Standard Health Insurance Fees for the Cayman Islands-June 2005

Gazette No. 15 dated 7 March, 2014.

THE STANDARD HEALTH INSURANCE FEES FOR THE CAYMAN ISLANDS - JUNE 2005

CPT Mod FEE 10021 Fine needle aspiration w/o imaging guidance 196.46

10022 Fine needle aspiration with imaging guidance 215.09

10040 Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)

10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous 134.44

10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous 358.05

10080 Incision and drainage of pilonidal cyst; simple

10081 Incision and drainage of pilonidal cyst; complicated 450.90

10120 Incision and removal of foreign body, subcutaneous tissues; simple 149.67

10121 Incision and removal of foreign body, subcutaneous tissues; complicated 413.45

10140 Incision and drainage of hematoma, seroma or fluid collection 183.32

10160 Puncture aspiration of abscess, hematoma, bulla, or cyst 125.34

10180 Incision and drainage, complex, postoperative wound infection 560.32

11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface 105.86

11001 Debridement of extensive eczematous or infected skin; each additional 10% of the body surface (List

11004 Dbrdmt skn subq t/m/f necro infctj gent&pr 756.94

11005 Dbrdmt skn subq t/m/f necro infctj abdl wall 1,068.79

11006 Dbrdmt skn subq t/m/f necro infctj gent/abdl 973.26

11008 Removal prosthetic matrl abdl wall for infection 437.12

11010 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); 1,060.20

11011 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); 1,257.30

11012 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s);

11042 Debridement; skin, and subcutaneous tissue 329.26

11043 Debridement; skin, subcutaneous tissue, and muscle 657.90

11044 Debridement; skin, subcutaneous tissue, muscle, and bone 846.90

11045 Deb subq tissue add-on 43.79

11046 Deb musc/fascia add-on 99.37

11047 Deb bone add-on 191.93

11055 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion 53.90

11056 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); two to four lesions 71.21

11057 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than four lesions 94.76

11100 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise 134.31

11101 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise 77.57

11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions 130.55

11201 Removal of skin tags, multiple fibrocutaneous tags, any area; each additional ten lesions (List separately in 94.70

11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less 113.80

11301 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm 142.45

11302 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm 178.74

11303 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm 289.80

11305 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 125.15

11306 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 166.40

11307 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1

11308 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 261.50

11310 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; 141.10

11311 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane;

11312 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane;

11313 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; 283.29

11400 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 151.78

11401 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.6 to 195.44

11402 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 1.1 to

11403 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 2.1 to 323.56

11404 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 3.1 to 435.46

11406 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter over 597.16

11420 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion 169.16

11421 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion 216.78

11422 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion 286.82

11423 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion 392.07

11424 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion 492.99

11426 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion 663.24

11440 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; 195.81

11441 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; 262.16

11442 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; 345.79

11443 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; 490.50

11444 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; 632.70

11446 Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; 791.10

11450 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair 1,283.40

11451 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair 1,612.80

11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair 1,218.60

11463 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair

11470 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or 1,282.38

11471 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex 1,171.35

CPT Mod FEE 11600 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or less 234.57

11601 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm 275.71

11602 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 1.1 to 2.0 cm 344.99

11603 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 2.1 to 3.0 cm 438.13

11604 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 3.1 to 4.0 cm 582.43

11606 Excision, malignant lesion, trunk, arms, or legs; lesion diameter over 4.0 cm 780.74

11620 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less 305.93

11621 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm 389.86

11622 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm 468.68

11623 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm 568.31

11624 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm

11626 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm 990.00

11640 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or less 356.89

11641 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.6 to 1.0 cm 457.43

11642 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0 cm 584.34

11643 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 2.1 to 3.0 cm 850.50

11644 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 3.1 to 4.0 cm

11646 Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter over 4.0 cm 1,174.50

11719 Trimming of nondystrophic nails, any number 39.46

11720 Debridement of nail(s) by any method(s); one to five 87.30

11721 Debridement of nail(s) by any method(s); six or more

11730 Avulsion of nail plate, partial or complete, simple; single 109.04

11732 Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to

11740 Evacuation of subungual hematoma

11750 Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed nail) for permanent removal; 341.38

11752 Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed nail) for permanent removal; 748.80

11755 Biopsy of nail unit, any method (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds)

11760 Repair of nail bed

11762 Reconstruction of nail bed with graft

11765 Wedge excision of skin of nail fold (eg, for ingrown toenail) 226.39

11770 Excision of pilonidal cyst or sinus; simple 669.18

11771 Excision of pilonidal cyst or sinus; extensive 1,315.80

11772 Excision of pilonidal cyst or sinus; complicated 1,673.10

11900 Injection, intralesional; up to and including seven lesions 68.38

11901 Injection, intralesional; more than seven lesions 103.02

11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including

11921 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including 1,409.40

11922 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including

11950 Subcutaneous injection of filling material (eg, collagen); 1 cc or less 348.30

11951 Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc 549.90

11952 Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc 899.10

11954 Subcutaneous injection of filling material (eg, collagen); over 10.0 cc

11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion 3,000.60

11970 Replacement of tissue expander with permanent prosthesis 3,060.90

11971 Removal of tissue expander(s) without insertion of prosthesis 1,102.50

11976 Removal, implantable contraceptive capsules

11980 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the 430.20

11981 Insj non-biodegradable drug delivery implant

11982 Removal non-biodegradable drug delivery implant 165.40

11983 Rmvl w/rinsj non-biodegradable drug dlvr implt 193.58

12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities 179.15

12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities 230.42

12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities

12005 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities 421.20

12006 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities 487.80

12007 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities 675.90

12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or 222.77

12013 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 288.43

12014 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 363.06

12015 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 477.90

12016 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 629.10

12017 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to

12018 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 1,124.10

12020 Treatment of superficial wound dehiscence; simple closure 388.79

12021 Treatment of superficial wound dehiscence; with packing

12031 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less 255.60

12032 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5

12034 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 423.00

12035 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 555.30

12036 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 719.10

CPT Mod FEE 12037 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm

12041 Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less

12042 Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm 352.09

12044 Layer closure of wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm

12045 Layer closure of wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm

12046 Layer closure of wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm 812.70

12047 Layer closure of wounds of neck, hands, feet and/or external genitalia; over 30.0 cm 963.00

12051 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

12052 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 470.70

12053 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm 549.00

12054 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm

12055 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm 942.30

12056 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm

12057 Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm 1,338.30

13100 Repair, complex, trunk; 1.1 cm to 2.5 cm

13101 Repair, complex, trunk; 2.6 cm to 7.5 cm 599.40

13102 Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary

13120 Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm 506.70

13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm 786.60

13122 Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code

13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 538.80

13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5

13133 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional

13150 Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less 590.40

13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm

13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm

13153 Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to

13160 Secondary closure of surgical wound or dehiscence, extensive or complicated 1,059.69

14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less 1,088.10

14001 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm 1,612.80

14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less 1,434.60

14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm 1,829.70

14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands 1,531.29

14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands 2,181.60

14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 1,995.30

14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 3,169.80

14301 Att/r any area defect 30.1-60sqcm 2,113.30

14302 Att/r any area defect ea addl 30sqcm or part 480.88

14350 Filleted finger or toe flap, including preparation of recipient site 1,583.10

15002 Prep site trunk/arm/leg 1st 100 sq cm/1pct 700.87

15003 Prep site t/a/l addl 100 sq cm/1pct 165.33

15004 Prep site f/s/n/h/f/g/m/d gt 1st 100 sq cm/1pct 832.59

15005 Prep site f/s/n/h/f/g/m/d gt addl 100 sq cm/1pct 265.38

15040 Harvest skin tissue cltr skin agrft 100 cm/< 563.25

15050 Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face),

15100 Split graft, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children 1,463.40

15101 Split graft, trunk, arms, legs; each additional 100 sq cm, or each additional one percent of body area of 889.20

15110 Epidrm agrft t/a/l 1st 100 cm/</1% bdy inft/chld 1,887.78

15111 Epidrm agrft t/a/l ea 100 cm/ea 1% bdy inft/chld 294.39

15115 Epidermal agrft f/s/n/h/f/g/m/d gt 1st 100 cm 1,815.60

15116 Epidermal agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 402.77

15120 Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 1,939.50

15121 Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each

15130 Dermal autograft trunk/arm/leg 1st 100 cm 1,469.33

15131 Dermal autograft trunk/arm/leg ea 100 cm/ea 246.06

15135 Dermal autograft f/s/n/h/f/g/m/d gt 1st 100 1,861.86

15136 Dermal agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 227.31

15150 Cltr epidermal autograft t/a/l 1st 25 cm/< 1,481.15

15151 Cltr epidermal agrft t/a/l addl 1 cm-75 cm 297.75

15152 Cltr epidrm agrft t/a/l ea 100 cm/ea 1 % bdy 391.91

15155 Cltr epidrm agrft f/s/n/h/f/g/m/d gt 1st 25cm/< 1,472.04

15156 Cltr epidrm agrft f/s/n/h/f/g/m/d gt addl 1-75cm 424.98

15157 Cltr epidrm agrft f/s/n/h/f/g/m/d gt ea 100 ea 481.51

15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less 1,299.60

15201 Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm (List

15220 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less 1,439.10

15221 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 1,093.50

15240 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, 1,896.30

15241 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae,

15260 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or

CPT Mod FEE 15261 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each 1,210.50

15271 Skin sub graft trnk/arm/leg 333.18

15272 Skin sub graft t/a/l add-on 61.22

15273 Skin sub grft t/arm/lg child 666.04

15274 Skn sub grft t/a/l child add 148.68

15275 Skin sub graft face/nk/hf/g 375.67

15276 Skin sub graft f/n/hf/g addl 82.06

15277 Skn sub grft f/n/hf/g child 722.08

15278 Skn sub grft f/n/hf/g ch add 178.84

15570 Formation of direct or tubed pedicle, with or without transfer; trunk

15572 Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs 2,704.50

15574 Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, 3,028.50

15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral

15600 Delay of flap or sectioning of flap (division and inset); at trunk 1,055.70

15610 Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs 1,318.50

15620 Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia,

15630 Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips 1,637.10

15650 Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, Walking tube), any location 1,534.50

15731 Forehead flap w/ preservation vascular pedicle 2,785.60

15732 Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter, 4,818.60

15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk 4,878.90

15736 Muscle, myocutaneous, or fasciocutaneous flap; upper extremity

15738 Muscle, myocutaneous, or fasciocutaneous flap; lower extremity 5,279.40

15740 Flap; island pedicle 2,682.00

15750 Flap; neurovascular pedicle 2,973.60

15756 Free muscle flap with or without skin with microvascular anastomosis 8,005.50

15757 Free skin flap with microvascular anastomosis 8,005.50

15758 Free fascial flap with microvascular anastomosis 7,990.20

15760 Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area 2,485.80

15770 Graft; derma-fat-fascia 1,962.00

15775 Punch graft for hair transplant; 1 to 15 punch grafts

15776 Punch graft for hair transplant; more than 15 punch grafts 477.00

15777 Acellular derm matrix implt 486.36

15780 Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) 2,763.90

15781 Dermabrasion; segmental, face

15782 Dermabrasion; regional, other than face

15783 Dermabrasion; superficial, any site, (eg, tattoo removal)

15786 Abrasion; single lesion (eg, keratosis, scar)

15787 Abrasion; each additional four lesions or less (List separately in addition to code for primary procedure)

15788 Chemical peel, facial; epidermal

15789 Chemical peel, facial; dermal 1,901.70

15792 Chemical peel, nonfacial; epidermal 544.50

15793 Chemical peel, nonfacial; dermal

15819 Cervicoplasty 2,246.40

15820 Blepharoplasty, lower eyelid; 2,253.60

15821 Blepharoplasty, lower eyelid; with extensive herniated fat pad 2,111.40

15822 Blepharoplasty, upper eyelid; 2,542.50

15823 Blepharoplasty, upper eyelid; with excessive skin weighting down lid 1,815.30

15824 Rhytidectomy; forehead 2,471.40

15825 Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap) 3,511.80

15826 Rhytidectomy; glabellar frown lines 2,010.60

15828 Rhytidectomy; cheek, chin, and neck 6,599.70

15829 Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap 4,630.50

15830 Excision skin abd infraumbilical panniculectomy 1,777.49

15832 Excision, excessive skin and subcutaneous tissue (including lipectomy); thigh 4,589.10

15833 Excision, excessive skin and subcutaneous tissue (including lipectomy); leg 4,349.70

15834 Excision, excessive skin and subcutaneous tissue (including lipectomy); hip 4,292.10

15835 Excision, excessive skin and subcutaneous tissue (including lipectomy); buttock 4,674.60

15836 Excision, excessive skin and subcutaneous tissue (including lipectomy); arm 2,920.50

15837 Excision, excessive skin and subcutaneous tissue (including lipectomy); forearm or hand

15838 Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad

15839 Excision, excessive skin and subcutaneous tissue (including lipectomy); other area 2,462.40

15840 Graft for facial nerve paralysis; free fascia graft (including obtaining fascia) 3,744.00

15841 Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

15842 Graft for facial nerve paralysis; free muscle flap by microsurgical technique 6,190.20

15845 Graft for facial nerve paralysis; regional muscle transfer 3,721.50

15850 Removal of sutures under anesthesia (other than local), same surgeon 215.03

15851 Removal of sutures under anesthesia (other than local), other surgeon 259.49

15852 Dressing change (for other than burns) under anesthesia (other than local)

15860 Intravenous injection of agent (eg, fluorescein) to test blood flow in flap or graft

CPT Mod FEE 15920 Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture 1,419.30

15922 Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure

15931 Excision, sacral pressure ulcer, with primary suture; 1,540.80

15933 Excision, sacral pressure ulcer, with primary suture; with ostectomy 2,388.60

15934 Excision, sacral pressure ulcer, with skin flap closure; 2,937.60

15935 Excision, sacral pressure ulcer, with skin flap closure; with ostectomy

15936 Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;

15937 Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with 4,108.50

15940 Excision, ischial pressure ulcer, with primary suture;

15941 Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)

15944 Excision, ischial pressure ulcer, with skin flap closure;

15945 Excision, ischial pressure ulcer, with skin flap closure; with ostectomy

15946 Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft 3,663.00

15950 Excision, trochanteric pressure ulcer, with primary suture;

15951 Excision, trochanteric pressure ulcer, with primary suture; with ostectomy

15952 Excision, trochanteric pressure ulcer, with skin flap closure;

15953 Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy

15956 Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; 3,924.90

15958 Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; 4,222.80

16000 Initial treatment, first degree burn, when no more than local treatment is required

16020 Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small 115.89

16025 Dressings and/or debridement, initial or subsequent; without anesthesia, medium (eg, whole face or whole 217.86

16030 Dressings and/or debridement, initial or subsequent; without anesthesia, large (eg, more than one 363.34

16035 Escharotomy; initial incision

16036 Escharotomy; each additional incision (List separately in addition to code for primary procedure)

17000 Destruction by any method, including laser, with or without surgical curettement, all benign or premalignant 97.34

17003 Destruction by any method, including laser, with or without surgical curettement, all benign or premalignant 37.26

17004 Destruction by any method, including laser, with or without surgical curettement, all benign or premalignant 540.00

17106 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm 621.00

17107 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 - 50.0 sq cm 1,326.60

17108 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm

17110 Destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions 110.03

17111 Destruction by any method of flat warts, molluscum contagiosum, or milia; 15 or more lesions

17250 Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)

17260 Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.5 cm or less

17261 Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm 211.98

17262 Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm

17263 Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 2.1 to 3.0 cm 333.90

17264 Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 3.1 to 4.0 cm

17266 Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter over 4.0 cm

17270 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or 234.00

17271 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm

17272 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm 371.70

17273 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm 344.97

17274 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm

17276 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm

17280 243.00

17281 279.83

17282

17283 521.10

17284 677.70

17286

17311 Mohs micrographic h/n/h/f/g 1st stage 5 blocks 1,151.03

17312 Mohs micrographic h/n/h/f/g each addl stage 698.32

17313 Mohs trunk/arm/leg 1st stage 5 blocks 1,056.66

17314 Mohs trunk/arm/leg ea stage after 1st stage 651.22

17315 Mohs trunk/arm/leg ea addl block any stage 139.63

17340 Cryotherapy (CO2 slush, liquid N2) for acne 74.83

17360 Chemical exfoliation for acne (eg, acne paste, acid)

17380 Electrolysis epilation, each 1/2 hour

19000 Puncture aspiration of cyst of breast; 158.21

19001 Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary 83.70

19020 Mastotomy with exploration or drainage of abscess, deep

19030 Injection procedure only for mammary ductogram or galactogram

19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)

19101 Biopsy of breast; open, incisional 781.20

19102 Biopsy of breast; percutaneous, needle core, using imaging guidance 386.34

19103 Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device, using imaging 910.80

19105 Abltj cryosurgical w/ us gid ea fibroadenoma 3,171.04

19110 Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct

CPT Mod FEE 19112 Excision of lactiferous duct fistula 1,004.40

19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, 1,105.37

19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion 1,289.70

19126 Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional 832.50

19260 Excision of chest wall tumor including ribs 3,146.40

19271 Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal 4,221.90

19272 Excision of chest wall tumor involving ribs, with plastic reconstruction; with mediastinal lymphadenectomy 5,622.30

19290 Preoperative placement of needle localization wire, breast;

19291 Preoperative placement of needle localization wire, breast; each additional lesion (List separately in addition

19295 Image guided placement, metallic localization clip, percutaneous, during breast biopsy (List separately in

19296 Plmt expandable cath brst following prtl mast 9,940.72

19297 Plmt expandable cath brst concurrent prtl mast 218.27

19298 Plmt radthx brachytx brst following prtl mast 3,605.44

19300 Mastectomy gynecomastia 1,131.18

19301 Mastectomy partial 933.84

19302 Mastectomy partial w/axillary lymphadenectomy 1,977.47

19303 Mastectomy simple complete 1,597.79

19304 Mastectomy subcutaneous 1,169.33

19305 Mast rad w/pectoral muscles axillary lymph nodes 2,032.87

19306 Mast rad w/pectoral musc ax int mam lymph nodes 2,299.98

19307 Mast modf rad w/ax lymph nod w/wo pect/alis min 2,325.26

19316 Mastopexy 2,891.70

19318 Reduction mammaplasty 4,137.80

19324 Mammaplasty, augmentation; without prosthetic implant 1,761.30

19325 Mammaplasty, augmentation; with prosthetic implant 2,711.70

19328 Removal of intact mammary implant 1,848.60

19330 Removal of mammary implant material 3,030.30

19340 Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction 3,031.20

19342 Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction 2,786.40

19350 Nipple/areola reconstruction

19355 Correction of inverted nipples

19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion

19361 Breast reconstruction with latissimus dorsi flap, with or without prosthetic implant 5,408.10

19364 Breast reconstruction with free flap 5,675.40

19366 Breast reconstruction with other technique 5,778.90

19367 Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, 8,446.50

19368 Breast reconstruction tram 1 pedcl mvasc anast 6,352.72

19369 Breast reconstruction tram flap double pedicle 5,552.58

19370 Open periprosthetic capsulotomy, breast

19371 Periprosthetic capsulectomy, breast

19380 Revision of reconstructed breast

19396 Preparation of moulage for custom breast implant

20005 Incision of soft tissue abscess (eg, secondary to osteomyelitis); deep or complicated 664.63

20100 Exploration of penetrating wound (separate procedure); neck 1,610.10

20101 Exploration of penetrating wound (separate procedure); chest

20102 Exploration of penetrating wound (separate procedure); abdomen/flank/back 798.30

20103 Exploration of penetrating wound (separate procedure); extremity 1,134.00

20150 Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial 2,912.40

20200 Biopsy, muscle; superficial

20205 Biopsy, muscle; deep 617.40

20206 Biopsy, muscle, percutaneous needle 272.70

20220 Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

20225 Biopsy, bone, trocar, or needle; deep (vertebral body, femur) 814.50

20240 Biopsy, bone, excisional; superficial (eg, ilium, sternum, spinous process, ribs, trochanter of femur)

20245 Biopsy, bone, excisional; deep (eg, humerus, ischium, femur) 1,028.70

20250 Biopsy, vertebral body, open; thoracic 3,141.00

20251 Biopsy, vertebral body, open; lumbar or cervical 2,589.30

20500 Injection of sinus tract; therapeutic (separate procedure)

20501 Injection of sinus tract; diagnostic (sinogram)

20520 Removal of foreign body in muscle or tendon sheath; simple 307.46

20525 Removal of foreign body in muscle or tendon sheath; deep or complicated

20526 Injection therapeutic carpal tunnel 135.84

20527 Inj dupuytren cord w/enzyme 184.62

20550 Injection, tendon sheath, ligament, trigger points or ganglion cyst 108.18

20551 Injection single tendon origin/insertion 104.87

20552 Injection single/mlt trigger point 1/2 muscles 103.78

20553 Injection single/mlt trigger point 3/> muscles 121.48

20555 Placement needles muscle subsequent radioelement 582.66

20600 Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst (eg, fingers, toes) 94.96

20605 Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst (eg, 107.28

CPT Mod FEE 20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial 135.03

20612 Aspiration&/injection ganglion cyst any location 105.01

20615 Aspiration and injection for treatment of bone cyst

20650 Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)

20660 Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure) 853.20

20661 Application of halo, including removal; cranial 1,326.60

20662 Application of halo, including removal; pelvic 902.70

20663 Application of halo, including removal; femoral

20664 Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric 1,032.30

20665 Removal of tongs or halo applied by another physician

20670 Removal of implant; superficial, (eg, buried wire, pin or rod) (separate procedure)

20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 857.90

20690 Application of a uniplane (pins or wires in one plane), unilateral, external fixation system 1,138.50

20692 Application of a multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, 1,752.30

20693 Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new 908.10

20694 Removal, under anesthesia, of external fixation system

20696 Xtrnl fixj w/stereotactic adjustment 1st&subq 1,752.70

20697 Xtrnl fixj w/strtctc adjustment exchange strut 2,193.99

20802 Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation 9,720.90

20805 Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation 10,085.40

20808 Replantation, hand (includes hand through metacarpophalangeal joints), complete amputation 11,040.30

20816 Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis 5,793.30

20822 Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation 5,794.20

20824 Replantation, thumb (includes carpometacarpal joint to MP joint), complete amputation 6,571.80

20827 Replantation, thumb (includes distal tip to MP joint), complete amputation

20838 Replantation, foot, complete amputation 9,888.30

20900 Bone graft, any donor area; minor or small (eg, dowel or button)

20902 Bone graft, any donor area; major or large 1,587.60

20910 Cartilage graft; costochondral 1,491.30

20912 Cartilage graft; nasal septum

20920 Fascia lata graft; by stripper

20922 Fascia lata graft; by incision and area exposure, complex or sheet 1,241.10

20924 Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris) 1,360.80

20926 Tissue grafts, other (eg, paratenon, fat, dermis) 1,014.30

20930 Allograft for spine surgery only; morselized

20931 Allograft for spine surgery only; structural

20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar

20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial

20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through 1,506.60

20950 Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique, needle

20955 Bone graft with microvascular anastomosis; fibula 10,791.90

20956 Bone graft with microvascular anastomosis; iliac crest 8,655.30

20957 Bone graft with microvascular anastomosis; metatarsal 8,967.60

20962 Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal 8,168.40

20969 Free osteocutaneous flap with microvascular anastomosis; other than iliac crest, metatarsal, or great toe 7,750.80

20970 Free osteocutaneous flap with microvascular anastomosis; iliac crest 9,907.20

20972 Free osteocutaneous flap with microvascular anastomosis; metatarsal 8,745.30

20973 Free osteocutaneous flap with microvascular anastomosis; great toe with web space 8,745.30

20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) 915.30

20975 Electrical stimulation to aid bone healing; invasive (operative)

20979 Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)

20982 Ablate bone tumor(s) perq 8,951.44

20985 Cptr-asst surgical navigation image-less 207.47

21010 Arthrotomy, temporomandibular joint 2,836.80

21011 Excision tumor soft tiss face/scalp subq < 2cm 441.95

21012 Excision tumor soft tiss face/scalp subq 2+cm 465.84

21013 Exc tumor soft tiss face&scalp subfascial < 2cm 767.09

21014 Exc tumor soft tiss face&scalp subfascial 2+cm 813.32

21015 Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scalp 1,773.90

21016 Rad resection tumor soft tiss face/scalp 2+cm 1,706.33

21025 Excision of bone (eg, for osteomyelitis or bone abscess); mandible 1,602.00

21026 Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s) 1,498.50

21029 Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)

21030 Excision of benign tumor or cyst of facial bone other than mandible 2,193.30

21031 Excision of torus mandibularis 696.60

21032 Excision of maxillary torus palatinus 1,056.60

21034 Excision of malignant tumor of facial bone other than mandible 3,169.80

21040 Excision of benign cyst or tumor of mandible; simple 1,246.50

21044 Excision of malignant tumor of mandible; 2,851.20

21045 Excision of malignant tumor of mandible; radical resection 5,918.40

CPT Mod FEE 21046 Exc benign tumor/cyst mndbl intra-oral osteot 1,872.04

21047 Exc b9 tum/cst mndbl xtr-oral osteot&prtl mndblc 2,304.17

21048 Exc benign tumor/cyst maxl intra-oral osteot 1,918.12

21049 Exc b9 tum/cst maxl xtr-oral osteot&prtl maxlct 2,210.72

21050 Condylectomy, temporomandibular joint (separate procedure) 3,355.20

21060 Meniscectomy, partial or complete, temporomandibular joint (separate procedure) 3,330.00

21070 Coronoidectomy (separate procedure) 2,724.30

21073 Mnpj of tmj w/anesth 524.35

21076 Impression&preparation surg obturator prosthesis 1,781.92

21077 Impression & preparation orbital prosthesis 4,473.18

21079 Impression&preparation interim obturator prosth 2,974.29

21080 Impression&prepj definitive obturator prosthesis 3,342.10

21081 Impression&prepj mandibular resection prosthesis 3,048.99

21082 Impression&prepj palatal augmentation prosthesis 2,792.30

21083 Impression&preparation palatal lift prosthesis 2,579.92

21084 Impression&preparation speech aid prosthesis 3,019.99

21085 Impression and custom preparation; oral surgical splint

21086 Impression&preparation auricular prosthesis 3,303.10

21087 Impression&preparation nasal prosthesis 3,302.27

21100 Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)

21110 Application of interdental fixation device for conditions other than fracture or dislocation, includes removal

21116 Injection procedure for temporomandibular joint arthrography

21120 Genioplasty; augmentation (autograft, allograft, prosthetic material) 2,880.90

21121 Genioplasty; sliding osteotomy, single piece

21122 Genioplasty; sliding osteotomies, two or more osteotomies (eg, wedge excision or bone wedge reversal for 2,385.00

21123 Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) 2,490.30

21125 Augmentation, mandibular body or angle; prosthetic material

21127 Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining

21137 Reduction forehead; contouring only

21138 Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining

21139 Rdctj fhd cntrg&setback ant frontal sinus wall 3,278.60

21141 Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face 4,120.20

21142 Reconstruction midface, LeFort I; two pieces, segment movement in any direction, without bone graft 4,326.30

21143 Reconstruction midface, LeFort I; three or more pieces, segment movement in any direction, without bone

21145 Rcnstj midface lefort i 1 piece w/bone grafts 4,496.20

21146 Reconstruction midface, LeFort I; two pieces, segment movement in any direction, requiring bone grafts 5,983.20

21147 Reconstruction midface, LeFort I; three or more pieces, segment movement in any direction, requiring bone 6,391.80

21150 Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins Syndrome) 5,568.30

21151 Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

21154 Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining 6,677.10

21155 Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining 6,431.40

21159 Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), 9,682.20

21160 Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), 10,815.30

21172 Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without 8,767.80

21175 Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, 9,409.50

21179 Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic 7,056.00

21180 Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining 6,390.00

21181 Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial 1,539.90

21182 Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial 6,723.90

21183 Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial 7,144.20

21184 Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial 7,754.40

21188 Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining 4,563.00

21193 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft 4,586.40

21194 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes 5,648.40

21195 Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation 4,891.50

21196 Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation 5,547.60

21198 Osteotomy, mandible, segmental;

21199 Osteotomy, mandible, segmental; with genioglossus advancement 3,879.00

21206 Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard) 4,425.30

21208 Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) 2,608.20

21209 Osteoplasty, facial bones; reduction 2,713.50

21210 Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) 3,510.00

21215 Graft, bone; mandible (includes obtaining graft) 3,878.10

21230 Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) 4,305.60

21235 Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)

21240 Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft) 4,120.20

21242 Arthroplasty, temporomandibular joint, with allograft 3,933.00

21243 Arthroplasty, temporomandibular joint, with prosthetic joint replacement 5,049.90

21244 Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate) 4,204.80

21245 Reconstruction of mandible or maxilla, subperiosteal implant; partial

CPT Mod FEE 21246 Reconstruction of mandible or maxilla, subperiosteal implant; complete 5,781.60

21247 Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for

21248 Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial 3,985.20

21249 Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete

21255 Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)

21256 Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) 5,800.50

21260 Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach 6,687.00

21261 Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach 8,191.80

21263 Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement 9,275.40

21267 Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach 6,246.90

21268 Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial 9,558.90

21270 Malar augmentation, prosthetic material 4,648.50

21275 Secondary revision of orbitocraniofacial reconstruction 6,386.40

21280 Medial canthopexy (separate procedure)

21282 Lateral canthopexy 1,957.50

21295 Reduction masseter muscle&bone extraoral 2,487.73

21296 Reduction masseter muscle&bone intraoral 2,095.08

21310 Closed treatment of nasal bone fracture without manipulation

21315 Closed treatment of nasal bone fracture; without stabilization 489.60

21320 Closed treatment of nasal bone fracture; with stabilization

21325 Open treatment of nasal fracture; uncomplicated 1,708.20

21330 Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation 2,563.20

21335 Open treatment of nasal fracture; with concomitant open treatment of fractured septum 2,959.20

21336 Open treatment of nasal septal fracture, with or without stabilization 1,738.80

21337 Closed treatment of nasal septal fracture, with or without stabilization

21338 Open treatment of nasoethmoid fracture; without external fixation 2,750.40

21339 Open treatment of nasoethmoid fracture; with external fixation 3,019.50

21340 Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including 3,490.20

21343 Open treatment of depressed frontal sinus fracture 3,550.50

21344 Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via

21345 Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation 3,108.60

21346 Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring and/or local fixation 3,837.60

21347 Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches

21348 Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining 3,829.50

21355 Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with 2,138.40

21356 Open treatment of depressed zygomatic arch fracture (eg, Gillies approach) 1,796.40

21360 Open treatment of depressed malar fracture, including zygomatic arch and malar tripod 2,407.50

21365 Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar 3,566.70

21366 Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar

21385 Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation)

21386 Open treatment of orbital floor blowout fracture; periorbital approach 2,984.40

21387 Open treatment of orbital floor blowout fracture; combined approach 3,267.00

21390 Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant 3,502.80

21395 Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining 3,692.70

21400 Closed treatment of fracture of orbit, except blowout; without manipulation 879.30

21401 Closed treatment of fracture of orbit, except blowout; with manipulation 2,475.90

21406 Open treatment of fracture of orbit, except blowout; without implant 2,877.30

21407 Open treatment of fracture of orbit, except blowout; with implant 3,400.20

21408 Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)

21421 Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of

21422 Open treatment of palatal or maxillary fracture (LeFort I type); 3,348.90

21423 Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial 2,865.60

21431 Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or

21432 Open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixation

21433 Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial 5,049.90

21435 Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external 4,278.60

21436 Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, 5,112.00

21440 Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure) 1,808.10

21445 Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure) 2,088.00

21450 Closed treatment of mandibular fracture; without manipulation 812.70

21451 Closed treatment of mandibular fracture; with manipulation 2,193.30

21452 Percutaneous treatment of mandibular fracture, with external fixation 1,540.80

21453 Closed treatment of mandibular fracture with interdental fixation 2,735.10

21454 Open treatment of mandibular fracture with external fixation 2,820.60

21461 Open treatment of mandibular fracture; without interdental fixation 2,774.70

21462 Open treatment of mandibular fracture; with interdental fixation 3,288.60

21465 Open treatment of mandibular condylar fracture 2,871.00

21470 Open treatment of complicated mandibular fracture by multiple surgical approaches including internal

21480 Closed treatment of temporomandibular dislocation; initial or subsequent

21485 Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary

CPT Mod FEE 21490 Open treatment of temporomandibular dislocation

21495 Open treatment of hyoid fracture 2,726.10

21497 Interdental wiring, for condition other than fracture 2,046.60

21501 Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;

21502 Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomy 946.80

21510 Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thorax 1,161.90

21550 Biopsy, soft tissue of neck or thorax 405.00

21552 Exc tumor soft tissue neck/ant thorax subq 3+cm 791.93

21554 Exc tumor soft tissue neck/thorax subfasc 5+cm 1,366.14

21555 Excision tumor, soft tissue of neck or thorax; subcutaneous 632.14

21556 Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular 1,127.30

21557 Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or thorax

21558 Rad resect tumor soft tiss neck/ant thorax 5+cm 2,439.66

21600 Excision of rib, partial

21610 Costotransversectomy (separate procedure) 3,476.70

21615 Excision first and/or cervical rib; 3,032.10

21616 Excision first and/or cervical rib; with sympathectomy 2,896.20

21620 Ostectomy of sternum, partial 3,269.70

21627 Sternal debridement 1,960.20

21630 Radical resection of sternum; 3,826.80

21632 Radical resection of sternum; with mediastinal lymphadenectomy

21685 Hyoid myotomy & suspension 2,168.29

21700 Division of scalenus anticus; without resection of cervical rib

21705 Division of scalenus anticus; with resection of cervical rib

21720 Division of sternocleidomastoid for torticollis, open operation; without cast application 1,333.80

21725 Division of sternocleidomastoid for torticollis, open operation; with cast application 1,486.80

21740 Reconstructive repair of pectus excavatum or carinatum

21750 Closure of sternotomy separation with or without debridement (separate procedure)

21800 Closed treatment of rib fracture, uncomplicated, each 219.60

21805 Open treatment of rib fracture without fixation, each 1,426.50

21810 Treatment of rib fracture requiring external fixation (flail chest) 3,409.20

21820 Closed treatment of sternum fracture

21825 Open treatment of sternum fracture with or without skeletal fixation 1,791.90

21920 Biopsy, soft tissue of back or flank; superficial 466.20

21925 Biopsy, soft tissue of back or flank; deep

21930 Excision, tumor, soft tissue of back or flank 1,846.80

21931 Excision tumor soft tissue back/flank subq 3+cm 1,124.11

21932 Exc tumor soft tiss back/flank subfascial <5cm 1,469.92

21933 Exc tumor soft tiss back/flank subfascial 5+cm 1,605.17

21935 Radical resection of tumor (eg, malignant neoplasm), soft tissue of back or flank 3,547.80

21936 Rad resection tumor soft tissue back/flank 5+cm 3,109.09

22010 I&d deep abscess pst spine crv thrc/cervicothrc 1,829.44

22015 I&d deep abscess pst spine lumbar sac/lumbosac 1,795.54

22100 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony

22101 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony 1,560.60

22102 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony 1,827.00

22103 Prtl exc pst vrt intrnsc b1y les 1 vrt sgm ea 421.75

22110 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve 2,437.20

22112 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve 2,290.50

22114 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve 1,809.90

22116 Prtl exc vrt bdy b1y les w/o spi cord 1 sgm ea 510.03

22206 Osteotomy spine posterior 3 column thoracic 8,139.79

22207 Osteotomy spine posterior 3 column lumbar 7,918.14

22208 Osteotomy spine posterior 3 column ea addl sgm 2,343.90

22210 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; cervical 5,474.70

22212 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; thoracic 5,826.60

22214 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar 5,076.00

22216 Osteot spi pst/pstlat appr 1 vrt sgm ea vrt sgm 1,650.31

22220 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; cervical 5,062.50

22222 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; thoracic

22224 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; lumbar

22226 Osteot spi w/dskc ant appr 1 vrt sgm ea vrt sgm 1,576.45

22305 Closed treatment of vertebral process fracture(s) 646.20

22310 Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or 1,089.00

22315 Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and 1,676.70

22318 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), 4,835.70

22319 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), 5,462.10

22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one 3,702.60

22326 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one 4,303.80

22327 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one 3,861.00

CPT Mod FEE 22328 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one

22505 Manipulation of spine requiring anesthesia, any region 594.00

22520 Percut vertebroplasty thor 10,247.30

22521 Percutaneous vertebroplasty lumbar 4,183.34

22522 Percutaneous vertebroplasty ea addl thrc/lmbr 499.51

22523 Percutaneous vertebral augmentation thoracic 1,477.34

22524 Percutaneous vertebral augmentation lumbar 1,382.74

22525 Perq vertebral augmentation ea addl thrc/lmbr 716.85

22526 Perq intrdscl electrothrm annuloplasty 1 lvl 3,625.48

22527 Perq intrdscl electrothrm annuloplasty addl lvl 2,933.60

22532 Arthrodesis lateral extracavitary thoracic 7,248.19

22533 Arthrodesis lateral extracavitary lumbar 6,841.56

22534 Arthrodesis lat extracavitary ea addl thrc/lmbr 1,793.42

22548 Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of 4,671.90

22551 Arthrd ant interbody decompress cervical belw c2 7,163.83

22552 Arthrd ant interdy cervcl belw c2 ea addl ntrspc 2,029.38

22554 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for

22556 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for 5,232.60

22558 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for 4,895.10

22585 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for 2,109.60

22586 Prescrl fuse w/ instr l5/s1 3,759.12

22590 Arthrodesis, posterior technique, craniocervical (occiput-C2)

22595 Arthrodesis, posterior technique, atlas-axis (C1-C2) 5,839.20

22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment

22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or without lateral transverse 4,143.60

22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse 4,961.70

22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List 1,858.50

22630 Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace 4,412.70

22632 Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace

22633 Lumbar spine fusion combined 4,570.04

22634 Spine fusion extra segment 1,228.63

22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments 4,953.60

22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments 6,030.00

22804 Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments 6,646.50

22808 Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments 4,555.80

22810 Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments

22812 Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments 5,985.90

22818 Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and 6,687.90

22819 Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and 7,163.10

22830 Exploration of spinal fusion 4,411.80

22840 Posterior non-segmental instrumentation (eg, Harrington rod technique), pedicle fixation across one 5,926.50

22841 Internal spinal fixation by wiring of spinous processes

22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar 6,488.10

22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar 2,050.20

22844 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar 2,503.80

22845 Anterior instrumentation; 2 to 3 vertebral segments 6,088.50

22846 Anterior instrumentation; 4 to 7 vertebral segments 6,129.00

22847 Anterior instrumentation 8/> vertebral segments 4,006.54

22848 Pelvic fixation other than sacrum 1,716.14

22849 Reinsertion of spinal fixation device 3,637.80

22850 Removal of posterior nonsegmental instrumentation (eg, Harrington rod) 2,196.90

22851 Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), 2,188.80

22852 Removal of posterior segmental instrumentation

22855 Removal of anterior instrumentation 3,174.30

22856 Tot disc arthrp art disc ant appro 1 ntrspc crv 7,409.11

22857 Tot disc arthrp art disc ant appro 1 ntrspc lmbr 7,481.77

22861 Revj rplcmt disc arthroplasty ant 1 ntrspc crv 9,122.80

22862 Revj rplcmt disc arthroplasty ant 1 ntrspc lmbr 8,973.95

22864 Rmvl disc arthroplasty ant 1 interspace cervical 8,487.18

22865 Rmvl disc arthroplasty ant 1 interspace lumbar 9,570.92

22900 Excision, abdominal wall tumor, subfascial (eg, desmoid) 1,592.10

22901 Exc tumor soft tissue abdl wall subfascial 5+cm 1,370.05

22902 Exc tumor soft tissue abdominal wall subq <3cm 861.30

22903 Exc tumor soft tissue abdominal wall subq 3+cm 901.22

22904 Rad resection tumor soft tissue abdl wall <5cm 2,178.75

22905 Rad resection tumor soft tissue abdl wall 5+cm 2,821.24

23000 Removal of subdeltoid (or intratendinous) calcareous deposits, any method 1,048.50

23020 Capsular contracture release (eg, Sever type procedure) 1,676.70

23030 Incision and drainage, shoulder area; deep abscess or hematoma

23031 Incision and drainage, shoulder area; infected bursa

CPT Mod FEE 23035 Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area 1,620.00

23040 Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body 1,976.40

23044 Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign 1,288.80

23065 Biopsy, soft tissue of shoulder area; superficial

23066 Biopsy, soft tissue of shoulder area; deep

23071 Excision tumor soft tissue shoulder subq 3+cm 656.15

23073 Exc tumor soft tissue shoulder subfascial 5+cm 1,601.52

23075 Excision, soft tissue tumor, shoulder area; subcutaneous

23076 Excision, soft tissue tumor, shoulder area; deep, subfascial, or intramuscular

23077 Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder area 3,457.80

23078 Rad resection tumor soft tissue shoulder 5+cm 3,049.94

23100 Arthrotomy, glenohumeral joint, including biopsy

23101 Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilage 1,510.20

23105 Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy

23106 Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy

23107 Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign body 2,521.80

23120 Claviculectomy; partial

23125 Claviculectomy; total 2,212.20

23130 Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release 1,876.50

23140 Excision or curettage of bone cyst or benign tumor of clavicle or scapula; 1,152.90

23145 Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining 1,894.50

23146 Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with allograft 1,276.20

23150 Excision or curettage of bone cyst or benign tumor of proximal humerus; 1,902.60

23155 Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining 2,513.70

23156 Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft 2,136.60

23170 Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle

23172 Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula

23174 Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck 2,029.50

23180 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle 1,142.10

23182 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), scapula 1,146.60

23184 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus

23190 Ostectomy of scapula, partial (eg, superior medial angle)

23195 Resection, humeral head 2,023.20

23200 Radical resection for tumor; clavicle 1,987.20

23210 Radical resection for tumor; scapula 2,709.00

23220 Radical resection of bone tumor, proximal humerus; 2,718.90

23330 Removal of foreign body, shoulder; subcutaneous

23331 Removal of foreign body, shoulder; deep (eg, Neer hemiarthroplasty removal) 1,851.30

23332 Removal of foreign body, shoulder; complicated (eg, total shoulder) 3,044.70

23350 Injection procedure for shoulder arthrography

23395 Muscle transfer, any type, shoulder or upper arm; single

23397 Muscle transfer, any type, shoulder or upper arm; multiple

23400 Scapulopexy (eg, Sprengels deformity or for paralysis) 2,549.70

23405 Tenotomy, shoulder area; single tendon 1,497.60

23406 Tenotomy, shoulder area; multiple tendons through same incision 2,154.60

23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff); acute 2,492.10

23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff); chronic 3,027.60

23415 Coracoacromial ligament release, with or without acromioplasty 1,882.80

23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) 3,345.30

23430 Tenodesis of long tendon of biceps

23440 Resection or transplantation of long tendon of biceps 1,823.40

23450 Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation

23455 Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure) 3,392.10

23460 Capsulorrhaphy, anterior, any type; with bone block 3,116.70

23462 Capsulorrhaphy, anterior, any type; with coracoid process transfer 3,337.20

23465 Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block 2,945.70

23466 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability 3,508.20

23470 Arthroplasty, glenohumeral joint; hemiarthroplasty 3,598.20

23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total 5,374.80

23473 Revis reconst shoulder joint 3,981.38

23474 Revis reconst shoulder joint 4,302.35

23480 Osteotomy, clavicle, with or without internal fixation; 1,863.00

23485 Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes 2,413.80

23490 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle 2,123.10

23491 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal 2,097.00

23500 Closed treatment of clavicular fracture; without manipulation

23505 Closed treatment of clavicular fracture; with manipulation 586.80

23515 Open treatment of clavicular fracture, with or without internal or external fixation 1,595.70

23520 Closed treatment of sternoclavicular dislocation; without manipulation

23525 Closed treatment of sternoclavicular dislocation; with manipulation 556.20

CPT Mod FEE 23530 Open treatment of sternoclavicular dislocation, acute or chronic; 1,455.30

23532 Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

23540 Closed treatment of acromioclavicular dislocation; without manipulation 418.50

23545 Closed treatment of acromioclavicular dislocation; with manipulation

23550 Open treatment of acromioclavicular dislocation, acute or chronic; 1,890.00

23552 Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft) 2,283.30

23570 Closed treatment of scapular fracture; without manipulation

23575 Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without

23585 Open treatment of scapular fracture (body, glenoid or acromion) with or without internal fixation 2,152.80

23600 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation

23605 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or

23615 Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or without internal or 2,034.00

23616 Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or without internal or

23620 Closed treatment of greater humeral tuberosity fracture; without manipulation 471.60

23625 Closed treatment of greater humeral tuberosity fracture; with manipulation 744.30

23630 Open treatment of greater humeral tuberosity fracture, with or without internal or external fixation 1,616.40

23650 Closed treatment of shoulder dislocation, with manipulation; without anesthesia 457.20

23655 Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia

23660 Open treatment of acute shoulder dislocation

23665 Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation 749.70

23670 Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with or without internal

23675 Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation 888.30

23680 Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, with or without internal or 2,415.60

23700 Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation 625.50

23800 Arthrodesis, glenohumeral joint; 3,604.50

23802 Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)

23900 Interthoracoscapular amputation (forequarter) 4,063.50

23920 Disarticulation of shoulder; 3,162.60

23921 Disarticulation of shoulder; secondary closure or scar revision 909.90

23930 Incision and drainage, upper arm or elbow area; deep abscess or hematoma 819.90

23931 Incision and drainage, upper arm or elbow area; bursa 675.90

23935 Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbow 1,374.30

24000 Arthrotomy, elbow, including exploration, drainage, or removal of foreign body

24006 Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)

24065 Biopsy, soft tissue of upper arm or elbow area; superficial

24066 Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular) 707.89

24071 Exc tumor soft tissue upper arm/elbow subq 3+cm 972.78

24073 Exc tumor soft tiss upper arm/elbw subfasc 5+cm 1,396.93

24075 Excision, tumor, upper arm or elbow area; subcutaneous 686.70

24076 Excision, tumor, upper arm or elbow area; deep, subfascial or intramuscular 1,179.00

24077 Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper arm or elbow area

24079 Rad resect tumor soft tiss upper arm/elbow 5+cm 2,604.12

24100 Arthrotomy, elbow; with synovial biopsy only 1,082.70

24101 Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign 1,861.20

24102 Arthrotomy, elbow; with synovectomy

24105 Excision, olecranon bursa 898.20

24110 Excision or curettage of bone cyst or benign tumor, humerus;

24115 Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft) 1,887.30

24116 Excision or curettage of bone cyst or benign tumor, humerus; with allograft

24120 Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; 1,485.00

24125 Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with 1,740.60

24126 Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with 1,524.60

24130 Excision, radial head 1,459.80

24134 Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus

24136 Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck

24138 Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process

24140 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus 2,168.10

24145 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or 1,442.70

24147 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon process 1,296.00

24149 Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate

24150 Radical resection for tumor, shaft or distal humerus; 2,443.50

24152 Radical resection for tumor, radial head or neck; 2,158.20

24155 Resection of elbow joint (arthrectomy)

24160 Implant removal; elbow joint 1,489.50

24164 Implant removal; radial head

24200 Removal of foreign body, upper arm or elbow area; subcutaneous 368.10

24201 Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular) 962.10

24220 Injection procedure for elbow arthrography

24300 Manipulation elbow under anesthesia 777.16

24301 Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 24320-24331) 1,998.00

CPT Mod FEE 24305 Tendon lengthening, upper arm or elbow, each tendon 900.90

24310 Tenotomy, open, elbow to shoulder, each tendon 955.80

24320 Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (Seddon-Brookes type 2,311.20

24330 Flexor-plasty, elbow (eg, Steindler type advancement); 2,269.80

24331 Flexor-plasty, elbow (eg, Steindler type advancement); with extensor advancement

24332 Tenolysis triceps 1,181.38

24340 Tenodesis of biceps tendon at elbow (separate procedure) 1,922.40

24341 Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes 1,816.20

24342 Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft 2,416.50

24343 Repair lateral collateral ligament elbow 1,858.95

24344 Rcnstj lat coltrl ligm elbow w/tendon graft 2,485.31

24345 Repair medial collateral ligament elbow 1,857.96

24346 Rcnstj medial coltrl ligm elbw w/tdn grf 2,718.04

24357 Tenotomy elbow lateral/medial percutaneous 1,115.21

24358 Tnot elbow lateral/medial debride open 1,270.13

24359 Tnot elbow lateral/medial debride open tdn rpr 1,520.03

24360 Arthroplasty, elbow; with membrane (eg, fascial) 3,267.00

24361 Arthroplasty, elbow; with distal humeral prosthetic replacement

24362 Arthroplasty, elbow; with implant and fascia lata ligament reconstruction 3,446.10

24363 Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow) 4,614.30

24365 Arthroplasty, radial head;

24366 Arthroplasty, radial head; with implant

24370 Revise reconst elbow joint 3,755.40

24371 Revise reconst elbow joint 4,324.97

24400 Osteotomy, humerus, with or without internal fixation 2,451.60

24410 Multiple osteotomies with realignment on intramedullary rod, humeral shaft (Sofield type procedure)

24420 Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876) 2,397.60

24430 Repair of nonunion or malunion, humerus; without graft (eg, compression technique) 2,629.80

24435 Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft) 3,298.50

24470 Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)

24495 Decompression fasciotomy, forearm, with brachial artery exploration 2,070.00

24498 Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft

24500 Closed treatment of humeral shaft fracture; without manipulation

24505 Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction 1,046.70

24515 Open treatment of humeral shaft fracture with plate/screws, with or without cerclage 2,314.80

24516 Open treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage

24530 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar 612.20

24535 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar

24538 Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without

24545 Open treatment of humeral supracondylar or transcondylar fracture, with or without internal or external 2,343.60

24546 Open treatment of humeral supracondylar or transcondylar fracture, with or without internal or external 2,875.50

24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation 535.50

24565 Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation 788.40

24566 Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation 1,277.10

24575 Open treatment of humeral epicondylar fracture, medial or lateral, with or without internal or external fixation 1,759.50

24576 Closed treatment of humeral condylar fracture, medial or lateral; without manipulation 549.90

24577 Closed treatment of humeral condylar fracture, medial or lateral; with manipulation

24579 Open treatment of humeral condylar fracture, medial or lateral, with or without internal or external fixation

24582 Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulation

24586 Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal

24587 Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal

24600 Treatment of closed elbow dislocation; without anesthesia

24605 Treatment of closed elbow dislocation; requiring anesthesia 753.30

24615 Open treatment of acute or chronic elbow dislocation 1,831.50

24620 Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with 952.20

24635 Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with 2,043.00

24640 Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation

24650 Closed treatment of radial head or neck fracture; without manipulation

24655 Closed treatment of radial head or neck fracture; with manipulation 778.50

24665 Open treatment of radial head or neck fracture, with or without internal fixation or radial head excision; 1,544.40

24666 Open treatment of radial head or neck fracture, with or without internal fixation or radial head excision; with

24670 Closed treatment of ulnar fracture, proximal end (olecranon process); without manipulation

24675 Closed treatment of ulnar fracture, proximal end (olecranon process); with manipulation

24685 Open treatment of ulnar fracture proximal end (olecranon process), with or without internal or external

24800 Arthrodesis, elbow joint; local

24802 Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft)

24900 Amputation, arm through humerus; with primary closure 1,834.20

24920 Amputation, arm through humerus; open, circular (guillotine)

24925 Amputation, arm through humerus; secondary closure or scar revision 774.90

24930 Amputation, arm through humerus; re-amputation 1,470.60

CPT Mod FEE 24931 Amputation, arm through humerus; with implant

24935 Stump elongation, upper extremity 2,499.30

24940 Cineplasty, upper extremity, complete procedure

25000 Incision, extensor tendon sheath, wrist (eg, deQuervains disease) 1,080.90

25001 Incision flexor tendon sheath wrist 963.51

25020 Decompression fasciotomy, forearm and/or wrist; flexor or extensor compartment

25023 Decompression fasciotomy, forearm and/or wrist; with debridement of nonviable muscle and/or nerve

25024 Dcmprn fasct f/arm&/wrst flxr&xtnsr w/o dbrdmt 1,555.24

25025 Dcmprn fasct f/arm&/wrst flxr&xtnsr dbrdmt nv 2,070.11

25028 Incision and drainage, forearm and/or wrist; deep abscess or hematoma 981.00

25031 Incision and drainage, forearm and/or wrist; bursa 586.80

25035 Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess)

25040 Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal of foreign body 1,479.60

25065 Biopsy, soft tissue of forearm and/or wrist; superficial 434.70

25066 Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)

25071 Exc tumor soft tiss forearm and/wrist subq 3+cm 1,308.04

25073 Exc tumor sft tiss forearm&//wrist subfasc 3+cm 1,806.54

25075 Excision, tumor, forearm and/or wrist area; subcutaneous 650.70

25076 Excision, tumor, forearm and/or wrist area; deep, subfascial or intramuscular

25077 Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/or wrist area 2,590.20

