| Procedure |
Short Descriptor |
Unadjusted Fee Schedule |
Payment Indicator |
Subject to the Multiple Procedure Discount |
| 0095T |
Rmvl artific disc addl crvcl
|
$XXX.XX
|
N1
|
N
|
| 0098T |
Rev artific disc addl
|
$XXX.XX
|
N1
|
N
|
| 0101T |
Esw muscskel sys nos
|
$XXX.XX
|
R2
|
Y
|
| 0102T |
Esw phy anes lat hmrl epcndl
|
$XXX.XX
|
G2
|
Y
|
| 0164T |
Remove lumb artif disc addl
|
$XXX.XX
|
N1
|
N
|
| 0165T |
Revise lumb artif disc addl
|
$XXX.XX
|
N1
|
N
|
| 0184T |
Exc rectal tumor endoscopic
|
$XXX.XX
|
G2
|
Y
|
| 0200T |
Perq sacral augmt unilat inj
|
$XXX.XX
|
J8
|
Y
|
| 0201T |
Perq sacral augmt bilat inj
|
$XXX.XX
|
G2
|
Y
|
| 0202T |
Post vert arthrplst 1 lumbar
|
$XXX.XX
|
J8
|
Y
|
| 0213T |
Njx paravert w/us cer/thor
|
$XXX.XX
|
R2
|
Y
|
| 0214T |
Njx paravert w/us cer/thor
|
$XXX.XX
|
N1
|
N
|
| 0215T |
Njx paravert w/us cer/thor
|
$XXX.XX
|
N1
|
N
|
| 0216T |
Njx paravert w/us lumb/sac
|
$XXX.XX
|
R2
|
Y
|
| 0217T |
Njx paravert w/us lumb/sac
|
$XXX.XX
|
N1
|
N
|
| 0218T |
Njx paravert w/us lumb/sac
|
$XXX.XX
|
N1
|
N
|
| 0219T |
Plmt post facet implt cerv
|
$XXX.XX
|
J8
|
Y
|
| 0220T |
Plmt post facet implt thor
|
$XXX.XX
|
J8
|
Y
|
| 0221T |
Plmt post facet implt lumb
|
$XXX.XX
|
J8
|
Y
|
| 0222T |
Plmt post facet implt addl
|
$XXX.XX
|
N1
|
N
|
| 0232T |
Njx platelet plasma
|
$XXX.XX
|
N1
|
N
|
| 0238T |
Trluml perip athrc iliac art
|
$XXX.XX
|
J8
|
Y
|
| 0253T |
Insert aqueous drain device
|
$XXX.XX
|
J8
|
Y
|
| 0263T |
Im b1 mrw cel ther cmpl
|
$XXX.XX
|
G2
|
N
|
| 0264T |
Im b1 mrw cel ther xcl hrvst
|
$XXX.XX
|
G2
|
N
|
| 0265T |
Im b1 mrw cel ther hrvst onl
|
$XXX.XX
|
G2
|
N
|
| 0266T |
Implt/rpl crtd sns dev total
|
$XXX.XX
|
D5
|
N
|
| 0267T |
Implt/rpl crtd sns dev lead
|
$XXX.XX
|
D5
|
N
|
| 0268T |
Implt/rpl crtd sns dev gen
|
$XXX.XX
|
D5
|
N
|
| 0269T |
Rev/remvl crtd sns dev total
|
$XXX.XX
|
D5
|
N
|
| 0270T |
Rev/remvl crtd sns dev lead
|
$XXX.XX
|
D5
|
N
|
| 0271T |
Rev/remvl crtd sns dev gen
|
$XXX.XX
|
D5
|
N
|
| 0274T |
Prq lamot/lam dcmpr crv/thrc
|
$XXX.XX
|
G2
|
Y
|
| 0275T |
Perq lamot/lam lumbar
|
$XXX.XX
|
D5
|
N
|
| 0278T |
Tempr
|
$XXX.XX
|
N1
|
N
|
| 0308T |
Insj ocular telescope prosth
|
$XXX.XX
|
J8
|
Y
|
| 0330T |
Tear film img uni/bi w/i&r
|
$XXX.XX
|
N1
|
N
|
| 0335T |
Insj sinus tarsi implant
|
$XXX.XX
|
J8
|
Y
|
| 0338T |
Trnscth renal symp denrv unl
|
$XXX.XX
|
J8
|
N
|
| 0339T |
Trnscth renal symp denrv bil
|
$XXX.XX
|
J8
|
N
|
| 0342T |
Thxp apheresis w/hdl delip
|
$XXX.XX
|
G2
|
N
|
| 0347T |
Ins bone device for rsa
|
$XXX.XX
|
N1
|
N
|
| 0348T |
Rsa spine exam
|
$XXX.XX
|
N1
|
N
|
| 0349T |
Rsa upper extr exam
|
$XXX.XX
|
N1
|
N
|
| 0350T |
Rsa lower extr exam
|
$XXX.XX
|
N1
|
N
|
| 0351T |
Intraop oct brst/node spec
|
$XXX.XX
|
N1
|
N
|
| 0353T |
Intraop oct breast cavity
|
$XXX.XX
|
N1
|
N
|
| 0379T |
Vis field assmnt tech suppt
|
$XXX.XX
|
N1
|
N
|
| 0397T |
Ercp w/optical endomicroscpy
|
$XXX.XX
|
N1
|
N
|
| 0402T |
Colgn crs-link crn&pachymtry
|
$XXX.XX
|
R2
|
Y
|
| 0408T |
Insj/rplc cardiac modulj sys
|
$XXX.XX
|
J8
|
Y
|
| 0409T |
Insj/rplc car modulj pls gn
|
$XXX.XX
|
J8
|
Y
|
| 0410T |
Insj/rplc car modulj atr elt
|
$XXX.XX
|
J8
|
Y
|
| 0411T |
Insj/rplc car modulj vnt elt
|
$XXX.XX
|
J8
|
Y
|
| 0412T |
Rmvl cardiac modulj pls gen
|
$XXX.XX
|
G2
|
N
|
| 0413T |
Rmvl car modulj tranvns elt
|
$XXX.XX
|
G2
|
N
|
| 0414T |
Rmvl & rpl car modulj pls gn
|
$XXX.XX
|
J8
|
Y
|
| 0415T |
Repos car modulj tranvns elt
|
$XXX.XX
|
G2
|
Y
|
| 0416T |
Reloc skin pocket pls gen
|
$XXX.XX
|
G2
|
Y
|
| 0419T |
Dstrj neurofibroma xtnsv
|
$XXX.XX
|
R2
|
Y
|
| 0420T |
Dstrj neurofibroma xtnsv
|
$XXX.XX
|
R2
|
Y
|
| 0421T |
Waterjet prostate abltj cmpl
|
$XXX.XX
|
D5
|
N
|
| 0437T |
Impltj synth rnfcmt abdl wal
|
$XXX.XX
|
N1
|
N
|
| 0439T |
Myocrd contrast prfuj echo
|
$XXX.XX
|
N1
|
N
|
| 0440T |
Abltj perc uxtr/perph nrv
|
$XXX.XX
|
J8
|
Y
|
| 0441T |
Abltj perc lxtr/perph nrv
|
$XXX.XX
|
J8
|
Y
|
| 0442T |
Abltj perc plex/trncl nrv
|
$XXX.XX
|
J8
|
Y
|
| 0443T |
R-t spctrl alys prst8 tiss
|
$XXX.XX
|
N1
|
N
|
| 0444T |
1st plmt drug elut oc ins
|
$XXX.XX
|
N1
|
N
|
| 0445T |
Sbsqt plmt drug elut oc ins
|
$XXX.XX
|
N1
|
N
|
| 0446T |
Insj impltbl glucose sensor
|
$XXX.XX
|
P2
|
Y
|
| 0447T |
Rmvl impltbl glucose sensor
|
$XXX.XX
|
P3
|
N
|
| 0448T |
Remvl insj impltbl gluc sens
|
$XXX.XX
|
P2
|
Y
|
| 0449T |
Insj aqueous drain dev 1st
|
$XXX.XX
|
J8
|
Y
|
| 0450T |
Insj aqueous drain dev each
|
$XXX.XX
|
N1
|
N
|
| 0479T |
Fxjl abl lsr 1st 100 sq cm
|
$XXX.XX
|
G2
|
Y
|
| 0480T |
Fxjl abl lsr ea addl 100sqcm
|
$XXX.XX
|
N1
|
N
|
| 0505T |
Ev fempop artl revsc
|
$XXX.XX
|
J8
|
Y
|
| 0510T |
Rmvl sinus tarsi implant
|
$XXX.XX
|
G2
|
N
|
| 0511T |
Rmvl&rinsj sinus tarsi implt
|
$XXX.XX
|
J8
|
Y
|
| 0512T |
Esw integ wnd hlg 1st wnd
|
$XXX.XX
|
R2
|
N
|
| 0513T |
Esw integ wnd hlg ea addl
|
$XXX.XX
|
N1
|
N
|
| 0515T |
Insj wcs lv compl sys
|
$XXX.XX
|
J8
|
Y
|
| 0516T |
Insj wcs lv eltrd only
|
$XXX.XX
|
J8
|
Y
|
| 0517T |
Insj wcs lv both compnt pg
|
$XXX.XX
|
J8
|
Y
|
| 0518T |
Rmvl pg wcs lv battery only
|
$XXX.XX
|
G2
|
N
|
| 0519T |
Rmv&rplcmt pg wcs lv both
|
$XXX.XX
|
G2
|
Y
|
| 0520T |
Rmv&rplcmt pg wcs lv battery
|
$XXX.XX
|
J8
|
Y
|
| 0523T |
Ntrapx c ffr w/3d funcjl map
|
$XXX.XX
|
N1
|
N
|
| 0524T |
Ev cath dir chem abltj w/img
|
$XXX.XX
|
J8
|
Y
|
| 0525T |
Insj/rplcmt compl iims
|
$XXX.XX
|
J8
|
Y
|
| 0526T |
Insj/rplcmt iims eltrd only
|
$XXX.XX
|
J8
|
Y
|
| 0527T |
Insj/rplcmt iims implt mntr
|
$XXX.XX
|
J8
|
Y
|
| 0530T |
Removal complete iims
|
$XXX.XX
|
G2
|
N
|
| 0531T |
Removal iims electrode only
|
$XXX.XX
|
G2
|
N
|
| 0532T |
Removal iims implt mntr only
|
$XXX.XX
|
G2
|
N
|
| 0581T |
Abltj mal brst tum perq crtx
|
$XXX.XX
|
J8
|
Y
|
| 0582T |
Trurl abltj mal prst8 tiss
|
$XXX.XX
|
J8
|
Y
|
| 0583T |
Tmpst auto tube dlvr sys
|
$XXX.XX
|
J8
|
Y
|
| 0587T |
Perq impltj/rplcmt isdns ptn
|
$XXX.XX
|
J8
|
Y
|
| 0588T |
Revision/removal isdns ptn
|
$XXX.XX
|
R2
|
Y
|
| 0594T |
Osteot hum xtrnl lngth dev
|
$XXX.XX
|
J8
|
Y
|
| 0596T |
Temp fml iu vlv-pmp 1st insj
|
$XXX.XX
|
P2
|
Y
|
| 0597T |
Temp fml iu valve-pmp rplcmt
|
$XXX.XX
|
P2
|
Y
|
| 0600T |
Ablt ire 1+ o/t lv/prst8 prq
|
$XXX.XX
|
J8
|
Y
|
| 0601T |
Abltj ire 1+tumors open
|
$XXX.XX
|
J8
|
Y
|
| 0614T |
Rmvl&rplcmt ss impl dfb pg
|
$XXX.XX
|
J8
|
Y
|
| 0619T |
Cysto w/prst8 commissurotomy
|
$XXX.XX
|
D5
|
N
|
| 0620T |
Evasc ven artlz tibl/prnl vn
|
$XXX.XX
|
J8
|
N
|
| 0621T |
Trabeculostomy interno laser
|
$XXX.XX
|
J8
|
Y
|
| 0627T |
Perq njx algc fluor lmbr 1st
|
$XXX.XX
|
J8
|
Y
|
| 0628T |
Perq njx algc fluor lmbr ea
|
$XXX.XX
|
N1
|
N
|
| 0629T |
Perq njx algc ct lmbr 1st
|
$XXX.XX
|
J8
|
Y
|
| 0630T |
Perq njx algc ct lmbr ea
|
$XXX.XX
|
N1
|
N
|
| 0632T |
Perq tcat us abltj nrv p-art
|
$XXX.XX
|
J8
|
Y
|
| 0644T |
Tcat rmvl/dblk icar mas perq
|
$XXX.XX
|
J8
|
Y
|
| 0645T |
Tcat impltj c sins rdctj dev
|
$XXX.XX
|
G2
|
Y
|
| 0647T |
Insj gtube perq mag gastrpxy
|
$XXX.XX
|
G2
|
Y
|
| 0651T |
Mag ctrld capsule endoscopy
|
$XXX.XX
|
J8
|
Y
|
| 0652T |
Egd flx transnasal dx br/wa
|
$XXX.XX
|
G2
|
Y
|
| 0653T |
Egd flx transnasal bx 1/mlt
|
$XXX.XX
|
G2
|
Y
|
| 0654T |
Egd flx transnasal tube/cath
|
$XXX.XX
|
G2
|
Y
|
| 0655T |
Tprnl focal abltj mal prst8
|
$XXX.XX
|
G2
|
Y
|
| 0656T |
Ant lmbr vrt bdy teth <7 seg
|
$XXX.XX
|
J8
|
Y
|
| 0657T |
Ant lmbr vrt bdy teth 8+ seg
|
$XXX.XX
|
J8
|
Y
|
| 0660T |
Implt ant sgm io nbio rx sys
|
$XXX.XX
|
G2
|
Y
|
| 0661T |
Rmvl&rimpltj ant sgm implt
|
$XXX.XX
|
G2
|
Y
|
| 0671T |
Insj ant sgm aq drg dev 1+
|
$XXX.XX
|
J8
|
Y
|
| 0673T |
Abltj b9 thyr ndul perq lasr
|
$XXX.XX
|
G2
|
Y
|
| 0674T |
Laps insj nw/rpcmt prm isdss
|
$XXX.XX
|
J8
|
Y
|
| 0675T |
Laps insj nw/rpcmt isdss 1ld
|
$XXX.XX
|
J8
|
Y
|
| 0676T |
Laps insj nw/rpcmt isdss ea
|
$XXX.XX
|
N1
|
N
|
| 0677T |
Laps repos lead isdss 1st ld
|
$XXX.XX
|
J8
|
Y
|
| 0678T |
Laps repos lead isdss ea add
|
$XXX.XX
|
N1
|
N
|
| 0679T |
Laps rmvl lead isdss
|
$XXX.XX
|
G2
|
Y
|
| 0680T |
Insj/rplcmt pg only isdss
|
$XXX.XX
|
J8
|
Y
|
| 0681T |
Rlcj pulse gen only isdss
|
$XXX.XX
|
G2
|
Y
|
| 0682T |
Removal pulse gen only isdss
|
$XXX.XX
|
G2
|
Y
|
| 0686T |
Histotripsy mal hepatcel tis
|
$XXX.XX
|
G2
|
N
|
| 0692T |
Therapeutic ultrafiltration
|
$XXX.XX
|
G2
|
N
|
| 0699T |
Njx pst chmbr eye medication
|
$XXX.XX
|
G2
|
Y
|
| 0707T |
Njx b1 sub mtrl sbchdrl dfct
|
$XXX.XX
|
J8
|
Y
|
| 0714T |
Tpla b9 prst8 hyprplsa<50ml
|
$XXX.XX
|
J8
|
Y
|
| 0717T |
Adrc ther prtl rc tear
|
$XXX.XX
|
G2
|
Y
|
| 0718T |
Adrc ther prtl rc tear njx
|
$XXX.XX
|
G2
|
Y
|
| 0737T |
Xenograft impltj artclr surf
|
$XXX.XX
|
J8
|
Y
|
| 0744T |
Insj bioprostc vlv fem vn
|
$XXX.XX
|
G2
|
Y
|
| 0784T |
Ins/rplmt eltrd ra spi nstim
|
$XXX.XX
|
J8
|
Y
|
| 0785T |
Revj/rmvl nea spi w/nstim
|
$XXX.XX
|
G2
|
Y
|
| 0786T |
Insj/rplcmt prq ra sac nstim
|
$XXX.XX
|
J8
|
Y
|
| 0787T |
Revj/rmvl nea sac w/nstim
|
$XXX.XX
|
G2
|
Y
|
| 0790T |
Revj rplcmt/rmvl vrt tethrg
|
$XXX.XX
|
J8
|
Y
|
| 0793T |
Prq tcat thrm ablt nrv p-art
|
$XXX.XX
|
J8
|
Y
|
| 0797T |
Tcat ins 2chmbr ldls pm rv
|
$XXX.XX
|
J8
|
Y
|
| 0800T |
Tcat rmvl 2chmbr ldls pm rv
|
$XXX.XX
|
J8
|
Y
|
| 0803T |
Tcat rmv&rpl2chmb ldls pm rv
|
$XXX.XX
|
J8
|
Y
|
| 0810T |
Subrta njx rx agt w/vtrc
|
$XXX.XX
|
G2
|
Y
|
| 0813T |
Egd vol adjmt bariatric balo
|
$XXX.XX
|
G2
|
Y
|
| 0816T |
Opn insj/rplcmt ins ptn subq
|
$XXX.XX
|
J8
|
Y
|
| 0817T |
Opn insj/rplcmt ins ptn subf
|
$XXX.XX
|
J8
|
Y
|
| 0818T |
Revj/rmvl ins ptn subq
|
$XXX.XX
|
G2
|
Y
|
| 0819T |
Revj/rmvl ins ptn subf
|
$XXX.XX
|
G2
|
Y
|
| 0861T |
Rmvl pg wcs lv both compnt
|
$XXX.XX
|
G2
|
N
|
| 0862T |
Rlcj pg wcs lv battery only
|
$XXX.XX
|
G2
|
Y
|
| 0863T |
Rlcj pg wcs lv trnsmtr only
|
$XXX.XX
|
G2
|
Y
|
| 0864T |
Low ntsty eswt corpus cvrnsm
|
$XXX.XX
|
R2
|
Y
|
| 0867T |
Tpla b9 prst8 hyprplsa>=50ml
|
$XXX.XX
|
G2
|
Y
|
| 0869T |
Njx b1 sub mtrl hw fixj aug
|
$XXX.XX
|
J8
|
Y
|
| 0884T |
Esphgsc flx 1st tndsc dilat
|
$XXX.XX
|
J8
|
Y
|
| 0885T |
Colsc flx 1st tndsc dilat
|
$XXX.XX
|
J8
|
Y
|
| 0886T |
Sgmdsc flx 1st tndsc dilat
|
$XXX.XX
|
J8
|
Y
|
| 0888T |
Histotripsy mal renal tissue
|
$XXX.XX
|
G2
|
N
|
| 0908T |
Opn imp int nstm sys vgs nrv
|
$XXX.XX
|
J8
|
Y
|
| 0909T |
Rplcmt int nstim sys vgs nrv
|
$XXX.XX
|
J8
|
Y
|
| 0910T |
Rmvl int nstim sys vagus nrv
|
$XXX.XX
|
G2
|
Y
|
| 0913T |
Prq tcat ther rx ntrac balo1
|
$XXX.XX
|
J8
|
Y
|
| 0914T |
Prq tcat thr rx ntrc bal sep
|
$XXX.XX
|
N1
|
N
|
| 0915T |
Insj perm ccm-d sys pg&eltrd
|
$XXX.XX
|
J8
|
Y
|
| 0916T |
Insj perm ccm-d sys pg only
|
$XXX.XX
|
J8
|
Y
|
| 0917T |
Insj perm ccm-d sys 1 lead
|
$XXX.XX
|
J8
|
Y
|
| 0918T |
Insj perm ccm-d sys dual ld
|
$XXX.XX
|
J8
|
Y
|
| 0919T |
Rmvl perm ccm-d sys pg only
|
$XXX.XX
|
G2
|
N
|
| 0920T |
Rmvl perm ccm-d sys 1 pac ld
|
$XXX.XX
|
G2
|
N
|
| 0921T |
Rmvl perm ccm-d sys 1 dfb ld
|
$XXX.XX
|
G2
|
N
|
| 0922T |
Rmvl perm ccm-d sys dual ld
|
$XXX.XX
|
G2
|
N
|
| 0923T |
Rmvl&rplcmt perm ccm-d pg
|
$XXX.XX
|
J8
|
Y
|
| 0924T |
Rpos prv ccm-d trnsvns eltrd
|
$XXX.XX
|
G2
|
Y
|
| 0925T |
Rlcj skin pocket ccm-d pg
|
$XXX.XX
|
G2
|
Y
|
| 0933T |
Tcat impl wrls l atr prs snr
|
$XXX.XX
|
J8
|
Y
|
| 0950T |
Abltj b9 prst8 tissue hifu
|
$XXX.XX
|
J8
|
Y
|
| 0956T |
Prt crn ch cr&tun elt s-sclp
|
$XXX.XX
|
J8
|
N
|
| 0957T |
Rev s-sclp eltr ra rcvr&tlmt
|
$XXX.XX
|
G2
|
Y
|
| 0958T |
Rmv s-sclp eltr ra rcvr&tlmt
|
$XXX.XX
|
G2
|
Y
|
| 0959T |
Rmv/rplc magnet coil assem
|
$XXX.XX
|
G2
|
N
|
| 0960T |
Rpl s-sclp eltr ra rcvr&tlmt
|
$XXX.XX
|
J8
|
N
|
| 0962T |
Asstv alg alys acous&ecg rec
|
$XXX.XX
|
G2
|
N
|
| 0963T |
Anosc sbmcsl njx bulking agt
|
$XXX.XX
|
J8
|
Y
|
| 0964T |
I&cust prep jaw xpnsj 1arch
|
$XXX.XX
|
G2
|
Y
|
| 0965T |
I&cst prp jw xpn dl arch non
|
$XXX.XX
|
G2
|
Y
|
| 0966T |
I&cst prp jw xpn dl arch fxd
|
$XXX.XX
|
G2
|
Y
|
| 0967T |
Tranal ins tmp clrc anst dev
|
$XXX.XX
|
J8
|
Y
|
| 0970T |
Ablt b9 brst tum perq lsr ea
|
$XXX.XX
|
J8
|
Y
|
| 0971T |
Ablt mal brst tum pq lsr uni
|
$XXX.XX
|
J8
|
Y
|
| 0973T |
Slctv nzmtc dbrdmt t/a/l 1st
|
$XXX.XX
|
G2
|
Y
|
| 0975T |
Slctv nzmtc dbrdmt s/n/hf 1
|
$XXX.XX
|
G2
|
Y
|
| 0977T |
Upr gi bld detcj snr capsule
|
$XXX.XX
|
G2
|
Y
|
| 0981T |
Tcat impl wrls ivc snr
|
$XXX.XX
|
J8
|
Y
|
| 0989T |
Revj/rmvl ins ptn subq&subf
|
$XXX.XX
|
G2
|
Y
|
| 0991T |
Cysto lo-nrg lithtrp&mcrsphr
|
$XXX.XX
|
J8
|
Y
|
| 0996T |
Ins&sclr fix caps bag prosth
|
$XXX.XX
|
G2
|
Y
|
| 10004 |
Fna bx w/o img gdn ea addl
|
$XXX.XX
|
N1
|
N
|
| 10005 |
Fna bx w/us gdn 1st les
|
$XXX.XX
|
G2
|
Y
|
| 10006 |
Fna bx w/us gdn ea addl
|
$XXX.XX
|
N1
|
N
|
| 10007 |
Fna bx w/fluor gdn 1st les
|
$XXX.XX
|
P3
|
Y
|
| 10008 |
Fna bx w/fluor gdn ea addl
|
$XXX.XX
|
N1
|
N
|
| 10009 |
Fna bx w/ct gdn 1st les
|
$XXX.XX
|
G2
|
Y
|
| 10010 |
Fna bx w/ct gdn ea addl
|
$XXX.XX
|
N1
|
N
|
| 10011 |
Fna bx w/mr gdn 1st les
|
$XXX.XX
|
R2
|
Y
|
| 10012 |
Fna bx w/mr gdn ea addl
|
$XXX.XX
|
N1
|
N
|
| 10021 |
Fna bx w/o img gdn 1st les
|
$XXX.XX
|
P3
|
Y
|
| 10030 |
Img gid flu coll drg sft tis
|
$XXX.XX
|
G2
|
Y
|
| 10035 |
Plmt sft tiss loclzj dev 1st
|
$XXX.XX
|
N1
|
Y
|
| 10036 |
Plmt sft tiss loclzj dev ea
|
$XXX.XX
|
N1
|
N
|
| 1003T |
Arthrp 1st crp/mtcrpl prostc
|
$XXX.XX
|
J8
|
Y
|
| 10040 |
Extraction
|
$XXX.XX
|
N1
|
N
|
| 10060 |
I&d abscess simple/single
|
$XXX.XX
|
P3
|
Y
|
| 10061 |
I&d abscess comp/multiple
|
$XXX.XX
|
P3
|
Y
|
| 10080 |
I&d pilonidal cyst simple
|
$XXX.XX
|
P3
|
Y
|
| 10081 |
I&d pilonidal cyst comp
|
$XXX.XX
|
P3
|
Y
|
| 10120 |
Inc&rmvl fb subq tiss smpl
|
$XXX.XX
|
P3
|
Y
|
| 10121 |
Inc&rmvl fb subq tiss comp
|
$XXX.XX
|
A2
|
Y
|
| 1012T |
Mtrz ab ntrno trph scl/tr mw
|
$XXX.XX
|
J8
|
Y
|
| 1013T |
Lap srg imp/rpl eso nea&pg/r
|
$XXX.XX
|
J8
|
Y
|
| 10140 |
I&d hmtma seroma/fluid collj
|
$XXX.XX
|
P3
|
Y
|
| 1014T |
Lap rv/rmv eso sph nstm eltr
|
$XXX.XX
|
G2
|
Y
|
| 1015T |
Rev/rmv lw esoph sphnc npg/r
|
$XXX.XX
|
G2
|
Y
|
| 10160 |
Pnxr aspir absc hmtma bulla
|
$XXX.XX
|
P3
|
Y
|
| 10180 |
I&d complex po wound infctj
|
$XXX.XX
|
A2
|
Y
|
| 1019T |
Lymphovenous bypass per xtr
|
$XXX.XX
|
G2
|
Y
|
| 1022T |
Prq tis dsplmt ntra-abdl/pel
|
$XXX.XX
|
N1
|
N
|
| 1023T |
Prq tis dsplmt intrathoracic
|
$XXX.XX
|
N1
|
N
|
| 1024T |
Perq tiss dsplmt soft tissue
|
$XXX.XX
|
N1
|
N
|
| 11000 |
Dbrdmt ecz/infected skin<10%
|
$XXX.XX
|
P3
|
Y
|
| 11001 |
Dbrdmt ecz/infct skn ea addl
|
$XXX.XX
|
N1
|
N
|
| 11010 |
Debride skin at fx site
|
$XXX.XX
|
A2
|
Y
|
| 11011 |
Debride skin musc at fx site
|
$XXX.XX
|
A2
|
Y
|
| 11012 |
Deb skin bone at fx site
|
$XXX.XX
|
A2
|
Y
|
| 11042 |
Dbrdmt subq tis 1st 20sqcm/<
|
$XXX.XX
|
A2
|
Y
|
| 11043 |
Dbrdmt musc&/fsca 1st 20/<
