relative values for physicians

Relative Values

for

Physicians

Relative Value Studies, Inc.

2004

CPT only ©2003 American Medical Association. All Rights Reserved. ©2003 Ingenix, Inc.

Introduction

Intr

odu

ctio

n

User Guide

Its long history and careful development make

Relative Values for Physicians

the most accurate and comprehensive relative value system available. Use of


spans North America and several European countries. In this relative value system, values are provided for physician services contained in the American Medical Association's (AMA)

Physicians’ Current Procedural Terminology

(CPT) system, as well as Medicare's HCPCS Level II (National) codes. Additional codes, as recommended by physicians,

have been included in this system and assigned relative values to address special reimbursement issues.


provides a user-friendly coded listing of physician services with unit values. The accompanying instruction guidelines and modifiers explain the application of these procedure descriptors and unit values in medical practice. All sections of the book may be used by any or all physicians. Appropriate surgery descriptors are not confined to use by surgeons, nor is the Medicine section confined to use by internists or primary care physicians.

Definitions of Terms in


Column Descriptions

(1) UPD

This column indicates the date the procedure was updated for


. Prior to 2000 (99.2), the number following the decimal indicated whether the change occurred in the first or second official update of that year.


is now an annual publication and as such is updated once each year. For the year 2004 the update stamp will read 040; for 2003, 030; etc.). The update stamp is removed after three years.

(2) TYPE

Indicates code type or AMA change:

M

Indicates a code that has been deleted from the CPT book. The CPT copyright remains with the AMA.

▲

The triangle indicates a CPT code identifier reflecting a change in the CPT code description.

●

The circle indicates a CPT code identifier reflecting that the code was added to the CPT book.

+

The plus indicates an add-on code. Add-on codes describe additional intra-service work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as a stand-alone code.

*

Indicates the procedure is modifier 51 exempt. Codes identified as exempt from modifier 51 are not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied.

R

Indicates a code that has been developed by Relative Value Studies, Inc. (RVSI). These descriptions and the unit value information appear under certain unlisted procedures. See the


with CPT

(1) (2) (3) (4) (5) (6) (7)

UPD (Type) Code Description Units Anes Global

020 *

31500 Intubation, endotracheal, emergency procedure

1.5 0 000

2 — Relative Values for Physicians

Introduction


Introd

uction

Codes section (page 4) for a full explanation. A complete listing of R codes can be found in the R Code Crosswalk (see page 687).

If the column is blank, no special consideration for the code is required.

(3) CODE

Indicates the numerical code for the procedure. The AMA holds copyright to CPT codes. Relative Value Studies, Inc. holds copyright to codes designated as "R" in the Type column. These codes are clearly identified by three numeric, two alpha-digit codes (e.g., 328AA, 471AA, etc.) in the R Code Crosswalk on page 687.

(4) DESCRIPTION

Provides a description of the procedure. The AMA holds copyright to CPT codes and descriptions. Relative Value Studies, Inc. (RVSI) holds copyright to codes and descriptions designated as "R" in the Type column. These codes are clearly identified by three numeric, two alpha-digit codes (e.g., 328AA, 471AA, etc.) in the R Code Crosswalk on page 687.

(5) UNITS

The numerical relative value assigned to the procedure. Special notations for this column include:

BR

By Report: Procedures denoted BR (by report) in the Units column indicate a variance too great to establish a relative value.

RNE

Relativity Not Established: Procedures denoted RNE in the Units column indicate a procedure that is new or uncommon.

xx.x (I)

Interim Value: Interim relative values (designated by the letter "I") have been established by the editor upon receipt of input that is below accepted


confidence levels. The decision has been made to publish these values as a guideline for keeping pace with the rapid changes in procedure technology. Any reimbursement disagreements should be resolved by treating I codes as BR or RNE.

xx.x (I-02)

Date stamped value: Some procedures flagged as an interim value will have a date stamp, e.g., I-02, which means:

• The procedure is new and considered to be technically difficult.

• Physicians may require special training to perform the procedure.

• The value of the procedure will automatically decline at the end of the year of the date stamp.

(6) ANES

Anesthesia Unit Value: Base value for general anesthesia, if required, for the procedure. (See Guidelines in the Anesthesia section.)

(7) GLOBAL

Global Period: Number of days for postoperative care when any subsequent care should be considered part of the original procedure. (See Guidelines in the Surgery section.)

The Global Period

In 2002, the editorial board of


elected to change the global period days within the product to reflect those assigned in the current Medicare Physician Fee Schedule. This change was made to make the payment systems more consistent with one another. The editorial board believes that this change has made the burden on the provider and the payer lighter in interpreting the rules in the


dataset.

The methodology used to crosswalk the new data into the 2002


was based upon which global services existed in the previous dataset and which were to be included in the 2002 dataset. Unit values were adjusted using primarily percentages. The percentages assigned reflected generally accepted values for the postoperative period relative to global periods. Codes were increased in value by 30 percent when


had previously assigned a value of 0 (zero) to the global period and the global period was changed to either 10 or 90 days. Codes were decreased in value by 30 percent when


had previously assigned a global period and the global period was changed to a 0 (zero).

There are some instances where the Medicare Physician Fee Schedule uses a letter designation for the global period; these were adopted as well. The following definitions were incorporated into


:

MMM

Describes services furnished in uncomplicated maternity care. This includes antepartum, delivery, and postpartum care. The usual global surgical concept does not apply.

XXX

Indicates that the global surgery concept does not apply.

YYY

Indicates that the global period is to be set by the local carrier.

ZZZ

Indicates that the code is an add-on service and therefore is treated in the global period of the other procedure that is billed in conjunction with a ZZZ code. Do not bill these codes with modifier 51. They should not be reduced.

The last area in which adjustments were made are those in which the global period was changed but not eliminated or was increased but not from zero. In those instances, adjustments were made based on the number of visits and

©2003 Ingenix, Inc. CPT only ©2003 American Medical Association. All Rights Reserved.

An

esth

esia

Anesthesia

Guidelines

I. General:

Values for anesthesia services are listed for each procedure in the Surgery section under the heading Anes and by CPT code in the Anesthesia section. These values are to be used only when the anesthesia is legally administered by or under the responsible supervision of a licensed physician. These values include usual pre- and postoperative visits, the administration of the anesthetic, and administration of fluids and/or blood incident to the anesthesia or surgery. Anesthesia services may be billed under the appropriate anesthesia code or, if the same physician performs both the surgical procedure and the anesthesia service, report the surgery code with modifier 47.

Note: Anesthesia unit values are determined in the same manner as unit values found in the other sections (e.g., Surgery, Radiology, Pathology, Medicine, and E/M). Please see The Research Behind Relative Value Units (in the Introduction) for a further explanation of our survey methodology.

Discussion of total values as derived from the base unit and time increment are discussed under Calculations of Total Anesthesia Values.

II. By Report (BR) Items:

BR in the value column indicates that the value of this service is to be determined by report, because the service is too unusual or variable to be assigned a unit value. A detailed clinical record is generally not necessary.

III. Unlisted Service or Procedure:

When an unlisted service or procedure is provided, the value should be substantiated by report (BR).

IV. Procedures Listed Without Specified Unit Values:

Procedures that have RNE (relativity not established) or BR (by report) in the Units column should be substantiated by report (see By Report items).

V. Materials Supplied By Physician:

Identify with CPT code 99070 or the appropriate HCPCS Level II code. The list of appropriately billable supplies for each CPT code is variable by contract. RVUs are not based on supply costs. However, traditional fees or conversion

factors may be constructed to account for supplies required for a given code.

VI. Stand-by Anesthesia:

When an anesthesiologist is requested by the attending physician to be present in the operating room to monitor vital signs and manage the patient from an anesthesia standpoint, even though the actual surgery is being done under local anesthesia, calculation will be the same as if general anesthesia had been administered (time + base value).

Stand-by anesthesia is generally accepted without justifying documentation for the following:

• Deliveries

• Subdural hematomas

• Femoral or brachial arterial embolectomies

• Patients with physical status 4 or 5 — the physi-cian must document the patient's condition (e.g., severe systemic disease, moribund patient)

• Insertion of a cardiac pacemaker

• Cataract extraction and/or lens implant

Stand-by anesthesia for other than the above generally requires documentation.

VII. More Than One Anesthesiologist:

When it is necessary to have a second anesthesiologist, the necessity should be substantiated by report (BR). It is recommended that the second anesthesiologist receive 5.0 base units plus time units (see Calculations of Total Anesthesia Values).

VIII. Physical Status Modifiers:

All anesthesia services are reported by use of the anesthesia five-digit procedure code (00100-01999) plus the addition of a physical status modifier. These modifying units may be added to the basic values. Other modifiers may be used if appropriate. A comprehensive listing of modifiers is provided in the Introduction.


Anesthesia


An

esthesia

Physical status modifiers are represented by the letter P followed by a single digit defined below:

UnitValues

1 Healthy patient 0

2 Patient with mild systemic disease 0

3 Patient with severe systemic disease 1

4 Patient with severe systemic disease thatis a constant threat to life 2

5 A moribund patient who is not expectedto survive without the operation 3

6 A declared brain-dead patient whose organs arebeing removed for donor purposes 0

The above six levels are consistent with the American Society of Anesthesiologists' (ASA) ranking of patient physical status.

Example: 00100 P1

IX. Qualifying Circumstances:

Some circumstances warrant additional value due to unusual events. The following list of CPT codes and the corre-sponding anesthesia unit values may be listed if appropriate. More than one code may be neces-sary. The value listed is added to the existing anesthesia base.

UnitCPT Values

99100 Anesthesia for patient of extreme age, under one year or over seventy 1

99116 Anesthesia complicated by utilizationof total body hypothermia 5

99135 Anesthesia complicated by utilizationof controlled hypotension 5

99140 Anesthesia complicated by emergency* conditions (specify) 2

*An emergency is defined as existing when delay in treatment of a patient would lead to a significant increase in the threat to life or body part.

X. Anesthesia Services Where Time Units Are Not Allowed:

During the past several years


(RVP) has listed a group of codes, for which anesthesiologists commonly perform the actual CPT service described in the Anesthesia Guidelines under the heading "Anesthesia Services Where Time Units Are Not Allowed." This listing was confusing relative to anesthesia values listed in the Surgery section of RVP and was incorrect in some circumstances.

To illustrate the problem we will take the case of a 54-year-old patient requiring injection of the hip joint (CPT code 20610). If the patient requires regional anesthesia while this service is provided by the orthopedic surgeon, the anesthesiologist should report the services he/she provides using code 01200 with time units added to the base unit of 4. If, on the other hand, the anesthesiologist performs the injection without anesthesia he/she would report code 20610 and would be reimbursed the anesthesia base of 3 with no time units allowed for the service. By reporting the services in this way, it would appear that anesthesia services are not allowed for the performance of the procedure. To add to the confusion in previous editions of RVP, the value listed in the Anesthesia section was not consistent with anesthesia values in the Surgery section.

To correct both issues, RVP was changed in 2003. The values now listed in the Surgery section are values that crosswalk to the anesthesia base value from the appropriate anesthesia code in the range 00100-01999. If there is no value assigned (BR) then the anesthesia service should be considered by report; if the service is assigned a value of 0 then no anesthesia base unit(s) should be allowed for the procedure if provided. For those surgical and medical services provided by the anesthesiologist, a list of codes and the corresponding values are listed in the table beginning on the next page.