25078 Rad rescj tum soft tissue forearm&/wrist 3+cm 3,198.24

25085 Capsulotomy, wrist (eg, contracture)

25100 Arthrotomy, wrist joint; with biopsy 1,330.20

25101 Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or 1,323.00

25105 Arthrotomy, wrist joint; with synovectomy 1,722.60

25107 Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complex 1,453.50

25109 Exc tendon forearm&/wrist flexor/extensor ea 1,481.65

25110 Excision, lesion of tendon sheath, forearm and/or wrist

25111 Excision of ganglion, wrist (dorsal or volar); primary 943.10

25112 Excision of ganglion, wrist (dorsal or volar); recurrent 1,357.20

25115 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or 2,098.80

25116 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or 2,058.30

25118 Synovectomy, extensor tendon sheath, wrist, single compartment; 1,926.00

25119 Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulna 1,556.10

25120 Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and 1,530.90

25125 Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and 1,812.60

25126 Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and

25130 Excision or curettage of bone cyst or benign tumor of carpal bones; 1,552.50

25135 Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)

25136 Excision or curettage of bone cyst or benign tumor of carpal bones; with allograft 1,669.50

25145 Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist

25150 Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna

25151 Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); radius 1,522.80

25170 Radical resection for tumor, radius or ulna 2,446.20

25210 Carpectomy; one bone 1,483.20

25215 Carpectomy; all bones of proximal row 2,278.80

25230 Radial styloidectomy (separate procedure) 1,163.70

25240 Excision distal ulna partial or complete (eg, Darrach type or matched resection) 1,516.50

25246 Injection procedure for wrist arthrography 223.20

25248 Exploration with removal of deep foreign body, forearm or wrist 1,003.50

25250 Removal of wrist prosthesis; (separate procedure)

25251 Removal of wrist prosthesis; complicated, including total wrist 2,194.20

25259 Manipulate wrist w/anesthes 1,033.88

25260 Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle 1,475.10

25263 Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle

25265 Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), 1,890.00

25270 Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle 1,206.90

25272 Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle

25274 Repair, tendon or muscle, extensor, secondary, with tendon graft (includes obtaining graft), forearm and/or

25275 Rpr tendon sheath extensor f/arm&/wrst w/graft 1,683.67

25280 Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon

25290 Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon 943.20

25295 Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon

25300 Tenodesis at wrist; flexors of fingers 1,893.60

25301 Tenodesis at wrist; extensors of fingers

25310 Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon

25312 Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) 2,202.30

25315 Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; 2,035.80

25316 Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; with tendon(s) 2,677.50

25320 Capsulorrhaphy or reconstruction, wrist, any method (eg, capsulodesis, ligament repair, tendon transfer or

CPT Mod FEE 25332 Arthroplasty, wrist, with or without interposition, with or without external or internal fixation 2,537.10

25335 Centralization of wrist on ulna (eg, radial club hand) 3,493.80

25337 Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue 1,961.10

25350 Osteotomy, radius; distal third

25355 Osteotomy, radius; middle or proximal third 1,962.90

25360 Osteotomy; ulna 1,773.00

25365 Osteotomy; radius AND ulna 2,209.50

25370 Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius OR ulna 2,259.00

25375 Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius AND ulna 3,060.90

25390 Osteoplasty, radius OR ulna; shortening 2,204.10

25391 Osteoplasty, radius OR ulna; lengthening with autograft 2,938.50

25392 Osteoplasty, radius AND ulna; shortening (excluding 64876) 2,710.80

25393 Osteoplasty, radius AND ulna; lengthening with autograft 3,029.40

25394 Osteoplasty carpal bone shortening 1,709.09

25400 Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique) 1,773.90

25405 Repair of nonunion or malunion, radius OR ulna; with iliac or other autograft (includes obtaining graft) 2,500.20

25415 Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique) 2,615.40

25420 Repair of nonunion or malunion, radius AND ulna; with iliac or other autograft (includes obtaining graft) 2,688.30

25425 Repair of defect with autograft; radius OR ulna 2,207.70

25426 Repair of defect with autograft; radius AND ulna 3,141.00

25430 Vasc graft into carpal bone 1,713.16

25431 Repair nonunion carpal bone each bone 2,472.29

25440 Repair of nonunion, scaphoid (navicular) bone, with or without radial styloidectomy (includes obtaining graft 2,318.40

25441 Arthroplasty with prosthetic replacement; distal radius

25442 Arthroplasty with prosthetic replacement; distal ulna 1,840.50

25443 Arthroplasty with prosthetic replacement; scaphoid (navicular) 2,010.60

25444 Arthroplasty with prosthetic replacement; lunate 2,404.80

25445 Arthroplasty with prosthetic replacement; trapezium 2,321.10

25446 Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist) 3,823.20

25447 Arthroplasty, interposition, intercarpal or carpometacarpal joints 2,806.20

25449 Revision of arthroplasty, including removal of implant, wrist joint 1,763.10

25450 Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna 1,053.00

25455 Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna 1,548.00

25490 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius

25491 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna

25492 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius AND

25500 Closed treatment of radial shaft fracture; without manipulation

25505 Closed treatment of radial shaft fracture; with manipulation 775.80

25515 Open treatment of radial shaft fracture, with or without internal or external fixation 1,587.60

25520 Closed treatment of radial shaft fracture, with dislocation of distal radio-ulnar joint (Galeazzi

25525 Open treatment of radial shaft fracture, with internal and/ or external fixation and closed treatment of 2,566.80

25526 Open treatment of radial shaft fracture, with internal and/or external fixation and open treatment, with or

25530 Closed treatment of ulnar shaft fracture; without manipulation

25535 Closed treatment of ulnar shaft fracture; with manipulation 811.80

25545 Open treatment of ulnar shaft fracture, with or without internal or external fixation 1,704.60

25560 Closed treatment of radial and ulnar shaft fractures; without manipulation 612.90

25565 Closed treatment of radial and ulnar shaft fractures; with manipulation

25574 Open treatment of radial AND ulnar shaft fractures, with internal or external fixation; of radius OR ulna 2,353.50

25575 Open treatment of radial AND ulnar shaft fractures, with internal or external fixation; of radius AND ulna 2,425.50

25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without

25605 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without

25606 Perq skel fixj distal radial fx/epiphysl sep 1,524.64

25607 Optx dstl radl x-artic fx/epiphysl sep 1,539.22

25608 Optx dstl radl i-artic fx/epiphysl sep 2 frag 1,895.26

25609 Optx dstl radl i-artic fx/epiphysl sep 3 frag 2,255.07

25622 Closed treatment of carpal scaphoid (navicular) fracture; without manipulation 612.90

25624 Closed treatment of carpal scaphoid (navicular) fracture; with manipulation 808.20

25628 Open treatment of carpal scaphoid (navicular) fracture, with or without internal or external fixation

25630 Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular)); without manipulation, each 506.70

25635 Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular)); with manipulation, each

25645 Open treatment of carpal bone fracture (excluding carpal scaphoid (navicular)), each bone

25650 Closed treatment of ulnar styloid fracture 758.70

25651 Prq skeletal fixation ulnar styloid fracture 1,006.20

25652 Open treatment ulnar styloid fracture 1,318.22

25660 Closed treatment of radiocarpal or intercarpal dislocation, one or more bones, with manipulation 781.20

25670 Open treatment of radiocarpal or intercarpal dislocation, one or more bones 1,624.50

25671 Prq skeletal fixj distal radioulnar dislocation 1,128.99

25675 Closed treatment of distal radioulnar dislocation with manipulation 776.70

25676 Open treatment of distal radioulnar dislocation, acute or chronic

25680 Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation 1,107.90

CPT Mod FEE 25685 Open treatment of trans-scaphoperilunar type of fracture dislocation 2,005.20

25690 Closed treatment of lunate dislocation, with manipulation

25695 Open treatment of lunate dislocation

25800 Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or 2,785.50

25805 Arthrodesis, wrist; with sliding graft 2,888.10

25810 Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft) 3,366.00

25820 Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal) 2,223.00

25825 Arthrodesis, wrist; with autograft (includes obtaining graft)

25830 Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, Sauve2,169.90

25900 Amputation, forearm, through radius and ulna; 1,926.00

25905 Amputation, forearm, through radius and ulna; open, circular (guillotine) 1,746.00

25907 Amputation, forearm, through radius and ulna; secondary closure or scar revision 837.00

25909 Amputation, forearm, through radius and ulna; re-amputation 1,625.40

25915 Krukenberg procedure 2,570.40

25920 Disarticulation through wrist;

25922 Disarticulation through wrist; secondary closure or scar revision 945.90

25924 Disarticulation through wrist; re-amputation 1,646.10

25927 Transmetacarpal amputation; 1,952.10

25929 Transmetacarpal amputation; secondary closure or scar revision

25931 Transmetacarpal amputation; re-amputation 1,794.60

26010 Drainage of finger abscess; simple

26011 Drainage of finger abscess; complicated (eg, felon)

26020 Drainage of tendon sheath, digit and/or palm, each

26025 Drainage of palmar bursa; single, bursa 1,323.90

26030 Drainage of palmar bursa; multiple bursa

26034 Incision, bone cortex, hand or finger (eg, osteomyelitis or bone abscess) 1,782.00

26035 Decompression fingers and/or hand, injection injury (eg, grease gun) 2,395.80

26037 Decompressive fasciotomy, hand (excludes 26035) 2,175.30

26040 Fasciotomy, palmar (eg, Dupuytren's contracture); percutaneous

26045 Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial 1,457.10

26055 Tendon sheath incision (eg, for trigger finger) 931.88

26060 Tenotomy, percutaneous, single, each digit 499.50

26070 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint

26075 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; metacarpophalangeal joint, 1,145.70

26080 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; interphalangeal joint, each 895.50

26100 Arthrotomy with biopsy; carpometacarpal joint, each 920.70

26105 Arthrotomy with biopsy; metacarpophalangeal joint, each

26110 Arthrotomy with biopsy; interphalangeal joint, each

26111 Ex tum/vasc malf sft tiss hand/fngr subq 1.5+cm 1,075.54

26113 Ex tum/vasc mal sft tis hand/fngr subfsc 1.5+cm 1,621.65

26115 Excision, tumor or vascular malformation, hand or finger; subcutaneous

26116 Excision, tumor or vascular malformation, hand or finger; deep, subfascial, intramuscular 1,284.30

26117 Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or finger 2,445.30

26118 Rad rescj tum soft tissue hand/finger 3+cm 3,201.59

26121 Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes 2,585.70

26123 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or 2,606.40

26125 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or

26130 Synovectomy, carpometacarpal joint 1,566.00

26135 Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each 1,762.20

26140 Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint 1,708.20

26145 Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon 1,744.20

26160 Excision of lesion of tendon sheath or capsule (eg, cyst, mucous cyst, or ganglion), hand or finger 913.50

26170 Excision of tendon, palm, flexor, single (separate procedure), each 945.90

26180 Excision of tendon, finger, flexor (separate procedure), each tendon 834.30

26185 Sesamoidectomy, thumb or finger (separate procedure)

26200 Excision or curettage of bone cyst or benign tumor of metacarpal; 1,137.60

26205 Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft) 1,695.60

26210 Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; 1,234.80

26215 Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with 1,538.10

26230 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal 1,121.40

26235 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle

26236 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of 931.50

26250 Radical resection, metacarpal; (eg, tumor) 1,561.50

26260 Radical resection, proximal or middle phalanx of finger (eg, tumor); 1,692.00

26262 Radical resection, distal phalanx of finger (eg, tumor) 1,568.70

26320 Removal of implant from finger or hand

26340 Manipulation finger joint under anes each joint 841.74

26341 Manipulat palm cord post inj 243.56

26350 Repair or advancement, flexor tendon, not in digital flexor tendon sheath (eg, no man's land); primary or 2,094.30

26352 Repair or advancement, flexor tendon, not in digital flexor tendon sheath (eg, no man's land); secondary 2,346.30

CPT Mod FEE 26356 Repair or advancement, flexor tendon, in digital flexor tendon sheath (eg, no man's land); primary, each

26357 Repair or advancement, flexor tendon, in digital flexor tendon sheath (eg, no man's land); secondary, each

26358 Repair or advancement, flexor tendon, in digital flexor tendon sheath (eg, no man's land); secondary with

26370 Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon

26372 Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft

26373 Repair or advancement of profundus tendon, with intact superficialis tendon; secondary without free graft,

26390 Excision flexor tendon, implantation of prosthetic rod for delayed tendon graft, hand or finger, each tendon 1,753.20

26392 Removal of prosthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each 2,260.80

26410 Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon

26412 Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendon 1,515.60

26415 Excision of extensor tendon, implantation of prosthetic rod for delayed tendon graft, hand or finger 1,444.50

26416 Removal of prosthetic rod and insertion of extensor tendon graft (includes obtaining graft), hand or finger, 1,515.60

26418 Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon 1,251.90

26420 Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon

26426 Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s),

26428 Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes 1,773.00

26432 Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger) 1,139.40

26433 Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger) 1,485.00

26434 Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft) 1,368.00

26437 Realignment of extensor tendon, hand, each tendon

26440 Tenolysis, flexor tendon; palm OR finger; each tendon 1,247.40

26442 Tenolysis, flexor tendon; palm AND finger, each tendon 1,440.90

26445 Tenolysis, extensor tendon, hand or finger; each tendon 1,212.30

26449 Tenolysis, complex, extensor tendon, finger, including forearm, each tendon

26450 Tenotomy, flexor, palm, open, each tendon 733.50

26455 Tenotomy, flexor, finger, open, each tendon 847.80

26460 Tenotomy, extensor, hand or finger, open, each tendon

26471 Tenodesis; of proximal interphalangeal joint, each joint 1,384.20

26474 Tenodesis; of distal joint, each joint 981.00

26476 Lengthening of tendon, extensor, hand or finger, each tendon 1,012.50

26477 Shortening of tendon, extensor, hand or finger, each tendon 1,078.20

26478 Lengthening of tendon, flexor, hand or finger, each tendon

26479 Shortening of tendon, flexor, hand or finger, each tendon 1,348.20

26480 Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon 1,838.70

26483 Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes

26485 Transfer or transplant of tendon, palmar; without free tendon graft, each tendon

26489 Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendon 2,232.90

26490 Opponensplasty; superficialis tendon transfer type, each tendon 2,045.70

26492 Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon 2,237.40

26494 Opponensplasty; hypothenar muscle transfer

26496 Opponensplasty; other methods

26497 Transfer of tendon to restore intrinsic function; ring and small finger 2,201.40

26498 Transfer of tendon to restore intrinsic function; all four fingers 2,544.30

26499 Correction claw finger, other methods 2,403.90

26500 Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure) 1,257.30

26502 Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft)

26508 Release of thenar muscle(s) (eg, thumb contracture) 1,460.70

26510 Cross intrinsic transfer

26516 Capsulodesis, metacarpophalangeal joint; single digit 1,593.90

26517 Capsulodesis, metacarpophalangeal joint; two digits

26518 Capsulodesis, metacarpophalangeal joint; three or four digits 2,031.30

26520 Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint 1,548.00

26525 Capsulectomy or capsulotomy; interphalangeal joint, each joint 1,649.70

26530 Arthroplasty, metacarpophalangeal joint; each joint

26531 Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint 1,847.70

26535 Arthroplasty, interphalangeal joint; each joint 1,657.80

26536 Arthroplasty, interphalangeal joint; with prosthetic implant, each joint

26540 Repair of collateral ligament, metacarpophalangeal or interphalangeal joint 1,791.00

26541 Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes 2,261.70

26542 Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor 2,025.00

26545 Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint 1,589.40

26546 Repair non-union, metacarpal or phalanx, (includes obtaining bone graft with or without external or internal

26548 Repair and reconstruction, finger, volar plate, interphalangeal joint

26550 Pollicization of a digit 3,405.60

26551 Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with bone graft 9,160.20

26553 Transfer, toe-to-hand with microvascular anastomosis; other than great toe, single 9,096.30

26554 Transfer, toe-to-hand with microvascular anastomosis; other than great toe, double 10,847.70

26555 Transfer, finger to another position without microvascular anastomosis 2,587.50

26556 Transfer, free toe joint, with microvascular anastomosis 9,251.10

26560 Repair of syndactyly (web finger) each web space; with skin flaps

CPT Mod FEE 26561 Repair of syndactyly (web finger) each web space; with skin flaps and grafts

26562 Repair of syndactyly (web finger) each web space; complex (eg, involving bone, nails) 2,721.60

26565 Osteotomy; metacarpal, each 1,844.10

26567 Osteotomy; phalanx of finger, each 1,483.20

26568 Osteoplasty, lengthening, metacarpal or phalanx 2,240.10

26580 Repair cleft hand 3,350.70

26587 Reconstruction of supernumerary digit, soft tissue and bone

26590 Repair macrodactylia 2,241.00

26591 Repair, intrinsic muscles of hand, each muscle 1,861.20

26593 Release, intrinsic muscles of hand, each muscle 1,684.80

26596 Excision of constricting ring of finger, with multiple Z-plasties 1,884.60

26600 Closed treatment of metacarpal fracture, single; without manipulation, each bone 341.10

26605 Closed treatment of metacarpal fracture, single; with manipulation, each bone

26607 Closed treatment of metacarpal fracture, with manipulation, with internal or external fixation, each bone 983.70

26608 Percutaneous skeletal fixation of metacarpal fracture, each bone 1,079.10

26615 Open treatment of metacarpal fracture, single, with or without internal or external fixation, each bone 1,511.10

26641 Closed treatment of carpometacarpal dislocation, thumb, with manipulation

26645 Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation

26650 Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with 1,207.80

26665 Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with or without internal or 1,818.90

26670 Closed treatment of carpometacarpal dislocation, other than thumb (Bennett fracture), single, with

26675 Closed treatment of carpometacarpal dislocation, other than thumb (Bennett fracture), single, with 617.66

26676 Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb (Bennett fracture), single,

26685 Open treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); single, with or without

26686 Open treatment of carpometacarpal dislocation, other than thumb (Bennett fracture); complex, multiple or 1,341.00

26700 Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia

26705 Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia

26706 Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation 847.80

26715 Open treatment of metacarpophalangeal dislocation, single, with or without internal or external fixation 1,225.80

26720 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without

26725 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with

26727 Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or 967.50

26735 Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without

26740 Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without 492.30

26742 Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with

26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, with or without

26750 Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each 227.70

26755 Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each 368.40

26756 Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each

26765 Open treatment of distal phalangeal fracture, finger or thumb, with or without internal or external fixation, 889.20

26770 Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia 244.56

26775 Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia

26776 Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation 712.80

26785 Open treatment of interphalangeal joint dislocation, with or without internal or external fixation, single 990.90

26820 Fusion in opposition, thumb, with autogenous graft (includes obtaining graft) 1,808.10

26841 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;

26842 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining

26843 Arthrodesis, carpometacarpal joint, digits, other than thumb;

26844 Arthrodesis, carpometacarpal joint, digits, other than thumb; with autograft (includes obtaining graft)

26850 Arthrodesis, metacarpophalangeal joint, with or without internal fixation; 1,919.70

26852 Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with autograft (includes obtaining

26860 Arthrodesis, interphalangeal joint, with or without internal fixation; 1,250.10

26861 Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (List

26862 Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)

26863 Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), 646.20

26910 Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer

26951 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with 910.80

26952 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with

26990 Incision and drainage, pelvis or hip joint area; deep abscess or hematoma 900.90

26991 Incision and drainage, pelvis or hip joint area; infected bursa

26992 Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess) 1,793.70

27000 Tenotomy, adductor of hip, percutaneous (separate procedure) 498.60

27001 Tenotomy, adductor of hip, open 912.60

27003 Tenotomy, adductor, subcutaneous, open, with obturator neurectomy

27005 Tenotomy, hip flexor(s), open (separate procedure) 1,452.60

27006 Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure) 1,012.50

27025 Fasciotomy, hip or thigh, any type 1,698.30

27027 Decompression fasciotomy pelvic compartment uni 1,637.28

27030 Arthrotomy, hip, with drainage (eg, infection) 2,173.50

27033 Arthrotomy, hip, including exploration or removal of loose or foreign body 2,332.80

CPT Mod FEE 27035 Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator

27036 Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor

27040 Biopsy, soft tissue of pelvis and hip area; superficial

27041 Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular

27043 Excision tumor soft tissue pelvis&hip subq 3+cm 877.66

27045 Exc tumor soft tissue pelvis & hip subfasc 5+cm 1,380.69

27047 Excision, tumor, pelvis and hip area; subcutaneous tissue

27048 Excision, tumor, pelvis and hip area; deep, subfascial, intramuscular 1,323.00

27049 Radical resection of tumor, soft tissue of pelvis and hip area (eg, malignant neoplasm) 3,126.60

27050 Arthrotomy, with biopsy; sacroiliac joint

27052 Arthrotomy, with biopsy; hip joint 2,218.50

27054 Arthrotomy with synovectomy, hip joint 2,638.80

27057 Dcmprn fasciotomy pelvic cmprt dbrdmt muscle uni 1,660.89

27059 Rad resection tumor soft tiss pelvis&hip 5+cm 3,359.14

27060 Excision; ischial bursa 999.90

27062 Excision; trochanteric bursa or calcification 904.50

27065 Excision of bone cyst or benign tumor; superficial (wing of ilium, symphysis pubis, or greater trochanter of 1,318.50

27066 Excision of bone cyst or benign tumor; deep, with or without autograft 1,965.60

27067 Excision of bone cyst or benign tumor; with autograft requiring separate incision

27070 Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess); superficial (eg, wing of 1,739.70

27071 Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or 1,902.60

27075 Radical resection of tumor or infection; wing of ilium, one pubic or ischial ramus or symphysis pubis 3,087.90

27076 Radical resection of tumor or infection; ilium, including acetabulum, both pubic rami, or ischium and 4,360.50

27077 Radical resection of tumor or infection; innominate bone, total 5,816.70

27078 Radical resection of tumor or infection; ischial tuberosity and greater trochanter of femur 1,979.10

27080 Coccygectomy, primary

27086 Removal of foreign body, pelvis or hip; subcutaneous tissue 332.10

27087 Removal of foreign body, pelvis or hip; deep (subfascial or intramuscular) 1,123.53

27090 Removal of hip prosthesis; (separate procedure)

27091 Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without 5,319.90

27093 Injection procedure for hip arthrography; without anesthesia

27095 Injection procedure for hip arthrography; with anesthesia

27096 Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid

27097 Release or recession, hamstring, proximal 1,754.10

27098 Transfer, adductor to ischium 2,065.50

27100 Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)

27105 Transfer paraspinal muscle to hip (includes fascial or tendon extension graft) 2,504.70

27110 Transfer iliopsoas; to greater trochanter

27111 Transfer iliopsoas; to femoral neck 2,898.90

27120 Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type) 3,783.60

27122 Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)

27125 Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty) 4,079.70

27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip replacement), with or without 5,616.90

27132 Conversion of previous hip surgery to total hip replacement, with or without autograft or allograft 6,371.10

27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 8,532.18

27137 Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft 5,851.80

27138 Revision of total hip arthroplasty; femoral component only, with or without allograft 5,899.50

27140 Osteotomy and transfer of greater trochanter (separate procedure) 2,176.20

27146 Osteotomy, iliac, acetabular or innominate bone; 3,255.30

27147 Osteotomy, iliac, acetabular or innominate bone; with open reduction of hip 3,914.10

27151 Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy 3,619.80

27156 Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with open reduction of hip 4,401.00

27158 Osteotomy, pelvis, bilateral (eg, congenital malformation)

27161 Osteotomy, femoral neck (separate procedure) 3,132.00

27165 Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast 3,549.60

27170 Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft) 3,708.00

27175 Treatment of slipped femoral epiphysis; by traction, without reduction 1,855.80

27176 Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ 2,770.20

27177 Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining 3,270.60

27178 Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning 3,458.70

27179 Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure) 2,672.10

27181 Open treatment of slipped femoral epiphysis; osteotomy and internal fixation 3,789.90

27185 Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter 1,233.00

27187 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck 4,241.70

27193 Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation

27194 Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring 1,568.70

27200 Closed treatment of coccygeal fracture 441.90

27202 Open treatment of coccygeal fracture 897.30

27220 Closed treatment of acetabulum (hip socket) fracture(s); without manipulation

27222 Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal traction

CPT Mod FEE 27226 Open treatment of posterior or anterior acetabular wall fracture, with internal fixation 3,602.70

27227 Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running 6,057.90

27228 Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture 6,196.50

27230 Closed treatment of femoral fracture, proximal end, neck; without manipulation 1,077.30

27232 Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction 1,769.40

27235 Percutaneous skeletal fixation of femoral fracture, proximal end, neck, undisplaced, mildly displaced, or 3,135.60

27236 Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement 3,712.50

27238 Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; without 1,142.10

27240 Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; with 2,139.30

27244 Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; with plate/screw 3,339.00

27245 Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral fracture; with intramedullary 3,947.40

27246 Closed treatment of greater trochanteric fracture, without manipulation

27248 Open treatment of greater trochanteric fracture, with or without internal or external fixation 2,221.20

27250 Closed treatment of hip dislocation, traumatic; without anesthesia 764.10

27252 Closed treatment of hip dislocation, traumatic; requiring anesthesia 1,134.90

27253 Open treatment of hip dislocation, traumatic, without internal fixation 2,451.60

27254 Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without

27256 Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by 1,652.40

27257 Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by 1,835.10

27258 Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), 2,468.70

27259 Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological),

27265 Closed treatment of post hip arthroplasty dislocation; without anesthesia

27266 Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia 1,535.40

27267 Closed tx femoral fracture prox head w/o mnpj 864.17

27268 Closed tx femoral fracture prox head w mnpj 1,109.74

27269 Open tx femoral fracture proximal end head 2,878.69

27275 Manipulation, hip joint, requiring general anesthesia 505.80

27280 Arthrodesis, sacroiliac joint (including obtaining graft) 2,464.20

27282 Arthrodesis, symphysis pubis (including obtaining graft) 2,461.50

27284 Arthrodesis, hip joint (including obtaining graft); 4,975.20

27286 Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy 4,097.70

27290 Interpelviabdominal amputation (hindquarter amputation) 5,978.70

27295 Disarticulation of hip 4,355.10

27301 Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region 832.94

27303 Incision, deep, with opening of bone cortex, femur or knee (eg, osteomyelitis or bone abscess) 1,818.00

27305 Fasciotomy, iliotibial (tenotomy), open 1,055.70

27306 Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure)

27307 Tenotomy, percutaneous, adductor or hamstring; multiple tendons 1,024.20

27310 Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)

27323 Biopsy, soft tissue of thigh or knee area; superficial

27324 Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) 807.30

27325 Neurectomy hamstring muscle 1,757.66

27326 Neurectomy popliteal 1,605.75

27327 Excision, tumor, thigh or knee area; subcutaneous 720.00

27328 Excision, tumor, thigh or knee area; deep, subfascial, or intramuscular

27329 Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or knee area 2,625.30

27330 Arthrotomy, knee; with synovial biopsy only 2,022.30

27331 Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies 1,806.30

27332 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateral 2,399.40

27333 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND lateral 3,174.14

27334 Arthrotomy, with synovectomy, knee; anterior OR posterior

27335 Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area 2,895.30

27337 Excison tumor soft tissue thigh/knee subq 3+cm 1,376.91

27339 Exc tumor soft tissue thigh/knee subfasc 5+cm 2,414.25

27340 Excision, prepatellar bursa 1,103.40

27345 Excision of synovial cyst of popliteal space (eg, Baker's cyst) 1,524.60

27347 Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee 784.80

27350 Patellectomy or hemipatellectomy 2,124.00

27355 Excision or curettage of bone cyst or benign tumor of femur;

27356 Excision or curettage of bone cyst or benign tumor of femur; with allograft

27357 Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft) 2,436.30

27358 Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (List in addition to code for 2,508.30

27360 Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg,

27364 Rad resection tumor soft tissue thigh/knee 5+cm 4,912.84

27365 Radical resection of tumor, bone, femur or knee 3,127.50

27370 Injection procedure for knee arthrography

27372 Removal of foreign body, deep, thigh region or knee area 955.80

27380 Suture of infrapatellar tendon; primary 1,602.00

27381 Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft

27385 Suture of quadriceps or hamstring muscle rupture; primary 1,827.90

CPT Mod FEE 27386 Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon 2,734.20

27390 Tenotomy, open, hamstring, knee to hip; single tendon

27391 Tenotomy, open, hamstring, knee to hip; multiple tendons, one leg

27392 Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral

27393 Lengthening of hamstring tendon; single tendon 1,071.00

27394 Lengthening of hamstring tendon; multiple tendons, one leg 1,632.60

27395 Lengthening of hamstring tendon; multiple tendons, bilateral 2,038.50

27396 Transplant, hamstring tendon to patella; single tendon 2,131.20

27397 Transplant, hamstring tendon to patella; multiple tendons 2,707.20

27400 Transfer, tendon or muscle, hamstrings to femur (eg, Egger's type procedure) 1,980.00

27403 Arthrotomy with meniscus repair, knee 2,745.00

27405 Repair, primary, torn ligament and/or capsule, knee; collateral 2,272.50

27407 Repair, primary, torn ligament and/or capsule, knee; cruciate 3,190.50

27409 Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments 3,634.20

27412 Autologous chondrocyte implantation knee 5,606.85

27415 Osteochondral allograft knee open 4,366.31

27416 Osteochondral autograft knee open mosaicplasty 2,968.11

27418 Anterior tibial tubercleplasty (eg, Maquet type procedure)

27420 Reconstruction of dislocating patella; (eg, Hauser type procedure) 2,293.20

27422 Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, 2,475.00

27424 Reconstruction of dislocating patella; with patellectomy 2,765.70

27425 Lateral retinacular release (any method) 2,367.00

27427 Ligamentous reconstruction (augmentation), knee; extra-articular 3,698.10

27428 Ligamentous reconstruction (augmentation), knee; intra-articular (open) 3,715.20

27429 Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular 4,960.80

27430 Quadricepsplasty (eg, Bennett or Thompson type) 2,210.40

27435 Capsulotomy, posterior capsular release, knee 2,236.50

27437 Arthroplasty, patella; without prosthesis 2,274.30

27438 Arthroplasty, patella; with prosthesis 2,720.70

27440 Arthroplasty, knee, tibial plateau; 3,292.20

27441 Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy

27442 Arthroplasty, femoral condyles or tibial plateau(s), knee; 3,510.00

27443 Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomy

27445 Arthroplasty, knee, hinge prosthesis (eg, Walldius type) 4,499.10

27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 4,126.63

27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella 5,226.12

27448 Osteotomy, femur, shaft or supracondylar; without fixation 2,877.30

27450 Osteotomy, femur, shaft or supracondylar; with fixation 2,826.90

27454 Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, Sofield type procedure)

27455 Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus

27457 Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus 2,886.30

27465 Osteoplasty, femur; shortening (excluding 64876) 3,267.90

27466 Osteoplasty, femur; lengthening 3,707.10

27468 Osteoplasty, femur; combined, lengthening and shortening with femoral segment transfer 4,853.70

27470 Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique) 3,579.30

27472 Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft 4,050.00

27475 Arrest, epiphyseal, any method (eg, epiphydiodesis); distal femur 2,453.40

27477 Arrest, epiphyseal, any method (eg, epiphydiodesis); tibia and fibula, proximal 2,636.10

27479 Arrest, epiphyseal, any method (eg, epiphydiodesis); combined distal femur, proximal tibia and fibula 3,160.80

27485 Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus)

27486 Revision of total knee arthroplasty, with or without allograft; one component 5,175.90

27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 6,452.10

27488 Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of 3,144.60

27495 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femur

27496 Decompression fasciotomy, thigh and/or knee, one compartment (flexor or extensor or adductor);

27497 Decompression fasciotomy, thigh and/or knee, one compartment (flexor or extensor or adductor); with

27498 Decompression fasciotomy, thigh and/or knee, multiple compartments;

27499 Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable

27500 Closed treatment of femoral shaft fracture, without manipulation 1,207.80

27501 Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, 1,495.80

27502 Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction 1,648.80

27503 Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, 2,035.80

27506 Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary

27507 Open treatment of femoral shaft fracture with plate/screws, with or without cerclage 3,386.70

27508 Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation 1,017.00

27509 Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or

27510 Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulation

27511 Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, with or

27513 Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, with or 3,411.90

27514 Open treatment of femoral fracture, distal end, medial or lateral condyle, with or without internal or external 3,283.20

CPT Mod FEE 27516 Closed treatment of distal femoral epiphyseal separation; without manipulation 1,274.40

27517 Closed treatment of distal femoral epiphyseal separation; with manipulation, with or without skin or skeletal

27519 Open treatment of distal femoral epiphyseal separation, with or without internal or external fixation 3,119.40

27520 Closed treatment of patellar fracture, without manipulation

27524 Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft

27530 Closed treatment of tibial fracture, proximal (plateau); without manipulation 852.30

27532 Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction 1,169.10

27535 Open treatment of tibial fracture, proximal (plateau); unicondylar, with or without internal or external fixation 2,665.80

27536 Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation 2,615.40

27538 Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation 950.40

27540 Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without internal or 2,468.70

27550 Closed treatment of knee dislocation; without anesthesia

27552 Closed treatment of knee dislocation; requiring anesthesia

27556 Open treatment of knee dislocation, with or without internal or external fixation; without primary ligamentous 2,856.60

27557 Open treatment of knee dislocation, with or without internal or external fixation; with primary ligamentous 3,537.90

27558 Open treatment of knee dislocation, with or without internal or external fixation; with primary ligamentous

27560 Closed treatment of patellar dislocation; without anesthesia

27562 Closed treatment of patellar dislocation; requiring anesthesia

27566 Open treatment of patellar dislocation, with or without partial or total patellectomy

27570 Manipulation of knee joint under general anesthesia (includes application of traction or other fixation 529.96

27580 Arthrodesis, knee, any technique 3,822.30

27590 Amputation, thigh, through femur, any level; 2,446.20

27591 Amputation, thigh, through femur, any level; immediate fitting technique including first cast 2,583.00

27592 Amputation, thigh, through femur, any level; open, circular (guillotine) 2,543.40

27594 Amputation, thigh, through femur, any level; secondary closure or scar revision

27596 Amputation, thigh, through femur, any level; re-amputation

27598 Disarticulation at knee 2,443.50

27600 Decompression fasciotomy, leg; anterior and/or lateral compartments only

27601 Decompression fasciotomy, leg; posterior compartment(s) only

27602 Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s) 1,403.10

27603 Incision and drainage, leg or ankle; deep abscess or hematoma 799.29

27604 Incision and drainage, leg or ankle; infected bursa 529.20

27605 Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia 489.60

27606 Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesia

27607 Incision (eg, osteomyelitis or bone abscess), leg or ankle

27610 Arthrotomy, ankle, including exploration, drainage, or removal of foreign body 1,504.80

27612 Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengthening

27613 Biopsy, soft tissue of leg or ankle area; superficial 421.20

27614 Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)

27615 Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle area 2,870.10

27616 Rad rescj tum soft tissue leg/ankle 5+cm 3,296.27

27618 Excision, tumor, leg or ankle area; subcutaneous tissue 846.00

27619 Excision, tumor, leg or ankle area; deep (subfascial or intramuscular) 1,333.80

27620 Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign 1,577.70

27625 Arthrotomy, with synovectomy, ankle; 2,103.30

27626 Arthrotomy, with synovectomy, ankle; including tenosynovectomy 2,202.30

27630 Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle

27632 Excision tumor soft tissue leg/ankle subq 3+ cm 802.95

27634 Exc tumor soft tissue leg/ankle subfasc 5+cm 1,801.95

27635 Excision or curettage of bone cyst or benign tumor, tibia or fibula; 1,979.10

27637 Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft) 2,095.20

27638 Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft 2,301.30

27640 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis or exostosis); tibia

27641 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis or exostosis); fibula 1,883.70

27645 Radical resection of tumor, bone; tibia

27646 Radical resection of tumor, bone; fibula 2,287.80

27647 Radical resection of tumor, bone; talus or calcaneus 2,766.60

27648 Injection procedure for ankle arthrography

27650 Repair, primary, open or percutaneous, ruptured Achilles tendon; 1,908.66

27652 Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft) 2,335.50

27654 Repair, secondary, Achilles tendon, with or without graft 2,672.10

27656 Repair, fascial defect of leg 1,035.90

27658 Repair, flexor tendon, leg; primary, without graft, each tendon 1,115.10

27659 Repair, flexor tendon, leg; secondary, with or without graft, each tendon

27664 Repair, extensor tendon, leg; primary, without graft, each tendon 1,085.40

27665 Repair, extensor tendon, leg; secondary, with or without graft, each tendon 1,157.40

27675 Repair, dislocating peroneal tendons; without fibular osteotomy 1,295.10

27676 Repair, dislocating peroneal tendons; with fibular osteotomy

27680 Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon 1,331.10

27681 Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incision(s)) 1,042.20

CPT Mod FEE 27685 Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure) 1,200.60

27686 Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), each 1,363.50

27687 Gastrocnemius recession (eg, Strayer procedure)

27690 Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial

27691 Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or

27692 Transfer or transplant of single tendon (with muscle redirection or rerouting); each additional tendon (List 544.50

27695 Repair, primary, disrupted ligament, ankle; collateral 1,703.70

27696 Repair, primary, disrupted ligament, ankle; both collateral ligaments

27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) 2,367.00

27700 Arthroplasty, ankle;

27702 Arthroplasty, ankle; with implant (total ankle) 4,042.80

27703 Arthroplasty, ankle; revision, total ankle 3,919.50

27704 Removal of ankle implant 2,137.50

27705 Osteotomy; tibia 2,241.00

27707 Osteotomy; fibula 1,283.40

27709 Osteotomy; tibia and fibula 2,755.80

27712 Osteotomy; multiple, with realignment on intramedullary rod (eg, Sofield type procedure)

27715 Osteoplasty, tibia and fibula, lengthening or shortening

27720 Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)

27722 Repair of nonunion or malunion, tibia; with sliding graft 3,027.60

27724 Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft) 3,375.90

27725 Repair of nonunion or malunion, tibia; by synostosis, with fibula, any method 3,711.60

27726 Repair fibula nonunion/malunion w int fixation 2,950.61

27727 Repair of congenital pseudarthrosis, tibia

27730 Arrest, epiphyseal (epiphysiodesis), any method; distal tibia 1,624.50

27732 Arrest, epiphyseal (epiphysiodesis), any method; distal fibula

27734 Arrest, epiphyseal (epiphysiodesis), any method; distal tibia and fibula 1,830.60

27740 Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; 2,415.60

27742 Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal 3,129.30

27745 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia 2,493.00

27750 Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation 702.97

27752 Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without

27756 Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws)

27758 Open treatment of tibial shaft fracture, (with or without fibular fracture) with plate/screws, with or without 2,968.20

27759 Open treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or 3,328.20

27760 Closed treatment of medial malleolus fracture; without manipulation

27762 Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction

27766 Open treatment of medial malleolus fracture, with or without internal or external fixation 1,553.40

27767 Cltx post ankle fx 548.09

27768 Closed treatment pst malleolus fracture w mnpj 868.53

27769 Open treatment posterior malleolus fracture 1,707.43

27780 Closed treatment of proximal fibula or shaft fracture; without manipulation 562.50

27781 Closed treatment of proximal fibula or shaft fracture; with manipulation 893.70

27784 Open treatment of proximal fibula or shaft fracture, with or without internal or external fixation 1,605.60

27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation

27788 Closed treatment of distal fibular fracture (lateral malleolus); with manipulation 818.10

27792 Open treatment of distal fibular fracture (lateral malleolus), with or without internal or external fixation 1,539.90

27808 Closed treatment of bimalleolar ankle fracture, (including Potts); without manipulation

27810 Closed treatment of bimalleolar ankle fracture, (including Potts); with manipulation 1,189.80

27814 Open treatment of bimalleolar ankle fracture, with or without internal or external fixation 2,196.90

27816 Closed treatment of trimalleolar ankle fracture; without manipulation

27818 Closed treatment of trimalleolar ankle fracture; with manipulation 1,312.20

27822 Open treatment of trimalleolar ankle fracture, with or without internal or external fixation, medial and/or

27823 Open treatment of trimalleolar ankle fracture, with or without internal or external fixation, medial and/or 2,880.90

27824 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with

27825 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with 1,673.10

27826 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial

27827 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial 2,786.40

27828 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial

27829 Open treatment of distal tibiofibular joint (syndesmosis) disruption, with or without internal or external

27830 Closed treatment of proximal tibiofibular joint dislocation; without anesthesia

27831 Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia 695.70

27832 Open treatment of proximal tibiofibular joint dislocation, with or without internal or external fixation, or with 1,254.60

27840 Closed treatment of ankle dislocation; without anesthesia

27842 Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation 761.40

27846 Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal

27848 Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or internal or 2,139.30

27860 Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)

27870 Arthrodesis, ankle, any method 2,708.10

27871 Arthrodesis, tibiofibular joint, proximal or distal 2,174.40

CPT Mod FEE 27880 Amputation, leg, through tibia and fibula; 2,462.40

27881 Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first cast

27882 Amputation, leg, through tibia and fibula; open, circular (guillotine) 2,366.10

27884 Amputation, leg, through tibia and fibula; secondary closure or scar revision

27886 Amputation, leg, through tibia and fibula; re-amputation 2,375.10

27888 Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic 2,007.90

27889 Ankle disarticulation 1,886.40

27892 Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable

27893 Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle

27894 Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of

28001 Incision and drainage, bursa, foot

28002 Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal space

28003 Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas

28005 Incision, bone cortex (eg, osteomyelitis or bone abscess), foot

28008 Fasciotomy, foot and/or toe 700.20

28010 Tenotomy, percutaneous, toe; single tendon

28011 Tenotomy, percutaneous, toe; multiple tendons

28020 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or 1,106.10

28022 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint 725.40

28024 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint

28035 Release, tarsal tunnel (posterior tibial nerve decompression)

28039 Excision tumor soft tissue foot/toe subq 1.5+cm 805.26

28041 Exc tumor soft tissue foot/toe subfasc 1.5+cm 941.09

28043 Excision, tumor, foot; subcutaneous tissue

28045 Excision, tumor, foot; deep, subfascial, intramuscular 1,077.30

28046 Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot 1,923.30

28047 Rad resection tumor soft tissue foot/toe 3+cm 1,845.03

28050 Arthrotomy with biopsy; intertarsal or tarsometatarsal joint 1,000.80

28052 Arthrotomy with biopsy; metatarsophalangeal joint

28054 Arthrotomy with biopsy; interphalangeal joint 588.60

28055 Neurectomy intrinsic musculature of foot 757.64

28060 Fasciectomy, plantar fascia; partial (separate procedure) 1,038.60

28062 Fasciectomy, plantar fascia; radical (separate procedure) 1,872.90

28070 Synovectomy; intertarsal or tarsometatarsal joint, each

28072 Synovectomy; metatarsophalangeal joint, each 727.20

28080 Excision, interdigital (Morton) neuroma, single, each 817.76

28086 Synovectomy, tendon sheath, foot; flexor

28088 Synovectomy, tendon sheath, foot; extensor 873.90

28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot 762.08

28092 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s),

28100 Excision or curettage of bone cyst or benign tumor, talus or calcaneus; 1,274.40

28102 Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or other autograft (includes

28103 Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft 1,577.70

28104 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bones, except talus or calcaneus; 1,057.50

28106 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bones, except talus or calcaneus; 1,435.50

28107 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bones, except talus or calcaneus;

28108 Excision or curettage of bone cyst or benign tumor, phalanges of foot 862.20

28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)

28111 Ostectomy, complete excision; first metatarsal head 1,013.40

28112 Ostectomy, complete excision; other metatarsal head (second, third or fourth)

28113 Ostectomy, complete excision; fifth metatarsal head

28114 Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first

28116 Ostectomy, excision of tarsal coalition 1,553.40

28118 Ostectomy, calcaneus; 1,267.20

28119 Ostectomy, calcaneus; for spur, with or without plantar fascial release

28120 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or

28122 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or 1,105.20

28124 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or 754.20

28126 Resection, partial or complete, phalangeal base, each toe 708.30

28130 Talectomy (astragalectomy) 1,640.70

28140 Metatarsectomy

28150 Phalangectomy, toe, each toe

28153 Resection, condyle(s), distal end of phalanx, each toe

28160 Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each 651.60

28171 Radical resection of tumor, bone; tarsal (except talus or calcaneus)

28173 Radical resection of tumor, bone; metatarsal 1,408.50

28175 Radical resection of tumor, bone; phalanx of toe 999.00

28190 Removal of foreign body, foot; subcutaneous 346.50

28192 Removal of foreign body, foot; deep 671.40

28193 Removal of foreign body, foot; complicated 1,028.70

CPT Mod FEE 28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon 1,134.00

28202 Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft) 1,766.70

28208 Repair, tendon, extensor, foot; primary or secondary, each tendon 967.50

28210 Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft) 1,038.60

28220 Tenolysis, flexor, foot; single tendon 803.70

28222 Tenolysis, flexor, foot; multiple tendons 1,048.50

28225 Tenolysis, extensor, foot; single tendon 580.50

28226 Tenolysis, extensor, foot; multiple tendons

28230 Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)

28232 Tenotomy, open, tendon flexor; toe, single tendon (separate procedure) 399.60

28234 Tenotomy, open, extensor, foot or toe, each tendon 517.50

28238 Reconstruction (advancement), posterior tibial tendon with excision of accessory navicular bone (eg, Kidner

28240 Tenotomy, lengthening, or release, abductor hallucis muscle 711.90

28250 Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)

28260 Capsulotomy, midfoot; medial release only (separate procedure) 1,608.30

28261 Capsulotomy, midfoot; with tendon lengthening

28262 Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, 2,923.20

28264 Capsulotomy, midtarsal (eg, Heyman type procedure) 2,145.60

28270 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure) 712.80

28272 Capsulotomy; interphalangeal joint, each joint (separate procedure)

28280 Syndactylization, toes (eg, webbing or Kelikian type procedure)

28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

28286 Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure)

28288 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head

28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first

28290 Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type

28292 Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller, McBride, or Mayo type

28293 Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant 1,776.60

28294 Correction, hallux valgus (bunion), with or without sesamoidectomy; with tendon transplants (eg, Joplin type 1,939.50

28296 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, 1,827.42

28297 Correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus type procedure 1,831.50

28298 Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy 1,392.30

28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by other methods (eg, double

28300 Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation 1,506.60

28302 Osteotomy; talus

28304 Osteotomy, tarsal bones, other than calcaneus or talus; 1,385.10

28305 Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (eg, Fowler

28306 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal

28307 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with

28308 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first 1,104.30

28309 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, Swanson 1,880.10

28310 Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure) 986.40

28312 Osteotomy, shortening, angular or rotational correction; other phalanges, any toe

28313 Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, 919.80

28315 Sesamoidectomy, first toe (separate procedure)

28320 Repair, nonunion or malunion; tarsal bones 1,640.70

28322 Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)

28340 Reconstruction, toe, macrodactyly; soft tissue resection 1,427.40

28341 Reconstruction, toe, macrodactyly; requiring bone resection

28344 Reconstruction, toe(s); polydactyly 1,073.70

28345 Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web 1,471.50

28360 Reconstruction, cleft foot 2,493.00

28400 Closed treatment of calcaneal fracture; without manipulation 621.90

28405 Closed treatment of calcaneal fracture; with manipulation 1,003.50

28406 Percutaneous skeletal fixation of calcaneal fracture, with manipulation 1,278.00

28415 Open treatment of calcaneal fracture, with or without internal or external fixation;

28420 Open treatment of calcaneal fracture, with or without internal or external fixation; with primary iliac or other 2,753.10

28430 Closed treatment of talus fracture; without manipulation

28435 Closed treatment of talus fracture; with manipulation 768.60

28436 Percutaneous skeletal fixation of talus fracture, with manipulation 918.00

28445 Open treatment of talus fracture, with or without internal or external fixation 1,998.00

28446 Open osteochondral autograft talus 2,581.39

28450 Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each 496.80

28455 Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each

28456 Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, each

28465 Open treatment of tarsal bone fracture (except talus and calcaneus), with or without internal or external

28470 Closed treatment of metatarsal fracture; without manipulation, each

28475 Closed treatment of metatarsal fracture; with manipulation, each

28476 Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each

28485 Open treatment of metatarsal fracture, with or without internal or external fixation, each 1,177.20

CPT Mod FEE 28490 Closed treatment of fracture great toe, phalanx or phalanges; without manipulation 266.40

28495 Closed treatment of fracture great toe, phalanx or phalanges; with manipulation

28496 Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation 576.90

28505 Open treatment of fracture great toe, phalanx or phalanges, with or without internal or external fixation 783.90

28510 Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each 208.80

28515 Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each

28525 Open treatment of fracture, phalanx or phalanges, other than great toe, with or without internal or external 744.30

28530 Closed treatment of sesamoid fracture 348.30

28531 Open tx sesamoid fracture +-internal fixation 880.47

28540 Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia 410.40

28545 Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia

28546 Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with manipulation

28555 Open treatment of tarsal bone dislocation, with or without internal or external fixation

28570 Closed treatment of talotarsal joint dislocation; without anesthesia

28575 Closed treatment of talotarsal joint dislocation; requiring anesthesia 577.80

28576 Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulation

28585 Open treatment of talotarsal joint dislocation, with or without internal or external fixation

28600 Closed treatment of tarsometatarsal joint dislocation; without anesthesia

28605 Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia

28606 Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation

28615 Open treatment of tarsometatarsal joint dislocation, with or without internal or external fixation

28630 Closed treatment of metatarsophalangeal joint dislocation; without anesthesia 335.70

28635 Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia

28636 Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulation

28645 Open treatment of metatarsophalangeal joint dislocation, with or without internal or external fixation 782.10

28660 Closed treatment of interphalangeal joint dislocation; without anesthesia

28665 Closed treatment of interphalangeal joint dislocation; requiring anesthesia

28666 Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulation

28675 Open treatment of interphalangeal joint dislocation, with or without internal or external fixation 684.90

28705 Arthrodesis; pantalar 2,897.10

28715 Arthrodesis; triple 3,185.10

28725 Arthrodesis; subtalar 2,137.50

28730 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;

28735 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction) 2,173.50

28737 Arthrodesis, with tendon lengthening and advancement, midtarsal navicular-cuneiform (eg, Miller type 1,982.70

28740 Arthrodesis, midtarsal or tarsometatarsal, single joint

28750 Arthrodesis, great toe; metatarsophalangeal joint 1,392.70

28755 Arthrodesis, great toe; interphalangeal joint 1,186.20

28760 Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint 1,071.90

28800 Amputation, foot; midtarsal (eg, Chopart type procedure) 1,847.70

28805 Amputation, foot; transmetatarsal 2,238.30

28810 Amputation, metatarsal, with toe, single 1,152.90

28820 Amputation, toe; metatarsophalangeal joint

28825 Amputation, toe; interphalangeal joint 782.10

28890 Eswt hi nrg pfrmd phys w/us gdn invg plntar fsca 905.09

29000 Application of halo type body cast (see 20661-20663 for insertion) 608.40

29010 Application of Risser jacket, localizer, body; only 492.30

29015 Application of Risser jacket, localizer, body; including head 670.50

29020 Application of turnbuckle jacket, body; only 534.60

29025 Application of turnbuckle jacket, body; including head

29035 Application of body cast, shoulder to hips;

29040 Application of body cast, shoulder to hips; including head, Minerva type

29044 Application of body cast, shoulder to hips; including one thigh

29046 Application of body cast, shoulder to hips; including both thighs 469.80

29049 Application; plaster figure-of-eight

29055 Application; shoulder spica 389.70

29058 Application; plaster Velpeau

29065 Application; shoulder to hand (long arm)

29075 Application; elbow to finger (short arm)

29085 Application; hand and lower forearm (gauntlet) 156.05

29086 Application cast finger 110.50

29105 Application of long arm splint (shoulder to hand)

29125 Application of short arm splint (forearm to hand); static 99.00

29126 Application of short arm splint (forearm to hand); dynamic

29130 Application of finger splint; static 82.80

29131 Application of finger splint; dynamic

29200 Strapping; thorax 81.00

29240 Strapping; shoulder (eg, Velpeau) 90.00

29260 Strapping; elbow or wrist 65.68

29280 Strapping; hand or finger 86.40

CPT Mod FEE 29305 Application of hip spica cast; one leg

29325 Application of hip spica cast; one and one-half spica or both legs

29345 Application of long leg cast (thigh to toes);

29355 Application of long leg cast (thigh to toes); walker or ambulatory type

29358 Application of long leg cast brace 451.80

29365 Application of cylinder cast (thigh to ankle)

29405 Application of short leg cast (below knee to toes); 215.17

29425 Application of short leg cast (below knee to toes); walking or ambulatory type

29435 Application of patellar tendon bearing (PTB) cast

29440 Adding walker to previously applied cast 83.70

29445 Application of rigid total contact leg cast

29450 Application of clubfoot cast with molding or manipulation, long or short leg

29505 Application of long leg splint (thigh to ankle or toes)

29515 Application of short leg splint (calf to foot)

29520 Strapping; hip 98.10

29530 Strapping; knee 95.40

29540 Strapping; ankle 73.52

29550 Strapping; toes 66.60

29580 Strapping; Unna boot 96.09

29581 Appl mlt-layer venous wound compress below knee 132.61

29582 Apply multlay comprs upr leg 177.41

29583 Apply multlay comprs upr arm 110.04

29584 Appl multlay comprs arm/hand 177.41

29700 Removal or bivalving; gauntlet, boot or body cast 92.42

29705 Removal or bivalving; full arm or full leg cast 90.31

29710 Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.