|
$XXX.XX
|
A2
|
Y
|
| 11044 |
Dbrdmt bone 1st 20 sq cm/<
|
$XXX.XX
|
A2
|
Y
|
| 11045 |
Dbrdmt subq tiss each addl
|
$XXX.XX
|
N1
|
N
|
| 11046 |
Dbrdmt musc&/fsca ea addl
|
$XXX.XX
|
N1
|
N
|
| 11047 |
Dbrdmt bone each addl
|
$XXX.XX
|
N1
|
N
|
| 11055 |
Paring/cutg b9 hyprker les 1
|
$XXX.XX
|
N1
|
N
|
| 11056 |
Parng/cutg b9 hyprkr les 2-4
|
$XXX.XX
|
N1
|
N
|
| 11057 |
Parng/cutg b9 hyprkr les >4
|
$XXX.XX
|
P3
|
Y
|
| 11102 |
Tangntl bx skin single les
|
$XXX.XX
|
P3
|
Y
|
| 11103 |
Tangntl bx skin ea sep/addl
|
$XXX.XX
|
N1
|
N
|
| 11104 |
Punch bx skin single lesion
|
$XXX.XX
|
P3
|
Y
|
| 11105 |
Punch bx skin ea sep/addl
|
$XXX.XX
|
N1
|
N
|
| 11106 |
Incal bx skn single les
|
$XXX.XX
|
P3
|
Y
|
| 11107 |
Incal bx skn ea sep/addl
|
$XXX.XX
|
N1
|
N
|
| 11200 |
Rmvl skin tags up to&inc 15
|
$XXX.XX
|
N1
|
N
|
| 11201 |
Rmvl skin tags ea addl 10
|
$XXX.XX
|
N1
|
N
|
| 11300 |
Shave skin lesion 0.5 cm/<
|
$XXX.XX
|
N1
|
N
|
| 11301 |
Shave skin lesion 0.6-1.0 cm
|
$XXX.XX
|
N1
|
N
|
| 11302 |
Shave skin lesion 1.1-2.0 cm
|
$XXX.XX
|
N1
|
N
|
| 11303 |
Shave skin lesion >2.0 cm
|
$XXX.XX
|
N1
|
N
|
| 11305 |
Shave skin lesion 0.5 cm/<
|
$XXX.XX
|
N1
|
N
|
| 11306 |
Shave skin lesion 0.6-1.0 cm
|
$XXX.XX
|
N1
|
N
|
| 11307 |
Shave skin lesion 1.1-2.0 cm
|
$XXX.XX
|
P3
|
Y
|
| 11308 |
Shave skin lesion >2.0 cm
|
$XXX.XX
|
N1
|
N
|
| 11310 |
Shave skin lesion 0.5 cm/<
|
$XXX.XX
|
P3
|
Y
|
| 11311 |
Shave skin lesion 0.6-1.0 cm
|
$XXX.XX
|
P3
|
Y
|
| 11312 |
Shave skin lesion 1.1-2.0 cm
|
$XXX.XX
|
P3
|
Y
|
| 11313 |
Shave skin lesion >2.0 cm
|
$XXX.XX
|
P3
|
Y
|
| 11400 |
Exc tr-ext b9+marg 0.5 cm<
|
$XXX.XX
|
P3
|
Y
|
| 11401 |
Exc tr-ext b9+marg 0.6-1 cm
|
$XXX.XX
|
P3
|
Y
|
| 11402 |
Exc tr-ext b9+marg 1.1-2 cm
|
$XXX.XX
|
P3
|
Y
|
| 11403 |
Exc tr-ext b9+marg 2.1-3cm
|
$XXX.XX
|
P3
|
Y
|
| 11404 |
Exc tr-ext b9+marg 3.1-4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11406 |
Exc tr-ext b9+marg >4.0 cm
|
$XXX.XX
|
A2
|
Y
|
| 11420 |
Exc h-f-nk-sp b9+marg 0.5/<
|
$XXX.XX
|
P3
|
Y
|
| 11421 |
Exc h-f-nk-sp b9+marg 0.6-1
|
$XXX.XX
|
P3
|
Y
|
| 11422 |
Exc h-f-nk-sp b9+marg 1.1-2
|
$XXX.XX
|
P3
|
Y
|
| 11423 |
Exc h-f-nk-sp b9+marg 2.1-3
|
$XXX.XX
|
P3
|
Y
|
| 11424 |
Exc h-f-nk-sp b9+marg 3.1-4
|
$XXX.XX
|
A2
|
Y
|
| 11426 |
Exc h-f-nk-sp b9+marg >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11440 |
Exc face-mm b9+marg 0.5 cm/<
|
$XXX.XX
|
P3
|
Y
|
| 11441 |
Exc face-mm b9+marg 0.6-1 cm
|
$XXX.XX
|
P3
|
Y
|
| 11442 |
Exc face-mm b9+marg 1.1-2 cm
|
$XXX.XX
|
P3
|
Y
|
| 11443 |
Exc face-mm b9+marg 2.1-3 cm
|
$XXX.XX
|
P3
|
Y
|
| 11444 |
Exc face-mm b9+marg 3.1-4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11446 |
Exc face-mm b9+marg >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11450 |
Exc skn hdrdnt ax smpl/ntrm
|
$XXX.XX
|
A2
|
Y
|
| 11451 |
Exc skn hdrdnt ax complex
|
$XXX.XX
|
A2
|
Y
|
| 11462 |
Exc skn hdrdnt ing smpl/ntrm
|
$XXX.XX
|
A2
|
Y
|
| 11463 |
Exc skn hdrdnt ing complex
|
$XXX.XX
|
A2
|
Y
|
| 11470 |
Exc skn h/p/p/u smpl/ntrm
|
$XXX.XX
|
A2
|
Y
|
| 11471 |
Exc skn h/p/p/u complex
|
$XXX.XX
|
A2
|
Y
|
| 11600 |
Exc tr-ext mal+marg 0.5 cm/<
|
$XXX.XX
|
P3
|
Y
|
| 11601 |
Exc tr-ext mal+marg 0.6-1 cm
|
$XXX.XX
|
P3
|
Y
|
| 11602 |
Exc tr-ext mal+marg 1.1-2 cm
|
$XXX.XX
|
P3
|
Y
|
| 11603 |
Exc tr-ext mal+marg 2.1-3 cm
|
$XXX.XX
|
P3
|
Y
|
| 11604 |
Exc tr-ext mal+marg 3.1-4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11606 |
Exc tr-ext mal+marg >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11620 |
Exc h-f-nk-sp mal+marg 0.5/<
|
$XXX.XX
|
P3
|
Y
|
| 11621 |
Exc s/n/h/f/g mal+mrg 0.6-1
|
$XXX.XX
|
P3
|
Y
|
| 11622 |
Exc s/n/h/f/g mal+mrg 1.1-2
|
$XXX.XX
|
P3
|
Y
|
| 11623 |
Exc s/n/h/f/g mal+mrg 2.1-3
|
$XXX.XX
|
P3
|
Y
|
| 11624 |
Exc s/n/h/f/g mal+mrg 3.1-4
|
$XXX.XX
|
A2
|
Y
|
| 11626 |
Exc s/n/h/f/g mal+mrg >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11640 |
Exc f/e/e/n/l mal+mrg 0.5cm<
|
$XXX.XX
|
P3
|
Y
|
| 11641 |
Exc f/e/e/n/l mal+mrg 0.6-1
|
$XXX.XX
|
P3
|
Y
|
| 11642 |
Exc f/e/e/n/l mal+mrg 1.1-2
|
$XXX.XX
|
P3
|
Y
|
| 11643 |
Exc f/e/e/n/l mal+mrg 2.1-3
|
$XXX.XX
|
P3
|
Y
|
| 11644 |
Exc f/e/e/n/l mal+mrg 3.1-4
|
$XXX.XX
|
A2
|
Y
|
| 11646 |
Exc f/e/e/n/l mal+mrg >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 11719 |
Trim nail(s) any number
|
$XXX.XX
|
N1
|
N
|
| 11720 |
Debride nail 1-5
|
$XXX.XX
|
N1
|
N
|
| 11721 |
Debride nail 6 or more
|
$XXX.XX
|
N1
|
N
|
| 11730 |
Avulsion nail plate simple 1
|
$XXX.XX
|
N1
|
N
|
| 11732 |
Avlsn nail plate simple each
|
$XXX.XX
|
N1
|
N
|
| 11740 |
Evacuation subungual hmtma
|
$XXX.XX
|
N1
|
N
|
| 11750 |
Excision nail&nail matrix
|
$XXX.XX
|
P3
|
Y
|
| 11755 |
Biopsy nail unit
|
$XXX.XX
|
P3
|
Y
|
| 11760 |
Repair of nail bed
|
$XXX.XX
|
P3
|
Y
|
| 11762 |
Reconstruction of nail bed
|
$XXX.XX
|
P3
|
Y
|
| 11765 |
Wedge excision skn nail fold
|
$XXX.XX
|
N1
|
N
|
| 11770 |
Exc pilonidal cyst simple
|
$XXX.XX
|
A2
|
Y
|
| 11771 |
Exc pilonidal cyst xtnsv
|
$XXX.XX
|
A2
|
Y
|
| 11772 |
Exc pilonidal cyst comp
|
$XXX.XX
|
A2
|
Y
|
| 11900 |
Inject skin lesions
|
$XXX.XX
|
N1
|
N
|
| 11901 |
Inject skin lesions >7
|
$XXX.XX
|
N1
|
N
|
| 11920 |
Correct skin color 6.0 cm/<
|
$XXX.XX
|
P3
|
Y
|
| 11921 |
Correct skn color 6.1-20.0cm
|
$XXX.XX
|
P3
|
Y
|
| 11922 |
Correct skin color ea 20.0cm
|
$XXX.XX
|
N1
|
N
|
| 11950 |
Subq njx filling matrl 1cc/<
|
$XXX.XX
|
P3
|
Y
|
| 11951 |
Subq njx fil matrl 1.1-5.0cc
|
$XXX.XX
|
P3
|
Y
|
| 11952 |
Subq njx fil matrl 5.1-10cc
|
$XXX.XX
|
P3
|
Y
|
| 11954 |
Subq njx fil matrl>10.0 cc
|
$XXX.XX
|
P3
|
Y
|
| 11960 |
Insert tissue expander(s)
|
$XXX.XX
|
A2
|
Y
|
| 11970 |
Rplcmt tiss xpndr perm implt
|
$XXX.XX
|
G2
|
Y
|
| 11971 |
Rmvl tis xpndr wo insj implt
|
$XXX.XX
|
A2
|
N
|
| 11976 |
Remove contraceptive capsule
|
$XXX.XX
|
P3
|
N
|
| 11980 |
Implant hormone pellet(s)
|
$XXX.XX
|
N1
|
N
|
| 11981 |
Insertion drug dlvr implant
|
$XXX.XX
|
N1
|
N
|
| 11982 |
Remove drug implant device
|
$XXX.XX
|
N1
|
N
|
| 11983 |
Remove/insert drug implant
|
$XXX.XX
|
N1
|
N
|
| 12001 |
Rpr s/n/ax/gen/trnk 2.5cm/<
|
$XXX.XX
|
N1
|
N
|
| 12002 |
Rpr s/n/ax/gen/trnk2.6-7.5cm
|
$XXX.XX
|
N1
|
N
|
| 12004 |
Rpr s/n/ax/gen/trk7.6-12.5cm
|
$XXX.XX
|
N1
|
N
|
| 12005 |
Rpr s/n/a/gen/trk12.6-20.0cm
|
$XXX.XX
|
A2
|
N
|
| 12006 |
Rpr s/n/a/gen/trk20.1-30.0cm
|
$XXX.XX
|
A2
|
N
|
| 12007 |
Rpr s/n/ax/gen/trnk >30.0 cm
|
$XXX.XX
|
A2
|
Y
|
| 12011 |
Rpr f/e/e/n/l/m 2.5 cm/<
|
$XXX.XX
|
N1
|
N
|
| 12013 |
Rpr f/e/e/n/l/m 2.6-5.0 cm
|
$XXX.XX
|
N1
|
N
|
| 12014 |
Rpr f/e/e/n/l/m 5.1-7.5 cm
|
$XXX.XX
|
N1
|
N
|
| 12015 |
Rpr f/e/e/n/l/m 7.6-12.5 cm
|
$XXX.XX
|
G2
|
N
|
| 12016 |
Rpr fe/e/en/l/m 12.6-20.0 cm
|
$XXX.XX
|
A2
|
N
|
| 12017 |
Rpr fe/e/en/l/m 20.1-30.0 cm
|
$XXX.XX
|
A2
|
N
|
| 12018 |
Rpr f/e/e/n/l/m >30.0 cm
|
$XXX.XX
|
A2
|
N
|
| 12020 |
Tx supfc wnd dehsn smpl clsr
|
$XXX.XX
|
A2
|
Y
|
| 12021 |
Tx supfc wnd dehsn w/packing
|
$XXX.XX
|
A2
|
Y
|
| 12031 |
Intmd rpr s/a/t/ext 2.5 cm/<
|
$XXX.XX
|
P3
|
Y
|
| 12032 |
Intmd rpr s/a/t/ext 2.6-7.5
|
$XXX.XX
|
P3
|
Y
|
| 12034 |
Intmd rpr s/tr/ext 7.6-12.5
|
$XXX.XX
|
A2
|
Y
|
| 12035 |
Intmd rpr s/a/t/ext 12.6-20
|
$XXX.XX
|
A2
|
Y
|
| 12036 |
Intmd rpr s/a/t/ext 20.1-30
|
$XXX.XX
|
A2
|
Y
|
| 12037 |
Intmd rpr s/tr/ext >30.0 cm
|
$XXX.XX
|
A2
|
Y
|
| 12041 |
Intmd rpr n-hf/genit 2.5cm/<
|
$XXX.XX
|
P3
|
N
|
| 12042 |
Intmd rpr n-hf/genit2.6-7.5
|
$XXX.XX
|
P3
|
Y
|
| 12044 |
Intmd rpr n-hf/genit7.6-12.5
|
$XXX.XX
|
A2
|
Y
|
| 12045 |
Intmd rpr n-hf/genit12.6-20
|
$XXX.XX
|
A2
|
Y
|
| 12046 |
Intmd rpr n-hf/genit20.1-30
|
$XXX.XX
|
A2
|
Y
|
| 12047 |
Intmd rpr n-hf/genit >30.0cm
|
$XXX.XX
|
A2
|
Y
|
| 12051 |
Intmd rpr face/mm 2.5 cm/<
|
$XXX.XX
|
P3
|
Y
|
| 12052 |
Intmd rpr face/mm 2.6-5.0 cm
|
$XXX.XX
|
P3
|
Y
|
| 12053 |
Intmd rpr face/mm 5.1-7.5 cm
|
$XXX.XX
|
P2
|
Y
|
| 12054 |
Intmd rpr face/mm 7.6-12.5cm
|
$XXX.XX
|
A2
|
N
|
| 12055 |
Intmd rpr face/mm 12.6-20 cm
|
$XXX.XX
|
A2
|
Y
|
| 12056 |
Intmd rpr face/mm 20.1-30.0
|
$XXX.XX
|
A2
|
N
|
| 12057 |
Intmd rpr face/mm >30.0 cm
|
$XXX.XX
|
A2
|
Y
|
| 13100 |
Cmplx rpr trunk 1.1-2.5 cm
|
$XXX.XX
|
A2
|
Y
|
| 13101 |
Cmplx rpr trunk 2.6-7.5 cm
|
$XXX.XX
|
A2
|
Y
|
| 13102 |
Cmplx rpr trunk addl 5cm/<
|
$XXX.XX
|
N1
|
N
|
| 13120 |
Cmplx rpr s/a/l 1.1-2.5 cm
|
$XXX.XX
|
A2
|
Y
|
| 13121 |
Cmplx rpr s/a/l 2.6-7.5 cm
|
$XXX.XX
|
A2
|
Y
|
| 13122 |
Cmplx rpr s/a/l addl 5 cm/>
|
$XXX.XX
|
N1
|
N
|
| 13131 |
Cmplx rpr f/c/c/m/n/ax/g/h/f
|
$XXX.XX
|
A2
|
Y
|
| 13132 |
Cmplx rpr f/c/c/m/n/ax/g/h/f
|
$XXX.XX
|
A2
|
Y
|
| 13133 |
Cmplx rpr f/c/c/m/n/ax/g/h/f
|
$XXX.XX
|
N1
|
N
|
| 13151 |
Cmplx rpr e/n/e/l 1.1-2.5 cm
|
$XXX.XX
|
A2
|
Y
|
| 13152 |
Cmplx rpr e/n/e/l 2.6-7.5 cm
|
$XXX.XX
|
A2
|
Y
|
| 13153 |
Cmplx rpr e/n/e/l addl 5cm/<
|
$XXX.XX
|
N1
|
N
|
| 13160 |
Sec clsr surg wnd/dehsn xtn
|
$XXX.XX
|
A2
|
Y
|
| 14000 |
Tis trnfr trunk 10 sq cm/<
|
$XXX.XX
|
A2
|
Y
|
| 14001 |
Tis trnfr trunk 10.1-30sqcm
|
$XXX.XX
|
A2
|
Y
|
| 14020 |
Tis trnfr s/a/l 10 sq cm/<
|
$XXX.XX
|
A2
|
Y
|
| 14021 |
Tis trnfr s/a/l 10.1-30 sqcm
|
$XXX.XX
|
A2
|
Y
|
| 14040 |
Tis trnfr f/c/c/m/n/a/g/h/f
|
$XXX.XX
|
A2
|
Y
|
| 14041 |
Tis trnfr f/c/c/m/n/a/g/h/f
|
$XXX.XX
|
A2
|
Y
|
| 14060 |
Tis trnfr e/n/e/l 10 sq cm/<
|
$XXX.XX
|
A2
|
Y
|
| 14061 |
Tis trnfr e/n/e/l10.1-30sqcm
|
$XXX.XX
|
A2
|
Y
|
| 14301 |
Tis trnfr any 30.1-60 sq cm
|
$XXX.XX
|
G2
|
Y
|
| 14302 |
Tis trnfr addl 30 sq cm
|
$XXX.XX
|
N1
|
N
|
| 14350 |
Filleted finger/toe flap
|
$XXX.XX
|
A2
|
Y
|
| 15002 |
Wound prep trk/arm/leg
|
$XXX.XX
|
A2
|
Y
|
| 15003 |
Wound prep addl 100 cm
|
$XXX.XX
|
N1
|
N
|
| 15004 |
Wound prep f/n/hf/g
|
$XXX.XX
|
A2
|
Y
|
| 15005 |
Wnd prep f/n/hf/g addl cm
|
$XXX.XX
|
N1
|
N
|
| 15011 |
Hrv skn cll ssp agrft 1st 25
|
$XXX.XX
|
G2
|
Y
|
| 15012 |
Hrv skn cll ssp agrft ea add
|
$XXX.XX
|
N1
|
N
|
| 15013 |
Prepj skn cll ssp agrft 1st
|
$XXX.XX
|
G2
|
N
|
| 15014 |
Prepj skn cll ssp agrft ea
|
$XXX.XX
|
N1
|
N
|
| 15015 |
App skn cl ssp agrft t/a/l 1
|
$XXX.XX
|
G2
|
Y
|
| 15016 |
App skn cl ssp agrf t/a/l ea
|
$XXX.XX
|
N1
|
N
|
| 15017 |
App skn cll ssp f/n/g/hf 1st
|
$XXX.XX
|
G2
|
Y
|
| 15018 |
App skn cll ssp f/n/g/hf ea
|
$XXX.XX
|
N1
|
N
|
| 15040 |
Harvest cultured skin graft
|
$XXX.XX
|
A2
|
Y
|
| 15050 |
Pinch graft up to 2 cm diam
|
$XXX.XX
|
A2
|
Y
|
| 15100 |
Splt agrft t/a/l 1st 100sqcm
|
$XXX.XX
|
A2
|
Y
|
| 15101 |
Splt agrft t/a/l ea addl 100
|
$XXX.XX
|
N1
|
N
|
| 15110 |
Epidrm agrft t/a/l 1st 100
|
$XXX.XX
|
A2
|
Y
|
| 15111 |
Epidrm agrft t/a/l ea addl
|
$XXX.XX
|
N1
|
N
|
| 15115 |
Epdrm agrft f/s/n/h/f/g/m 1
|
$XXX.XX
|
A2
|
Y
|
| 15116 |
Epdrm agrft f/s/n/h/f/g/m ea
|
$XXX.XX
|
N1
|
N
|
| 15120 |
Splt agrft f/s/n/h/f/g/m 1st
|
$XXX.XX
|
A2
|
Y
|
| 15121 |
Splt agrft f/s/n/h/f/g/m ea
|
$XXX.XX
|
N1
|
N
|
| 15130 |
Drm agrft t/a/l 1st 100 sqcm
|
$XXX.XX
|
A2
|
Y
|
| 15131 |
Drm agrft t/a/l ea addl
|
$XXX.XX
|
N1
|
N
|
| 15135 |
Drm agrft f/s/n/h/f/g/m 1st
|
$XXX.XX
|
A2
|
Y
|
| 15136 |
Drm agrft f/s/n/h/f/g/m ea
|
$XXX.XX
|
N1
|
N
|
| 15150 |
Tis cltr skn agrft t/a/l 1st
|
$XXX.XX
|
A2
|
Y
|
| 15151 |
Tis cltr skn agrft t/a/l add
|
$XXX.XX
|
N1
|
N
|
| 15152 |
Tis cltr skn agrft t/a/l ea
|
$XXX.XX
|
N1
|
N
|
| 15155 |
Tis cltr agrft f/s/n/h/f/g 1
|
$XXX.XX
|
A2
|
Y
|
| 15156 |
Tis clt agrft f/s/n/h/f/g ad
|
$XXX.XX
|
N1
|
N
|
| 15157 |
Tis clt agrft f/s/n/h/f/g ea
|
$XXX.XX
|
N1
|
N
|
| 15200 |
Fth/gft fr trnk 20 sq cm/<
|
$XXX.XX
|
A2
|
Y
|
| 15201 |
Fth/gft fr trnk each addl
|
$XXX.XX
|
N1
|
N
|
| 15220 |
Fth/gft fr s/a/l 20 sq cm/<
|
$XXX.XX
|
A2
|
Y
|
| 15221 |
Fth/gft fr s/a/l each addl
|
$XXX.XX
|
N1
|
N
|
| 15240 |
Fth/gft f/c/c/m/n/ax/g/h/f20
|
$XXX.XX
|
A2
|
Y
|
| 15241 |
Fth/gft f/c/c/m/n/a/g/h/f ea
|
$XXX.XX
|
N1
|
N
|
| 15260 |
Fth/gft fr n/e/e/l 20 sqcm/<
|
$XXX.XX
|
A2
|
Y
|
| 15261 |
Fth/gft fr n/e/e/l each addl
|
$XXX.XX
|
N1
|
N
|
| 15271 |
Skin sub graft trnk/arm/leg
|
$XXX.XX
|
G2
|
Y
|
| 15272 |
Skin sub graft t/a/l add-on
|
$XXX.XX
|
N1
|
N
|
| 15273 |
Skin sub grft t/arm/lg child
|
$XXX.XX
|
G2
|
Y
|
| 15274 |
Skn sub grft t/a/l child add
|
$XXX.XX
|
N1
|
N
|
| 15275 |
Skin sub graft face/nk/hf/g
|
$XXX.XX
|
P3
|
Y
|
| 15276 |
Skin sub graft f/n/hf/g addl
|
$XXX.XX
|
N1
|
N
|
| 15277 |
Skn sub grft f/n/hf/g child
|
$XXX.XX
|
G2
|
Y
|
| 15278 |
Skn sub grft f/n/hf/g ch add
|
$XXX.XX
|
N1
|
N
|
| 15570 |
Skin pedicle flap trunk
|
$XXX.XX
|
A2
|
Y
|
| 15572 |
Skin pedicle flap arms/legs
|
$XXX.XX
|
A2
|
Y
|
| 15574 |
Pedcle fh/ch/ch/m/n/ax/g/h/f
|
$XXX.XX
|
A2
|
Y
|
| 15576 |
Pedicle e/n/e/l/ntroral
|
$XXX.XX
|
A2
|
Y
|
| 15600 |
Delay flap trunk
|
$XXX.XX
|
A2
|
Y
|
| 15610 |
Delay flap arms/legs
|
$XXX.XX
|
A2
|
Y
|
| 15620 |
Delay flap f/c/c/n/ax/g/h/f
|
$XXX.XX
|
A2
|
Y
|
| 15630 |
Delay flap eye/nos/ear/lip
|
$XXX.XX
|
A2
|
Y
|
| 15650 |
Transfer skin pedicle flap
|
$XXX.XX
|
A2
|
Y
|
| 15730 |
Mdfc flap w/prsrv vasc pedcl
|
$XXX.XX
|
G2
|
Y
|
| 15731 |
Forehead flap w/vasc pedicle
|
$XXX.XX
|
A2
|
Y
|
| 15733 |
Musc myoq/fscq flp h&n pedcl
|
$XXX.XX
|
A2
|
Y
|
| 15734 |
Muscle-skin graft trunk
|
$XXX.XX
|
A2
|
Y
|
| 15736 |
Muscle-skin graft arm
|
$XXX.XX
|
A2
|
Y
|
| 15738 |
Muscle-skin graft leg
|
$XXX.XX
|
A2
|
Y
|
| 15740 |
Island pedicle flap graft
|
$XXX.XX
|
A2
|
Y
|
| 15750 |
Neurovascular pedicle flap
|
$XXX.XX
|
A2
|
Y
|
| 15760 |
Composite skin graft
|
$XXX.XX
|
A2
|
Y
|
| 15769 |
Grfg autol soft tiss dir exc
|
$XXX.XX
|
G2
|
Y
|
| 15770 |
Derma-fat-fascia graft
|
$XXX.XX
|
A2
|
Y
|
| 15771 |
Grfg autol fat lipo 50 cc/<
|
$XXX.XX
|
G2
|
Y
|
| 15773 |
Grfg autol fat lipo 25 cc/<
|
$XXX.XX
|
G2
|
Y
|
| 15775 |
Hair trnspl 1-15 punch grfts
|
$XXX.XX
|
A2
|
Y
|
| 15776 |
Hair trnspl >15 punch grafts
|
$XXX.XX
|
A2
|
Y
|
| 15777 |
Acellular derm matrix implt
|
$XXX.XX
|
N1
|
N
|
| 15780 |
Dermabrasion total face
|
$XXX.XX
|
P3
|
Y
|
| 15781 |
Dermabrasion segmental face
|
$XXX.XX
|
P3
|
Y
|
| 15782 |
Dermabrasion other than face
|
$XXX.XX
|
P3
|
Y
|
| 15783 |
Dermabrasion suprfl any site
|
$XXX.XX
|
P2
|
Y
|
| 15786 |
Abrasion lesion single
|
$XXX.XX
|
N1
|
N
|
| 15787 |
Abrasion lesions add-on
|
$XXX.XX
|
N1
|
N
|
| 15788 |
Chemical peel facial epidrm
|
$XXX.XX
|
N1
|
N
|
| 15789 |
Chemical peel facial dermal
|
$XXX.XX
|
P3
|
Y
|
| 15792 |
Chem peel nonfacial epidrm
|
$XXX.XX
|
N1
|
N
|
| 15793 |
Chemical peel nonfacial drm
|
$XXX.XX
|
N1
|
N
|
| 15820 |
Blepharoplasty lower eyelid
|
$XXX.XX
|
A2
|
Y
|
| 15821 |
Blepharp lwr eyelid fat pad
|
$XXX.XX
|
A2
|
Y
|
| 15822 |
Blepharoplasty upper eyelid
|
$XXX.XX
|
A2
|
Y
|
| 15823 |
Blepharp upr eyelid xcsv skn
|
$XXX.XX
|
A2
|
Y
|
| 15824 |
Rhytidectomy forehead
|
$XXX.XX
|
A2
|
Y