With the requirements dictated to health care through HIPAA, it should be noted that reporting of anesthesia services related to general or regional anesthesia should only be allowed under current anesthesia codes 00100-01999 and anesthesia modifiers P1-P5 or 99100-99140. As such the anesthesia values assigned in the Surgery section are for reference in cross-walking those values assigned to the anesthesia base value from the Anesthesia section of the manual.

If the anesthesiologist is performing the actual service described by the listed CPT code then the service should be reported under the appropriate CPT code from the Medicine or the Surgery section. In such cases it is recommended that the values assigned to the code listed in this table be used to value the service.

NOTE: Values in the Surgery section under the heading Anes for these and other procedures are considered to be anesthesia base units and additional time units should be allowed for the administration of anesthesia if provided during the procedure by the anesthesiologist as provided in these guidelines.


Surgery

Su

rger

y

Guidelines

I. Surgical Package Definition and Global Values.

Surgical services, while having many elements in common, are by their nature variable services that must be tailored to the needs of each patient. For this reason, surgical procedures include a variety of services, but always include a defined set of services. The included services differ slightly for therapeutic and diagnostic procedures.

A. Therapeutic Surgical Procedures.

The relative

values for therapeutic surgical procedures are considered global and always include:

1. The immediate preoperative care that starts after the decision for surgery has been made in which there are no complications requiring extra stabilizing care. This would include a single, related E/M service on the date immediately prior to or on the date of the procedure inclusive of a history and physical. Additional value is warranted for preoperative services under the following circumstances:

a. Evaluation and management services unrelated to the primary procedure.

b. Services required to stabilize the patient for the primary procedure.

c. When procedures not usually part of the basic surgical procedure (e.g., bronchoscopy prior to chest surgery) are provided during the immediate preoperative period.

2. The surgical procedure, including local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia, when used.

3. Normal uncomplicated follow-up care for the indicated global period. This includes dictating operative notes, talking with family, conferring with other physicians, writing orders, and evaluating the patient in the postanesthesia recovery area. Additional value is warranted for care rendered during

the global period when additional services are required due to:

a. An unusual circumstance, complication, exacerbation, recurrence.

b. Unrelated diseases or injuries treated during the follow-up period.

B.

Diagnostic Procedures.

Care for diagnostic procedures (e.g., endoscopy, injection procedures for radiography, etc.) includes only that care related to the diagnostic procedure itself. Care of the conditions for which the diagnostic procedures were performed or other concomitant conditions are not included, and may be listed separately. Follow-up care related to the diagnostic procedure is included for the indicated global period.

C.

Additional Surgical Procedures.

When an additional surgical procedure is carried out within the listed period of follow-up care for a previous surgery, the follow-up periods will continue concurrently to their normal terminations.

II.

Starred (*) Procedures:

The starred procedure designation has been deleted from the CPT coding nomenclature. Prior rules associated with starred procedures are no longer valid.

III.

Separate Procedures:

Procedures identified as separate are frequently included in the global value of other procedures. Listing of separate codes is not appropriate when a procedure is included in the global value of another (e.g., 29870 is not appropriate to list in conjunction with 29874).

IV.

Unusual Service or Procedure:

A service may necessitate use of the skills and time of the physician over and above listed services and values. If substantiated by report (BR), additional values may be warranted. Use modifier 22 to indicate these procedures.


Surgery


Su

rgery

V.

Unlisted Service or Procedure:

When a service or procedure provided is not adequately identified, use of the unlisted procedure code for the related anatomical area is appropriate. Most codes of this nature have 99 for the last two digits. The value should be substantiated by report (BR).

VI. Procedures Without Specified Unit Values:

Procedures that have RNE (relativity not established) or BR (by report) in the units column should be substantiated by report (see By Report).

VII. By Report (BR):

The value of a procedure should be established for any by report circumstance by identifying a similar service and justifying value difference. When a report is indicated, the report should include the following:

• Accurate procedure definition or description

• Operative report

• Justification for procedural variance, when appropriate

• Similar procedure and value comparisons

• Justification for value difference

VIII.

Reduced Values:

Under some circumstances, value for a procedure may be reduced or eliminated. Use modifier 52 to identify reduced value services.

IX. Operating Microscope:

When an operating microscope is used to perform a procedure, report CPT code 69990 in addition to the primary code unless included as a service in the primary code.

X. Anesthesia By Surgeon:

Regional or general anesthesia provided by a surgeon should be indicated using modifier 47. The surgeon may receive a value for the procedure equal to the base anesthesia value listed in the Anes column. Anesthesia and surgery relative value units are based on different scales.

Note: Customary conversion factors for anesthesia are approximately 25 percent of surgery conversion factors.

XI. Preoperative, Surgery, and/or Postoperative Care Provided by Different Physicians

A. Surgical Care Only:

When a physician provides only the surgical care and another physician provides preoperative and postoperative care, this circumstance should be indicated by the use of modifier 54. A customary value of 70 percent of the listed value is allowed.

B. Postoperative Management Only:

If a physician provides the postoperative care only, the use of modifier 55 is warranted. A customary value of 30 percent of the listed value is appropriate.

C. Preoperative Management Only:

If a physician provides the preoperative care only, the use of modifier 56 is warranted. A customary value of 10 percent of the listed value is appropriate.

XII. Two Surgeons:

Under certain circumstances, the skills of two surgeons (usually with different skills) may be required in the management of a specific surgical problem (e.g., a urologist and a general surgeon in the creation of an ileal conduit, etc.). The procedure should be valued at the customary value of 125 percent of the value listed. The total value (125 percent) may be apportioned in relation to the responsibility and work done, provided the patient is made aware of the arrangement. Such procedures should be marked using modifier 62.

XIII. Surgical Team:

Under some circumstances, a highly complex procedure identified by a single code requires the services of several physicians, often of different specialties. These circumstances should be identified by adding modifier 66. The value should be supported by a report to include itemization of the services and personnel included in a global value. See Concurrent Care and Multiple Procedures for help in determining the global value.

XIV. Surgical Assistants:

An assistant surgeon, regardless of type, can provide other services on the same date. These services warrant a value of 100 percent of the values listed.

A. Assistant Surgeon:

When surgical assistance is provided by a qualified physician, the use of modifier 80 is appropriate. The use of this modifier customarily warrants 20 percent of the listed values.

B. Minimum Assistant Surgeon:

When minimal surgical assistance is provided, the use of modifier 81 is appropriate. The use of this modifier customarily warrants 10 percent of the listed values.

C. Assistant Surgeon (when a qualified resident surgeon is not available):

When a qualified resident surgeon is unavailable and a qualified nonresident surgeon provides surgical assistance, use of modifier 82 is appropriate. The use of this modifier customarily warrants 20 percent of the listed values.

Surgery

Relative Values for Physicians — 65

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y

UPD Code Description Units Anes Global

040

20500

Injection of sinus tract; therapeutic (separate procedure) 0.5 3 010

040

20501

diagnostic (sinogram) 1.0 3 000

040

20520

Removal of foreign body in muscle or tendon sheath; simple 2.2 3 010

040

20525

deep or complicated 3.7 3 010

020

20526

Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel

0.6 (I) 3 000

040

▲

20550

Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)

0.4 3 000

040

▲

20551

single tendon origin/insertion 0.6 (I) 3 000

040

▲

20552

single or multiple trigger point(s), one or two muscle(s) 0.6 (I) 3 000

030

20553

single or multiple trigger point(s), three or more muscle(s)

1.8 (I) 3 000

040

20600

Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)

0.4 3 000

040

20605

intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)

0.5 3 000

040

20610

major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)

0.6 3 000

030

20612

Aspiration and/or injection of ganglion cyst(s) any location 0.6 (I) 3 000

020

20615

Aspiration and injection for treatment of bone cyst 3.7 3 010

040

20650

Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)

2.0 4 010

020

****

20660

Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)

Note: Multiple procedure guidelines for reduction of value are not applicable for this code.

2.1 5 000

020

20661

Application of halo, including removal; cranial 4.7 5 090

020

20662

pelvic 6.5 6 090

020

20663

femoral 6.5 4 090

020

20664

Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta), requiring general anesthesia

11.1 5 090

040

20665

Removal of tongs or halo applied by another physician 0.5 5 010

040

20670

Removal of implant; superficial, (eg, buried wire, pin or rod) (separate procedure)

2.0 3 010

020

20680

deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

5.2 5 090


Surgery

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

020

****

20690

Application of a uniplane (pins or wires in one plane), unilateral, external fixation system


6.5 3 090

020

****

20692

Application of a multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)


11.7 3 090

020

20693

Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))

5.9 3 090

020

20694

Removal, under anesthesia, of external fixation system 2.6 3 090

020

20802

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

65.0 6 090

020

20805

Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation

65.0 6 090

020

20808

Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation

60.0 6 090

020

20816

Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis tendon), complete amputation

28.0 6 090

020

20822

Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation

20.0 6 090

020

20824

Replantation, thumb (includes carpometacarpal joint to MP joint), complete amputation

32.0 6 090

020

20827

Replantation, thumb (includes distal tip to MP joint), complete amputation

27.5 6 090

020

20838

Replantation, foot, complete amputation 65.0 8 090

020

****

20900

Bone graft, any donor area; minor or small (eg, dowel or button)


3.1 3 090

020

****

20902

major or large


6.8 6 090

020

****

20910

Cartilage graft; costochondral


6.2 6 090

020

****

20912

nasal septum


6.2 5 090

020

****

20920

Fascia lata graft; by stripper


2.6 4 090


Surgery


✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


30420

including major septal repair 26.2 5 090

020

30430

Rhinoplasty, secondary; minor revision (small amount of nasal tip work)

8.5 5 090

020

30435

intermediate revision (bony work with osteotomies) 16.3 5 090

020

30450

major revision (nasal tip work and osteotomies) 20.8 5 090

020

30460

Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only

17.8 5 090

020

30462

tip, septum, osteotomies 32.5 5 090

040

30465

Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)

18.5 5 090

30520

Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

11.0 5 090

020

30540

Repair choanal atresia; intranasal 17.8 5 090

020

30545

transpalatine 22.6 5 090

040

30560

Lysis intranasal synechia 1.2 5 010

30580

Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)

10.0 5 090

30600

oronasal 10.0 5 090

30620

Septal or other intranasal dermatoplasty (does not include obtaining graft)

10.0 5 090

30630

Repair nasal septal perforations 11.0 5 090

040

30801

Cautery and/or ablation, mucosa of turbinates, unilateral or bilateral, any method, (separate procedure); superficial

1.0 5 010

020

30802

intramural 1.6 5 010

040

30901

Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method

1.0 5 000

040

30903

Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method

1.5 5 000

040

30905

Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial

2.9 5 000

040

30906

subsequent 2.3 5 000

020

30915

Ligation arteries; ethmoidal 16.3 5 090

020

30920

internal maxillary artery, transantral 19.5 5 090

020

30930

Fracture nasal turbinate(s), therapeutic 0.7 5 010

020

30999

Unlisted procedure, nose BR 5 YYY

040

31000

Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)