29715 Removal or bivalving; turnbuckle jacket

29720 Repair of spica, body cast or jacket 87.30

29730 Windowing of cast 85.50

29740 Wedging of cast (except clubfoot casts)

29750 Wedging of clubfoot cast 97.20

29800 Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)

29804 Arthroscopy, temporomandibular joint, surgical

29805 Arthroscopy shoulder dx +-synovial biopsy spx 1,129.02

29806 Arthroscopy shoulder surgical capsulorrhaphy 2,796.86

29807 Arthroscopy shoulder surgical repair slap lesion 2,663.48

29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body 2,304.90

29820 Arthroscopy, shoulder, surgical; synovectomy, partial 2,215.80

29821 Arthroscopy, shoulder, surgical; synovectomy, complete

29822 Arthroscopy, shoulder, surgical; debridement, limited 2,419.20

29823 Arthroscopy, shoulder, surgical; debridement, extensive

29824 Arthroscopy shoulder distal claviculectomy 1,813.74

29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation 2,412.00

29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or 2,722.75

29827 Arthroscopy shoulder rotator cuff repair 2,928.75

29828 Arthroscopy shoulder biceps tenodesis 2,558.94

29830 Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure) 1,206.00

29834 Arthroscopy, elbow, surgical; with removal of loose body or foreign body 2,052.00

29835 Arthroscopy, elbow, surgical; synovectomy, partial 2,308.50

29836 Arthroscopy, elbow, surgical; synovectomy, complete 2,322.90

29837 Arthroscopy, elbow, surgical; debridement, limited 1,981.80

29838 Arthroscopy, elbow, surgical; debridement, extensive 2,250.90

29840 Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure) 1,214.10

29843 Arthroscopy, wrist, surgical; for infection, lavage and drainage

29844 Arthroscopy, wrist, surgical; synovectomy, partial 1,881.00

29845 Arthroscopy, wrist, surgical; synovectomy, complete

29846 Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement

29847 Arthroscopy, wrist, surgical; internal fixation for fracture or instability 2,093.40

29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament

29850 Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or 2,285.10

29851 Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or 2,887.20

29855 Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, with or without internal or

29856 Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal or 2,907.90

29860 Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure) 1,547.10

29861 Arthroscopy, hip, surgical; with removal of loose body or foreign body 2,295.90

29862 Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion 2,525.40

29863 Arthroscopy, hip, surgical; with synovectomy 2,306.70

29866 Arthroscopy knee osteochondral agrft mosaicplast 2,666.26

29867 Arthroscopy knee osteochondral allograft 4,120.16

29868 Arthroscopy knee meniscal trnsplj med/lat 5,488.61

CPT Mod FEE 29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)

29871 Arthroscopy, knee, surgical; for infection, lavage and drainage

29873 Arthroscopy knee lateral release 1,675.37

29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans

29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) 2,459.70

29876 Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (eg, medial or lateral) 2,733.79

29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) 2,552.87

29879 Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple

29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) 3,254.71

29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) 2,787.13

29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 2,919.72

29883 Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral) 3,747.60

29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure) 2,337.30

29885 Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal 2,697.30

29886 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion

29887 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation 3,380.40

29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 4,793.75

29889 Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction 4,867.20

29891 Arthroscopy, ankle, surgical; excision of osteochondral defect of talus and/or tibia, including drilling of the

29892 Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond 2,223.90

29893 Endoscopic plantar fasciotomy 1,233.00

29894 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body 2,206.80

29895 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial 2,299.50

29897 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited 2,115.00

29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive 2,721.60

29899 Arthroscopy ankle surgical w/ankle arthrodesis 2,665.75

29900 Arthroscopy metacarpophalangeal synovial biopsy 1,121.89

29901 Arthrs metacarpophalangeal joint debridement 1,598.44

29902 Arthrs mtcarphlngl jt w/rdctj ur coltrl ligm 1,839.03

29904 Arthrs subtalar joint remove loose/foreign body 2,032.59

29905 Arthroscopy subtalar joint with synovectomy 2,146.58

29906 Arthroscopy subtalar joint with debridement 2,078.55

29907 Arthroscopy subtalar joint subtalar arthrodesis 2,547.20

29914 Arthroscopy hip w/femoroplasty 2,638.07

29915 Arthroscopy hip w/acetabuloplasty 2,795.34

29916 Arthroscopy hip w/labral repair 2,795.34

30000 Drainage abscess or hematoma, nasal, internal approach

30020 Drainage abscess or hematoma, nasal septum

30100 Biopsy, intranasal

30110 Excision, nasal polyp(s), simple

30115 Excision, nasal polyp(s), extensive

30117 Excision or destruction, any method (including laser), intranasal lesion; internal approach

30118 Excision or destruction, any method (including laser), intranasal lesion; external approach (lateral 2,187.00

30120 Excision or surgical planing of skin of nose for rhinophyma

30124 Excision dermoid cyst, nose; simple, skin, subcutaneous 774.00

30125 Excision dermoid cyst, nose; complex, under bone or cartilage 1,936.80

30130 Excision turbinate, partial or complete, any method

30140 Submucous resection turbinate, partial or complete, any method 1,149.30

30150 Rhinectomy; partial 2,242.80

30160 Rhinectomy; total 2,889.00

30200 Injection into turbinate(s), therapeutic

30210 Displacement therapy (Proetz type)

30220 Insertion, nasal septal prosthesis (button) 401.40

30300 Removal foreign body, intranasal; office type procedure 134.21

30310 Removal foreign body, intranasal; requiring general anesthesia 567.90

30320 Removal foreign body, intranasal; by lateral rhinotomy 1,482.30

30400 Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip

30410 Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or 3,969.90

30420 Rhinoplasty, primary; including major septal repair 4,673.70

30430 Rhinoplasty, secondary; minor revision (small amount of nasal tip work) 1,877.40

30435 Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) 2,531.70

30450 Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) 4,104.90

30460 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar 2,551.50

30462 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar 4,778.10

30465 Repair nasal vestibular stenosis 2,367.57

30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft 2,891.27

30540 Repair choanal atresia; intranasal

30545 Repair choanal atresia; transpalatine 3,063.60

30560 Lysis intranasal synechia 240.30

30580 Repair fistula; oromaxillary (combine with 31030 if antrotomy is included) 1,683.00

CPT Mod FEE 30600 Repair fistula; oronasal 1,819.80

30620 Septal or other intranasal dermatoplasty (does not include obtaining graft)

30630 Repair nasal septal perforations

30801 Cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any method, (separate

30802 Cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any method, (separate

30901 Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method 189.81

30903 Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method 280.57

30905 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cauterization, any method; initial

30906 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cauterization, any method;

30915 Ligation arteries; ethmoidal

30920 Ligation arteries; internal maxillary artery, transantral 2,600.10

30930 Fracture nasal turbinate(s), therapeutic

31000 Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium) 134.23

31002 Lavage by cannulation; sphenoid sinus

31020 Sinusotomy, maxillary (antrotomy); intranasal

31030 Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps 1,966.50

31032 Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polyps

31040 Pterygomaxillary fossa surgery, any approach 3,172.50

31050 Sinusotomy, sphenoid, with or without biopsy;

31051 Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s) 2,057.40

31070 Sinusotomy frontal; external, simple (trephine operation) 1,499.40

31075 Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type) 2,574.00

31080 Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation) 3,005.10

31081 Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation) 2,971.80

31084 Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision

31085 Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incision 3,885.30

31086 Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incision 3,278.70

31087 Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision 3,210.30

31090 Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid) 4,236.30

31200 Ethmoidectomy; intranasal, anterior 1,301.40

31201 Ethmoidectomy; intranasal, total

31205 Ethmoidectomy; extranasal, total

31225 Maxillectomy; without orbital exenteration 4,426.20

31230 Maxillectomy; with orbital exenteration (en bloc) 5,388.30

31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) 244.28

31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture) 683.10

31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or

31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)

31238 Nasal/sinus endoscopy, surgical; with control of epistaxis 909.90

31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy 2,768.40

31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection

31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) 1,690.20

31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) 1,789.35

31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; 1,530.00

31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus 1,867.50

31276 Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal

31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; 1,337.40

31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus

31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region 3,514.50

31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region 3,903.30

31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital wall decompression 3,122.10

31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall decompression 3,414.60

31294 Nasal/sinus endoscopy, surgical; with optic nerve decompression 3,854.70

31295 2,597.07

31296 2,881.60

31297 2,872.95

31300 Laryngotomy (thyrotomy, laryngofissure); with removal of tumor or laryngocele, cordectomy 2,842.20

31320 Laryngotomy (thyrotomy, laryngofissure); diagnostic

31360 Laryngectomy; total, without radical neck dissection 3,825.90

31365 Laryngectomy; total, with radical neck dissection 5,740.20

31367 Laryngectomy; subtotal supraglottic, without radical neck dissection 4,111.20

31368 Laryngectomy; subtotal supraglottic, with radical neck dissection 6,336.00

31370 Partial laryngectomy (hemilaryngectomy); horizontal 4,670.10

31375 Partial laryngectomy (hemilaryngectomy); laterovertical 3,898.80

31380 Partial laryngectomy (hemilaryngectomy); anterovertical 3,970.80

31382 Partial laryngectomy (hemilaryngectomy); antero-latero-vertical 4,020.30

31390 Pharyngolaryngectomy, with radical neck dissection; without reconstruction 5,854.50

31395 Pharyngolaryngectomy, with radical neck dissection; with reconstruction 6,849.90

31400 Arytenoidectomy or arytenoidopexy, external approach 2,953.80

31420 Epiglottidectomy 2,694.60

CPT Mod FEE 31500 Intubation, endotracheal, emergency procedure 307.80

31502 Tracheotomy tube change prior to establishment of fistula tract

31505 Laryngoscopy, indirect; diagnostic (separate procedure) 217.68

31510 Laryngoscopy, indirect; with biopsy

31511 Laryngoscopy, indirect; with removal of foreign body

31512 Laryngoscopy, indirect; with removal of lesion

31513 Laryngoscopy, indirect; with vocal cord injection 585.90

31515 Laryngoscopy direct, with or without tracheoscopy; for aspiration 377.10

31520 Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn 460.04

31525 Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn

31526 Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope

31527 Laryngoscopy direct, with or without tracheoscopy; with insertion of obturator 1,164.60

31528 Laryngoscopy direct, with or without tracheoscopy; with dilatation, initial

31529 Laryngoscopy direct, with or without tracheoscopy; with dilatation, subsequent

31530 Laryngoscopy, direct, operative, with foreign body removal;

31531 Laryngoscopy, direct, operative, with foreign body removal; with operating microscope 1,302.30

31535 Laryngoscopy, direct, operative, with biopsy;

31536 Laryngoscopy, direct, operative, with biopsy; with operating microscope

31540 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; 1,155.60

31541 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with 1,328.82

31545 Largsc mcrscp/tlscp rmvl les vocal c/d flap 1,137.51

31546 Largsc mcrscp/tlscp rmvl les vocal c/d grf 1,746.43

31560 Laryngoscopy, direct, operative, with arytenoidectomy;

31561 Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope 2,378.70

31570 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; 1,323.90

31571 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope 1,458.90

31575 Laryngoscopy, flexible fiberoptic; diagnostic 323.11

31576 Laryngoscopy, flexible fiberoptic; with biopsy

31577 Laryngoscopy, flexible fiberoptic; with removal of foreign body 982.80

31578 Laryngoscopy, flexible fiberoptic; with removal of lesion

31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy 626.40

31580 Laryngoplasty; for laryngeal web, two stage, with keel insertion and removal

31582 Laryngoplasty; for laryngeal stenosis, with graft or core mold, including tracheotomy 4,155.30

31584 Laryngoplasty; with open reduction of fracture 3,971.70

31587 Laryngoplasty, cricoid split 2,544.30

31588 Laryngoplasty, not otherwise specified (eg, for burns, reconstruction after partial laryngectomy) 3,209.40

31590 Laryngeal reinnervation by neuromuscular pedicle 2,811.60

31595 Section recurrent laryngeal nerve, therapeutic (separate procedure), unilateral

31600 Tracheostomy, planned (separate procedure);

31601 Tracheostomy, planned (separate procedure); under two years 1,423.80

31603 Tracheostomy, emergency procedure; transtracheal 1,230.30

31605 Tracheostomy, emergency procedure; cricothyroid membrane 957.60

31610 Tracheostomy, fenestration procedure with skin flaps 1,731.60

31611 Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, 1,748.70

31612 Tracheal puncture, percutaneous with transtracheal aspiration and/or injection

31613 Tracheostoma revision; simple, without flap rotation

31614 Tracheostoma revision; complex, with flap rotation

31615 Tracheobronchoscopy through established tracheostomy incision 555.30

31620 Endobrncl us bronchoscopic dx/ther ivntj 798.23

31622 Bronchoscopy (rigid or flexible); diagnostic, with or without cell washing (separate procedure)

31623 Bronchoscopy (rigid or flexible); with brushing or protected brushings 686.70

31624 Bronchoscopy (rigid or flexible); with bronchial alveolar lavage 693.00

31625 Bronchoscopy (rigid or flexible); with biopsy

31626 Brnchsc w/plmt fiducial markers 1/mlt 823.11

31627 Brnchsc w/cptr-asst image-guided navigation 948.86

31628 Bronchoscopy (rigid or flexible); with transbronchial lung biopsy, with or without fluoroscopic guidance 915.30

31629 Bronchoscopy (rigid or flexible); with transbronchial needle aspiration biopsy

31630 Bronchoscopy (rigid or flexible); with tracheal or bronchial dilation or closed reduction of fracture

31631 Bronchoscopy (rigid or flexible); with tracheal dilation and placement of tracheal stent 1,018.80

31632 Brnchsc w/transbrncl lung bx ea lobe 221.90

31633 Brnchsc w/transbrncl ndl aspir bx ea lobe 302.61

31634 Bronch w/balloon occlusion 4,626.58

31635 Bronchoscopy (rigid or flexible); with removal of foreign body

31636 Brnchsc w/placement brncl stent 1st bronchus 822.83

31637 Brnchsc ea major bronchus stented 274.30

31638 Brnchsc revj tracheal/brncl stent ins prev sess 907.48

31640 Bronchoscopy (rigid or flexible); with excision of tumor

31641 Bronchoscopy (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than

31643 Bronchoscopy (rigid or flexible); with placement of catheter(s) for intracavitary radioelement application 606.60

31645 Bronchoscopy (rigid or flexible); with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of

CPT Mod FEE 31646 Bronchoscopy (rigid or flexible); with therapeutic aspiration of tracheobronchial tree, subsequent 706.50

31647 Bronchial valve init insert 533.65

31648 Bronchial valve addl insert 560.82

31649 Bronchial valve remov init 172.16

31651 Bronchial valve remov addl 181.98

31660 Bronch thermoplsty 1 lobe 536.25

31661 Bronch thermoplsty 2/> lobes 566.59

31717 Catheterization with bronchial brush biopsy

31720 Catheter aspiration (separate procedure); nasotracheal

31725 Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside

31730 Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy 668.70

31750 Tracheoplasty; cervical

31755 Tracheoplasty; tracheopharyngeal fistulization, each stage 3,572.10

31760 Tracheoplasty; intrathoracic

31766 Carinal reconstruction

31770 Bronchoplasty; graft repair 3,687.30

31775 Bronchoplasty; excision stenosis and anastomosis 4,083.30

31780 Excision tracheal stenosis and anastomosis; cervical

31781 Excision tracheal stenosis and anastomosis; cervicothoracic 4,003.20

31785 Excision of tracheal tumor or carcinoma; cervical 3,078.00

31786 Excision of tracheal tumor or carcinoma; thoracic 4,113.90

31800 Suture of tracheal wound or injury; cervical 2,929.50

31805 Suture of tracheal wound or injury; intrathoracic 2,932.20

31820 Surgical closure tracheostomy or fistula; without plastic repair 899.10

31825 Surgical closure tracheostomy or fistula; with plastic repair 1,259.10

31830 Revision of tracheostomy scar

32035 Thoracostomy; with rib resection for empyema

32036 Thoracostomy; with open flap drainage for empyema 1,944.00

32096 Open wedge/bx lung infiltr 2,016.26

32097 Open wedge/bx lung nodule 2,016.26

32098 Open biopsy of lung pleura 1,955.37

32100 Thoracotomy, major; with exploration and biopsy 2,701.80

32110 Thoracotomy, major; with control of traumatic hemorrhage and/or repair of lung tear 3,024.90

32120 Thoracotomy, major; for postoperative complications 2,522.70

32124 Thoracotomy, major; with open intrapleural pneumonolysis 2,365.20

32140 Thoracotomy, major; with cyst(s) removal, with or without a pleural procedure

32141 Thoracotomy, major; with excision-plication of bullae, with or without any pleural procedure 2,962.80

32150 Thoracotomy, major; with removal of intrapleural foreign body or fibrin deposit

32151 Thoracotomy, major; with removal of intrapulmonary foreign body 2,255.40

32160 Thoracotomy, major; with cardiac massage 2,646.00

32200 Pneumonostomy; with open drainage of abscess or cyst 2,478.60

32201 Pneumonostomy; with percutaneous drainage of abscess or cyst

32215 Pleural scarification for repeat pneumothorax 2,565.90

32220 Decortication, pulmonary (separate procedure); total 3,480.30

32225 Decortication, pulmonary (separate procedure); partial

32310 Pleurectomy, parietal (separate procedure) 3,073.50

32320 Decortication and parietal pleurectomy 4,303.80

32400 Biopsy, pleura; percutaneous needle

32405 Biopsy, lung or mediastinum, percutaneous needle 518.40

32440 Removal of lung, total pneumonectomy; 4,605.30

32442 Removal of lung, total pneumonectomy; with resection of segment of trachea followed by broncho-tracheal 4,649.40

32445 Removal of lung, total pneumonectomy; extrapleural 4,839.30

32480 Removal of lung, other than total pneumonectomy; single lobe (lobectomy) 4,327.20

32482 Removal of lung, other than total pneumonectomy; two lobes (bilobectomy) 4,661.10

32484 Removal of lung, other than total pneumonectomy; single segment (segmentectomy) 4,255.20

32486 Removal of lung, other than total pneumonectomy; with circumferential resection of segment of bronchus 4,365.00

32488 Removal of lung, other than total pneumonectomy; all remaining lung following previous removal of a 5,346.00

32491 Rmvl lng oth/thn pnumec exc-plctj emphy lng 3,131.92

32501 Rescj&bronchoplasty pfrmd tm lobec/sgmectomy 529.40

32503 Rescj apical lng tum w/o ch wall rcnstj 4,016.73

32504 Rescj apical lng tum w/ch wall rcnstj 4,300.61

32505 Wedge resect of lung initial 2,383.63

32506 Wedge resect of lung add-on

32507 Wedge resect of lung diag

32540 Extrapleural enucleation of empyema (empyemectomy)

32550 Insert pleural cath 739.02

32551 Tube thoracostomy includes water seal 397.73

32552 Remove lung catheter 393.46

32553 Ins mark thor for rt perq 603.94

32554 Aspirate pleura w/o imaging 1,393.37

CPT Mod FEE 32555 Aspirate pleura w/ imaging 1,606.11

32556 Insert cath pleura w/o image 1,464.89

32557 Insert cath pleura w/ image 2,398.33

32560 Treat pleurodesis w/agent 300.45

32561 Lyse chest fibrin init day 184.63

32562 Lyse chest fibrin subq day 170.85

32601 Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, without biopsy

32604 Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy 1,803.60

32606 Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy 1,832.40

32607 Thoracoscopy w/bx infiltrate 795.40

32608 Thoracoscopy w/bx nodule 979.00

32609 Thoracoscopy w/bx pleura 675.96

32650 Thoracoscopy, surgical; with pleurodesis, any method

32651 Thoracoscopy, surgical; with partial pulmonary decortication 2,722.50

32652 Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis 3,548.70

32653 Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit 2,567.70

32654 Thoracoscopy, surgical; with control of traumatic hemorrhage

32655 Thoracoscopy, surgical; with excision-plication of bullae, including any pleural procedure 2,972.70

32656 Thoracoscopy, surgical; with parietal pleurectomy 2,995.20

32658 Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac 2,766.60

32659 Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for 2,986.20

32661 Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass

32662 Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass 3,102.30

32663 Thoracoscopy, surgical; with lobectomy, total or segmental 3,747.60

32664 Thoracoscopy, surgical; with thoracic sympathectomy

32665 Thoracoscopy, surgical; with esophagomyotomy (Heller type) 3,350.70

32666 Thoracoscopy w/wedge resect 2,222.05

32667 Thoracoscopy w/w resect addl

32668 Thoracoscopy w/w resect diag 411.71

32669 Thoracoscopy remove segment 3,335.83

32670 Thoracoscopy bilobectomy 3,974.02

32671 Thoracoscopy pneumonectomy 4,409.85

32672 Thoracoscopy for lvrs 3,774.81

32673 Thoracoscopy w/thymus resect 2,957.25

32674 Thoracoscopy lymph node exc 531.96

32701 Thorax stereo rad targetw/tx 545.49

32800 Repair lung hernia through chest wall 2,565.00

32810 Closure of chest wall following open flap drainage for empyema (Clagett type procedure) 2,710.80

32815 Open closure of major bronchial fistula 4,140.90

32820 Major reconstruction, chest wall (posttraumatic) 3,856.50

32851 Lung transplant single 8,134.00

32852 Lung transplant with bypass 8,881.42

32853 Lung transplant double 11,365.84

32854 Lung transplant with bypass 12,075.71

32900 Resection of ribs, extrapleural, all stages 2,188.80

32905 Thoracoplasty, Schede type or extrapleural (all stages);

32906 Thoracoplasty, Schede type or extrapleural (all stages); with closure of bronchopleural fistula

32940 Pneumonolysis, extraperiosteal, including filling or packing procedures

32960 Pneumothorax, therapeutic, intrapleural injection of air

32997 Total lung lavage (unilateral) 993.60

32998 Ablation pulmonary tumor perq rf uni 2,369.98

33010 Pericardiocentesis; initial

33011 Pericardiocentesis; subsequent

33015 Tube pericardiostomy

33020 Pericardiotomy for removal of clot or foreign body (primary procedure) 2,667.60

33025 Creation of pericardial window or partial resection for drainage

33030 Pericardiectomy, subtotal or complete; without cardiopulmonary bypass 4,041.00

33031 Pericardiectomy, subtotal or complete; with cardiopulmonary bypass 5,037.30

33050 Excision of pericardial cyst or tumor 3,219.30

33120 Excision of intracardiac tumor, resection with cardiopulmonary bypass 6,552.90

33130 Resection of external cardiac tumor 4,139.10

33140 Transmyocrd laser revsc thorcom spx 3,384.56

33141 Transmyocrd laser revsc pfrmd tm oth opn car px 1,649.90

33202 Insertion epicardial electrode open 2,051.82

33203 Insertion epicardial electrode endoscopic 2,105.33

33206 Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial 2,232.90

33207 Insertion or replacement of permanent pacemaker with transvenous electrode(s); ventricular 2,424.60

33208 Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular 3,028.50

33210 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter

33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)

CPT Mod FEE 33212 Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular 1,445.40

33213 Insertion or replacement of pacemaker pulse generator only; dual chamber

33214 Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system 1,986.30

33215 Rpsg prev implted pm/cvdfb r atr/r ventr eltrd 829.37

33216 Insertion or repositioning of a transvenous electrode (15 days or more after initial insertion); single chamber 1,427.40

33217 Insertion or repositioning of a transvenous electrode (15 days or more after initial insertion); dual chamber 1,512.90

33218 Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber 1,392.30

33220 Repair of two transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing 1,192.50

33221 Insert pulse gen mult leads 887.15

33222 Revision or relocation of skin pocket for pacemaker 1,442.70

33223 Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator 1,238.40

33224 Insj eltrd car ven sys attch pm/cvdfb pls gen 1,345.09

33225 Insj eltrd car ven sys tm insj cvdfb/pm pls gen 1,199.61

33226 Rpsg prev implted car ven sys l ventr eltrd 1,296.07

33227 Remove&replace pm gen singl 848.55

33228 Remv&replc pm gen dual lead 884.94

33229 Remv&replc pm gen mult leads 920.48

33230 Insrt pulse gen w/dual leads 960.14

33231 Insrt pulse gen w/mult leads 995.68

33233 Removal of permanent pacemaker pulse generator 995.40

33234 Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular 1,511.10

33235 Removal of transvenous pacemaker electrode(s); dual lead system 1,649.70

33236 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or 1,722.60

33237 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system 2,735.10

33238 Removal of permanent transvenous electrode(s) by thoracotomy

33240 Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator 1,513.80

33241 Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator

33243 Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by thoracotomy 3,192.30

33244 Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by transvenous extraction 2,707.20

33249 Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and

33250 Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, Wolff-Parkinson-White, A-V

33251 Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, Wolff-Parkinson-White, A-V

33254 Ablation & rcnstj atria lmtd 2,975.87

33255 Ablation & rcnstj atria x10sv w/o bypass 3,580.01

33256 Ablation & rcnstj atria x10sv w/bypass 4,278.05

33257 Atria ablate & rcnstj w other procedure limited 1,362.89

33258 Atria abltj &rcnstj w other px extensive w/o byp 1,535.93

33259 Atria ablate &rcnstj w other px extensive w byp 2,004.34

33261 Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass 5,135.40

33262 Remv&replc cvd gen sing lead 925.34

33263 Remv&replc cvd gen dual lead 961.72

33264 Remv&replc cvd gen mult lead 997.26

33265 Ndsc ablation & rcnstj atria lmtd w/o bypass 2,970.81

33266 Ndsc ablation & rcnstj atria x10sv w/o bypass 4,068.64

33282 Implant pat-active ht record 786.37

33284 Remove pat-active ht record 567.29

33300 Repair of cardiac wound; without bypass

33305 Repair of cardiac wound; with cardiopulmonary bypass 5,122.80

33310 Cardiotomy, exploratory (includes removal of foreign body); without bypass 3,654.90

33315 Cardiotomy, exploratory (includes removal of foreign body); with cardiopulmonary bypass 5,318.10

33320 Suture repair of aorta or great vessels; without shunt or cardiopulmonary bypass 4,713.30

33321 Sutr rpr aorta/grt vsl w/shunt byp 3,833.13

33322 Suture repair of aorta or great vessels; with cardiopulmonary bypass 5,744.70

33330 Insertion of graft, aorta or great vessels; without shunt, or cardiopulmonary bypass 6,261.30

33332 Insj grf aorta/grt vsl w/shunt byp 5,066.72

33335 Insertion of graft, aorta or great vessels; with cardiopulmonary bypass 6,984.00

33361 Replace aortic valve perq 3,285.90

33362 3,594.86

33363 3,722.19

33364 3,961.38

33365 4,362.52

33367 1,531.20

33368 1,856.07

33369 2,450.22

33400 Valvuloplasty, aortic valve; open, with cardiopulmonary bypass

33401 Valvuloplasty, aortic valve; open, with inflow occlusion 5,706.90

33403 Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass 6,159.60

33404 Construction of apical-aortic conduit

33405 Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve other than homograft or 7,717.50

33406 Replacement, aortic valve, with cardiopulmonary bypass; with homograft valve (freehand) 7,029.90

CPT Mod FEE 33410 Rplcmt a-valve stent< tiss valve 6,661.86

33411 Replacement, aortic valve; with aortic annulus enlargement, noncoronary cusp 7,921.80

33412 Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure) 8,019.00

33413 Replacement, aortic valve; by translocation of autologous pulmonary valve with homograft replacement of 7,622.10

33414 Rpr ventr o/f trc obstrcj patch enlgment o/f trc 6,825.57

33415 Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis 6,087.60

33416 Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal 6,592.50

33417 Aortoplasty (gusset) for supravalvular stenosis 6,952.50

33420 Valvotomy, mitral valve; closed heart 5,495.40

33422 Valvotomy, mitral valve; open heart, with cardiopulmonary bypass 6,451.20

33425 Valvuloplasty, mitral valve, with cardiopulmonary bypass; 6,628.50

33426 Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring 7,905.60

33427 Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring 6,978.60

33430 Replacement, mitral valve, with cardiopulmonary bypass 7,627.50

33460 Valvectomy, tricuspid valve, with cardiopulmonary bypass 6,223.50

33463 Valvuloplasty, tricuspid valve; without ring insertion 7,105.50

33464 Valvuloplasty, tricuspid valve; with ring insertion 6,801.30

33465 Replacement, tricuspid valve, with cardiopulmonary bypass 6,721.20

33468 Tricuspid valve repositioning and plication for Ebstein anomaly 6,988.50

33470 Valvotomy, pulmonary valve, closed heart; transventricular 5,030.10

33471 Valvotomy, pulmonary valve, closed heart; via pulmonary artery 4,708.80

33472 Valvotomy, pulmonary valve, open heart; with inflow occlusion 4,979.70

33474 Valvotomy, pulmonary valve, open heart; with cardiopulmonary bypass 5,535.90

33475 Replacement, pulmonary valve 7,105.50

33476 Right ventricular resection for infundibular stenosis, with or without commissurotomy

33478 Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection

33496 Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (separate procedure) 5,799.60

33500 Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass 5,355.90

33501 Repair of coronary arteriovenous or arteriocardiac chamber fistula; without cardiopulmonary bypass 4,027.50

33502 Repair of anomalous coronary artery; by ligation 3,878.10

33503 Repair of anomalous coronary artery; by graft, without cardiopulmonary bypass

33504 Repair of anomalous coronary artery; by graft, with cardiopulmonary bypass 6,170.40

33505 Rpr anom c art w/constj intrap-art tunnel 5,183.04

33506 Rpr anom c art from p-art to aorta 5,719.19

33507 Rpr anom aortic origin c art unroofing/tlcj 5,300.00

33508 Ndsc surg w/vid-asstd harvest vein cab 260.39

33510 Coronary artery bypass, vein only; single coronary venous graft 7,254.00

33511 Coronary artery bypass, vein only; two coronary venous grafts 7,448.40

33512 Coronary artery bypass, vein only; three coronary venous grafts 8,284.50

33513 Coronary artery bypass, vein only; four coronary venous grafts 9,268.20

33514 Coronary artery bypass, vein only; five coronary venous grafts 10,083.60

33516 Coronary artery bypass, vein only; six or more coronary venous grafts 10,809.00

33517 Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in 1,161.90

33518 Coronary artery bypass, using venous graft(s) and arterial graft(s); two venous grafts (List separately in 1,747.80

33519 Coronary artery bypass, using venous graft(s) and arterial graft(s); three venous grafts (List separately in

33521 Coronary artery bypass, using venous graft(s) and arterial graft(s); four venous grafts (List separately in

33522 Coronary artery bypass, using venous graft(s) and arterial graft(s); five venous grafts (List separately in 3,634.20

33523 Coronary artery bypass, using venous graft(s) and arterial graft(s); six or more venous grafts (List 4,606.20

33530 Reoperation, coronary artery bypass procedure or valve procedure, more than one month after original

33533 Coronary artery bypass, using arterial graft(s); single arterial graft 6,878.70

33534 Coronary artery bypass, using arterial graft(s); two coronary arterial grafts 7,822.80

33535 Coronary artery bypass, using arterial graft(s); three coronary arterial grafts 8,479.80

33536 Coronary artery bypass, using arterial graft(s); four or more coronary arterial grafts 8,454.60

33542 Myocardial resection (eg, ventricular aneurysmectomy) 6,769.80

33545 Repair of postinfarction ventricular septal defect, with or without myocardial resection 7,679.70

33548 Surg ventr rstrj px w/prostc patch pfrmd 7,924.63

33572 Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery

33600 Closure of atrioventricular valve (mitral or tricuspid) by suture or patch

33602 Closure of semilunar valve (aortic or pulmonary) by suture or patch 6,479.10

33606 Anastomosis of pulmonary artery to aorta (Damus-Kaye-Stansel procedure) 6,581.70

33608 Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by 6,643.80

33610 Rpr car anomal surg enlgment ventr septl dfct 6,591.66

33611 Rpr 2 outlet r vntrc w/intraventr tunnel rpr 6,644.56

33612 Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow

33615 Repair of complex cardiac anomalies (eg, tricuspid atresia) by closure of atrial septal defect and

33617 Rpr cplx car anomal modf fontan px 7,584.08

33619 Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart 8,214.30

33620 Application right & left pulmonary artery bands 5,156.44

33621 Tthrc catheter insert for stent placement 2,733.50

33622 Reconstruction complex cardiac anomaly 10,660.54

CPT Mod FEE 33641 Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch 5,459.40

33645 Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage 6,368.40

33647 Repair of atrial septal defect and ventricular septal defect, with direct or patch closure 7,210.80

33660 Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without 6,916.50

33665 Repair of intermediate or transitional atrioventricular canal, with or without atrioventricular valve repair 7,938.00

33670 Repair of complete atrioventricular canal, with or without prosthetic valve 7,625.70

33675 Closure multiple ventricular septal defects 6,647.90

33676 Closure multiple vsd w/resection 6,341.84

33677 Closure multiple vsd w/removal artery band 6,334.62

33681 Closure of ventricular septal defect, with or without patch; 6,144.30

33684 Closure of ventricular septal defect, with or without patch; with pulmonary valvotomy or infundibular 6,494.40

33688 Closure of ventricular septal defect, with or without patch; with removal of pulmonary artery band, with or 6,613.20

33690 Banding of pulmonary artery

33692 Complete repair tetralogy of Fallot without pulmonary atresia;

33694 Complete repair tetralogy of Fallot without pulmonary atresia; with transannular patch 7,090.20

33697 Complete repair tetralogy of Fallot with pulmonary atresia including construction of conduit from right 7,173.90

33702 Repair sinus of Valsalva fistula, with cardiopulmonary bypass; 5,951.70

33710 Repair sinus of Valsalva fistula, with cardiopulmonary bypass; with repair of ventricular septal defect 7,786.80

33720 Repair sinus of Valsalva aneurysm, with cardiopulmonary bypass

33722 Closure of aortico-left ventricular tunnel

33724 Repair isolated partial pulm venous return 5,384.20

33726 Repair pulmonary venous stenosis 6,373.14

33730 Complete repair of anomalous venous return (supracardiac, intracardiac, or infracardiac types) 6,602.40

33732 Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial membrane 5,942.70

33735 Atrial septectomy or septostomy; closed heart (Blalock-Hanlon type operation) 4,538.70

33736 Atrial septectomy or septostomy; open heart with cardiopulmonary bypass 5,480.10

33737 Atrial septectomy or septostomy; open heart, with inflow occlusion

33750 Shunt; subclavian to pulmonary artery (Blalock-Taussig type operation) 4,233.60

33755 Shunt; ascending aorta to pulmonary artery (Waterston type operation) 4,748.40

33762 Shunt; descending aorta to pulmonary artery (Potts-Smith type operation) 4,645.80

33764 Shunt; central, with prosthetic graft

33766 Shunt; superior vena cava to pulmonary artery for flow to one lung (classical Glenn procedure)

33767 Shunt; superior vena cava to pulmonary artery for flow to both lungs (bidirectional Glenn procedure)

33768 Anast cavopulm 2nd suprior v/c 1,373.84

33770 Repair of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; 7,014.60

33771 Rpr tga enlgmnt v-septl dfct 7,655.60

33774 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with

33775 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with 6,685.20

33776 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with 8,601.30

33777 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with 8,343.00

33778 Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); 9,038.70

33779 Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with

33780 Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with

33781 Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with

33782 A-root tlcj vsd pulm stns rpr w/o c ost rimpltj 12,843.24

33783 A-root tlcj vsd pulm stns rpr w/ rimpltj c ostia 13,932.80

33786 Total repair, truncus arteriosus (Rastelli type operation)

33788 Reimplantation of an anomalous pulmonary artery 5,548.50

33800 Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheomalacia) (separate procedure)

33802 Division of aberrant vessel (vascular ring);

33803 Division of aberrant vessel (vascular ring); with reanastomosis 3,893.40

33813 Obliteration of aortopulmonary septal defect; without cardiopulmonary bypass 4,243.50

33814 Obliteration of aortopulmonary septal defect; with cardiopulmonary bypass 5,994.90

33820 Repair of patent ductus arteriosus; by ligation 3,869.10

33822 Repair of patent ductus arteriosus; by division, under 18 years 3,641.40

33824 Repair of patent ductus arteriosus; by division, 18 years and older 4,058.10

33840 Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis 4,342.50

33845 Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with graft 6,087.60

33851 Exc coarcj aorta w/l subcla art/prostc as gusset 5,986.48

33852 Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without 5,514.30

33853 Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; with 6,901.20

33860 Ascending aorta graft, with cardiopulmonary bypass, with or without valve suspension; 7,323.30

33863 Ascending aorta graft, with cardiopulmonary bypass, with or without valve suspension; with aortic root 7,577.10

33864 Ascending aorta grf valve spare root remodel 7,601.41

33870 Transverse arch graft, with cardiopulmonary bypass 9,652.50

33875 Descending thoracic aorta graft, with or without bypass 7,810.20

33877 Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass 9,241.20

33880 Evasc rpr dta coverage art origin 1st endoprosth 5,712.22

33881 Evasc rpr dta exp coverage w/o art origin 4,930.62

33883 Plmt prox xtn prosth evasc rpr dta 1st xtn 3,643.31

CPT Mod FEE 33884 Plmt prox xtn prosth evasc rpr dta ea prox xtn 1,385.57

33886 Plmt dstl xtn prosth dlyd after evasc rpr dta 3,119.61

33889 Opn subcla crtd art trpos nck inc ulat 2,690.56

33891 Byp grf w/dta rpr nck inc 3,430.57

33910 Pulmonary artery embolectomy; with cardiopulmonary bypass 6,566.40

33915 Pulmonary artery embolectomy; without cardiopulmonary bypass

33916 Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary bypass 4,653.00

33917 Repair of pulmonary artery stenosis by reconstruction with patch or graft 6,633.90

33920 Repair of pulmonary atresia with ventricular septal defect, by construction or replacement of conduit from 6,891.30

33922 Transection of pulmonary artery with cardiopulmonary bypass

33924 Lig&tkdn sysic-to-p-art shunt w/cgen hrt px 1,096.26

33925 Rpr p-art arborizj anomal unifclizj w/o card byp 6,455.33

33926 Rpr p-art arborizj anomal unifclizj w/card byp 8,708.02

33935 Transplantation heart/lung 12,504.94

33945 Heart transplant, with or without recipient cardiectomy 11,331.00

33960 Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial 24 hours 2,981.70

33961 Prolonged extracorporeal circulation for cardiopulmonary insufficiency; each additional 24 hours (List 1,626.30

33967 Insertion intra-aortic balloon assist dev prq 681.97

33968 Removal intra-aortic balloon assist device prq 98.27

33970 Insertion of intra-aortic balloon assist device through the femoral artery, open approach

33971 Removal of intra-aortic balloon assist device including repair of femoral artery, with or without graft

33973 Insertion of intra-aortic balloon assist device through the ascending aorta 2,047.50

33974 Removal of intra-aortic balloon assist device from the ascending aorta, including repair of the ascending

33975 Implantation of ventricular assist device; single ventricle support

33976 Implantation of ventricular assist device; biventricular support 4,364.10

33977 Removal of ventricular assist device; single ventricle support 3,388.50

33978 Removal of ventricular assist device; biventricular support 3,780.00

33979 Insj ventr assist dev impltable icorp 1 vntrc 6,113.20

33980 Rmvl ventr assist dev impltable icorp 1 vntrc 9,056.83

33981 Replace vad pump ext 2,099.36

33982 Replace vad intra w/o bp 5,143.44

33983 Replace vad intra w/bp 5,744.73

33990 Insert vad artery access 1,068.94

33991 Insert vad art&vein access 1,557.41

33992 Remove vad different session 507.95

33993 Reposition vad diff session 445.98

34001 Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck

34051 Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision 2,909.70

34101 Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by 2,623.50

34111 Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision 2,964.60

34151 Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by 3,651.30

34201 Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision 2,886.30

34203 Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision 2,952.90

34401 Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal incision

34421 Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by leg incision 2,549.70

34451 Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision 2,923.20

34471 Thrombectomy, direct or with catheter; subclavian vein, by neck incision

34490 Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision 2,148.30

34501 Valvuloplasty, femoral vein

34502 Reconstruction of vena cava, any method 5,296.50

34510 Venous valve transposition, any vein donor

34520 Cross-over vein graft to venous system 3,444.30

34530 Saphenopopliteal vein anastomosis 2,738.70

34800 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube 3,621.60

34802 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated 3,996.90

34803 Evasc rpr aaa w/mdlr bfrc prosth 2 limbs 4,301.78

34804 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using unibody bifurcated 3,996.90

34805 Evasc rpr aaa aorto-uniiliac/aorto-unifem prosth 3,987.05

34806 Tcat placement physiologic sensor aneurysmal sac 420.95

34808 Endovascular placement of iliac artery occlusion device (List separately in addition to code for primary

34812 Open femoral artery exposure for delivery of aortic endovascular prosthesis, by groin incision, unilateral 1,125.90

34813 Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair (List separately in 800.10

34820 Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular 1,626.30

34825 Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic

34826 Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic

34830 Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following 5,635.80

34831 Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following 6,093.00

34832 Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following 6,093.00

34833 Iliac art expos w/crtj conduit uni 1,682.17

34834 Brach art expos dplmnt aortic/iliac prosth uni 965.20

CPT Mod FEE 34900 Endovasc iliac repr w/graft 2,239.64

35001 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,978.00

35002 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,092.30

35005 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,744.00

35011 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,550.50

35013 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,780.90

35021 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,011.30

35022 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,035.60

35045 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,766.50

35081 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 5,967.00

35082 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 7,056.00

35091 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 6,876.00

35092 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 7,870.50

35102 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 6,484.50

35103 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 6,972.30

35111 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,826.70

35112 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,327.30

35121 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,541.40

35122 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without

35131 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,762.80

35132 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,635.00

35141 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without

35142 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,619.70

35151 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 4,226.40

35152 Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without 3,790.80

35180 Repair, congenital arteriovenous fistula; head and neck

35182 Repair, congenital arteriovenous fistula; thorax and abdomen 4,532.40

35184 Repair, congenital arteriovenous fistula; extremities 3,888.00

35188 Repair, acquired or traumatic arteriovenous fistula; head and neck 3,234.60

35189 Repair, acquired or traumatic arteriovenous fistula; thorax and abdomen

35190 Repair, acquired or traumatic arteriovenous fistula; extremities

35201 Repair blood vessel, direct; neck

35206 Repair blood vessel, direct; upper extremity 3,393.00

35207 Repair blood vessel, direct; hand, finger

35211 Repair blood vessel, direct; intrathoracic, with bypass 4,775.40

35216 Repair blood vessel, direct; intrathoracic, without bypass 4,719.60

35221 Repair blood vessel, direct; intra-abdominal 4,332.60

35226 Repair blood vessel, direct; lower extremity 4,322.70

35231 Repair blood vessel with vein graft; neck 3,770.10

35236 Repair blood vessel with vein graft; upper extremity 5,035.50

35241 Repair blood vessel with vein graft; intrathoracic, with bypass 4,771.80

35246 Repair blood vessel with vein graft; intrathoracic, without bypass 4,289.40

35251 Repair blood vessel with vein graft; intra-abdominal 5,365.80

35256 Repair blood vessel with vein graft; lower extremity

35261 Repair blood vessel with graft other than vein; neck

35266 Repair blood vessel with graft other than vein; upper extremity 3,907.80

35271 Repair blood vessel with graft other than vein; intrathoracic, with bypass 5,134.50

35276 Repair blood vessel with graft other than vein; intrathoracic, without bypass

35281 Repair blood vessel with graft other than vein; intra-abdominal

35286 Repair blood vessel with graft other than vein; lower extremity 4,189.50

35301 Thromboendarterectomy, with or without patch graft; carotid, vertebral, subclavian, by neck incision 4,066.20

35302 Teaec w/graft superficial femoral art 3,050.03

35303 Teaec w/graft popliteal art 3,211.06

35304 Teaec w/graft tibioperoneal trunk art 3,248.55

35305 Teaec w/graft tibial/peroneal art 1st vessel 3,210.32

35306 Teaec w/graft ea addl tibial/peroneal art 1,331.62

35311 Thromboendarterectomy, with or without patch graft; subclavian, innominate, by thoracic incision

35321 Thromboendarterectomy, with or without patch graft; axillary-brachial

35331 Thromboendarterectomy, with or without patch graft; abdominal aorta 5,119.20

35341 Thromboendarterectomy, with or without patch graft; mesenteric, celiac, or renal 4,953.60

35351 Thromboendarterectomy, with or without patch graft; iliac 4,340.70

35355 Thromboendarterectomy, with or without patch graft; iliofemoral 4,176.00

35361 Thromboendarterectomy, with or without patch graft; combined aortoiliac 5,794.20

35363 Thromboendarterectomy, with or without patch graft; combined aortoiliofemoral

35371 Thromboendarterectomy, with or without patch graft; common femoral

35372 Thromboendarterectomy, with or without patch graft; deep (profunda) femoral 4,039.20

35390 Reoperation, carotid, thromboendarterectomy, more than one month after original operation (List separately

35400 Angioscopy (non-coronary vessels or grafts) during therapeutic intervention (List separately in addition to

35450 Transluminal balloon angioplasty, open; renal or other visceral artery 2,514.60

35452 Transluminal balloon angioplasty, open; aortic

CPT Mod FEE 35458 Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel

35460 Transluminal balloon angioplasty, open; venous

35471 Transluminal balloon angioplasty, percutaneous; renal or visceral artery

35472 Transluminal balloon angioplasty, percutaneous; aortic

35475 Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel 2,426.40

35476 Transluminal balloon angioplasty, percutaneous; venous

35500 Harvest uxtr vein 1 sgm lxtr/cab px 871.62

35501 Bypass graft, with vein; carotid 3,636.00

35506 Bypass graft, with vein; carotid-subclavian 4,938.30

35508 Bypass graft, with vein; carotid-vertebral

35509 Bypass graft, with vein; carotid-carotid

35510 Byp w/vein crtd-brach 3,271.58

35511 Bypass graft, with vein; subclavian-subclavian 3,365.10

35512 Byp w/vein subcla-brach 3,264.42

35515 Bypass graft, with vein; subclavian-vertebral 3,420.00

35516 Bypass graft, with vein; subclavian-axillary 3,505.50

35518 Bypass graft, with vein; axillary-axillary 4,264.20

35521 Bypass graft, with vein; axillary-femoral 4,596.30

35522 Byp w/vein ax-brach 3,209.65

35523 Bypass graft with vein brachial-ulnar/-radial 3,277.08

35525 Byp w/vein brach-brach 3,187.18

35526 Bypass graft, with vein; aortosubclavian or carotid

35531 Bypass graft, with vein; aortoceliac or aortomesenteric 4,910.40

35533 Bypass graft, with vein; axillary-femoral-femoral 4,089.60

35535 Bypass graft with vein hepatorenal 4,060.85

35536 Bypass graft, with vein; splenorenal 4,485.60

35537 Byp w/vein aortoiliac 4,523.50

35538 Byp w/vein aortobi-iliac 5,514.25

35539 Byp w/vein aortofemoral 5,177.02

35540 Byp w/vein aortobifemoral 5,915.40

35556 Bypass graft, with vein; femoral-popliteal 4,336.20

35558 Bypass graft, with vein; femoral-femoral 4,312.80

35560 Bypass graft, with vein; aortorenal 4,439.70

35563 Bypass graft, with vein; ilioiliac 3,582.90

35565 Bypass graft, with vein; iliofemoral 4,176.90

35566 Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels 5,097.60

35570 Byp tibl-tibl/proneal-tibl/tibl/proneal trk-tibl 3,570.22

35571 Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels 4,784.40

35572 Harvest fempop vein 1 sgm vasc rcnstj px 878.05

35583 In-situ vein bypass; femoral-popliteal 4,646.70

35585 In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery 5,580.90

35587 In-situ vein bypass; popliteal-tibial, peroneal 5,259.60

35600 Harvest of upper extremity artery, one segment, for coronary artery bypass procedure

35601 Bypass graft, with other than vein; carotid

35606 Bypass graft, with other than vein; carotid-subclavian 4,417.20

35612 Bypass graft, with other than vein; subclavian-subclavian

35616 Bypass graft, with other than vein; subclavian-axillary 3,502.80

35621 Bypass graft, with other than vein; axillary-femoral 4,295.70

35623 Bypass graft, with other than vein; axillary-popliteal or -tibial 4,099.50

35626 Bypass graft, with other than vein; aortosubclavian or carotid 5,134.50

35631 Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal 4,752.00

35632 Bypass graft w/other than vein ilio-celiac 3,986.67

35633 Bypass graft w/other than vein ilio-mesenteric 4,261.60

35634 Bypass graft w/other than vein iliorenal 3,929.70

35636 Bypass graft, with other than vein; splenorenal (splenic to renal arterial anastomosis)

35637 Byp oth/thn vein aortoiliac 3,861.68

35638 Byp oth/thn vein aortobi-iliac 3,898.02

35642 Bypass graft, with other than vein; carotid-vertebral 3,672.00

35645 Bypass graft, with other than vein; subclavian-vertebral 3,720.60

35646 Bypass graft, with other than vein; aortofemoral or bifemoral 5,142.60

35647 Byp oth/thn vein aortofem 3,664.37

35650 Bypass graft, with other than vein; axillary-axillary 4,328.10

35654 Bypass graft, with other than vein; axillary-femoral-femoral 5,381.10

35656 Bypass graft, with other than vein; femoral-popliteal 4,311.00

35661 Bypass graft, with other than vein; femoral-femoral 4,134.60

35663 Bypass graft, with other than vein; ilioiliac 3,662.10

35665 Bypass graft, with other than vein; iliofemoral 4,484.70

35666 Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery

35671 Bypass graft, with other than vein; popliteal-tibial or -peroneal artery 4,197.60

35681 Bypass graft; composite, prosthetic and vein (List separately in addition to code for primary procedure) 3,032.10

CPT Mod FEE 35682 Bypass graft; autogenous composite, two segments of veins from two locations (List separately in addition 1,248.30

35683 Bypass graft; autogenous composite, three or more segments of vein from two or more locations (List 1,425.60

35685 Plmt vein patch/cuff dstl anast byp conduit 840.77

35686 Crtj dstl arven fstl lxtr byp surg non-hemo 858.30

35691 Transposition and/or reimplantation; vertebral to carotid artery 3,834.00

35693 Transposition and/or reimplantation; vertebral to subclavian artery 3,316.50

35694 Transposition and/or reimplantation; subclavian to carotid artery

35695 Transposition and/or reimplantation; carotid to subclavian artery 3,321.00

35697 Rimpltj visc art infrarnl aortic prosth ea art 1,617.23

35700 Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery or other

35701 Exploration (not followed by surgical repair), with or without lysis of artery; carotid artery 1,827.90

35721 Exploration (not followed by surgical repair), with or without lysis of artery; femoral artery 1,711.80

35741 Exploration (not followed by surgical repair), with or without lysis of artery; popliteal artery 1,733.40

35761 Exploration (not followed by surgical repair), with or without lysis of artery; other vessels 1,645.20

35800 Exploration for postoperative hemorrhage, thrombosis or infection; neck

35820 Exploration for postoperative hemorrhage, thrombosis or infection; chest 2,691.90

35840 Exploration for postoperative hemorrhage, thrombosis or infection; abdomen

35860 Exploration for postoperative hemorrhage, thrombosis or infection; extremity 1,816.20

35870 Repair of graft-enteric fistula 5,026.50

35875 Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula); 2,820.60

35876 Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula); with revision of arterial or 3,186.90