|
| 15825 |
Rhytdct nck pltysml tghtg
|
$XXX.XX
|
A2
|
Y
|
| 15826 |
Rhytidectomy glblr frn lines
|
$XXX.XX
|
A2
|
Y
|
| 15828 |
Rhytidectomy cheek chn & nck
|
$XXX.XX
|
A2
|
Y
|
| 15829 |
Rhytidectomy smas flap
|
$XXX.XX
|
A2
|
Y
|
| 15830 |
Exc excessive skin abdomen
|
$XXX.XX
|
A2
|
Y
|
| 15832 |
Exc excessive skin thigh
|
$XXX.XX
|
A2
|
Y
|
| 15833 |
Exc excessive skin leg
|
$XXX.XX
|
A2
|
Y
|
| 15834 |
Exc excessive skin hip
|
$XXX.XX
|
A2
|
Y
|
| 15835 |
Exc excessive skin buttock
|
$XXX.XX
|
A2
|
Y
|
| 15836 |
Exc excessive skin arm
|
$XXX.XX
|
A2
|
Y
|
| 15837 |
Exc excsv skin forearm/hand
|
$XXX.XX
|
G2
|
Y
|
| 15838 |
Exc excsv submental fat pad
|
$XXX.XX
|
G2
|
Y
|
| 15839 |
Exc excessive skn other area
|
$XXX.XX
|
A2
|
Y
|
| 15840 |
Nerve palsy fascial graft
|
$XXX.XX
|
A2
|
Y
|
| 15841 |
Nerve palsy muscle graft
|
$XXX.XX
|
A2
|
Y
|
| 15842 |
Nerve palsy microsurg graft
|
$XXX.XX
|
G2
|
Y
|
| 15845 |
Skin and muscle repair face
|
$XXX.XX
|
A2
|
Y
|
| 15847 |
Exc skin abd add-on
|
$XXX.XX
|
N1
|
N
|
| 15851 |
Removal sutr/staple req anes
|
$XXX.XX
|
R2
|
Y
|
| 15852 |
Dressing change not for burn
|
$XXX.XX
|
N1
|
N
|
| 15860 |
Iv njx tst vasc flo flap/grf
|
$XXX.XX
|
N1
|
N
|
| 15876 |
Suction lipectomy head&neck
|
$XXX.XX
|
A2
|
Y
|
| 15877 |
Suction lipectomy trunk
|
$XXX.XX
|
A2
|
Y
|
| 15878 |
Suction lipectomy upr extrem
|
$XXX.XX
|
A2
|
Y
|
| 15879 |
Suction lipectomy lwr extrem
|
$XXX.XX
|
A2
|
Y
|
| 15920 |
Exc coccygl pr ulc prim sutr
|
$XXX.XX
|
A2
|
Y
|
| 15922 |
Exc coccygl pr ulc flap clsr
|
$XXX.XX
|
A2
|
Y
|
| 15931 |
Exc sacral pr ulc prim sutr
|
$XXX.XX
|
A2
|
Y
|
| 15933 |
Exc sac pr ulc prim str ostc
|
$XXX.XX
|
A2
|
Y
|
| 15934 |
Exc sacral pr ulc skn flap
|
$XXX.XX
|
A2
|
Y
|
| 15935 |
Exc sac pr ulc skn flp ostc
|
$XXX.XX
|
A2
|
Y
|
| 15936 |
Exc sac pr ulc prep mus flap
|
$XXX.XX
|
A2
|
Y
|
| 15937 |
Exc sac pr ulc prep mus ostc
|
$XXX.XX
|
A2
|
Y
|
| 15940 |
Exc ischial pr ulc prim sutr
|
$XXX.XX
|
A2
|
Y
|
| 15941 |
Exc isch pr ulc prm sut ostc
|
$XXX.XX
|
A2
|
Y
|
| 15944 |
Exc isch pr ulc skn flp clsr
|
$XXX.XX
|
A2
|
Y
|
| 15945 |
Exc isch pr ulc skn flp ostc
|
$XXX.XX
|
A2
|
Y
|
| 15946 |
Exc isch pr ulc prep mus flp
|
$XXX.XX
|
A2
|
Y
|
| 15950 |
Exc trchntr pr ulc prim sutr
|
$XXX.XX
|
A2
|
Y
|
| 15951 |
Exc trchntr pr ulc ostc
|
$XXX.XX
|
A2
|
Y
|
| 15952 |
Exc trchntr pr ulc flp clsr
|
$XXX.XX
|
A2
|
Y
|
| 15953 |
Exc trchntr pr ulc flp ostc
|
$XXX.XX
|
A2
|
Y
|
| 15956 |
Exc trchntr pr ulc prep flap
|
$XXX.XX
|
A2
|
Y
|
| 15958 |
Exc trchntr pr ulc prep ostc
|
$XXX.XX
|
A2
|
Y
|
| 16000 |
Initial treatment of burn(s)
|
$XXX.XX
|
N1
|
N
|
| 16020 |
Dress/debrid p-thick burn s
|
$XXX.XX
|
N1
|
N
|
| 16025 |
Dress/debrid p-thick burn m
|
$XXX.XX
|
A2
|
Y
|
| 16030 |
Dress/debrid p-thick burn l
|
$XXX.XX
|
A2
|
Y
|
| 16035 |
Escharotomy 1st incision
|
$XXX.XX
|
G2
|
Y
|
| 17000 |
Destruct premalg lesion
|
$XXX.XX
|
N1
|
N
|
| 17003 |
Destruct premalg les 2-14
|
$XXX.XX
|
N1
|
N
|
| 17004 |
Destroy premal lesions 15/>
|
$XXX.XX
|
P3
|
Y
|
| 17106 |
Dstr cut vsc prlf les<10sqcm
|
$XXX.XX
|
P3
|
Y
|
| 17107 |
Dstr cut vsc prlf les10-50sq
|
$XXX.XX
|
P3
|
Y
|
| 17108 |
Dstr cut vsc prlf les>50sqcm
|
$XXX.XX
|
P3
|
Y
|
| 17110 |
Destruction b9 les up to 14
|
$XXX.XX
|
N1
|
N
|
| 17111 |
Destruction b9 lesions 15/>
|
$XXX.XX
|
N1
|
N
|
| 17250 |
Chem caut of granltj tissue
|
$XXX.XX
|
N1
|
N
|
| 17260 |
Dstrj mal les t/a/l 0.5 cm/<
|
$XXX.XX
|
N1
|
N
|
| 17261 |
Dstrj mal les t/a/l .6-1.0cm
|
$XXX.XX
|
N1
|
N
|
| 17262 |
Dstrj mal les t/a/l 1.1-2.0
|
$XXX.XX
|
N1
|
N
|
| 17263 |
Dstrj mal les t/a/l 2.1-3.0
|
$XXX.XX
|
N1
|
N
|
| 17264 |
Dstrj mal les t/a/l 3.1-4.0
|
$XXX.XX
|
P3
|
Y
|
| 17266 |
Dstrj mal les t/a/l >4.0 cm
|
$XXX.XX
|
P3
|
Y
|
| 17270 |
Dstr mal les s/n/h/f/g .5 /<
|
$XXX.XX
|
P3
|
Y
|
| 17271 |
Dstr mal les s/n/h/f/g 0.6-1
|
$XXX.XX
|
P3
|
Y
|
| 17272 |
Dstr mal les s/n/h/f/g 1.1-2
|
$XXX.XX
|
N1
|
N
|
| 17273 |
Dstr mal les s/n/h/f/g 2.1-3
|
$XXX.XX
|
P3
|
Y
|
| 17274 |
Dstr mal les s/n/h/f/g 3.1-4
|
$XXX.XX
|
P3
|
Y
|
| 17276 |
Dstr mal les s/n/h/f/g >4.0
|
$XXX.XX
|
P3
|
Y
|
| 17280 |
Dstr mal ls f/e/e/n/l/m .5/<
|
$XXX.XX
|
N1
|
N
|
| 17281 |
Dstr mal ls f/e/e/n/l/m .6-1
|
$XXX.XX
|
P2
|
Y
|
| 17282 |
Dstr mal ls f/e/e/n/l/m1.1-2
|
$XXX.XX
|
P2
|
Y
|
| 17283 |
Dstr mal ls f/e/e/n/l/m2.1-3
|
$XXX.XX
|
P3
|
Y
|
| 17284 |
Dstr mal ls f/e/e/n/l/m3.1-4
|
$XXX.XX
|
P3
|
Y
|
| 17286 |
Dstr mal ls f/e/e/n/l/m>4.0
|
$XXX.XX
|
P3
|
Y
|
| 17311 |
Mohs 1 stage h/n/hf/g
|
$XXX.XX
|
P2
|
Y
|
| 17312 |
Mohs addl stage
|
$XXX.XX
|
N1
|
N
|
| 17313 |
Mohs 1 stage t/a/l
|
$XXX.XX
|
P2
|
Y
|
| 17314 |
Mohs addl stage t/a/l
|
$XXX.XX
|
N1
|
N
|
| 17315 |
Mohs surg addl block
|
$XXX.XX
|
N1
|
N
|
| 17340 |
Cryotherapy for acne
|
$XXX.XX
|
N1
|
N
|
| 17360 |
Chemical exfoliation acne
|
$XXX.XX
|
N1
|
N
|
| 17380 |
Electrolysis epilation ea 30
|
$XXX.XX
|
R2
|
Y
|
| 19000 |
Puncture aspir cyst breast
|
$XXX.XX
|
P3
|
Y
|
| 19001 |
Puncture aspir cyst brst ea
|
$XXX.XX
|
N1
|
N
|
| 19020 |
Mastotomy expl drg absc dp
|
$XXX.XX
|
A2
|
Y
|
| 19030 |
Njx px only mam ducto/glcto
|
$XXX.XX
|
N1
|
N
|
| 19081 |
Bx breast 1st lesion strtctc
|
$XXX.XX
|
G2
|
Y
|
| 19082 |
Bx breast add lesion strtctc
|
$XXX.XX
|
N1
|
N
|
| 19083 |
Bx breast 1st lesion us imag
|
$XXX.XX
|
G2
|
Y
|
| 19084 |
Bx breast add lesion us imag
|
$XXX.XX
|
N1
|
N
|
| 19085 |
Bx breast 1st lesion mr imag
|
$XXX.XX
|
G2
|
Y
|
| 19086 |
Bx breast add lesion mr imag
|
$XXX.XX
|
N1
|
N
|
| 19100 |
Bx breast percut w/o image
|
$XXX.XX
|
A2
|
Y
|
| 19101 |
Biopsy of breast open
|
$XXX.XX
|
A2
|
Y
|
| 19105 |
Cryosurg ablate fa each
|
$XXX.XX
|
J8
|
Y
|
| 19110 |
Nipple exploration
|
$XXX.XX
|
A2
|
Y
|
| 19112 |
Excise breast duct fistula
|
$XXX.XX
|
A2
|
Y
|
| 19120 |
Removal of breast lesion
|
$XXX.XX
|
A2
|
Y
|
| 19125 |
Excision breast lesion
|
$XXX.XX
|
A2
|
Y
|
| 19126 |
Excision addl breast lesion
|
$XXX.XX
|
N1
|
N
|
| 19281 |
Perq device breast 1st imag
|
$XXX.XX
|
N1
|
N
|
| 19282 |
Perq device breast ea imag
|
$XXX.XX
|
N1
|
N
|
| 19283 |
Perq dev breast 1st strtctc
|
$XXX.XX
|
N1
|
N
|
| 19284 |
Perq dev breast add strtctc
|
$XXX.XX
|
N1
|
N
|
| 19285 |
Perq dev breast 1st us imag
|
$XXX.XX
|
N1
|
N
|
| 19286 |
Perq dev breast add us imag
|
$XXX.XX
|
N1
|
N
|
| 19287 |
Perq dev breast 1st mr guide
|
$XXX.XX
|
N1
|
N
|
| 19288 |
Perq dev breast add mr guide
|
$XXX.XX
|
N1
|
N
|
| 19294 |
Prepj tum cav iort prtl mast
|
$XXX.XX
|
N1
|
N
|
| 19296 |
Place po breast cath for rad
|
$XXX.XX
|
J8
|
Y
|
| 19297 |
Place breast cath for rad
|
$XXX.XX
|
N1
|
N
|
| 19298 |
Place breast rad tube/caths
|
$XXX.XX
|
J8
|
Y
|
| 19300 |
Mastectomy for gynecomastia
|
$XXX.XX
|
A2
|
Y
|
| 19301 |
Partial mastectomy
|
$XXX.XX
|
A2
|
Y
|
| 19302 |
P-mastectomy w/ln removal
|
$XXX.XX
|
A2
|
Y
|
| 19303 |
Mast simple complete
|
$XXX.XX
|
A2
|
Y
|
| 19307 |
Mast mod rad
|
$XXX.XX
|
G2
|
Y
|
| 19316 |
Mastopexy
|
$XXX.XX
|
A2
|
Y
|
| 19318 |
Breast reduction
|
$XXX.XX
|
A2
|
Y
|
| 19325 |
Breast augmentation w/implt
|
$XXX.XX
|
G2
|
Y
|
| 19328 |
Rmvl intact breast implant
|
$XXX.XX
|
A2
|
N
|
| 19330 |
Rmvl ruptured breast implant
|
$XXX.XX
|
A2
|
N
|
| 19340 |
Insj breast implt sm d mast
|
$XXX.XX
|
A2
|
Y
|
| 19342 |
Insj/rplcmt brst implt sep d
|
$XXX.XX
|
A2
|
Y
|
| 19350 |
Nipple/areola reconstruction
|
$XXX.XX
|
A2
|
Y
|
| 19355 |
Correct inverted nipple(s)
|
$XXX.XX
|
A2
|
Y
|
| 19357 |
Tiss xpndr plmt brst rcnstj
|
$XXX.XX
|
J8
|
Y
|
| 19370 |
Revj peri-implt capsule brst
|
$XXX.XX
|
A2
|
Y
|
| 19371 |
Peri-implt capslc brst compl
|
$XXX.XX
|
A2
|
Y
|
| 19380 |
Revj reconstructed breast
|
$XXX.XX
|
A2
|
Y
|
| 19396 |
Design custom breast implant
|
$XXX.XX
|
G2
|
Y
|
| 20100 |
Expl pentrg wound neck
|
$XXX.XX
|
G2
|
Y
|
| 20101 |
Expl pentrg wound chest
|
$XXX.XX
|
G2
|
Y
|
| 20102 |
Expl pentrg wnd abd/flnk/bk
|
$XXX.XX
|
G2
|
Y
|
| 20103 |
Expl pentrg wound extremity
|
$XXX.XX
|
G2
|
Y
|
| 20150 |
Excision epiphyseal bar
|
$XXX.XX
|
G2
|
Y
|
| 20200 |
Muscle biopsy superficial
|
$XXX.XX
|
A2
|
Y
|
| 20205 |
Deep muscle biopsy
|
$XXX.XX
|
A2
|
Y
|
| 20206 |
Biopsy muscle perq needle
|
$XXX.XX
|
A2
|
Y
|
| 20220 |
Bone biopsy trocar/ndl supfc
|
$XXX.XX
|
A2
|
Y
|
| 20225 |
Bone biopsy trocar/ndl deep
|
$XXX.XX
|
A2
|
Y
|
| 20240 |
Bone biopsy open superficial
|
$XXX.XX
|
A2
|
Y
|
| 20245 |
Bone biopsy open deep
|
$XXX.XX
|
A2
|
Y
|
| 20250 |
Biopsy vrt bdy open thoracic
|
$XXX.XX
|
G2
|
Y
|
| 20251 |
Biopsy vrt bdy open lmbr/crv
|
$XXX.XX
|
A2
|
Y
|
| 20500 |
Njx sinus tract therapeutic
|
$XXX.XX
|
P3
|
Y
|
| 20501 |
Njx sinus tract diagnostic
|
$XXX.XX
|
N1
|
N
|
| 20520 |
Rmvl fb musc/tdn simple
|
$XXX.XX
|
P3
|
Y
|
| 20525 |
Rmvl fb musc/tdn deep/comp
|
$XXX.XX
|
A2
|
Y
|
| 20526 |
Ther injection carp tunnel
|
$XXX.XX
|
P3
|
Y
|
| 20527 |
Njx nzm palmar fascial cord
|
$XXX.XX
|
P3
|
Y
|
| 20550 |
Njx 1 tendon sheath/ligament
|
$XXX.XX
|
P3
|
Y
|
| 20551 |
Njx 1 tendon origin/insj
|
$XXX.XX
|
P3
|
Y
|
| 20552 |
Njx 1/mlt trigger point 1/2
|
$XXX.XX
|
P3
|
Y
|
| 20553 |
Njx 1/mlt trigger points 3/>
|
$XXX.XX
|
P3
|
Y
|
| 20555 |
Place ndl musc/tis for rt
|
$XXX.XX
|
R2
|
Y
|
| 20600 |
Drain/inj joint/bursa w/o us
|
$XXX.XX
|
P3
|
Y
|
| 20604 |
Drain/inj joint/bursa w/us
|
$XXX.XX
|
P3
|
Y
|
| 20605 |
Drain/inj joint/bursa w/o us
|
$XXX.XX
|
P3
|
Y
|
| 20606 |
Drain/inj joint/bursa w/us
|
$XXX.XX
|
P3
|
Y
|
| 20610 |
Drain/inj joint/bursa w/o us
|
$XXX.XX
|
P3
|
Y
|
| 20611 |
Drain/inj joint/bursa w/us
|
$XXX.XX
|
P3
|
Y
|
| 20612 |
Aspirate/inj ganglion cyst
|
$XXX.XX
|
P3
|
Y
|
| 20615 |
Treatment of bone cyst
|
$XXX.XX
|
P3
|
Y
|
| 20650 |
Insert and remove bone pin
|
$XXX.XX
|
G2
|
Y
|
| 20660 |
Apply rem fixation device
|
$XXX.XX
|
G2
|
N
|
| 20661 |
Application halo cranial
|
$XXX.XX
|
J8
|
N
|
| 20662 |
Application halo pelvic
|
$XXX.XX
|
R2
|
Y
|
| 20663 |
Application halo femoral
|
$XXX.XX
|
R2
|
Y
|
| 20664 |
Appl halo cranial 6+pins
|
$XXX.XX
|
J8
|
N
|
| 20665 |
Rmvl tongs/halo anthr indiv
|
$XXX.XX
|
G2
|
N
|
| 20670 |
Removal implant superficial
|
$XXX.XX
|
A2
|
N
|
| 20680 |
Removal of implant deep
|
$XXX.XX
|
A2
|
N
|
| 20690 |
Appl unipln uni ext fixj sys
|
$XXX.XX
|
J8
|
Y
|
| 20692 |
Appl mltpln uni ext fixj sys
|
$XXX.XX
|
J8
|
Y
|
| 20693 |
Adjmt/revj ext fixj sys anes
|
$XXX.XX
|
A2
|
Y
|
| 20694 |
Rmvl ext fixj sys under anes
|
$XXX.XX
|
A2
|
N
|
| 20696 |
App mltpln uni xtrnl fix 1st
|
$XXX.XX
|
J8
|
Y
|
| 20697 |
App mltpln uni xtrnl fix xch
|
$XXX.XX
|
P2
|
Y
|
| 20700 |
Mnl prep&insj dp rx dlvr dev
|
$XXX.XX
|
N1
|
N
|
| 20802 |
Replantation arm complete
|
$XXX.XX
|
J8
|
Y
|
| 20805 |
Replant forearm complete
|
$XXX.XX
|
J8
|
Y
|
| 20808 |
Replantation hand complete
|
$XXX.XX
|
J8
|
Y
|
| 20816 |
Replantation digit complete
|
$XXX.XX
|
J8
|
Y
|
| 20822 |
Replantation digit complete
|
$XXX.XX
|
G2
|
Y
|
| 20824 |
Replantation thumb complete
|
$XXX.XX
|
J8
|
Y
|
| 20827 |
Replantation thumb complete
|
$XXX.XX
|
G2
|
Y
|
| 20838 |
Replantation foot complete
|
$XXX.XX
|
J8
|
Y
|
| 20900 |
Removal of bone for graft
|
$XXX.XX
|
J8
|
Y
|
| 20902 |
Removal of bone for graft
|
$XXX.XX
|
A2
|
Y
|
| 20910 |
Remove cartilage for graft
|
$XXX.XX
|
A2
|
Y
|
| 20912 |
Remove cartilage for graft
|
$XXX.XX
|
A2
|
Y
|
| 20920 |
Removal of fascia for graft
|
$XXX.XX
|
A2
|
Y
|
| 20922 |
Removal of fascia for graft
|
$XXX.XX
|
A2
|
Y
|
| 20924 |
Removal of tendon for graft
|
$XXX.XX
|
A2
|
Y
|
| 20930 |
Sp bone algrft morsel add-on
|
$XXX.XX
|
N1
|
N
|
| 20931 |
Sp bone algrft struct add-on
|
$XXX.XX
|
N1
|
N
|
| 20932 |
Osteoart algrft w/surf & b1
|
$XXX.XX
|
N1
|
N
|
| 20933 |
Hemicrt intrclry algrft prtl
|
$XXX.XX
|
N1
|
N
|
| 20934 |
Intercalary algrft compl
|
$XXX.XX
|
N1
|
N
|
| 20936 |
Sp bone agrft local add-on
|
$XXX.XX
|
N1
|
N
|
| 20937 |
Sp bone agrft morsel add-on
|
$XXX.XX
|
N1
|
N
|
| 20938 |
Sp bone agrft struct add-on
|
$XXX.XX
|
N1
|
N
|
| 20939 |
Bone marrow aspir bone grfg
|
$XXX.XX
|
N1
|
N
|
| 20950 |
Mntr intrstitial fluid press
|
$XXX.XX
|
G2
|
Y
|
| 20955 |
Fibula bone graft microvasc
|
$XXX.XX
|
J8
|
Y
|
| 20956 |
Iliac bone graft microvasc
|
$XXX.XX
|
J8
|
Y
|
| 20957 |
Mt bone graft microvasc
|
$XXX.XX
|
J8
|
Y
|
| 20962 |
Other bone graft microvasc
|
$XXX.XX
|
J8
|
Y
|
| 20969 |
Bone/skin graft microvasc
|
$XXX.XX
|
J8
|
Y
|
| 20970 |
Bone/skin graft iliac crest
|
$XXX.XX
|
J8
|
Y
|
| 20972 |
Bone/skin graft metatarsal
|
$XXX.XX
|
G2
|
Y
|
| 20973 |
Bone/skin graft great toe
|
$XXX.XX
|
J8
|
Y
|
| 20975 |
Estim aid bone healg invasiv
|
$XXX.XX
|
N1
|
N
|
| 20979 |
Lw ntsty us stimj bone healg
|
$XXX.XX
|
N1
|
N
|
| 20982 |
Ablate bone tumor(s) perq
|
$XXX.XX
|
G2
|
Y
|
| 20983 |
Ablate bone tumor(s) perq
|
$XXX.XX
|
J8
|
Y
|
| 20985 |
Cptr-asst dir ms px
|
$XXX.XX
|
N1
|
N
|
| 21010 |
Incision of jaw joint
|
$XXX.XX
|
A2
|
Y
|
| 21011 |
Exc face les sc <2 cm
|
$XXX.XX
|
P3
|
Y
|
| 21012 |
Exc face les sbq 2 cm/>
|
$XXX.XX
|
R2
|
Y
|
| 21013 |
Exc face tum deep < 2 cm
|
$XXX.XX
|
P3
|
Y
|
| 21014 |
Exc face tum deep 2 cm/>
|
$XXX.XX
|
R2
|
Y
|
| 21015 |
Resect face/scalp tum < 2 cm
|
$XXX.XX
|
G2
|
Y
|
| 21016 |
Resect face/scalp tum 2 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 21025 |
Excision of bone lower jaw
|
$XXX.XX
|
A2
|
Y
|
| 21026 |
Excision of facial bone(s)
|
$XXX.XX
|
A2
|
Y
|
| 21029 |
Contour of face bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 21030 |
Excise max/zygoma b9 tumor
|
$XXX.XX
|
P3
|
Y
|
| 21031 |
Remove exostosis mandible
|
$XXX.XX
|
P3
|
Y
|
| 21032 |
Remove exostosis maxilla
|
$XXX.XX
|
P3
|
Y
|
| 21034 |
Excise max/zygoma mal tumor
|
$XXX.XX
|
A2
|
Y
|
| 21040 |
Excise mandible lesion
|
$XXX.XX
|
A2
|
Y
|
| 21044 |
Removal of jaw bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 21045 |
Extensive jaw surgery
|
$XXX.XX
|
G2
|
Y
|
| 21046 |
Remove mandible cyst complex
|
$XXX.XX
|
A2
|
Y
|
| 21047 |
Excise lwr jaw cyst w/repair
|
$XXX.XX
|
A2
|
Y
|
| 21048 |
Remove maxilla cyst complex
|
$XXX.XX
|
R2
|
Y
|
| 21049 |
Excis uppr jaw cyst w/repair
|
$XXX.XX
|
G2
|
Y
|
| 21050 |
Removal of jaw joint
|
$XXX.XX
|
A2
|
Y
|
| 21060 |
Remove jaw joint cartilage
|
$XXX.XX
|
A2
|
Y
|
| 21070 |
Remove coronoid process
|
$XXX.XX
|
A2
|
Y
|
| 21073 |
Mnpj of tmj w/anesth
|
$XXX.XX
|
P3
|
Y
|
| 21076 |
Impres&prep surg obt prosth
|
$XXX.XX
|
P3
|
Y
|
| 21077 |
Impres&prep orbital prosth
|
$XXX.XX
|
P3
|
Y
|
| 21079 |
Impres&prep intrm obt prosth
|
$XXX.XX
|
P3
|
Y
|
| 21080 |
Impres&prep def obt prosth
|
$XXX.XX
|
P3
|
Y
|
| 21081 |
Impres&prep mndbl res prosth
|
$XXX.XX
|
P3
|
Y
|
| 21082 |
Impres&prep paltl aug prosth
|
$XXX.XX
|
P3
|
Y
|
| 21083 |