1.3 5 010


Surgery

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

040

31002

sphenoid sinus 1.3 5 010

31020

Sinusotomy, maxillary (antrotomy); intranasal 5.5 5 090

030

31030

radical (Caldwell-Luc) without removal of antrochoanal polyps

13.5 5 090

030

31032

radical (Caldwell-Luc) with removal of antrochoanal polyps

14.0 5 090

030

31040

Pterygomaxillary fossa surgery, any approach 20.0 7 090

31050

Sinusotomy, sphenoid, with or without biopsy; 8.5 5 090

31051

with mucosal stripping or removal of polyp(s) 10.0 5 090

31070

Sinusotomy frontal; external, simple (trephine operation) 10.5 5 090

020

31075

transorbital, unilateral (for mucocele or osteoma, Lynch type)

16.0 5 090

030

31080

obliterative without osteoplastic flap, brow incision (includes ablation)

16.5 7 090

030

31081

obliterative, without osteoplastic flap, coronal incision (includes ablation)

16.5 7 090

030

31084

obliterative, with osteoplastic flap, brow incision 24.0 7 090

030

31085

obliterative, with osteoplastic flap, coronal incision 24.0 7 090

030

31086

nonobliterative, with osteoplastic flap, brow incision 18.0 7 090

030

31087

nonobliterative, with osteoplastic flap, coronal incision 18.0 7 090

020

31090

Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)

25.0 5 090

31200

Ethmoidectomy; intranasal, anterior 7.0 5 090

31201

intranasal, total 11.5 5 090

31205

extranasal, total 14.5 5 090

030

31225

Maxillectomy; without orbital exenteration 22.5 7 090

020

31230

with orbital exenteration (en bloc) 28.0 7 090

31231

Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)

1.2 5 000

31233

Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)

2.6 5 000

31235

Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)

4.5 5 000

31237

Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)

3.2 5 000

020

31238

with control of nasal hemorrhage 5.4 5 000

020

31239

with dacryocystorhinostomy 12.0 5 010


Surgery


✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


020

49560

Repair initial incisional or ventral hernia; reducible 15.0 6 090

030

49561

incarcerated or strangulated 18.6 7 090

020

49565

Repair recurrent incisional or ventral hernia; reducible 16.9 6 090

030

49566


020

++++

49568

Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to code for the incisional or ventral hernia repair)

Note: This code is an add-on procedure and as such is valued appropriately. Multiple procedure guidelines for reduction of value are not applicable.

2.0 0 ZZZ

020

49570

Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)

5.2 4 090

020

49572


020

49580

Repair umbilical hernia, under age 5 years; reducible 9.1 4 090

020

49582


020

49585

Repair umbilical hernia, age 5 years or over; reducible 10.4 4 090

020

49587


020

49590

Repair spigelian hernia 11.7 4 090

020

49600

Repair of small omphalocele, with primary closure 13.7 7 090

020

49605

Repair of large omphalocele or gastroschisis; with or without prosthesis

33.8 7 090

020

49606

with removal of prosthesis, final reduction and closure, in operating room

27.3 7 090

020

49610

Repair of omphalocele (Gross type operation); first stage 15.6 7 090

020

49611

second stage 15.6 7 090

020

49650

Laparoscopy, surgical; repair initial inguinal hernia 11.1 (I) 6 090

020

49651

repair recurrent inguinal hernia 13.7 (I) 6 090

020

49659

Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy

BR 6 YYY

020

49900

Suture, secondary, of abdominal wall for evisceration or dehiscence

8.1 6 090

040

49904

Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)

15.4 (I) 13 090

030

++++

49905

Omental flap, intra-abdominal (List separately in addition to code for primary procedure)


12.6 0 ZZZ

49906

Free omental flap with microvascular anastomosis 32.0 7 090


Surgery

✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

020

49999

Unlisted procedure, abdomen, peritoneum and omentum BR 7 YYY

50010

Renal exploration, not necessitating other specific procedures 15.0 7 090

50020

Drainage of perirenal or renal abscess; open 13.5 7 090

50021

percutaneous 5.0 6 000

50040

Nephrostomy, nephrotomy with drainage 18.0 7 090

50045

Nephrotomy, with exploration 18.0 7 090

50060

Nephrolithotomy; removal of calculus 20.0 7 090

50065

secondary surgical operation for calculus 25.0 7 090

50070

complicated by congenital kidney abnormality 25.0 7 090

50075

removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

26.0 7 090

50080

Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting or basket extraction; up to 2 cm

20.0 7 090

50081

over 2 cm 23.0 7 090

50100

Transection or repositioning of aberrant renal vessels (separate procedure)

16.3 15 090

50120

Pyelotomy; with exploration 19.0 7 090

50125

with drainage, pyelostomy 19.0 7 090

50130

with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

20.0 7 090

50135

complicated (eg, secondary operation, congenital kidney abnormality)

25.0 7 090

040

50200

Renal biopsy; percutaneous, by trocar or needle 2.8 6 000

020

50205

by surgical exposure of kidney 10.4 7 090

020

50220

Nephrectomy, including partial ureterectomy, any open approach including rib resection;

21.0 7 090

50225

complicated because of previous surgery on same kidney 23.7 7 090

50230

radical, with regional lymphadenectomy and/or vena caval thrombectomy

32.5 7 090

50234

Nephrectomy with total ureterectomy and bladder cuff; through same incision

24.0 7 090

50236

through separate incision 28.0 7 090

50240

Nephrectomy, partial 24.0 7 090

50280

Excision or unroofing of cyst(s) of kidney 16.0 7 090

50290

Excision of perinephric cyst 16.0 6 090


Surgery


✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

22.0 7 090

030

39520

Repair, diaphragmatic hernia (esophageal hiatal); transthoracic

17.0 12 090

030

39530

combined, thoracoabdominal 19.0 12 090

030

39531

combined, thoracoabdominal, with dilation of stricture (with or without gastroplasty)

19.0 12 090

39540

Repair, diaphragmatic hernia (other than neonatal), traumatic; acute

19.0 7 090

39541

chronic 19.0 7 090

39545

Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic

12.0 12 090

040

39560

Resection, diaphragm; with simple repair (eg, primary suture) 20.0 7 090

040

39561

with complex repair (eg, prosthetic material, local muscle flap)

26.0 7 090

030

39599

Unlisted procedure, diaphragm BR 12 YYY

40490

Biopsy of lip 0.6 5 000

020

40500

Vermilionectomy (lip shave), with mucosal advancement 10.7 5 090

020

40510

Excision of lip; transverse wedge excision with primary closure

9.8 5 090

020

40520

V-excision with primary direct linear closure 9.0 5 090

020

40525

full thickness, reconstruction with local flap (eg, Estlander or fan)

10.3 5 090

40527

full thickness, reconstruction with cross lip flap (Abbe-Estlander)

20.0 5 090

020

40530

Resection of lip, more than one-fourth, without reconstruction

9.4 5 090

020

40650

Repair lip, full thickness; vermilion only 3.9 5 090

020

40652

up to half vertical height 5.2 5 090

020

40654

over one-half vertical height, or complex 7.8 5 090

40700

Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral

16.0 6 090

40701

primary bilateral, one stage procedure 24.0 6 090

40702

primary bilateral, one of two stages 14.0 6 090

40720

secondary, by recreation of defect and reclosure 16.0 6 090

40761

with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

25.0 6 090

020

40799

Unlisted procedure, lips BR 5 YYY


Surgery

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

040

40800

Drainage of abscess, cyst, hematoma, vestibule of mouth; simple

1.0 5 010

020

40801

complicated 2.0 5 010

040

40804

Removal of embedded foreign body, vestibule of mouth; simple

1.0 5 010

020

40805

complicated 2.0 5 010

40806

Incision of labial frenum (frenotomy) 1.5 5 000

020

40808

Biopsy, vestibule of mouth 0.9 5 010

020

40810

Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair

0.8 5 010

020

40812

with simple repair 1.2 5 010

020

40814

with complex repair 2.6 5 090

020

40816

complex, with excision of underlying muscle 3.9 5 090

020

40818

Excision of mucosa of vestibule of mouth as donor graft 2.6 5 090

020

40819

Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)

2.0 5 090

020

40820

Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical)

0.7 5 010

020

40830

Closure of laceration, vestibule of mouth; 2.5 cm or less 1.0 5 010

020

40831

over 2.5 cm or complex 1.6 5 010

40840

Vestibuloplasty; anterior 8.0 5 090

40842

posterior, unilateral 8.0 5 090

40843

posterior, bilateral 10.0 5 090

40844

entire arch 12.0 5 090

020

40845

complex (including ridge extension, muscle repositioning)

14.0 5 090

020

40899

Unlisted procedure, vestibule of mouth BR 5 YYY

040

41000

Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual

1.0 5 010

040

41005

sublingual, superficial 1.0 5 010

020

41006

sublingual, deep, supramylohyoid 1.0 5 090

020

41007

submental space 1.0 5 090

020

41008

submandibular space 1.0 5 090

020

41009

masticator space 1.0 5 090

020

41010

Incision of lingual frenum (frenotomy) 1.8 5 010


Surgery


✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


020

49560

Repair initial incisional or ventral hernia; reducible 15.0 6 090

030

49561


020

49565

Repair recurrent incisional or ventral hernia; reducible 16.9 6 090

030

49566


020

++++

49568

Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to code for the incisional or ventral hernia repair)


2.0 0 ZZZ

020

49570

Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)

5.2 4 090

020

49572


020

49580

Repair umbilical hernia, under age 5 years; reducible 9.1 4 090

020

49582


020

49585

Repair umbilical hernia, age 5 years or over; reducible 10.4 4 090

020

49587


020

49590

Repair spigelian hernia 11.7 4 090

020

49600

Repair of small omphalocele, with primary closure 13.7 7 090

020

49605

Repair of large omphalocele or gastroschisis; with or without prosthesis

33.8 7 090

020

49606

with removal of prosthesis, final reduction and closure, in operating room

27.3 7 090

020

49610

Repair of omphalocele (Gross type operation); first stage 15.6 7 090

020

49611

second stage 15.6 7 090

020

49650

Laparoscopy, surgical; repair initial inguinal hernia 11.1 (I) 6 090

020

49651

repair recurrent inguinal hernia 13.7 (I) 6 090

020

49659

Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy

BR 6 YYY

020

49900

Suture, secondary, of abdominal wall for evisceration or dehiscence

8.1 6 090

040

49904

Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)

15.4 (I) 13 090

030

++++

49905

Omental flap, intra-abdominal (List separately in addition to code for primary procedure)


12.6 0 ZZZ

49906

Free omental flap with microvascular anastomosis 32.0 7 090


Surgery

✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

020

49999

Unlisted procedure, abdomen, peritoneum and omentum BR 7 YYY

50010

Renal exploration, not necessitating other specific procedures 15.0 7 090

50020

Drainage of perirenal or renal abscess; open 13.5 7 090

50021

percutaneous 5.0 6 000

50040

Nephrostomy, nephrotomy with drainage 18.0 7 090

50045

Nephrotomy, with exploration 18.0 7 090

50060

Nephrolithotomy; removal of calculus 20.0 7 090

50065

secondary surgical operation for calculus 25.0 7 090

50070

complicated by congenital kidney abnormality 25.0 7 090

50075

removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

26.0 7 090

50080

Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting or basket extraction; up to 2 cm

20.0 7 090

50081

over 2 cm 23.0 7 090

50100

Transection or repositioning of aberrant renal vessels (separate procedure)