35879 Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty 3,326.40

35881 Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition 3,647.70

35883 Revision femoral anast open nonautog graft 3,256.61

35884 Revision femoral anast open w/autog graft 3,453.76

35901 Excision of infected graft; neck 2,307.60

35903 Excision of infected graft; extremity

35905 Excision of infected graft; thorax 2,797.20

35907 Excision of infected graft; abdomen

36000 Introduction of needle or intracatheter, vein 128.91

36002 Njx px prq tx xtr pseudoarysm 282.31

36005 Injection procedure for contrast venography (including introduction of needle or intracatheter)

36010 Introduction of catheter, superior or inferior vena cava

36011 Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) 510.30

36012 Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal 679.50

36013 Introduction of catheter, right heart or main pulmonary artery

36014 Selective catheter placement, left or right pulmonary artery 591.30

36015 Selective catheter placement, segmental or subsegmental pulmonary artery

36100 Introduction of needle or intracatheter, carotid or vertebral artery

36120 Introduction of needle or intracatheter; retrograde brachial artery

36140 Introduction of needle or intracatheter; extremity artery

36147 Access av dial grft for eval 1,052.96

36148 Access av dial grft for proc 325.12

36160 Introduction of needle or intracatheter, aortic, translumbar 650.70

36200 Introduction of catheter, aorta 624.60

36215 Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a

36216 Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within 729.00

36217 Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic

36218 Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or

36221 Place cath thoracic aorta 2,880.37

36222 Place cath carotid/inom art 3,561.38

36223 Place cath carotid/inom art 3,896.31

36224 Place cath carotd art 4,230.34

36225 Place cath subclavian art 3,867.22

36226 Place cath vertebral art 4,313.16

36227 Place cath xtrnl carotid 614.41

36228 Place cath intracranial art 2,960.01

36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery 768.60

36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity

36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower 1,114.20

36248 Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal,

36251 Ins cath ren art 1st unilat 3,755.03

36252 Ins cath ren art 1st bilat 4,101.15

36253 Ins cath ren art 2nd+ unilat 5,728.31

36254 Ins cath ren art 2nd+ bilat 5,947.12

36260 Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of liver) 2,344.50

36261 Revision of implanted intra-arterial infusion pump 919.80

36262 Removal of implanted intra-arterial infusion pump

36400 Venipuncture, under age 3 years; femoral, jugular or sagittal sinus 57.60

36405 Venipuncture, under age 3 years; scalp vein 87.30

CPT Mod FEE 36406 Venipuncture, under age 3 years; other vein 93.20

36410 Venipuncture, child over age 3 years or adult, necessitating physician's skill (separate procedure), for 75.26

36415 Routine venipuncture or finger/heel/ear stick for collection of specimen(s) 17.04

36420 Venipuncture, cutdown; under age 1 year

36425 Venipuncture, cutdown; age 1 or over

36430 Transfusion, blood or blood components

36440 Push transfusion, blood, 2 years or under

36450 Exchange transfusion, blood; newborn

36455 Exchange transfusion, blood; other than newborn

36460 Transfusion, intrauterine, fetal

36470 Injection of sclerosing solution; single vein 152.52

36471 Injection of sclerosing solution; multiple veins, same leg 246.87

36475 Endoven abltj incmptnt vein xtr rf 1st vein 3,072.75

36476 Endoven abltj incmptnt vein xtr rf 2nd+ veins 1,042.37

36478 Endoven abltj incmptnt vein xtr laser 1st vein 2,978.33

36479 Endoven abltj incmptnt vein xtr laser 2nd+ veins 1,045.01

36481 Percutaneous portal vein catheterization by any method 1,143.00

36500 Venous catheterization for selective organ blood sampling

36510 Catheterization of umbilical vein for diagnosis or therapy, newborn

36511 Ther apheresis white bld cells 274.52

36512 Ther apheresis red bld cells 273.39

36513 Ther apheresis pltlts 276.08

36514 Ther apheresis plsm pheresis 482.70

36515 Apheresis adsorp/reinfuse 2,040.30

36516 Apheresis selective 2,129.80

36522 Photopheresis, extracorporeal

36555 Insj non-tun ctr cvc under 5 yr 500.71

36556 Insj non-tun ctr cvc age 5 yr/> 373.52

36557 Insj tun ctr cvc w/o subq port/pmp under 5 yr 1,519.07

36558 Insj tun ctr cvc w/o subq port/pmp age 5 yr/> 1,287.53

36560 Insj tun ctr ctr vad w/subq port under 5 yr 1,595.76

36561 Insj tun ctr ctr vad w/subq port age 5 yr/> 1,280.08

36563 Insj tun ctr ctr vad w/subq pmp 1,557.18

36565 Insj tun vad req 2 cath 2 sits w/o subq port/pmp 1,535.22

36566 Insj tun vad req 2 cath 2 sits w/subq port 2,580.53

36568 Insj prph cvc w/o subq port/pmp under 5 yr 548.20

36569 Insj prph cvc w/o subq port/pmp age 5 yr/> 459.11

36570 Insj prph ctr vad w/subq port under 5 yr 1,264.84

36571 Insj prph ctr vad w/subq port age 5 yr/> 1,302.40

36575 Rpr tun/non-tun ctr vad cath w/o subq port/pmp 294.90

36576 Rpr ctr vad w/subq port/pmp ctr/prph insj sit 671.12

36578 Rplcmt cath ctr vad subq port/pmp 1,052.89

36580 Rplcmt compl non-tun cvc w/o subq port/pmp 402.39

36581 Rplcmt compl tun cvc w/o subq port/pmp 1,347.18

36582 Rplcmt compl tun ctr vad w/subq port 1,777.44

36583 Rplcmt compl tun ctr vad w/subq pmp 1,809.20

36584 Rplcmt compl prph cvc w/o subq port/pmp 423.34

36585 Rplcmt compl prph ctr vad w/subq port 1,778.45

36589 Rmvl tun cvc w/o subq port/pmp 388.65

36590 Rmvl tun ctr vad w/subq port/pmp ctr/prph insj 579.93

36591 Collect blood from implant venous access device 40.50

36592 Collect blood from catheter venous nos 52.78

36593 Declot by thrombolytic agent implant device/cath 146.47

36595 Mchnl rmvl pricath obstr cv dev via ven access 1,257.21

36596 Mchnl rmvl intral obstr cv dev thru dev lumen 265.15

36597 Rpsg previously placed cvc under fluor gdn 238.99

36598 Cntrst njx rad eval ctr vad fluor img&reprt 282.77

36600 Arterial puncture, withdrawal of blood for diagnosis 91.80

36620 Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure);

36625 Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); cutdown

36640 Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown

36660 Catheterization, umbilical artery, newborn, for diagnosis or therapy

36680 Placement of needle for intraosseous infusion

36800 Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein

36810 Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (Scribner 1,357.20

36815 Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, 1,125.90

36818 Arven anast opn upr arm cephalic vein trpos 1,990.48

36819 Arteriovenous anastomosis, open; by basilic vein transposition 4,174.20

36820 Arven anast opn f/arm vein trpos 2,132.80

36821 Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure) 2,295.00

CPT Mod FEE 36822 Insertion of cannula(s) for prolonged extracorporeal circulation for cardiopulmonary insufficiency (ECMO)

36823 Insertion of cannula(s) 3,310.72

36825 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure);

36830 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); 3,022.20

36831 Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft 1,346.40

36832 Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft 2,439.90

36833 Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft 1,944.90

36835 Insj thomas shunt spx 1,480.23

36838 Dstl revsc&interval lig uxtr hemo access 3,556.18

36860 External cannula declotting (separate procedure); without balloon catheter

36861 External cannula declotting (separate procedure); with balloon catheter

36870 Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes 3,973.50

37140 Venous anastomosis; portocaval 5,608.80

37145 Venous anastomosis; renoportal 3,990.60

37160 Venous anastomosis; caval-mesenteric 5,255.10

37180 Venous anastomosis; splenorenal, proximal 4,969.80

37181 Venous anastomosis; splenorenal, distal (selective decompression of esophagogastric varices, any 5,961.60

37182 Insert hepatic shunt (tips) 1,959.09

37183 Remove hepatic shunt (tips) 15,255.65

37184 Prim prq trluml mchnl thrmbc 1st vsl 2,214.84

37185 Prim prq trluml mchnl thrmbc sbsq vsl 872.39

37186 Sec prq trluml thrmbc 1,250.30

37187 Prq trluml mchnl thrmbc vein 1,941.11

37188 Prq trluml mchnl thrmbc vein repeat tx 1,473.77

37191 Ins endovas vena cava filtr 6,918.36

37192 Redo endovas vena cava filtr 4,487.46

37193 Rem endovas vena cava filter 4,282.95

37195 Thrombolysis, cerebral, by intravenous infusion 846.90

37197 Remove intrvas foreign body 3,887.58

37200 Tcat bx 814.79

37202 Transcatheter therapy, infusion other than for thrombolysis, any type (eg, spasmolytic, vasoconstrictive)

37204 Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a

37205 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), percutaneous; initial vessel 1,905.30

37206 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), percutaneous; each additional

37207 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), open; initial vessel 2,070.00

37208 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), open; each additional vessel

37210 Uterine fibroid embolization perq w/rad gid 2,665.16

37211 Thrombolytic art therapy 972.47

37212 Thrombolytic venous therapy 858.67

37213 Thromblytic art/ven therapy 599.49

37214 Cessj therapy cath removal 353.25

37215 Tcat iv stent crv crtd art embolic protecj 3,812.78

37216 Tcat iv stent crv crtd art w/o embolic protecj 3,498.17

37220 Iliac revasc 2,257.95

37221 Iliac revasc w/stent 3,035.71

37222 Iliac revasc add-on 861.42

37223 Iliac revasc w/stent add-on 1,606.46

37224 Fem/popl revas w/tla 2,605.53

37225 Fem/popl revas w/ather 5,405.06

37226 Fem/popl revasc w/stent 4,490.45

37227 Fem/popl revasc stnt & ather 7,098.85

37228 Tib/per revasc w/tla 3,436.34

37229 Tib/per revasc w/ather 5,676.63

37230 Tib/per revasc w/stent 4,780.81

37231 Tib/per revasc stent & ather 6,604.22

37232 Tib/per revasc add-on 1,046.39

37233 Tibper revasc w/ather add-on 1,367.77

37234 Revsc opn/prq tib/pero stent 2,092.73

37235 Tib/per revasc stnt & ather 2,470.73

37250 Iv us non-c vsl dx eval&/ther ivntj 1st vsl 408.08

37251 Iv us non-c vsl dx eval&/ther ivntj ea vsl 319.58

37500 Vasc ndsc seps 2,240.80

37565 Ligation, internal jugular vein 1,462.50

37600 Ligation; external carotid artery

37605 Ligation; internal or common carotid artery 1,402.20

37606 Ligation; internal or common carotid artery, with gradual occlusion, as with Selverstone or Crutchfield clamp 1,670.40

37607 Ligation or banding of angioaccess arteriovenous fistula 1,293.30

37609 Ligation or biopsy, temporal artery 689.40

37615 Ligation, major artery (eg, post-traumatic, rupture); neck 1,608.30

37616 Ligation, major artery (eg, post-traumatic, rupture); chest 2,796.30

CPT Mod FEE 37617 Ligation, major artery (eg, post-traumatic, rupture); abdomen 2,619.00

37618 Ligation, major artery (eg, post-traumatic, rupture); extremity

37619 Ligation of inf vena cava 4,215.75

37650 Ligation of femoral vein 1,337.40

37660 Ligation of common iliac vein

37700 Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions 998.10

37718 Lig div&stripping short saphenous vein 1,006.21

37722 Lig div&strip long saph saphfem junct kne/belw 1,208.89

37735 Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer 2,844.00

37760 Ligation of perforators, subfascial, radical (Linton type), with or without skin graft

37761 Lig prfratr vein subfscal open incl us gid 1 leg 1,390.71

37765 Stab phlebt varicose veins 1 xtr 10-20 stab incs 1,167.91

37766 Stab phlebt varicose veins 1 xtr > 20 incs 1,416.38

37780 Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) 641.70

37785 Ligation, division, and/or excision of recurrent or secondary varicose veins (clusters), one leg

37788 Pen revsc art +-vein grf 4,092.33

37790 Pen ven occlusive px 1,527.94

38100 Splenectomy; total (separate procedure) 2,660.40

38101 Splenectomy; partial (separate procedure) 2,975.40

38102 Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (List in addition to 1,835.10

38115 Repair of ruptured spleen (splenorrhaphy) with or without partial splenectomy

38120 Laps surg splenc 3,954.23

38200 Injection procedure for splenoportography 351.00

38204 Bl donor search management 232.57

38205 Bld-drv hematop progen cell hrvg trnsplj algnc 718.59

38206 Bld-drv hematop progen cell hrvg trnsplj autol 718.94

38220 Marrow aspiration only 293.47

38221 Marrow bx ndl/trocar 316.63

38230 Bone marrow harvesting for transplantation

38232 Bone marrow harvest autolog 507.29

38240 Marrow/bld-drv prph stem cell trnsplj allogeneic 1,089.69

38241 Marrow/bld-drv prph stem cell trnsplj autol 986.52

38242 Marrow/bld-drv prph stem cell trnsplj algc don 1,082.79

38243 Transplj hematopoietic boost 270.17

38300 Drainage of lymph node abscess or lymphadenitis; simple

38305 Drainage of lymph node abscess or lymphadenitis; extensive 729.00

38308 Lymphangiotomy or other operations on lymphatic channels 884.70

38380 Suture and/or ligation of thoracic duct; cervical approach 1,355.40

38381 Suture and/or ligation of thoracic duct; thoracic approach

38382 Suture and/or ligation of thoracic duct; abdominal approach 2,037.60

38500 Biopsy or excision of lymph node(s); open, superficial 587.77

38505 Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) 399.60

38510 Biopsy or excision of lymph node(s); open, deep cervical node(s) 850.50

38520 Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad

38525 Biopsy or excision of lymph node(s); open, deep axillary node(s) 1,233.90

38530 Biopsy or excision of lymph node(s); open, internal mammary node(s) 1,210.50

38542 Dissection, deep jugular node(s)

38550 Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection 1,267.20

38555 Excision of cystic hygroma, axillary or cervical; with deep neurovascular dissection

38562 Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic 2,771.10

38564 Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic) 2,665.80

38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple 2,667.60

38571 Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy

38572 Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling

38700 Suprahyoid lymphadenectomy 2,449.80

38720 Cervical lymphadenectomy (complete)

38724 Cervical lymphadenectomy (modified radical neck dissection) 3,672.00

38740 Axillary lymphadenectomy; superficial 1,797.30

38745 Axillary lymphadenectomy; complete 2,779.20

38746 Thoracic lymphadenectomy, regional, including mediastinal and peritracheal nodes (List separately in 846.00

38747 Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para1,178.10

38760 Inguinofemoral lymphadenectomy, superficial, including Cloquets node (separate procedure) 2,240.10

38765 Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external 3,024.90

38770 Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure) 3,276.00

38780 Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes 4,169.70

38790 Injection procedure; lymphangiography

38792 Injection for identification of sentinel node 174.37

38794 Cannulation thrc dux 1,099.47

38900 Intraop sentinel lymph id w/dye njx 526.99

39000 Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; cervical approach 1,619.10

CPT Mod FEE 39010 Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; transthoracic approach,

39200 Excision of mediastinal cyst

39220 Excision of mediastinal tumor 3,410.10

39400 Mediastinoscopy, with or without biopsy 1,290.60

39501 Repair, laceration of diaphragm, any approach

39503 Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of 3,626.10

39540 Repair, diaphragmatic hernia (other than neonatal), traumatic; acute

39541 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic 3,515.40

39545 Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic 3,464.10

39560 Rescj dphrm smpl rpr 3,485.19

39561 Rescj dphrm cplx rpr 5,241.89

40490 Biopsy of lip

40500 Vermilionectomy (lip shave), with mucosal advancement

40510 Excision of lip; transverse wedge excision with primary closure 1,710.90

40520 Excision of lip; V-excision with primary direct linear closure

40525 Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) 3,300.30

40527 Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) 3,558.60

40530 Resection of lip, more than one-fourth, without reconstruction

40650 Repair lip, full thickness; vermilion only 1,409.40

40652 Repair lip, full thickness; up to half vertical height 1,440.00

40654 Repair lip, full thickness; over one-half vertical height, or complex

40700 Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral

40701 Plastic repair of cleft lip/nasal deformity; primary bilateral, one stage procedure 4,107.60

40702 Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages 2,590.20

40720 Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure

40761 Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including

40800 Drainage of abscess, cyst, hematoma, vestibule of mouth; simple

40801 Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated

40804 Removal of embedded foreign body, vestibule of mouth; simple

40805 Removal of embedded foreign body, vestibule of mouth; complicated 657.90

40806 Incision of labial frenum (frenotomy)

40808 Biopsy, vestibule of mouth 202.50

40810 Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair

40812 Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair

40814 Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair

40816 Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying

40818 Excision of mucosa of vestibule of mouth as donor graft 627.30

40819 Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)

40820 Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical) 349.20

40830 Closure of laceration, vestibule of mouth; 2.5 cm or less 232.24

40831 Closure of laceration, vestibule of mouth; over 2.5 cm or complex 528.30

40840 Vestibuloplasty; anterior 1,712.70

40842 Vestibuloplasty; posterior, unilateral 1,566.90

40843 Vestibuloplasty; posterior, bilateral 2,436.30

40844 Vestibuloplasty; entire arch 3,133.80

40845 Vestibuloplasty; complex (including ridge extension, muscle repositioning) 3,672.90

41000 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual

41005 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, 286.20

41006 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; sublingual, deep, 610.20

41007 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space

41008 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submandibular

41009 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; masticator space 810.00

41010 Incision of lingual frenum (frenotomy)

41015 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual

41016 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submental 839.70

41017 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; submandibular 829.80

41018 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space

41019 Placement needle head/neck radioelement applicat 1,028.05

41100 Biopsy of tongue; anterior two-thirds

41105 Biopsy of tongue; posterior one-third

41108 Biopsy of floor of mouth

41110 Excision of lesion of tongue without closure 393.30

41112 Excision of lesion of tongue with closure; anterior two-thirds 642.60

41113 Excision of lesion of tongue with closure; posterior one-third 954.00

41114 Excision of lesion of tongue with closure; with local tongue flap 2,168.10

41115 Excision of lingual frenum (frenectomy)

41116 Excision, lesion of floor of mouth

41120 Glossectomy; less than one-half tongue 1,905.30

41130 Glossectomy; hemiglossectomy 2,204.10

41135 Glossectomy; partial, with unilateral radical neck dissection 4,789.80

CPT Mod FEE 41140 Glossectomy; complete or total, with or without tracheostomy, without radical neck dissection 4,610.70

41145 Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck dissection 5,366.70

41150 Glossectomy; composite procedure with resection floor of mouth and mandibular resection, without radical 4,663.80

41153 Glossectomy; composite procedure with resection floor of mouth, with suprahyoid neck dissection 4,880.70

41155 Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck 6,470.10

41250 Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue 361.80

41251 Repair of laceration 2.5 cm or less; posterior one-third of tongue

41252 Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex 838.80

41500 Fixation of tongue, mechanical, other than suture (eg, K-wire) 766.80

41510 Suture of tongue to lip for micrognathia (Douglas type procedure) 1,354.50

41512 Tongue base suspension permanent suture tq 1,094.85

41520 Frenoplasty (surgical revision of frenum, eg, with Z-plasty)

41530 Tongue base vol reduction 6,950.37

41800 Drainage of abscess, cyst, hematoma from dentoalveolar structures

41805 Removal of embedded foreign body from dentoalveolar structures; soft tissues

41806 Removal of embedded foreign body from dentoalveolar structures; bone

41820 Gingivectomy, excision gingiva, each quadrant

41822 Excision of fibrous tuberosities, dentoalveolar structures

41823 Excision of osseous tuberosities, dentoalveolar structures 705.60

41825 Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair

41826 Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair

41827 Excision of lesion or tumor (except listed above), dentoalveolar structures; with complex repair

41828 Excision of hyperplastic alveolar mucosa, each quadrant (specify)

41830 Alveolectomy, including curettage of osteitis or sequestrectomy

41850 Destruction of lesion (except excision), dentoalveolar structures

41870 Periodontal mucosal grafting

41872 Gingivoplasty, each quadrant (specify)

41874 Alveoloplasty, each quadrant (specify) 756.90

42000 Drainage of abscess of palate, uvula

42100 Biopsy of palate, uvula

42104 Excision, lesion of palate, uvula; without closure

42106 Excision, lesion of palate, uvula; with simple primary closure

42107 Excision, lesion of palate, uvula; with local flap closure

42120 Resection of palate or extensive resection of lesion 2,958.30

42140 Uvulectomy, excision of uvula 470.70

42145 Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty) 2,509.20

42160 Destruction of lesion, palate or uvula (thermal, cryo or chemical)

42180 Repair, laceration of palate; up to 2 cm 416.96

42182 Repair, laceration of palate; over 2 cm or complex 825.30

42200 Palatoplasty for cleft palate, soft and/or hard palate only

42205 Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only 3,186.00

42210 Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes

42215 Palatoplasty for cleft palate; major revision 2,664.90

42220 Palatoplasty for cleft palate; secondary lengthening procedure

42225 Palatoplasty for cleft palate; attachment pharyngeal flap 2,811.60

42226 Lengthening of palate, and pharyngeal flap 3,475.80

42227 Lengthening of palate, with island flap

42235 Repair of anterior palate, including vomer flap 2,310.30

42260 Repair of nasolabial fistula

42280 Maxillary impression for palatal prosthesis

42281 Insertion of pin-retained palatal prosthesis 355.50

42300 Drainage of abscess; parotid, simple 324.90

42305 Drainage of abscess; parotid, complicated 806.40

42310 Drainage of abscess; submaxillary or sublingual, intraoral

42320 Drainage of abscess; submaxillary, external 597.60

42330 Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral 415.95

42335 Sialolithotomy; submandibular (submaxillary), complicated, intraoral

42340 Sialolithotomy; parotid, extraoral or complicated intraoral 1,092.60

42400 Biopsy of salivary gland; needle

42405 Biopsy of salivary gland; incisional

42408 Excision of sublingual salivary cyst (ranula)

42409 Marsupialization of sublingual salivary cyst (ranula)

42410 Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection 2,012.40

42415 Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve 3,630.60

42420 Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve 4,627.80

42425 Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve 3,363.30

42426 Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection 6,180.30

42440 Excision of submandibular (submaxillary) gland 2,312.10

42450 Excision of sublingual gland

42500 Plastic repair of salivary duct, sialodochoplasty; primary or simple 1,374.30

CPT Mod FEE 42505 Plastic repair of salivary duct, sialodochoplasty; secondary or complicated

42507 Parotid duct diversion, bilateral (Wilke type procedure); 2,302.20

42508 Parotid duct diversion, bilateral (Wilke type procedure); with excision of one submandibular gland

42509 Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands 3,194.10

42510 Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) 2,726.10

42550 Injection procedure for sialography 193.50

42600 Closure salivary fistula

42650 Dilation salivary duct

42660 Dilation and catheterization of salivary duct, with or without injection

42665 Ligation salivary duct, intraoral

42700 Incision and drainage abscess; peritonsillar

42720 Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral approach

42725 Incision and drainage abscess; retropharyngeal or parapharyngeal, external approach 1,467.00

42800 Biopsy; oropharynx

42802 Biopsy; hypopharynx

42804 Biopsy; nasopharynx, visible lesion, simple

42806 Biopsy; nasopharynx, survey for unknown primary lesion

42808 Excision or destruction of lesion of pharynx, any method

42809 Removal of foreign body from pharynx 312.30

42810 Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues 878.40

42815 Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into 1,880.10

42820 Tonsillectomy and adenoidectomy; under age 12 816.61

42821 Tonsillectomy and adenoidectomy; age 12 or over 1,031.40

42825 Tonsillectomy, primary or secondary; under age 12

42826 Tonsillectomy, primary or secondary; age 12 or over

42830 Adenoidectomy, primary; under age 12 581.64

42831 Adenoidectomy, primary; age 12 or over

42835 Adenoidectomy, secondary; under age 12 536.40

42836 Adenoidectomy, secondary; age 12 or over

42842 Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without closure

42844 Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with local flap (eg, tongue,

42845 Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with other flap 4,507.20

42860 Excision of tonsil tags

42870 Excision or destruction lingual tonsil, any method (separate procedure)

42890 Limited pharyngectomy 2,689.20

42892 Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior

42894 Resection of pharyngeal wall requiring closure with myocutaneous flap 4,776.30

42900 Suture pharynx for wound or injury

42950 Pharyngoplasty (plastic or reconstructive operation on pharynx) 1,989.90

42953 Pharyngoesophageal repair

42955 Pharyngostomy (fistulization of pharynx, external for feeding)

42960 Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple

42961 Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); complicated, requiring 600.30

42962 Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical

42970 Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); simple, with 629.10

42971 Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); complicated, 945.00

42972 Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); with secondary 1,179.00

43020 Esophagotomy, cervical approach, with removal of foreign body

43030 Cricopharyngeal myotomy 2,510.10

43045 Esophagotomy, thoracic approach, with removal of foreign body

43100 Excision of lesion, esophagus, with primary repair; cervical approach 2,568.60

43101 Excision of lesion, esophagus, with primary repair; thoracic or abdominal approach 3,299.40

43107 Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical 5,637.60

43108 Total or near total esophagectomy, without thoracotomy; with colon interposition or small bowel

43112 Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical

43113 Tot esphg w/thorcom w/colon ntrpstj/int rcnstj 5,426.85

43116 Prtl esphg crv w/fr intstinal grf 6,171.24

43117 Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without 6,574.50

43118 Prtl esphg dstl thorcom abdl inc ntrpstj/rcnstj 5,531.39

43121 Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with 6,251.40

43122 Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; 5,902.20

43123 Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy;

43124 Tot/prtl esphg w/o rcnstj w/crv esophagostomy 4,452.63

43130 Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach 2,642.40

43135 Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach

43200 Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or 567.90

43201 Esphgsc rgd/flx dired sbmcsl njx any sbst 754.53

43202 Esophagoscopy, rigid or flexible; with biopsy, single or multiple

43204 Esophagoscopy, rigid or flexible; with injection sclerosis of esophageal varices

43205 Esophagoscopy, rigid or flexible; with band ligation of esophageal varices

CPT Mod FEE 43215 Esophagoscopy, rigid or flexible; with removal of foreign body 832.50

43216 Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 839.70

43217 Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

43219 Esophagoscopy, rigid or flexible; with insertion of plastic tube or stent 1,022.40

43220 Esophagoscopy, rigid or flexible; with balloon dilation (less than 30 mm diameter)

43226 Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation over guide wire

43227 Esophagoscopy, rigid or flexible; with control of bleeding, any method 1,059.30

43228 Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to 1,025.10

43231 Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination

43232 Esophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided intramural or transmural fine 782.57

43235 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum 575.48

43236 Stomach-intestine scope inject intestine wall 833.87

43237 Upr gi ndsc ndsc us xm lmtd esoph 605.29

43238 Upr gi ndsc tndsc us fine ndl aspir/bx esoph 712.37

43239 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum 645.72

43240 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum 1,233.90

43241 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43242 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum 968.40

43243 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43244 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43245 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43246 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43247 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43248 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum 733.50

43249 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43250 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43251 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43255 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43256 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43257 Upr gi ndsc dlvr thermal nrg sphnctr/cardia 1,070.28

43258 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43259 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum

43260 Endoscopic retrograde cholangio-pancreatography (ERCP); diagnostic, with or without collection of

43261 Endoscopic retrograde cholangio-pancreatography (ERCP); with biopsy, single or multiple

43262 Endoscopic retrograde cholangio-pancreatography (ERCP); with sphincterotomy/papillotomy

43263 Endoscopic retrograde cholangio-pancreatography (ERCP); with pressure measurement of sphincter of

43264 Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic retrograde removal of stone(s)

43265 Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic retrograde destruction,

43267 Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic retrograde insertion of

43268 Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic retrograde insertion of tube or

43269 Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic retrograde removal of foreign 1,462.50

43271 Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic retrograde balloon dilation of 1,741.50

43272 Endoscopic retrograde cholangio-pancreatography (ERCP); with ablation of tumor(s), polyp(s), or other

43273 Endoscopic papilla cannulation bile pancreatic 320.58

43279 Laps esophagomyotomy w/fundoplasty if performed 2,872.69

43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)

43281 Laps rpr paraesphgl hrna incl fundplsty w/o mesh 3,859.31

43282 Laps rpr paraesphgl hrna incl fundplsty w/mesh 4,088.80

43283 Laps esophageal lengthening addl 405.69

43300 Esophagoplasty, (plastic repair or reconstruction), cervical approach; without repair of tracheoesophageal 3,110.40

43305 Esophagoplasty, (plastic repair or reconstruction), cervical approach; with repair of tracheoesophageal 3,627.90

43310 Esophagoplasty, (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal 4,030.20

43312 Esophagoplasty, (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal 4,640.40

43313 Esphgp cgen dfct thrc appr w/o rpr fstl 5,873.36

43314 Esphgp cgen dfct thrc appr w/rpr fstl 6,478.08

43320 Esophagogastrostomy (cardioplasty), with or without vagotomy and pyloroplasty, transabdominal or 3,590.10

43325 Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure) 3,429.90

43327 Esopg/gstr fundoplasty w/lapt 1,847.23

43328 Esopg/gstr fundoplasty w/thorcom 2,706.08

43330 Esophagomyotomy (Heller type); abdominal approach 2,917.80

43331 Esophagomyotomy (Heller type); thoracic approach 3,198.60

43332 Rpr paraesoph hiatal hernia w/lapt w/o mesh 2,635.13

43333 Lapt rpr paraesoph hiatal hernia w/ mesh 2,873.14

43334 Rpr paraesoph hiatal hernia w/thorcom w/o mesh 2,906.96

43335 Rpr paraesoph hiatal hernia w/thorcom w/mesh 3,144.71

43336 Rpr paraesoph hiatal hernia thorcoabdom w/o mesh 3,422.52

43337 Rpr paraesoph hiatal hernia thorcoabdom w/mesh 3,761.84

43338 Esophagus lengthening 307.64

43340 Esophagojejunostomy (without total gastrectomy); abdominal approach 3,551.40

43341 Esophagojejunostomy (without total gastrectomy); thoracic approach

CPT Mod FEE 43350 Esophagostomy, fistulization of esophagus, external; abdominal approach 2,381.40

43351 Esophagostomy, fistulization of esophagus, external; thoracic approach

43352 Esophagostomy, fistulization of esophagus, external; cervical approach

43360 Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or 5,664.60

43361 Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or

43400 Ligation, direct, esophageal varices 3,172.50

43401 Transection of esophagus with repair, for esophageal varices

43405 Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation 3,349.80

43410 Suture of esophageal wound or injury; cervical approach

43415 Suture of esophageal wound or injury; transthoracic or transabdominal approach 3,114.00

43420 Closure of esophagostomy or fistula; cervical approach 1,954.80

43425 Closure of esophagostomy or fistula; transthoracic or transabdominal approach 3,115.80

43450 Dilation of esophagus, by unguided sound or bougie, single or multiple passes

43453 Dilation of esophagus, over guide wire 414.90

43456 Dilation of esophagus, by balloon or dilator, retrograde

43458 Dilation of esophagus with balloon (30 mm diameter or larger) for achalasia

43460 Esophagogastric tamponade, with balloon (Sengstaaken type)

43500 Gastrotomy; with exploration or foreign body removal 1,981.80

43501 Gastrotomy; with suture repair of bleeding ulcer 2,765.70

43502 Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, Mallory-Weiss)

43510 Gastrotomy; with esophageal dilation and insertion of permanent intraluminal tube (eg, Celestin or 2,067.30

43520 Pyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type operation) 1,850.40

43605 Biopsy of stomach; by laparotomy 1,977.30

43610 Excision, local; ulcer or benign tumor of stomach 2,572.20

43611 Excision, local; malignant tumor of stomach

43620 Gastrectomy, total; with esophagoenterostomy 4,644.90

43621 Gastrectomy, total; with Roux-en-Y reconstruction 4,995.90

43622 Gastrectomy, total; with formation of intestinal pouch, any type

43631 Gastrectomy, partial, distal; with gastroduodenostomy 3,541.50

43632 Gastrectomy, partial, distal; with gastrojejunostomy 3,864.60

43633 Gastrectomy, partial, distal; with Roux-en-Y reconstruction 3,953.70

43634 Gastrectomy, partial, distal; with formation of intestinal pouch

43635 Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary

43640 Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective 3,064.50

43641 Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell (highly selective)

43644 Laps gstr rstcv px w/byp roux-en-y <150 cm 5,644.84

43645 Laps gstr rstcv px w/byp&sm int rcnstj 6,078.45

43651 Laps surg trnsxj vagus nrv truncal 2,584.61

43652 Laps surg trnsxj vagus nrv slctv/hily slctv 2,984.62

43653 Laps surg gastrostomy w/o constj gstr tube spx 1,909.82

43752 Naso/oro-gastric tube plmt req phys&fluor gdn 87.45

43753 Gastric tube plmt w/aspir & lavage 51.44

43754 Dx gastr intub w/asp spec 92.15

43755 Dx gastr intub w/asp specs 216.19

43756 Dx duod intub w/asp spec 225.22

43757 Dx duod intub w/asp specs 330.91

43760 Change of gastrostomy tube

43761 Repositioning of the gastric feeding tube, any method, through the duodenum for enteric nutrition

43770 Laps gastric restrictive procedure place device 3,192.15

43771 Laps gastric restrictive px revision device 2,947.87

43772 Laps gastric restrictive px remove device 2,562.77

43773 Laps gastric restrictive px remove&rplcmt device 3,259.75

43774 Laps gastric restrictive px remove device &port 2,594.55

43775 Laps gstrc rstrictiv px longitudinal gastrectomy 3,427.22

43800 Pyloroplasty 2,172.60

43810 Gastroduodenostomy 2,296.80

43820 Gastrojejunostomy; without vagotomy 2,688.30

43825 Gastrojejunostomy; with vagotomy, any type 3,096.00

43830 Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure) (separate procedure)

43831 Gastrostomy, open; neonatal, for feeding

43832 Gastrostomy, open; with construction of gastric tube (eg, Janeway procedure) 2,553.30

43840 Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury 2,344.50

43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty

43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded

43845 Gstr rstcv w/prtl gstrct 50-100 cm 5,446.89

43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (less than 100 cm) Roux4,532.40

43847 Gstr rstcv w/byp w/sm int rcnstj limit absrpj 5,096.43

43848 Revision open gastric restrictive px not device 5,284.93

43850 Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; without vagotomy 4,078.80

43855 Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; with vagotomy 4,171.50

CPT Mod FEE 43860 Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial 4,131.90

43865 Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial 3,879.90

43870 Closure of gastrostomy, surgical 1,687.50

43880 Closure of gastrocolic fistula

43886 Gstr rstcv px opn revj subq port component only 925.03

43887 Gstr rstcv px opn rmvl subq port component only 886.07

43888 Gstr rstcv opn rmvl&rplcmt subq port 1,353.63

44005 Enterolysis (freeing of intestinal adhesion) (separate procedure) 2,305.69

44010 Duodenotomy, for exploration, biopsy(s), or foreign body removal 2,306.70

44015 Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method (List separately in 1,448.10

44020 Enterotomy, small bowel, other than duodenum; for exploration, biopsy(s), or foreign body removal 2,232.00

44021 Enterotomy, small bowel, other than duodenum; for decompression (eg, Baker tube) 2,319.30

44025 Colotomy, for exploration, biopsy(s), or foreign body removal 2,389.50

44050 Reduction of volvulus, intussusception, internal hernia, by laparotomy 2,321.10

44055 Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus (eg, Ladd

44100 Biopsy of intestine by capsule, tube, peroral (one or more specimens) 485.10

44110 Excision of one or more lesions of small or large bowel not requiring anastomosis, exteriorization, or 2,351.70

44111 Excision of one or more lesions of small or large bowel not requiring anastomosis, exteriorization, or 3,157.20

44120 Enterectomy, resection of small intestine; single resection and anastomosis 2,880.00

44121 Enterectomy, resection of small intestine; each additional resection and anastomosis (List separately in

44125 Enterectomy, resection of small intestine; with enterostomy 3,114.00

44126 Entrc rescj atresia rescj&anast w/o tapring 5,370.66

44127 Entrc rescj atresia rescj&anast sgm w/tapring 5,598.46

44128 Entrc rescj atresia ea rescj&anast 1,016.67

44130 Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure) 2,694.60

44139 Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in

44140 Colectomy, partial; with anastomosis 3,340.80

44141 Colectomy, partial; with skin level cecostomy or colostomy 3,333.65

44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)

44144 Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula

44145 Colectomy, partial; with coloproctostomy (low pelvic anastomosis) 3,887.10

44146 Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy 4,293.90

44147 Colectomy, partial; abdominal and transanal approach 4,626.90

44150 Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy 4,718.70

44151 Colectomy, total, abdominal, without proctectomy; with continent ileostomy 5,408.10

44155 Colectomy, total, abdominal, with proctectomy; with ileostomy 5,751.90

44156 Colectomy, total, abdominal, with proctectomy; with continent ileostomy

44157 Colct ttl abd w/prctect ileoanal anast 4,865.79

44158 Colct ttl abd w/prctect ileoanal anast & rsvr 5,014.80

44160 Colectomy with removal of terminal ileum and ileocolostomy 4,014.90

44180 Laps enterolss fring intstinal adhesion spx 1,859.50

44186 Laps jejunostomy 1,441.07

44187 Laps ileost/jejunostomy non-tube 2,229.44

44188 Laps clst/skn lvl cecostomy 2,477.27

44202 Laparoscopy, surgical; intestinal resection, with anastomosis (intra or extracorporeal) 4,013.10

44203 Laps ea sm int rescj&anast 742.32

44204 Laps colct prtl w/anast 3,237.04

44205 Laps colct prtl w/rmvl terminal ile 3,053.39

44206 Laps colct prtl w/end clst&clsr dstl sgm 3,562.31

44207 Laps colct prtl w/colopxtstmy lw anast 3,989.43

44208 Laps colct prtl w/colopxtstmy lw anast w/clst 4,162.98

44210 Laps colct tot w/o prctect w/ileost/ileopxts 3,925.87

44211 Laps colct ttl abd w/prctect ileoanal anast&rsvr 5,320.26

44212 Laps colct abdl w/prctect w/ileost 4,588.99

44213 Laps moblj splenic flxr pfrmd w/prtl colct 455.45

44227 Laps clsr ntrstm lg/sm int w/rescj&anast 3,432.69

44300 Enterostomy or cecostomy, tube (eg, for decompression or feeding) (separate procedure)

44310 Ileostomy or jejunostomy, non-tube (separate procedure)

44312 Revision of ileostomy; simple (release of superficial scar) (separate procedure)

44314 Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure) 2,343.60

44316 Continent ileostomy (Kock procedure) (separate procedure)

44320 Colostomy or skin level cecostomy; (separate procedure) 2,201.40

44322 Colostomy or skin level cecostomy; with multiple biopsies (eg, for Hirschsprung disease) (separate 2,568.60

44340 Revision of colostomy; simple (release of superficial scar) (separate procedure) 918.00

44345 Revision of colostomy; complicated (reconstruction in-depth) (separate procedure) 2,093.40

44346 Revision of colostomy; with repair of paracolostomy hernia (separate procedure) 2,365.20

44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; 864.90

44361 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with 863.10

44363 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with 804.60

44364 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with

CPT Mod FEE 44365 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with

44366 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with 1,076.40

44369 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with

44370 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with

44372 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with 1,199.70

44373 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with 904.50

44376 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic,

44377 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy,

44378 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control

44379 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with 1,137.60

44380 Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing

44382 Ileoscopy, through stoma; with biopsy, single or multiple

44383 Ilesc thru stoma w/tndsc stent plmt 917.99

44385 Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; diagnostic, with or without collection

44386 Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; with biopsy, single or multiple

44388 Colonoscopy through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing

44389 Colonoscopy through stoma; with biopsy, single or multiple

44390 Colonoscopy through stoma; with removal of foreign body

44391 Colonoscopy through stoma; with control of bleeding, any method 1,166.40

44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or 1,255.50

44393 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal 1,321.20

44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 1,102.50

44397 Colonoscopy through stoma; with transendoscopic stent placement (includes predilation) 596.70

44500 Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure)

44602 Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single 2,248.20

44603 Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple 2,656.80

44604 Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or 2,258.45

44605 Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or 2,991.60

44615 Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation, for intestinal obstruction 2,626.20

44620 Closure of enterostomy, large or small intestine; 1,713.65

44625 Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectal 3,033.90

44626 Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of 3,744.90

44640 Closure of intestinal cutaneous fistula 2,372.40

44650 Closure of enteroenteric or enterocolic fistula

44660 Closure of enterovesical fistula; without intestinal or bladder resection

44661 Closure of enterovesical fistula; with bowel and/or bladder resection 3,927.60

44680 Intestinal plication (separate procedure) 2,871.90

44700 Exclusion of small bowel from pelvis by mesh or other prosthesis, or native tissue (eg, bladder or omentum) 2,709.90

44701 Intraop colonic lvg 305.32

44720 Prep donor intestine/venous 581.85

44721 Prep donor intestine/artery 929.76

44800 Excision of Meckel's diverticulum (diverticulectomy) or omphalomesenteric duct

44820 Excision of lesion of mesentery (separate procedure) 2,034.00

44850 Suture of mesentery (separate procedure)

44900 Incision and drainage of appendiceal abscess; open

44901 Incision and drainage of appendiceal abscess; percutaneous

44950 Appendectomy; 1,537.19

44955 Appendectomy; when done for indicated purpose at time of other major procedure (not as separate

44960 Appendectomy; for ruptured appendix with abscess or generalized peritonitis 2,357.10

44970 Laparoscopy, surgical, appendectomy 2,130.30

45000 Transrectal drainage of pelvic abscess

45005 Incision and drainage of submucosal abscess, rectum 522.90

45020 Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess 893.70

45100 Biopsy of anorectal wall, anal approach (eg, congenital megacolon)

45108 Anorectal myomectomy

45110 Proctectomy; complete, combined abdominoperineal, with colostomy 4,392.90

45111 Proctectomy; partial resection of rectum, transabdominal approach 3,498.30

45112 Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis) 4,645.80

45113 Prctect prtl w/mucosec ileoanal anast rsvr 4,837.19

45114 Proctectomy, partial, with anastomosis; abdominal and transsacral approach 4,489.20

45116 Proctectomy, partial, with anastomosis; transsacral approach only (Kraske type)

45119 Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation

45120 Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through 4,650.30

45121 Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with subtotal or total

45123 Proctectomy, partial, without anastomosis, perineal approach 3,149.10

45126 Pelvic exenteration for colorectal malignancy, with proctectomy (with or without colostomy), with removal of 6,470.10

45130 Excision of rectal procidentia, with anastomosis; perineal approach 2,864.70

45135 Excision of rectal procidentia, with anastomosis; abdominal and perineal approach 4,033.80

45136 Exc ileoanal rsvr w/ileost 4,548.02

45150 Division of stricture of rectum 1,278.00

CPT Mod FEE 45160 Excision of rectal tumor by proctotomy, transsacral or transcoccygeal approach 2,827.80

45171 Exc rct tum not incl muscularis propria 1,349.29

45172 Exc rct tum incl muscularis propria 1,853.35

45190 Destruction of rectal tumor, any method (eg, electrodesiccation) transanal approach

45300 Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing 142.39

45303 Proctosigmoidoscopy, rigid; with dilation, any method

45305 Proctosigmoidoscopy, rigid; with biopsy, single or multiple

45307 Proctosigmoidoscopy, rigid; with removal of foreign body 386.10

45308 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or

45309 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique 430.20

45315 Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, 582.30

45317 Proctosigmoidoscopy, rigid; with control of bleeding, any method 585.00

45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal

45321 Proctosigmoidoscopy, rigid; with decompression of volvulus 534.60

45327 Proctosgmdsc rgd tndsc stent plmt 219.12

45330 Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing 253.73

45331 Sigmoidoscopy, flexible; with biopsy, single or multiple 339.86

45332 Sigmoidoscopy, flexible; with removal of foreign body

45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or 558.90

45334 Sigmoidoscopy, flexible; with control of bleeding, any method

45335 Sgmdsc flx dired sbmcsl njx any sbst 714.94

45337 Sigmoidoscopy, flexible; with decompression of volvulus, any method

45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45339 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by 604.80

45340 Sgmdsc flx dilat balo 1/more strixs 400.18

45341 Sigmoidoscopy, flexible; with endoscopic ultrasound examination

45342 Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle 700.20

45345 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)

45355 Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple

45378 Diagnostic colonoscopy 304.71

45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by 858.15

45379 Colonoscopy, flexible, proximal to splenic flexure; with removal of foreign body 1,099.80

45380 Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple 961.77

45381 Colsc flx prox splenic flxr sbmcsl njx 975.00

45382 Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding, any method 1,107.00

45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not 1,203.49

45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by 1,162.09

45385 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by 1,287.91

45386 Colsc flx prox splenic flxr dilat balo 1+ strixs 958.72

45387 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes 950.40

45391 Colsc flx prox splenic flxr ndsc us xm 568.04

45392 Colsc flx prox splenic flxr us gid ndl aspir/bx

45395 Laps prctect compl cmbn abdominoprnl w/clst 3,966.46

45397 Laps prctect cmbn pull-thru crtj rsvr 4,303.15

45400 Laps proctopexy for prolapse 2,322.57

45402 Laps proctopexy for prolapse sigmoid rescj 3,124.42

45500 Proctoplasty; for stenosis 1,570.50

45505 Proctoplasty; for prolapse of mucous membrane

45520 Perirectal injection of sclerosing solution for prolapse

45540 Proctopexy for prolapse; abdominal approach 3,206.70

45541 Proctopexy for prolapse; perineal approach

45550 Proctopexy combined with sigmoid resection, abdominal approach 3,591.00

45560 Repair of rectocele (separate procedure)

45562 Exploration, repair, and presacral drainage for rectal injury;

45563 Exploration, repair, and presacral drainage for rectal injury; with colostomy 3,095.10

45800 Closure of rectovesical fistula; 3,066.30

45805 Closure of rectovesical fistula; with colostomy 3,103.20

45820 Closure of rectourethral fistula;

45825 Closure of rectourethral fistula; with colostomy 3,057.30

45900 Reduction of procidentia (separate procedure) under anesthesia 497.70

45905 Dilation of anal sphincter (separate procedure) under anesthesia other than local

45910 Dilation of rectal stricture (separate procedure) under anesthesia other than local 384.30

45915 Removal of fecal impaction or foreign body (separate procedure) under anesthesia

45990 Anrct xm surg req anes general spi/edrl dx 219.72

46020 Plmt seton 230.01

46030 Removal of anal seton, other marker

46040 Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)

46045 Incision and drainage of intramural, intramuscular, or submucosal abscess, transanal, under anesthesia 775.80

46050 Incision and drainage, perianal abscess, superficial

46060 Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, 1,665.00

CPT Mod FEE 46070 Incision, anal septum (infant)

46080 Sphincterotomy, anal, division of sphincter (separate procedure)

46083 Incision of thrombosed hemorrhoid, external

46200 Fissurectomy, with or without sphincterotomy

46220 Papillectomy or excision of single tag, anus (separate procedure)

46221 Hemorrhoidectomy, by simple ligature (eg, rubber band)

46230 Excision of external hemorrhoid tags and/or multiple papillae

46250 Hemorrhoidectomy, external, complete 952.20

46255 Hemorrhoidectomy, internal and external, simple; 1,133.02

46257 Hemorrhoidectomy, internal and external, simple; with fissurectomy 1,395.90

46258 Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or without fissurectomy 1,494.90

46260 Hemorrhoidectomy, internal and external, complex or extensive; 1,744.20

46261 Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy 1,469.73

46262 Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without

46270 Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous

46275 Surgical treatment of anal fistula (fistulectomy/fistulotomy); submuscular 1,426.50

46280 Surgical treatment of anal fistula (fistulectomy/fistulotomy); complex or multiple, with or without placement of

46285 Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage

46288 Closure of anal fistula with rectal advancement flap

46320 Enucleation or excision of external thrombotic hemorrhoid 252.07

46500 Injection of sclerosing solution, hemorrhoids

46505 Chemodnrvtj int anal sphnctr 620.82

46600 Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 70.85

46604 Anoscopy; with dilation, any method

46606 Anoscopy; with biopsy, single or multiple

46608 Anoscopy; with removal of foreign body

46610 Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery

46611 Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique

46612 Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or

46614 Anoscopy; with control of bleeding, any method

46615 Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy

46700 Anoplasty, plastic operation for stricture; adult 1,498.68

46705 Anoplasty, plastic operation for stricture; infant

46706 Rpr anal fstl w/fibrin glue 389.22

46707 Repair anorectal fistula plug 1,162.37

46710 Rpr ileoanal pouch fstl/pouch advmnt tprnl appr 2,534.97

46712 Rpr ileoanal pouch fstl/pouch advmnt cmbn appr 4,490.29

46715 Repair of low imperforate anus; with anoperineal fistula (cut-back procedure) 1,563.30

46716 Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula 1,954.80

46730 Repair of high imperforate anus without fistula; perineal or sacroperineal approach 3,294.00

46735 Repair of high imperforate anus without fistula; combined transabdominal and sacroperineal approaches 3,994.20

46740 Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach 4,257.00

46742 Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and

46744 Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach 5,304.60

46746 Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and

46748 Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and 7,020.00

46750 Sphincteroplasty, anal, for incontinence or prolapse; adult 1,944.72

46751 Sphincteroplasty, anal, for incontinence or prolapse; child

46753 Graft (Thiersch operation) for rectal incontinence and/or prolapse

46754 Removal of Thiersch wire or suture, anal canal 287.10

46760 Sphincteroplasty, anal, for incontinence, adult; muscle transplant 1,932.30

46761 Sphnctrop anal levator musc imbrcj 2,142.41

46762 Sphnctrop anal impltj artif sphnctr 2,033.00

46900 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;

46910 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; 325.80

46916 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; 330.30

46917 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple;

46922 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; 441.90

46924 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 861.30

46930 Destroy internal hemorrhoids 309.16

46940 Curettage or cauterization of anal fissure, including dilation of anal sphincter (separate procedure); initial

46942 Curettage or cauterization of anal fissure, including dilation of anal sphincter (separate procedure);

46945 Ligation of internal hemorrhoids; single procedure

46946 Ligation of internal hemorrhoids; multiple procedures

46947 Hemorrhoidopexy stapling 578.58

47000 Biopsy of liver, needle; percutaneous

47001 Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in 362.70

47010 Hepatotomy; for open drainage of abscess or cyst, one or two stages 2,399.40

47011 Hepatotomy; for percutaneous drainage of abscess or cyst, one or two stages 562.50

47015 Laparotomy, with aspiration and/or injection of hepatic parasitic (eg, amoebic or echinococcal) cyst(s) or

CPT Mod FEE 47100 Biopsy of liver, wedge 1,659.60

47120 Hepatectomy, resection of liver; partial lobectomy 4,094.10

47122 Hepatectomy, resection of liver; trisegmentectomy 5,055.30

47125 Hepatectomy, resection of liver; total left lobectomy 5,123.70

47130 Hepatectomy, resection of liver; total right lobectomy 5,660.10

47135 Transplantation of liver 11,907.94

47136 Transplantation of liver 10,222.38

47140 8,705.32

47141 9,173.83

47142 11,446.63

47146 Prep donor liver/venous 795.89

47147 Prep donor liver/arterial 928.21

47300 Marsupialization of cyst or abscess of liver 2,345.40

47350 Management of liver hemorrhage; simple suture of liver wound or injury 2,863.80

47360 Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery

47361 Management of liver hemorrhage; exploration of hepatic wound, extensive debridement, coagulation and/or 5,294.70

47362 Management of liver hemorrhage; re-exploration of hepatic wound for removal of packing 2,229.30

47370 Laparo ablate liver tumor rf 3,013.06

47371 Laparo ablate liver cryosurg 3,066.51

47380 Open ablate liver tumor rf 3,485.82

47381 Open ablate liver tumor cryo 3,608.38

47382 Percut ablate liver rf 12,779.28

47400 Hepaticotomy or hepaticostomy with exploration, drainage, or removal of calculus 2,941.20

47420 Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without 2,731.50

47425 Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without 3,064.50

47460 Transduodenal sphincterotomy or sphincteroplasty, with or without transduodenal extraction of calculus 3,170.70

47480 Cholecystotomy or cholecystostomy with exploration, drainage, or removal of calculus (separate procedure) 1,964.70

47490 Percutaneous cholecystostomy

47500 Injection procedure for percutaneous transhepatic cholangiography 501.30

47505 Injection procedure for cholangiography through an existing catheter (eg, percutaneous transhepatic or T239.40

47510 Introduction of percutaneous transhepatic catheter for biliary drainage 825.30

47511 Introduction of percutaneous transhepatic stent for internal and external biliary drainage

47525 Change of percutaneous biliary drainage catheter

47530 Revision and/or reinsertion of transhepatic tube 613.80

47550 Biliary endoscopy, intraoperative (choledochoscopy) (List separately in addition to code for primary

47552 Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with or without collection of

47553 Biliary endoscopy, percutaneous via T-tube or other tract; with biopsy, single or multiple

47554 Biliary endoscopy, percutaneous via T-tube or other tract; with removal of stone(s) 1,421.10

47555 Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) without 1,138.50

47556 Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent

47560 Laps surg w/gid transhepatc cholangrph w/o bx 1,510.58

47561 Laparoscopy, surgical; with guided transhepatic cholangiography with biopsy

47562 Laparoscopy, surgical; cholecystectomy

47563 Laparoscopy, surgical; cholecystectomy with cholangiography 2,978.08

47564 Laparoscopy, surgical; cholecystectomy with exploration of common duct

47570 Laparoscopy, surgical; cholecystoenterostomy 2,934.90

47600 Cholecystectomy; 2,425.73

47605 Cholecystectomy; with cholangiography 2,408.40

47610 Cholecystectomy with exploration of common duct;

47612 Cholecystectomy with exploration of common duct; with choledochoenterostomy 3,743.10

47620 Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty,

47630 Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique)

47700 Exploration for congenital atresia of bile ducts, without repair, with or without liver biopsy, with or without 2,565.00

47701 Portoenterostomy (eg, Kasai procedure) 3,919.50

47711 Excision of bile duct tumor, with or without primary repair of bile duct; extrahepatic 3,893.40

47712 Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic 4,233.60

47715 Excision of choledochal cyst 2,894.40

47720 Cholecystoenterostomy; direct 2,518.20

47721 Cholecystoenterostomy; with gastroenterostomy

47740 Cholecystoenterostomy; Roux-en-Y 3,231.00

47741 Cholecystoenterostomy; Roux-en-Y with gastroenterostomy 3,558.60

47760 Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract

47765 Anastomosis, of intrahepatic ducts and gastrointestinal tract

47780 Anastomosis, Roux-en-Y, of extrahepatic biliary ducts and gastrointestinal tract 4,051.80

47785 Anastomosis, Roux-en-Y, of intrahepatic biliary ducts and gastrointestinal tract 4,861.80

47800 Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end anastomosis 3,579.30

47801 Placement of choledochal stent 2,097.00

47802 U-tube hepaticoenterostomy

47900 Suture of extrahepatic biliary duct for pre-existing injury (separate procedure) 3,095.10

48000 Placement of drains, peripancreatic, for acute pancreatitis; 2,626.20

CPT Mod FEE 48001 Placement of drains, peripancreatic, for acute pancreatitis; with cholecystostomy, gastrostomy, and

48020 Removal of pancreatic calculus

48100 Biopsy of pancreas, open, any method (eg, fine needle aspiration, needle core biopsy, wedge biopsy) 2,138.40

48102 Biopsy of pancreas, percutaneous needle 634.50

48105 Resecj/dbrdmt pancreas necrotizing pancreatitis 5,451.85

48120 Excision of lesion of pancreas (eg, cyst, adenoma)

48140 Pancreatectomy, distal subtotal, with or without splenectomy; without pancreaticojejunostomy 3,533.40

48145 Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy 3,700.80

48146 Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure)