Impres&prep paltl lft prosth
|
$XXX.XX
|
P3
|
Y
|
| 21084 |
Impres&prep sp aid prosth
|
$XXX.XX
|
P3
|
Y
|
| 21085 |
Impres&prep oral surg splint
|
$XXX.XX
|
P2
|
Y
|
| 21086 |
Impres&prep auricular prosth
|
$XXX.XX
|
P3
|
Y
|
| 21087 |
Impres&prep nasal prosth
|
$XXX.XX
|
P3
|
Y
|
| 21088 |
Impres&prep facial prosth
|
$XXX.XX
|
R2
|
Y
|
| 21100 |
Maxillofacial fixation
|
$XXX.XX
|
A2
|
Y
|
| 21110 |
Interdental fixation
|
$XXX.XX
|
P3
|
N
|
| 21116 |
Injection jaw joint x-ray
|
$XXX.XX
|
N1
|
N
|
| 21120 |
Genioplasty augmentation
|
$XXX.XX
|
G2
|
Y
|
| 21121 |
Geniop sldg osteot 1
|
$XXX.XX
|
J8
|
Y
|
| 21122 |
Geniop sldg osteot 2/>
|
$XXX.XX
|
A2
|
Y
|
| 21123 |
Geniop sldg augmentation
|
$XXX.XX
|
A2
|
Y
|
| 21125 |
Augmentation mndblr prostc
|
$XXX.XX
|
J8
|
Y
|
| 21127 |
Augmentation mndblr b1 grf
|
$XXX.XX
|
P2
|
Y
|
| 21137 |
Rdctj forehead cntrg only
|
$XXX.XX
|
G2
|
Y
|
| 21138 |
Rdctj forehead cntrg&prostc
|
$XXX.XX
|
G2
|
Y
|
| 21139 |
Rdctj forehead cntrg&setback
|
$XXX.XX
|
G2
|
Y
|
| 21141 |
Rcnstj midface lefort i 1pc
|
$XXX.XX
|
G2
|
Y
|
| 21142 |
Rcnstj midface lefort i 2pcs
|
$XXX.XX
|
J8
|
Y
|
| 21143 |
Rcnstj mdface lefort i 3/>pc
|
$XXX.XX
|
G2
|
Y
|
| 21145 |
Rcnstj mdfc lefort i 1 w/grf
|
$XXX.XX
|
J8
|
Y
|
| 21146 |
Rcnstj mdfc lefort i 2 w/grf
|
$XXX.XX
|
J8
|
Y
|
| 21147 |
Rcnstj mdfc lefort i 3/>grf
|
$XXX.XX
|
J8
|
Y
|
| 21150 |
Rcnstj mdfc lefrtii ant ntru
|
$XXX.XX
|
J8
|
Y
|
| 21151 |
Rcnstj mdfc lefrtii w/b1 grf
|
$XXX.XX
|
J8
|
Y
|
| 21154 |
Rcnstj mdfc lefort iii w/o i
|
$XXX.XX
|
J8
|
Y
|
| 21155 |
Rcnstj mdfc lefort iii w/i
|
$XXX.XX
|
J8
|
Y
|
| 21159 |
Rcnst mdfc lfrtiii advm wo i
|
$XXX.XX
|
J8
|
Y
|
| 21160 |
Rcnst mdfc lfrtiii advm w/i
|
$XXX.XX
|
J8
|
Y
|
| 21172 |
Rcnst supr-lat orb rm&lw fhd
|
$XXX.XX
|
G2
|
Y
|
| 21175 |
Rcnst bfrnt sp orb rm&lw fhd
|
$XXX.XX
|
G2
|
Y
|
| 21179 |
Rcnstj forehead with grafts
|
$XXX.XX
|
J8
|
Y
|
| 21180 |
Rcnstj forehead w/autograft
|
$XXX.XX
|
J8
|
Y
|
| 21181 |
Rcnst cntrg b9 tum crnl xtrc
|
$XXX.XX
|
A2
|
Y
|
| 21182 |
Reconstruct cranial bone
|
$XXX.XX
|
J8
|
Y
|
| 21183 |
Reconstruct cranial bone
|
$XXX.XX
|
J8
|
Y
|
| 21184 |
Reconstruct cranial bone
|
$XXX.XX
|
J8
|
Y
|
| 21188 |
Reconstruction of midface
|
$XXX.XX
|
J8
|
Y
|
| 21193 |
Reconst lwr jaw w/o graft
|
$XXX.XX
|
G2
|
Y
|
| 21194 |
Reconst lwr jaw w/graft
|
$XXX.XX
|
J8
|
Y
|
| 21195 |
Reconst lwr jaw w/o fixation
|
$XXX.XX
|
J8
|
Y
|
| 21196 |
Reconst lwr jaw w/fixation
|
$XXX.XX
|
G2
|
Y
|
| 21198 |
Reconstr lwr jaw segment
|
$XXX.XX
|
R2
|
Y
|
| 21199 |
Reconstr lwr jaw w/advance
|
$XXX.XX
|
G2
|
Y
|
| 21206 |
Reconstruct upper jaw bone
|
$XXX.XX
|
A2
|
Y
|
| 21208 |
Augmentation of facial bones
|
$XXX.XX
|
A2
|
Y
|
| 21209 |
Reduction of facial bones
|
$XXX.XX
|
A2
|
Y
|
| 21210 |
Face bone graft
|
$XXX.XX
|
A2
|
Y
|
| 21215 |
Lower jaw bone graft
|
$XXX.XX
|
A2
|
Y
|
| 21230 |
Rib cartilage graft
|
$XXX.XX
|
A2
|
Y
|
| 21235 |
Ear cartilage graft
|
$XXX.XX
|
A2
|
Y
|
| 21240 |
Reconstruction of jaw joint
|
$XXX.XX
|
A2
|
Y
|
| 21242 |
Reconstruction of jaw joint
|
$XXX.XX
|
A2
|
Y
|
| 21243 |
Reconstruction of jaw joint
|
$XXX.XX
|
J8
|
Y
|
| 21244 |
Reconstruction of lower jaw
|
$XXX.XX
|
J8
|
Y
|
| 21245 |
Reconstruction of jaw
|
$XXX.XX
|
J8
|
Y
|
| 21246 |
Reconstruction of jaw
|
$XXX.XX
|
J8
|
Y
|
| 21247 |
Reconstruct lower jaw bone
|
$XXX.XX
|
G2
|
Y
|
| 21248 |
Reconstruction of jaw
|
$XXX.XX
|
A2
|
Y
|
| 21249 |
Reconstruction of jaw
|
$XXX.XX
|
A2
|
Y
|
| 21255 |
Reconstruct lower jaw bone
|
$XXX.XX
|
J8
|
Y
|
| 21256 |
Reconstruction of orbit
|
$XXX.XX
|
J8
|
Y
|
| 21260 |
Revise eye sockets
|
$XXX.XX
|
G2
|
Y
|
| 21261 |
Revise eye sockets
|
$XXX.XX
|
G2
|
Y
|
| 21263 |
Revise eye sockets
|
$XXX.XX
|
G2
|
Y
|
| 21267 |
Revise eye sockets
|
$XXX.XX
|
J8
|
Y
|
| 21268 |
Revise eye sockets
|
$XXX.XX
|
J8
|
Y
|
| 21270 |
Augmentation cheek bone
|
$XXX.XX
|
J8
|
Y
|
| 21275 |
Revision orbitofacial bones
|
$XXX.XX
|
J8
|
Y
|
| 21280 |
Medial canthopexy
|
$XXX.XX
|
A2
|
Y
|
| 21282 |
Lateral canthopexy
|
$XXX.XX
|
A2
|
Y
|
| 21295 |
Revision of jaw muscle/bone
|
$XXX.XX
|
A2
|
Y
|
| 21296 |
Revision of jaw muscle/bone
|
$XXX.XX
|
A2
|
Y
|
| 21315 |
Clsd tx nsl fx mnpj wo stblj
|
$XXX.XX
|
A2
|
Y
|
| 21320 |
Clsd tx nsl fx w/mnpj&stablj
|
$XXX.XX
|
A2
|
Y
|
| 21325 |
Open tx nose fx uncomplicatd
|
$XXX.XX
|
A2
|
Y
|
| 21330 |
Open tx nose fx w/skele fixj
|
$XXX.XX
|
A2
|
Y
|
| 21335 |
Open tx nose & septal fx
|
$XXX.XX
|
A2
|
Y
|
| 21336 |
Open tx septal fx w/wo stabj
|
$XXX.XX
|
A2
|
Y
|
| 21337 |
Closed tx septal&nose fx
|
$XXX.XX
|
A2
|
Y
|
| 21338 |
Open nasoethmoid fx w/o fixj
|
$XXX.XX
|
A2
|
Y
|
| 21339 |
Open nasoethmoid fx w/ fixj
|
$XXX.XX
|
A2
|
Y
|
| 21340 |
Perq tx nasoethmoid fx
|
$XXX.XX
|
A2
|
Y
|
| 21343 |
Open tx dprsd front sinus fx
|
$XXX.XX
|
J8
|
Y
|
| 21344 |
Open tx compl front sinus fx
|
$XXX.XX
|
G2
|
Y
|
| 21345 |
Closed tx nose/jaw fx
|
$XXX.XX
|
A2
|
Y
|
| 21346 |
Opn tx nasomax fx w/fixj
|
$XXX.XX
|
G2
|
Y
|
| 21347 |
Opn tx nasomax fx multple
|
$XXX.XX
|
J8
|
Y
|
| 21348 |
Opn tx nasomax fx w/graft
|
$XXX.XX
|
J8
|
Y
|
| 21355 |
Perq tx malar fracture
|
$XXX.XX
|
A2
|
Y
|
| 21356 |
Opn tx dprsd zygomatic arch
|
$XXX.XX
|
A2
|
Y
|
| 21360 |
Opn tx dprsd malar fracture
|
$XXX.XX
|
G2
|
Y
|
| 21365 |
Opn tx complx malar fx
|
$XXX.XX
|
G2
|
Y
|
| 21366 |
Opn tx complx malar w/grft
|
$XXX.XX
|
J8
|
Y
|
| 21385 |
Opn tx orbit fx transantral
|
$XXX.XX
|
G2
|
Y
|
| 21386 |
Opn tx orbit fx periorbital
|
$XXX.XX
|
G2
|
Y
|
| 21387 |
Opn tx orbit fx combined
|
$XXX.XX
|
G2
|
Y
|
| 21390 |
Opn tx orbit periorbtl implt
|
$XXX.XX
|
G2
|
Y
|
| 21395 |
Opn tx orbit periorbt w/grft
|
$XXX.XX
|
G2
|
Y
|
| 21400 |
Closed tx orbit w/o manipulj
|
$XXX.XX
|
A2
|
Y
|
| 21401 |
Closed tx orbit w/manipulj
|
$XXX.XX
|
A2
|
Y
|
| 21406 |
Opn tx orbit fx w/o implant
|
$XXX.XX
|
G2
|
Y
|
| 21407 |
Opn tx orbit fx w/implant
|
$XXX.XX
|
G2
|
Y
|
| 21408 |
Opn tx orbit fx w/bone grft
|
$XXX.XX
|
G2
|
Y
|
| 21421 |
Cltx palatal/max fx wire fix
|
$XXX.XX
|
A2
|
Y
|
| 21422 |
Optx palatal/max fracture
|
$XXX.XX
|
J8
|
Y
|
| 21423 |
Optx palatal/max fx comp
|
$XXX.XX
|
J8
|
Y
|
| 21431 |
Cltx craniofacial separation
|
$XXX.XX
|
J8
|
Y
|
| 21432 |
Optx cranfcl sep w/wiring
|
$XXX.XX
|
J8
|
Y
|
| 21433 |
Optx cranfcl sep comp mlt
|
$XXX.XX
|
J8
|
Y
|
| 21435 |
Optx crnfc sep comp int&/xtr
|
$XXX.XX
|
J8
|
Y
|
| 21436 |
Optx crnfcl sep comp mlt int
|
$XXX.XX
|
J8
|
Y
|
| 21440 |
Cltx mndblr/max alv ridge fx
|
$XXX.XX
|
P3
|
Y
|
| 21445 |
Optx mndblr/max alv ridge fx
|
$XXX.XX
|
A2
|
Y
|
| 21450 |
Cltx mndblr fx w/o mnpj
|
$XXX.XX
|
G2
|
Y
|
| 21451 |
Cltx mndblr fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 21452 |
Perq tx mndblr fx xtrnl fixj
|
$XXX.XX
|
A2
|
Y
|
| 21453 |
Cltx mndblr fx ntrdntl fixj
|
$XXX.XX
|
A2
|
Y
|
| 21454 |
Optx mndblr fx xtrnl fixj
|
$XXX.XX
|
A2
|
Y
|
| 21461 |
Optx mndblr fx wo ntrdntl
|
$XXX.XX
|
J8
|
Y
|
| 21462 |
Optx mndblr fx w/ntrdntl
|
$XXX.XX
|
J8
|
Y
|
| 21465 |
Optx mndblr cndylr fx
|
$XXX.XX
|
J8
|
Y
|
| 21470 |
Optx complicated mndblr fx
|
$XXX.XX
|
J8
|
Y
|
| 21480 |
Cltx tmprmand dislc 1st/sbsq
|
$XXX.XX
|
A2
|
Y
|
| 21485 |
Cltx tmprmand dislc comp
|
$XXX.XX
|
A2
|
Y
|
| 21490 |
Optx tmprmand dislocation
|
$XXX.XX
|
J8
|
Y
|
| 21497 |
Interdental wirg oth/thn fx
|
$XXX.XX
|
A2
|
Y
|
| 21501 |
I&d dp absc/hmtma sft ts nck
|
$XXX.XX
|
A2
|
Y
|
| 21502 |
I&d dp abs/hmtm nck rib ostc
|
$XXX.XX
|
A2
|
Y
|
| 21510 |
Inc deep opng b1 crtx thorax
|
$XXX.XX
|
G2
|
Y
|
| 21550 |
Biopsy of neck/chest
|
$XXX.XX
|
G2
|
Y
|
| 21552 |
Exc neck les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 21554 |
Exc neck tum deep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 21555 |
Exc neck les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 21556 |
Exc neck tum deep < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 21557 |
Resect neck thorax tumor<5cm
|
$XXX.XX
|
G2
|
Y
|
| 21558 |
Resect neck tumor 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 21600 |
Partial removal of rib
|
$XXX.XX
|
A2
|
Y
|
| 21601 |
Exc chest wall tumor w/ribs
|
$XXX.XX
|
G2
|
Y
|
| 21602 |
Exc ch wal tum w/o lymphadec
|
$XXX.XX
|
J8
|
Y
|
| 21603 |
Exc ch wal tum w/lymphadec
|
$XXX.XX
|
J8
|
Y
|
| 21610 |
Costotransversectomy
|
$XXX.XX
|
A2
|
Y
|
| 21615 |
Excision 1st &/cervical rib
|
$XXX.XX
|
G2
|
Y
|
| 21616 |
Exc 1st&/crv rib w/sympth
|
$XXX.XX
|
G2
|
Y
|
| 21620 |
Ostectomy sternum partial
|
$XXX.XX
|
G2
|
Y
|
| 21627 |
Sternal debridement
|
$XXX.XX
|
G2
|
Y
|
| 21630 |
Radical resection sternum
|
$XXX.XX
|
G2
|
Y
|
| 21685 |
Hyoid myotomy & suspension
|
$XXX.XX
|
J8
|
Y
|
| 21700 |
Revision of neck muscle
|
$XXX.XX
|
A2
|
Y
|
| 21705 |
Revision of neck muscle/rib
|
$XXX.XX
|
G2
|
Y
|
| 21720 |
Revision of neck muscle
|
$XXX.XX
|
A2
|
Y
|
| 21725 |
Revision of neck muscle
|
$XXX.XX
|
A2
|
Y
|
| 21740 |
Reconstruction of sternum
|
$XXX.XX
|
J8
|
Y
|
| 21742 |
Repair stern/nuss w/o scope
|
$XXX.XX
|
J8
|
Y
|
| 21743 |
Repair sternum/nuss w/scope
|
$XXX.XX
|
J8
|
Y
|
| 21750 |
Repair of sternum separation
|
$XXX.XX
|
J8
|
Y
|
| 21820 |
Treat sternum fracture
|
$XXX.XX
|
A2
|
Y
|
| 21825 |
Treat sternum fracture
|
$XXX.XX
|
J8
|
Y
|
| 21920 |
Biopsy soft tissue of back
|
$XXX.XX
|
P3
|
Y
|
| 21925 |
Biopsy soft tissue of back
|
$XXX.XX
|
A2
|
Y
|
| 21930 |
Exc back les sc < 3 cm
|
$XXX.XX
|
P3
|
Y
|
| 21931 |
Exc back les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 21932 |
Exc back tum deep < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 21933 |
Exc back tum deep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 21935 |
Resect back tum < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 21936 |
Resect back tum 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 22010 |
I&d p-spine c/t/cerv-thor
|
$XXX.XX
|
G2
|
Y
|
| 22015 |
I&d abscess p-spine l/s/ls
|
$XXX.XX
|
G2
|
Y
|
| 22100 |
Remove part of neck vertebra
|
$XXX.XX
|
G2
|
Y
|
| 22101 |
Remove part thorax vertebra
|
$XXX.XX
|
G2
|
Y
|
| 22102 |
Remove part lumbar vertebra
|
$XXX.XX
|
G2
|
Y
|
| 22103 |
Remove extra spine segment
|
$XXX.XX
|
N1
|
N
|
| 22110 |
Remove part of neck vertebra
|
$XXX.XX
|
G2
|
Y
|
| 22112 |
Remove part thorax vertebra
|
$XXX.XX
|
G2
|
Y
|
| 22114 |
Remove part lumbar vertebra
|
$XXX.XX
|
G2
|
Y
|
| 22116 |
Remove extra spine segment
|
$XXX.XX
|
N1
|
N
|
| 22206 |
Incis spine 3 column thorac
|
$XXX.XX
|
G2
|
Y
|
| 22207 |
Incis spine 3 column lumbar
|
$XXX.XX
|
G2
|
Y
|
| 22208 |
Incis spine 3 column adl seg
|
$XXX.XX
|
N1
|
N
|
| 22210 |
Incis 1 vertebral seg cerv
|
$XXX.XX
|
J8
|
Y
|
| 22212 |
Incis 1 vertebral seg thorac
|
$XXX.XX
|
J8
|
Y
|
| 22214 |
Incis 1 vertebral seg lumbar
|
$XXX.XX
|
J8
|
Y
|
| 22216 |
Incis addl spine segment
|
$XXX.XX
|
N1
|
N
|
| 22220 |
Osteot dsc ant 1 vrt sgm crv
|
$XXX.XX
|
J8
|
Y
|
| 22222 |
Osteot dsc ant 1vrt sgm thrc
|
$XXX.XX
|
G2
|
Y
|
| 22224 |
Osteot dsc ant 1vrt sgm lmbr
|
$XXX.XX
|
G2
|
Y
|
| 22226 |
Osteot dsc ant 1vrt sgm ea
|
$XXX.XX
|
N1
|
N
|
| 22310 |
Closed tx vert fx w/o manj
|
$XXX.XX
|
A2
|
Y
|
| 22315 |
Closed tx vert fx w/manj
|
$XXX.XX
|
A2
|
Y
|
| 22318 |
Treat odontoid fx w/o graft
|
$XXX.XX
|
G2
|
Y
|
| 22319 |
Treat odontoid fx w/graft
|
$XXX.XX
|
J8
|
Y
|
| 22325 |
Treat spine fracture
|
$XXX.XX
|
J8
|
Y
|
| 22326 |
Treat neck spine fracture
|
$XXX.XX
|
G2
|
Y
|
| 22327 |
Treat thorax spine fracture
|
$XXX.XX
|
J8
|
Y
|
| 22328 |
Treat each add spine fx
|
$XXX.XX
|
N1
|
N
|
| 22505 |
Manipulation of spine
|
$XXX.XX
|
A2
|
Y
|
| 22510 |
Perq cervicothoracic inject
|
$XXX.XX
|
G2
|
Y
|
| 22511 |
Perq lumbosacral injection
|
$XXX.XX
|
G2
|
Y
|
| 22512 |
Vertebroplasty addl inject
|
$XXX.XX
|
N1
|
N
|
| 22513 |
Perq vertebral augmentation
|
$XXX.XX
|
G2
|
Y
|
| 22514 |
Perq vertebral augmentation
|
$XXX.XX
|
G2
|
Y
|
| 22515 |
Perq vertebral augmentation
|
$XXX.XX
|
N1
|
N
|
| 22532 |
Arthrd lat xtrcvtry tq thrc
|
$XXX.XX
|
G2
|
Y
|
| 22533 |
Arthrd lat xtrcvtry tq lmbr
|
$XXX.XX
|
G2
|
Y
|
| 22534 |
Arthrd lat xtrcvtry tq ea ad
|
$XXX.XX
|
N1
|
N
|
| 22548 |
Arthrd ant toral/xoral c1-c2
|
$XXX.XX
|
J8
|
Y
|
| 22551 |
Arthrd ant ntrbdy cervical
|
$XXX.XX
|
J8
|
Y
|
| 22552 |
Arthrd ant ntrbd cervical ea
|
$XXX.XX
|
N1
|
N
|
| 22554 |
Arthrd ant ntrbd min dsc crv
|
$XXX.XX
|
J8
|
Y
|
| 22556 |
Arthrd ant ntrbd min dsc thc
|
$XXX.XX
|
J8
|
Y
|
| 22558 |
Arthrd ant ntrbd min dsc lum
|
$XXX.XX
|
J8
|
Y
|
| 22585 |
Arthrd ant ntrbd min dsc ea
|
$XXX.XX
|
N1
|
N
|
| 22586 |
Arthrd pre-sac ntrbdy l5-s1
|
$XXX.XX
|
J8
|
Y
|
| 22590 |
Arthrd pst tq craniocervical
|
$XXX.XX
|
J8
|
Y
|
| 22595 |
Arthrd pst tq atlas-axis
|
$XXX.XX
|
G2
|
Y
|
| 22600 |
Arthrd pst tq 1ntrspc crv
|
$XXX.XX
|
J8
|
Y
|
| 22610 |
Arthrd pst tq 1ntrspc thrc
|
$XXX.XX
|
J8
|
Y
|
| 22612 |
Arthrd pst tq 1ntrspc lumbar
|
$XXX.XX
|
J8
|
Y
|
| 22614 |
Arthrd pst tq 1ntrspc ea add
|
$XXX.XX
|
N1
|
N
|
| 22630 |
Arthrd pst tq 1ntrspc lum
|
$XXX.XX
|
J8
|
Y
|
| 22632 |
Arthrd pst tq 1ntrspc lm ea
|
$XXX.XX
|
N1
|
N
|
| 22633 |
Arthrd cmbn 1ntrspc lumbar
|
$XXX.XX
|
J8
|
Y
|
| 22800 |
Arthrd pst dfrm<6 vrt sgm
|
$XXX.XX
|
J8
|
Y
|
| 22802 |
Arthrd pst dfrm 7-12 vrt sgm
|
$XXX.XX
|
J8
|
Y
|
| 22804 |
Arthrd pst dfrm 13+ vrt sgm
|
$XXX.XX
|
J8
|
Y
|
| 22808 |
Arthrd ant dfrm 2-3 vrt sgm
|
$XXX.XX
|
J8
|
Y
|
| 22810 |
Arthrd ant dfrm 4-7 vrt sgm
|
$XXX.XX
|
J8
|
Y
|
| 22812 |
Arthrd ant dfrm 8+ vrt sgm
|
$XXX.XX
|
J8
|
Y
|
| 22818 |
Kyphectomy 1-2 segments
|
$XXX.XX
|
G2
|
Y
|
| 22819 |
Kyphectomy 3 or more
|
$XXX.XX
|
G2
|
Y
|
| 22830 |
Exploration of spinal fusion
|
$XXX.XX
|
J8
|
Y
|
| 22836 |
Ant thrc vrt body tethrg <7
|
$XXX.XX
|
J8
|
Y
|
| 22837 |
Ant thrc vrt body tethrg 8+
|
$XXX.XX
|
J8
|
Y
|
| 22838 |
Rev rplc/rmv thrc vrt tethrg
|
$XXX.XX
|
J8
|
Y
|
| 22840 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22841 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22842 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22843 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22844 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22845 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22846 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22847 |
Insert spine fixation device
|
$XXX.XX
|
N1
|
N
|
| 22848 |
Insert pelv fixation device
|
$XXX.XX
|
N1
|
N
|
| 22849 |
Reinsert spinal fixation
|
$XXX.XX
|
J8
|
Y
|
| 22850 |
Remove spine fixation device
|
$XXX.XX
|
G2
|
Y
|
| 22852 |
Remove spine fixation device
|
$XXX.XX
|
G2
|
Y
|
| 22853 |
Insj biomechanical device
|
$XXX.XX
|
N1
|
N
|
| 22854 |
Insj biomechanical device
|
$XXX.XX
|
N1
|
N
|
| 22855 |
Removal anterior instrmj
|
$XXX.XX