16.3 15 090

50120

Pyelotomy; with exploration 19.0 7 090

50125

with drainage, pyelostomy 19.0 7 090

50130

with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

20.0 7 090

50135

complicated (eg, secondary operation, congenital kidney abnormality)

25.0 7 090

040

50200

Renal biopsy; percutaneous, by trocar or needle 2.8 6 000

020

50205

by surgical exposure of kidney 10.4 7 090

020

50220

Nephrectomy, including partial ureterectomy, any open approach including rib resection;

21.0 7 090

50225

complicated because of previous surgery on same kidney 23.7 7 090

50230

radical, with regional lymphadenectomy and/or vena caval thrombectomy

32.5 7 090

50234

Nephrectomy with total ureterectomy and bladder cuff; through same incision

24.0 7 090

50236

through separate incision 28.0 7 090

50240

Nephrectomy, partial 24.0 7 090

50280

Excision or unroofing of cyst(s) of kidney 16.0 7 090

50290

Excision of perinephric cyst 16.0 6 090


Surgery


✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


020

54000

Slitting of prepuce, dorsal or lateral (separate procedure); newborn

1.0 3 010

020

54001

except newborn 1.8 3 010

020

54015

Incision and drainage of penis, deep 1.7 3 010

040

54050

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical

0.5 3 010

040

54055

electrodesiccation 1.0 3 010

020

54056

cryosurgery 1.0 3 010

020

54057

laser surgery 2.0 3 010

020

54060

surgical excision 2.0 3 010

020

54065

Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

2.7 3 010

020

54100

Biopsy of penis; (separate procedure) 0.7 3 000

020

54105

deep structures 1.4 3 010

020

54110

Excision of penile plaque (Peyronie disease); 10.8 3 090

020

54111

with graft to 5 cm in length 24.1 3 090

020

54112

with graft greater than 5 cm in length 26.7 3 090

020

54115

Removal foreign body from deep penile tissue (eg, plastic implant)

7.2 3 090

020

54120

Amputation of penis; partial 13.0 3 090

54125

complete 20.0 4 090

54130

Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy

28.0 6 090

54135

in continuity with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes

34.0 8 090

020

54150

Circumcision, using clamp or other device; newborn 1.7 3 010

020

54152


020

54160

Circumcision, surgical excision other than clamp, device or dorsal slit; newborn

0.7 3 010

020

54161


020

54162

Lysis or excision of penile post-circumcision adhesions 4.0 (I) 3 010

020

54163

Repair incomplete circumcision 3.7 (I) 3 010

020

54164

Frenulotomy of penis 3.3 (I) 3 010

040

54200

Injection procedure for Peyronie disease; 0.7 3 010

020

54205

with surgical exposure of plaque 6.5 3 090


Surgery

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

54220

Irrigation of corpora cavernosa for priapism 1.8 3 000

020

54230

Injection procedure for corpora cavernosography 1.0 3 000

020

54231

Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (eg, papaverine, phentolamine)

2.8 3 000

020

54235

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

1.0 3 000

030

54240

Penile plethysmography 1.0 000

54250

Nocturnal penile tumescence and/or rigidity test 2.0 000

020

54300

Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra

10.4 3 090

54304

Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps

14.0 3 090

54308

Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm

14.0 3 090

54312

greater than 3 cm 16.0 3 090

54316

Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia

18.0 3 090

54318

Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg, third stage Cecil repair)

10.0 3 090

54322

One stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advancement (eg, Magpi, V-flap)

12.0 3 090

54324

with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)

14.0 3 090

54326

with urethroplasty by local skin flaps and mobilization of urethra

16.0 3 090

54328

with extensive dissection to correct chordee and urethroplasty with local skin flaps, skin graft patch, and/or island flap

20.5 3 090

54332

One stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap

23.0 3 090

54336

One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap

26.5 3 090

54340

Repair of hypospadias complications (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple

10.5 3 090

54344

requiring mobilization of skin flaps and urethroplasty with flap or patch graft

16.0 3 090

54348

requiring extensive dissection and urethroplasty with flap, patch or tubed graft (includes urinary diversion)

20.0 3 090


Surgery


✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


040

61000

Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial

2.0 5 000

040

61001

subsequent taps 1.4 5 000

040

61020

Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection

2.0 5 000

040

61026

with injection of medication or other substance for diagnosis or treatment

3.0 5 000

040

61050

Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure)

2.5 5 000

040

61055

with injection of medication or other substance for diagnosis or treatment (eg, C1-C2)

4.1 5 000

040

61070

Puncture of shunt tubing or reservoir for aspiration or injection procedure

1.6 5 000

040

61105

Twist drill hole for subdural or ventricular puncture; 13.0 9 090

040

****

61107

for implanting ventricular catheter or pressure recording device


10.7 9 000

020

61108

for evacuation and/or drainage of subdural hematoma 26.0 9 090

020

61120

Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material)

13.0 9 090

020

61140

Burr hole(s) or trephine; with biopsy of brain or intracranial lesion

28.6 9 090

020

61150

with drainage of brain abscess or cyst 28.6 9 090

020

61151

with subsequent tapping (aspiration) of intracranial abscess or cyst

29.3 9 090

61154

Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural

22.0 9 090

61156

Burr hole(s); with aspiration of hematoma or cyst, intracerebral

21.5 9 090

040

****

61210

for implanting ventricular catheter, reservoir, EEG electrode(s) or pressure recording device (separate procedure)


8.0 9 000

020

61215

Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter

9.1 9 090

61250

Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery

15.0 9 090

61253

Burr hole(s) or trephine, infratentorial, unilateral or bilateral 25.5 9 090

61304

Craniectomy or craniotomy, exploratory; supratentorial 35.0 11 090


Surgery

✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

61305

infratentorial (posterior fossa) 37.0 13 090

61312

Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural

36.0 11 090

61313

intracerebral 38.0 11 090

61314

Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural

45.0 13 090

61315

intracerebellar 49.0 13 090

040

++++

61316

Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure)


1.1 (I) 0 ZZZ

61320

Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial

32.0 11 090

61321

infratentorial 35.0 13 090

040

61322

Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy

22.7 (I) 11 090

040

61323

with lobectomy 23.9 (I) 11 090

61330

Decompression of orbit only, transcranial approach 30.0 11 090

61332

Exploration of orbit (transcranial approach); with biopsy 40.0 11 090

61333

with removal of lesion 40.0 11 090

61334

with removal of foreign body 40.0 11 090

030

61340

Subtemporal cranial decompression (pseudotumor cerebri, slit ventricle syndrome)

22.0 11 090

61343

Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (eg, Arnold-Chiari malformation)

45.0 13 090

61345

Other cranial decompression, posterior fossa 19.5 13 090

61440

Craniotomy for section of tentorium cerebelli (separate procedure)

26.0 13 090

61450

Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion

35.0 13 090

61458

Craniectomy, suboccipital; for exploration or decompression of cranial nerves

39.0 13 090

61460

for section of one or more cranial nerves 38.0 11 090

61470

for medullary tractotomy 38.0 11 090

61480

for mesencephalic tractotomy or pedunculotomy 38.0 11 090

61490

Craniotomy for lobotomy, including cingulotomy 25.0 11 090


Surgery


✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rger

y


020

65125

Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)

7.8 5 090

020

65130

Insertion of ocular implant secondary; after evisceration, in scleral shell

15.0 5 090

020

65135

after enucleation, muscles not attached to implant 16.3 5 090

020

65140

after enucleation, muscles attached to implant 19.5 5 090

020

65150

Reinsertion of ocular implant; with or without conjunctival graft

14.3 5 090

020

65155

with use of foreign material for reinforcement and/or attachment of muscles to implant

15.6 5 090

020

65175

Removal of ocular implant 9.8 5 090

040

65205

Removal of foreign body, external eye; conjunctival superficial 0.7 5 000

040

65210

conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating

0.8 5 000

040

65220

corneal, without slit lamp 0.8 5 000

040

65222

corneal, with slit lamp 1.2 5 000

020

65235

Removal of foreign body, intraocular; from anterior chamber of eye or lens

19.5 5 090

020

65260

from posterior segment, magnetic extraction, anterior or posterior route

26.0 5 090

020

65265

from posterior segment, nonmagnetic extraction 26.0 5 090

040

65270

Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure

2.6 5 010

020

65272

conjunctiva, by mobilization and rearrangement, without hospitalization

3.9 5 090

020

65273

conjunctiva, by mobilization and rearrangement, with hospitalization

6.5 5 090

020

65275

cornea, nonperforating, with or without removal foreign body

10.1 5 090

020

65280

cornea and/or sclera, perforating, not involving uveal tissue

18.2 5 090

020

65285

cornea and/or sclera, perforating, with reposition or resection of uveal tissue

19.5 5 090

020

65286

application of tissue glue, wounds of cornea and/or sclera 13.0 5 090

020

65290

Repair of wound, extraocular muscle, tendon and/or Tenon’s capsule

13.0 5 090

020

65400

Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

10.4 5 090

040

65410

Biopsy of cornea 6.0 5 000


Surgery

✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Su

rgery

020

65420

Excision or transposition of pterygium; without graft 6.5 5 090

020

65426

with graft 9.1 5 090

040

65430

Scraping of cornea, diagnostic, for smear and/or culture 0.6 5 000

040

65435

Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)

1.0 5 000

020

65436

with application of chelating agent (eg, EDTA) 2.6 5 090

020

65450

Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization

1.7 5 090

020

65600

Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo)

7.8 5 090

65710

Keratoplasty (corneal transplant); lamellar 24.0 6 090

65730

penetrating (except in aphakia) 29.5 6 090

65750

penetrating (in aphakia) 35.0 6 090

65755

penetrating (in pseudophakia) 25.0 6 090

020

65760

Keratomileusis 22.4 5 XXX

020

65765

Keratophakia 24.5 6 XXX

020

65767

Epikeratoplasty 19.6 5 XXX

65770

Keratoprosthesis 30.0 6 090

020

65771

Radial keratotomy 9.8 5 XXX

65772

Corneal relaxing incision for correction of surgically induced astigmatism

17.0 5 090

65775

Corneal wedge resection for correction of surgically induced astigmatism

22.0 5 090

040

●

65780

Ocular surface reconstruction; amniotic membrane transplantation

7.2 (I) 5 090

040

●

65781

limbal stem cell allograft (eg, cadaveric or living donor) 11.0 (I) 5 090

040

●

65782

limbal conjunctival autograft (includes obtaining graft) 9.5 (I) 5 090

040

65800

Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration of aqueous

3.0 5 000

040

65805

with therapeutic release of aqueous 2.5 5 000

65810

with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection

10.0 5 090

65815

with removal of blood, with or without irrigation and/or air injection

15.0 5 090

020

65820

Goniotomy 13.7 4 090

020

65850

Trabeculotomy ab externo 20.8 5 090



Radiology

Rad

iolo

gy

Guidelines

I. General:

Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician.

A. Total:

The unit value listed on the 00 line represents the global value of the procedure. The five-digit code is used to represent this service, including the professional services and technical value of providing that service. Professional and technical components are defined below.

B. Professional:

The unit value listed on the 26 line is used to value only the professional component of a service. Modifier 26 is added to the procedure code to designate the professional component. The professional component includes examination of the patient, when indicated; performance and/or supervision of the procedure; interpretation and written report of the examination; and consultation with referring physicians.