48148 Excision of ampulla of Vater 3,132.00

48150 Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy 6,010.20

48152 Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy 5,525.10

48153 Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and

48154 Pncrtect prox stot w/o pancreatojejunostomy 5,545.84

48155 Pancreatectomy, total 5,987.70

48400 Injection procedure for intraoperative pancreatography (List separately in addition to code for primary

48500 Marsupialization of cyst of pancreas

48510 External drainage, pseudocyst of pancreas; open 3,393.00

48511 External drainage, pseudocyst of pancreas; percutaneous

48520 Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct 3,391.20

48540 Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y 3,727.80

48545 Pancreatorrhaphy for trauma

48547 Duodenal exclusion with gastrojejunostomy for pancreatic trauma

48548 Pancreaticojejunostomy side-to-side anast 3,894.97

48552 Prep donor pancreas/venous 568.43

48554 Transplantation of pancreatic allograft 5,886.90

48556 Removal of transplanted pancreatic allograft 2,919.60

49000 Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) 2,088.85

49002 Reopening of recent laparotomy 1,898.10

49010 Exploration, retroperitoneal area with or without biopsy(s) (separate procedure) 2,083.50

49020 Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open 1,682.10

49021 Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous

49040 Drainage of subdiaphragmatic or subphrenic abscess; open

49041 Drainage of subdiaphragmatic or subphrenic abscess; percutaneous

49060 Drainage of retroperitoneal abscess; open 1,845.90

49061 Drainage of retroperitoneal abscess; percutaneous 633.60

49062 Drainage of extraperitoneal lymphocele to peritoneal cavity, open 1,874.70

49082 Abd paracentesis 439.20

49083 Abd paracentesis w/imaging 793.44

49084 Peritoneal lavage 237.37

49180 Biopsy, abdominal or retroperitoneal mass, percutaneous needle 811.80

49203 Excision/destruction open abdominal tumors 5 cm 2,801.62

49204 Exc/destruction open abdmnl tumors 5.1-10.0 cm 3,508.35

49205 Exc/destruction open abdominal tumors >10.0 cm 4,192.01

49215 Excision of presacral or sacrococcygeal tumor 3,955.50

49220 Staging celiotomy (laparotomy) for Hodgkins disease or lymphoma (includes splenectomy, needle or open 3,829.50

49250 Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)

49255 Omentectomy, epiploectomy, resection of omentum (separate procedure)

49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by 1,557.11

49321 Laparoscopy, surgical; with biopsy (single or multiple) 1,716.30

49322 Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)

49323 Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity 1,908.90

49324 Laps insertion tunneled intraperitoneal catheter 943.82

49325 Laps w/revision intraperitoneal catheter 950.46

49326 Laps w/omentopexy 706.80

49327 Laps w/insertion ntrstl dev w/img gid 1+ 378.09

49400 Injection of air or contrast into peritoneal cavity (separate procedure) 233.10

49402 Removal peritoneal foreign body from cavity 1,902.20

49411 Interstitial dev plmt radiation therapy 1/mlt 880.63

49412 Plmt intrstl dev opn w/img gid 1+ 303.29

49418 Insert tun ip cath perc 1,335.02

49419 Insertion tunnel intraperitoneal cath subq port 985.96

49421 Insertion of intraperitoneal cannula or catheter for drainage or dialysis; permanent 1,449.00

49422 Removal of permanent intraperitoneal cannula or catheter 1,191.60

49423 Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate

49424 Contrast injection for assessment of abscess or cyst via previously placed catheter (separate procedure)

49425 Insertion of peritoneal-venous shunt

49426 Revision of peritoneal-venous shunt

49427 Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt

49428 Lig prtl-ven shunt 953.79

CPT Mod FEE 49429 Rmvl prtl-ven shunt 1,148.24

49435 Insj subq extension intraperitoneal catheter 343.46

49436 Delayed creation exit site embedded catheter 485.16

49440 Place gastrostomy tube perc 2,849.89

49441 Place duod/jej tube perc 3,205.41

49442 Place cecostomy tube perc 2,719.49

49446 Change g-tube to g-j perc 2,770.54

49450 Replace g/c tube perc 2,007.64

49451 Replace duod/jej tube perc 2,121.12

49452 Replace g-j tube perc 2,487.98

49460 Fix g/colon tube w/device 2,124.43

49465 Fluoro exam of g/colon tube 492.81

49491 Rpr 1st ingun hrna preterm inft rdc 1,510.04

49492 Rpr 1st ingun hrna preterm inft ncrc8 1,735.71

49495 Repair initial inguinal hernia, under age 6 months, with or without hydrocelectomy; reducible 1,575.90

49496 Repair initial inguinal hernia, under age 6 months, with or without hydrocelectomy; incarcerated or 1,755.00

49500 Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; reducible

49501 Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; incarcerated or

49505 Repair initial inguinal hernia, age 5 years or over; reducible 1,547.55

49507 Repair initial inguinal hernia, age 5 years or over; incarcerated or strangulated 1,889.72

49520 Repair recurrent inguinal hernia, any age; reducible 2,031.30

49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated

49525 Repair inguinal hernia, sliding, any age

49540 Repair lumbar hernia 1,574.10

49550 Repair initial femoral hernia, any age; reducible 1,616.40

49553 Repair initial femoral hernia, any age; incarcerated or strangulated

49555 Repair recurrent femoral hernia; reducible

49557 Repair recurrent femoral hernia; incarcerated or strangulated

49560 Repair initial incisional or ventral hernia; reducible 1,978.57

49561 Repair initial incisional or ventral hernia; incarcerated or strangulated 2,116.80

49565 Repair recurrent incisional or ventral hernia; reducible

49566 Repair recurrent incisional or ventral hernia; incarcerated or strangulated 2,693.70

49568 Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to 736.24

49570 Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure) 1,421.10

49572 Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated 1,670.40

49580 Repair umbilical hernia, under age 5 years; reducible 1,189.80

49582 Repair umbilical hernia, under age 5 years; incarcerated or strangulated

49585 Repair umbilical hernia, age 5 years or over; reducible

49587 Repair umbilical hernia, age 5 years or over; incarcerated or strangulated 1,646.00

49590 Repair spigelian hernia

49600 Repair of small omphalocele, with primary closure

49605 Repair of large omphalocele or gastroschisis; with or without prosthesis 3,263.40

49606 Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in

49610 Repair of omphalocele (Gross type operation); first stage

49611 Repair of omphalocele (Gross type operation); second stage

49650 Laparoscopy, surgical; repair initial inguinal hernia 1,924.20

49651 Laparoscopy, surgical; repair recurrent inguinal hernia 2,074.50

49652 Laps repair hernia except incal/ingun reducible 2,109.14

49653 Lap rpr hrna xcpt incal/ingun ncrc8/strangulated 2,603.68

49654 Laparoscopy repair incisional hernia reducible 2,373.28

49655 Laps rpr incisional hernia ncrc8/strangulated 2,891.21

49656 Laps rpr recurrent incisional hernia reducible 2,400.68

49657 Laps rpr recurrent incal hrna ncrc8/strangulated 3,469.04

49900 Suture, secondary, of abdominal wall for evisceration or dehiscence

49904 Omental flap xtr-abdl 3,010.88

49905 Omental flap (eg, for reconstruction of sternal and chest wall defects) (List separately in addition to code for

50010 Renal exploration, not necessitating other specific procedures 2,369.70

50020 Drainage of perirenal or renal abscess; open

50021 Drainage of perirenal or renal abscess; percutaneous

50040 Nephrostomy, nephrotomy with drainage 2,388.60

50045 Nephrotomy, with exploration 2,695.50

50060 Nephrolithotomy; removal of calculus 3,464.10

50065 Nephrolithotomy; secondary surgical operation for calculus

50070 Nephrolithotomy; complicated by congenital kidney abnormality 3,739.50

50075 Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic 3,556.80

50080 Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, 3,374.10

50081 Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, 3,953.70

50100 Transection or repositioning of aberrant renal vessels (separate procedure)

50120 Pyelotomy; with exploration

50125 Pyelotomy; with drainage, pyelostomy 2,860.20

CPT Mod FEE 50130 Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy) 3,258.00

50135 Pyelotomy; complicated (eg, secondary operation, congenital kidney abnormality) 3,535.20

50200 Renal biopsy; percutaneous, by trocar or needle 563.40

50205 Renal biopsy; by surgical exposure of kidney 1,523.70

50220 Nephrectomy, including partial ureterectomy, any approach including rib resection;

50225 Nephrectomy, including partial ureterectomy, any approach including rib resection; complicated because of

50230 Nephrectomy, including partial ureterectomy, any approach including rib resection; radical, with regional 4,735.80

50234 Nephrectomy with total ureterectomy and bladder cuff; through same incision 4,532.40

50236 Nephrectomy with total ureterectomy and bladder cuff; through separate incision 4,327.20

50240 Nephrectomy, partial 3,764.70

50250 Open ablation renal mass cryosurg ultrasound 3,098.95

50280 Excision or unroofing of cyst(s) of kidney 2,828.70

50290 Excision of perinephric cyst 2,653.20

50320 Donor nephrectomy, open from living donor (excluding preparation and maintenance of allograft)

50327 Prep renal graft/venous 518.41

50328 Prep renal graft/arterial 452.32

50329 Prep renal graft/ureteral 410.96

50340 Recipient nephrectomy (separate procedure) 2,797.20

50360 Renal allotransplantation, implantation of graft; excluding donor and recipient nephrectomy 6,304.50

50365 Renal allotransplantation, implantation of graft; with recipient nephrectomy 7,696.80

50370 Removal of transplanted renal allograft

50380 Renal autotransplantation, reimplantation of kidney 4,360.50

50382 Change ureter stent percut 1,292.64

50384 Remove ureter stent percut 1,139.86

50385 Change stent via transureth 1,174.03

50386 Remove stent via transureth 916.76

50387 Rmvl&rplcmt xtrnlly accessible urtrl stent 540.10

50389 Rmvl nfros tube req fluor gid 344.26

50390 Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous 465.30

50391 Instlj agt rnl pelvis&/urtr thru tube 374.44

50392 Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous 666.00

50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection,

50394 Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade pyeloureterograms)

50395 Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract,

50396 Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

50398 Change of nephrostomy or pyelostomy tube

50400 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on 3,541.50

50405 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on 3,802.50

50500 Nephrorrhaphy, suture of kidney wound or injury 3,298.50

50520 Closure of nephrocutaneous or pyelocutaneous fistula 2,853.00

50525 Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; abdominal approach 3,438.00

50526 Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach

50540 Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other plastic procedure, unilateral or 4,071.60

50541 Laparoscopy, surgical; ablation of renal cysts 2,673.90

50542 Laps abltj rnl mass les w/intraop us 2,662.34

50543 Laps prtl nfrct 3,268.75

50544 Laparoscopy, surgical; pyeloplasty 3,692.70

50545 Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty 3,990.60

50546 Laparoscopy, surgical; nephrectomy, including partial ureterectomy 3,727.80

50547 Laparoscopy, surgical; donor nephrectomy from living donor (excluding preparation and maintenance of 4,762.80

50548 Laparoscopy, surgical; nephrectomy with total ureterectomy 5,098.50

50551 Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or 777.60

50553 Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or 774.00

50555 Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or 995.40

50557 Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or

50561 Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or

50562 Rnl ndsc nfros/pyelostomy rescj tum 1,158.89

50570 1,117.80

50572 2,024.10

50574 2,061.00

50575 2,292.30

50576

50580

50590 Lithotripsy, extracorporeal shock wave 3,424.50

50592 Abltj 1+ rnl tum prq uni rf 2,900.54

50593 Perc cryo ablate renal tum 3,501.52

50600 Ureterotomy with exploration or drainage (separate procedure) 2,530.80

50605 Ureterotomy for insertion of indwelling stent, all types 2,730.60

50610 Ureterolithotomy; upper one-third of ureter 3,156.30

50620 Ureterolithotomy; middle one-third of ureter 3,373.20

CPT Mod FEE 50630 Ureterolithotomy; lower one-third of ureter

50650 Ureterectomy, with bladder cuff (separate procedure) 3,143.70

50660 Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach

50684 Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral

50686 Manometric studies through ureterostomy or indwelling ureteral catheter

50688 Change of ureterostomy tube

50690 Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic

50700 Ureteroplasty, plastic operation on ureter (eg, stricture) 2,943.00

50715 Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis

50722 Ureterolysis for ovarian vein syndrome

50725 Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava 3,769.20

50727 Revision of urinary-cutaneous anastomosis (any type urostomy); 1,869.30

50728 Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia

50740 Ureteropyelostomy, anastomosis of ureter and renal pelvis 3,374.10

50750 Ureterocalycostomy, anastomosis of ureter to renal calyx

50760 Ureteroureterostomy 3,244.50

50770 Transureteroureterostomy, anastomosis of ureter to contralateral ureter

50780 Ureteroneocystostomy; anastomosis of single ureter to bladder 3,356.10

50782 Ureteroneocystostomy; anastomosis of duplicated ureter to bladder 3,492.90

50783 Ureteroneocystostomy; with extensive ureteral tailoring

50785 Ureteroneocystostomy; with vesico-psoas hitch or bladder flap 3,877.20

50800 Ureteroenterostomy, direct anastomosis of ureter to intestine

50810 Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal 4,635.00

50815 Ureterocolon conduit, including bowel anastomosis 4,789.80

50820 Ureteroileal conduit (ileal bladder), including bowel anastomosis (Bricker operation) 5,985.00

50825 Continent diversion, including bowel anastomosis using any segment of small and/or large bowel (Kock

50830 Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy 5,469.30

50840 Replacement of all or part of ureter by bowel segment, including bowel anastomosis 3,718.80

50845 Cutaneous appendico-vesicostomy 4,222.80

50860 Ureterostomy, transplantation of ureter to skin

50900 Ureterorrhaphy, suture of ureter (separate procedure)

50920 Closure of ureterocutaneous fistula 2,907.90

50930 Closure of ureterovisceral fistula (including visceral repair)

50940 Deligation of ureter

50945 Laparoscopy, surgical; ureterolithotomy 2,889.90

50947 Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement 4,301.10

50948 Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement 3,933.00

50951 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or

50953 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or

50955 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or 731.70

50957 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or

50961 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or

50970 Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography,

50972 Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, 791.10

50974 Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography,

50976 Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, 1,040.40

50980 Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, 936.90

51020 Cystotomy or cystostomy; with fulguration and/or insertion of radioactive material 1,968.30

51030 Cystotomy or cystostomy; with cryosurgical destruction of intravesical lesion 1,923.30

51040 Cystostomy, cystotomy with drainage 1,717.20

51045 Cystotomy, with insertion of ureteral catheter or stent (separate procedure) 1,909.80

51050 Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection

51060 Transvesical ureterolithotomy 2,581.20

51065 Cystotomy, with stone basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral

51080 Drainage of perivesical or prevesical space abscess

51100 Drain bladder by needle 178.51

51101 Drain bladder by trocar/cath 271.08

51102 Drain bl w/cath insertion 591.70

51500 Excision of urachal cyst or sinus, with or without umbilical hernia repair 2,151.00

51520 Cystotomy; for simple excision of vesical neck (separate procedure)

51525 Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)

51530 Cystotomy; for excision of bladder tumor 2,457.00

51535 Cystotomy for excision, incision, or repair of ureterocele 2,631.60

51550 Cystectomy, partial; simple 2,953.80

51555 Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location) 3,749.40

51565 Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy) 4,053.60

51570 Cystectomy, complete; (separate procedure) 5,027.40

51575 Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and 6,365.70

51580 Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; 5,994.00

51585 Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic 6,684.30

CPT Mod FEE 51590 Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including bowel anastomosis; 7,559.10

51595 Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including bowel anastomosis; with 8,475.30

51596 Cystectomy, complete, with continent diversion, any technique, using any segment of small and/or large 8,883.90

51597 Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and 10,661.40

51600 Injection procedure for cystography or voiding urethrocystography

51605 Injection procedure and placement of chain for contrast and/or chain urethrocystography

51610 Injection procedure for retrograde urethrocystography

51700 Bladder irrigation, simple, lavage and/or instillation

51701 Insj non-ndwellg bldr cath 119.17

51702 Insj temp ndwellg bldr cath smpl 222.55

51703 Insj temp ndwellg bldr cath comp 222.42

51705 Change of cystostomy tube; simple

51710 Change of cystostomy tube; complicated

51715 Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck

51720 Bladder instillation of anticarcinogenic agent (including detention time)

51725 Simple cystometrogram (CMG) (eg, spinal manometer) 253.80

51725 Simple cystometrogram (CMG) (eg, spinal manometer)

51725 TC Simple cystometrogram 187.19

51726 Complex cystometrogram (eg, calibrated electronic equipment)

51726 Complex cystometrogram (eg, calibrated electronic equipment)

51726 TC Complex cystometrogram 258.79

51727 252.33

51727 686.90

51727 TC 434.58

51728 251.61

51728 686.02

51728 TC 434.41

51729 261.04

51729 704.40

51729 TC 443.36

51736 Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter)

51736 Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter)

51736 TC Urine flow measurement 77.28

51741 Complex uroflowmetry (eg, calibrated electronic equipment)

51741 Complex uroflowmetry (eg, calibrated electronic equipment)

51741 TC Electro-uroflowmetry first 79.98

51784 Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique

51784 Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique

51784 TC Anal/urinary muscle study 148.69

51785 Needle electromyography studies (EMG) of anal or urethral sphincter, any technique

51785 Needle electromyography studies (EMG) of anal or urethral sphincter, any technique

51785 TC Anal/urinary muscle study 175.98

51792 Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time) 202.50

51792 Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time)

51792 TC Urinary reflex study 181.58

51797 Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal)

51797 Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal)

51797 TC Intraabdominal pressure test 166.46

51798 Meas post-voiding residual urine&/bldr cap 51.15

51800 Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior Y-plasty, 2,849.40

51820 Cystourethroplasty with unilateral or bilateral ureteroneocystostomy 3,780.00

51840 Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple 2,495.70

51841 Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); complicated (eg,

51845 Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, Stamey, Raz, modified

51860 Cystorrhaphy, suture of bladder wound, injury or rupture; simple 2,200.50

51865 Cystorrhaphy, suture of bladder wound, injury or rupture; complicated 2,982.60

51880 Closure of cystostomy (separate procedure)

51900 Closure of vesicovaginal fistula, abdominal approach 3,454.20

51920 Closure of vesicouterine fistula; 2,559.60

51925 Closure of vesicouterine fistula; with hysterectomy

51940 Closure of bladder exstrophy

51960 Enterocystoplasty, including bowel anastomosis 4,652.10

51980 Cutaneous vesicostomy 2,439.00

51990 Laparoscopy, surgical; urethral suspension for stress incontinence 2,447.10

51992 Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic) 2,637.00

52000 Cystourethroscopy (separate procedure) 405.34

52001 Csto w/irrg&evac mlt obstructing clots 676.66

52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography,

52007 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, 640.80

52010 Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct 576.00

CPT Mod FEE 52204 Cystourethroscopy, with biopsy 595.75

52214 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck,

52224 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less

52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL

52235 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM 1,761.30

52240 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE 2,543.40

52250 Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration

52260 Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia 592.18

52265 Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia

52270 Cystourethroscopy, with internal urethrotomy; female 819.00

52275 Cystourethroscopy, with internal urethrotomy; male 882.00

52276 Cystourethroscopy with direct vision internal urethrotomy 1,261.80

52277 Cystourethroscopy, with resection of external sphincter (sphincterotomy) 1,206.90

52281 Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without 580.93

52282 Cystourethroscopy, with insertion of urethral stent

52283 Cystourethroscopy, with steroid injection into stricture 563.40

52285 Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral 686.56

52287 Cystoscopy chemodenervation 745.19

52290 Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral 737.10

52300 Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral 975.60

52301 Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral

52305 Cystourethroscopy; with incision or resection of orifice of bladder diverticulum, single or multiple 1,019.70

52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder

52315 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder 1,328.40

52317 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments;

52318 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; 1,948.50

52320 Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus

52325 Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic 1,559.70

52327 Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material

52330 Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral

52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 924.30

52334 Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous

52341 Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and 1,350.00

52342 Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, 1,461.60

52343 Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and 1,619.10

52344 Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, 1,776.60

52345 Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, 1,845.00

52346 Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, 2,074.50

52351 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic

52352 Scope bladder & ureter remove or move stones 1,629.42

52353 Scope bladder & ureter break up kidney stone 2,027.72

52354 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of lesion 1,728.00

52355 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of tumor 2,030.40

52400 Cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or 2,414.70

52402 Csto w/trurl rescj/inc ejaculatory duxs 641.48

52450 Transurethral incision of prostate 1,562.40

52500 Transurethral resection of bladder neck (separate procedure) 1,719.90

52601 Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete 2,701.80

52630 Transurethral resection; of regrowth of obstructive tissue longer than one year postoperative

52640 Transurethral resection; of postoperative bladder neck contracture 2,140.20

52647 Non-contact laser coagulation of prostate, including control of postoperative bleeding, complete 2,169.90

52648 Contact laser vaporization with or without transurethral resection of prostate, including control of

52649 Laser enucleation prostate w morcellation 2,156.95

52700 Transurethral drainage of prostatic abscess 1,305.00

53000 Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra 414.90

53010 Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external

53020 Meatotomy, cutting of meatus (separate procedure); except infant 583.86

53025 Meatotomy, cutting of meatus (separate procedure); infant

53040 Drainage of deep periurethral abscess 692.10

53060 Drainage of Skene's gland abscess or cyst

53080 Drainage of perineal urinary extravasation; uncomplicated (separate procedure) 761.40

53085 Drainage of perineal urinary extravasation; complicated

53200 Biopsy of urethra

53210 Urethrectomy, total, including cystostomy; female 2,104.20

53215 Urethrectomy, total, including cystostomy; male

53220 Excision or fulguration of carcinoma of urethra 1,617.30

53230 Excision of urethral diverticulum (separate procedure); female

53235 Excision of urethral diverticulum (separate procedure); male

53240 Marsupialization of urethral diverticulum, male or female 852.30

53250 Excision of bulbourethral gland (Cowper's gland)

CPT Mod FEE 53260 Excision or fulguration; urethral polyp(s), distal urethra

53265 Excision or fulguration; urethral caruncle

53270 Excision or fulguration; Skene's glands

53275 Excision or fulguration; urethral prolapse

53400 Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type)

53405 Urethroplasty; second stage (formation of urethra), including urinary diversion 2,250.90

53410 Urethroplasty, one-stage reconstruction of male anterior urethra 2,686.50

53415 Urethroplasty, transpubic or perineal, one stage, for reconstruction or repair of prostatic or membranous 3,239.10

53420 Urethroplasty, two-stage reconstruction or repair of prostatic or membranous urethra; first stage 2,888.10

53425 Urethroplasty, two-stage reconstruction or repair of prostatic or membranous urethra; second stage 2,995.20

53430 Urethroplasty, reconstruction of female urethra 2,496.60

53431 Urtp w/tubularization post urt&/lwr bldr 2,797.78

53440 Operation for correction of male urinary incontinence, with or without introduction of prosthesis 2,991.60

53442 Removal of perineal prosthesis introduced for continence

53444 Insj tandem cuff 2,081.89

53445 Operation for correction of urinary incontinence with placement of inflatable urethral or bladder neck

53446 Rmvl nfltbl urtl/bldr nck sphnctr 1,825.77

53447 Removal, repair, or replacement of inflatable sphincter including pump and/or reservoir and/or cuff 2,507.40

53448 Rmvl&rplcmt nfltbl nck sphnctr thru infct fld 3,364.59

53449 Surgical correction of hydraulic abnormality of inflatable sphincter device

53450 Urethromeatoplasty, with mucosal advancement

53460 Urethromeatoplasty, with partial excision of distal urethral segment (Richardson type procedure)

53500 Urethrolss trvg sec opn w/csto 1,914.08

53502 Urethrorrhaphy, suture of urethral wound or injury, female 1,486.80

53505 Urethrorrhaphy, suture of urethral wound or injury; penile

53510 Urethrorrhaphy, suture of urethral wound or injury; perineal 1,917.90

53515 Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous

53520 Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure) 1,213.20

53600 Dilation of urethral stricture by passage of sound or urethral dilator, male; initial

53601 Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent

53605 Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator, male, general or

53620 Dilation of urethral stricture by passage of filiform and follower, male; initial 218.70

53621 Dilation of urethral stricture by passage of filiform and follower, male; subsequent

53660 Dilation of female urethra including suppository and/or instillation; initial

53661 Dilation of female urethra including suppository and/or instillation; subsequent

53665 Dilation of female urethra, general or conduction (spinal) anesthesia

53850 Transurethral destruction of prostate tissue; by microwave thermotherapy 1,637.10

53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy 1,448.10

53855 Insert temp prostatic ureth stent w/measurement 1,749.79

53860 Transurethral rf treatment 4,303.14

54000 Slitting of prepuce, dorsal or lateral (separate procedure); newborn

54001 Slitting of prepuce, dorsal or lateral (separate procedure); except newborn

54015 Incision and drainage of penis, deep

54050 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 134.50

54055 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 271.58

54056 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 239.88

54057 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 601.20

54060 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 481.62

54065 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), 906.65

54100 Biopsy of penis; (separate procedure) 266.40

54105 Biopsy of penis; deep structures 447.30

54110 Excision of penile plaque (Peyronie disease); 1,395.90

54111 Excision of penile plaque (Peyronie disease); with graft to 5 cm in length

54112 Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length 2,682.90

54115 Removal foreign body from deep penile tissue (eg, plastic implant)

54120 Amputation of penis; partial 2,043.00

54125 Amputation of penis; complete 2,709.00

54130 Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy 3,754.80

54135 Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy, including external iliac, 4,963.50

54150 Circumcision, using clamp or other device; newborn 272.00

54160 Circumcision, surgical excision other than clamp, device or dorsal slit; newborn 403.94

54161 Circumcision, surgical excision other than clamp, device or dorsal slit; except newborn 860.79

54162 Lss/exc pen post-circumcision ads 426.82

54163 Rpr incompl circumcision 415.19

54164 Frenulotomy pns 409.15

54200 Injection procedure for Peyronie disease;

54205 Injection procedure for Peyronie disease; with surgical exposure of plaque

54220 Irrigation of corpora cavernosa for priapism 500.40

54230 Injection procedure for corpora cavernosography

54231 Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (eg, papaverine,

CPT Mod FEE 54235 Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)

54240 Penile plethysmography

54240 Penile plethysmography

54240 TC Penis study 114.40

54250 Nocturnal penile tumescence and/or rigidity test 300.60

54250 Nocturnal penile tumescence and/or rigidity test 354.60

54250 TC Penis study 36.49

54300 Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of

54304 Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without 2,242.80

54308 Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm 2,268.00

54312 Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm

54316 Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained 3,016.80

54318 Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg, third stage Cecil repair) 1,798.20

54322 One stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal

54324 One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local 2,382.30

54326 One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local 2,894.40

54328 One stage distal hypospadias repair (with or without chordee or circumcision); with extensive dissection to 3,250.80

54332 One stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct 3,355.20

54336 One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty 3,821.40

54340 Repair of hypospadias complications (ie, fistula, stricture, diverticula); by closure, incision, or excision,

54344 Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps 2,642.40

54348 Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring extensive dissection and 2,793.60

54352 Repair of hypospadias cripple requiring extensive dissection and excision of previously constructed 4,481.10

54360 Plastic operation on penis to correct angulation 2,171.70

54380 Plastic operation on penis for epispadias distal to external sphincter;

54385 Plastic operation on penis for epispadias distal to external sphincter; with incontinence 2,791.80

54390 Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder 3,728.70

54400 Insertion of penile prosthesis; non-inflatable (semi-rigid) 2,731.50

54401 Insertion of penile prosthesis; inflatable (self-contained)

54405 Insertion of inflatable (multi-component) penile prosthesis, including placement of pump, cylinders, and/or 4,616.10

54406 Rmvl nfltbl pen prosth w/o rplcmt prosth 1,880.16

54408 Rpr component multi-component nfltbl pen prosth 1,921.58

54410 Rmvl&rplcmt nfltbl pen prosth sm sess 2,100.99

54411 Rmvl&rplcmt nfltbl pen prosth thru infct fld 2,627.25

54415 Rmvl non-nfltbl/nfltbl pen prosth w/o rplcmt 1,371.75

54416 Rmvl&rplcmt non-nfltbl/nfltbl prosth sm sess 1,604.70

54417 Rmvl&rplcmt non-nfltbl/nfltbl pen infct sm sess 2,244.96

54420 Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or bilateral

54430 Corpora cavernosa-corpus spongiosum shunt (priapism operation), unilateral or bilateral 2,107.80

54435 Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter procedure, rongeur, or punch) for 1,043.10

54440 Plastic operation of penis for injury 2,582.10

54450 Foreskin manipulation including lysis of preputial adhesions and stretching

54500 Biopsy of testis, needle (separate procedure) 216.90

54505 Biopsy of testis, incisional (separate procedure) 644.40

54512 Excision of extraparenchymal lesion of testis

54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal 1,175.40

54522 Orchiectomy, partial 1,944.00

54530 Orchiectomy, radical, for tumor; inguinal approach

54535 Orchiectomy, radical, for tumor; with abdominal exploration

54550 Exploration for undescended testis (inguinal or scrotal area) 1,594.80

54560 Exploration for undescended testis with abdominal exploration 1,918.80

54600 Reduction of torsion of testis, surgical, with or without fixation of contralateral testis 1,393.65

54620 Fixation of contralateral testis (separate procedure) 835.20

54640 Orchiopexy, inguinal approach, with or without hernia repair 1,790.10

54650 Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens) 2,026.80

54660 Insertion of testicular prosthesis (separate procedure) 810.90

54670 Suture or repair of testicular injury

54680 Transplantation of testis(es) to thigh (because of scrotal destruction)

54690 Laparoscopy, surgical; orchiectomy 1,737.90

54692 Laparoscopy, surgical; orchiopexy for intra-abdominal testis 1,801.80

54700 Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma) 458.10

54800 Biopsy of epididymis, needle

54830 Excision of local lesion of epididymis 927.90

54840 Excision of spermatocele, with or without epididymectomy 1,296.00

54860 Epididymectomy; unilateral 1,228.50

54861 Epididymectomy; bilateral 1,728.00

54865 Exploration epididymis w/wo biopsy 355.87

54900 Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral 2,325.60

54901 Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral

55000 Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication

CPT Mod FEE 55040 Excision of hydrocele; unilateral 1,405.80

55041 Excision of hydrocele; bilateral 2,132.10

55060 Repair of tunica vaginalis hydrocele (Bottle type)

55100 Drainage of scrotal wall abscess

55110 Scrotal exploration 1,147.50

55120 Removal of foreign body in scrotum 633.60

55150 Resection of scrotum

55175 Scrotoplasty; simple 1,220.40

55180 Scrotoplasty; complicated

55200 Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) 648.90

55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)

55300 Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral

55400 Vasovasostomy, vasovasorrhaphy

55450 Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure)

55500 Excision of hydrocele of spermatic cord, unilateral (separate procedure) 1,228.50

55520 Excision of lesion of spermatic cord (separate procedure) 1,085.40

55530 Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure) 1,527.30

55535 Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach 1,635.30

55540 Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair 1,801.80

55550 Laparoscopy, surgical, with ligation of spermatic veins for varicocele 1,717.20

55600 Vesiculotomy; 1,231.20

55605 Vesiculotomy; complicated

55650 Vesiculectomy, any approach 2,868.30

55680 Excision of Mullerian duct cyst 2,533.50

55700 Biopsy, prostate; needle or punch, single or multiple, any approach 395.58

55705 Biopsy, prostate; incisional, any approach

55706 Bx prostate strtctc saturation sampling img gid 1,380.90

55720 Prostatotomy, external drainage of prostatic abscess, any approach; simple 1,424.70

55725 Prostatotomy, external drainage of prostatic abscess, any approach; complicated 1,768.50

55801 Prostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy,

55810 Prostatectomy, perineal radical; 3,842.10

55812 Prostatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic lymphadenectomy) 4,482.00

55815 Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric 6,071.40

55821 Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration 3,183.30

55831 Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration 3,345.30

55840 Prostatectomy, retropubic radical, with or without nerve sparing; 3,969.90

55842 Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s) (limited pelvic

55845 Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, 5,271.39

55860 Exposure of prostate, any approach, for insertion of radioactive substance; 2,182.50

55862 Exposure of prostate, any approach, for insertion of radioactive substance; with lymph node biopsy(s) 3,091.50

55865 Exposure of prostate, any approach, for insertion of radioactive substance; with bilateral pelvic 3,793.50

55866 Laps prstect retropubic rad w/nrv sparing robot 4,611.87

55870 Electroejaculation

55873 Cryosurgical ablation of the prostate (includes ultrasonic guidance for interstitial cryosurgical probe 2,685.60

55875 Tprnl plmt ndl/caths into prst8 radj insj 1,796.65

55876 Place interstitial dev radiation tx prostate 1+ 323.66

55920 Placement needle pelvic organ radioelement appl 1,072.06

56405 Incision and drainage of vulva or perineal abscess 259.20

56420 Incision and drainage of Bartholin's gland abscess 243.90

56440 Marsupialization of Bartholin's gland cyst

56441 Lysis of labial adhesions

56442 Hymenotomy simple incision 126.23

56501 Destruction of lesion(s), vulva; simple, any method 259.47

56515 Destruction of lesion(s), vulva; extensive, any method 850.10

56605 Biopsy of vulva or perineum (separate procedure); one lesion 199.48

56606 Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in

56620 Vulvectomy simple; partial 2,186.10

56625 Vulvectomy simple; complete

56630 Vulvectomy, radical, partial; 3,249.90

56631 Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy 4,042.80

56632 Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy 4,846.50

56633 Vulvectomy, radical, complete; 4,097.70

56634 Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy 4,748.40

56637 Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy 5,682.60

56640 Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy 5,745.60

56700 Partial hymenectomy or revision of hymenal ring

56740 Excision of Bartholin's gland or cyst 920.70

56800 Plastic repair of introitus 898.20

56805 Clitoroplasty for intersex state 2,296.80

56810 Perineoplasty, repair of perineum, nonobstetrical (separate procedure) 1,035.90

CPT Mod FEE 56820 Colposcopy vulva 198.44

56821 Colposcopy vulva w/bx 293.12

57000 Colpotomy; with exploration

57010 Colpotomy; with drainage of pelvic abscess

57020 Colpocentesis (separate procedure) 249.30

57022 Incision and drainage of vaginal hematoma; post-obstetrical

57023 Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma, spontaneous bleeding)

57061 Destruction of vaginal lesion(s); simple, any method

57065 Destruction of vaginal lesion(s); extensive, any method 1,008.47

57100 Biopsy of vaginal mucosa; simple (separate procedure)

57105 Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)

57106 Vaginectomy, partial removal of vaginal wall; 1,195.20

57107 Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) 3,107.70

57109 Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with 3,578.40

57110 Vaginectomy, complete removal of vaginal wall; 2,316.60

57111 Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) 3,666.60

57112 Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) 3,849.30

57120 Colpocleisis (Le Fort type) 2,274.30

57130 Excision of vaginal septum 940.50

57135 Excision of vaginal cyst or tumor 710.87

57150 Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease

57155 Insj uterine tandem&/vag ovoids 1,064.04

57156 Ins vag brachytx device 549.64

57160 Fitting and insertion of pessary or other intravaginal support device

57170 Diaphragm or cervical cap fitting with instructions 99.00

57180 Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal

57200 Colporrhaphy, suture of injury of vagina (nonobstetrical)

57210 Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical)

57220 Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication)

57230 Plastic repair of urethrocele

57240 Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele

57250 Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy 1,559.70

57260 Combined anteroposterior colporrhaphy; 2,090.70

57265 Combined anteroposterior colporrhaphy; with enterocele repair 2,418.62

57267 Insj mesh/prosth pel floor dfct ea sit 693.09

57268 Repair of enterocele, vaginal approach (separate procedure) 1,725.30

57270 Repair of enterocele, abdominal approach (separate procedure) 2,124.90

57280 Colpopexy, abdominal approach

57282 Sacrospinous ligament fixation for prolapse of vagina

57283 Colpopexy vag intra-prtl appr 1,612.15

57284 Paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete

57285 Paravaginal defect repair vaginal approach 1,555.83

57287 Removal or revision of sling for stress incontinence (eg, fascia or synthetic) 2,081.70

57288 Sling operation for stress incontinence (eg, fascia or synthetic)

57289 Pereyra procedure, including anterior colporrhaphy 2,429.10

57291 Construction of artificial vagina; without graft

57292 Construction of artificial vagina; with graft 3,924.90

57295 Revj rmvl prostc vag grf vag appr 1,167.58

57296 Revj w/rmvl prosthetic vag grf abd appro 2,490.17

57300 Closure of rectovaginal fistula; vaginal or transanal approach 1,933.20

57305 Closure of rectovaginal fistula; abdominal approach

57307 Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy 2,581.20

57308 Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without

57310 Closure of urethrovaginal fistula;

57311 Closure of urethrovaginal fistula; with bulbocavernosus transplant

57320 Closure of vesicovaginal fistula; vaginal approach

57330 Closure of vesicovaginal fistula; transvesical and vaginal approach

57335 Vaginoplasty for intersex state 3,069.90

57400 Dilation of vagina under anesthesia

57410 Pelvic examination under anesthesia

57415 Removal of impacted vaginal foreign body (separate procedure) under anesthesia 415.80

57420 Colposcopy entire vag w/cervix if present 238.08

57421 Colposcopy entire vag w/cervix bx 339.81

57423 Paravaginal defect repair laparoscopic approach 2,061.99

57425 Laps surg colpopexy ssp vag apex 2,099.02

57426 Revision prosthetic vaginal graft laparoscopic 1,885.00

57452 Colposcopy (vaginoscopy); (separate procedure) 242.93

57454 Colposcopy (vaginoscopy); with biopsy(s) of the cervix and/or endocervical curettage 343.46

57455 Colposcopy cervix vag bx cervix 169.72

57456 Colposcopy cervix vag endocrv curtg 187.31

CPT Mod FEE 57460 Colposcopy (vaginoscopy); with loop electrode excision procedure of the cervix 953.23

57461 Colposcopy cervix vag eltrd conization cervix 893.18

57500 Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) 251.05

57505 Endocervical curettage (not done as part of a dilation and curettage)

57510 Cauterization of cervix; electro or thermal 308.03

57511 Cauterization of cervix; cryocautery, initial or repeat 287.10

57513 Cauterization of cervix; laser ablation

57520 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; 1,079.10

57522 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; 1,080.48

57530 Trachelectomy (cervicectomy), amputation of cervix (separate procedure) 979.20

57531 Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling 4,499.10

57540 Excision of cervical stump, abdominal approach; 2,022.30

57545 Excision of cervical stump, abdominal approach; with pelvic floor repair

57550 Excision of cervical stump, vaginal approach;

57555 Excision of cervical stump, vaginal approach; with anterior and/or posterior repair 2,096.10

57556 Excision of cervical stump, vaginal approach; with repair of enterocele 2,295.90

57558 Dilation & curettage cervical stump 286.85

57700 Cerclage of uterine cervix, nonobstetrical

57720 Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach 1,098.90

57800 Dilation of cervical canal, instrumental (separate procedure)

58100 Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any 266.06

58110 Endometrial bx conjunct w/colposcopy 146.06

58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) 903.20

58140 Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate procedure); abdominal 2,851.59

58145 Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate procedure); vaginal approach 2,299.50

58146 Myomectomy 5+ > 250 gm abdl 2,845.00

58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without 3,175.21

58152 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without

58180 Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or 3,280.50

58200 Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node 3,940.20

58210 Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node 6,048.90

58240 Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or 8,435.70

58260 Vaginal hysterectomy; 3,085.20

58262 Vaginal hysterectomy; with removal of tube(s), and/or ovary(s)

58263 Vaginal hysterectomy; with removal of tube(s), and/or ovary(s), with repair of enterocele 3,879.90

58267 Vaginal hysterectomy; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type, with or 3,544.20

58270 Vaginal hysterectomy; with repair of enterocele 3,762.90

58275 Vaginal hysterectomy, with total or partial colpectomy;

58280 Vaginal hysterectomy, with total or partial colpectomy; with repair of enterocele 3,493.80

58285 Vaginal hysterectomy, radical (Schauta type operation) 3,948.30

58290 Vaginal hysterectomy uterus > 250 gm 3,249.20

58291 Vag hyst > 250 gm rmvl tube&/ovary 3,588.32

58292 Vag hyst > 250 gm rmvl tube&/ovary w/rpr ntrcl 3,867.52

58293 Vag hyst > 250 gm colpo-urtcstopexy +-ndsc ctrl 4,011.49

58294 Vag hyst > 250 gm rpr ntrcl 3,502.18

58300 Insertion of intrauterine device (IUD)

58301 Removal of intrauterine device (IUD)

58321 Artificial insemination; intra-cervical

58322 Artificial insemination; intra-uterine

58323 Sperm washing for artificial insemination

58340 Catheterization and introduction of saline or contrast material for hysterosonography or 279.39

58345 Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any 1,163.70

58346 Insj heyman capsls clinical brachytx 1,416.42

58350 Chromotubation of oviduct, including materials

58353 Endometrial ablation, thermal, without hysteroscopic guidance

58356 Endometrial cryoablation 2,930.73

58400 Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine 1,903.50

58410 Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine 2,566.80

58520 Hysterorrhaphy, repair of ruptured uterus (nonobstetrical)

58540 Hysteroplasty, repair of uterine anomaly (Strassman type)

58541 Laps supracrv hyst 250 g/< 2,275.20

58542 Laps supracrv hyst 250 g/< rmvl tube/ovary 2,512.31

58543 Laps supracrv hyst >250 g 2,546.70

58544 Laps supracrv hyst >250 g rmvl tube/ovary 2,839.57

58545 Laps myomectomy exc 1-4 250 gm/< 2,496.86

58546 Laps myomectomy exc 5+ > 250 grams 3,009.13

58548 Laps w/rad hyst w/bilat lmphadec rmvl tube/ovary 4,382.63

58550 Laparoscopy, surgical; with vaginal hysterectomy with or without removal of tube(s), with or without removal 3,277.49

58552 Laps w/vag hyst 250 gm/< rmvl tube&/ovary 2,608.28

58553 Laps w/vag hyst > 250 grams 3,010.69

CPT Mod FEE 58554 Laps vag hyst > 250 gm rmvl tube&/ovary 3,357.56

58555 Hysteroscopy, diagnostic (separate procedure) 857.70

58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C 1,402.27

58559 Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)

58560 Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)

58561 Hysteroscopy, surgical; with removal of leiomyomata 2,065.50

58562 Hysteroscopy, surgical; with removal of impacted foreign body

58563 Hysteroscopy, surgical; with endometrial ablation (any method) 2,528.26

58565 Hystsc occlusion plmt prm 4,424.15

58570 Laparoscopy w total hysterectomy uterus 250 g/< 2,503.83

58571 Laps total hysterectomy 250 g/<w tube/ovary 2,801.61

58572 Laparoscopy total hysterectomy uterus>250 g 3,013.79

58573 Laparoscopy tot hysterectomy >250 g w tube/ovary 3,509.08

58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral 1,508.40

58605 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or 1,312.20

58611 Ligation or transection of fallopian tube(s) when done at the time of cesarean section or intra-abdominal 861.75

58615 Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach

58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) 2,250.71

58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or

58662 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal 2,523.37

58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection)

58671 Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)

58672 Laparoscopy, surgical; with fimbrioplasty

58673 Laparoscopy, surgical; with salpingostomy (salpingoneostomy)

58700 Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)

58720 Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure) 2,178.51

58740 Lysis of adhesions (salpingolysis, ovariolysis) 2,415.84

58750 Tubotubal anastomosis 3,936.60

58752 Tubouterine implantation

58760 Fimbrioplasty

58770 Salpingostomy (salpingoneostomy)

58800 Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); vaginal approach

58805 Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); abdominal approach 1,800.90

58820 Drainage of ovarian abscess; vaginal approach, open

58822 Drainage of ovarian abscess; abdominal approach 1,772.10

58823 Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (eg, ovarian, pericolic) 706.50

58825 Transposition, ovary(s)

58900 Biopsy of ovary, unilateral or bilateral (separate procedure)

58920 Wedge resection or bisection of ovary, unilateral or bilateral 2,329.20

58925 Ovarian cystectomy, unilateral or bilateral 2,331.00

58940 Oophorectomy, partial or total, unilateral or bilateral; 2,069.10

58943 Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, 3,457.80

58950 Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and 3,549.60

58951 Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and

58952 Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and 5,935.50

58953 Bso w/omntc tah&rad dsj debulking 7,745.77

58954 Bso w/omntc tah debulking w/lmphadec 8,407.75

58956 Bso tot omntc tah mal 5,467.49

58957 Resection recrt mal w/omentectomy 5,807.52

58958 Resection recrt mal w/omentectomy pel lmphadec 6,432.44

58960 Laparotomy, for staging or restaging of ovarian, tubal or primary peritoneal malignancy (second look), with 3,839.96

58970 Follicle puncture for oocyte retrieval, any method 1,406.70

58974 Embryo transfer, intrauterine

58976 Gamete, zygote, or embryo intrafallopian transfer, any method

59000 Amniocentesis, any method 332.21

59001 Amniocnts ther amniotic flu rdctj us gid 440.43

59012 Cordocentesis (intrauterine), any method

59015 Chorionic villus sampling, any method

59020 Fetal contract stress test 90.59

59020 Fetal contraction stress test 178.81

59020 TC Fetal contract stress test 88.22

59025 69.45

59025 115.69

59025 TC 46.24

59030 Fetal scalp blood sampling

59050 Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report;

59051 Ftl mntr labor phys wrttn reprt interpj only 109.29

59070 Tabdl amnionfs us gid 959.77

59072 Ftl umbilical cord occlusion w/us gid 1,227.78

59074 Ftl flu drg us gid 935.82

CPT Mod FEE 59076 Ftl shunt plmt us gid 1,204.41

59100 Hysterotomy, abdominal (eg, for hydatidiform mole, abortion) 1,908.00

59120 Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, 2,453.40

59121 Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy 2,041.20

59130 Surgical treatment of ectopic pregnancy; abdominal pregnancy 2,061.90

59135 Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy 2,800.80

59136 Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus 2,285.10

59140 Surgical treatment of ectopic pregnancy; cervical, with evacuation 1,562.40

59150 Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy

59151 Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy 2,414.78

59160 Curettage, postpartum

59200 Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure) 276.79

59300 Episiotomy or vaginal repair, by other than attending physician

59320 Cerclage of cervix, during pregnancy; vaginal 1,122.47

59325 Cerclage of cervix, during pregnancy; abdominal

59350 Hysterorrhaphy of ruptured uterus 2,176.20

59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or

59409 Vaginal delivery only (with or without episiotomy and/or forceps); 1,588.98

59410 Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care 1,924.97

59412 External cephalic version, with or without tocolysis (List in addition to code(s) for delivery)

59414 Delivery of placenta (separate procedure) 484.20

59425 Antepartum care only; 4-6 visits

59426 Antepartum care only; 7 or more visits 1,168.00

59430 Postpartum care only (separate procedure) 240.30

59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

59514 Cesarean delivery only; 2,233.35

59515 Cesarean delivery only; including postpartum care 2,676.17

59525 Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary

59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or

59612 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);

59614 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including 2,339.10

59618 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following

59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery;

59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including 2,632.19

59812 Treatment of incomplete abortion, any trimester, completed surgically 800.34

59820 Treatment of missed abortion, completed surgically; first trimester 815.24

59821 Treatment of missed abortion, completed surgically; second trimester

59830 Treatment of septic abortion, completed surgically

59840 Induced abortion, by dilation and curettage

59841 Induced abortion, by dilation and evacuation 1,118.90

59850 Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital 1,398.60

59851 Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital

59852 Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital 1,869.30

59855 Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation

59856 Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation

59857 Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation 1,810.80

59866 Multifetal pregnancy reduction(s) (MPR)

59870 Uterine evacuation and curettage for hydatidiform mole

59871 Removal of cerclage suture under anesthesia (other than local) 444.60

60000 Incision and drainage of thyroglossal cyst, infected 305.10

60100 Biopsy thyroid, percutaneous core needle

60200 Excision of cyst or adenoma of thyroid, or transection of isthmus 1,590.30

60210 Partial thyroid lobectomy, unilateral; with or without isthmusectomy 2,587.50

60212 Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy 3,165.30

60220 Total thyroid lobectomy, unilateral; with or without isthmusectomy 2,613.60

60225 Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy 3,329.10

60240 Thyroidectomy, total or complete 3,250.80

60252 Thyroidectomy, total or subtotal for malignancy; with limited neck dissection 3,743.10

60254 Thyroidectomy, total or subtotal for malignancy; with radical neck dissection 5,427.00

60260 Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid

60270 Thyroidectomy, including substernal thyroid gland; sternal split or transthoracic approach 4,066.20

60271 Thyroidectomy, including substernal thyroid gland; cervical approach 3,284.10

60280 Excision of thyroglossal duct cyst or sinus; 2,004.30

60281 Excision of thyroglossal duct cyst or sinus; recurrent

60300 Aspir/inj thyroid cyst 304.43

60500 Parathyroidectomy or exploration of parathyroid(s); 3,088.80

60502 Parathyroidectomy or exploration of parathyroid(s); re-exploration

60505 Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic 3,624.30

60512 Parathyroid autotransplantation (List separately in addition to code for primary procedure) 802.80

60520 Thymectomy, partial or total; transcervical approach (separate procedure) 3,260.70

CPT Mod FEE 60521 Thymectomy, partial or total; sternal split or transthoracic approach, without radical mediastinal dissection

60522 Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection 4,230.00

60540 Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, 3,249.90

60545 Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, 3,646.80

60600 Excision of carotid body tumor; without excision of carotid artery 3,170.70

60605 Excision of carotid body tumor; with excision of carotid artery

60650 Laps adrnlectomy prtl/compl tabdl 2,901.27

61000 Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial

61001 Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps

61020 Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular 477.00

61026 Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular 539.10

61050 Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure)

61055 Cisternal or lateral cervical (C1-C2) puncture; with injection of drug or other substance for diagnosis or

61070 Puncture of shunt tubing or reservoir for aspiration or injection procedure

61105 Twist drill hole for subdural or ventricular puncture;

61107 Twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure recording

61108 Twist drill hole for subdural or ventricular puncture; for evacuation and/or drainage of subdural hematoma

61120 Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material) 1,748.70

61140 Burr hole(s) or trephine; with biopsy of brain or intracranial lesion 3,785.40

61150 Burr hole(s) or trephine; with drainage of brain abscess or cyst

61151 Burr hole(s) or trephine; with subsequent tapping (aspiration) of intracranial abscess or cyst 1,149.30

61154 Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural 4,333.50

61156 Burr hole(s); with aspiration of hematoma or cyst, intracerebral 3,850.20

61210 Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s) or pressure recording device

61215 Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular

61250 Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery 2,483.10

61253 Burr hole(s) or trephine, infratentorial, unilateral or bilateral 3,609.90

61304 Craniectomy or craniotomy, exploratory; supratentorial

61305 Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa) 5,964.30

61312 Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural 6,644.70

61313 Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral 6,731.10

61314 Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural 6,798.60

61315 Craniectomy or craniotomy for evacuation of hematoma, infratentorial; intracerebellar 7,305.30

61316 Inc&subq plmt crnl b1 grf 1,146.13

61320 Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial 6,000.30

61321 Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial 5,699.70

61322 Crnec/crx dcmprive w/o lobec 5,756.79

61323 Crnec/crx dcmprive w/lobec 6,798.55

61330 Decompression of orbit only, transcranial approach 4,500.90

61332 Exploration of orbit (transcranial approach); with biopsy 5,355.00

61333 Exploration of orbit (transcranial approach); with removal of lesion 5,422.50

61334 Exploration of orbit (transcranial approach); with removal of foreign body 5,355.00

61340 Other cranial decompression (eg, subtemporal), supratentorial 4,254.30

61343 Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or 7,812.00

61345 Other cranial decompression, posterior fossa 3,861.00

61440 Craniotomy for section of tentorium cerebelli (separate procedure)

61450 Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian 5,769.00

61458 Craniectomy, suboccipital; for exploration or decompression of cranial nerves 6,541.20

61460 Craniectomy, suboccipital; for section of one or more cranial nerves 6,573.60

61470 Craniectomy, suboccipital; for medullary tractotomy 5,194.80

61480 Craniectomy, suboccipital; for mesencephalic tractotomy or pedunculotomy 4,833.00

61490 Craniotomy for lobotomy, including cingulotomy 3,848.40

61500 Craniectomy; with excision of tumor or other bone lesion of skull 5,799.60

61501 Craniectomy; for osteomyelitis 5,518.80

61510 Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except 7,210.80

61512 Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial 7,498.80

61514 Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial 6,441.30

61516 Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial 6,448.50

61517 Impltj brn intrcv chemotx agt 317.57

61518 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, 7,177.50

61519 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; meningioma 7,713.00

61520 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor 8,054.10

61521 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull 8,868.60

61522 Craniectomy, infratentorial or posterior fossa; for excision of brain abscess 6,534.00

61524 Craniectomy, infratentorial or posterior fossa; for excision or fenestration of cyst 6,491.70

61526 Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; 7,533.00

61530 Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; 7,915.50

61531 Subdural implantation of strip electrodes through one or more burr or trephine hole(s) for long term seizure 4,017.60

61533 Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long term seizure 5,459.40

61534 Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography 5,832.00

CPT Mod FEE 61535 Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision 3,613.50

61536 Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with 6,593.40

61537 Crx b1 flap temporal lobe w/o ecog 5,691.54

61538 Craniotomy with elevation of bone flap; for lobectomy with electrocorticography during surgery, temporal 7,169.40

61539 Craniotomy with elevation of bone flap; for lobectomy with electrocorticography during surgery, other than 6,920.10