|
G2
|
Y
|
| 22856 |
Tot disc arthrp 1ntrspc crv
|
$XXX.XX
|
J8
|
Y
|
| 22857 |
Tot disc arthrp 1ntrspc lmbr
|
$XXX.XX
|
J8
|
Y
|
| 22858 |
Tot disc arthrp 2nd lvl crv
|
$XXX.XX
|
N1
|
N
|
| 22859 |
Insj biomechanical device
|
$XXX.XX
|
N1
|
N
|
| 22860 |
Tot disc arthrp 2ntrspc lmbr
|
$XXX.XX
|
N1
|
N
|
| 22861 |
Rev rplcm arthrp 1ntrspc crv
|
$XXX.XX
|
J8
|
Y
|
| 22862 |
Rev rplcm rthrp 1ntrspc lmbr
|
$XXX.XX
|
J8
|
Y
|
| 22864 |
Rmvl tot arthrp 1ntrspc crv
|
$XXX.XX
|
G2
|
Y
|
| 22865 |
Rmvl tot arthrp 1ntrspc lmbr
|
$XXX.XX
|
G2
|
Y
|
| 22867 |
Insj stablj dev w/dcmprn
|
$XXX.XX
|
J8
|
Y
|
| 22868 |
Insj stablj dev w/dcmprn
|
$XXX.XX
|
N1
|
N
|
| 22869 |
Insj stablj dev w/o dcmprn
|
$XXX.XX
|
J8
|
Y
|
| 22870 |
Insj stablj dev w/o dcmprn
|
$XXX.XX
|
N1
|
N
|
| 22900 |
Exc abdl tum deep < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 22901 |
Exc abdl tum deep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 22902 |
Exc abd les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 22903 |
Exc abd les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 22904 |
Radical resect abd tumor<5cm
|
$XXX.XX
|
G2
|
Y
|
| 22905 |
Rad resect abd tumor 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 23000 |
Rmvl sbdltd clcreous dep opn
|
$XXX.XX
|
A2
|
Y
|
| 23020 |
Capsular contracture release
|
$XXX.XX
|
A2
|
Y
|
| 23030 |
I&d shoulder deep absc/hmtma
|
$XXX.XX
|
A2
|
Y
|
| 23031 |
I&d shoulder infected bursa
|
$XXX.XX
|
A2
|
Y
|
| 23035 |
Incision bone cortex sho
|
$XXX.XX
|
A2
|
Y
|
| 23040 |
Arthrt gh jt expl/drg/rmv fb
|
$XXX.XX
|
A2
|
Y
|
| 23044 |
Arthrt ac sc jt exp/rmvl fb
|
$XXX.XX
|
A2
|
Y
|
| 23065 |
Biopsy shoulder tissues
|
$XXX.XX
|
P3
|
Y
|
| 23066 |
Biopsy shoulder tissues
|
$XXX.XX
|
A2
|
Y
|
| 23071 |
Exc shoulder les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 23073 |
Exc shoulder tum deep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 23075 |
Exc shoulder les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 23076 |
Exc shoulder tum deep < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 23077 |
Rad rescj tum shoulder<5 cm
|
$XXX.XX
|
R2
|
Y
|
| 23078 |
Rad rescj tum shoulder 5cm/>
|
$XXX.XX
|
G2
|
Y
|
| 23100 |
Arthrotomy glenhumrl jt w/bx
|
$XXX.XX
|
A2
|
Y
|
| 23101 |
Arthrt acrmclv/strnclav jt
|
$XXX.XX
|
A2
|
Y
|
| 23105 |
Arthrotomy glenohumeral jt
|
$XXX.XX
|
A2
|
Y
|
| 23106 |
Arthrotomy strnclav joint
|
$XXX.XX
|
A2
|
Y
|
| 23107 |
Arthrt glenhumrl jt w/expl
|
$XXX.XX
|
A2
|
Y
|
| 23120 |
Claviculectomy partial
|
$XXX.XX
|
A2
|
Y
|
| 23125 |
Claviculectomy total
|
$XXX.XX
|
A2
|
Y
|
| 23130 |
Acromp/acromionectomy prtl
|
$XXX.XX
|
A2
|
Y
|
| 23140 |
Removal of bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 23145 |
Removal of bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 23146 |
Removal of bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 23150 |
Removal of humerus lesion
|
$XXX.XX
|
A2
|
Y
|
| 23155 |
Removal of humerus lesion
|
$XXX.XX
|
A2
|
Y
|
| 23156 |
Removal of humerus lesion
|
$XXX.XX
|
A2
|
Y
|
| 23170 |
Sequestrectomy clavicle
|
$XXX.XX
|
J8
|
Y
|
| 23172 |
Sequestrectomy scapula
|
$XXX.XX
|
J8
|
Y
|
| 23174 |
Sqstrctmy humrl head srg nck
|
$XXX.XX
|
A2
|
Y
|
| 23180 |
Prtl excision bone clavicle
|
$XXX.XX
|
A2
|
Y
|
| 23182 |
Prtl excision bone scapula
|
$XXX.XX
|
A2
|
Y
|
| 23184 |
Prtl excision bone prox hum
|
$XXX.XX
|
A2
|
Y
|
| 23190 |
Ostectomy scapula partial
|
$XXX.XX
|
A2
|
Y
|
| 23195 |
Resection humeral head
|
$XXX.XX
|
J8
|
Y
|
| 23200 |
Radical rescj tumor clavicle
|
$XXX.XX
|
G2
|
Y
|
| 23210 |
Radical rescj tumor scapula
|
$XXX.XX
|
G2
|
Y
|
| 23220 |
Radical rescj tumor prox hum
|
$XXX.XX
|
G2
|
Y
|
| 23330 |
Remove shoulder foreign body
|
$XXX.XX
|
A2
|
Y
|
| 23333 |
Remove shoulder fb deep
|
$XXX.XX
|
G2
|
Y
|
| 23334 |
Shoulder prosthesis removal
|
$XXX.XX
|
G2
|
Y
|
| 23335 |
Shoulder prosthesis removal
|
$XXX.XX
|
J8
|
Y
|
| 23350 |
Injection for shoulder x-ray
|
$XXX.XX
|
N1
|
N
|
| 23395 |
Muscle transfer shoulder/arm
|
$XXX.XX
|
A2
|
Y
|
| 23397 |
Muscle transfers
|
$XXX.XX
|
A2
|
Y
|
| 23400 |
Fixation of shoulder blade
|
$XXX.XX
|
A2
|
Y
|
| 23405 |
Incision of tendon & muscle
|
$XXX.XX
|
A2
|
Y
|
| 23406 |
Incise tendon(s) & muscle(s)
|
$XXX.XX
|
A2
|
Y
|
| 23410 |
Repair rotator cuff acute
|
$XXX.XX
|
A2
|
Y
|
| 23412 |
Repair rotator cuff chronic
|
$XXX.XX
|
A2
|
Y
|
| 23415 |
Release of shoulder ligament
|
$XXX.XX
|
A2
|
Y
|
| 23420 |
Repair of shoulder
|
$XXX.XX
|
J8
|
Y
|
| 23430 |
Repair biceps tendon
|
$XXX.XX
|
J8
|
Y
|
| 23440 |
Remove/transplant tendon
|
$XXX.XX
|
J8
|
Y
|
| 23450 |
Repair shoulder capsule
|
$XXX.XX
|
J8
|
Y
|
| 23455 |
Repair shoulder capsule
|
$XXX.XX
|
J8
|
Y
|
| 23460 |
Repair shoulder capsule
|
$XXX.XX
|
J8
|
Y
|
| 23462 |
Repair shoulder capsule
|
$XXX.XX
|
A2
|
Y
|
| 23465 |
Repair shoulder capsule
|
$XXX.XX
|
G2
|
Y
|
| 23466 |
Repair shoulder capsule
|
$XXX.XX
|
A2
|
Y
|
| 23470 |
Reconstruct shoulder joint
|
$XXX.XX
|
J8
|
Y
|
| 23472 |
Reconstruct shoulder joint
|
$XXX.XX
|
J8
|
Y
|
| 23473 |
Revis reconst shoulder joint
|
$XXX.XX
|
J8
|
Y
|
| 23474 |
Revis reconst shoulder joint
|
$XXX.XX
|
J8
|
Y
|
| 23480 |
Revision of collar bone
|
$XXX.XX
|
A2
|
Y
|
| 23485 |
Revision of collar bone
|
$XXX.XX
|
J8
|
Y
|
| 23490 |
Reinforce clavicle
|
$XXX.XX
|
A2
|
Y
|
| 23491 |
Reinforce shoulder bones
|
$XXX.XX
|
J8
|
Y
|
| 23500 |
Cltx clavicular fx w/o mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23505 |
Cltx clavicular fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23515 |
Optx clavicular fx w/int fix
|
$XXX.XX
|
J8
|
Y
|
| 23520 |
Cltx strnclav dislc w/o mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23525 |
Cltx strnclav dislc w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23530 |
Optx strnclav dislc aqt/chrn
|
$XXX.XX
|
J8
|
Y
|
| 23532 |
Optx strclv dslc aq/chrn grf
|
$XXX.XX
|
A2
|
Y
|
| 23540 |
Cltx acromclav dislc wo mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23545 |
Cltx acromclav dislc w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23550 |
Optx acromclv dislc aqt/chrn
|
$XXX.XX
|
J8
|
Y
|
| 23552 |
Optx acrclv dslc aq/chrn grf
|
$XXX.XX
|
J8
|
Y
|
| 23570 |
Cltx scapular fx w/o mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23575 |
Cltx scap fx w/mnpj +-tractj
|
$XXX.XX
|
A2
|
Y
|
| 23585 |
Optx scapular fx w/int fixj
|
$XXX.XX
|
J8
|
Y
|
| 23600 |
Cltx prox humrl fx w/o mnpj
|
$XXX.XX
|
P2
|
Y
|
| 23605 |
Cltx prx hmrl fx mnpj+-tract
|
$XXX.XX
|
A2
|
Y
|
| 23615 |
Optx prox humrl fx w/int fix
|
$XXX.XX
|
J8
|
Y
|
| 23616 |
Optx prx hmrl fx fix rpr rpl
|
$XXX.XX
|
J8
|
Y
|
| 23620 |
Cltx gr hmrl tbrs fx wo mnpj
|
$XXX.XX
|
P2
|
Y
|
| 23625 |
Cltx gr hmrl tbrs fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23630 |
Optx gr hmrl tbrs fx int fix
|
$XXX.XX
|
J8
|
Y
|
| 23650 |
Cltx sho dslc w/mnpj wo anes
|
$XXX.XX
|
A2
|
Y
|
| 23655 |
Cltx sho dslc w/mnpj w/anes
|
$XXX.XX
|
A2
|
Y
|
| 23660 |
Optx acute shoulder dislc
|
$XXX.XX
|
A2
|
Y
|
| 23665 |
Cltx sho dslc fx gr hmrl tbr
|
$XXX.XX
|
A2
|
Y
|
| 23670 |
Optx sho dislc fx
|
$XXX.XX
|
A2
|
Y
|
| 23675 |
Cltx sho dislc neck fx mnpj
|
$XXX.XX
|
A2
|
Y
|
| 23680 |
Optx sho dislc neck fx fixj
|
$XXX.XX
|
J8
|
Y
|
| 23700 |
Mnpj anes sho jt fixj aprats
|
$XXX.XX
|
A2
|
Y
|
| 23800 |
Arthrodesis glenohumeral jt
|
$XXX.XX
|
G2
|
Y
|
| 23802 |
Arthrd glenohumeral jt w/grf
|
$XXX.XX
|
G2
|
Y
|
| 23900 |
Interthoracoscplr amputation
|
$XXX.XX
|
G2
|
Y
|
| 23920 |
Disarticulation shoulder
|
$XXX.XX
|
G2
|
Y
|
| 23921 |
Disarticulation sho sec clsr
|
$XXX.XX
|
A2
|
Y
|
| 23930 |
I&d upr a/e dp absc/hmtma
|
$XXX.XX
|
A2
|
Y
|
| 23931 |
I&d upr a/e bursa
|
$XXX.XX
|
A2
|
Y
|
| 23935 |
Inc dp opn b1 crtx hum/elbw
|
$XXX.XX
|
A2
|
Y
|
| 24000 |
Arthrt elbw expl drg/rmvl fb
|
$XXX.XX
|
A2
|
Y
|
| 24006 |
Arthrt elbw capsl exc rls
|
$XXX.XX
|
A2
|
Y
|
| 24065 |
Biopsy arm/elbow soft tissue
|
$XXX.XX
|
P3
|
Y
|
| 24066 |
Biopsy arm/elbow soft tissue
|
$XXX.XX
|
A2
|
Y
|
| 24071 |
Exc arm/elbow les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 24073 |
Ex arm/elbow tum deep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 24075 |
Exc arm/elbow les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 24076 |
Ex arm/elbow tum deep < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 24077 |
Rad rescj tum tiss a/e <5cm
|
$XXX.XX
|
G2
|
Y
|
| 24079 |
Rad rescj tum tiss a/e 5 cm+
|
$XXX.XX
|
G2
|
Y
|
| 24100 |
Arthrt elbw synovial bx only
|
$XXX.XX
|
A2
|
Y
|
| 24101 |
Arthrt elbw jt expl bx rmvl
|
$XXX.XX
|
A2
|
Y
|
| 24102 |
Arthrt elbow w/synovectomy
|
$XXX.XX
|
A2
|
Y
|
| 24105 |
Excision olecranon bursa
|
$XXX.XX
|
A2
|
Y
|
| 24110 |
Exc/curtg b1 cst/b9 tum hum
|
$XXX.XX
|
A2
|
Y
|
| 24115 |
Exc/crtg b1 cst/tum hum agrf
|
$XXX.XX
|
A2
|
Y
|
| 24116 |
Exc/crtg b1 cst/tum hum algr
|
$XXX.XX
|
J8
|
Y
|
| 24120 |
Exc/crtg b1 cst/b9 tum rds
|
$XXX.XX
|
A2
|
Y
|
| 24125 |
Exc/crtg b1 cst/tum rds agrf
|
$XXX.XX
|
A2
|
Y
|
| 24126 |
Exc/crtg b1 cst/tum rds algr
|
$XXX.XX
|
A2
|
Y
|
| 24130 |
Excision radial head
|
$XXX.XX
|
A2
|
Y
|
| 24134 |
Sequestrectomy shft/dstl hum
|
$XXX.XX
|
A2
|
Y
|
| 24136 |
Sequestrectomy radial h/n
|
$XXX.XX
|
A2
|
Y
|
| 24138 |
Sequestrectomy olecrn proces
|
$XXX.XX
|
A2
|
Y
|
| 24140 |
Partial exc bone humerus
|
$XXX.XX
|
A2
|
Y
|
| 24145 |
Prtl exc bone radial h/n
|
$XXX.XX
|
A2
|
Y
|
| 24147 |
Prtl exc bone olecrn process
|
$XXX.XX
|
A2
|
Y
|
| 24149 |
Radical resection of elbow
|
$XXX.XX
|
G2
|
Y
|
| 24150 |
Rad rescj tum dstl/shft hum
|
$XXX.XX
|
G2
|
Y
|
| 24152 |
Rad resection tum radial h/n
|
$XXX.XX
|
J8
|
Y
|
| 24155 |
Resection of elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24160 |
Rmvl prosthhumrl&ulnar cmpnt
|
$XXX.XX
|
A2
|
N
|
| 24164 |
Removal prosth radial head
|
$XXX.XX
|
A2
|
N
|
| 24200 |
Rmvl fb upper arm/elbw subq
|
$XXX.XX
|
P3
|
Y
|
| 24201 |
Rmvl fb upper arm/elbw deep
|
$XXX.XX
|
A2
|
Y
|
| 24220 |
Injection px for elbow arthg
|
$XXX.XX
|
N1
|
N
|
| 24300 |
Mnpj elbow under anes
|
$XXX.XX
|
G2
|
Y
|
| 24301 |
Musc/tdn transfer upr a/e 1
|
$XXX.XX
|
A2
|
Y
|
| 24305 |
Tendon lngth upr a/e ea tdn
|
$XXX.XX
|
A2
|
Y
|
| 24310 |
Tnot opn elbw to sho ea tdn
|
$XXX.XX
|
A2
|
Y
|
| 24320 |
Tenoplasty elbow to sho 1
|
$XXX.XX
|
A2
|
Y
|
| 24330 |
Flexor-plasty elbow
|
$XXX.XX
|
A2
|
Y
|
| 24331 |
Flexor-plasty elbw w/advmnt
|
$XXX.XX
|
J8
|
Y
|
| 24332 |
Tenolysis triceps
|
$XXX.XX
|
G2
|
Y
|
| 24340 |
Tenodesis biceps tdn at elbw
|
$XXX.XX
|
G2
|
Y
|
| 24341 |
Rpr tdn/musc upr a/e each
|
$XXX.XX
|
A2
|
Y
|
| 24342 |
Repair of ruptured tendon
|
$XXX.XX
|
A2
|
Y
|
| 24343 |
Repr elbow lat ligmnt w/tiss
|
$XXX.XX
|
G2
|
Y
|
| 24344 |
Reconstruct elbow lat ligmnt
|
$XXX.XX
|
J8
|
Y
|
| 24345 |
Repr elbw med ligmnt w/tissu
|
$XXX.XX
|
A2
|
Y
|
| 24346 |
Reconstruct elbow med ligmnt
|
$XXX.XX
|
G2
|
Y
|
| 24357 |
Repair elbow perc
|
$XXX.XX
|
G2
|
Y
|
| 24358 |
Repair elbow w/deb open
|
$XXX.XX
|
G2
|
Y
|
| 24359 |
Repair elbow deb/attch open
|
$XXX.XX
|
G2
|
Y
|
| 24360 |
Reconstruct elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24361 |
Reconstruct elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24362 |
Reconstruct elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24363 |
Replace elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24365 |
Reconstruct head of radius
|
$XXX.XX
|
J8
|
Y
|
| 24366 |
Reconstruct head of radius
|
$XXX.XX
|
J8
|
Y
|
| 24370 |
Revise reconst elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24371 |
Revise reconst elbow joint
|
$XXX.XX
|
J8
|
Y
|
| 24400 |
Osteot humerus w/wo int fixj
|
$XXX.XX
|
A2
|
Y
|
| 24410 |
Mlt osteot rlgnm imed rd hum
|
$XXX.XX
|
G2
|
Y
|
| 24420 |
Osteoplasty humerus
|
$XXX.XX
|
G2
|
Y
|
| 24430 |
Rpr non/mal humerus wo graft
|
$XXX.XX
|
J8
|
Y
|
| 24435 |
Rpr non/mal hum with agrft
|
$XXX.XX
|
J8
|
Y
|
| 24470 |
Hemiepiphyseal arrest
|
$XXX.XX
|
A2
|
Y
|
| 24495 |
Decompression fasct forearm
|
$XXX.XX
|
A2
|
Y
|
| 24498 |
Proph tx w/wo mthylmthcrylt
|
$XXX.XX
|
J8
|
Y
|
| 24500 |
Cltx humrl shft fx w/o mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24505 |
Cltx humrl shft fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24515 |
Optx humrl shft fx plate/scr
|
$XXX.XX
|
J8
|
Y
|
| 24516 |
Tx humrl shaft fx imed implt
|
$XXX.XX
|
J8
|
Y
|
| 24530 |
Cltx sprcndylr humeral fx wo
|
$XXX.XX
|
A2
|
Y
|
| 24535 |
Cltx sprcndylr humeral fx w/
|
$XXX.XX
|
A2
|
Y
|
| 24538 |
Prq skel fix sprcndlr hum fx
|
$XXX.XX
|
A2
|
Y
|
| 24545 |
Optx hum fx wo ntrcndylr xtn
|
$XXX.XX
|
J8
|
Y
|
| 24546 |
Optx hum fx w/ntrcndylr xtn
|
$XXX.XX
|
J8
|
Y
|
| 24560 |
Cltx hum epcndylr fx wo mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24565 |
Cltx hum epcndylr fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24566 |
Prq skel fix epcndylr hum fx
|
$XXX.XX
|
A2
|
Y
|
| 24575 |
Optx humeral epcndylr fx
|
$XXX.XX
|
J8
|
Y
|
| 24576 |
Cltx humrl cndylr fx wo mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24577 |
Cltx humrl cndylr fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24579 |
Optx humrl cndylr fracture
|
$XXX.XX
|
J8
|
Y
|
| 24582 |
Prq skel fix humrl cndylr fx
|
$XXX.XX
|
J8
|
Y
|
| 24586 |
Optx partclr fx&/dislc elbow
|
$XXX.XX
|
J8
|
Y
|
| 24587 |
Optx partclr fx&/dslc elbw w
|
$XXX.XX
|
J8
|
Y
|
| 24600 |
Tx clsd elbow dislc w/o anes
|
$XXX.XX
|
A2
|
Y
|
| 24605 |
Tx clsd elbow dislc req anes
|
$XXX.XX
|
A2
|
Y
|
| 24615 |
Optx aqt/chrnc elbow dislc
|
$XXX.XX
|
J8
|
Y
|
| 24620 |
Cltx monteggia fx dislc elbw
|
$XXX.XX
|
A2
|
Y
|
| 24635 |
Optx monteggia fx dislc elbw
|
$XXX.XX
|
J8
|
Y
|
| 24640 |
Cltx rdl head sublxtj nrsemd
|
$XXX.XX
|
P3
|
Y
|
| 24650 |
Cltx rdl head/nck fx wo mnpj
|
$XXX.XX
|
P2
|
Y
|
| 24655 |
Cltx rdl head/nck fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24665 |
Optx radial head/neck fx
|
$XXX.XX
|
A2
|
Y
|
| 24666 |
Optx radial head/nck fx rplc
|
$XXX.XX
|
J8
|
Y
|
| 24670 |
Cltx ulnar fx prox w/o mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24675 |
Cltx ulnar fx prox w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 24685 |
Optx ulnar fx prox end w/fix
|
$XXX.XX
|
J8
|
Y
|
| 24800 |
Arthrodesis elbw joint local
|
$XXX.XX
|
A2
|
Y
|
| 24802 |
Arthrd elbow jt autog graft
|
$XXX.XX
|
G2
|
Y
|
| 24900 |
Amputation of upper arm
|
$XXX.XX
|
G2
|
Y
|
| 24920 |
Amputation of upper arm
|
$XXX.XX
|
G2
|
Y
|
| 24925 |
Amputation follow-up surgery
|
$XXX.XX
|
A2
|
Y
|
| 24930 |
Amputation follow-up surgery
|
$XXX.XX
|
G2
|
Y
|
| 24931 |
Amputate upper arm & implant
|
$XXX.XX
|
J8
|
Y
|
| 24935 |
Revision of amputation
|
$XXX.XX
|
G2
|
Y
|
| 24940 |
Revision of upper arm