C. Technical:

The unit value listed on the TC line is used to designate the technical value of providing the service. Modifier TC may be used to designate this component. The technical component includes personnel, materials, space, equipment, and other allocated facility overhead normally included in providing the service. Note: Modifier TC is not a CPT modifier and may not be accepted by all payers. Check with the specific payer prior to use of this HCPCS Level II modifier.

II. Supervision and Interpretation Only:

A code designated as "Supervision and Interpretation Only" is used to indicate radiological services provided by a radiologist and staff in conjunction with component surgical services provided by either the radiologist or another physician (e.g., injection, insertion of catheter). When a physician other than the radiologist performed the component service, the other physician should list separately the appropriate component procedure code and the radiologist should bill using the appropriate supervision and interpretation only code. If the radiologist and staff provide both portions

of the service, the CPT book requires reporting with the supervision and interpretation code and the appropriate component procedure code. Check with the payer for appropriate reporting.

III. Complete Procedures:

Procedures designated as complete procedures are used to denote radiological services that are performed by the radiologist and staff only. If other physicians provide some part of the procedure, see Supervision and Interpretation Only.

IV. Unlisted Services or Procedure:

A service or procedure that is not identified by a particular code should be listed using the appropriate unlisted procedure code. These codes often have 99 as the final two digits. Values should be substantiated by report (see By Report).

V. Procedures Without Specified Unit Values:


VI. Unusual Service or Procedure:

When a procedure of an unusual nature is performed, modifier 22 should be added and the value substantiated by report (see By Report).

VII By Report:

The value of a procedure should be established for any by report circumstance by identifying a similar service and justifying value difference. Procedures that require a report should include the following:

• Accurate definition

• Clinical history

• Related procedure values

• Reason for value adjustment

VIII. Separate or Multiple Procedures:

Multiple radiology procedures performed on the same date should be designated by separate entries. Customarily each procedure is allowed 100 percent of the listed value.

IX. Reduced Value:

If a physician elects to reduce the value of a procedure, modifier 52 should be added to


Radiology

✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Rad

iology

the procedure code. Modifier 52 and the appropriate code may be used to indicate a limited or follow-up computerized axial tomography (CT) scan.

X. Services or Procedures Listed in Other Sections:

Services or procedures provided by a radiologist may be listed in another section of the book (e.g., consultations listed in Medicine). The radiologist should use these procedure codes following the guidelines appropriate to that section.

Note: The conversion factor for each section generally differs.

XI. Modifiers:

A comprehensive listing of modifiers is provided in the Introduction. Value adjustments significant to radiology and modifiers are detailed in the guidelines above.

XII. Unit Values and Dyes:

Lower cost dyes are included in the unit value. Higher cost/special dyes (e.g., non-ionic dyes), however, are not included in the unit value. Code 99070 or the appropriate HCPCS Level II code should be used to report the use of these higher cost dyes.

Magnetic Resonance Imaging (MRI)

The MRI codes listed and their corresponding unit values reflect current changes to existing expanded MRI procedures and the common practice of using 25 or more slices for each MRI service performed.


Pathology and Laboratory

Pat

hol

ogy

Guidelines

I. General:

Values in this section include recording of the specimen, performance of the test, and reporting of the result. They do not include specimen collection and transfer or individual patient administrative services.

A. Total:

The unit value listed on the 00 line represents the global value of the procedure. The five-digit procedure code is used to represent this service, including the professional services and technical cost of providing that service. Professional and technical components are described below.

B. Professional:

The unit value listed on the 26 line is used to value only the professional component of a service. Modifier 26 is added to the procedure code to designate the professional component. The professional component includes examination of the patient, when indicated; performance and/or supervision of the procedure or lab test; interpretation and/or written report concerning the examination or lab test; and consultation with referring physicians.

C. Technical:


II. Unlisted Service or Procedure:

A service or procedure that is not identified by a particular code should be listed using the appropriate unlisted procedure code. These codes often have 99 as the final two digits. Values should be substantiated by report (see By Report).

III. Procedures Without Specified Unit Values:

Procedures that have RNE (relativity not established) or BR (by

report) in the units column should be substantiated by report (see By Report).

IV. Unusual Service or Procedure:

When a procedure of unusual nature is performed, modifier 22 should be added and value substantiated by report (see By Report).

V. By Report:

The value of a procedure should be established for any by report circumstance by identifying a similar service and justifying the difference. Procedures that require a report should include the following:

• Accurate definition

• Clinical history

• Related procedure values

• Reason for value adjustment

VI. Reference (Outside) Laboratory:

The laboratory tests and services listed in this section, when performed by other than the physician, require the use of the applicable procedure number with modifier 90.

VII. Collection and Handling:

Procedure codes for the collection and handling of samples for laboratory and pathology tests are listed in Medicine (codes 99000 and 99001), Surgery (codes 36415, 36416, 36540, 36600), and HCPCS (code G0001). See Guidelines for each appropriate section and use the appropriate conversion factor.

VIII. Separate or Multiple Procedures:

Multiple procedures performed on the same date should be designated by separate entries. Customarily each procedure is allowed 100 percent of the listed value.

IX. Reduced Value:

If a physician elects to reduce the value of a procedure, modifier 52 should be added to the procedure code.

X. Consultation:

Several consultation codes are listed for various types of pathology consults (e.g., 80500, 80502, 88321–88332). Medicine codes may also be used if appropriate (see Services or Procedures Listed in Other Sections).


Pathology and Laboratory

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Path

ology

XI. Services or Procedures Listed in Other Sections:

Services or procedures provided by a pathologist may be listed in another section of the book (e.g., consultations listed in Medicine). The pathologist should use these procedure codes following the guidelines appropriate to that section.

Note: The conversion factor for each section generally differs.

XII. Modifiers:

A comprehensive listing of modifiers is provided in the Introduction. Value adjustments significant to pathology and laboratory and modifiers for those adjustments are listed in this section.


Medicine

Med

icin

e

Guidelines

I. General:

Some of the procedures in this section include a total value and professional and technical components.

A. Total:

The unit value listed on the 00 line represents the global value of the procedure. The five-digit procedure code is used to represent this service, including the professional services and technical cost of providing that service. Professional and technical components are described below.

B. Professional:

The unit value listed on the 26 line is used to value only the professional component of a service. Modifier 26 is added to the procedure code to designate the professional component. The professional component includes examination of the patient, when indicated; performance and/or supervision of the procedure or lab test; interpretation and/or written report concerning the examination or lab test; and consultation with referring physicians.

C. Technical:


II. Separate Procedures:

Procedures identified as separate are frequently included in the global value of other procedures. Listing of a separate procedure code and full value is appropriate if the procedure is not included in the global value of another. Listing of separate procedure codes is not appropriate when the procedure is included in the global value of another.

III. Unusual Service or Procedure:

A service may necessitate skills and time of the physician over and above listed services and values. If substantiated by

report (BR), additional values may be warranted. Use modifier 22 to indicate these procedures.

IV. Unlisted Service or Procedure:

When a service or procedure provided is not adequately identified, use of the unlisted procedure code for the related anatomical area is appropriate. Most codes of this nature have 99 for the last two digits. Value should be substantiated by report (BR).

V. Procedures Without Specified Unit Values:


VI. By Report:

The value of a procedure should be established for any by report circumstance by identifying a similar service and justifying value difference. When a report is indicated, the report should include the following:

• Accurate procedure definition or description

• Operative report

• Justification for procedural variance, when appropriate

• Similar procedure and value

• Justification for value difference

VII. Reduced Values:

Under some circumstances, a value for a procedure may be reduced or eliminated. Use modifier 52 to identify reduced value services.

VIII. Concurrent Care:

Concurrent care designates a circumstance where separate procedures or services are provided by two or more physicians on the same date. The CPT book has deleted modifier 75 and does not require any special reporting for concurrent care.

IX. Multiple Modifiers:

If circumstances require the use of more than one modifier with any one procedure code, modifier 99 should be added to the procedure code. Other modifiers are attached to the procedure code and listed separately with appropriate values for each.


Medicine

✚

Add-on Code *

Modifier -51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Med

icine

X. Materials Supplied By Physician:

Use CPT code 99070 or the appropriate HCPCS Level II code. The list of appropriately billable supplies for each CPT code is variable by contract. RVUs are not based on supply costs. However, traditional fees or conversion factors may be constructed to account for supplies required for a given code.


Evaluation and Management

E/M

Guidelines

I. General:

Visits, examinations, consultations, and similar services as listed in this section reflect the wide variations required in time and skill. The following alphabetical list of definitions is included to aid in the determination of the correct code for the service provided. Documentation for each aspect of the service performed should be included in the patient record to substantiate the level of service. The listed relativities for each code group apply only when these services are performed by or under the responsible supervision of a physician.

Chief Complaint:

A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter.

Classification of Service:

Each code in this section is grouped into a category. The groupings are defined by place (e.g., office, hospital, nursing home, etc.) and type of service (e.g., consultation, preventive, etc.). Some of the codes are grouped into subcategories (e.g., new patient, established patient, initial, etc.). Each code in the group represents a different level of service defined by the clinical components of a patient encounter for E/M (see Levels of Service).

Components:

Each level of service recognizes seven components. The components include history, physical examination, medical decision making, counseling, coordination of care, nature of presenting problem, and time (see Levels of Service, Key Components, History, Physical Examination, Medical Decision Making, Counseling, Problem, and Time).

Concurrent Care:

The provision of similar services (e.g., hospital visits) to the same patient by more than one physician on the same day. The CPT book has deleted modifier 75 and does not require any special reporting for concurrent care.

Consultation:

There are three categories for consultation: outpatient, inpatient, and confirmatory. Any physician may use an appropriate consultation code on any patient for any problem including one that has been previously evaluated by the consulting physician provided the following criteria are met:

The attending physician or appropriate source requests that the physician render advice or opinion regarding the evaluation and/or management of a specific problem.

• The need for the consultation, the consultant's opinion, and any services ordered or performed must be well documented in the patient's record.

• The information is communicated to the requesting physician or appropriate source.

Counseling:

A discussion with the patient and/or family concerning one or more of the following:

• Diagnostic results, impressions, and/or recommended diagnostic studies

• Prognosis

• Risks and benefits of management options

• Instructions for management and/or follow-up

• Importance of compliance with chosen management

• Risk factor reduction

• Patient and family education (see Key Components and Time)

Established Patient:

A patient who has received professional services from a physician or another physician in the same specialty within the same group within the last three years. In the instance a physician is covering for or is on call for another physician, the patient is classified as an established patient if the other physician or a member of the providing physician specialty group has provided services for the patient within the last three years.

Family History:

A review of medical events in the patient's family that includes significant information about:

• The health status or cause of death of parents, siblings, and children


Evaluation and Management


E/M

• Specific diseases related to problems identified in the chief complaint or history of the present illness, and/or system review

• Diseases of family members that may be hereditary or place the patient at risk

History:

This key component relates to the type of history obtained during a patient encounter. The four types of history are defined as follows:

•

Problem focused:

Brief history of present illness or problem as related to the chief complaint

•

Expanded problem focused:

Brief history of present illness relating to chief complaint and pertinent system review

•

Detailed:

Extended history of present illness related to chief complaint, an extended system review, and pertinent past, family, and/or social history

•

Comprehensive:

Extended history of present illness related to chief complaint, complete system review, and complete past, family, and social history

History of Present Illness:

A chronological description of the development of the patient's present illness from the first sign and/or symptom to the present. This includes a description of location, quality, severity, timing, context, modifying factors, and associated signs and symptoms significantly related to the presenting problem.