61540 Crx b1 flap lobec oth/thn temporal lobe w/o ecog 6,750.11

61541 Craniotomy with elevation of bone flap; for transection of corpus callosum 7,540.20

61542 Craniotomy with elevation of bone flap; for total hemispherectomy

61543 Craniotomy with elevation of bone flap; for partial or subtotal hemispherectomy 6,798.60

61544 Craniotomy with elevation of bone flap; for excision or coagulation of choroid plexus 5,931.00

61545 Craniotomy with elevation of bone flap; for excision of craniopharyngioma 9,750.60

61546 Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial approach 7,222.50

61548 Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic 6,168.60

61550 Craniectomy for craniosynostosis; single cranial suture 3,863.70

61552 Craniectomy for craniosynostosis; multiple cranial sutures 4,626.90

61556 Craniotomy for craniosynostosis; frontal or parietal bone flap 4,708.80

61557 Craniotomy for craniosynostosis; bifrontal bone flap 5,355.90

61558 Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); not requiring bone 6,180.30

61559 Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); recontouring with

61563 Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); without optic nerve 5,598.00

61564 Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous dysplasia); with optic nerve

61566 Crx b1 flap slctv amygdalohippocampectomy 6,648.74

61567 Crx b1 flap mlt subpial trnsxjs w/ecog 7,585.18

61570 Craniectomy or craniotomy; with excision of foreign body from brain 6,655.50

61571 Craniectomy or craniotomy; with treatment of penetrating wound of brain 7,112.70

61575 Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of 5,925.60

61576 Transoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of 6,066.00

61580 Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, 5,279.40

61581 Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, 6,869.70

61582 Craniofacial approach to anterior cranial fossa; extradural, including unilateral or bifrontal craniotomy, 6,235.20

61583 Craniofacial approach to anterior cranial fossa; intradural, including unilateral or bifrontal craniotomy, 6,881.40

61584 Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and

61585 Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital ridge osteotomy and 7,112.70

61586 Bicoronal, transzygomatic and/or LeFort I osteotomy approach to anterior cranial fossa with or without 4,247.10

61590 Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and 8,847.90

61591 Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, 9,154.80

61592 Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and carotid artery, clivus, basilar 7,725.60

61595 Transtemporal approach to posterior cranial fossa, jugular foramen or midline skull base, including 6,030.00

61596 Transcochlear approach to posterior cranial fossa, jugular foramen or midline skull base, including

61597 Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or midline skull base, 7,729.20

61598 Transpetrosal approach to posterior cranial fossa, clivus or foramen magnum, including ligation of superior 6,545.70

61600 Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural 5,345.10

61601 Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, 6,008.40

61605 Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal 5,562.90

61606 Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal 7,875.00

61607 Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus 7,877.70

61608 Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus 8,641.80

61609 Transection or ligation, carotid artery in cavernous sinus; without repair (List separately in addition to code 2,159.10

61610 Transection or ligation, carotid artery in cavernous sinus; with repair by anastomosis or graft (List separately 5,758.20

61611 Transection or ligation, carotid artery in petrous canal; without repair (List separately in addition to code for 1,481.40

61612 Transection or ligation, carotid artery in petrous canal; with repair by anastomosis or graft (List separately in

61613 Obliteration of carotid aneurysm, arteriovenous malformation, or carotid-cavernous fistula by dissection 8,973.90

61615 Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular 6,874.20

61616 Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular 8,987.40

61618 Secondary repair of dura for CSF leak, anterior, middle or posterior cranial fossa following surgery of the 3,795.30

61619 Secondary repair of dura for CSF leak, anterior, middle or posterior cranial fossa following surgery of the 6,327.00

61623 Evasc temp balo artl occlusion 2,587.65

61624 Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a 4,705.20

61626 Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a

61630 Balo angiop icra prq 4,445.59

61635 Tcat plmt iv stent icra w/balo angiop if pfrmd 5,059.80

61640 Balo dilat icra prq 1st vsl 3,692.54

61641 Balo dilat icra prq ea vsl sm vasc fam 1,825.26

61642 Balo dilat icra prq ea vsl diff vasc fam 1,874.98

61680 Surgery of intracranial arteriovenous malformation; supratentorial, simple 7,841.70

61682 Surgery of intracranial arteriovenous malformation; supratentorial, complex 9,553.50

61684 Surgery of intracranial arteriovenous malformation; infratentorial, simple 8,433.00

61686 Surgery of intracranial arteriovenous malformation; infratentorial, complex 10,935.90

61690 Surgery of intracranial arteriovenous malformation; dural, simple 7,769.70

61692 Surgery of intracranial arteriovenous malformation; dural, complex 8,279.10

CPT Mod FEE 61697 Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation 8,145.00

61698 Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation 7,839.00

61700 Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation 8,034.30

61702 Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar circulation 7,725.60

61703 Surgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid

61705 Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial and cervical 8,181.00

61708 Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intracranial electrothrombosis 6,218.10

61710 Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intra-arterial embolization, 5,119.20

61711 Anastomosis, arterial, extracranial-intracranial (eg, middle cerebral/cortical) arteries 6,508.80

61720 Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, 4,897.80

61735 Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, 5,054.40

61750 Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion;

61751 Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion; with computerized 5,544.00

61760 Stereotactic implantation of depth electrodes into the cerebrum for long term seizure monitoring 5,960.70

61770 Stereotactic localization, including burr hole(s), with insertion of catheter(s) or probe(s) for placement of 5,312.70

61781 Strtctc cptr asstd px idrl crnl 946.82

61782 Strtctc cptr asstd px xdrl crnl 758.02

61783 Strtctc cptr asstd px spinal 798.88

61790 Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, 4,118.40

61791 Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, 3,960.90

61796 Stereotactic radiosurgery 1 simple cranial les 4,260.08

61797 Strtctc radiosurgery ea addl cranial les simple 1,148.15

61798 Stereotactic radiosurgery 1 complex cranial les 4,339.38

61799 Strtctc radiosurgery ea addl cranial les complex 1,612.19

61800 Appl strtctc headframe stereotactic radiosurgery 806.16

61850 Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical 3,304.80

61860 Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical 4,075.20

61863 Strtctc impltj nstim eltrd w/o mer 1st ra 3,473.61

61864 Strtctc impltj nstim eltrd w/o mer ea ra 1,609.63

61867 Strtctc impltj nstim eltrd w/mer 1st ra 5,176.91

61868 Strtctc impltj nstim eltrdw/mer ea ra 2,433.01

61870 Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical 3,723.30

61875 Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical

61880 Revision or removal of intracranial neurostimulator electrodes 2,471.40

61885 Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or 943.20

61886 Incision and subcutaneous placement of cranial neurostimulator pulse generator or receiver, direct or

61888 Revision or removal of cranial neurostimulator pulse generator or receiver

62000 Elevation of depressed skull fracture; simple, extradural 3,420.00

62005 Elevation of depressed skull fracture; compound or comminuted, extradural 4,185.00

62010 Elevation of depressed skull fracture; with repair of dura and/or debridement of brain 5,310.00

62100 Craniotomy for repair of dural/CSF leak, including surgery for rhinorrhea/otorrhea 5,804.10

62115 Reduction of skull defect 2,946.76

62116 Reduction of skull defect 4,497.88

62117 Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy and reconstruction with

62120 Repair of encephalocele, skull vault, including cranioplasty 4,874.40

62121 Craniotomy for repair of encephalocele, skull base 4,878.00

62140 Cranioplasty for skull defect; up to 5 cm diameter 4,598.10

62141 Cranioplasty for skull defect; larger than 5 cm diameter 4,816.80

62142 Removal of bone flap or prosthetic plate of skull 3,197.70

62143 Replacement of bone flap or prosthetic plate of skull

62145 Cranioplasty for skull defect with reparative brain surgery 4,948.20

62146 Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter

62147 Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter 4,841.10

62148 Incise&retrieval subq cranioplasty bone graft 445.59

62160 Neuroendoscopy add-on 479.08

62161 Nundsc icra dsj ads fenestration septum csts 5,992.94

62162 Nundsc icra fenestration/exc cst plmt cath drg 6,085.95

62163 Nundsc icra w/retrieval fb 6,926.90

62164 Nundsc icra exc tum plmt cath drg 7,165.41

62165 Nundsc icra exc pituitary tum 6,442.36

62180 Ventriculocisternostomy (Torkildsen type operation)

62190 Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular 3,469.50

62192 Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus 3,523.50

62194 Replacement or irrigation, subarachnoid/subdural catheter 1,296.90

62200 Ventriculocisternostomy, third ventricle; 4,726.80

62201 Ventriculocisternostomy 3rd vntrc neurondsc 4,996.62

62220 Creation of shunt; ventriculo-atrial, -jugular, -auricular 4,307.40

62223 Creation of shunt; ventriculo-peritoneal, -pleural, other terminus 4,331.70

62225 Replacement or irrigation, ventricular catheter 1,852.20

62230 Replacement or revision of CSF shunt, obstructed valve, or distal catheter in shunt system 3,162.60

CPT Mod FEE 62252 Csf shunt reprogram 122.96

62252 Reprogramming of programmable CSF shunt

62252 TC Csf shunt reprogram 113.74

62256 Removal of complete CSF shunt system; without replacement 1,863.00

62258 Removal of complete CSF shunt system; with replacement by similar or other shunt at same operation 4,531.50

62263 Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or 1,090.80

62264 Prq lss edrl ads sln njx/mchnl loclzj 1 d 1,042.86

62267 Interdiscal perq aspir dx 816.24

62268 Percutaneous aspiration, spinal cord cyst or syrinx 1,906.20

62269 Biopsy of spinal cord, percutaneous needle

62270 Spinal puncture, lumbar, diagnostic

62272 Spinal puncture, therapeutic, for drainage of spinal fluid (by needle or catheter)

62273 Injection, epidural, of blood or clot patch 512.10

62280 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other

62281 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other

62282 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other 636.30

62284 Injection procedure for myelography and/or computerized axial tomography, spinal (other than C1-C2 and 522.90

62287 Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any 3,543.30

62290 Injection procedure for diskography, each level; lumbar 551.70

62291 Injection procedure for diskography, each level; cervical or thoracic 524.70

62292 Injection procedure for chemonucleolysis, including diskography, intervertebral disk, single or multiple 2,452.50

62294 Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal 1,232.10

62310 Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast

62311 Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast 933.30

62318 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic 968.40

62319 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic 942.30

62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication

62351 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication 2,763.90

62355 Removal of previously implanted intrathecal or epidural catheter 1,368.00

62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir

62361 Impltj/rplcmt ithcl/edrl nfs non-prgrbl pmp 1,849.28

62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump,

62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion

62367 Analyze spine infus pump 103.05

62368 Analyze sp inf pump w/reprog 136.97

62369 Anal sp inf pmp w/reprg&fill 314.44

62370 Anl sp inf pmp w/mdreprg&fil 326.18

63001 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without 4,944.60

63003 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without 5,364.90

63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without 4,862.70

63011 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without

63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda

63015 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without 6,095.70

63016 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without

63017 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without 5,402.70

63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, 4,932.00

63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, 5,275.80

63035 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, 1,433.70

63040 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, 5,602.50

63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, 6,077.70

63045 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, 5,896.80

63046 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, 5,850.90

63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, 6,197.40

63048 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord,

63050 Lamop crv w/dcmprn spi cord 2/more vrt seg 5,247.21

63051 Lamop crv dcmprn spi cord 2+ seg rcnstj b1 5,950.77

63055 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated 6,694.20

63056 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated 5,550.30

63057 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated

63064 Costovertebral approach with decompression of spinal cord or nerve root(s), (eg, herniated intervertebral 5,833.80

63066 Costovertebral approach with decompression of spinal cord or nerve root(s), (eg, herniated intervertebral

63075 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; 5,081.40

63076 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; 1,952.10

63077 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; 4,871.70

63078 Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; 1,342.80

63081 Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression 6,626.70

63082 Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression

63085 Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with 7,022.70

63086 Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with 1,986.30

63087 Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach

CPT Mod FEE 63088 Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach

63090 Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal 6,551.10

63091 Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal

63101 Vcrpec lat xtrcavitary dcmprn thrc 1 sgm 6,101.26

63102 Vcrpec lat xtrcavitary dcmprn lmbr 1 sgm 6,074.85

63103 Vcrpec lat xtrcavitary dcmprn thrc/lmbr ea sgm 1,901.26

63170 Laminectomy with myelotomy (eg, Bischof or DREZ type), cervical, thoracic, or thoracolumbar

63172 Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space 5,694.30

63173 Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal space 5,922.90

63180 Laminectomy and section of dentate ligaments, with or without dural graft, cervical; one or two segments 5,348.70

63182 Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than two segments 5,603.40

63185 Laminectomy with rhizotomy; one or two segments 4,599.00

63190 Laminectomy with rhizotomy; more than two segments 5,452.20

63191 Laminectomy with section of spinal accessory nerve 3,994.20

63194 Laminectomy with cordotomy, with section of one spinothalamic tract, one stage; cervical 4,356.90

63195 Laminectomy with cordotomy, with section of one spinothalamic tract, one stage; thoracic 4,849.20

63196 Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage; cervical 4,980.60

63197 Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage; thoracic 5,346.00

63198 Laminectomy with cordotomy with section of both spinothalamic tracts, two stages within 14 days; cervical 5,892.30

63199 Laminectomy with cordotomy with section of both spinothalamic tracts, two stages within 14 days; thoracic 5,892.30

63200 Laminectomy, with release of tethered spinal cord, lumbar 4,874.40

63250 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical

63251 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic 6,669.90

63252 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar 7,471.80

63265 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical 5,824.80

63266 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic 6,412.50

63267 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar 5,632.20

63268 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral 4,805.10

63270 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical 5,739.30

63271 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic 5,804.10

63272 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar 5,796.00

63273 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral 5,023.80

63275 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical 6,346.80

63276 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic 6,246.90

63277 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar 5,616.90

63278 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral 5,306.40

63280 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical 6,412.50

63281 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic 6,556.50

63282 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar 6,702.30

63283 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral 5,282.10

63285 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical 6,808.50

63286 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic 7,128.00

63287 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar 7,533.00

63290 Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level 7,120.80

63295 Ostpl rcnstj dorsal spi elmnts flwg ispi px 876.68

63300 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 6,033.60

63301 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 6,150.60

63302 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 6,551.10

63303 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single

63304 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 6,502.50

63305 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 6,653.70

63306 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 6,643.80

63307 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single 7,065.90

63308 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single

63600 Creation of lesion of spinal cord by stereotactic method, percutaneous, any modality (including stimulation 3,244.50

63610 Stereotactic stimulation of spinal cord, percutaneous, separate procedure not followed by other surgery 2,502.90

63615 Stereotactic biopsy, aspiration, or excision of lesion, spinal cord 3,785.40

63620 Stereotactic radiosurgery 1 spinal lesion 1,894.72

63621 Stereotactic radiosurgery ea addl spinal lesion 590.80

63650 Percutaneous implantation of neurostimulator electrode array, epidural 3,397.50

63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural 4,462.20

63661 Remove spine eltrd perq aray 1,863.09

63662 Rmvl spinal nstim eltrd plate/paddle incl fluor 3,176.79

63663 Revise spine eltrd perq aray 2,705.03

63664 Revj incl rplcmt nstim eltrd plt/pdle incl fluor 3,472.26

63685 Incision and subcutaneous placement of spinal neurostimulator pulse generator or receiver, direct or 2,304.90

63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver 1,452.60

63700 Repair of meningocele; less than 5 cm diameter 3,715.20

63702 Repair of meningocele; larger than 5 cm diameter 3,716.10

63704 Repair of myelomeningocele; less than 5 cm diameter 4,053.60

CPT Mod FEE 63706 Repair of myelomeningocele; larger than 5 cm diameter 4,401.00

63707 Repair of dural/CSF leak, not requiring laminectomy 4,411.80

63709 Repair of dural/CSF leak or pseudomeningocele, with laminectomy 5,055.30

63710 Dural graft, spinal 4,424.40

63740 Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy 4,424.40

63741 Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring 2,841.30

63744 Replacement, irrigation or revision of lumbosubarachnoid shunt

63746 Removal of entire lumbosubarachnoid shunt system without replacement

64400 Injection, anesthetic agent; trigeminal nerve, any division or branch

64402 Injection, anesthetic agent; facial nerve 243.90

64405 Injection, anesthetic agent; greater occipital nerve

64408 Injection, anesthetic agent; vagus nerve

64410 Injection, anesthetic agent; phrenic nerve

64412 Injection, anesthetic agent; spinal accessory nerve

64413 Injection, anesthetic agent; cervical plexus 299.70

64415 Injection, anesthetic agent; brachial plexus

64416 Injection anes brachial plexus cont nfs cath 305.64

64417 Injection, anesthetic agent; axillary nerve

64418 Injection, anesthetic agent; suprascapular nerve 274.07

64420 Injection, anesthetic agent; intercostal nerve, single

64421 Injection, anesthetic agent; intercostal nerves, multiple, regional block 486.90

64425 Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves

64430 Injection, anesthetic agent; pudendal nerve

64435 Injection, anesthetic agent; paracervical (uterine) nerve

64445 Injection, anesthetic agent; sciatic nerve 326.70

64446 Injection anes sciatic nerve cont infusion cath 305.97

64447 Njx anes fem nrv 1 228.81

64448 Injection anes femoral nerve cont infusion cath 275.13

64449 Injection anes lumbar plexus post cont nfs cath 306.30

64450 Injection, anesthetic agent; other peripheral nerve or branch

64455 N block inj plantar digit 157.67

64479 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level 485.10

64480 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, each additional level 436.50

64483 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level 398.11

64484 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level 447.30

64490 Inj paravert f jnt c/t 1 lev 404.72

64491 Inj paravert f jnt c/t 2 lev 287.25

64492 Inj paravert f jnt c/t 3 lev 287.36

64493 Inj paravert f jnt l/s 1 lev 398.98

64494 Inj paravert f jnt l/s 2 lev 227.39

64495 Inj paravert f jnt l/s 3 lev 227.49

64505 Injection, anesthetic agent; sphenopalatine ganglion 244.80

64508 Injection, anesthetic agent; carotid sinus (separate procedure)

64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) 295.20

64517 Njx anes suprior hypogstr plexus 385.18

64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) 490.41

64530 Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring

64550 Application of surface (transcutaneous) neurostimulator 123.54

64553 Percutaneous implantation of neurostimulator electrodes; cranial nerve

64555 Percutaneous implantation of neurostimulator electrodes; peripheral nerve

64561 Prq impltj nstim eltrds sac nrv 1,611.28

64565 Percutaneous implantation of neurostimulator electrodes; neuromuscular

64566 Neuroeltrd stim post tibial 266.83

64568 Inc impltj crnl nrv nstim eltrds & pulse gener 1,127.59

64569 Revision/replmt nstim crnl eltrds 1,130.12

64570 Removal crnl nrv nstim eltrds & pulse generator 999.18

64575 Incision for implantation of neurostimulator electrodes; peripheral nerve 963.90

64580 Incision for implantation of neurostimulator electrodes; neuromuscular 793.80

64581 Inc impltj nstim eltrds sac nrv 1,141.09

64585 Revision or removal of peripheral neurostimulator electrodes 678.60

64590 Incision and subcutaneous placement of peripheral neurostimulator pulse generator or receiver, direct or

64595 Revision or removal of peripheral neurostimulator pulse generator or receiver

64600 Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar

64605 Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

64610 Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

64611 Chemodenerv saliv glands 140.10

64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial 377.10

64613 Chemodenervation of muscle(s); cervical spinal muscle(s) (eg, for spasmodic torticollis)

64614 Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) (eg, for dystonia, cerebral palsy,

64615 Chemodenerv musc migraine 358.72

CPT Mod FEE 64620 Destruction by neurolytic agent, intercostal nerve

64630 Destruction by neurolytic agent; pudendal nerve

64632 N block inj common digit 278.02

64633 Destroy cerv/thor facet jnt 1,004.45

64634 Destroy c/th facet jnt addl 457.76

64635 Destroy lumb/sac facet jnt 986.15

64636 Destroy l/s facet jnt addl 412.31

64640 Destruction by neurolytic agent; other peripheral nerve or branch 394.20

64650 Chemodnrvtj eccrine glnds bth ax 106.28

64653 Chemodnrvtj eccrine glnds oth area pr d 139.04

64680 Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring 685.80

64681 Dstrj nulyt +-rad mntr suprior hypogstr plexus 734.56

64702 Neuroplasty; digital, one or both, same digit

64704 Neuroplasty; nerve of hand or foot

64708 Neuroplasty, major peripheral nerve, arm or leg; other than specified 1,944.90

64712 Neuroplasty, major peripheral nerve, arm or leg; sciatic nerve

64713 Neuroplasty, major peripheral nerve, arm or leg; brachial plexus 2,725.20

64714 Neuroplasty, major peripheral nerve, arm or leg; lumbar plexus 2,422.80

64716 Neuroplasty and/or transposition; cranial nerve (specify) 2,464.20

64718 Neuroplasty and/or transposition; ulnar nerve at elbow

64719 Neuroplasty and/or transposition; ulnar nerve at wrist 1,989.90

64721 Neuroplasty and/or transposition; median nerve at carpal tunnel

64722 Decompression; unspecified nerve(s) (specify) 2,050.20

64726 Decompression; plantar digital nerve

64727 Internal neurolysis, requiring use of operating microscope (List separately in addition to code for 2,111.40

64732 Transection or avulsion of; supraorbital nerve

64734 Transection or avulsion of; infraorbital nerve

64736 Transection or avulsion of; mental nerve 1,255.50

64738 Transection or avulsion of; inferior alveolar nerve by osteotomy

64740 Transection or avulsion of; lingual nerve

64742 Transection or avulsion of; facial nerve, differential or complete

64744 Transection or avulsion of; greater occipital nerve 1,597.50

64746 Transection or avulsion of; phrenic nerve 803.70

64752 Transection or avulsion of; vagus nerve (vagotomy), transthoracic 2,326.50

64755 Transection or avulsion of; vagi limited to proximal stomach (selective proximal vagotomy, proximal gastric 3,316.50

64760 Transection or avulsion of; vagus nerve (vagotomy), abdominal 1,964.70

64761 Transection or avulsion of; pudendal nerve

64763 Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy 1,021.50

64766 Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy

64771 Transection or avulsion of other cranial nerve, extradural

64772 Transection or avulsion of other spinal nerve, extradural 2,052.90

64774 Excision of neuroma; cutaneous nerve, surgically identifiable

64776 Excision of neuroma; digital nerve, one or both, same digit

64778 Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary

64782 Excision of neuroma; hand or foot, except digital nerve 1,261.80

64783 Excision of neuroma; hand or foot, each additional nerve, except same digit (List separately in addition to

64784 Excision of neuroma; major peripheral nerve, except sciatic

64786 Excision of neuroma; sciatic nerve 2,403.00

64787 Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision)

64788 Excision of neurofibroma or neurolemmoma; cutaneous nerve

64790 Excision of neurofibroma or neurolemmoma; major peripheral nerve 2,151.90

64792 Excision of neurofibroma or neurolemmoma; extensive (including malignant type)

64795 Biopsy of nerve

64802 Sympathectomy, cervical

64804 Sympathectomy, cervicothoracic 3,587.40

64809 Sympathectomy, thoracolumbar 2,945.70

64818 Sympathectomy, lumbar

64820 Sympth dgtal arts ea dgt 1,219.55

64821 Sympth rdl art 1,203.16

64822 Sympth ur art 1,201.92

64823 Sympth supfc plmr arch 1,223.47

64831 Suture of digital nerve, hand or foot; one nerve 1,704.60

64832 Suture of digital nerve, hand or foot; each additional digital nerve (List separately in addition to code for 927.90

64834 Suture of one nerve, hand or foot; common sensory nerve 1,899.00

64835 Suture of one nerve, hand or foot; median motor thenar 1,967.40

64836 Suture of one nerve, hand or foot; ulnar motor 2,360.70

64837 Suture of each additional nerve, hand or foot (List separately in addition to code for primary procedure) 1,134.90

64840 Suture of posterior tibial nerve 2,778.30

64856 Suture of major peripheral nerve, arm or leg, except sciatic; including transposition 2,831.40

64857 Suture of major peripheral nerve, arm or leg, except sciatic; without transposition 2,518.20

CPT Mod FEE 64858 Suture of sciatic nerve 2,503.80

64859 Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure) 1,147.50

64861 Suture of; brachial plexus 2,703.60

64862 Suture of; lumbar plexus 3,292.20

64864 Suture of facial nerve; extracranial 2,355.30

64865 Suture of facial nerve; infratemporal, with or without grafting 3,441.60

64866 Anastomosis; facial-spinal accessory 3,690.90

64868 Anastomosis; facial-hypoglossal 4,108.50

64870 Anastomosis; facial-phrenic 3,644.10

64872 Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary 1,768.50

64874 Suture of nerve; requiring extensive mobilization, or transposition of nerve (List separately in addition to 2,524.50

64876 Repair nerve/shorten bone 441.19

64885 Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length

64886 Nerve graft (includes obtaining graft), head or neck; more than 4 cm length 3,234.60

64890 Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm length 3,495.60

64891 Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length 2,845.80

64892 Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length 2,796.30

64893 Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length 3,074.40

64895 Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length 3,388.50

64896 Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length 3,841.20

64897 Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length 3,540.60

64898 Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length 3,940.20

64901 Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure)

64902 Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary 2,455.20

64905 Nerve pedicle transfer; first stage 2,021.40

64907 Nerve pedicle transfer; second stage 2,226.60

64910 Nerve repair w/conduit ea nerve 1,599.15

64911 Nerve repair w/autogenous vein graft ea nerve 1,901.18

65091 Evisceration of ocular contents; without implant 1,363.50

65093 Evisceration of ocular contents; with implant 1,705.50

65101 Enucleation of eye; without implant 2,083.44

65103 Enucleation of eye; with implant, muscles not attached to implant 1,895.40

65105 Enucleation of eye; with implant, muscles attached to implant

65110 Exenteration of orbit (does not include skin graft), removal of orbital contents; only 3,046.50

65112 Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of 3,127.50

65114 Exenteration of orbit (does not include skin graft), removal of orbital contents; with muscle or myocutaneous 3,379.50

65125 Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis

65130 Insertion of ocular implant secondary; after evisceration, in scleral shell

65135 Insertion of ocular implant secondary; after enucleation, muscles not attached to implant 1,566.00

65140 Insertion of ocular implant secondary; after enucleation, muscles attached to implant 2,068.20

65150 Reinsertion of ocular implant; with or without conjunctival graft

65155 Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to

65175 Removal of ocular implant 1,166.40

65205 Removal of foreign body, external eye; conjunctival superficial 116.74

65210 Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or 131.60

65220 Removal of foreign body, external eye; corneal, without slit lamp

65222 Removal of foreign body, external eye; corneal, with slit lamp 163.91

65235 Removal of foreign body, intraocular; from anterior chamber or lens 1,715.40

65260 Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior

65265 Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction

65270 Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure 275.02

65272 Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization

65273 Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization

65275 Repair of laceration; cornea, nonperforating, with or without removal foreign body 821.70

65280 Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue 2,082.60

65285 Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue 3,026.69

65286 Repair of laceration; application of tissue glue, wounds of cornea and/or sclera

65290 Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

65400 Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

65410 Biopsy of cornea 466.20

65420 Excision or transposition of pterygium; without graft 944.78

65426 Excision or transposition of pterygium; with graft 1,369.33

65430 Scraping of cornea, diagnostic, for smear and/or culture

65435 Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)

65436 Removal of corneal epithelium; with application of chelating agent (eg, EDTA)

65450 Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization

65600 Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo) 817.20

65710 Keratoplasty (corneal transplant); lamellar 3,068.10

65730 Keratoplasty (corneal transplant); penetrating (except in aphakia)

65750 Keratoplasty (corneal transplant); penetrating (in aphakia)

CPT Mod FEE 65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia) 3,698.10

65756 Keratoplasty endothelial 2,478.45

65760 Keratomileusis 3,709.80

65765 Keratophakia 3,844.80

65767 Epikeratoplasty 3,079.80

65770 Keratoprosthesis

65771 Radial keratotomy 1,617.30

65772 Corneal relaxing incision for correction of surgically induced astigmatism 1,199.70

65775 Corneal wedge resection for correction of surgically induced astigmatism

65778 Cover eye w/membrane 2,613.91

65779 Cover eye w/membrane suture 2,106.15

65780 Ocular surface reconstruction amniotic membrane 1,555.66

65781 Ocular surface reconstruction limbal allograft 2,458.31

65782 Occular surface reconstruction limbal autograft 1,989.88

65800 Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration of aqueous

65810 Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of 1,247.40

65815 Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without 1,110.60

65820 Goniotomy

65850 Trabeculotomy ab externo 2,154.60

65855 Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)

65860 Severing adhesions of anterior segment, laser technique (separate procedure) 1,277.10

65865 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid)

65870 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid)

65875 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) 1,417.50

65880 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) 1,403.10

65900 Removal of epithelial downgrowth, anterior chamber eye

65920 Removal of implanted material, anterior segment eye 1,873.17

65930 Removal of blood clot, anterior segment eye 1,298.70

66020 Injection, anterior chamber (separate procedure); air or liquid

66030 Injection, anterior chamber (separate procedure); medication

66130 Excision of lesion, sclera

66150 Fistulization of sclera for glaucoma; trephination with iridectomy

66155 Fistulization of sclera for glaucoma; thermocauterization with iridectomy

66160 Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy 1,874.70

66165 Fistulization of sclera for glaucoma; iridencleisis or iridotasis 1,788.30

66170 Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery 2,064.60

66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or 2,304.00

66174 Trluml dilat aqueous canal w/o dev/stnt 1,664.54

66175 Trluml dilat aqueous canal w/dev/stnt 1,755.21

66180 Aqueous shunt to extraocular reservoir (eg, Molteno, Schocket, Denver-Krupin) 2,621.70

66185 Revision of aqueous shunt to extraocular reservoir 1,754.10

66220 Repair of scleral staphyloma; without graft

66225 Repair of scleral staphyloma; with graft 3,115.80

66250 Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure

66500 Iridotomy by stab incision (separate procedure); except transfixion

66505 Iridotomy by stab incision (separate procedure); with transfixion as for iris bombe

66600 Iridectomy, with corneoscleral or corneal section; for removal of lesion 1,434.60

66605 Iridectomy, with corneoscleral or corneal section; with cyclectomy

66625 Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma (separate procedure) 1,401.30

66630 Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate procedure) 1,356.30

66635 Iridectomy, with corneoscleral or corneal section; optical (separate procedure) 1,356.30

66680 Repair of iris, ciliary body (as for iridodialysis) 1,522.80

66682 Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, McCannel 1,645.20

66700 Ciliary body destruction; diathermy 1,231.20

66710 Ciliary body destruction; cyclophotocoagulation

66711 Ciliary bdy dstrj cyclopc ndsc 1,283.69

66720 Ciliary body destruction; cryotherapy

66740 Ciliary body destruction; cyclodialysis

66761 Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (one or more sessions)

66762 Iridoplasty by photocoagulation (one or more sessions) (eg, for improvement of vision, for widening of 1,241.10

66770 Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure) 1,347.30

66820 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid);

66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); 1,117.54

66825 Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)

66830 Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with

66840 Removal of lens material; aspiration technique, one or more stages

66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg,

66852 Removal of lens material; pars plana approach, with or without vitrectomy 2,191.50

66920 Removal of lens material; intracapsular 2,442.60

66930 Removal of lens material; intracapsular, for dislocated lens 2,337.30

CPT Mod FEE 66940 Removal of lens material; extracapsular (other than 66840, 66850, 66852)

66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual 2,692.80

66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedure) 2,913.30

66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual 2,961.00

66985 Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal

66986 Exchange of intraocular lens 2,513.70

66990 Ophthalmic endoscope add-on 208.58

67005 Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal

67010 Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with 3,078.00

67015 Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy) 1,328.40

67025 Injection of vitreous substitute, pars plana or limbal approach, (fluid-gas exchange), with or without

67027 Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of

67028 Intravitreal injection of a pharmacologic agent (separate procedure) 677.70

67030 Discission of vitreous strands (without removal), pars plana approach

67031 Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (one 1,725.30

67036 Vitrectomy, mechanical, pars plana approach; 3,816.00

67039 Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation 4,336.20

67040 Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation

67041 Vitrectomy pars plana remove preretinal membrane 3,643.85

67042 Vitrectomy pars plana remove int memb retina 4,430.03

67043 Vitrectomy pars plana remove subretinal membrane 4,581.88

67101 Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of 2,293.20

67105 Repair of retinal detachment, one or more sessions; photocoagulation, with or without drainage of subretinal

67107 Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling 3,351.60

67108 Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal 4,954.50

67110 Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy) 2,899.80

67112 Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal 3,100.50

67113 Rpr complex retina detach vitrectomy & memb peel 4,729.72

67115 Release of encircling material (posterior segment)

67120 Removal of implanted material, posterior segment; extraocular 1,269.90

67121 Removal of implanted material, posterior segment; intraocular 1,663.20

67141 Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more

67145 Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more 1,518.03

67208 Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; cryotherapy,

67210 Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; 1,524.43

67218 Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; radiation by

67220 Destruction of localized lesion of choroid (eg, choroidal neovascularization); photocoagulation (eg, laser), 1,760.40

67221 Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes

67225 Dstrj les choroid pdt 2nd eye 1 sess 424.48

67227 Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions; 1,713.60

67228 Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions; 1,702.39

67229 Extensive retinopathy 1+ sess preterm infant 1,631.69

67250 Scleral reinforcement (separate procedure); without graft 1,955.70

67255 Scleral reinforcement (separate procedure); with graft 2,400.30

67311 Strabismus surgery, recession or resection procedure; one horizontal muscle

67312 Strabismus surgery, recession or resection procedure; two horizontal muscles

67314 Strabismus surgery, recession or resection procedure; one vertical muscle (excluding superior oblique)

67316 Strabismus surgery, recession or resection procedure; two or more vertical muscles (excluding superior

67318 Strabismus surgery, any procedure, superior oblique muscle 2,106.90

67320 Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (List

67331 Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular

67332 Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular injury, strabismus or 2,152.80

67334 Strabismus surgery by posterior fixation suture technique, with or without muscle recession (List separately

67335 Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of

67340 Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in

67343 Release of extensive scar tissue without detaching extraocular muscle (separate procedure)

67345 Chemodenervation of extraocular muscle 539.10

67346 Biopsy extraocular muscle 544.18

67400 Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy

67405 Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only 1,980.90

67412 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion 2,352.60

67413 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body 2,716.20

67414 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for 2,228.40

67415 Fine needle aspiration of orbital contents

67420 Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of lesion

67430 Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of foreign body 2,887.20

67440 Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with drainage 3,031.20

67445 Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of bone for 2,722.50

67450 Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for exploration, with or without biopsy 2,966.40

67500 Retrobulbar injection; medication (separate procedure, does not include supply of medication)

CPT Mod FEE 67505 Retrobulbar injection; alcohol

67515 Injection of therapeutic agent into Tenon's capsule

67550 Orbital implant (implant outside muscle cone); insertion

67560 Orbital implant (implant outside muscle cone); removal or revision

67570 Optic nerve decompression (eg, incision or fenestration of optic nerve sheath) 2,440.80

67700 Blepharotomy, drainage of abscess, eyelid 184.47

67710 Severing of tarsorrhaphy

67715 Canthotomy (separate procedure)

67800 Excision of chalazion; single 218.88

67801 Excision of chalazion; multiple, same lid 304.59

67805 Excision of chalazion; multiple, different lids 356.44

67808 Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple

67810 Biopsy of eyelid

67820 Correction of trichiasis; epilation, by forceps only 94.99

67825 Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery)

67830 Correction of trichiasis; incision of lid margin

67835 Correction of trichiasis; incision of lid margin, with free mucous membrane graft 1,691.10

67840 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure 353.47

67850 Destruction of lesion of lid margin (up to 1 cm)

67875 Temporary closure of eyelids by suture (eg, Frost suture)

67880 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; 864.00

67882 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal

67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 1,399.50

67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material 2,169.00

67902 Repair of blepharoptosis; frontalis muscle technique with fascial sling (includes obtaining fascia) 2,372.40

67903 Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach

67904 Repair of blepharoptosis; (tarso) levator resection or advancement, external approach 2,879.10

67906 Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) 2,122.20

67908 Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) 1,909.80

67909 Reduction of overcorrection of ptosis 1,689.30

67911 Correction of lid retraction

67912 Corrj lagophthalmos impltj upr eyelid lid load 2,145.90

67914 Repair of ectropion; suture

67915 Repair of ectropion; thermocauterization

67916 Repair of ectropion; blepharoplasty, excision tarsal wedge 1,341.90

67917 Repair of ectropion; blepharoplasty, extensive (eg, Kuhnt-Szymanowski or tarsal strip operations)

67921 Repair of entropion; suture

67922 Repair of entropion; thermocauterization

67923 Repair of entropion; blepharoplasty, excision tarsal wedge

67924 Repair of entropion; blepharoplasty, extensive (eg, Wheeler operation) 1,857.60

67930 Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; 949.50

67935 Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full

67938 Removal of embedded foreign body, eyelid 222.30

67950 Canthoplasty (reconstruction of canthus) 1,822.50

67961 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may 2,062.80

67966 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may

67971 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two2,272.50

67973 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total 3,181.50

67974 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total 3,420.90

67975 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second 1,535.40

68020 Incision of conjunctiva, drainage of cyst 166.30

68040 Expression of conjunctival follicles (eg, for trachoma)

68100 Biopsy of conjunctiva

68110 Excision of lesion, conjunctiva; up to 1 cm 365.72

68115 Excision of lesion, conjunctiva; over 1 cm 454.50

68130 Excision of lesion, conjunctiva; with adjacent sclera

68135 Destruction of lesion, conjunctiva

68200 Subconjunctival injection

68320 Conjunctivoplasty; with conjunctival graft or extensive rearrangement

68325 Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft) 2,090.70

68326 Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement 2,130.30

68328 Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft) 2,104.20

68330 Repair of symblepharon; conjunctivoplasty, without graft 1,292.40

68335 Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft) 1,466.10

68340 Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens 1,123.20

68360 Conjunctival flap; bridge or partial (separate procedure)

68362 Conjunctival flap; total (such as Gunderson thin flap or purse string flap) 1,544.40

68371 Hrvg cjncl algrft liv don 817.41

68400 Incision, drainage of lacrimal gland

68420 Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy) 362.70

CPT Mod FEE 68440 Snip incision of lacrimal punctum 276.30

68500 Excision of lacrimal gland (dacryoadenectomy), except for tumor; total

68505 Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial 1,574.10

68510 Biopsy of lacrimal gland 674.10

68520 Excision of lacrimal sac (dacryocystectomy) 1,632.60

68525 Biopsy of lacrimal sac 518.40

68530 Removal of foreign body or dacryolith, lacrimal passages

68540 Excision of lacrimal gland tumor; frontal approach 2,062.80

68550 Excision of lacrimal gland tumor; involving osteotomy

68700 Plastic repair of canaliculi 1,694.70

68705 Correction of everted punctum, cautery

68720 Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity) 2,123.10

68745 Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube

68750 Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent 2,332.80

68760 Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery

68761 Closure of the lacrimal punctum; by plug, each

68770 Closure of lacrimal fistula (separate procedure)

68801 Dilation of lacrimal punctum, with or without irrigation

68810 Probing of nasolacrimal duct, with or without irrigation;

68811 Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia

68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent 532.80

68816 Probe nl duct w/balloon 1,322.33

68840 Probing of lacrimal canaliculi, with or without irrigation

68850 Injection of contrast medium for dacryocystography

69000 Drainage external ear, abscess or hematoma; simple

69005 Drainage external ear, abscess or hematoma; complicated

69020 Drainage external auditory canal, abscess

69090 Ear piercing

69100 Biopsy external ear

69105 Biopsy external auditory canal

69110 Excision external ear; partial, simple repair 848.70

69120 Excision external ear; complete amputation 1,729.80

69140 Excision exostosis(es), external auditory canal

69145 Excision soft tissue lesion, external auditory canal

69150 Radical excision external auditory canal lesion; without neck dissection 2,611.80

69155 Radical excision external auditory canal lesion; with neck dissection 4,492.80

69200 Removal foreign body from external auditory canal; without general anesthesia

69205 Removal foreign body from external auditory canal; with general anesthesia 525.89

69210 Removal impacted cerumen (separate procedure), one or both ears 64.34

69220 Debridement, mastoidectomy cavity, simple (eg, routine cleaning) 104.73

69222 Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning)

69300 Otoplasty, protruding ear, with or without size reduction 2,126.70

69310 Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to trauma, infection) (separate 3,252.60

69320 Reconstruction external auditory canal for congenital atresia, single stage 3,473.10

69400 Eustachian tube inflation, transnasal; with catheterization

69401 Eustachian tube inflation, transnasal; without catheterization

69405 Eustachian tube catheterization, transtympanic

69420 Myringotomy including aspiration and/or eustachian tube inflation

69421 Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia

69424 Ventilating tube removal when originally inserted by another physician

69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia 426.42

69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia 621.90

69440 Middle ear exploration through postauricular or ear canal incision 2,028.60

69450 Tympanolysis, transcanal 2,083.50

69501 Transmastoid antrotomy (simple mastoidectomy) 2,442.60

69502 Mastoidectomy; complete 3,323.70

69505 Mastoidectomy; modified radical 3,462.30

69511 Mastoidectomy; radical

69530 Petrous apicectomy including radical mastoidectomy 4,139.10

69535 Resection temporal bone, external approach 6,341.40

69540 Excision aural polyp

69550 Excision aural glomus tumor; transcanal 3,636.90

69552 Excision aural glomus tumor; transmastoid 4,195.80

69554 Excision aural glomus tumor; extended (extratemporal) 5,842.80

69601 Revision mastoidectomy; resulting in complete mastoidectomy 3,073.50

69602 Revision mastoidectomy; resulting in modified radical mastoidectomy 3,607.20

69603 Revision mastoidectomy; resulting in radical mastoidectomy 3,481.20

69604 Revision mastoidectomy; resulting in tympanoplasty 3,876.30

69605 Revision mastoidectomy; with apicectomy 3,746.70

69610 Tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch

CPT Mod FEE 69620 Myringoplasty (surgery confined to drumhead and donor area) 2,461.50

69631 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial 3,134.70

69632 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial

69633 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial

69635 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery,

69636 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, 4,133.70

69637 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, 4,131.90

69641 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); 3,818.70

69642 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); 4,161.60

69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); 4,333.50

69644 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); 4,814.10

69645 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); 4,619.70

69646 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); 5,045.40

69650 Stapes mobilization 2,429.10

69660 Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign 3,344.40

69661 Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign 3,737.70

69662 Revision of stapedectomy or stapedotomy 4,239.90

69666 Repair oval window fistula 3,217.50

69667 Repair round window fistula 3,156.30

69670 Mastoid obliteration (separate procedure)

69676 Tympanic neurectomy 2,268.90

69700 Closure postauricular fistula, mastoid (separate procedure) 1,625.40

69711 Removal or repair of electromagnetic bone conduction hearing device in temporal bone

69714 Impltj oi implt b1 w/o mstdc 2,985.05

69715 Impltj oi implt b1 mstdc 3,580.56

69717 Rplcmt oi implt b1 w/o mstdc 3,079.84

69718 Rplcmt oi implt b1 mstdc 3,691.07

69720 Decompression facial nerve, intratemporal; lateral to geniculate ganglion 3,883.50

69725 Decompression facial nerve, intratemporal; including medial to geniculate ganglion 5,624.10

69740 Suture facial nerve, intratemporal, with or without graft or decompression; lateral to geniculate ganglion 4,449.60

69745 Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate 5,244.30

69801 Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or 3,175.20

69805 Endolymphatic sac operation; without shunt

69806 Endolymphatic sac operation; with shunt

69820 Fenestration semicircular canal 3,438.00

69840 Revision fenestration operation 2,353.50

69905 Labyrinthectomy; transcanal 3,857.40

69910 Labyrinthectomy; with mastoidectomy 4,439.70

69915 Vestibular nerve section, translabyrinthine approach 5,052.60

69930 Cochlear device implantation, with or without mastoidectomy 5,318.10

69950 Vestibular nerve section, transcranial approach 5,448.60

69955 Total facial nerve decompression and/or repair (may include graft) 5,846.40

69960 Decompression internal auditory canal 5,529.60

69970 Removal of tumor, temporal bone 6,309.00

69990 Use of operating microscope (List separately in addition to code for primary procedure) 834.30

70010 Myelography, posterior fossa, radiological supervision and interpretation

70015 Cisternography, positive contrast, radiological supervision and interpretation

70015 Cisternography, positive contrast, radiological supervision and interpretation

70015 TC Contrast x-ray of brain 220.54

70030 Radiologic examination, eye, for detection of foreign body 37.80

70030 Radiologic examination, eye, for detection of foreign body 94.50

70030 TC X-ray eye for foreign body 70.25

70100 Radiologic examination, mandible; partial, less than four views 34.20

70100 Radiologic examination, mandible; partial, less than four views 85.50

70100 TC X-ray exam of jaw <4views 65.59

70110 Radiologic examination, mandible; complete, minimum of four views 48.60

70110 Radiologic examination, mandible; complete, minimum of four views

70110 TC X-ray exam of jaw 4/> views 87.20

70120 Radiologic examination, mastoids; less than three views per side 30.60

70120 Radiologic examination, mastoids; less than three views per side 77.40

70120 TC X-ray exam of mastoids 60.05

70130 Radiologic examination, mastoids; complete, minimum of three views per side 54.00

70130 Radiologic examination, mastoids; complete, minimum of three views per side

70130 TC X-ray exam of mastoids 99.47

70134 Radiologic examination, internal auditory meati, complete 54.00

70134 Radiologic examination, internal auditory meati, complete

70134 TC X-ray exam of middle ear 90.87

70140 33.04

70140 Radiologic examination, facial bones; less than three views 109.49

70140 TC 76.44

CPT Mod FEE 70150 Radiologic examination, facial bones; complete, minimum of three views 136.31

70150 Radiologic examination, facial bones; complete, minimum of three views

70150 TC 84.82

70160 X-ray exam of nasal bones 20.43

70160 Radiologic examination, nasal bones, complete, minimum of three views 88.51

70160 TC X-ray exam of nasal bones 68.08

70170 Dacryocystography, nasolacrimal duct, radiological supervision and interpretation 45.00

70170 Dacryocystography, nasolacrimal duct, radiological supervision and interpretation

70190 Radiologic examination; optic foramina 40.50

70190 Radiologic examination; optic foramina 112.55

70190 TC X-ray exam of eye sockets 82.66

70200 Radiologic examination; orbits, complete, minimum of four views 51.30

70200 Radiologic examination; orbits, complete, minimum of four views 144.04

70200 TC X-ray exam of eye sockets 103.00

70210 Radiologic examination, sinuses, paranasal, less than three views 35.10

70210 Radiologic examination, sinuses, paranasal, less than three views 97.90

70210 TC X-ray exam of sinuses 73.35

70220 Radiologic examination, sinuses, paranasal, complete, minimum of three views 49.50

70220 Radiologic examination, sinuses, paranasal, complete, minimum of three views 149.69

70220 TC X-ray exam of sinuses 106.70

70240 Radiologic examination, sella turcica 34.20

70240 Radiologic examination, sella turcica 85.50

70240 TC X-ray exam pituitary saddle 60.65

70250 Radiologic examination, skull; less than four views, with or without stereo 38.70

70250 Radiologic examination, skull; less than four views, with or without stereo 112.19

70250 TC X-ray exam of skull 78.42

70260 Radiologic examination, skull; complete, minimum of four views, with or without stereo 55.80

70260 Radiologic examination, skull; complete, minimum of four views, with or without stereo 156.89

70260 TC X-ray exam of skull 105.84

70300 Radiologic examination, teeth; single view 12.60

70300 Radiologic examination, teeth; single view 30.60

70300 TC X-ray exam of teeth 19.52

70310 Radiologic examination, teeth; partial examination, less than full mouth 19.80

70310 Radiologic examination, teeth; partial examination, less than full mouth 48.60

70310 TC X-ray exam of teeth 39.63

70320 Radiologic examination, teeth; complete, full mouth 36.90

70320 Radiologic examination, teeth; complete, full mouth 92.70

70320 TC Full mouth x-ray of teeth 74.62

70328 Radiologic examination, temporomandibular joint, open and closed mouth; unilateral 47.70

70328 Radiologic examination, temporomandibular joint, open and closed mouth; unilateral

70328 TC X-ray exam of jaw joint 87.57

70330 Radiologic examination, temporomandibular joint, open and closed mouth; bilateral 55.80

70330 Radiologic examination, temporomandibular joint, open and closed mouth; bilateral

70330 TC X-ray exam of jaw joints 107.37

70332 Temporomandibular joint arthrography, radiological supervision and interpretation 79.20

70332 Temporomandibular joint arthrography, radiological supervision and interpretation

70332 TC X-ray exam of jaw joint 149.30

70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) 244.80

70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) 1,227.60

70336 TC Magnetic image jaw joint 1,005.20

70350 Cephalogram, orthodontic 30.60

70350 Cephalogram, orthodontic 77.40

70350 TC X-ray head for orthodontia 44.28

70355 Orthopantogram 36.90

70355 Orthopantogram 92.70

70355 TC Panoramic x-ray of jaws 47.54

70360 Radiologic examination; neck, soft tissue 30.60

70360 Radiologic examination; neck, soft tissue 99.35

70360 TC X-ray exam of neck 72.62

70370 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique 62.10

70370 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique

70370 TC Throat x-ray & fluoroscopy 171.02

70371 116.96

70371 339.02

70371 TC 222.06

70373 Laryngography, contrast, radiological supervision and interpretation 72.00

70373 Laryngography, contrast, radiological supervision and interpretation

70373 TC Contrast x-ray of larynx 183.66

70380 Radiologic examination, salivary gland for calculus 28.80

70380 Radiologic examination, salivary gland for calculus 98.10

CPT Mod FEE 70380 TC X-ray exam of salivary gland 77.06

70390 Sialography, radiological supervision and interpretation 83.70

70390 Sialography, radiological supervision and interpretation

70390 TC X-ray exam of salivary duct 197.41

70450 Computerized axial tomography, head or brain; without contrast material

70450 Computerized axial tomography, head or brain; without contrast material 758.16

70450 TC Ct head/brain w/o dye 584.36

70460 Computerized axial tomography, head or brain; with contrast material(s)

70460 Computerized axial tomography, head or brain; with contrast material(s) 848.86

70460 TC Ct head/brain w/dye 652.28

70470 Computerized axial tomography, head or brain; without contrast material, followed by contrast material(s)

70470 Computerized axial tomography, head or brain; without contrast material, followed by contrast material(s) 1,034.56

70470 TC Ct head/brain w/o & w/dye 764.80

70480 Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without

70480 Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without 773.58

70480 TC Ct orbit/ear/fossa w/o dye 613.43

70481 Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast 254.70

70481 Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast

70481 TC Ct orbit/ear/fossa w/dye 681.77

70482 Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without

70482 Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without 1,072.55

70482 TC Ct orbit/ear/fossa w/o&w/dye 878.02

70486 Computerized axial tomography, maxillofacial area; without contrast material

70486 Computerized axial tomography, maxillofacial area; without contrast material 731.70

70486 TC Ct maxillofacial w/o dye 567.96

70487 Computerized axial tomography, maxillofacial area; with contrast material(s)

70487 Computerized axial tomography, maxillofacial area; with contrast material(s)

70487 TC Ct maxillofacial w/dye 609.02

70488 Computerized axial tomography, maxillofacial area; without contrast material, followed by contrast

70488 Computerized axial tomography, maxillofacial area; without contrast material, followed by contrast

70488 TC Ct maxillofacial w/o & w/dye 790.88

70490 Computerized axial tomography, soft tissue neck; without contrast material

70490 Computerized axial tomography, soft tissue neck; without contrast material

70490 TC Ct soft tissue neck w/o dye 571.99

70491 Computerized axial tomography, soft tissue neck; with contrast material(s)

70491 Computerized axial tomography, soft tissue neck; with contrast material(s)

70491 TC Ct soft tissue neck w/dye 586.24

70492 Computerized axial tomography, soft tissue neck; without contrast material followed by contrast material(s)

70492 Computerized axial tomography, soft tissue neck; without contrast material followed by contrast material(s)

70492 TC Ct sft tsue nck w/o & w/dye 838.10

70496 Ct angiography head 176.34

70496 Computed tomographic angiography, head, without contrast material(s), followed by contrast material(s) and

70496 TC Ct angiography head 956.76

70498 Ct angiography neck 170.45

70498 Computed tomographic angiography, neck, without contrast material(s), followed by contrast material(s) and

70498 TC Ct angiography neck 962.65

70540 Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast material(s)

70540 Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast material(s)