|
$XXX.XX
|
J8
|
Y
|
| 25000 |
Incision of tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 25001 |
Incise flexor carpi radialis
|
$XXX.XX
|
G2
|
Y
|
| 25020 |
Decompress forearm 1 space
|
$XXX.XX
|
A2
|
Y
|
| 25023 |
Decompress forearm 1 space
|
$XXX.XX
|
A2
|
Y
|
| 25024 |
Decompress forearm 2 spaces
|
$XXX.XX
|
A2
|
Y
|
| 25025 |
Decompress forearm 2 spaces
|
$XXX.XX
|
A2
|
Y
|
| 25028 |
I&d f/arm&/wrst dp absc/hmtm
|
$XXX.XX
|
A2
|
Y
|
| 25031 |
I&d forearm&/wrist bursa
|
$XXX.XX
|
A2
|
Y
|
| 25035 |
Inc dp bone crtx f/arm&/wrst
|
$XXX.XX
|
A2
|
Y
|
| 25040 |
Arthrt rdcrpl/midcarpl jt
|
$XXX.XX
|
A2
|
Y
|
| 25065 |
Biopsy forearm soft tissues
|
$XXX.XX
|
P3
|
Y
|
| 25066 |
Biopsy forearm soft tissues
|
$XXX.XX
|
A2
|
Y
|
| 25071 |
Exc forearm les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 25073 |
Exc forearm tum deep 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 25075 |
Exc forearm les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 25076 |
Exc forearm tum deep < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 25077 |
Resect forearm/wrist tum<3cm
|
$XXX.XX
|
G2
|
Y
|
| 25078 |
Resect forarm/wrist tum 3cm>
|
$XXX.XX
|
G2
|
Y
|
| 25085 |
Incision of wrist capsule
|
$XXX.XX
|
A2
|
Y
|
| 25100 |
Biopsy of wrist joint
|
$XXX.XX
|
A2
|
Y
|
| 25101 |
Explore/treat wrist joint
|
$XXX.XX
|
A2
|
Y
|
| 25105 |
Remove wrist joint lining
|
$XXX.XX
|
A2
|
Y
|
| 25107 |
Remove wrist joint cartilage
|
$XXX.XX
|
A2
|
Y
|
| 25109 |
Excise tendon forearm/wrist
|
$XXX.XX
|
G2
|
Y
|
| 25110 |
Remove wrist tendon lesion
|
$XXX.XX
|
A2
|
Y
|
| 25111 |
Remove wrist tendon lesion
|
$XXX.XX
|
A2
|
Y
|
| 25112 |
Reremove wrist tendon lesion
|
$XXX.XX
|
A2
|
Y
|
| 25115 |
Remove wrist/forearm lesion
|
$XXX.XX
|
A2
|
Y
|
| 25116 |
Remove wrist/forearm lesion
|
$XXX.XX
|
A2
|
Y
|
| 25118 |
Excise wrist tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 25119 |
Partial removal of ulna
|
$XXX.XX
|
A2
|
Y
|
| 25120 |
Removal of forearm lesion
|
$XXX.XX
|
A2
|
Y
|
| 25125 |
Remove/graft forearm lesion
|
$XXX.XX
|
A2
|
Y
|
| 25126 |
Remove/graft forearm lesion
|
$XXX.XX
|
A2
|
Y
|
| 25130 |
Removal of wrist lesion
|
$XXX.XX
|
A2
|
Y
|
| 25135 |
Remove & graft wrist lesion
|
$XXX.XX
|
A2
|
Y
|
| 25136 |
Remove & graft wrist lesion
|
$XXX.XX
|
A2
|
Y
|
| 25145 |
Remove forearm bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 25150 |
Partial removal of ulna
|
$XXX.XX
|
A2
|
Y
|
| 25151 |
Partial removal of radius
|
$XXX.XX
|
A2
|
Y
|
| 25170 |
Resect radius/ulnar tumor
|
$XXX.XX
|
G2
|
Y
|
| 25210 |
Removal of wrist bone
|
$XXX.XX
|
A2
|
Y
|
| 25215 |
Removal of wrist bones
|
$XXX.XX
|
A2
|
Y
|
| 25230 |
Partial removal of radius
|
$XXX.XX
|
A2
|
Y
|
| 25240 |
Partial removal of ulna
|
$XXX.XX
|
A2
|
Y
|
| 25246 |
Injection for wrist x-ray
|
$XXX.XX
|
N1
|
N
|
| 25248 |
Remove forearm foreign body
|
$XXX.XX
|
A2
|
Y
|
| 25250 |
Removal of wrist prosthesis
|
$XXX.XX
|
A2
|
N
|
| 25251 |
Removal of wrist prosthesis
|
$XXX.XX
|
A2
|
N
|
| 25259 |
Manipulate wrist w/anesthes
|
$XXX.XX
|
G2
|
Y
|
| 25260 |
Repair forearm tendon/muscle
|
$XXX.XX
|
A2
|
Y
|
| 25263 |
Repair forearm tendon/muscle
|
$XXX.XX
|
A2
|
Y
|
| 25265 |
Repair forearm tendon/muscle
|
$XXX.XX
|
A2
|
Y
|
| 25270 |
Repair forearm tendon/muscle
|
$XXX.XX
|
A2
|
Y
|
| 25272 |
Repair forearm tendon/muscle
|
$XXX.XX
|
A2
|
Y
|
| 25274 |
Repair forearm tendon/muscle
|
$XXX.XX
|
A2
|
Y
|
| 25275 |
Repair forearm tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 25280 |
Revise wrist/forearm tendon
|
$XXX.XX
|
A2
|
Y
|
| 25290 |
Incise wrist/forearm tendon
|
$XXX.XX
|
A2
|
Y
|
| 25295 |
Release wrist/forearm tendon
|
$XXX.XX
|
A2
|
Y
|
| 25300 |
Fusion of tendons at wrist
|
$XXX.XX
|
A2
|
Y
|
| 25301 |
Fusion of tendons at wrist
|
$XXX.XX
|
A2
|
Y
|
| 25310 |
Transplant forearm tendon
|
$XXX.XX
|
A2
|
Y
|
| 25312 |
Transplant forearm tendon
|
$XXX.XX
|
A2
|
Y
|
| 25315 |
Revise palsy hand tendon(s)
|
$XXX.XX
|
A2
|
Y
|
| 25316 |
Revise palsy hand tendon(s)
|
$XXX.XX
|
A2
|
Y
|
| 25320 |
Repair/revise wrist joint
|
$XXX.XX
|
G2
|
Y
|
| 25332 |
Revise wrist joint
|
$XXX.XX
|
J8
|
Y
|
| 25335 |
Centralization wrist on ulna
|
$XXX.XX
|
A2
|
Y
|
| 25337 |
Reconstruct ulna/radioulnar
|
$XXX.XX
|
A2
|
Y
|
| 25350 |
Revision of radius
|
$XXX.XX
|
J8
|
Y
|
| 25355 |
Revision of radius
|
$XXX.XX
|
A2
|
Y
|
| 25360 |
Revision of ulna
|
$XXX.XX
|
J8
|
Y
|
| 25365 |
Revise radius & ulna
|
$XXX.XX
|
A2
|
Y
|
| 25370 |
Revise radius or ulna
|
$XXX.XX
|
A2
|
Y
|
| 25375 |
Revise radius & ulna
|
$XXX.XX
|
A2
|
Y
|
| 25390 |
Shorten radius or ulna
|
$XXX.XX
|
J8
|
Y
|
| 25391 |
Lengthen radius or ulna
|
$XXX.XX
|
J8
|
Y
|
| 25392 |
Shorten radius & ulna
|
$XXX.XX
|
A2
|
Y
|
| 25393 |
Lengthen radius & ulna
|
$XXX.XX
|
J8
|
Y
|
| 25394 |
Repair carpal bone shorten
|
$XXX.XX
|
G2
|
Y
|
| 25400 |
Repair radius or ulna
|
$XXX.XX
|
J8
|
Y
|
| 25405 |
Repair/graft radius or ulna
|
$XXX.XX
|
J8
|
Y
|
| 25415 |
Repair radius & ulna
|
$XXX.XX
|
J8
|
Y
|
| 25420 |
Repair/graft radius & ulna
|
$XXX.XX
|
J8
|
Y
|
| 25425 |
Repair/graft radius or ulna
|
$XXX.XX
|
J8
|
Y
|
| 25426 |
Repair/graft radius & ulna
|
$XXX.XX
|
J8
|
Y
|
| 25430 |
Vasc graft into carpal bone
|
$XXX.XX
|
G2
|
Y
|
| 25431 |
Repair nonunion carpal bone
|
$XXX.XX
|
J8
|
Y
|
| 25440 |
Repair nonu scphd carpl b1
|
$XXX.XX
|
A2
|
Y
|
| 25441 |
Arthrp w/prostc dstl rds
|
$XXX.XX
|
J8
|
Y
|
| 25442 |
Arthrp w/prostc dstl ulna
|
$XXX.XX
|
J8
|
Y
|
| 25443 |
Arthrp prostc dstl scph crpl
|
$XXX.XX
|
J8
|
Y
|
| 25444 |
Arthrp w/prostc lunate
|
$XXX.XX
|
J8
|
Y
|
| 25445 |
Arthrp w/prostc trapezium
|
$XXX.XX
|
J8
|
Y
|
| 25446 |
Arthrp w/prostc dst rds&crps
|
$XXX.XX
|
J8
|
Y
|
| 25447 |
Arthrp ntrcrp/crp/mtcr ntrps
|
$XXX.XX
|
A2
|
Y
|
| 25448 |
Arthrp ntrcrpl/crp/mtcrp ssp
|
$XXX.XX
|
G2
|
Y
|
| 25449 |
Revj arthrp wrist joint
|
$XXX.XX
|
A2
|
Y
|
| 25450 |
Epiphysl arrst dstl rds/ulna
|
$XXX.XX
|
A2
|
Y
|
| 25455 |
Epiphysl arrst dstl rds&ulna
|
$XXX.XX
|
A2
|
Y
|
| 25490 |
Prophylactic tx radius
|
$XXX.XX
|
A2
|
Y
|
| 25491 |
Prophylactic tx ulna
|
$XXX.XX
|
J8
|
Y
|
| 25492 |
Prophylactic tx radius&ulna
|
$XXX.XX
|
A2
|
Y
|
| 25500 |
Cltx rdl shft fx w/o mnpj
|
$XXX.XX
|
P2
|
Y
|
| 25505 |
Cltx rdl shft fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25515 |
Optx radial shaft fracture
|
$XXX.XX
|
J8
|
Y
|
| 25520 |
Cltx rdl shft fx&dislc
|
$XXX.XX
|
A2
|
Y
|
| 25525 |
Optx rdl shft fx&cltx rad/ul
|
$XXX.XX
|
J8
|
Y
|
| 25526 |
Optx rdl shft fx&dstl rad/ul
|
$XXX.XX
|
J8
|
Y
|
| 25530 |
Cltx ulnar shft fx w/o mnpj
|
$XXX.XX
|
P2
|
Y
|
| 25535 |
Cltx ulnar shft fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25545 |
Optx ulnar shft fx int fixj
|
$XXX.XX
|
J8
|
Y
|
| 25560 |
Cltx rdl&uln shft fx wo mnpj
|
$XXX.XX
|
P2
|
Y
|
| 25565 |
Cltx rdl&uln shft fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25574 |
Optx rdl&uln shft fx rds/uln
|
$XXX.XX
|
J8
|
Y
|
| 25575 |
Optx rdl&uln shft fx rds&uln
|
$XXX.XX
|
J8
|
Y
|
| 25600 |
Cltx dst rdl fx/ephys sep wo
|
$XXX.XX
|
P2
|
Y
|
| 25605 |
Cltx dst rdl fx/ephys sep w/
|
$XXX.XX
|
A2
|
Y
|
| 25606 |
Perq skel fixj dstl rdl fx
|
$XXX.XX
|
A2
|
Y
|
| 25607 |
Optx dst rd xartc fx/epi sep
|
$XXX.XX
|
J8
|
Y
|
| 25608 |
Optx dst rd xart fx/epi sep2
|
$XXX.XX
|
J8
|
Y
|
| 25609 |
Optx dst rd xart fx/ep sep3+
|
$XXX.XX
|
J8
|
Y
|
| 25622 |
Cltx carpl scphd fx w/o mnpj
|
$XXX.XX
|
P2
|
Y
|
| 25624 |
Cltx carpl scphd fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25628 |
Optx carpl scphd fx int fixj
|
$XXX.XX
|
A2
|
Y
|
| 25630 |
Cltx carpl fx w/o mnpj ea b1
|
$XXX.XX
|
P2
|
Y
|
| 25635 |
Cltx carpl fx w/mnpj ea b1
|
$XXX.XX
|
A2
|
Y
|
| 25645 |
Optx crpl fx oth/thn scph ea
|
$XXX.XX
|
A2
|
Y
|
| 25650 |
Cltx ulnar styloid fracture
|
$XXX.XX
|
P2
|
Y
|
| 25651 |
Perq skel fix ulnar styld fx
|
$XXX.XX
|
J8
|
Y
|
| 25652 |
Optx ulnar styloid fracture
|
$XXX.XX
|
J8
|
Y
|
| 25660 |
Cltx rdcrpl/ntrcrpl dislc 1+
|
$XXX.XX
|
A2
|
Y
|
| 25670 |
Optx rdcrpl/ntrcrpl dislc 1+
|
$XXX.XX
|
J8
|
Y
|
| 25671 |
Perq skel fix rad/uln dislc
|
$XXX.XX
|
A2
|
Y
|
| 25675 |
Cltx dstl rad/uln dislc mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25676 |
Optx rad/uln dislc aqt/chrnc
|
$XXX.XX
|
A2
|
Y
|
| 25680 |
Cltx trns-scphprlnr fx mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25685 |
Optx trns-scphprlnr fx dislc
|
$XXX.XX
|
A2
|
Y
|
| 25690 |
Cltx lunate dislc w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 25695 |
Optx lunate dislocation
|
$XXX.XX
|
A2
|
Y
|
| 25800 |
Arthrd wrist complete wo grf
|
$XXX.XX
|
J8
|
Y
|
| 25805 |
Arthrd wrist w/sliding graft
|
$XXX.XX
|
A2
|
Y
|
| 25810 |
Arthrd wrst iliac/oth agrft
|
$XXX.XX
|
J8
|
Y
|
| 25820 |
Arthrd wrist lmtd w/o b1 grf
|
$XXX.XX
|
J8
|
Y
|
| 25825 |
Arthrd wrist with autograft
|
$XXX.XX
|
J8
|
Y
|
| 25830 |
Arthrd dst rad/ul jt sgm rsc
|
$XXX.XX
|
A2
|
Y
|
| 25900 |
Amputation of forearm
|
$XXX.XX
|
G2
|
Y
|
| 25905 |
Amputation of forearm
|
$XXX.XX
|
G2
|
Y
|
| 25907 |
Amputation follow-up surgery
|
$XXX.XX
|
A2
|
Y
|
| 25909 |
Amputation follow-up surgery
|
$XXX.XX
|
G2
|
Y
|
| 25915 |
Amputation of forearm
|
$XXX.XX
|
G2
|
Y
|
| 25920 |
Amputate hand at wrist
|
$XXX.XX
|
G2
|
Y
|
| 25922 |
Amputate hand at wrist
|
$XXX.XX
|
A2
|
Y
|
| 25924 |
Amputation follow-up surgery
|
$XXX.XX
|
G2
|
Y
|
| 25927 |
Amputation of hand
|
$XXX.XX
|
G2
|
Y
|
| 25929 |
Amputation follow-up surgery
|
$XXX.XX
|
A2
|
Y
|
| 25931 |
Amputation follow-up surgery
|
$XXX.XX
|
G2
|
Y
|
| 26010 |
Drainage of finger abscess
|
$XXX.XX
|
P2
|
Y
|
| 26011 |
Drainage of finger abscess
|
$XXX.XX
|
A2
|
Y
|
| 26020 |
Drain hand tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 26025 |
Drainage of palm bursa
|
$XXX.XX
|
A2
|
Y
|
| 26030 |
Drainage of palm bursas
|
$XXX.XX
|
A2
|
Y
|
| 26034 |
Treat hand bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 26035 |
Decompress fingers/hand
|
$XXX.XX
|
G2
|
Y
|
| 26037 |
Decompress fingers/hand
|
$XXX.XX
|
G2
|
Y
|
| 26040 |
Release palm contracture
|
$XXX.XX
|
A2
|
Y
|
| 26045 |
Release palm contracture
|
$XXX.XX
|
A2
|
Y
|
| 26055 |
Incise finger tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 26060 |
Incision of finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26070 |
Explore/treat hand joint
|
$XXX.XX
|
A2
|
Y
|
| 26075 |
Explore/treat finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26080 |
Explore/treat finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26100 |
Biopsy hand joint lining
|
$XXX.XX
|
A2
|
Y
|
| 26105 |
Biopsy finger joint lining
|
$XXX.XX
|
A2
|
Y
|
| 26110 |
Biopsy finger joint lining
|
$XXX.XX
|
A2
|
Y
|
| 26111 |
Exc hand les sc 1.5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 26113 |
Exc hand tum deep 1.5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 26115 |
Exc hand les sc < 1.5 cm
|
$XXX.XX
|
G2
|
Y
|
| 26116 |
Exc hand tum deep < 1.5 cm
|
$XXX.XX
|
G2
|
Y
|
| 26117 |
Rad resect hand tumor < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 26118 |
Rad resect hand tumor 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 26121 |
Release palm contracture
|
$XXX.XX
|
A2
|
Y
|
| 26123 |
Release palm contracture
|
$XXX.XX
|
A2
|
Y
|
| 26125 |
Release palm contracture
|
$XXX.XX
|
N1
|
N
|
| 26130 |
Remove wrist joint lining
|
$XXX.XX
|
A2
|
Y
|
| 26135 |
Revise finger joint each
|
$XXX.XX
|
A2
|
Y
|
| 26140 |
Revise finger joint each
|
$XXX.XX
|
A2
|
Y
|
| 26145 |
Tendon excision palm/finger
|
$XXX.XX
|
A2
|
Y
|
| 26160 |
Remove tendon sheath lesion
|
$XXX.XX
|
A2
|
Y
|
| 26170 |
Removal of palm tendon each
|
$XXX.XX
|
A2
|
Y
|
| 26180 |
Removal of finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26185 |
Remove finger bone
|
$XXX.XX
|
A2
|
Y
|
| 26200 |
Remove hand bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 26205 |
Remove/graft bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 26210 |
Removal of finger lesion
|
$XXX.XX
|
A2
|
Y
|
| 26215 |
Remove/graft finger lesion
|
$XXX.XX
|
A2
|
Y
|
| 26230 |
Partial removal of hand bone
|
$XXX.XX
|
A2
|
Y
|
| 26235 |
Partial removal finger bone
|
$XXX.XX
|
A2
|
Y
|
| 26236 |
Partial removal finger bone
|
$XXX.XX
|
A2
|
Y
|
| 26250 |
Extensive hand surgery
|
$XXX.XX
|
J8
|
Y
|
| 26260 |
Resect prox finger tumor
|
$XXX.XX
|
A2
|
Y
|
| 26262 |
Resect distal finger tumor
|
$XXX.XX
|
A2
|
Y
|
| 26320 |
Removal of implant from hand
|
$XXX.XX
|
A2
|
N
|
| 26340 |
Manipulate finger w/anesth
|
$XXX.XX
|
G2
|
Y
|
| 26341 |
Manipulat palm cord post inj
|
$XXX.XX
|
P3
|
Y
|
| 26350 |
Repair finger/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26352 |
Repair/graft hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26356 |
Repair finger/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26357 |
Repair finger/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26358 |
Repair/graft hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26370 |
Repair finger/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26372 |
Repair/graft hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26373 |
Repair finger/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26390 |
Revise hand/finger tendon
|
$XXX.XX
|
J8
|
Y
|
| 26392 |
Repair/graft hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26410 |
Repair hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26412 |
Repair/graft hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26415 |
Excision hand/finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26416 |
Graft hand or finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26418 |
Repair finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26420 |
Repair/graft finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26426 |
Repair finger/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26428 |
Repair/graft finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26432 |
Repair finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26433 |
Repair finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26434 |
Repair/graft finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26437 |
Realignment of tendons
|
$XXX.XX
|
A2
|
Y
|
| 26440 |
Release palm/finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26442 |
Release palm & finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26445 |
Release hand/finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26449 |
Release forearm/hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26450 |
Incision of palm tendon
|
$XXX.XX
|
A2
|
Y
|
| 26455 |
Incision of finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26460 |
Incise hand/finger tendon
|
$XXX.XX
|
A2
|
Y
|
| 26471 |