Key Components:

Those components that are used primarily to determine the appropriate code level. These components include medical decision making, physical examination, and history (see History, Physical Examination, Medical Decision Making). Time is not considered a key component unless counseling constitutes more than 50 percent of the face-to-face patient/physician encounter (see Time, Counseling).

Levels of Service:

Each category and subcategory contains two to seven levels of service indicated by code. The services include examinations, evaluations, treatments, conferences with or concerning patients, preventative pediatric and adult health supervision, and similar services. Each level of service recognizes seven clinical components. Three of these components are considered key components (see Components of Service, History, Physical Examination, and Medical Decision Making). All physicians may use each level of service.

Medical Decision Making:

The complexity of establishing a diagnosis or selecting a management option. Medical decision making is divided into four categories. The level of medical decision making is

determined using documentation in the patient record for three subcategories including: number of possible diagnoses and or the number of management options considered; the amount and/or complexity of medical records, diagnostic tests, and/or other information that must be obtained, reviewed, and analyzed; and the risk of significant complications, morbidity and/or mortality, as well as comorbidities, associated with the patient's presenting problem, the diagnostic procedure, and/or the possible management options. The following four classifications for level of medical decision making are used in determining the proper code.

•

Straightforward:

Minimal number of possible diagnoses or management options, minimal or no amount and/or complexity of data to be reviewed, and minimal risk of complications and/or morbidity or mortality

•

Low Complexity:

Limited number of possible diagnoses or management options, limited amount and/or complexity of data to be reviewed, and low risk of complications and/or morbidity or mortality

•

Moderate Complexity:

Multiple number of possible diagnoses or management options, moderate amount and/or complexity of data to be reviewed, and moderate risk of complications and/or morbidity or mortality

•

High Complexity:

Extensive number of possible diagnoses or management options, extensive amount and/or complexity of data to be reviewed, and high risk of complications and/or morbidity or mortality

Nature of Presenting Problem:

A presenting problem is a disease, condition, illness, injury, symptom, sign, finding, complaint, or other reason for the encounter, with or without a diagnosis being established at the time of the encounter. The E/M codes recognize five types of presenting problems that are defined as follows:

•

Minimal:

A problem that may not require the presence of the physician, but service is provided under the physician's supervision

•

Self-limited or minor:

A problem that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status, or has a good prognosis with management/compliance

•

Low severity:

A problem where the risk of morbidity without treatment is low; there is little to no risk of mortality without treatment; full recovery without functional impairment is expected


Category II Codes

Cat

egor

y II

C

odes

Category II codes are supplemental tracking codes that were added to the CPT book in 2004. These codes were developed to track performance measurement and are intended to facilitate data collection related to quality of care. The coding of performance measures that support compliance with quality of care requirements, as well as state and federal law, allows the health care provider to identify performance of these measures and tests without the need for record abstraction or chart review.

Category II codes are alphanumeric codes that consist of four digits followed by an alpha character. Services and procedures or test results described by these codes are typically included as part of evaluation and management services and/or laboratory tests and procedures. For this

reason, relative values do not apply to these services, procedures, and tests.


designates these codes as 0.0. Because these performance measures are included in the relative values for evaluation and management and/or laboratory services codes, relative values will not be developed for Category II codes.

The use of these codes is optional. The codes are not required for correct coding and may not be used as a substitute for Category I codes.

Category II codes are published twice a year (January 1 and July 1). The most current listing may be obtained at www.ama-assn.org/go/cpt.

UPD Code Description Units

040

●

0001F

Blood pressure, measured 0.0

040

●

0002F

Tobacco use, smoking, assessed 0.0

040

●

0003F

Tobacco use, non-smoking, assessed 0.0

040

●

0004F

Tobacco use cessation intervention, counseling 0.0

040

●

0005F

Tobacco use cessation intervention, pharmacologic therapy 0.0

040

●

0006F

Statin therapy, prescribed 0.0

040

●

0007F

Beta-blocker therapy, prescribed 0.0

040

●

0008F

ACE inhibitor therapy, prescribed 0.0

040

●

0009F

Anginal symptoms and level of activity, assessed 0.0

040

●

0010F

Anginal symptoms and level of activity, assessed using a standardized instrument (e.g., Canadian Cardiovascular Society Classification-CCSC- System, Seattle Angina Questionnaire-SAQ)

0.0

040

●

0011F

Oral antiplatelet therapy prescribed (e.g., aspirin, clopidogrel/Plavix, or combination of aspirin and dipyidamole/Aggrenox)

0.0


Category III Codes

Cat

egor

y II

I C

odes

This section contains a set of temporary CPT codes for emerging technology, services, and procedures. Category III codes will allow data collection for these services/procedures. Use of unlisted codes does not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported instead of a Category I unlisted code. This is an activity that is critically important in the evaluation of health care delivery and the formation of public and private policy. The use of the codes in this section will allow physicians and other qualified health care professionals, insurers, health services researchers, and health policy experts to identify emerging technology, services, and procedures for clinical efficacy, utilization and outcomes.

The inclusion of a service or procedure in this section neither implies nor endorses clinical efficacy, safety or the applicability to clinical practice. The codes in this section do not conform to the usual requirements for Category I codes established by the CPT Editorial Panel. For Category I codes, the Panel requires that the service/procedure be performed by many health care professionals in clinical practice in multiple locations and that FDA approval, as appropriate, has already been received. The nature of emerging technology, services, and procedures is such that these requirements may not be met. For these reasons, temporary codes for emerging technology, services and procedures have been placed in a separate section of the


and CPT books and the codes are differentiated from Category I codes by the use of alphanumeric characters.

Services/procedures described in this section make use of alphanumeric characters. These codes have an alpha character as the fifth character in the string, preceded by four digits. The digits are not intended to reflect the placement of the code in the Category I section nomenclature. Codes in this section may or may not eventually receive a Category I code. In either case, a given Category III code will be archived after five years of its inception unless it is demonstrated that a temporary code is still needed. New codes in this section are released semi-annually via the AMA/CPT internet site, to expedite dissemination for reporting. The full set of temporary codes for emerging technology, services, and procedures is published annually in the CPT book. RVSI will use the same methodology for unit value development for these Category III codes as it does for Category I codes.


Category III Codes

✚

Add-on Code *

Modifier 51 Exempt

▲

Revised code

●

New code

M

Deleted from CPT

R

RVSI Code

(I)

Interim Value


Category III

Cod

es


040

0001T

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, modular bifurcated prosthesis (two docking limbs)

RNE

040

M

0002T

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; aorto-uni-iliac or aorto-unifemoral prosthesis

Note: This code has been deleted. To report, use 34805.

RNE

020

0003T

Cervicography RNE

020

0005T

Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous; initial vessel

RNE

020

++++

0006T

each additional vessel (List separately in addition to code for primary procedure


RNE

020

0007T

Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous, radiological supervision and interpretation, each vessel

RNE

020

0008T

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with suturing of the esophagogastric junction

RNE

020

0009T

Endometrial cryoablation with ultrasonic guidance RNE

020

0010T

Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response

RNE

030

0012T

Arthroscopy, knee, surgical, implantation of osteochondral graft(s) for treatment of articular surface defect; autografts

RNE

030

0013T

allografts RNE

030

0014T

Meniscal transplantation, medial or lateral, knee (any method) RNE

020

0016T

Destruction of localized lesion of choroid (eg, choroidal neovascularization), transpupillary thermotherapy

RNE

020

0017T

Destruction of macular drusen, photocoagulation RNE

020

0018T

Delivery of high power, focal magnetic pulses for direct stimulation to cortical neurons

RNE

020

0019T

Extracorporeal shock wave therapy; involving musculoskeletal system RNE

020

0020T

involving plantar fascia RNE

020

0021T

Insertion of transcervical or transvaginal fetal oximetry sensor RNE

020

0023T

Infectious agent drug susceptibility phenotype prediction using genotypic comparison to known genotypic/phenotypic database, HIV 1

RNE

020

0024T

Non-surgical septal reduction therapy (eg, alcohol ablation), for hypertrophic obstructive cardiomyopathy; with coronary arteriograms, with or without temporary pacemaker

RNE

040

M

0025T

Determination of corneal thickness (eg, pachymetry) with interpretation and report, bilateral

Note: This code has been deleted. To report, use code 76514.

RNE

©2003 Ingenix, Inc.

HCPCS

HC

PC

S


includes a listing of HCPCS Level II codes as they relate to physician services. The following is a list of these codes as developed by the Centers for Medicare and Medicaid Services (CMS) for the current year. The editors are researching a methodology for assigning values to all HCPCS codes. Many of these procedures have relative values or value guidelines for use with the conversion factor used for Medicine. Other codes list or include the cost of medical equipment and supplies. These codes are supplied in the comprehensive listing for your convenience. Values for most codes cannot be determined under the current relative value structure. The editors are researching fees for these procedures with the intention of publishing a fee range for each medical equipment or supply code in the future. A relative value is not available for procedures with an RNE (relativity not established) in the Units column. These codes should be treated as by report codes, and substantiating documentation should accompany the code submission.

The

Current Procedural Terminology

, Fourth Edition, (CPT) copyrighted by the American Medical Association is a listing of descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures performed by health care professionals. The CMS Healthcare Common Procedure Coding System (HCPCS) includes CPT descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures and other materials contained in the CPT book that are copyrighted by the American Medical Association. Participants will be authorized to use copies of CPT material in HCPCS only for the purposes directly related to participating in CMS programs. Permission for any other use must be obtained from the AMA.

Note: The D codes for HCPCS are not included in this publication. These codes are related to dental procedures and have no unit values assigned.

HCPCS Disclaimer

HCPCS is designed to promote uniform medical services reporting and statistical data collection. Inclusion of a service, product, or supply does not constitute endorsement by the HCPCS editorial panel that it is non-investigational or is commonly and customarily recognized as appropriate for medical care and treatment. Inclusion or exclusion of a

procedure, product, or supply does not imply any health insurance coverage or reimbursement policy.