70540 TC Mri orbit/face/neck w/o dye 1,175.21

70542 308.94

70542 2,211.94

70542 TC 1,903.00

70543 273.12

70543 2,662.89

70543 TC 2,389.78

70544 202.12

70544 1,705.17

70544 TC 1,503.06

70545 222.98

70545 1,878.16

70545 TC 1,655.18

70546 242.33

70546 2,427.25

70546 TC 2,184.92

70547 199.21

70547 1,680.70

70547 TC 1,481.49

70548 225.62

70548 1,907.79

70548 TC 1,682.17

CPT Mod FEE 70549 242.21

70549 2,427.31

70549 TC 2,185.10

70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material 276.30

70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material

70551 TC Mri brain stem w/o dye 1,169.28

70552 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) 315.00

70552 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) 1,575.90

70552 TC Mri brain stem w/dye 1,313.73

70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by 379.80

70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by 1,899.00

70553 TC Mri brain stem w/o & w/dye 1,543.06

70554 353.42

70554 2,075.79

70554 TC 1,722.37

71010 Radiologic examination, chest; single view, frontal 28.80

71010 Radiologic examination, chest; single view, frontal 77.84

71010 TC Chest x-ray 1 view frontal 50.46

71015 Radiologic examination, chest; stereo, frontal 34.20

71015 Radiologic examination, chest; stereo, frontal 85.50

71015 TC Chest x-ray stereo frontal 59.20

71020 Radiologic examination, chest, two views, frontal and lateral; 36.90

71020 Radiologic examination, chest, two views, frontal and lateral; 97.87

71020 TC Chest x-ray 2vw frontal&latl 66.43

71021 Radiologic examination, chest, two views, frontal and lateral; with apical lordotic procedure 47.70

71021 Radiologic examination, chest, two views, frontal and lateral; with apical lordotic procedure

71021 TC Chest x-ray frnt lat lordotc 80.10

71022 Radiologic examination, chest, two views, frontal and lateral; with oblique projections 50.40

71022 Radiologic examination, chest, two views, frontal and lateral; with oblique projections

71022 TC Chest x-ray frnt lat oblique 88.93

71023 Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy 57.60

71023 Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy

71023 TC Chest x-ray and fluoroscopy 108.64

71030 Radiologic examination, chest, complete, minimum of four views; 50.40

71030 Radiologic examination, chest, complete, minimum of four views; 143.52

71030 TC Chest x-ray 4/> views 101.54

71034 Radiologic examination, chest, complete, minimum of four views; with fluoroscopy 80.10

71034 Radiologic examination, chest, complete, minimum of four views; with fluoroscopy 199.80

71034 TC Chest x-ray&fluoro 4/> views 153.58

71035 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies) 35.10

71035 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies) 87.30

71035 TC Chest x-ray special views 68.36

71100 Radiologic examination, ribs, unilateral; two views 41.40

71100 Radiologic examination, ribs, unilateral; two views 106.92

71100 TC X-ray exam ribs uni 2 views 73.97

71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views 47.70

71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views

71101 TC X-ray exam unilat ribs/chest 83.75

71110 Radiologic examination, ribs, bilateral; three views 52.20

71110 Radiologic examination, ribs, bilateral; three views 132.67

71110 TC X-ray exam ribs bil 3 views 93.05

71111 Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of four views 64.80

71111 Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of four views

71111 TC X-ray exam ribs/chest4/> vws 119.20

71120 Radiologic examination; sternum, minimum of two views 38.70

71120 Radiologic examination; sternum, minimum of two views 98.10

71120 TC X-ray exam breastbone 2/>vws 70.91

71130 Radiologic examination; sternoclavicular joint or joints, minimum of three views 44.10

71130 Radiologic examination; sternoclavicular joint or joints, minimum of three views

71130 TC X-ray strenoclavic jt 3/>vws 80.53

71250 Computerized axial tomography, thorax; without contrast material

71250 Computerized axial tomography, thorax; without contrast material

71250 TC Ct thorax w/o dye 597.55

71260 Computerized axial tomography, thorax; with contrast material(s)

71260 Computerized axial tomography, thorax; with contrast material(s) 879.30

71260 TC Ct thorax w/dye 692.10

71270 Computerized axial tomography, thorax; without contrast material, followed by contrast material(s) and

71270 Computerized axial tomography, thorax; without contrast material, followed by contrast material(s) and 1,165.08

71270 TC Ct thorax w/o & w/dye 940.42

71275 262.35

CPT Mod FEE 71275 1,529.25

71275 TC 1,266.90

71550 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal 328.50

71550 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal

71550 TC Mri chest w/o dye 1,417.10

71551 297.91

71551 2,011.20

71551 TC 1,713.29

71552 297.95

71552 2,678.97

71552 TC 2,381.02

71555 Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)

71555 Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) 1,369.80

71555 TC Mri angio chest w or w/o dye 1,132.07

72010 Radiologic examination, spine, entire, survey study, anteroposterior and lateral 94.50

72010 Radiologic examination, spine, entire, survey study, anteroposterior and lateral 234.15

72010 TC X-ray exam spine ap&lat 172.13

72020 Radiologic examination, spine, single view, specify level 30.60

72020 Radiologic examination, spine, single view, specify level 81.12

72020 TC X-ray exam of spine 1 view 57.34

72040 Radiologic examination, spine, cervical; two or three views 40.50

72040 Radiologic examination, spine, cervical; two or three views 111.06

72040 TC X-ray exam neck spine 3/<vws 77.35

72050 Radiologic examination, spine, cervical; minimum of four views 59.40

72050 Radiologic examination, spine, cervical; minimum of four views 151.90

72050 TC X-ray exam neck spine 4/5vws 106.15

72052 Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies 80.10

72052 Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies 192.87

72052 TC X-ray exam neck spine 6/>vws 141.14

72069 Radiologic examination, spine, thoracolumbar, standing (scoliosis) 42.30

72069 Radiologic examination, spine, thoracolumbar, standing (scoliosis)

72069 TC X-ray exam trunk spine stand 75.82

72070 Radiologic examination, spine; thoracic, two views 43.20

72070 Radiologic examination, spine; thoracic, two views 112.53

72070 TC X-ray exam thorac spine 2vws 79.23

72072 Radiologic examination, spine; thoracic, three views 46.80

72072 Radiologic examination, spine; thoracic, three views 129.38

72072 TC X-ray exam thorac spine 3vws 95.75

72074 Radiologic examination, spine; thoracic, minimum of four views 58.50

72074 Radiologic examination, spine; thoracic, minimum of four views

72074 TC X-ray exam thorac spine4/>vw 131.85

72080 Radiologic examination, spine; thoracolumbar, two views 45.00

72080 Radiologic examination, spine; thoracolumbar, two views

72080 TC X-ray exam trunk spine 2 vws 79.28

72090 Radiologic examination, spine; scoliosis study, including supine and erect studies 52.20

72090 Radiologic examination, spine; scoliosis study, including supine and erect studies

72090 TC X-ray exam scloiosis erect 95.41

72100 Radiologic examination, spine, lumbosacral; two or three views 42.30

72100 Radiologic examination, spine, lumbosacral; two or three views 110.02

72100 TC X-ray exam l-s spine 2/3 vws 76.93

72110 Radiologic examination, spine, lumbosacral; minimum of four views 63.00

72110 Radiologic examination, spine, lumbosacral; minimum of four views 159.34

72110 TC X-ray exam l-2 spine 4/>vws 112.01

72114 Radiologic examination, spine, lumbosacral; complete, including bending views 90.90

72114 Radiologic examination, spine, lumbosacral; complete, including bending views 214.75

72114 TC X-ray exam l-s spine bending 162.66

72120 Radiologic examination, spine, lumbosacral, bending views only, minimum of four views 50.40

72120 Radiologic examination, spine, lumbosacral, bending views only, minimum of four views

72120 TC X-ray bend only l-s spine 124.29

72125 Computerized axial tomography, cervical spine; without contrast material

72125 Computerized axial tomography, cervical spine; without contrast material

72125 TC Ct neck spine w/o dye 598.95

72126 Computerized axial tomography, cervical spine; with contrast material

72126 Computerized axial tomography, cervical spine; with contrast material

72126 TC Ct neck spine w/dye 694.06

72127 Computerized axial tomography, cervical spine; without contrast material, followed by contrast material(s)

72127 Computerized axial tomography, cervical spine; without contrast material, followed by contrast material(s)

72127 TC Ct neck spine w/o & w/dye 870.28

72128 Computerized axial tomography, thoracic spine; without contrast material

72128 Computerized axial tomography, thoracic spine; without contrast material

CPT Mod FEE 72128 TC Ct chest spine w/o dye 592.76

72129 Computerized axial tomography, thoracic spine; with contrast material

72129 Computerized axial tomography, thoracic spine; with contrast material

72129 TC Ct chest spine w/dye 694.77

72130 Computerized axial tomography, thoracic spine; without contrast material, followed by contrast material(s)

72130 Computerized axial tomography, thoracic spine; without contrast material, followed by contrast material(s)

72130 TC Ct chest spine w/o & w/dye 871.32

72131 Computerized axial tomography, lumbar spine; without contrast material

72131 Computerized axial tomography, lumbar spine; without contrast material 865.78

72131 TC Ct lumbar spine w/o dye 682.30

72132 Computerized axial tomography, lumbar spine; with contrast material

72132 Computerized axial tomography, lumbar spine; with contrast material 992.07

72132 TC Ct lumbar spine w/dye 785.75

72133 Computerized axial tomography, lumbar spine; without contrast material, followed by contrast material(s)

72133 Computerized axial tomography, lumbar spine; without contrast material, followed by contrast material(s)

72133 TC Ct lumbar spine w/o & w/dye 871.43

72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material

72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material

72141 TC Mri neck spine w/o dye 1,090.97

72142 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)

72142 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)

72142 TC Mri neck spine w/dye 1,328.48

72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material

72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material 1,468.80

72146 TC Mri chest spine w/o dye 1,192.23

72147 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)

72147 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)

72147 TC Mri chest spine w/dye 1,291.68

72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 290.70

72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material 1,451.70

72148 TC Mri lumbar spine w/o dye 1,193.47

72149 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)

72149 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) 1,593.90

72149 TC Mri lumbar spine w/dye 1,324.94

72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by

72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by 2,248.20

72156 TC Mri neck spine w/o & w/dye 1,787.03

72157 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by 450.90

72157 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by 2,253.60

72157 TC Mri chest spine w/o & w/dye 1,755.53

72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by 439.20

72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by 2,196.00

72158 TC Mri lumbar spine w/o & w/dye 1,770.53

72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) 297.90

72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)

72159 TC Mr angio spine w/o&w/dye 1,241.44

72170 Radiologic examination, pelvis; one or two views 35.10

72170 Radiologic examination, pelvis; one or two views 100.07

72170 TC X-ray exam of pelvis 70.25

72190 Radiologic examination, pelvis; complete, minimum of three views 54.00

72190 Radiologic examination, pelvis; complete, minimum of three views 138.89

72190 TC X-ray exam of pelvis 105.42

72191 243.76

72191 1,421.72

72191 TC 1,177.96

72192 Computerized axial tomography, pelvis; without contrast material

72192 Computerized axial tomography, pelvis; without contrast material 658.80

72192 TC Ct pelvis w/o dye 475.28

72193 Computerized axial tomography, pelvis; with contrast material(s)

72193 Computerized axial tomography, pelvis; with contrast material(s)

72193 TC Ct pelvis w/dye 621.83

72194 Computerized axial tomography, pelvis; without contrast material, followed by contrast material(s) and

72194 Computerized axial tomography, pelvis; without contrast material, followed by contrast material(s) and 1,009.01

72194 TC Ct pelvis w/o & w/dye 830.05

72195 243.96

72195 1,640.10

72195 TC 1,396.14

72196 Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)

72196 Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)

72196 TC Mri pelvis w/dye 1,124.60

CPT Mod FEE 72197 260.00

72197 2,310.35

72197 TC 2,050.35

72198 Magnetic resonance angiography, pelvis, with or without contrast material(s)

72198 Magnetic resonance angiography, pelvis, with or without contrast material(s) 1,368.90

72198 TC Mr angio pelvis w/o & w/dye 1,135.28

72200 Radiologic examination, sacroiliac joints; less than three views 41.40

72200 Radiologic examination, sacroiliac joints; less than three views 112.07

72200 TC X-ray exam si joints 82.69

72202 Radiologic examination, sacroiliac joints; three or more views 41.40

72202 Radiologic examination, sacroiliac joints; three or more views 123.04

72202 TC X-ray exam si joints 3/> vws 93.32

72220 Radiologic examination, sacrum and coccyx, minimum of two views 38.70

72220 Radiologic examination, sacrum and coccyx, minimum of two views 109.91

72220 TC X-ray exam sacrum tailbone 80.44

72240 Myelography, cervical, radiological supervision and interpretation

72240 Myelography, cervical, radiological supervision and interpretation 627.30

72240 TC Myelography neck spine 428.51

72255 Myelography, thoracic, radiological supervision and interpretation

72255 Myelography, thoracic, radiological supervision and interpretation 528.30

72255 TC Myelography thoracic spine 351.43

72265 Myelography, lumbosacral, radiological supervision and interpretation

72265 Myelography, lumbosacral, radiological supervision and interpretation

72265 TC Myelography l-s spine 381.71

72270 Myelography, entire spinal canal, radiological supervision and interpretation

72270 Myelography, entire spinal canal, radiological supervision and interpretation 795.60

72270 TC Myelogphy 2/> spine regions 554.19

72275 198.36

72275 659.11

72275 TC 460.76

72285 Diskography, cervical or thoracic, radiological supervision and interpretation 225.90

72285 Diskography, cervical or thoracic, radiological supervision and interpretation 902.70

72285 TC Discography cerv/thor spine 469.02

72295 Diskography, lumbar, radiological supervision and interpretation

72295 Diskography, lumbar, radiological supervision and interpretation 854.10

72295 TC X-ray of lower spine disk 519.20

73000 Radiologic examination; clavicle, complete 29.70

73000 Radiologic examination; clavicle, complete 91.46

73000 TC X-ray exam of collar bone 67.89

73010 Radiologic examination; scapula, complete 36.90

73010 Radiologic examination; scapula, complete 98.83

73010 TC X-ray exam of shoulder blade 71.38

73020 Radiologic examination, shoulder; one view 28.80

73020 Radiologic examination, shoulder; one view 80.86

73020 TC X-ray exam of shoulder 57.49

73030 Radiologic examination, shoulder; complete, minimum of two views 38.70

73030 Radiologic examination, shoulder; complete, minimum of two views 95.62

73030 TC X-ray exam of shoulder 67.00

73040 Radiologic examination, shoulder, arthrography, radiological supervision and interpretation 90.00

73040 Radiologic examination, shoulder, arthrography, radiological supervision and interpretation 253.80

73040 TC Contrast x-ray of shoulder 194.60

73050 Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction 35.10

73050 Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction 99.90

73050 TC X-ray exam of shoulders 74.79

73060 Radiologic examination; humerus, minimum of two views 33.30

73060 Radiologic examination; humerus, minimum of two views 93.18

73060 TC X-ray exam of humerus 68.19

73070 Radiologic examination, elbow; two views 27.90

73070 Radiologic examination, elbow; two views 81.13

73070 TC X-ray exam of elbow 60.84

73080 Radiologic examination, elbow; complete, minimum of three views 35.10

73080 Radiologic examination, elbow; complete, minimum of three views 97.23

73080 TC X-ray exam of elbow 74.78

73085 Radiologic examination, elbow, arthrography, radiological supervision and interpretation 99.90

73085 Radiologic examination, elbow, arthrography, radiological supervision and interpretation

73085 TC Contrast x-ray of elbow 212.67

73090 Radiologic examination; forearm, two views 33.30

73090 Radiologic examination; forearm, two views 80.87

73090 TC X-ray exam of forearm 59.28

73092 Radiologic examination; upper extremity, infant, minimum of two views 36.00

CPT Mod FEE 73092 Radiologic examination; upper extremity, infant, minimum of two views 90.90

73092 TC X-ray exam of arm infant 70.11

73100 Radiologic examination, wrist; two views 30.60

73100 Radiologic examination, wrist; two views 76.29

73100 TC X-ray exam of wrist 55.81

73110 Radiologic examination, wrist; complete, minimum of three views 36.90

73110 Radiologic examination, wrist; complete, minimum of three views 88.33

73110 TC X-ray exam of wrist 70.27

73115 Radiologic examination, wrist, arthrography, radiological supervision and interpretation 91.80

73115 Radiologic examination, wrist, arthrography, radiological supervision and interpretation

73115 TC Contrast x-ray of wrist 177.32

73120 Radiologic examination, hand; two views 28.80

73120 Radiologic examination, hand; two views 73.95

73120 TC X-ray exam of hand 53.97

73130 Radiologic examination, hand; minimum of three views 36.90

73130 Radiologic examination, hand; minimum of three views 87.88

73130 TC X-ray exam of hand 66.97

73140 Radiologic examination, finger(s), minimum of two views 28.80

73140 Radiologic examination, finger(s), minimum of two views 67.89

73140 TC X-ray exam of finger(s) 55.43

73200 Computerized axial tomography, upper extremity; without contrast material

73200 Computerized axial tomography, upper extremity; without contrast material 721.80

73200 TC Ct upper extremity w/o dye 565.21

73201 Computerized axial tomography, upper extremity; with contrast material(s) 225.90

73201 Computerized axial tomography, upper extremity; with contrast material(s)

73201 TC Ct upper extremity w/dye 598.85

73202 Computerized axial tomography, upper extremity; without contrast material, followed by contrast material(s)

73202 Computerized axial tomography, upper extremity; without contrast material, followed by contrast material(s) 917.10

73202 TC Ct uppr extremity w/o&w/dye 764.26

73206 200.46

73206 1,105.19

73206 TC 904.73

73218 154.29

73218 1,120.22

73218 TC 965.93

73219 184.15

73219 1,320.16

73219 TC 1,136.01

73220 351.00

73220

TC Mri uppr extremity w/o&w/dye 1,463.40

73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)

73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)

73221 TC Mri joint upr extrem w/o dye 1,046.87

73222 200.81

73222 1,431.78

73222 TC 1,230.96

73223 185.05

73223 1,773.84

73223 TC 1,588.79

73225 231.15

73225 1,324.05

73225 TC 1,092.90

73500 Radiologic examination, hip, unilateral; one view 31.50

73500 Radiologic examination, hip, unilateral; one view 73.92

73500 TC X-ray exam of hip 49.95

73510 Radiologic examination, hip, unilateral; complete, minimum of two views 41.40

73510 Radiologic examination, hip, unilateral; complete, minimum of two views 92.40

73510 TC X-ray exam of hip 67.89

73520 Radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of 51.30

73520 Radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of 119.00

73520 TC X-ray exam of hips 82.41

73525 Radiologic examination, hip, arthrography, radiological supervision and interpretation 90.90

73525 Radiologic examination, hip, arthrography, radiological supervision and interpretation

73525 TC Contrast x-ray of hip 193.09

73530 Radiologic examination, hip, during operative procedure 57.60

73530 Radiologic examination, hip, during operative procedure

73540 Radiologic examination, pelvis and hips, infant or child, minimum of two views 40.50

73540 Radiologic examination, pelvis and hips, infant or child, minimum of two views

73540 TC X-ray exam of pelvis & hips 78.77

CPT Mod FEE 73550 Radiologic examination, femur, two views 36.90

73550 Radiologic examination, femur, two views 87.00

73550 TC X-ray exam of thigh 60.77

73560 Radiologic examination, knee; one or two views 36.00

73560 Radiologic examination, knee; one or two views 83.40

73560 TC X-ray exam of knee 1 or 2 59.50

73562 Radiologic examination, knee; three views 41.40

73562 Radiologic examination, knee; three views 95.34

73562 TC X-ray exam of knee 3 72.04

73564 Radiologic examination, knee; complete, four or more views 52.20

73564 Radiologic examination, knee; complete, four or more views 115.16

73564 TC X-ray exam knee 4 or more 86.18

73565 Radiologic examination, knee; both knees, standing, anteroposterior 46.80

73565 Radiologic examination, knee; both knees, standing, anteroposterior 95.31

73565 TC X-ray exam of knees 70.87

73580 Radiologic examination, knee, arthrography, radiological supervision and interpretation

73580 Radiologic examination, knee, arthrography, radiological supervision and interpretation

73580 TC Contrast x-ray of knee joint 261.54

73590 Radiologic examination; tibia and fibula, two views 36.00

73590 Radiologic examination; tibia and fibula, two views 84.75

73590 TC X-ray exam of lower leg 60.92

73592 Radiologic examination; lower extremity, infant, minimum of two views 31.50

73592 Radiologic examination; lower extremity, infant, minimum of two views 80.70

73592 TC X-ray exam of leg infant 60.12

73600 Radiologic examination, ankle; two views 31.50

73600 Radiologic examination, ankle; two views 77.08

73600 TC X-ray exam of ankle 57.22

73610 Radiologic examination, ankle; complete, minimum of three views 38.70

73610 Radiologic examination, ankle; complete, minimum of three views 94.72

73610 TC X-ray exam of ankle 72.85

73615 Radiologic examination, ankle, arthrography, radiological supervision and interpretation 79.20

73615 Radiologic examination, ankle, arthrography, radiological supervision and interpretation

73615 TC Contrast x-ray of ankle 197.29

73620 Radiologic examination, foot; two views 31.50

73620 Radiologic examination, foot; two views 79.34

73620 TC X-ray exam of foot 59.82

73630 Radiologic examination, foot; complete, minimum of three views 38.70

73630 Radiologic examination, foot; complete, minimum of three views 88.02

73630 TC X-ray exam of foot 67.34

73650 Radiologic examination; calcaneus, minimum of two views 31.50

73650 Radiologic examination; calcaneus, minimum of two views 73.47

73650 TC X-ray exam of heel 55.17

73660 Radiologic examination; toe(s), minimum of two views 27.90

73660 Radiologic examination; toe(s), minimum of two views 64.91

73660 TC X-ray exam of toe(s) 52.41

73700 Computerized axial tomography, lower extremity; without contrast material

73700 Computerized axial tomography, lower extremity; without contrast material 712.03

73700 TC Ct lower extremity w/o dye 558.06

73701 Computerized axial tomography, lower extremity; with contrast material(s) 254.70

73701 Computerized axial tomography, lower extremity; with contrast material(s) 786.89

73701 TC Ct lower extremity w/dye 629.35

73702 Computerized axial tomography, lower extremity; without contrast material, followed by contrast material(s)

73702 Computerized axial tomography, lower extremity; without contrast material, followed by contrast material(s)

73702 TC Ct lwr extremity w/o&w/dye 772.18

73706 250.57

73706 1,319.96

73706 TC 1,069.39

73718 176.75

73718 1,277.59

73718 TC 1,100.84

73719 202.15

73719 1,448.72

73719 TC 1,246.57

73720

1,755.90

73720 TC Mri lwr extremity w/o&w/dye 1,464.84

73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material

73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material 1,381.27

73721 TC Mri jnt of lwr extre w/o dye 1,071.83

73722 200.52

CPT Mod FEE 73722 1,430.28

73722 TC 1,229.76

73723 180.97

73723 1,732.45

73723 TC 1,551.48

73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s) 307.80

73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s) 1,534.50

73725 TC Mr ang lwr ext w or w/o dye 1,272.15

74000 Radiologic examination, abdomen; single anteroposterior view 33.30

74000 Radiologic examination, abdomen; single anteroposterior view 83.17

74000 TC 55.14

74010 Radiologic examination, abdomen; anteroposterior and additional oblique and cone views 41.40

74010 Radiologic examination, abdomen; anteroposterior and additional oblique and cone views

74010 TC 74.73

74020 Radiologic examination, abdomen; complete, including decubitus and/or erect views 44.10

74020 Radiologic examination, abdomen; complete, including decubitus and/or erect views 121.37

74020 TC 85.83

74022 Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or 54.90

74022 Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or 159.47

74022 TC X-ray exam series abdomen 113.63

74150 Computerized axial tomography, abdomen; without contrast material

74150 Computerized axial tomography, abdomen; without contrast material 829.56

74150 TC Ct abdomen w/o dye 578.22

74160 Computerized axial tomography, abdomen; with contrast material(s)

74160 Computerized axial tomography, abdomen; with contrast material(s) 1,028.92

74160 TC Ct abdomen w/dye 818.08

74170 Computerized axial tomography, abdomen; without contrast material, followed by contrast material(s) and

74170 Computerized axial tomography, abdomen; without contrast material, followed by contrast material(s) and 1,162.71

74170 TC Ct abdomen w/o & w/dye 935.32

74174 279.53

74174 TC 1,137.30

74174 1,416.83

74175 281.04

74175 1,414.10

74175 TC 1,133.06

74176 251.39

74176 646.96

74176 TC 395.57

74177 257.26

74177 994.23

74177 TC 736.97

74178 296.15

74178 1,294.62

74178 TC 998.47

74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)

74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)

74181 TC Mri abdomen w/o dye 1,113.50

74182 268.02

74182 1,925.46

74182 TC 1,657.45

74183 343.24

74183 2,299.20

74183 TC 1,955.96

74185 Magnetic resonance angiography, abdomen, with or without contrast material(s) 333.90

74185 Magnetic resonance angiography, abdomen, with or without contrast material(s)

74185 TC Mri angio abdom w orw/o dye 1,388.10

74190 Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation 70.20

74190 Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation

74210 Radiologic examination; pharynx and/or cervical esophagus 66.60

74210 Radiologic examination; pharynx and/or cervical esophagus 180.23

74210 TC Contrst x-ray exam of throat 144.68

74220 Radiologic examination; esophagus 73.80

74220 Radiologic examination; esophagus

74220 TC Contrast x-ray esophagus 143.55

74230 Swallowing function, pharynx and/or esophagus, with cineradiography and/or video 93.60

74230 Swallowing function, pharynx and/or esophagus, with cineradiography and/or video 233.10

74230 TC Cine/vid x-ray throat/esoph 172.89

74235 Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and

74235 Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and

74240 Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB

CPT Mod FEE 74240 Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB 264.87

74240 TC X-ray upper gi delay w/o kub 192.76

74241 Radiologic examination, gastrointestinal tract, upper; with or without delayed films, with KUB

74241 Radiologic examination, gastrointestinal tract, upper; with or without delayed films, with KUB 271.25

74241 TC X-rayupper gi delay w/kub 202.52

74245 Radiologic examination, gastrointestinal tract, upper; with small bowel, includes multiple serial films

74245 Radiologic examination, gastrointestinal tract, upper; with small bowel, includes multiple serial films 365.40

74245 TC X-ray upper gi&small intest 282.73

74246 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium,

74246 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium,

74246 TC 199.51

74247 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium,

74247 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, 272.70

74247 TC 214.46

74249 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium,

74249 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, 384.30

74249 TC 303.91

74250 Radiologic examination, small bowel, includes multiple serial films; 83.70

74250 Radiologic examination, small bowel, includes multiple serial films; 215.55

74250 TC 174.11

74251 Radiologic examination, small bowel, includes multiple serial films; via enteroclysis tube

74251 Radiologic examination, small bowel, includes multiple serial films; via enteroclysis tube

74251 TC 245.53

74260 Duodenography, hypotonic 87.30

74260 Duodenography, hypotonic 218.70

74260 TC 204.84

74261 253.22

74261 1,384.23

74261 TC 1,131.01

74262 282.77

74262 1,555.63

74262 TC 1,272.86

74263 261.58

74263 1,656.89

74263 TC 1,395.31

74270 Radiologic examination, colon; barium enema, with or without KUB

74270 Radiologic examination, colon; barium enema, with or without KUB 291.32

74270 TC 234.93

74280 Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon

74280 Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon 386.64

74280 TC 310.24

74283 Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg,

74283 Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg,

74283 TC 275.11

74290 Cholecystography, oral contrast; 55.80

74290 Cholecystography, oral contrast;

74290 TC Contrast x-ray gallbladder 110.32

74291 Cholecystography, oral contrast; additional or repeat examination or multiple day examination 37.80

74291 Cholecystography, oral contrast; additional or repeat examination or multiple day examination 94.50

74291 TC Contrast x-rays gallbladder 82.14

74300 X-ray bile ducts/pancreas 67.14

74300 Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation

74301 X-rays at surgery add-on 46.90

74301 Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and

74305 Cholangiography and/or pancreatography; postoperative, radiological supervision and interpretation 70.20

74305 Cholangiography and/or pancreatography; postoperative, radiological supervision and interpretation

74320 Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation 91.80

74320 Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation

74320 TC Contrast x-ray of bile ducts 280.43

74327 Postoperative biliary duct stone removal, percutaneous via T-tube tract, basket, or snare (eg, Burhenne

74327 Postoperative biliary duct stone removal, percutaneous via T-tube tract, basket, or snare (eg, Burhenne

74327 TC X-ray bile stone removal 315.00

74328 Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation

74328 Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation

74329 Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation

74329 Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation

74330 Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision

74330 Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision

74340 Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and films,

74340 Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and films, 334.80

CPT Mod FEE 74355 Percutaneous placement of enteroclysis tube, radiological supervision and interpretation

74355 Percutaneous placement of enteroclysis tube, radiological supervision and interpretation 349.20

74400 Urography (pyelography), intravenous, with or without KUB, with or without tomography 76.50

74400 Urography (pyelography), intravenous, with or without KUB, with or without tomography 242.95

74400 TC 196.03

74410 Urography, infusion, drip technique and/or bolus technique; 78.30

74410 Urography, infusion, drip technique and/or bolus technique;

74410 TC 212.22

74415 Urography, infusion, drip technique and/or bolus technique; with nephrotomography 84.60

74415 Urography, infusion, drip technique and/or bolus technique; with nephrotomography

74415 TC 239.70

74420 Urography, retrograde, with or without KUB 63.00

74420 Urography, retrograde, with or without KUB

74425 Urography, antegrade, (pyelostogram, nephrostogram, loopogram), radiological supervision and 83.70

74425 Urography, antegrade, (pyelostogram, nephrostogram, loopogram), radiological supervision and 207.12

74430 Cystography, minimum of three views, radiological supervision and interpretation 63.00

74430 Cystography, minimum of three views, radiological supervision and interpretation

74430 TC Contrast x-ray bladder 117.10

74440 69.94

74440 239.72

74440 TC 169.77

74445 Corpora cavernosography, radiological supervision and interpretation

74445 Corpora cavernosography, radiological supervision and interpretation

74450 Urethrocystography, retrograde, radiological supervision and interpretation 63.00

74450 Urethrocystography, retrograde, radiological supervision and interpretation

74455 Urethrocystography, voiding, radiological supervision and interpretation 78.30

74455 Urethrocystography, voiding, radiological supervision and interpretation 223.20

74455 TC X-ray urethra/bladder 185.78

74470 Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and 83.70

74470 Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and 235.80

74475 113.11

74475 738.97

74475 TC 625.86

74480 111.45

74480 727.96

74480 TC 616.52

74485 94.43

74485 516.61

74485 TC 422.18

74710 Pelvimetry, with or without placental localization 62.10

74710 Pelvimetry, with or without placental localization

74710 TC X-ray measurement of pelvis 89.33

74740 Hysterosalpingography, radiological supervision and interpretation 70.20

74740 Hysterosalpingography, radiological supervision and interpretation 211.01

74740 TC X-ray female genital tract 166.28

74775 Perineogram (eg, vaginogram, for sex determination or extent of anomalies) 99.00

74775 Perineogram (eg, vaginogram, for sex determination or extent of anomalies)

75557 445.94

75557 1,929.44

75557 TC 1,483.50

75559 594.96

75559 2,492.69

75559 TC 1,897.73

75561 523.12

75561 2,389.24

75561 TC 1,866.12

75563 661.87

75563 3,028.15

75563 TC 2,366.29

75565 43.41

75565 307.65

75565 TC 264.25

75571 92.13

75571 399.50

75571 TC 307.37

75572 285.42

75572 502.21

75572 TC 216.79

75573 410.16

75573 677.66

CPT Mod FEE 75573 TC 267.50

75574 391.64

75574 1,934.02

75574 TC 1,542.37

75600 Contrast exam thoracic aorta 18.09

75600 Aortography, thoracic, without serialography, radiological supervision and interpretation 179.10

75600 TC Contrast exam thoracic aorta 161.01

75605 222.53

75605 1,358.34

75605 TC 1,135.81

75625 Contrast exam abdominl aorta 78.33

75625 Aortography, abdominal, by serialography, radiological supervision and interpretation

75625 TC Contrast exam abdominl aorta 158.37

75630 X-ray aorta leg arteries 124.01

75630 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological

75630 TC X-ray aorta leg arteries 161.29

75635 417.99

75635 2,186.77

75635 TC 1,768.78

75658 Artery x-rays arm 80.43

75658 Angiography, brachial, retrograde, radiological supervision and interpretation

75658 TC Artery x-rays arm 176.97

75705 Artery x-rays spine 113.08

75705 Angiography, spinal, selective, radiological supervision and interpretation

75705 TC Artery x-rays spine 170.42

75710 Artery x-rays arm/leg 68.99

75710 Angiography, extremity, unilateral, radiological supervision and interpretation

75710 TC Artery x-rays arm/leg 181.21

75716 Artery x-rays arms/legs 83.89

75716 Angiography, extremity, bilateral, radiological supervision and interpretation

75716 TC Artery x-rays arms/legs 224.81

75726 Artery x-rays abdomen 81.80

75726 Angiography, visceral, selective or supraselective, (with or without flush aortogram), radiological supervision 288.00

75726 TC Artery x-rays abdomen 206.20

75731 Artery x-rays adrenal gland 77.96

75731 Angiography, adrenal, unilateral, selective, radiological supervision and interpretation

75731 TC Artery x-rays adrenal gland 179.44

75733 Artery x-rays adrenals 74.40

75733 Angiography, adrenal, bilateral, selective, radiological supervision and interpretation

75733 TC Artery x-rays adrenals 193.80

75736 Artery x-rays pelvis 69.91

75736 Angiography, pelvic, selective or supraselective, radiological supervision and interpretation

75736 TC Artery x-rays pelvis 177.59

75741 96.14

75741 Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation

75741 TC 169.36

75743 Artery x-rays lungs 125.32

75743 Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation

75743 TC Artery x-rays lungs 193.28

75746 65.62

75746 Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and

75746 TC 150.38

75756 Artery x-rays chest 70.34

75756 Angiography, internal mammary, radiological supervision and interpretation

75756 TC Artery x-rays chest 166.36

75774 Artery x-ray each vessel 25.09

75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and

75774 TC Artery x-ray each vessel 132.41

75791

1,479.93

75791 TC 1,083.03

75801 Lymph vessel x-ray arm/leg 114.60

75801 Lymphangiography, extremity only, unilateral, radiological supervision and interpretation

75803 Lymph vessel x-ray arms/legs 157.54

75803 Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

75805 Lymph vessel x-ray trunk 124.70

75805 Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation

75807 Lymph vessel x-ray trunk 182.44

75807 Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation

75809 Nonvascular shunt x-ray 17.39

CPT Mod FEE 75809 Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, 84.60

75809 TC Nonvascular shunt x-ray 67.21

75810 Vein x-ray spleen/liver 135.11

75810 Splenoportography, radiological supervision and interpretation

75820 Vein x-ray arm/leg 38.02

75820 Venography, extremity, unilateral, radiological supervision and interpretation

75820 TC Vein x-ray arm/leg 115.88

75822 Vein x-ray arms/legs 64.72

75822 Venography, extremity, bilateral, radiological supervision and interpretation

75822 TC Vein x-ray arms/legs 150.38

75825 Vein x-ray trunk 75.33

75825 Venography, caval, inferior, with serialography, radiological supervision and interpretation

75825 TC Vein x-ray trunk 146.07

75827 Vein x-ray chest 76.56

75827 Venography, caval, superior, with serialography, radiological supervision and interpretation

75827 TC Vein x-ray chest 155.64

75831 Vein x-ray kidney 85.46

75831 Venography, renal, unilateral, selective, radiological supervision and interpretation

75831 TC Vein x-ray kidney 151.24

75833 Vein x-ray kidneys 108.15

75833 Venography, renal, bilateral, selective, radiological supervision and interpretation 312.30

75833 TC Vein x-ray kidneys 204.15

75840 Vein x-ray adrenal gland 94.90

75840 Venography, adrenal, unilateral, selective, radiological supervision and interpretation

75840 TC Vein x-ray adrenal gland 162.50

75842 Vein x-ray adrenal glands 110.73

75842 Venography, adrenal, bilateral, selective, radiological supervision and interpretation

75842 TC Vein x-ray adrenal glands 203.37

75860 Vein x-ray neck 70.19

75860 Venography, sinus or jugular, catheter, radiological supervision and interpretation

75860 TC Vein x-ray neck 141.31

75870 Vein x-ray skull 70.69

75870 Venography, superior sagittal sinus, radiological supervision and interpretation

75870 TC Vein x-ray skull 140.81

75872 Vein x-ray skull epidural 70.69

75872 Venography, epidural, radiological supervision and interpretation

75872 TC Vein x-ray skull epidural 140.81

75880 Vein x-ray eye socket 19.98

75880 Venography, orbital, radiological supervision and interpretation

75880 TC Vein x-ray eye socket 119.52

75885 104.28

75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and

75885 TC 169.32

75887 Vein x-ray liver w/o hemodyn 93.37

75887 Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and

75887 TC Vein x-ray liver w/o hemodyn 154.13

75889 74.13

75889 Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and

75889 TC 152.67

75891 Vein x-ray liver 71.08

75891 Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and

75891 TC Vein x-ray liver 144.92

75893 Venous sampling by catheter 35.44

75893 Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin),

75893 TC Venous sampling by catheter 159.86

75894 X-rays transcath therapy 179.45

75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation

75896 X-rays transcath therapy 197.36

75896 Transcatheter therapy, infusion, any method (eg, thrombolysis other than coronary), radiological supervision

75898 Follow-up angiography 301.96

75898 Angiogram through existing catheter for follow-up study for transcatheter therapy, embolization or infusion

75901 90.97

75901 397.59

75901 TC 306.62

75902 65.17

75902 321.61

75902 TC 256.44

75960 Transcath iv stent rs&i 62.48

75960 Transcatheter introduction of intravascular stent(s), (non-coronary vessel), percutaneous and/or open,

75960 TC Transcath iv stent rs&i 153.52

CPT Mod FEE 75962 36.90

75962 Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation

75962 TC 199.80

75964 22.81

75964 Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and

75964 TC 111.29

75966 92.08

75966 Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation

75966 TC 191.42

75968 24.33

75968 Transluminal balloon angioplasty, each additional visceral artery, radiological supervision and interpretation

75968 TC 116.97

75970 Vascular biopsy 121.35

75970 Transcatheter biopsy, radiological supervision and interpretation

75978 Repair venous blockage 33.27

75978 Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological supervision and

75978 TC Repair venous blockage 178.23

75980 Contrast xray exam bile duct 223.85

75980 Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and

75982 Contrast xray exam bile duct 210.75

75982 Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a

75984 Xray control catheter change 41.16

75984 Change of percutaneous tube or drainage catheter with contrast monitoring (eg, gastrointestinal system,

75984 TC Xray control catheter change 102.84

75989 Abscess drainage under x-ray 100.69

75989 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography) for percutaneous drainage

75989 TC Abscess drainage under x-ray 136.01

76000 Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (eg, cardiac 38.70

76000 Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (eg, cardiac 201.24

76000 TC Fluoroscope examination 171.01

76010 Radiologic examination from nose to rectum for foreign body, single view, child 28.80

76010 Radiologic examination from nose to rectum for foreign body, single view, child 72.00

76010 TC X-ray nose to rectum 50.17

76080 Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation 87.30

76080 Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation

76080 TC X-ray exam of fistula 104.19

76098 Radiological examination, surgical specimen 31.50

76098 Radiological examination, surgical specimen 79.20

76098 TC X-ray exam breast specimen 48.31

76100 Radiologic examination, single plane body section (eg, tomography), other than with urography 98.10

76100 Radiologic examination, single plane body section (eg, tomography), other than with urography

76100 TC X-ray exam of body section 154.34

76101 Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography),

76101 Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography),

76101 TC Complex body section x-ray 201.61

76102 Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography),

76102 Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography),

76102 TC Complex body section x-rays 261.89

76120 Cine/video x-rays 42.57

76120 Cineradiography, except where specifically included

76120 TC Cine/video x-rays 142.83

76125 Cine/video x-rays add-on 40.64

76125 Cineradiography to complement routine examination (List separately in addition to code for primary

76376 29.96

76376 361.98

76376 TC 332.02

76377 107.30

76377 448.98

76377 TC 341.68

76380 CAT scan follow-up study 116.87

76380 Computerized tomography, limited or localized follow-up study 443.70

76380 TC CAT scan follow-up study 326.83

76390 Magnetic resonance spectroscopy

76390 Magnetic resonance spectroscopy

76390 TC Mr spectroscopy 1,099.81

76506 Echoencephalography, B-scan and/or real time with image documentation (gray scale) (for determination of

76506 Echoencephalography, B-scan and/or real time with image documentation (gray scale) (for determination of

76506 TC Echo exam of head 230.67

76510 202.99

76510 401.87

CPT Mod FEE 76510 TC 198.88

76511 Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude quantification

76511 Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude quantification

76511 TC Ophth us quant a only 145.66

76512 Ophthalmic ultrasound, echography, diagnostic; contact B-scan (with or without simultaneous A-scan)

76512 Ophthalmic ultrasound, echography, diagnostic; contact B-scan (with or without simultaneous A-scan) 302.40

76512 TC Ophth us b w/non-quant a 138.31

76513 Ophthalmic ultrasound, echography, diagnostic; anterior segment ultrasound, immersion (water bath) B120.60

76513 Ophthalmic ultrasound, echography, diagnostic; anterior segment ultrasound, immersion (water bath) B302.40

76513 TC Echo exam of eye water bath 199.67

76514 31.94

76514 40.07

76514 TC 8.13

76516 Ophthalmic biometry by ultrasound echography, A-scan; 91.80

76516 Ophthalmic biometry by ultrasound echography, A-scan; 227.70

76516 TC 145.73

76519 Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation 99.00

76519 Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation 248.40

76519 TC 162.58

76529 Ophthalmic ultrasonic foreign body localization

76529 Ophthalmic ultrasonic foreign body localization

76529 TC 162.79

76536 Echography, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), B-scan and/or real time with

76536 Echography, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), B-scan and/or real time with 257.72

76536 TC Us exam of head and neck 204.91

76604 Echography, chest, B-scan (includes mediastinum) and/or real time with image documentation

76604 Echography, chest, B-scan (includes mediastinum) and/or real time with image documentation

76604 TC Us exam chest 185.54

76645 Echography, breast(s) (unilateral or bilateral), B-scan and/or real time with image documentation

76645 Echography, breast(s) (unilateral or bilateral), B-scan and/or real time with image documentation 251.93

76645 TC Us exam breast(s) 188.77

76700 Echography, abdominal, B-scan and/or real time with image documentation; complete

76700 Echography, abdominal, B-scan and/or real time with image documentation; complete 320.01

76700 TC Us exam abdom complete

76705 Echography, abdominal, B-scan and/or real time with image documentation; limited (eg, single organ, 99.90

76705 Echography, abdominal, B-scan and/or real time with image documentation; limited (eg, single organ, 246.20

76705 TC Echo exam of abdomen 186.85

76770 Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with image documentation;

76770 Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with image documentation; 318.12

76770 TC Us exam abdo back wall comp 238.77

76775 Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with image documentation; 92.70

76775 Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with image documentation; 214.87

76775 TC Us exam abdo back wall lim 164.00

76776 94.76

76776 324.32

76776 TC 229.57

76800 Echography, spinal canal and contents

76800 Echography, spinal canal and contents

76800 TC Us exam spinal canal 200.59

76801 120.01

76801 318.00

76801 TC 197.99

76802 90.37

76802 178.50

76802 TC 88.13

76805 Echography, pregnant uterus, B-scan and/or real time with image documentation; complete (complete fetal

76805 Echography, pregnant uterus, B-scan and/or real time with image documentation; complete (complete fetal 275.25

76805 TC Ob us >/= 14 wks sngl fetus 192.07

76810 Echography, pregnant uterus, B-scan and/or real time with image documentation; complete (complete fetal

76810 Echography, pregnant uterus, B-scan and/or real time with image documentation; complete (complete fetal

76810 TC Ob us >/= 14 wks addl fetus 279.50

76811 215.59

76811 531.56

76811 TC 315.97

76812 213.69

76812 357.40

76812 TC 143.71

76813 133.46

76813 297.61

76813 TC 164.15

CPT Mod FEE 76814 112.56

76814 197.24

76814 TC 84.68

76815 Echography, pregnant uterus, B-scan and/or real time with image documentation; limited (fetal size, heart 85.50

76815 Echography, pregnant uterus, B-scan and/or real time with image documentation; limited (fetal size, heart 199.06

76815 TC Ob us limited fetus(s) 136.06

76816 Echography, pregnant uterus, B-scan and/or real time with image documentation; follow-up or repeat 86.40

76816 Echography, pregnant uterus, B-scan and/or real time with image documentation; follow-up or repeat

76816 TC Ob us follow-up per fetus 129.46

76817 105.50

76817 267.84

76817 TC 162.34

76818 Fetal biophysical profile; with non-stress testing

76818 Fetal biophysical profile; with non-stress testing 284.12

76818 TC Fetal biophys profile w/nst 173.25

76819 115.96

76819 297.07

76819 TC 181.10

76820 66.54

76820 221.10

76820 TC 154.56

76821 103.74

76821 282.43

76821 TC 178.69

76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M180.00

76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M345.33

76825 TC 226.21

76826 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M166.50

76826 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M236.70

76826 TC 169.14

76827 Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or continuous wave with spectral

76827 Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or continuous wave with spectral

76827 TC 150.88

76828 Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or continuous wave with spectral 86.40

76828 Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or continuous wave with spectral

76828 TC 71.34

76830 Echography, transvaginal

76830 Echography, transvaginal 271.17

76830 TC Transvaginal us non-ob 156.86

76831 Echo exam uterus 74.65

76831 Hysterosonography, with or without color flow Doppler 285.80

76831 TC Echo exam uterus 211.16

76856 Echography, pelvic (nonobstetric), B-scan and/or real time with image documentation; complete

76856 Echography, pelvic (nonobstetric), B-scan and/or real time with image documentation; complete 262.16

76856 TC Us exam pelvic complete 198.09

76857 Echography, pelvic (nonobstetric), B-scan and/or real time with image documentation; limited or follow-up 78.30

76857 Echography, pelvic (nonobstetric), B-scan and/or real time with image documentation; limited or follow-up 210.38

76857 TC Us exam pelvic limited 172.16

76870 Echography, scrotum and contents

76870 Echography, scrotum and contents 244.26

76870 TC Us exam scrotum 188.02

76872 Echography, transrectal;

76872 Echography, transrectal; 343.53

76872 TC Us transrectal 196.06

76873 Echography, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

76873 Echography, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

76873 TC Echograp trans r pros study 305.43

76881 87.64

76881 352.03

76881 TC 264.39

76882 65.70

76882 99.72

76882 TC 34.02

76885 Us exam infant hips dynamic 68.44

76885 Echography of infant hips, real time with imaging documentation; dynamic (eg, requiring manipulation)

76885 TC Us exam infant hips dynamic 241.16

76886 Us exam infant hips static 70.64

76886 Echography of infant hips, real time with imaging documentation; limited, static (eg, not requiring

76886 TC Us exam infant hips static 207.46

76930 Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation

CPT Mod FEE 76930 Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation

76930 TC Echo guide cardiocentesis 172.61

76932 Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation

76932 Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation

76936 Ultrasound guided compression repair of arterial pseudo-aneurysm or arteriovenous fistulae (includes

76936 Ultrasound guided compression repair of arterial pseudo-aneurysm or arteriovenous fistulae (includes

76936 TC Echo guide for artery repair 630.31

76937 44.58

76937 95.77

76937 TC 51.19

76941 Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and

76941 Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and

76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging

76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging

76942 TC Echo guide for biopsy 263.36

76945 Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation

76945 Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation

76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation 63.90

76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation 296.44

76946 TC Echo guide for amniocentesis 133.52

76948 Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation 85.50

76948 Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation

76948 TC Echo guide ova aspiration 126.33

76950 Ultrasonic guidance for placement of radiation therapy fields 99.00

76950 Ultrasonic guidance for placement of radiation therapy fields

76950 TC Echo guidance radiotherapy 111.85

76965 Ultrasonic guidance for interstitial radioelement application

76965 Ultrasonic guidance for interstitial radioelement application

76965 TC Echo guidance radiotherapy 201.59

76970 Ultrasound study follow-up (specify) 72.90

76970 Ultrasound study follow-up (specify)

76970 TC Ultrasound exam follow-up 149.49

76975 Gastrointestinal endoscopic ultrasound, supervision and interpretation

76975 Gastrointestinal endoscopic ultrasound, supervision and interpretation 263.70

76977 Us bone density measure 65.88

76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method 179.53

76977 TC Us bone density measure 113.66

77001 55.57

77001 260.72

77001 TC 205.15

77002 77.53

77002 227.71

77002 TC 150.18

77003 84.18

77003 218.53

77003 TC 134.36

77011 172.26

77011 1,109.83

77011 TC 937.57

77012 160.08

77012 1,017.89

77012 TC 857.81

77014 138.15

77014 522.89

77014 TC 384.74

77021 258.11

77021 1,609.20

77021 TC 1,351.09

77031 216.08

77031 896.06

77031 TC 679.99

77032 83.67

77032 227.89

77032 TC 144.22

77051 9.78

77051 56.04

77051 TC 46.26

77052 9.49

77052 54.33

77052 TC 44.84

CPT Mod FEE 77053 47.05

77053 302.99

77053 TC 255.93

77054 50.96

77054 348.54

77054 TC 297.57

77055 74.51

77055 165.49

77055 TC 90.98

77056 97.02

77056 216.05

77056 TC 119.03

77057 69.47

77057 165.80

77057 TC 96.33

77058 248.53

77058 2,273.48

77058 TC 2,024.95

77059 238.70

77059 2,939.71

77059 TC 2,701.01

77071 Manual appl stress pfrmd phys joint radiography 68.11

77072 25.66

77072 79.09

77072 TC 53.43

77073 35.07

77073 111.25

77073 TC 76.19

77074 46.67

77074 129.11

77074 TC 82.44

77075 65.81

77075

TC 140.29

77076 70.08

77076 137.87

77076 TC 67.80

77077 32.33

77077 115.37

77077 TC 83.04

77078 29.88

77078 310.42

77078 TC 280.54

77080 34.02

77080 311.04

77080 TC 277.02

77081 27.53

77081 97.24

77081 TC 69.71

77082 19.41

77082 84.82

77082 TC 65.41

77084 66.56

77084 253.26

77084 TC 186.69

77261 Therapeutic radiology treatment planning; simple

77262 Therapeutic radiology treatment planning; intermediate 496.80

77263 Therapeutic radiology treatment planning; complex

77280 Therapeutic radiology simulation-aided field setting; simple

77280 Therapeutic radiology simulation-aided field setting; simple 453.60

77280 TC 372.97

77285 Therapeutic radiology simulation-aided field setting; intermediate

77285 Therapeutic radiology simulation-aided field setting; intermediate 640.80

77285 TC 543.91

77290 Therapeutic radiology simulation-aided field setting; complex

77290 Therapeutic radiology simulation-aided field setting; complex 869.40

77290 TC 751.87

77295 Therapeutic radiology simulation-aided field setting; three-dimensional 857.70

77295 Therapeutic radiology simulation-aided field setting; three-dimensional

77295 TC 1,754.09

CPT Mod FEE 77300 Basic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap calculation, off axis factor,

77300 Basic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap calculation, off axis factor,

77300 TC Radiation therapy dose plan 150.95

77301 1,060.49

77301 4,104.56

77301 TC 3,044.07

77305 Teletherapy, isodose plan (whether hand or computer calculated); simple (one or two parallel opposed

77305 Teletherapy, isodose plan (whether hand or computer calculated); simple (one or two parallel opposed

77305 TC Teletx isodose plan simple 150.65

77310 Teletherapy, isodose plan (whether hand or computer calculated); intermediate (three or more treatment

77310 Teletherapy, isodose plan (whether hand or computer calculated); intermediate (three or more treatment

77310 TC Teletx isodose plan intermed 188.17

77315 Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle or inverted Y, tangential 295.20

77315 Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle or inverted Y, tangential 590.40

77315 TC Teletx isodose plan complex 262.65

77321 Special teletherapy port plan, particles, hemibody, total body

77321 Special teletherapy port plan, particles, hemibody, total body 536.40

77321 TC Special teletx port plan 270.22

77326 Brachytherapy isodose calculation; simple (calculation made from single plane, one to four sources/ribbon

77326 Brachytherapy isodose calculation; simple (calculation made from single plane, one to four sources/ribbon

77326 TC Brachytx isodose calc simp 257.77

77327 Brachytherapy isodose calculation; intermediate (multiplane dosage calculations, application involving 5 to

77327 Brachytherapy isodose calculation; intermediate (multiplane dosage calculations, application involving 5 to 540.00

77327 TC Brachytx isodose calc interm 367.40

77328 Brachytherapy isodose calculation; complex (multiplane isodose plan, volume implant calculations, over 10

77328 Brachytherapy isodose calculation; complex (multiplane isodose plan, volume implant calculations, over 10 784.80

77328 TC Brachytx isodose plan compl 501.72

77331 Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician

77331 Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician

77331 TC Special radiation dosimetry 67.83

77332 Treatment devices, design and construction; simple (simple block, simple bolus)

77332 Treatment devices, design and construction; simple (simple block, simple bolus)

77332 TC 190.34

77333 Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special

77333 Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special 375.30

77333 TC 75.48

77334 Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, 243.00

77334 Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, 606.60

77334 TC 372.27

77336 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance 249.30

77338 576.91

77338 1,236.29

77338 TC 659.38

77370 Special medical radiation physics consultation

77372 Radiation delivery stereotactic cranial linear 3,063.96

77373 Stereotactic body radiation delivery 5,714.33

77401 Radiation treatment delivery, superficial and/or ortho voltage

77402 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or

77403 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or

77404 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or

77406 Radj dlvr 1 area 1/prll opsd ports smpl 20mev/< 237.77

77407 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area,

77408 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area,

77409 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area,

77411 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area,

77412 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports,

77413 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports,

77414 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports,

77416 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports,

77417 Therapeutic radiology port film(s) 77.40

77418 Ntsty modul dlvr 1/mlt flds/arcs pr tx session 2,378.84

77421 71.58

77421 474.62

77421 TC 403.04

77422 Hi nrg neutron radj tx dlvr 1 tx area 248.82

77423 Hi nrg neutron radj tx dlvr 1/> isocenter 361.47

77427 Radiation treatment management, five treatments

77431 Radiation therapy management with complete course of therapy consisting of one or two fractions only

77432 Stereotactic radiation treatment management of cerebral lesion(s) (complete course of treatment consisting

77435 Stereotactic body radiation management 2,444.40

CPT Mod FEE 77469 Io radiation tx management 801.93

77470 Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral, endocavitary or

77470 Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral, endocavitary or 1,327.50