Fusion of finger tendons
|
$XXX.XX
|
A2
|
Y
|
| 26474 |
Fusion of finger tendons
|
$XXX.XX
|
A2
|
Y
|
| 26476 |
Tendon lengthening
|
$XXX.XX
|
A2
|
Y
|
| 26477 |
Tendon shortening
|
$XXX.XX
|
A2
|
Y
|
| 26478 |
Lengthening of hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26479 |
Shortening of hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26480 |
Transplant hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26483 |
Transplant/graft hand tendon
|
$XXX.XX
|
A2
|
Y
|
| 26485 |
Transplant palm tendon
|
$XXX.XX
|
A2
|
Y
|
| 26489 |
Transplant/graft palm tendon
|
$XXX.XX
|
A2
|
Y
|
| 26490 |
Revise thumb tendon
|
$XXX.XX
|
A2
|
Y
|
| 26492 |
Tendon transfer with graft
|
$XXX.XX
|
A2
|
Y
|
| 26494 |
Hand tendon/muscle transfer
|
$XXX.XX
|
A2
|
Y
|
| 26496 |
Revise thumb tendon
|
$XXX.XX
|
A2
|
Y
|
| 26497 |
Finger tendon transfer
|
$XXX.XX
|
A2
|
Y
|
| 26498 |
Finger tendon transfer
|
$XXX.XX
|
A2
|
Y
|
| 26499 |
Correction claw finger other
|
$XXX.XX
|
A2
|
Y
|
| 26500 |
Hand tendon reconstruction
|
$XXX.XX
|
A2
|
Y
|
| 26502 |
Hand tendon reconstruction
|
$XXX.XX
|
A2
|
Y
|
| 26508 |
Release thumb contracture
|
$XXX.XX
|
A2
|
Y
|
| 26510 |
Thumb tendon transfer
|
$XXX.XX
|
A2
|
Y
|
| 26516 |
Fusion of knuckle joint
|
$XXX.XX
|
A2
|
Y
|
| 26517 |
Fusion of knuckle joints
|
$XXX.XX
|
A2
|
Y
|
| 26518 |
Fusion of knuckle joints
|
$XXX.XX
|
J8
|
Y
|
| 26520 |
Release knuckle contracture
|
$XXX.XX
|
A2
|
Y
|
| 26525 |
Release finger contracture
|
$XXX.XX
|
A2
|
Y
|
| 26530 |
Revise knuckle joint
|
$XXX.XX
|
J8
|
Y
|
| 26531 |
Revise knuckle with implant
|
$XXX.XX
|
J8
|
Y
|
| 26535 |
Revise finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26536 |
Revise/implant finger joint
|
$XXX.XX
|
J8
|
Y
|
| 26540 |
Repair hand joint
|
$XXX.XX
|
A2
|
Y
|
| 26541 |
Repair hand joint with graft
|
$XXX.XX
|
J8
|
Y
|
| 26542 |
Repair hand joint with graft
|
$XXX.XX
|
J8
|
Y
|
| 26545 |
Reconstruct finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26546 |
Repair nonunion hand
|
$XXX.XX
|
A2
|
Y
|
| 26548 |
Reconstruct finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26550 |
Pollicization digit
|
$XXX.XX
|
A2
|
Y
|
| 26551 |
Great toe-hand transfer
|
$XXX.XX
|
J8
|
Y
|
| 26553 |
Single transfer toe-hand
|
$XXX.XX
|
J8
|
Y
|
| 26554 |
Double transfer toe-hand
|
$XXX.XX
|
J8
|
Y
|
| 26555 |
Positional change of finger
|
$XXX.XX
|
A2
|
Y
|
| 26556 |
Toe joint transfer
|
$XXX.XX
|
J8
|
Y
|
| 26560 |
Repair of web finger
|
$XXX.XX
|
A2
|
Y
|
| 26561 |
Repair of web finger
|
$XXX.XX
|
A2
|
Y
|
| 26562 |
Repair of web finger
|
$XXX.XX
|
A2
|
Y
|
| 26565 |
Correct metacarpal flaw
|
$XXX.XX
|
A2
|
Y
|
| 26567 |
Correct finger deformity
|
$XXX.XX
|
A2
|
Y
|
| 26568 |
Lengthen metacarpal/finger
|
$XXX.XX
|
J8
|
Y
|
| 26580 |
Repair cleft hand
|
$XXX.XX
|
A2
|
Y
|
| 26587 |
Reconstruct extra finger
|
$XXX.XX
|
A2
|
Y
|
| 26590 |
Repair finger deformity
|
$XXX.XX
|
A2
|
Y
|
| 26591 |
Repair muscles of hand
|
$XXX.XX
|
A2
|
Y
|
| 26593 |
Release muscles of hand
|
$XXX.XX
|
A2
|
Y
|
| 26596 |
Excision constricting tissue
|
$XXX.XX
|
A2
|
Y
|
| 26600 |
Treat metacarpal fracture
|
$XXX.XX
|
P2
|
Y
|
| 26605 |
Treat metacarpal fracture
|
$XXX.XX
|
A2
|
Y
|
| 26607 |
Treat metacarpal fracture
|
$XXX.XX
|
A2
|
Y
|
| 26608 |
Treat metacarpal fracture
|
$XXX.XX
|
A2
|
Y
|
| 26615 |
Treat metacarpal fracture
|
$XXX.XX
|
A2
|
Y
|
| 26641 |
Treat thumb dislocation
|
$XXX.XX
|
P2
|
Y
|
| 26645 |
Treat thumb fracture
|
$XXX.XX
|
A2
|
Y
|
| 26650 |
Treat thumb fracture
|
$XXX.XX
|
A2
|
Y
|
| 26665 |
Treat thumb fracture
|
$XXX.XX
|
A2
|
Y
|
| 26670 |
Treat hand dislocation
|
$XXX.XX
|
P2
|
Y
|
| 26675 |
Treat hand dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26676 |
Pin hand dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26685 |
Treat hand dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26686 |
Treat hand dislocation
|
$XXX.XX
|
J8
|
Y
|
| 26700 |
Treat knuckle dislocation
|
$XXX.XX
|
P2
|
Y
|
| 26705 |
Treat knuckle dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26706 |
Pin knuckle dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26715 |
Treat knuckle dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26720 |
Treat finger fracture each
|
$XXX.XX
|
P2
|
Y
|
| 26725 |
Treat finger fracture each
|
$XXX.XX
|
P2
|
Y
|
| 26727 |
Treat finger fracture each
|
$XXX.XX
|
A2
|
Y
|
| 26735 |
Treat finger fracture each
|
$XXX.XX
|
A2
|
Y
|
| 26740 |
Treat finger fracture each
|
$XXX.XX
|
P2
|
Y
|
| 26742 |
Treat finger fracture each
|
$XXX.XX
|
A2
|
Y
|
| 26746 |
Treat finger fracture each
|
$XXX.XX
|
A2
|
Y
|
| 26750 |
Treat finger fracture each
|
$XXX.XX
|
P2
|
Y
|
| 26755 |
Treat finger fracture each
|
$XXX.XX
|
G2
|
Y
|
| 26756 |
Pin finger fracture each
|
$XXX.XX
|
A2
|
Y
|
| 26765 |
Treat finger fracture each
|
$XXX.XX
|
A2
|
Y
|
| 26770 |
Treat finger dislocation
|
$XXX.XX
|
G2
|
Y
|
| 26775 |
Treat finger dislocation
|
$XXX.XX
|
P2
|
Y
|
| 26776 |
Pin finger dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26785 |
Treat finger dislocation
|
$XXX.XX
|
A2
|
Y
|
| 26820 |
Thumb fusion with graft
|
$XXX.XX
|
G2
|
Y
|
| 26841 |
Fusion of thumb
|
$XXX.XX
|
A2
|
Y
|
| 26842 |
Thumb fusion with graft
|
$XXX.XX
|
A2
|
Y
|
| 26843 |
Fusion of hand joint
|
$XXX.XX
|
A2
|
Y
|
| 26844 |
Fusion/graft of hand joint
|
$XXX.XX
|
J8
|
Y
|
| 26850 |
Fusion of knuckle
|
$XXX.XX
|
A2
|
Y
|
| 26852 |
Fusion of knuckle with graft
|
$XXX.XX
|
A2
|
Y
|
| 26860 |
Fusion of finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26861 |
Fusion of finger jnt add-on
|
$XXX.XX
|
N1
|
N
|
| 26862 |
Fusion/graft of finger joint
|
$XXX.XX
|
A2
|
Y
|
| 26863 |
Fuse/graft added joint
|
$XXX.XX
|
N1
|
N
|
| 26910 |
Amputate metacarpal bone
|
$XXX.XX
|
A2
|
Y
|
| 26951 |
Amputation of finger/thumb
|
$XXX.XX
|
A2
|
Y
|
| 26952 |
Amputation of finger/thumb
|
$XXX.XX
|
A2
|
Y
|
| 26990 |
Drainage of pelvis lesion
|
$XXX.XX
|
A2
|
Y
|
| 26991 |
Drainage of pelvis bursa
|
$XXX.XX
|
A2
|
Y
|
| 26992 |
Drainage of bone lesion
|
$XXX.XX
|
G2
|
Y
|
| 27000 |
Tenotomy adductor hip perq
|
$XXX.XX
|
A2
|
Y
|
| 27001 |
Tenotomy adductor hip open
|
$XXX.XX
|
A2
|
Y
|
| 27003 |
Tnot adductr subq opn neurct
|
$XXX.XX
|
A2
|
Y
|
| 27005 |
Tenotomy hip flexor open
|
$XXX.XX
|
G2
|
Y
|
| 27006 |
Tenotomy abductor&/xtnsr hip
|
$XXX.XX
|
G2
|
Y
|
| 27025 |
Fasciotomy hip/thigh any typ
|
$XXX.XX
|
J8
|
Y
|
| 27027 |
Dcmprn fasct pel compartment
|
$XXX.XX
|
G2
|
Y
|
| 27030 |
Arthrotomy hip w/drainage
|
$XXX.XX
|
G2
|
Y
|
| 27033 |
Arthrt hip expl/rmv loose/fb
|
$XXX.XX
|
A2
|
Y
|
| 27035 |
Denervation of hip joint
|
$XXX.XX
|
A2
|
Y
|
| 27036 |
Capsulectomy/capsulotomy hip
|
$XXX.XX
|
G2
|
Y
|
| 27040 |
Biopsy of soft tissues
|
$XXX.XX
|
A2
|
Y
|
| 27041 |
Biopsy of soft tissues
|
$XXX.XX
|
A2
|
Y
|
| 27043 |
Exc hip pelvis les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27045 |
Exc hip/pelv tum deep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27047 |
Exc hip/pelvis les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 27048 |
Exc hip/pelv tum deep < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 27049 |
Resect hip/pelv tum < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 27050 |
Biopsy of sacroiliac joint
|
$XXX.XX
|
A2
|
Y
|
| 27052 |
Biopsy of hip joint
|
$XXX.XX
|
A2
|
Y
|
| 27054 |
Removal of hip joint lining
|
$XXX.XX
|
G2
|
Y
|
| 27057 |
Buttock fasciotomy w/dbrdmt
|
$XXX.XX
|
J8
|
Y
|
| 27059 |
Resect hip/pelv tum 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27060 |
Removal of ischial bursa
|
$XXX.XX
|
J8
|
Y
|
| 27062 |
Remove femur lesion/bursa
|
$XXX.XX
|
A2
|
Y
|
| 27065 |
Remove hip bone les super
|
$XXX.XX
|
A2
|
Y
|
| 27066 |
Remove hip bone les deep
|
$XXX.XX
|
A2
|
Y
|
| 27067 |
Remove/graft hip bone lesion
|
$XXX.XX
|
J8
|
Y
|
| 27070 |
Part remove hip bone super
|
$XXX.XX
|
J8
|
Y
|
| 27071 |
Part removal hip bone deep
|
$XXX.XX
|
G2
|
Y
|
| 27075 |
Resect hip tumor
|
$XXX.XX
|
J8
|
Y
|
| 27076 |
Resect hip tum incl acetabul
|
$XXX.XX
|
G2
|
Y
|
| 27077 |
Resect hip tum w/innom bone
|
$XXX.XX
|
G2
|
Y
|
| 27078 |
Rsect hip tum incl femur
|
$XXX.XX
|
G2
|
Y
|
| 27080 |
Removal of tail bone
|
$XXX.XX
|
A2
|
Y
|
| 27086 |
Remove hip foreign body
|
$XXX.XX
|
A2
|
Y
|
| 27087 |
Remove hip foreign body
|
$XXX.XX
|
A2
|
Y
|
| 27090 |
Removal of hip prosthesis
|
$XXX.XX
|
G2
|
Y
|
| 27091 |
Removal of hip prosthesis
|
$XXX.XX
|
G2
|
Y
|
| 27093 |
Injection for hip x-ray
|
$XXX.XX
|
N1
|
N
|
| 27095 |
Injection for hip x-ray
|
$XXX.XX
|
N1
|
N
|
| 27097 |
Revision of hip tendon
|
$XXX.XX
|
A2
|
Y
|
| 27098 |
Transfer tendon to pelvis
|
$XXX.XX
|
J8
|
Y
|
| 27100 |
Transfer of abdominal muscle
|
$XXX.XX
|
J8
|
Y
|
| 27105 |
Transfer of spinal muscle
|
$XXX.XX
|
J8
|
Y
|
| 27110 |
Transfer of iliopsoas muscle
|
$XXX.XX
|
J8
|
Y
|
| 27111 |
Transfer of iliopsoas muscle
|
$XXX.XX
|
A2
|
Y
|
| 27120 |
Reconstruction of hip socket
|
$XXX.XX
|
J8
|
Y
|
| 27122 |
Reconstruction of hip socket
|
$XXX.XX
|
G2
|
Y
|
| 27125 |
Partial hip replacement
|
$XXX.XX
|
J8
|
Y
|
| 27130 |
Total hip arthroplasty
|
$XXX.XX
|
J8
|
Y
|
| 27132 |
Total hip arthroplasty
|
$XXX.XX
|
J8
|
Y
|
| 27134 |
Revise hip joint replacement
|
$XXX.XX
|
J8
|
Y
|
| 27137 |
Revise hip joint replacement
|
$XXX.XX
|
J8
|
Y
|
| 27138 |
Revise hip joint replacement
|
$XXX.XX
|
J8
|
Y
|
| 27140 |
Transplant femur ridge
|
$XXX.XX
|
G2
|
Y
|
| 27146 |
Incision of hip bone
|
$XXX.XX
|
J8
|
Y
|
| 27147 |
Revision of hip bone
|
$XXX.XX
|
J8
|
Y
|
| 27151 |
Incision of hip bones
|
$XXX.XX
|
J8
|
Y
|
| 27156 |
Revision of hip bones
|
$XXX.XX
|
J8
|
Y
|
| 27158 |
Revision of pelvis
|
$XXX.XX
|
J8
|
Y
|
| 27161 |
Incision of neck of femur
|
$XXX.XX
|
J8
|
Y
|
| 27165 |
Incision/fixation of femur
|
$XXX.XX
|
J8
|
Y
|
| 27170 |
Repair/graft femur head/neck
|
$XXX.XX
|
J8
|
Y
|
| 27175 |
Treat slipped epiphysis
|
$XXX.XX
|
G2
|
Y
|
| 27176 |
Treat slipped epiphysis
|
$XXX.XX
|
J8
|
Y
|
| 27177 |
Treat slipped epiphysis
|
$XXX.XX
|
J8
|
Y
|
| 27178 |
Treat slipped epiphysis
|
$XXX.XX
|
J8
|
Y
|
| 27179 |
Revise head/neck of femur
|
$XXX.XX
|
G2
|
Y
|
| 27181 |
Treat slipped epiphysis
|
$XXX.XX
|
J8
|
Y
|
| 27185 |
Revision of femur epiphysis
|
$XXX.XX
|
J8
|
Y
|
| 27187 |
Reinforce hip bones
|
$XXX.XX
|
J8
|
Y
|
| 27197 |
Clsd tx pelvic ring fx
|
$XXX.XX
|
G2
|
Y
|
| 27198 |
Clsd tx pelvic ring fx
|
$XXX.XX
|
G2
|
Y
|
| 27200 |
Treat tail bone fracture
|
$XXX.XX
|
P2
|
Y
|
| 27202 |
Treat tail bone fracture
|
$XXX.XX
|
A2
|
Y
|
| 27220 |
Treat hip socket fracture
|
$XXX.XX
|
G2
|
Y
|
| 27222 |
Treat hip socket fracture
|
$XXX.XX
|
G2
|
Y
|
| 27226 |
Treat hip wall fracture
|
$XXX.XX
|
J8
|
Y
|
| 27227 |
Treat hip fracture(s)
|
$XXX.XX
|
J8
|
Y
|
| 27228 |
Treat hip fracture(s)
|
$XXX.XX
|
J8
|
Y
|
| 27230 |
Treat thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27232 |
Treat thigh fracture
|
$XXX.XX
|
G2
|
Y
|
| 27235 |
Treat thigh fracture
|
$XXX.XX
|
G2
|
Y
|
| 27236 |
Treat thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27238 |
Treat thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27240 |
Treat thigh fracture
|
$XXX.XX
|
G2
|
Y
|
| 27244 |
Treat thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27245 |
Treat thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27246 |
Treat thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27248 |
Treat thigh fracture
|
$XXX.XX
|
G2
|
Y
|
| 27250 |
Treat hip dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27252 |
Treat hip dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27253 |
Treat hip dislocation
|
$XXX.XX
|
G2
|
Y
|
| 27254 |
Treat hip dislocation
|
$XXX.XX
|
G2
|
Y
|
| 27256 |
Treat hip dislocation
|
$XXX.XX
|
G2
|
Y
|
| 27257 |
Treat hip dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27258 |
Treat hip dislocation
|
$XXX.XX
|
G2
|
Y
|
| 27259 |
Treat hip dislocation
|
$XXX.XX
|
J8
|
Y
|
| 27265 |
Treat hip dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27266 |
Treat hip dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27267 |
Cltx thigh fx
|
$XXX.XX
|
G2
|
Y
|
| 27268 |
Cltx thigh fx w/mnpj
|
$XXX.XX
|
G2
|
Y
|
| 27269 |
Optx thigh fx
|
$XXX.XX
|
J8
|
Y
|
| 27275 |
Manipulation of hip joint
|
$XXX.XX
|
A2
|
Y
|
| 27278 |
Arthrd si jt plmt iartic dev
|
$XXX.XX
|
J8
|
Y
|
| 27279 |
Arthrd si jt plmt tartclr dv
|
$XXX.XX
|
J8
|
Y
|
| 27280 |
Arthr si jt opn b1grf instrm
|
$XXX.XX
|
J8
|
Y
|
| 27282 |
Arthrodesis symphysis pubis
|
$XXX.XX
|
J8
|
Y
|
| 27284 |
Arthrodesis hip joint
|
$XXX.XX
|
J8
|
Y
|
| 27286 |
Arthrd hip jt sbtrchc osteot
|
$XXX.XX
|
J8
|
Y
|
| 27290 |
Amputation of leg at hip
|
$XXX.XX
|
G2
|
Y
|
| 27295 |
Amputation of leg at hip
|
$XXX.XX
|
G2
|
Y
|
| 27301 |
Drain thigh/knee lesion
|
$XXX.XX
|
A2
|
Y
|
| 27303 |
Drainage of bone lesion
|
$XXX.XX
|
J8
|
Y
|
| 27305 |
Incise thigh tendon & fascia
|
$XXX.XX
|
A2
|
Y
|
| 27306 |
Incision of thigh tendon
|
$XXX.XX
|
A2
|
Y
|
| 27307 |
Incision of thigh tendons
|
$XXX.XX
|
A2
|
Y
|
| 27310 |
Exploration of knee joint
|
$XXX.XX
|
A2
|
Y
|
| 27323 |
Biopsy thigh soft tissues
|
$XXX.XX
|
A2
|
Y
|
| 27324 |
Biopsy thigh soft tissues
|
$XXX.XX
|
A2
|
Y
|
| 27325 |
Neurectomy hamstring
|
$XXX.XX
|
A2
|
Y
|
| 27326 |
Neurectomy popliteal
|
$XXX.XX
|
A2
|
Y
|
| 27327 |
Exc thigh/knee les sc < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 27328 |
Exc thigh/knee tum deep <5cm
|
$XXX.XX
|
G2
|
Y
|
| 27329 |
Resect thigh/knee tum < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 27330 |
Biopsy knee joint lining
|
$XXX.XX
|
A2
|
Y
|
| 27331 |
Explore/treat knee joint
|
$XXX.XX
|
A2
|
Y
|
| 27332 |
Removal of knee cartilage
|
$XXX.XX
|
A2
|
Y
|
| 27333 |
Removal of knee cartilage
|
$XXX.XX
|
A2
|
Y
|
| 27334 |
Remove knee joint lining
|
$XXX.XX
|
A2
|
Y
|
| 27335 |
Remove knee joint lining
|
$XXX.XX
|
A2
|
Y
|
| 27337 |
Exc thigh/knee les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27339 |
Exc thigh/knee tum dep 5cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27340 |
Removal of kneecap bursa
|
$XXX.XX
|
A2
|
Y
|
| 27345 |
Removal of knee cyst
|
$XXX.XX
|
A2
|
Y
|
| 27347 |
Remove knee cyst
|
$XXX.XX
|
A2
|
Y
|
| 27350 |
Removal of kneecap
|
$XXX.XX
|
A2
|
Y
|
| 27355 |
Remove femur lesion
|
$XXX.XX
|
A2
|
Y
|
| 27356 |
Remove femur lesion/graft
|
$XXX.XX
|
J8
|
Y
|
| 27357 |
Remove femur lesion/graft
|
$XXX.XX
|
J8
|
Y
|
| 27358 |
Remove femur lesion/fixation
|
$XXX.XX
|
N1
|
N
|
| 27360 |
Partial removal leg bone(s)
|
$XXX.XX
|
A2
|
Y
|
| 27364 |
Resect thigh/knee tum 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27365 |
Resect femur/knee tumor
|
$XXX.XX
|
G2
|
Y
|