Level II (HCPCS/National) Modifiers

A1 Dressing for one wound

A2 Dressing for two wounds

A3 Dressing for three wounds

A4 Dressing for four wounds

A5 Dressing for five wounds

A6 Dressing for six wounds

A7 Dressing for seven wounds

A8 Dressing for eight wounds

A9 Dressing for nine or more wounds

AA Anesthesia services performed personally by anes-thesiologist

AD Medical supervision by a physician: more than four concurrent anesthesia procedures

AH Clinical psychologist

AJ Clinical social worker

AM Physician, team member service

AP Determination of refractive state was not performed in the course of diagnostic ophthalmological exami-nation

AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery

AT Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942)

AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply

AV Item furnished in conjunction with a prosthetic device, prosthetic or orthotic


HCPCS


HC

PC

S

AW Item furnished in conjunction with a surgical dress-ing

AX Item furnished in conjunction with dialysis services

BA Item furnished in conjunction with parenteral or enteral nutrition (PEN) services

BO Orally administered nutrition, not by feeding tube

BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item

BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item

BU The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision

CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission

CB Service ordered by a renal dialysis facility (rdf) phy-sician as part of the esrd beneficiary's dialysis bene-fit, is not part of the composite rate, and is separately reimbursable

CC Procedure code change (use CC when the proce-dure code submitted was changed either for admin-istrative reasons or because an incorrect code was filed)

E1 Upper left, eyelid

E2 Lower left, eyelid

E3 Upper right, eyelid

E4 Lower right, eyelid

EJ Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab

EM Emergency reserve supply (for ESRD benefit only)

EP Service provided as part of Medicaid early periodic screening diagnosis and treatment (EPSDT) pro-gram

ET Emergency services

EY No physician or other licensed health care provider order for this item or service

F1 Left hand, second digit

F2 Left hand, third digit

F3 Left hand, fourth digit

F4 Left hand, fifth digit

F5 Right hand, thumb

F6 Right hand, second digit

F7 Right hand, third digit

F8 Right hand, fourth digit

F9 Right hand, fifth digit

FA Left hand, thumb

FP Service provided as part of Medicaid family plan-ning program

G1 Most recent urea reduction ratio (URR) reading of less than 60

G2 Most recent urea reduction ration (URR) reading of 60 to 64.9

G3 Most recent urea reduction ratio (URR) reading of 65 to 69.9

G4 Most recent urea reduction ratio (URR) reading of 70 to 74.9

G5 Most recent urea reduction ratio (URR) reading of 75 or greater

G6 ESRD patient for whom less than six dialysis ses-sions have been provided in a month

G7 Pregnancy resulted from rape or incest or preg-nancy certified by physician as life threatening

G8 Monitored anesthesia care (MAC) for deep com-plex, complicated, or markedly invasive surgical procedure

G9 Monitored anesthesia care for patient who has his-tory of severe cardio-pulmonary condition

GA Waiver of liability statement on file

GB Claim being re-submitted for payment because it is no longer covered under a global payment demon-stration

GC This service has been performed in part by a resi-dent under the direction of a teaching physician

GE This service has been performed by a resident with-out the presence of a teaching physician under the primary care exception

GF Non-physician (e.g. nurse practitioner (np), certi-fied registered nurse anaesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital

HCPCS


▲

Revised code

●

New code

M

Deleted from HCPCS

R

RVSI Code

(I)

Interim Value


HC

PC

S


H0001

Alcohol and/or drug assessment RNE

030

H0002

Behavioral health screening to determine eligibility for admission to treatment program

RNE

H0003

Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs

RNE

030

H0004

Behavioral health counseling and therapy, per 15 minutes RNE

H0005

Alcohol and/or drug services; group counseling by a clinician RNE

H0006

Alcohol and/or drug services; case management RNE

H0007

Alcohol and/or drug services; crisis intervention (outpatient) RNE

H0008

Alcohol and/or drug services; sub-acute detoxification (hospital inpatient) RNE

H0009

Alcohol and/or drug services; acute detoxification (hospital inpatient) RNE

H0010

Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient)

RNE

H0011

Alcohol and/or drug services; acute detoxification (residential addiction program inpatient)

RNE

H0012

Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient)

RNE

H0013

Alcohol and/or drug services; acute detoxification (residential addiction program outpatient)

RNE

H0014

Alcohol and/or drug services; ambulatory detoxification RNE

H0015

Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education

RNE

H0016

Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)

RNE

030

H0017

Behavioral health; residential (hospital residential treatment program), without room and board, per diem

RNE

030

H0018

Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem

RNE

030

H0019

Behavioral health; long-term residential (non-medial, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem

RNE

H0020

Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)

RNE

H0021

Alcohol and/or drug training service (for staff and personnel not employed by providers)

RNE

H0022

Alcohol and/or drug intervention service (planned facilitation) RNE

030

H0023

Behavioral health outreach service (planned approach to reach a targeted population)

RNE


HCPCS

▲

Revised code

●

New code

M

Deleted from HCPCS

R

RVSI Code

(I)

Interim Value


HC

PC

S

030

H0024

Behavioral health prevention information dissemination service (one-way direct or non-direct contact with service audiences to affect knowledge and attitude)

RNE

030

H0025

Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)

RNE

H0026

Alcohol and/or drug prevention process service, community-based (delivery of services to develop skills of impactors)

RNE

H0027

Alcohol and/or drug prevention environmental service (broad range of external activities geared toward modifying systems in order to mainstream prevention through policy and law)

RNE

H0028

Alcohol and/or drug prevention problem identification and referral service (e.g., student assistance and employee assistance programs), does not include assessment

RNE

H0029

Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g., alcohol free social events)

RNE

030

H0030

Behavioral health hotline service RNE

030

H0031

Mental health assessment, by non-physician RNE

030

H0032

Mental health service plan development by non-physician RNE

030

H0033

Oral medication administration, direct observation RNE

030

H0034

Medication training and support, per 15 minutes RNE

030

H0035

Mental health partial hospitalization, treatment, less than 24 hours RNE

030

H0036

Community psychiatric supportive treatment, face-to-face, per 15 minutes RNE

030

H0037

Community psychiatric supportive treatment program, per diem RNE

030

H0038

Self-help/peer services, per 15 minutes RNE

030

H0039

Assertive community treatment, face-to-face, per 15 minutes RNE

030

H0040

Assertive community treatment program, per diem RNE

030

H0041

Foster care, child, non-therapeutic, per diem RNE

030

H0042

Foster care, child, non-therapeutic, per month RNE

030

H0043

Supported housing, per diem RNE

030

H0044

Supported housing, per month RNE

030

H0045

Respite care services, not in the home, per diem RNE

030

H0046

Mental health services, not otherwise specified RNE

030

H0047

Alcohol and/or other drug abuse services, not otherwise specified RNE

030

H0048

Alcohol and/or other drug testing: collection and handling only, specimens other than blood

RNE

020

H1000

Prenatal care, at-risk assessment RNE


HCPCS


▲

Revised code

●

New code

M

Deleted from HCPCS

R

RVSI Code

(I)

Interim Value


HC

PC

S


P9021

Red blood cells, each unit RNE

P9022

Red blood cells, washed, each unit RNE

P9023

Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit RNE

P9031

Platelets, leukocytes reduced, each unit RNE

P9032

Platelets, irradiated, each unit RNE

P9033

Platelets, leukocytes reduced, irradiated, each unit RNE

P9034

Platelets, pheresis, each unit RNE

P9035

Platelets, pheresis, leukocytes reduced, each unit RNE

P9036

Platelets, pheresis, irradiated, each unit RNE

P9037

Platelets, pheresis, leukocytes reduced, irradiated, each unit RNE

P9038

Red blood cells, irradiated, each unit RNE

P9039

Red blood cells, deglycerolized, each unit RNE

P9040

Red blood cells, leukocytes reduced, irradiated, each unit RNE

020

P9041

Infusion, albumin (human), 5%, 50 ml RNE

020

P9043

Infusion, plasma protein fraction (human), 5%, 50 ml RNE

P9044

Plasma, cryoprecipitate reduced, each unit RNE

020

P9045


020

P9046


020

P9047


020

P9048

Infusion, plasma protein fraction (human), 5%, 250 ml RNE

020

P9050

Granulocytes, pheresis, each unit RNE

040

●

P9051

Whole blood or red blood cells, leukocytes reduced, CMV-negative, each unit

RNE

040

●

P9052

Platelets, HLA-matched leukocytes reduced, apheresis/pheresis, each unit RNE

040

●

P9053

Platelets, pheresis, leukocytes reduced, CMV-negative, irradiated, each unit RNE

040

●

P9054

Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, each unit

RNE

040

●

P9055

Platelets, leukocytes reduced, CMV-negative, apheresis/pheresis, each unit RNE

040

●

P9056

Whole blood, leukocytes reduced, irradiated, each unit RNE

040

●

P9057

Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit

RNE

040

●

P9058

Red blood cells, leukocytes reduced, CMV-negative, irradiated, each unit RNE

040

●

P9059

Fresh frozen plasma between 8-24 hours of collection, each unit RNE


HCPCS

▲

Revised code

●

New code

M

Deleted from HCPCS

R

RVSI Code

(I)

Interim Value


HC

PC

S

040

●

P9060

Fresh frozen plasma, donor retested, each unit RNE

P9603

Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing home bound patient; prorated miles actually travelled

RNE

P9604

Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing home bound patient; prorated trip charge

RNE

040

P9612

Catheterization for collection of specimen, single patient, all places of service

1.0 (I)

040

P9615

Catheterization for collection of specimen(s) (multiple patients) 1.0 (I)

Q0035 0026TC

Cardiokymography 5.92.53.4

Q0081

Infusion therapy, using other than chemotherapeutic drugs, per visit RNE

Q0083

Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit

RNE

Q0084

Chemotherapy administration by infusion technique only, per visit RNE

Q0085

Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit

RNE

040

M

Q0086

Physical therapy evaluation/treatment, per visit

This code has been deleted.

RNE

Q0091

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

2.8

Q0092

Set-up portable x-ray equipment 2.6

040

Q0111

Wet mounts, including preparations of vaginal, cervical or skin specimens 1.5 (I)

040

Q0112

All potassium hydroxide (KOH) preparations 1.5 (I)

040

Q0113

Pinworm examination 2.0 (I)

040

Q0114

Fern test 2.7 (I)

040

Q0115

Post-coital direct, qualitative examinations of vaginal or cervical mucous 3.7 (I)

Q0136

Injection, epoetin alpha, (for non ESRD use), per 1,000 units RNE

040

●

Q0137

Injection, darbepoetin alfa, 1 mcg (non-ESRD use) RNE

030

Q0144

Azithromycin dihydrate, oral, capsules/powder, 1 gram RNE

Q0163

Diphenhydramine HCl, 50 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen

RNE

Q0164

Prochlorperazine maleate, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen

RNE



R Code Crosswalk

R C

ode

Cro

ssw

alk

The editors have decided to include some descriptions and unit values not found in the standard coding nomenclature in order to assist users in addressing reimbursement issues that the standard nomenclature may not cover.

When a procedure or service provided is not adequately identified, use of an unlisted procedure code for the related anatomical area is usually appropriate. Most codes of this nature have 99 for the last two digits. The editors have decided to list under several unlisted service/procedure codes some R code descriptions and unit values that might help the user with reimbursement. These codes are clearly identified by an "Rx" in the Type column.

The editors will continue to expand the coding system to further simplify the reimbursement process. Such codes will have a separate designation. Payers and physicians may use either the separate code or the CPT code indicated including the description and value listed in


. Many new or uncommon procedures may require an operative report based upon the individual case, physician and/or payer. (Note: Payers and providers may or may not contractually require specific use of nomenclature. Communicate your questions to the individual payer or physician, as appropriate.) A complete R code crosswalk appears below.

