg, each

A7509 Filter holder and integrated filter housing, and adhesive, for use as a

tracheostoma heat and moisture exchange system, each

A7527 Tracheostomy/laryngectomy tube plug/stop, each

A9578 Injection, gadobenate dimeglumine (MultiHance multipack), per ml

A9700 Supply of injectable contrast material for use in echocardiography, per

study

E0705 Transfer device, any type, each

E1038 Transport chair, adult size, patient weight capacity up to and including 300

pounds

E2208 Wheelchair accessory, cylinder tank carrier, each

G0105 Colorectal cancer screening; colonoscopy on individual at high risk

G0124 Screening cytopathology, cervical or vaginal (any reporting system),

collected in preservative fluid, automated thin layer preparation, requiring

interpretation by physician G0141 Screening cytopathology smears, cervical or vaginal, performed by

automated system, with manual rescreening, requiring interpretation by

physician G0246 Follow-up physician evaluation and management of a diabetic patient with

diabetic sensory neuropathy resulting in a loss of protective sensation

(LOPS) to include at least the following: (1) a patient history, (2) a physical

examination that includes: (a) visual inspection of the forefoot, hindfoot,

and toe web spaces, (b) evaluation of protective sensation, (c) evaluation

of foot structure and biomechanics, (d) evaluation of vascular status and

skin integrity, and (e) evaluation and recommendat

G0278 Iliac and/or femoral artery angiography, nonselective, bilateral or

ipsilateral to catheter insertion, performed at the same time as cardiac

catheterization and/or coronary angiography, includes positioning or

placement of the catheter in the distal aorta or ipsilateral femoral or iliac

artery, injection of dye, production of permanent images, and radiologic

supervision and interpretation (List separately in addition to primary

procedure)

J0670 Injection, mepivacaine HCl, per 10 ml

J0735 Injection, clonidine HCl, 1 mg

J1250 Injection, Dobutamine HCl, per 250 mg

J1650 Injection, enoxaparin sodium, 10 mg

J2250 Injection, midazolam HCl, per 1 mg

J2791 Injection, Rho(D) immune globulin (human), (Rhophylac), intramuscular or

intravenous, 100 IU

J2795 Injection, ropivacaine HCl, 1 mg

J7500 Azathioprine, oral, 50 mg

J7510 Prednisolone, oral, per 5 mg

J7512 Prednisone, immediate release or delayed release, oral, 1 mg

J7605 Arformoterol, inhalation solution, FDA approved final product,

noncompounded, administered through DME, unit dose form, 15 mcg

L4392 Replacement, soft interface material, static AFO

L7600 Prosthetic donning sleeve, any material, each

Q0144 Azithromycin dihydrate, oral, capsules/powder, 1 g

Q0163 Diphenhydramine HCl, 50 mg, oral, FDA approved prescription antiemetic,

for use as a complete therapeutic substitute for an IV antiemetic at time of

chemotherapy treatment not to exceed a 48-hour dosage regimen

Q9958 High osmolar contrast material, up to 149 mg/ml iodine concentration, per

ml

Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per

ml

Q9993 Injection, triamcinolone acetonide, preservative-free, extended-release,

microsphere formulation, 1 mg

S0028 Injection, famotidine, 20 mg

S0030 Injection, metronidazole, 500 mg

S0077 Injection, clindamycin phosphate, 300 mg

S0119 Ondansetron, oral, 4 mg (for circumstances falling under the Medicare

statute, use HCPCS Q code)

Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of

the Blue Cross and Blue Shield Association.

NYEPEC-2147-19 January 2020

www.empireblue.com/nymedicaiddoc

proc code proc description...date of service as audiologic function testing ... recording,...

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