77470 TC Special radiation treatment 444.04

77600 Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) 334.80

77600 Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less)

77600 TC 557.89

77605 Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)

77605 Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)

77605 TC 769.93

77610 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators

77610 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators

77610 TC 595.82

77615 Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators

77615 Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators

77615 TC 769.26

77620 Hyperthermia generated by intracavitary probe(s)

77620 Hyperthermia generated by intracavitary probe(s)

77620 TC 562.91

77750 Infusion or instillation of radioelement solution

77750 Infusion or instillation of radioelement solution

77750 TC Infuse radioactive materials 321.96

77761 Intracavitary radiation source application; simple 573.30

77761 Intracavitary radiation source application; simple

77761 TC Apply intrcav radiat simple 401.39

77762 Intracavitary radiation source application; intermediate

77762 Intracavitary radiation source application; intermediate

77762 TC Apply intrcav radiat interm 519.25

77763 Intracavitary radiation source application; complex 1,178.10

77763 Intracavitary radiation source application; complex 1,473.30

77763 TC Apply intrcav radiat compl 619.07

77776 Interstitial radiation source application; simple 783.00

77776 Interstitial radiation source application; simple

77776 TC Apply interstit radiat simpl 460.40

77777 Interstitial radiation source application; intermediate 1,178.10

77777 Interstitial radiation source application; intermediate 1,471.50

77777 TC Apply interstit radiat inter 551.41

77778 Interstitial radiation source application; complex 1,817.10

77778 Interstitial radiation source application; complex

77778 TC Apply interstit radiat compl 821.73

77785 175.33

77785 471.94

77785 TC 296.61

77786 401.03

77786 1,393.84

77786 TC 992.82

77787 616.72

77787 2,088.30

77787 TC 1,471.58

77789 Surface application of radiation source 148.50

77789 Surface application of radiation source

77789 TC Apply surface radiation 99.89

77790 Supervision, handling, loading of radiation source

77790 Supervision, handling, loading of radiation source

77790 TC Radiation handling 108.39

78012 24.11

78012 TC 209.83

78012 233.94

78013 46.01

78013 TC 546.50

78013 592.51

78014 62.58

78014 TC 621.78

78014 684.36

78015 Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)

78015 Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)

78015 TC Thyroid met imaging 384.78

78016 Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) 148.50

78016 Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery)

78016 TC Thyroid met imaging/studies 440.64

CPT Mod FEE 78018 Thyroid carcinoma metastases imaging; whole body

78018 Thyroid carcinoma metastases imaging; whole body 668.70

78018 TC Thyroid met imaging body 592.04

78020 Thyroid met uptake 33.33

78020 Thyroid carcinoma metastases uptake (List separately in addition to code for primary procedure)

78020 TC Thyroid met uptake 78.27

78070 Parathyroid imaging 86.40

78070 Parathyroid imaging

78070 TC Parathyroid planar imaging 191.52

78071 147.77

78071 TC 866.92

78071 1,014.69

78075 Adrenal imaging, cortex and/or medulla 98.10

78075 Adrenal imaging, cortex and/or medulla 486.90

78075 TC Adrenal cortex & medulla img 452.51

78102 Bone marrow imaging; limited area 82.80

78102 Bone marrow imaging; limited area

78102 TC Bone marrow imaging ltd 236.36

78103 Bone marrow imaging; multiple areas

78103 Bone marrow imaging; multiple areas

78103 TC Bone marrow imaging mult 349.18

78104 Bone marrow imaging; whole body 150.30

78104 Bone marrow imaging; whole body 501.30

78104 TC Bone marrow imaging body 432.94

78110 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling 43.20

78110 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling

78110 TC Plasma volume single 131.07

78111 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings 61.20

78111 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings

78111 TC Plasma volume multiple 273.53

78120 Red cell volume determination (separate procedure); single sampling 37.80

78120 Red cell volume determination (separate procedure); single sampling 189.90

78120 TC Red cell mass single 169.46

78121 Red cell volume determination (separate procedure); multiple samplings 62.10

78121 Red cell volume determination (separate procedure); multiple samplings

78121 TC Red cell mass multiple 261.23

78122 Whole blood volume determination, including separate measurement of plasma volume and red cell volume 95.40

78122 Whole blood volume determination, including separate measurement of plasma volume and red cell volume

78122 TC Blood volume 389.48

78130

TC 281.51

78135 Red cell survival study; differential organ/tissue kinetics, (eg, splenic and/or hepatic sequestration)

78135 Red cell survival study; differential organ/tissue kinetics, (eg, splenic and/or hepatic sequestration)

78135 TC Red cell survival kinetics 485.50

78140 Labeled red cell sequestration, differential organ/tissue, (eg, splenic and/or hepatic)

78140 Labeled red cell sequestration, differential organ/tissue, (eg, splenic and/or hepatic)

78140 TC Red cell sequestration 349.46

78185 Spleen imaging only, with or without vascular flow 86.40

78185 Spleen imaging only, with or without vascular flow

78185 TC Spleen imaging

78190 Kinetics, study of platelet survival, with or without differential organ/tissue localization 165.60

78190 Kinetics, study of platelet survival, with or without differential organ/tissue localization 661.50

78190 TC Platelet survival kinetics 583.62

78191 Platelet survival study

78191 Platelet survival study

78191 TC Platelet survival 584.92

78195 Lymphatics and lymph glands imaging 155.70

78195 Lymphatics and lymph glands imaging 519.30

78195 TC Lymph system imaging 444.29

78201 Liver imaging; static only

78201 Liver imaging; static only 363.60

78201 TC Liver imaging 326.66

78202 Liver imaging; with vascular flow

78202 Liver imaging; with vascular flow 440.10

78202 TC Liver imaging with flow 396.48

78205 Liver imaging (SPECT);

78205 Liver imaging (SPECT); 810.90

78205 TC Liver imaging (3D) 696.85

78206 Liver image (3d) with flow 71.32

CPT Mod FEE 78206 Liver imaging (SPECT); with vascular flow 603.00

78206 TC Liver image (3d) with flow 531.68

78215 Liver and spleen imaging; static only

78215 Liver and spleen imaging; static only

78215 TC Liver and spleen imaging 409.00

78216 Liver and spleen imaging; with vascular flow

78216 Liver and spleen imaging; with vascular flow

78216 TC Liver & spleen image/flow 398.64

78226 96.68

78226 TC 1,002.03

78226 1,098.72

78227 115.93

78227 TC 1,372.08

78227 1,488.01

78230

TC 303.73

78231 Salivary gland imaging; with serial images 92.70

78231 Salivary gland imaging; with serial images

78231 TC Serial salivary imaging 305.83

78232 Salivary gland function study 94.50

78232 Salivary gland function study 376.20

78232 TC Salivary gland function exam 308.33

78258 Esophageal motility

78258 Esophageal motility 392.40

78258 TC Esophageal motility study 337.65

78261

480.60

78261 TC 423.10

78262 Gastroesophageal reflux study

78262 Gastroesophageal reflux study

78262 TC Gastroesophageal reflux exam 437.00

78264 151.20

78264 504.90

78264 TC 445.17

78270 Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor 34.20

78270 Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor

78270 TC Vit B-12 absorption exam 152.94

78271 Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor 41.40

78271 Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor

78271 TC Vit b-12 absrp exam int fac 184.73

78272 Vitamin B-12 absorption studies combined, with and without intrinsic factor 54.90

78272 Vitamin B-12 absorption studies combined, with and without intrinsic factor

78272 TC Vit b-12 absorp combined 238.14

78278 Acute gastrointestinal blood loss imaging 188.10

78278 Acute gastrointestinal blood loss imaging 626.40

78278 TC Acute GI blood loss imaging 550.16

78290 Bowel imaging (eg, ectopic gastric mucosa, Meckels localization, volvulus)

78290 Bowel imaging (eg, ectopic gastric mucosa, Meckels localization, volvulus)

78290 TC Meckels divert exam 336.84

78291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)

78291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt) 392.40

78291 TC Leveen/shunt patency exam 334.62

78300 Bone and/or joint imaging; limited area

78300 Bone and/or joint imaging; limited area

78300 TC Bone imaging limited area 346.26

78305 Bone and/or joint imaging; multiple areas

78305 Bone and/or joint imaging; multiple areas

78305 TC Bone imaging multiple areas 410.38

78306 Bone and/or joint imaging; whole body

78306 Bone and/or joint imaging; whole body 548.10

78306 TC Bone imaging whole body 468.07

78315 Bone and/or joint imaging; three phase study

78315 Bone and/or joint imaging; three phase study 619.20

78315 TC Bone imaging 3 phase 541.52

78320 Bone and/or joint imaging; tomographic (SPECT)

78320 Bone and/or joint imaging; tomographic (SPECT) 792.90

78320 TC Bone imaging (3D) 639.32

78350 Bone density (bone mineral content) study, one or more sites; single photon absorptiometry 64.80

78350 Bone density (bone mineral content) study, one or more sites; single photon absorptiometry

CPT Mod FEE 78350 TC Bone mineral single photon 150.11

78351 B1 dns std 1+ sits dual phtn absrptm 1+ sits 233.90

78428 Cardiac shunt detection

78428 Cardiac shunt detection 335.70

78428 TC Cardiac shunt imaging 275.68

78445 Non-cardiac vascular flow imaging (ie, angiography, venography)

78445 Non-cardiac vascular flow imaging (ie, angiography, venography)

78445 TC Vascular flow imaging 328.42

78451 169.90

78451 600.93

78451 TC 431.03

78452 196.26

78452 968.65

78452 TC 772.38

78453 121.18

78453 513.38

78453 TC 392.20

78454 161.76

78454 539.02

78454 TC 377.27

78456 129.45

78456 823.92

78456 TC 694.47

78457 Venous thrombosis imaging, venogram; unilateral

78457 Venous thrombosis imaging, venogram; unilateral 342.00

78457 TC Venous thrombosis imaging 286.06

78458 Venous thrombosis imaging, venogram; bilateral

78458 Venous thrombosis imaging, venogram; bilateral

78458 TC Ven thrombosis images bilat 424.77

78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative

78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative 441.00

78466 TC Heart infarct image 371.78

78468 Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique

78468 Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique 477.90

78468 TC Heart infarct image (ef) 395.49

78469 Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification 171.90

78469 Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification 689.40

78469 TC Heart infarct image (3D) 567.89

78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or

78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or 651.60

78472 TC Gated heart planar single

78473 Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at 299.70

78473 Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at 997.20

78473 TC Gated heart multiple 783.46

78481 Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or with stress (exercise

78481 Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or with stress (exercise

78481 TC Heart first pass single 515.31

78483 Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest and with stress (exercise

78483 Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest and with stress (exercise 940.50

78483 TC Heart first pass multiple 695.14

78494 Heart image spect 163.27

78494 Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with 736.20

78494 TC Heart image spect 572.93

78496 Heart first pass add-on 113.47

78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by

78496 TC Heart first pass add-on 116.03

78579 64.63

78579 TC 563.47

78579 628.10

78580 Pulmonary perfusion imaging, particulate

78580 Pulmonary perfusion imaging, particulate

78580 TC Lung perfusion imaging 354.80

78582 138.36

78582 TC 963.43

78582 1,101.79

78597 94.78

78597 TC 589.53

78597 684.31

78598 108.43

78598 TC 916.14

CPT Mod FEE 78598 1,024.57

78600 Brain imaging, limited procedure; static

78600 Brain imaging, limited procedure; static

78600 TC Brain image < 4 views 372.10

78601 Brain imaging, limited procedure; with vascular flow

78601 Brain imaging, limited procedure; with vascular flow 487.80

78601 TC Brain image w/flow < 4 views 438.56

78605 Brain imaging, complete study; static

78605 Brain imaging, complete study; static 491.40

78605 TC Brain image 4+ views 433.91

78606 Brain imaging, complete study; with vascular flow

78606 Brain imaging, complete study; with vascular flow 513.90

78606 TC Brain image w/flow 4 + views 473.22

78607 Brain imaging, complete study; tomographic (SPECT)

78607 Brain imaging, complete study; tomographic (SPECT) 827.10

78607 TC Brain imaging (3D) 708.09

78609 Brn img p+ emij tomog prfuj eval 174.63

78609 Brn img p+ emij tomog prfuj eval 1,322.05

78610 Brain imaging, vascular flow only 73.80

78610 Brain imaging, vascular flow only

78610 TC Brain flow imaging only 228.75

78630 Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography

78630 Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography 636.68

78630 TC Cerebrospinal fluid scan 583.08

78635 Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography

78635 Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography

78635 TC CSF ventriculography 323.78

78645 Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation

78645 Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation

78645 TC CSF shunt evaluation 456.59

78647 Cerebrospinal fluid flow, imaging (not including introduction of material); tomographic (SPECT) 176.40

78647 Cerebrospinal fluid flow, imaging (not including introduction of material); tomographic (SPECT) 878.40

78647 TC Cerebrospinal fluid scan 786.20

78650 CSF leakage detection and localization

78650 CSF leakage detection and localization 671.40

78650 TC CSF leakage imaging 618.78

78660 Radiopharmaceutical dacryocystography

78660 Radiopharmaceutical dacryocystography

78660 TC Nuclear exam of tear flow 305.42

78700 Kidney imaging; static only

78700 Kidney imaging; static only

78700 TC Kidney imaging morphol 398.96

78701 Kidney imaging; with vascular flow

78701 Kidney imaging; with vascular flow

78701 TC Kidney imaging with flow 371.14

78707 Kidney imaging with vascular flow and function; single study without pharmacological intervention

78707 Kidney imaging with vascular flow and function; single study without pharmacological intervention 561.60

78707 TC K flow/funct image w/o drug 463.30

78708 Kidney imaging with vascular flow and function; single study, with pharmacological intervention (eg,

78708 Kidney imaging with vascular flow and function; single study, with pharmacological intervention (eg,

78708 TC K flow/funct image w/drug 412.52

78709 Kidney imaging with vascular flow and function; multiple studies, with and without pharmacological

78709 Kidney imaging with vascular flow and function; multiple studies, with and without pharmacological 617.40

78709 TC K flow/funct image multiple 516.85

78710 Kidney imaging, tomographic (SPECT)

78710 Kidney imaging, tomographic (SPECT) 685.80

78710 TC Kidney imaging (3D) 599.46

78725 Kidney function study, non-imaging radioisotopic study 82.80

78725 Kidney function study, non-imaging radioisotopic study

78725 TC Kidney function study 231.31

78730 Urinary bladder residual study 58.50

78730 Urinary bladder residual study

78730 TC Urinary bladder retention 177.78

78740 Ureteral reflux study (radiopharmaceutical voiding cystogram)

78740 Ureteral reflux study (radiopharmaceutical voiding cystogram)

78740 TC Ureteral reflux study 312.41

78761 Testicular imaging; with vascular flow

78761 Testicular imaging; with vascular flow

78761 TC Testicular imaging w/flow 397.17

78800 Radiopharmaceutical localization of tumor; limited area

CPT Mod FEE 78800 Radiopharmaceutical localization of tumor; limited area

78800 TC Tumor imaging limited area 345.92

78801 Radiopharmaceutical localization of tumor; multiple areas 151.20

78801 Radiopharmaceutical localization of tumor; multiple areas

78801 TC Tumor imaging mult areas 433.88

78802 Radiopharmaceutical localization of tumor; whole body

78802 Radiopharmaceutical localization of tumor; whole body

78802 TC Tumor imaging whole body 567.43

78803 Radiopharmaceutical localization of tumor; tomographic (SPECT)

78803 Radiopharmaceutical localization of tumor; tomographic (SPECT)

78803 TC Tumor imaging (3D) 640.97

78804 185.68

78804 1,723.26

78804 TC 1,537.58

78805 Radiopharmaceutical localization of inflammatory process; limited area

78805 Radiopharmaceutical localization of inflammatory process; limited area

78805 TC Abscess imaging ltd area 354.35

78806 Radiopharmaceutical localization of inflammatory process; whole body

78806 Radiopharmaceutical localization of inflammatory process; whole body

78806 TC Abscess imaging whole body 658.22

78807 Radiopharmaceutical localization of inflammatory process; tomographic (SPECT) 184.50

78807 Radiopharmaceutical localization of inflammatory process; tomographic (SPECT)

78807 TC Nuclear localization/abscess 641.83

78808 Njx rp loclzj non-img probe study intravenous 185.07

79005 396.85

79005 757.99

79005 TC 361.14

79101 424.82

79101 781.38

79101 TC 356.56

79200 Intracavitary radioactive colloid therapy 313.20

79200 Intracavitary radioactive colloid therapy 521.10

79200 TC Nuclear rx intracav admin 199.42

79403 508.30

79403 1,097.46

79403 TC 589.16

79440 Intra-articular radiopharmaceutical therapy 395.10

79440 Intra-articular radiopharmaceutical therapy 658.80

79440 TC Nuclear rx intra-articular 236.36

80047 Metabolic panel ionized ca 40.47

80048 Basic metabolic panel This panel must include the following: Calcium (82310) Carbon dioxide (82374) 35.13

80050 General health panel This panel must include the following: Comprehensive metabolic panel (80053) 92.38

80051 Electrolyte panel This panel must include the following: Carbon dioxide (82374) Chloride (82435) Potassium 32.38

80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total 44.50

80061 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct 59.76

80069 Renal function panel This panel must include the following: Albumin (82040) Calcium (82310) Carbon 35.68

80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody 137.37

80076 Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) 45.97

80102 Drug confirmation, each procedure 98.10

80150 Amikacin 80.10

80152 Amitriptyline 87.30

80154 Benzodiazepines 87.30

80156 Carbamazepine; total 64.80

80157 Assay carbamazepine free 48.78

80158 Cyclosporine 85.06

80160 Desipramine 93.60

80162 Digoxin 45.49

80164 Dipropylacetic acid (valproic acid) 46.96

80166 Doxepin 81.00

80168 Ethosuximide 73.80

80170 Gentamicin 76.50

80172 Gold 86.40

80173 Haloperidol 78.30

80174 Imipramine 87.30

80176 Lidocaine 78.30

80178 Lithium 29.96

80182 Nortriptyline 86.40

80184 Phenobarbital 69.30

80185 Phenytoin; total 62.10

80186 Phenytoin; free 83.70

CPT Mod FEE 80188 Primidone 72.90

80190 Procainamide; 72.90

80192 Procainamide; with metabolites (eg, n-acetyl procainamide) 79.20

80194 Quinidine 73.80

80195 Assay of sirolimus 66.33

80196 Salicylate 50.40

80197 Tacrolimus

80198 Theophylline 61.20

80200 Tobramycin 99.00

80201 Topiramate 69.30

80202 Vancomycin 72.00

80299 Quantitative assay drug 54.77

80400 ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2)

80402 ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533

80406 ACTH stimulation panel; for 3 beta-hydroxydehydrogenase deficiency This panel must include the following:

80500 Clinical pathology consultation; limited, without review of patient's history and medical records 59.40

80502 Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient's

81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, 17.96

81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, 16.53

81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, 15.26

81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, 15.04

81005 Urinalysis; qualitative or semiquantitative, except immunoassays 16.54

81007 Urinalysis; bacteriuria screen, except by culture or dipstick 23.40

81015 Urinalysis; microscopic only 14.05

81020 Urinalysis; two or three glass test 15.82

81025 Urine pregnancy test, by visual color comparison methods 25.64

81050 Volume measurement for timed collection, each 22.50

82000 Acetaldehyde, blood 56.13

82003 Acetaminophen 77.40

82009 Acetone or other ketone bodies, serum; qualitative 27.00

82010 Acetone or other ketone bodies, serum; quantitative 64.80

82013 Acetylcholinesterase 63.00

82016 Acylcarnitines; qualitative, each specimen 84.60

82017 Acylcarnitines; quantitative, each specimen 90.90

82024 Adrenocorticotropic hormone (ACTH)

82030 Adenosine, 5-monophosphate, cyclic (cyclic AMP)

82040 Albumin; serum 19.50

82042 Albumin; urine or other source, quantitative, each specimen 36.00

82043 Albumin; urine, microalbumin, quantitative 64.80

82044 Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay) 23.33

82055 Alcohol (ethanol); any specimen except breath 61.20

82075 Alcohol (ethanol); breath 40.50

82085 Aldolase 50.40

82088 Aldosterone

82101 Alkaloids, urine, quantitative

82103 Alpha-1-antitrypsin; total 65.75

82104 Alpha-1-antitrypsin; phenotype 76.35

82105 Alpha-fetoprotein; serum 60.23

82106 Alpha-fetoprotein; amniotic fluid 63.83

82107 Alpha-fetoprotein l3 84.35

82108 Aluminum

82127 Amino acids; single, qualitative, each specimen 63.90

82128 Amino acids; multiple, qualitative, each specimen 48.60

82131 Amino acids; single, quantitative, each specimen 165.60

82135 Aminolevulinic acid, delta (ALA) 72.00

82136 Amino acids, 2 to 5 amino acids, quantitative, each specimen

82139 Amino acids, 6 or more amino acids, quantitative, each specimen

82140 Ammonia 81.00

82143 Amniotic fluid scan (spectrophotometric) 69.30

82145 Amphetamine or methamphetamine 82.80

82150 Amylase 24.59

82154 Androstanediol glucuronide

82157 Androstenedione

82160 Androsterone 99.31

82163 Angiotensin II

82164 Angiotensin I - converting enzyme (ACE) 76.50

82172 Apolipoprotein, each 77.40

82175 Arsenic 87.30

82180 Ascorbic acid (Vitamin C), blood 54.00

82190 Atomic absorption spectroscopy, each analyte 80.10

CPT Mod FEE 82205 Barbiturates, not elsewhere specified 62.10

82232 Beta-2 microglobulin 74.55

82239 Bile acids; total 78.30

82240 Bile acids; cholylglycine

82247 Bilirubin; total 19.50

82248 Bilirubin; direct 20.85

82252 Bilirubin; feces, qualitative 16.20

82261 Biotinidase, each specimen 65.70

82270 Blood, occult, by peroxidase activity (eg, guaiac); feces, 1-3 simultaneous determinations 15.14

82271 Occult blood other sources 12.71

82272 Occult bld feces 1-3 tests 11.59

82274 Assay test for blood fecal 46.67

82286 Bradykinin

82300 Cadmium 80.10

82306 Calcifediol (25-OH Vitamin D-3)

82308 Calcitonin

82310 Calcium; total 18.83

82330 Calcium; ionized 64.80

82331 Calcium; after calcium infusion test 35.10

82340 Calcium; urine quantitative, timed specimen 41.40

82355 Calculus (stone); qualitative analysis 65.70

82360 Calculus (stone); quantitative analysis, chemical 66.60

82365 Calculus (stone); infrared spectroscopy 66.60

82370 Calculus (stone); x-ray diffraction 63.90

82373 Carbohydrate deficient transferrin 38.70

82374 Carbon dioxide (bicarbonate) 26.10

82375 Carbon monoxide, (carboxyhemoglobin); quantitative 64.80

82376 Carbon monoxide, (carboxyhemoglobin); qualitative 21.60

82378 Carcinoembryonic antigen (CEA) 69.48

82379 Carnitine (total and free), quantitative, each specimen 90.90

82380 Carotene 56.70

82382 Catecholamines; total urine

82383 Catecholamines; blood

82384 Catecholamines; fractionated

82387 Cathepsin-D

82390 Ceruloplasmin 47.50

82397 Chemiluminescent assay 65.70

82415 Chloramphenicol 77.40

82435 Chloride; blood 21.60

82436 Chloride; urine 35.10

82438 Chloride; other source 26.10

82441 Chlorinated hydrocarbons, screen 30.60

82465 Cholesterol, serum or whole blood, total 19.73

82480 Cholinesterase; serum 50.40

82482 Cholinesterase; RBC 63.90

82485 Chondroitin B sulfate, quantitative

82486 Chromatography, qualitative; column (eg, gas liquid or HPLC), analyte not elsewhere specified

82487 Chromatography, qualitative; paper, 1-dimensional, analyte not elsewhere specified 86.40

82488 Chromatography, qualitative; paper, 2-dimensional, analyte not elsewhere specified

82489 Chromatography, qualitative; thin layer, analyte not elsewhere specified 77.40

82491 Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not elsewhere specified, 87.30

82492 Chromatography, quantitative, column (eg, gas liquid or HPLC); multiple analytes, single stationary and 67.10

82495 Chromium

82507 Citrate 150.30

82520 Cocaine or metabolite 82.80

82523 Collagen cross links, any method

82525 Copper 49.36

82528 Corticosterone

82530 Cortisol; free

82533 Cortisol; total 60.16

82540 Creatine 25.45

82541 Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; 82.80

82542 Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; 82.80

82543 Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; 82.80

82544 Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte not elsewhere specified; 82.80

82550 Creatine kinase (CK), (CPK); total 26.93

82552 Creatine kinase (CK), (CPK); isoenzymes 51.61

82553 Creatine kinase (CK), (CPK); MB fraction only 37.86

82554 Creatine kinase (CK), (CPK); isoforms 55.80

82565 Creatinine; blood 20.63

CPT Mod FEE 82570 Creatinine; other source 30.60

82575 Creatinine; clearance 39.21

82585 Cryofibrinogen 36.00

82595 Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit) 36.90

82600 Cyanide 77.40

82607 Cyanocobalamin (Vitamin B-12); 58.36

82608 Cyanocobalamin (Vitamin B-12); unsaturated binding capacity 76.50

82615 Cystine and homocystine, urine, qualitative 52.20

82626 Dehydroepiandrosterone (DHEA)

82627 Dehydroepiandrosterone-sulfate (DHEA-S)

82633 Desoxycorticosterone, 11-

82634 Deoxycortisol, 11-

82638 Dibucaine number 48.60

82646 Dihydrocodeinone 94.50

82649 Dihydromorphinone 99.00

82651 Dihydrotestosterone (DHT)

82652 Dihydroxyvitamin D, 1,25-

82654 Dimethadione 91.80

82658 Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each 82.80

82664 Electrophoretic technique, not elsewhere specified

82666 Epiandrosterone 99.00

82668 Erythropoietin 87.86

82670 Estradiol 75.69

82671 Estrogens; fractionated 118.17

82672 Estrogens; total 94.88

82677 Estriol 75.19

82679 Estrone

82690 Ethchlorvynol 92.70

82693 Ethylene glycol 80.10

82696 Etiocholanolone

82705 Fat or lipids, feces; qualitative 34.20

82710 Fat or lipids, feces; quantitative

82715 Fat differential, feces, quantitative 64.80

82725 Fatty acids, nonesterified 61.20

82728 Ferritin 53.27

82731 Assay of fetal fibronectin 106.77

82735 Fluoride 86.40

82742 Flurazepam 90.90

82746 Folic acid; serum 60.53

82747 Folic acid; RBC 88.20

82757 Fructose, semen 47.70

82759 Galactokinase, RBC 54.00

82760 Galactose 54.00

82775 Galactose-1-phosphate uridyl transferase; quantitative 71.10

82776 Galactose-1-phosphate uridyl transferase; screen 27.00

82784 Gammaglobulin; IgA, IgD, IgG, IgM, each 61.20

82785 Gammaglobulin; IgE 67.09

82787 Gammaglobulin; immunoglobulin subclasses, (IgG1, 2, 3, or 4), each

82800 Gases, blood, pH only 38.70

82803 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); 80.10

82805 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 90.90

82810 Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry 47.70

82820 Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen) 62.10

82930 Gastric analy w/ph ea spec 21.15

82938 Gastrin after secretin stimulation 86.40

82941 Gastrin 80.10

82943 Glucagon 94.50

82945 Glucose, body fluid, other than blood 35.14

82946 Glucagon tolerance test 59.40

82947 Glucose; quantitative, blood (except reagent strip) 16.94

82948 Glucose; blood, reagent strip 13.86

82950 Glucose; post glucose dose (includes glucose) 26.45

82951 Glucose; tolerance test (GTT), three specimens (includes glucose) 54.62

82952 Glucose; tolerance test, each additional beyond three specimens 27.36

82953 Glucose; tolbutamide tolerance test 72.90

82955 Glucose-6-phosphate dehydrogenase (G6PD); quantitative 71.10

82960 Glucose-6-phosphate dehydrogenase (G6PD); screen 28.63

82962 Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use 17.01

82963 Glucosidase, beta 82.80

82965 Glutamate dehydrogenase 28.80

CPT Mod FEE 82975 Glutamine (glutamic acid amide) 59.40

82977 Glutamyltransferase, gamma (GGT) 22.79

82978 Glutathione 59.40

82979 Glutathione reductase, RBC 46.80

82980 Glutethimide 84.60

82985 Glycated protein 40.90

83001 Gonadotropin; follicle stimulating hormone (FSH) 67.52

83002 Gonadotropin; luteinizing hormone (LH) 69.32

83003 Growth hormone, human (HGH) (somatotropin) 90.00

83008 Guanosine monophosphate (GMP), cyclic 90.90

83010 Haptoglobin; quantitative 71.10

83012 Haptoglobin; phenotypes 82.80

83015 Heavy metal (arsenic, barium, beryllium, bismuth, antimony, mercury); screen

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

83020 Hemoglobin electrophoresis 48.11

83020 Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 56.48

83021 Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F) 69.91

83026 Hemoglobin; by copper sulfate method, non-automated 14.40

83030 Hemoglobin; F (fetal), chemical 45.00

83033 Hemoglobin; F (fetal), qualitative 27.00

83036 Hemoglobin; glycated 38.57

83037 Glycosylated hb home device 36.80

83045 Hemoglobin; methemoglobin, qualitative 22.50

83050 Hemoglobin; methemoglobin, quantitative 27.90

83051 Hemoglobin; plasma 33.30

83055 Hemoglobin; sulfhemoglobin, qualitative 27.00

83060 Hemoglobin; sulfhemoglobin, quantitative 43.20

83065 Hemoglobin; thermolabile 37.80

83068 Hemoglobin; unstable, screen 38.70

83069 Hemoglobin; urine 22.50

83070 Hemosiderin; qualitative 26.10

83071 Hemosiderin; quantitative 30.60

83080 b-Hexosaminidase, each assay 65.70

83088 Histamine

83090 Homocystine 78.30

83150 Homovanillic acid (HVA) 90.90

83491 Hydroxycorticosteroids, 17- (17-OHCS) 90.00

83497 Hydroxyindolacetic acid, 5-(HIAA) 72.90

83498 Hydroxyprogesterone, 17-d

83499 Hydroxyprogesterone, 20-

83500 Hydroxyproline; free 98.10

83505 Hydroxyproline; total

83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or 54.24

83518 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or 77.40

83519 Immunoassay, analyte, quantitative; by radiopharmaceutical technique (eg, RIA) 85.50

83520 Immunoassay, analyte, quantitative; not otherwise specified 72.72

83525 Insulin; total 66.60

83527 Insulin; free 70.20

83528 Intrinsic factor 86.40

83540 Iron 23.16

83550 Iron binding capacity 33.38

83570 Isocitric dehydrogenase (IDH) 47.70

83582 Ketogenic steroids, fractionation 76.50

83586 Ketosteroids, 17- (17-KS); total 79.20

83593 Ketosteroids, 17- (17-KS); fractionation

83605 Lactate (lactic acid) 49.50

83615 Lactate dehydrogenase (LD), (LDH); 20.46

83625 Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation 71.10

83630 Lactoferrin fecal (qual) 57.08

83631 Lactoferrin fecal (quant) 57.08

83632 Lactogen, human placental (HPL) human chorionic somatomammotropin

83633 Lactose, urine; qualitative 33.30

83634 Lactose, urine; quantitative 50.40

83655 Lead 51.30

83661 Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio

83662 Fetal lung maturity assessment; foam stability test 72.00

83663 Fetal lung maturity assessment; fluorescence polarization 43.20

83664 Fetal lung maturity assessment; lamellar body density 24.30

83670 Leucine aminopeptidase (LAP) 43.20

83690 Lipase 38.70

CPT Mod FEE 83695 Assay of lipoprotein(a) 42.74

83698 Assay lipoprotein pla2 71.98

83700 Lipopro bld electrophoretic 54.59

83701 Lipoprotein bld hr fraction 78.62

83704 Lipoprotein bld by nmr 89.82

83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) 29.28

83719 Lipoprotein, direct measurement; direct measurement, VLDL cholesterol 47.70

83721 Lipoprotein, direct measurement; direct measurement, LDL cholesterol 36.90

83727 Luteinizing releasing factor (LRH) 92.70

83735 Magnesium 25.04

83775 Malate dehydrogenase 38.70

83785 Manganese

83788 Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; 82.80

83789 Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; 82.80

83805 Meprobamate 82.80

83825 Mercury, quantitative 90.00

83835 Metanephrines

83840 Methadone 87.30

83857 Methemalbumin 57.60

83858 Methsuximide 91.80

83864 Mucopolysaccharides, acid; quantitative 40.61

83866 Mucopolysaccharides, acid; screen 38.70

83872 Mucin, synovial fluid (Ropes test) 27.00

83873 Myelin basic protein, CSF 94.50

83874 Myoglobin 58.45

83876 Assay myeloperoxidase 70.01

83880 Assay of natriuretic peptide 74.87

83883 Nephelometry, each analyte not elsewhere specified 62.10

83885 Nickel 98.10

83887 Nicotine 90.90

83915 Nucleotidase 5- 45.00

83916 Oligoclonal immunoglobulin (oligoclonal bands) 93.60

83918 Organic acids; total, quantitative, each specimen 92.70

83919 Organic acids qual each 56.54

83921 Organic acid single quant 51.15

83925 Opiates, (eg, morphine, meperidine) 66.60

83930 Osmolality; blood 42.30

83935 Osmolality; urine 58.50

83937 Osteocalcin (bone g1a protein)

83945 Oxalate 72.90

83950 Oncoprotein her-2/neu 203.90

83951 Oncoprotein dcp 203.90

83970 Parathormone (parathyroid hormone)

83986 pH, body fluid, except blood 20.70

83987 Exhaled breath condensate 18.52

83992 Phencyclidine (PCP) 72.00

83993 Assay for calprotectin fecal 67.79

84022 Phenothiazine 68.40

84030 Phenylalanine (PKU), blood 19.19

84035 Phenylketones, qualitative 20.70

84060 Phosphatase, acid; total 41.57

84061 Phosphatase, acid; forensic examination 43.20

84066 Phosphatase, acid; prostatic 57.60

84075 Phosphatase, alkaline; 19.20

84078 Phosphatase, alkaline; heat stable (total not included) 46.80

84080 Phosphatase, alkaline; isoenzymes 77.40

84081 Phosphatidylglycerol 95.40

84085 Phosphogluconate, 6-, dehydrogenase, RBC 38.70

84087 Phosphohexose isomerase 47.70

84100 Phosphorus inorganic (phosphate); 17.40

84105 Phosphorus inorganic (phosphate); urine 31.50

84106 Porphobilinogen, urine; qualitative 33.30

84110 Porphobilinogen, urine; quantitative 48.60

84112 Placenta alpha micro ig c/v 62.66

84119 Porphyrins, urine; qualitative 44.10

84120 Porphyrins, urine; quantitation and fractionation 78.30

84126 Porphyrins, feces; quantitative 78.30

84127 Porphyrins, feces; qualitative 45.00

84132 Potassium; serum 18.75

84133 Potassium; urine 36.00

CPT Mod FEE 84134 Prealbumin 55.80

84135 Pregnanediol 88.20

84138 Pregnanetriol 86.40

84140 Pregnenolone 94.50

84143 17-hydroxypregnenolone 78.97

84144 Progesterone 66.04

84146 Prolactin 65.14

84150 Prostaglandin, each 97.20

84152 Prostate specific antigen (PSA); complexed (direct measurement) 64.24

84153 Prostate specific antigen (PSA); total 58.72

84154 Prostate specific antigen (PSA); free 84.60

84155 Protein; total, except refractometry 21.00

84156 Assay of protein urine 16.88

84157 Assay of protein other 15.80

84160 Protein; refractometric 17.10

84165 Protein; electrophoretic fractionation and quantitation 47.29

84166 Protein e-phoresis/urine/csf 48.11

84166 Protein e-phoresis/urine/csf 49.66

84181 Western blot test 48.11

84181 Protein; Western Blot, with interpretation and report, blood or other body fluid 91.80

84182 Protein western blot test 43.78

84182 Protein; Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band

84202 Protoporphyrin, RBC; quantitative 71.10

84203 Protoporphyrin, RBC; screen 27.90

84206 Proinsulin 97.20

84207 Pyridoxal phosphate (Vitamin B-6)

84210 Pyruvate 66.60

84220 Pyruvate kinase 57.60

84228 Quinine 63.90

84233 Receptor assay; estrogen

84234 Receptor assay; progesterone

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

84238 Receptor assay; non-endocrine (eg, acetylcholine) (specify receptor)

84244 Renin

84252 Riboflavin (Vitamin B-2) 82.80

84255 Selenium 87.30

84260 Serotonin

84270 Sex hormone binding globulin (SHBG)

84275 Sialic acid 78.30

84285 Silica

84295 Sodium; serum 24.30

84300 Sodium; urine 24.30

84302 Assay of sweat sodium 17.46

84305 Somatomedin

84307 Somatostatin 99.00

84311 Spectrophotometry, analyte not elsewhere specified 36.90

84315 Specific gravity (except urine) 14.40

84375 Sugars, chromatographic, TLC or paper chromatography 49.50

84402 Testosterone; free 101.52

84403 Testosterone; total 79.82

84425 Thiamine (Vitamin B-1)

84430 Thiocyanate 66.60

84432 Thyroglobulin

84436 Thyroxine; total 26.37

84437 Thyroxine; requiring elution (eg, neonatal) 35.10

84439 Thyroxine; free 45.91

84442 Thyroxine binding globulin (TBG) 65.70

84443 Thyroid stimulating hormone (TSH) 61.92

84445 Thyroid stimulating immunoglobulins (TSI)

84446 Tocopherol alpha (Vitamin E) 66.60

84449 Transcortin (cortisol binding globulin) 82.80

84450 Transferase; aspartate amino (AST) (SGOT) 21.04

84460 Transferase; alanine amino (ALT) (SGPT) 22.42

84466 Transferrin 43.98

84478 Triglycerides 20.19

84479 Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) 31.94

84480 Triiodothyronine T3; total (TT-3) 57.98

84481 Triiodothyronine T3; free 75.47

84482 Triiodothyronine T3; reverse 78.73

84485 Trypsin; duodenal fluid 36.00

CPT Mod FEE 84488 Trypsin; feces, qualitative 28.80

84490 Trypsin; feces, quantitative, 24-hour collection 24.30

84510 Tyrosine 44.10

84520 Urea nitrogen; quantitative 20.19

84525 Urea nitrogen; semiquantitative (eg, reagent strip test) 13.59

84540 Urea nitrogen, urine 25.89

84545 Urea nitrogen, clearance 36.00

84550 Uric acid; blood 20.19

84560 Uric acid; other source 33.30

84577 Urobilinogen, feces, quantitative 57.60

84578 Urobilinogen, urine; qualitative 15.30

84580 Urobilinogen, urine; quantitative, timed specimen 36.00

84583 Urobilinogen, urine; semiquantitative 17.10

84585 Vanillylmandelic acid (VMA), urine 69.30

84586 Assay of vip 112.57

84588 Vasopressin (antidiuretic hormone, ADH)

84590 Vitamin A 83.70

84591 Vitamin, not otherwise specified 62.10

84597 Vitamin K 87.30

84600 Volatiles (eg, acetic anhydride, carbon tetrachloride, dichloroethane, dichloromethane, diethylether, 57.60

84620 Xylose absorption test, blood and/or urine 68.40

84630 Zinc 59.40

84681 C-peptide 99.00

84702 Gonadotropin, chorionic (hCG); quantitative 60.68

84703 Gonadotropin, chorionic (hCG); qualitative 31.99

84704 Hcg free betachain test 54.40

84830 Ovulation tests, by visual color comparison methods for human luteinizing hormone 54.00

85002 Bleeding time 25.61

85004 Automated diff wbc count 18.87

85007 Blood count; manual differential WBC count (includes RBC morphology and platelet estimation) 17.85

85008 Blood count; manual blood smear examination without differential parameters 15.30

85009 Blood count; differential WBC count, buffy coat 20.70

85013 Blood count; spun microhematocrit 15.30

85014 Blood count; other than spun hematocrit 15.30

85018 Blood count; hemoglobin 14.24

85025 Blood count; hemogram and platelet count, automated, and automated complete differential WBC count 26.32

85027 Blood count; hemogram and platelet count, automated 24.27

85032 Manual cell count each 19.02

85041 Blood count; red blood cell (RBC) only 14.83

85044 Blood count; reticulocyte count, manual 20.74

85045 Blood count; reticulocyte count, flow cytometry 20.68

85048 Blood count; white blood cell (WBC) 18.90

85049 Automated platelet count 16.68

85060 Blood smear, peripheral, interpretation by physician with written report 56.70

85097 Bone marrow; smear interpretation only, with or without differential cell count

85130 Chromogenic substrate assay 55.80

85170 Clot retraction 22.50

85175 Clot lysis time, whole blood dilution 36.00

85210 Clotting; factor II, prothrombin, specific 54.00

85220 Clotting; factor V (AcG or proaccelerin), labile factor

85230 Clotting; factor VII (proconvertin, stable factor)

85240 Clotting; factor VIII (AHG), one stage

85244 Clotting; factor VIII related antigen

85245 Clotting; factor VIII, VW factor, ristocetin cofactor

85246 Clotting; factor VIII, VW factor antigen

85247 Clotting; factor VIII, von Willebrand factor, multimetric analysis

85250 Clotting; factor IX (PTC or Christmas)

85260 Clotting; factor X (Stuart-Prower) 97.20

85270 Clotting; factor XI (PTA) 97.20

85280 Clotting; factor XII (Hageman) 97.20

85290 Clotting; factor XIII (fibrin stabilizing)

85291 Clotting; factor XIII (fibrin stabilizing), screen solubility 56.70

85292 Clotting; prekallikrein assay (Fletcher factor assay)

85293 Clotting; high molecular weight kininogen assay (Fitzgerald factor assay)

85300 Clotting inhibitors or anticoagulants; antithrombin III, activity 62.80

85301 Clotting inhibitors or anticoagulants; antithrombin III, antigen assay 55.24

85302 Clotting inhibitors or anticoagulants; protein C, antigen

85303 Clotting inhibitors or anticoagulants; protein C, activity 72.77

85305 Clotting inhibitors or anticoagulants; protein S, total

85306 Clotting inhibitors or anticoagulants; protein S, free 76.81

CPT Mod FEE 85307 Activated Protein C (APC) resistance assay

85335 Factor inhibitor test 59.40

85337 Thrombomodulin 55.80

85345 Coagulation time; Lee and White 13.93

85347 Coagulation time; activated 21.60

85348 Coagulation time; other methods 28.80

85360 Euglobulin lysis 46.80

85362 Fibrin(ogen) degradation (split) products (FDP)(FSP); agglutination slide, semiquantitative 42.30

85366 Fibrin(ogen) degradation (split) products (FDP)(FSP); paracoagulation 47.70

85370 Fibrin(ogen) degradation (split) products (FDP)(FSP); quantitative 62.10

85378 Fibrin degradation products, D-dimer; semiquantitative 27.67

85379 Fibrin degradation products, D-dimer; quantitative 56.70

85380 Fibrin degradj d-dimer 52.91

85384 Fibrinogen; activity 44.10

85385 Fibrinogen; antigen 45.00

85390 Fibrinolysins or coagulopathy screen, interpretation and report 46.80

85396 Coagj/fbrnlys assay whl bld use additive pr d 41.59

85397 Clotting funct activity 65.98

85400 Fibrinolytic factors and inhibitors; plasmin 47.70

85410 Fibrinolytic factors and inhibitors; alpha-2 antiplasmin 47.70

85415 Fibrinolytic factors and inhibitors; plasminogen activator 65.70

85420 Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay 51.30

85421 Fibrinolytic factors and inhibitors; plasminogen, antigenic assay 98.10

85441 Heinz bodies; direct 15.30

85445 Heinz bodies; induced, acetyl phenylhydrazine 28.80

85460 Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke) 41.40

85461 Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette 44.10

85475 Hemolysin, acid 55.80

85520 Heparin assay 70.20

85525 Heparin neutralization 63.90

85530 Heparin-protamine tolerance test 76.50

85536 Iron stain, peripheral blood 38.70

85540 Leukocyte alkaline phosphatase with count 50.40

85547 Mechanical fragility, RBC 48.60

85549 Muramidase 92.70

85555 Osmotic fragility, RBC; unincubated 44.10

85557 Osmotic fragility, RBC; incubated 83.70

85576 Blood platelet aggregation 33.67

85576 Platelet; aggregation (in vitro), each agent 82.80

85597 Platelet neutralization 72.00

85598 Hexagnal phosph pltlt neutrl 66.30

85610 Prothrombin time; 16.09

85611 Prothrombin time; substitution, plasma fractions, each 26.10

85612 Russell viper venom time (includes venom); undiluted 47.70

85613 Russell viper venom time (includes venom); diluted 56.70

85635 Reptilase test 45.00

85651 Sedimentation rate, erythrocyte; non-automated 14.60

85652 Sedimentation rate, erythrocyte; automated 13.25

85660 Sickling of RBC, reduction 16.80

85670 Thrombin time; plasma 36.00

85675 Thrombin time; titer 36.00

85705 Thromboplastin inhibition; tissue 64.80

85730 Thromboplastin time, partial (PTT); plasma or whole blood 20.30

85732 Thromboplastin time, partial (PTT); substitution, plasma fractions, each 34.20

85810 Viscosity 46.80

86000 Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub 59.40

86001 Allergen specific IgG quantitative or semiquantitative, each allergen 18.90

86003 Allergen specific IgE; quantitative or semiquantitative, each allergen 18.39

86005 Allergen specific IgE; qualitative, multiallergen screen (dipstick, paddle or disk) 46.80

86021 Antibody identification; leukocyte antibodies

86022 Antibody identification; platelet antibodies

86023 Antibody identification; platelet associated immunoglobulin assay 84.60

86038 Antinuclear antibodies (ANA); 46.54

86039 Antinuclear antibodies (ANA); titer 65.70

86060 Antistreptolysin 0; titer 30.28

86063 Antistreptolysin 0; screen 26.20

86077 Blood bank physician services; difficult cross match and/or evaluation of irregular antibody(s), interpretation

86078 Blood bank physician services; investigation of transfusion reaction including suspicion of transmissible

86079 Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use

86140 C-reactive protein 26.20

CPT Mod FEE 86141 C-reactive protein hs 39.84

86146 Beta 2 Glycoprotein I antibody, each

86147 Cardiolipin (phospholipid) antibody, each Ig class 93.97

86155 Chemotaxis assay, specify method 51.30

86156 Cold agglutinin; screen 31.50

86157 Cold agglutinin; titer 36.90

86160 Complement; antigen, each component 59.64

86161 Complement; functional activity, each component 59.64

86162 Complement; total hemolytic (CH50)

86171 Complement fixation tests, each antigen 79.20

86185 Counterimmunoelectrophoresis, each antigen 49.50

86200 Ccp antibody 60.48

86215 Deoxyribonuclease, antibody 66.60

86225 Deoxyribonucleic acid (DNA) antibody; native or double stranded 59.18

86226 Deoxyribonucleic acid (DNA) antibody; single stranded 66.60

86235 Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each 65.00

86243 Fc receptor 90.00

86255 Fluorescent antibody screen 30.55

86255 Fluorescent noninfectious agent antibody; screen, each antibody 50.59

86256 Fluorescent antibody titer 28.02

86256 Fluorescent noninfectious agent antibody; titer, each antibody 79.20

86277 Growth hormone, human (HGH), antibody 72.00

86280 Hemagglutination inhibition test (HAI) 49.50

86294 Immunoassay tumor qual 125.22

86300 Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29) 73.32

86301 Immunoassay for tumor antigen, quantitative; CA 19-9 97.20

86304 Immunoassay for tumor antigen, quantitative; CA 125 73.32

86308 Heterophile antibodies; screening 21.58

86309 Heterophile antibodies; titer 42.30

86310 Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney 42.30

86316 Immunoassay for tumor antigen; other antigen, quantitative (eg, CA 50, 72-4, 549), each 71.97

86317 Immunoassay for infectious agent antibody, quantitative, not otherwise specified 78.30

86318 Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent 53.71

86320 Serum immunoelectrophoresis 43.05

86320 Immunoelectrophoresis; serum 89.34

86325 Other immunoelectrophoresis 35.94

86325 Immunoelectrophoresis; other fluids (eg, urine, CSF) with concentration

86327 Immunoelectrophoresis assay 30.11

86327 Immunoelectrophoresis; crossed (2-dimensional assay) 86.40

86329 Immunodiffusion; not elsewhere specified 72.00

86331 Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody 60.09

86332 Immune complex assay

86334 Immunofix e-phoresis serum 31.14

86334 Immunofixation electrophoresis 80.56

86335 Immunfix e-phorsis/urine/csf 31.24

86335 Immunfix e-phorsis/urine/csf 141.90

86336 Inhibin A 123.77

86337 Insulin antibodies 86.64

86340 Intrinsic factor antibodies 80.10

86341 Islet cell antibody 66.60

86343 Leukocyte histamine release test (LHR) 68.40

86344 Leukocyte phagocytosis 43.20

86353 Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis

86355 B cells total count 145.98

86356 Mononuclear cell antigen 131.19

86357 Nk cells total count 160.16

86359 T cells; total count

86360 T cell absolute count/ratio 164.67

86361 T cells; absolute CD4 count

86367 Stem cells total count 167.25

86376 Microsomal antibodies (eg, thyroid or liver-kidney), each 88.20

86378 Migration inhibitory factor test (MIF) 90.90

86382 Neutralization test, viral 90.90

86384 Nitroblue tetrazolium dye test (NTD) 54.00

86403 Particle agglutination; screen, each antibody 32.04

86406 Particle agglutination; titer, each antibody 38.70

86430 Rheumatoid factor; qualitative 33.77

86431 Rheumatoid factor; quantitative 37.80

86480 Tb test cell immun measure 78.05

86481 Tb ag response t-cell susp 78.05

CPT Mod FEE 86485 Skin test; candida 26.10

86486 Skin test unlisted antigen each 15.85

86490 Skin test; coccidioidomycosis 29.70

86510 Skin test; histoplasmosis 27.90

86580 Skin test; tuberculosis, intradermal 20.70

86590 Streptokinase, antibody 34.20

86592 Syphilis test; qualitative (eg, VDRL, RPR, ART) 25.81

86593 Syphilis test; quantitative 27.58

86602 Antibody; actinomyces 59.40

86603 Antibody; adenovirus 57.87

86606 Antibody; Aspergillus 79.20

86609 Antibody; bacterium, not elsewhere specified

86611 Antibody; Bartonella 55.80

86612 Antibody; Blastomyces 70.20

86615 Antibody; Bordetella 67.95

86617 Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western blot or immunoblot)

86618 Antibody; Borrelia burgdorferi (Lyme disease) 98.10

86619 Antibody; Borrelia (relapsing fever) 72.90

86622 Antibody; Brucella 44.10

86625 Antibody; Campylobacter 92.70

86628 Antibody; Candida 82.80

86631 Antibody; Chlamydia 55.53

86632 Antibody; Chlamydia, IgM 66.60

86635 Antibody; Coccidioides 80.10

86638 Antibody; Coxiella Brunetii (Q fever) 73.80

86641 Antibody; Cryptococcus 56.70

86644 Antibody; cytomegalovirus (CMV) 71.11

86645 Antibody; cytomegalovirus (CMV), IgM 73.90

86648 Antibody; Diphtheria 82.80

86651 Antibody; encephalitis, California (La Crosse) 70.20

86652 Antibody; encephalitis, Eastern equine 70.20

86653 Antibody; encephalitis, St. Louis 70.20

86654 Antibody; encephalitis, Western equine 70.20

86658 Antibody; enterovirus (eg, coxsackie, echo, polio) 90.90

86663 Antibody; Epstein-Barr (EB) virus, early antigen (EA) 77.18

86664 Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) 82.80

86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) 87.30

86666 Antibody; Ehrlichia 55.80

86668 Antibody; Francisella Tularensis 52.20

86671 Antibody; fungus, not elsewhere specified 94.50

86674 Antibody; Giardia Lamblia 75.60

86677 Antibody; Helicobacter pylori 80.08

86682 Antibody; helminth, not elsewhere specified 94.50

86684 Antibody; Hemophilus influenza 84.60

86687 Antibody; HTLV-I 58.77

86688 Antibody; HTLV-II 54.50

86689 Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) 93.92

86692 Antibody; hepatitis, delta agent 91.80

86694 Antibody; herpes simplex, non-specific type test 70.00

86695 Antibody; herpes simplex, type I 69.55

86696 Antibody; herpes simplex, type 2 68.65

86698 Antibody; histoplasma 71.10

86701 Antibody; HIV-1 58.12