Code

Modif

ier CPTReferral

UPD Unit AnesGlobal Period

Long Descriptions

328AA 32999

144.0 (I) 15 YYY Lung Transplant, double (bilateral sequential or en bloc); with bronchoplasty

471AA 47399

152.0 (I) 30 YYY Liver allotransplantation; with aorto-hepatic arterial conduit

471AB 47399

156.0 (I) 30 YYY Liver allotransplantation; with port-hepatic venous conduit

471AC 47399

148.0 (I) 30 YYY Liver allotransplantation; with choledochojejunostomy

471AD 47399

152.0 (I) 30 YYY Liver allotransplantation; with take down of portocaval shunt

471AE 47399

148.0 (I) 30 YYY Liver allotransplantation; with take down splenorenal shunt, proximal

471AF 47399

148.0 (I) 30 YYY Liver allotransplantation; with take down splenorenal shunt, distal

471AG 47399

148.0 (I) 30 YYY Liver allotransplantation; with mesocaval shunt

471AH 47399

150.0 (I) 30 YYY Liver allotransplantation; with splenectomy for hyperslenism


Procedural Index

Ind

ex

This index is intended to direct the user to a general area. Please refer to your CPT index for a more specific procedural description and/or code reference.

Abdomen

Excision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22900Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . 22999

Abdomen, Peritoneum, and Omentum

Excision . . . . . . . . . . . . . . . . . . . . . . . . . 49180-49255Hernioplasty, Herniorrhaphy, Herniotomy

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49491-49611Incision. . . . . . . . . . . . . . . . . . . . . . . . . . 49000-49085Introduction and Revision . . . . . . . . . . . 49400-49429Laparoscopy - Hernia Repair . . . . . . . . . 49650-49659Laparoscopy - Other. . . . . . . . . . . . . . . . 49320-49329Other Procedures . . . . . . . . . . . . . . . . . . 49904-49999Suture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49900

Accessory Sinuses

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . 31231-31294Excision . . . . . . . . . . . . . . . . . . . . . . . . . 31200-31230Incision. . . . . . . . . . . . . . . . . . . . . . . . . . 31000-31090Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . 31299

Allergy and Clinical Immunology

Allergen Immunotherapy . . . . . . . . . . . . 95115-95199Allergy Testing . . . . . . . . . . . . . . . . . . . . 95004-95078

Anatomic Pathology

. . . . . . . . . . . . . . . . . . 88000-88099

Anesthesia

Abdomen Lower. . . . . . . . . . . . . . . . . . . . . . . . 00800-00882Upper. . . . . . . . . . . . . . . . . . . . . . . . 00700-00797

ArmForearm, Wrist, and Hand. . . . . . . . 01810-01860Upper Arm and Elbow. . . . . . . . . . . 01710-01782

Burn Excisions or Debridement . . . . . . . 01951-01953Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00100-00222Intrathoracic. . . . . . . . . . . . . . . . . . . . . . 00500-00580Leg

Knee and Popliteal Area . . . . . . . . . 01320-01444Lower Leg Below Knee . . . . . . . . . . 01462-01522Upper Leg Except Knee. . . . . . . . . . 01200-01274

Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00300-00352

Obstetric . . . . . . . . . . . . . . . . . . . . . . . . . 01958-01969Other Anesthesia Procedures . . . . . . . . . 01990-01999

Pelvis . . . . . . . . . . . . . . . . . . . . . . . . 01112-01190Perineum . . . . . . . . . . . . . . . . . . . . . 00902-00952Radiological Procedures . . . . . . . . . . 01905-01933Shoulder and Axilla . . . . . . . . . . . . . 01610-01682Spine and Spinal Cord . . . . . . . . . . . 00600-00797Thorax . . . . . . . . . . . . . . . . . . . . . . . 00400-00474

Anus

Destruction . . . . . . . . . . . . . . . . . . . . . . . 46900-46942Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . 46600-46615Excision. . . . . . . . . . . . . . . . . . . . . . . . . . 46200-46320Incision . . . . . . . . . . . . . . . . . . . . . . . . . . 46020-46083Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 46500Other Procedures. . . . . . . . . . . . . . . . . . . . . . . . 46999Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . 46700-46762Suture . . . . . . . . . . . . . . . . . . . . . . . . . . . 46945-46946

Appendix

Excision. . . . . . . . . . . . . . . . . . . . . . . . . . 44950-44960Incision . . . . . . . . . . . . . . . . . . . . . . . . . . 44900-44901Laparoscopy . . . . . . . . . . . . . . . . . . . . . . 44970-44979

Application of Casts and Strapping

Body and Upper Extremity . . . . . . . . . . . 29000-29280Lower Extremity . . . . . . . . . . . . . . . . . . . 29305-29590Other Procedures. . . . . . . . . . . . . . . . . . . . . . . . 29799Removal or Repair . . . . . . . . . . . . . . . . . . 29700-29750

Arteries and Veins

Adjuvant Techniques. . . . . . . . . . . . . . . . 35685-35686Aneurysm or Excision Repair . . . . . . . . . 35001-35162Angioscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35400Arterial. . . . . . . . . . . . . . . . . . . . . . . . . . . 36600-36660Arterial Embolectomy or Thrombectomy34001-34203Arterial Transposition . . . . . . . . . . . . . . . 35691-35697Bypass Graft, In-Situ Vein . . . . . . . . . . . . 35582-35587Bypass Graft, Vein . . . . . . . . . . . . . . . . . . 35500-35572Bypass Graft, With Other Than Vein. . . . 35600-35671Central Venous Access . . . . . . . . . . . . . . 36555-36597Composite Graft . . . . . . . . . . . . . . . . . . . 35681-35683Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . 37500-37501Endovascular Repair Abdominal Aortic Aneurysm . .

34800-34834


Procedural Index


Ind

ex

Endovascular Repair Iliac Aneurysm . . . . . . . . . 34900Exploration. . . . . . . . . . . . . . . . . . . . . . . 35700-35907In-Situ Vein Bypass. . . . . . . . . . . . . . . . . 35582-35587Intervascular Cannulization or Shunt . . 36800-36870Intravascular Ultrasound . . . . . . . . . . . . 37250-37251Intraosseous . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36680Ligation and Other Procedures . . . . . . . 37565-37799Portal Decompression . . . . . . . . . . . . . . 37140-37183Repair Arteriovenous Fistula . . . . . . . . . 35180-35190Repair Other Blood Vessel . . . . . . . . . . . 35201-35286Thromboendarterectomy . . . . . . . . . . . . 35301-35390Transcatheter . . . . . . . . . . . . . . . . . . . . . 37195-37209Transcatheter Therapy and Biopsy . . . . . . . . . . . 37200Transluminal Angioplasty . . . . . . . . . . . 35450-35476Transluminal Atherectomy. . . . . . . . . . . 35480-35495Vascular Injections . . . . . . . . . . . . . . . . . 36000-36299Venipuncture . . . . . . . . . . . . . . . . . . . . . 36400-36550Venous Reconstruction . . . . . . . . . . . . . 34501-34530Venous Thrombectomy . . . . . . . . . . . . . 34401-34490

Arthroscopy

. . . . . . . . . . . . . . . . . . . . . . . . . 29800-29999

Auditory System

External Ear . . . . . . . . . . . . . . . . . . . . . . 69000-69399Inner Ear . . . . . . . . . . . . . . . . . . . . . . . . 69801-69949Middle Ear . . . . . . . . . . . . . . . . . . . . . . . 69400-69799Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . 69979Temporal Bone, Middle Fossa

Approach . . . . . . . . . . . . . . . . . . . . . 69950-69970

Back and Flank

Excision . . . . . . . . . . . . . . . . . . . . . . . . . 21920-21935

Biliary Tract

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . 47550-47556Excision . . . . . . . . . . . . . . . . . . . . . . . . . 47600-47716Incision. . . . . . . . . . . . . . . . . . . . . . . . . . 47400-47490Introduction . . . . . . . . . . . . . . . . . . . . . . 47500-47530Laparoscopy . . . . . . . . . . . . . . . . . . . . . . 47560-47579Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . 47999Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . 47720-47900

Biofeedback

. . . . . . . . . . . . . . . . . . . . . . . . . 90901-90911

Bladder

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . 52000-52010Excision . . . . . . . . . . . . . . . . . . . . . . . . . . 5150051597Incision. . . . . . . . . . . . . . . . . . . . . . . . . . . 5100051080Introduction . . . . . . . . . . . . . . . . . . . . . . . 5160051720Laparoscopy . . . . . . . . . . . . . . . . . . . . . . . 5199051992Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5180051980Ureter and Pelvis Surgery . . . . . . . . . . . . 52320-52355Urethra and Bladder Surgery . . . . . . . . . 52204-52318Urodynamics . . . . . . . . . . . . . . . . . . . . . . 5172551798Vesical, Neck, Prostate Surgery . . . . . . . 52400-52700

Bone Marrow Transplantation

. . . . . . . . . . 38204-38242

Breast

Excision . . . . . . . . . . . . . . . . . . . . . . . . . 19100-19272

Incision . . . . . . . . . . . . . . . . . . . . . . . . . . 19000-19030Introduction . . . . . . . . . . . . . . . . . . . . . . 19290-19295Other Procedures . . . . . . . . . . . . . . . . . . . . . . . 19499Repair, Revision or Reconstruction. . . . . 19316-19396

Cardiovascular

Cardiac Catheterization. . . . . . . . . . . . . . 93501-93572Cardiography. . . . . . . . . . . . . . . . . . . . . . 93000-93278Echocardiography . . . . . . . . . . . . . . . . . . 93303-93350Intracardiac ElectrophysiologicalProcedures. . . . . . . . . . . . . . . . . . . . . . . . 93600-93662Other Procedures . . . . . . . . . . . . . . . . . . 93797-93799Other Vascular Studies . . . . . . . . . . . . . . 93701-93790Peripheral Arterial Disease

Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . 93668Repair of Septal Defect . . . . . . . . . . . . . . 93580-93581Therapeutic Services . . . . . . . . . . . . . . . . 92950-92998

Care Plan Oversight Services

. . . . . . . . . . . . 99374-99380

Case Management Services

Team Conferences . . . . . . . . . . . . . . . . . . 99361-99362Telephone Calls . . . . . . . . . . . . . . . . . . . . 99371-99373

Central Nervous System Assessments/Tests

96100-96117

Cervix Uteri

Endoscopy. . . . . . . . . . . . . . . . . . . . . . . . 57452-57461Excision. . . . . . . . . . . . . . . . . . . . . . . . . . 57500-57556Manipulation. . . . . . . . . . . . . . . . . . . . . . 57800-57820Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . 57700-57720

Chemistry

. . . . . . . . . . . . . . . . . . . . . . . . . . . 82000-84999

Chemotherapy Administration

. . . . . . . . . .96400–96549

Chemotherapy Administration

. . . . . . . . . . . 96400-96549

Chiropractic Manipulative Treatment

. . . . . 98940-98943

Clinical Treatment Management

Clinical Brachytherapy . . . . . . . . . . . . . . 77750-77799Clinical Intracavitary Hyperthermia . . . . . . . . . 77620Hyperthermia . . . . . . . . . . . . . . . . . . . . . 77600-77615

Consultations

Confirmatory Consultations . . . . . . . . . . 99271-99275Follow-Up Inpatient Consultations . . . . 99261-99263Initial Inpatient Consultations . . . . . . . . 99251-99255Office or Other Outpatient

Consultations . . . . . . . . . . . . . . . . . . 99241-99245

Consultations (Clinical Pathology)

. . . . . . . 80500-80502

Corpus Uteri

Excision. . . . . . . . . . . . . . . . . . . . . . . . . . 58100-58294Introduction . . . . . . . . . . . . . . . . . . . . . . 58300-58353Laparoscopy and Hysteroscopy. . . . . . . . 58545-58579Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . 58400-58540

relative values for physicians

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