| 27369 |
Njx cntrst kne arthg/ct/mri
|
$XXX.XX
|
N1
|
N
|
| 27372 |
Removal of foreign body
|
$XXX.XX
|
A2
|
Y
|
| 27380 |
Repair of kneecap tendon
|
$XXX.XX
|
A2
|
Y
|
| 27381 |
Repair/graft kneecap tendon
|
$XXX.XX
|
A2
|
Y
|
| 27385 |
Repair of thigh muscle
|
$XXX.XX
|
A2
|
Y
|
| 27386 |
Repair/graft of thigh muscle
|
$XXX.XX
|
A2
|
Y
|
| 27390 |
Incision of thigh tendon
|
$XXX.XX
|
A2
|
Y
|
| 27391 |
Incision of thigh tendons
|
$XXX.XX
|
A2
|
Y
|
| 27392 |
Incision of thigh tendons
|
$XXX.XX
|
A2
|
Y
|
| 27393 |
Lengthening of thigh tendon
|
$XXX.XX
|
J8
|
Y
|
| 27394 |
Lengthening of thigh tendons
|
$XXX.XX
|
A2
|
Y
|
| 27395 |
Lengthening of thigh tendons
|
$XXX.XX
|
A2
|
Y
|
| 27396 |
Transplant of thigh tendon
|
$XXX.XX
|
A2
|
Y
|
| 27397 |
Transplants of thigh tendons
|
$XXX.XX
|
J8
|
Y
|
| 27400 |
Revise thigh muscles/tendons
|
$XXX.XX
|
A2
|
Y
|
| 27403 |
Repair of knee cartilage
|
$XXX.XX
|
J8
|
Y
|
| 27405 |
Repair of knee ligament
|
$XXX.XX
|
A2
|
Y
|
| 27407 |
Repair of knee ligament
|
$XXX.XX
|
J8
|
Y
|
| 27409 |
Repair of knee ligaments
|
$XXX.XX
|
A2
|
Y
|
| 27412 |
Autochondrocyte implant knee
|
$XXX.XX
|
G2
|
Y
|
| 27415 |
Osteochondral knee allograft
|
$XXX.XX
|
J8
|
Y
|
| 27416 |
Osteochondral knee autograft
|
$XXX.XX
|
G2
|
Y
|
| 27418 |
Repair degenerated kneecap
|
$XXX.XX
|
G2
|
Y
|
| 27420 |
Revision of unstable kneecap
|
$XXX.XX
|
A2
|
Y
|
| 27422 |
Revision of unstable kneecap
|
$XXX.XX
|
A2
|
Y
|
| 27424 |
Revision/removal of kneecap
|
$XXX.XX
|
A2
|
Y
|
| 27425 |
Lat retinacular release open
|
$XXX.XX
|
A2
|
Y
|
| 27427 |
Reconstruction knee
|
$XXX.XX
|
J8
|
Y
|
| 27428 |
Reconstruction knee
|
$XXX.XX
|
J8
|
Y
|
| 27429 |
Reconstruction knee
|
$XXX.XX
|
J8
|
Y
|
| 27430 |
Revision of thigh muscles
|
$XXX.XX
|
G2
|
Y
|
| 27435 |
Incision of knee joint
|
$XXX.XX
|
A2
|
Y
|
| 27437 |
Revise kneecap
|
$XXX.XX
|
A2
|
Y
|
| 27438 |
Revise kneecap with implant
|
$XXX.XX
|
A2
|
Y
|
| 27440 |
Revision of knee joint
|
$XXX.XX
|
J8
|
Y
|
| 27441 |
Revision of knee joint
|
$XXX.XX
|
G2
|
Y
|
| 27442 |
Revision of knee joint
|
$XXX.XX
|
J8
|
Y
|
| 27443 |
Revision of knee joint
|
$XXX.XX
|
J8
|
Y
|
| 27446 |
Revision of knee joint
|
$XXX.XX
|
J8
|
Y
|
| 27447 |
Total knee arthroplasty
|
$XXX.XX
|
J8
|
Y
|
| 27448 |
Incision of thigh
|
$XXX.XX
|
G2
|
Y
|
| 27450 |
Incision of thigh
|
$XXX.XX
|
J8
|
Y
|
| 27454 |
Realignment of thigh bone
|
$XXX.XX
|
J8
|
Y
|
| 27455 |
Realignment of knee
|
$XXX.XX
|
G2
|
Y
|
| 27457 |
Realignment of knee
|
$XXX.XX
|
G2
|
Y
|
| 27458 |
Osteot femur imed lngth dev
|
$XXX.XX
|
J8
|
Y
|
| 27465 |
Shortening of thigh bone
|
$XXX.XX
|
J8
|
Y
|
| 27466 |
Lengthening of thigh bone
|
$XXX.XX
|
J8
|
Y
|
| 27468 |
Shorten/lengthen thighs
|
$XXX.XX
|
D5
|
N
|
| 27470 |
Repair of thigh
|
$XXX.XX
|
G2
|
Y
|
| 27472 |
Repair/graft of thigh
|
$XXX.XX
|
J8
|
Y
|
| 27475 |
Surgery to stop leg growth
|
$XXX.XX
|
G2
|
Y
|
| 27477 |
Surgery to stop leg growth
|
$XXX.XX
|
J8
|
Y
|
| 27479 |
Surgery to stop leg growth
|
$XXX.XX
|
G2
|
Y
|
| 27485 |
Surgery to stop leg growth
|
$XXX.XX
|
G2
|
Y
|
| 27486 |
Revise/replace knee joint
|
$XXX.XX
|
G2
|
Y
|
| 27487 |
Revise/replace knee joint
|
$XXX.XX
|
J8
|
Y
|
| 27488 |
Removal of knee prosthesis
|
$XXX.XX
|
J8
|
Y
|
| 27495 |
Reinforce thigh
|
$XXX.XX
|
J8
|
Y
|
| 27496 |
Decompression of thigh/knee
|
$XXX.XX
|
A2
|
Y
|
| 27497 |
Decompression of thigh/knee
|
$XXX.XX
|
A2
|
Y
|
| 27498 |
Decompression of thigh/knee
|
$XXX.XX
|
A2
|
Y
|
| 27499 |
Decompression of thigh/knee
|
$XXX.XX
|
A2
|
Y
|
| 27500 |
Treatment of thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27501 |
Treatment of thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27502 |
Treatment of thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27503 |
Treatment of thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27506 |
Treatment of thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27507 |
Treatment of thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27508 |
Treatment of thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27509 |
Treatment of thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27510 |
Treatment of thigh fracture
|
$XXX.XX
|
A2
|
Y
|
| 27511 |
Treatment of thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27513 |
Treatment of thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27514 |
Treatment of thigh fracture
|
$XXX.XX
|
J8
|
Y
|
| 27516 |
Treat thigh fx growth plate
|
$XXX.XX
|
A2
|
Y
|
| 27517 |
Treat thigh fx growth plate
|
$XXX.XX
|
A2
|
Y
|
| 27519 |
Treat thigh fx growth plate
|
$XXX.XX
|
J8
|
Y
|
| 27520 |
Treat kneecap fracture
|
$XXX.XX
|
A2
|
Y
|
| 27524 |
Treat kneecap fracture
|
$XXX.XX
|
G2
|
Y
|
| 27530 |
Treat knee fracture
|
$XXX.XX
|
A2
|
Y
|
| 27532 |
Treat knee fracture
|
$XXX.XX
|
A2
|
Y
|
| 27535 |
Treat knee fracture
|
$XXX.XX
|
J8
|
Y
|
| 27536 |
Treat knee fracture
|
$XXX.XX
|
J8
|
Y
|
| 27538 |
Treat knee fracture(s)
|
$XXX.XX
|
A2
|
Y
|
| 27540 |
Treat knee fracture
|
$XXX.XX
|
G2
|
Y
|
| 27550 |
Treat knee dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27552 |
Treat knee dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27556 |
Treat knee dislocation
|
$XXX.XX
|
G2
|
Y
|
| 27557 |
Treat knee dislocation
|
$XXX.XX
|
J8
|
Y
|
| 27558 |
Treat knee dislocation
|
$XXX.XX
|
J8
|
Y
|
| 27560 |
Treat kneecap dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27562 |
Treat kneecap dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27566 |
Treat kneecap dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27570 |
Fixation of knee joint
|
$XXX.XX
|
A2
|
Y
|
| 27580 |
Fusion of knee
|
$XXX.XX
|
J8
|
Y
|
| 27590 |
Amputate leg at thigh
|
$XXX.XX
|
G2
|
Y
|
| 27591 |
Amputate leg at thigh
|
$XXX.XX
|
G2
|
Y
|
| 27592 |
Amputate leg at thigh
|
$XXX.XX
|
G2
|
Y
|
| 27594 |
Amputation follow-up surgery
|
$XXX.XX
|
A2
|
Y
|
| 27596 |
Amputation follow-up surgery
|
$XXX.XX
|
G2
|
Y
|
| 27598 |
Amputate lower leg at knee
|
$XXX.XX
|
G2
|
Y
|
| 27600 |
Decompression of lower leg
|
$XXX.XX
|
A2
|
Y
|
| 27601 |
Decompression of lower leg
|
$XXX.XX
|
A2
|
Y
|
| 27602 |
Decompression of lower leg
|
$XXX.XX
|
A2
|
Y
|
| 27603 |
Drain lower leg lesion
|
$XXX.XX
|
A2
|
Y
|
| 27604 |
Drain lower leg bursa
|
$XXX.XX
|
A2
|
Y
|
| 27605 |
Incision of achilles tendon
|
$XXX.XX
|
A2
|
Y
|
| 27606 |
Incision of achilles tendon
|
$XXX.XX
|
A2
|
Y
|
| 27607 |
Treat lower leg bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 27610 |
Explore/treat ankle joint
|
$XXX.XX
|
A2
|
Y
|
| 27612 |
Exploration of ankle joint
|
$XXX.XX
|
A2
|
Y
|
| 27613 |
Biopsy lower leg soft tissue
|
$XXX.XX
|
P3
|
Y
|
| 27614 |
Biopsy lower leg soft tissue
|
$XXX.XX
|
A2
|
Y
|
| 27615 |
Resect leg/ankle tum < 5 cm
|
$XXX.XX
|
G2
|
Y
|
| 27616 |
Resect leg/ankle tum 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27618 |
Exc leg/ankle tum < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 27619 |
Exc leg/ankle tum deep <5 cm
|
$XXX.XX
|
G2
|
Y
|
| 27620 |
Explore/treat ankle joint
|
$XXX.XX
|
A2
|
Y
|
| 27625 |
Remove ankle joint lining
|
$XXX.XX
|
A2
|
Y
|
| 27626 |
Remove ankle joint lining
|
$XXX.XX
|
A2
|
Y
|
| 27630 |
Removal of tendon lesion
|
$XXX.XX
|
A2
|
Y
|
| 27632 |
Exc leg/ankle les sc 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27634 |
Exc leg/ankle tum dep 5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 27635 |
Remove lower leg bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 27637 |
Remove/graft leg bone lesion
|
$XXX.XX
|
J8
|
Y
|
| 27638 |
Remove/graft leg bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 27640 |
Partial removal of tibia
|
$XXX.XX
|
A2
|
Y
|
| 27641 |
Partial removal of fibula
|
$XXX.XX
|
A2
|
Y
|
| 27645 |
Resect tibia tumor
|
$XXX.XX
|
G2
|
Y
|
| 27646 |
Resect fibula tumor
|
$XXX.XX
|
G2
|
Y
|
| 27647 |
Resect talus/calcaneus tum
|
$XXX.XX
|
G2
|
Y
|
| 27648 |
Injection for ankle x-ray
|
$XXX.XX
|
N1
|
N
|
| 27650 |
Repair achilles tendon
|
$XXX.XX
|
J8
|
Y
|
| 27652 |
Repair/graft achilles tendon
|
$XXX.XX
|
J8
|
Y
|
| 27654 |
Repair of achilles tendon
|
$XXX.XX
|
J8
|
Y
|
| 27656 |
Repair leg fascia defect
|
$XXX.XX
|
A2
|
Y
|
| 27658 |
Repair of leg tendon each
|
$XXX.XX
|
A2
|
Y
|
| 27659 |
Repair of leg tendon each
|
$XXX.XX
|
A2
|
Y
|
| 27664 |
Repair of leg tendon each
|
$XXX.XX
|
A2
|
Y
|
| 27665 |
Repair of leg tendon each
|
$XXX.XX
|
J8
|
Y
|
| 27675 |
Repair lower leg tendons
|
$XXX.XX
|
A2
|
Y
|
| 27676 |
Repair lower leg tendons
|
$XXX.XX
|
A2
|
Y
|
| 27680 |
Release of lower leg tendon
|
$XXX.XX
|
A2
|
Y
|
| 27681 |
Release of lower leg tendons
|
$XXX.XX
|
A2
|
Y
|
| 27685 |
Revision of lower leg tendon
|
$XXX.XX
|
A2
|
Y
|
| 27686 |
Revise lower leg tendons
|
$XXX.XX
|
A2
|
Y
|
| 27687 |
Revision of calf tendon
|
$XXX.XX
|
A2
|
Y
|
| 27690 |
Revise lower leg tendon
|
$XXX.XX
|
A2
|
Y
|
| 27691 |
Revise lower leg tendon
|
$XXX.XX
|
A2
|
Y
|
| 27692 |
Revise additional leg tendon
|
$XXX.XX
|
N1
|
N
|
| 27695 |
Repair of ankle ligament
|
$XXX.XX
|
J8
|
Y
|
| 27696 |
Repair of ankle ligaments
|
$XXX.XX
|
J8
|
Y
|
| 27698 |
Repair of ankle ligament
|
$XXX.XX
|
J8
|
Y
|
| 27700 |
Revision of ankle joint
|
$XXX.XX
|
J8
|
Y
|
| 27702 |
Reconstruct ankle joint
|
$XXX.XX
|
J8
|
Y
|
| 27703 |
Reconstruction ankle joint
|
$XXX.XX
|
J8
|
Y
|
| 27704 |
Removal of ankle implant
|
$XXX.XX
|
A2
|
N
|
| 27705 |
Osteotomy tibia
|
$XXX.XX
|
J8
|
Y
|
| 27707 |
Osteotomy fibula
|
$XXX.XX
|
A2
|
Y
|
| 27709 |
Osteotomy tibia & fibula
|
$XXX.XX
|
J8
|
Y
|
| 27712 |
Osteot mlt relignmt imed rod
|
$XXX.XX
|
J8
|
Y
|
| 27713 |
Osteot tibia imed lngth dev
|
$XXX.XX
|
J8
|
Y
|
| 27715 |
Ostpl tibfib lngth/shrt
|
$XXX.XX
|
J8
|
Y
|
| 27720 |
Repair of tibia
|
$XXX.XX
|
J8
|
Y
|
| 27722 |
Repair/graft of tibia
|
$XXX.XX
|
J8
|
Y
|
| 27724 |
Repair/graft of tibia
|
$XXX.XX
|
J8
|
Y
|
| 27725 |
Repair of lower leg
|
$XXX.XX
|
J8
|
Y
|
| 27726 |
Repair fibula nonunion
|
$XXX.XX
|
J8
|
Y
|
| 27727 |
Repair of lower leg
|
$XXX.XX
|
G2
|
Y
|
| 27730 |
Repair of tibia epiphysis
|
$XXX.XX
|
J8
|
Y
|
| 27732 |
Repair of fibula epiphysis
|
$XXX.XX
|
A2
|
Y
|
| 27734 |
Repair lower leg epiphyses
|
$XXX.XX
|
A2
|
Y
|
| 27740 |
Repair of leg epiphyses
|
$XXX.XX
|
G2
|
Y
|
| 27742 |
Repair of leg epiphyses
|
$XXX.XX
|
A2
|
Y
|
| 27745 |
Reinforce tibia
|
$XXX.XX
|
J8
|
Y
|
| 27750 |
Treatment of tibia fracture
|
$XXX.XX
|
A2
|
Y
|
| 27752 |
Treatment of tibia fracture
|
$XXX.XX
|
A2
|
Y
|
| 27756 |
Treatment of tibia fracture
|
$XXX.XX
|
J8
|
Y
|
| 27758 |
Treatment of tibia fracture
|
$XXX.XX
|
J8
|
Y
|
| 27759 |
Treatment of tibia fracture
|
$XXX.XX
|
J8
|
Y
|
| 27760 |
Cltx medial ankle fx
|
$XXX.XX
|
A2
|
Y
|
| 27762 |
Cltx med ankle fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 27766 |
Optx medial ankle fx
|
$XXX.XX
|
A2
|
Y
|
| 27767 |
Cltx post ankle fx
|
$XXX.XX
|
P2
|
Y
|
| 27768 |
Cltx post ankle fx w/mnpj
|
$XXX.XX
|
G2
|
Y
|
| 27769 |
Optx post ankle fx
|
$XXX.XX
|
J8
|
Y
|
| 27780 |
Treatment of fibula fracture
|
$XXX.XX
|
A2
|
Y
|
| 27781 |
Treatment of fibula fracture
|
$XXX.XX
|
A2
|
Y
|
| 27784 |
Treatment of fibula fracture
|
$XXX.XX
|
A2
|
Y
|
| 27786 |
Treatment of ankle fracture
|
$XXX.XX
|
A2
|
Y
|
| 27788 |
Treatment of ankle fracture
|
$XXX.XX
|
A2
|
Y
|
| 27792 |
Treatment of ankle fracture
|
$XXX.XX
|
J8
|
Y
|
| 27808 |
Treatment of ankle fracture
|
$XXX.XX
|
A2
|
Y
|
| 27810 |
Treatment of ankle fracture
|
$XXX.XX
|
A2
|
Y
|
| 27814 |
Treatment of ankle fracture
|
$XXX.XX
|
J8
|
Y
|
| 27816 |
Treatment of ankle fracture
|
$XXX.XX
|
A2
|
Y
|
| 27818 |
Treatment of ankle fracture
|
$XXX.XX
|
A2
|
Y
|
| 27822 |
Treatment of ankle fracture
|
$XXX.XX
|
J8
|
Y
|
| 27823 |
Treatment of ankle fracture
|
$XXX.XX
|
J8
|
Y
|
| 27824 |
Treat lower leg fracture
|
$XXX.XX
|
A2
|
Y
|
| 27825 |
Treat lower leg fracture
|
$XXX.XX
|
A2
|
Y
|
| 27826 |
Treat lower leg fracture
|
$XXX.XX
|
J8
|
Y
|
| 27827 |
Treat lower leg fracture
|
$XXX.XX
|
J8
|
Y
|
| 27828 |
Treat lower leg fracture
|
$XXX.XX
|
J8
|
Y
|
| 27829 |
Treat lower leg joint
|
$XXX.XX
|
J8
|
Y
|
| 27830 |
Treat lower leg dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27831 |
Treat lower leg dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27832 |
Treat lower leg dislocation
|
$XXX.XX
|
J8
|
Y
|
| 27840 |
Treat ankle dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27842 |
Treat ankle dislocation
|
$XXX.XX
|
A2
|
Y
|
| 27846 |
Treat ankle dislocation
|
$XXX.XX
|
J8
|
Y
|
| 27848 |
Treat ankle dislocation
|
$XXX.XX
|
J8
|
Y
|
| 27860 |
Fixation of ankle joint
|
$XXX.XX
|
A2
|
Y
|
| 27870 |
Fusion of ankle joint open
|
$XXX.XX
|
J8
|
Y
|
| 27871 |
Fusion of tibiofibular joint
|
$XXX.XX
|
J8
|
Y
|
| 27880 |
Amputation of lower leg
|
$XXX.XX
|
G2
|
Y
|
| 27881 |
Amputation of lower leg
|
$XXX.XX
|
G2
|
Y
|
| 27882 |
Amputation of lower leg
|
$XXX.XX
|
G2
|
Y
|
| 27884 |
Amputation follow-up surgery
|
$XXX.XX
|
A2
|
Y
|
| 27886 |
Amputation follow-up surgery
|
$XXX.XX
|
G2
|
Y
|
| 27888 |
Amputation of foot at ankle
|
$XXX.XX
|
G2
|
Y
|
| 27889 |
Ankle disarticulation
|
$XXX.XX
|
A2
|
Y
|
| 27892 |
Decompression of leg
|
$XXX.XX
|
A2
|
Y
|
| 27893 |
Decompression of leg
|
$XXX.XX
|
J8
|
Y
|
| 27894 |
Decompression of leg
|
$XXX.XX
|
A2
|
Y
|
| 28001 |
Drainage of bursa of foot
|
$XXX.XX
|
P3
|
Y
|
| 28002 |
Treatment of foot infection
|
$XXX.XX
|
A2
|
Y
|
| 28003 |
Treatment of foot infection
|
$XXX.XX
|
A2
|
Y
|
| 28005 |
Treat foot bone lesion
|
$XXX.XX
|
A2
|
Y
|
| 28008 |
Incision of foot fascia
|
$XXX.XX
|
A2
|
Y
|
| 28010 |
Incision of toe tendon
|
$XXX.XX
|
P3
|
Y
|
| 28011 |
Incision of toe tendons
|
$XXX.XX
|
A2
|
Y
|
| 28020 |
Exploration of foot joint
|
$XXX.XX
|
A2
|
Y
|
| 28022 |
Exploration of foot joint
|
$XXX.XX
|
A2
|
Y
|
| 28024 |
Exploration of toe joint
|
$XXX.XX
|
A2
|
Y
|
| 28035 |
Decompression of tibia nerve
|
$XXX.XX
|
A2
|
Y
|
| 28039 |
Exc foot/toe tum sc 1.5 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 28041 |
Exc foot/toe tum dep 1.5cm/>
|
$XXX.XX
|
G2
|
Y
|
| 28043 |
Exc foot/toe tum sc < 1.5 cm
|
$XXX.XX
|
G2
|
Y
|
| 28045 |
Exc foot/toe tum deep <1.5cm
|
$XXX.XX
|
G2
|
Y
|
| 28046 |
Resect foot/toe tumor < 3 cm
|
$XXX.XX
|
G2
|
Y
|
| 28047 |
Resect foot/toe tumor 3 cm/>
|
$XXX.XX
|
G2
|
Y
|
| 28050 |
Biopsy of foot joint lining
|
$XXX.XX
|
A2
|
Y
|
| 28052 |
Biopsy of foot joint lining
|
$XXX.XX
|
A2
|
Y
|
| 28054 |
Biopsy of toe joint lining
|
$XXX.XX
|
A2
|
Y
|
| 28055 |
Neurectomy foot
|
$XXX.XX
|
A2
|
Y
|
| 28060 |
Partial removal foot fascia
|
$XXX.XX
|
A2
|
Y
|
| 28062 |
Removal of foot fascia
|
$XXX.XX
|
A2
|
Y
|
| 28070 |
Removal of foot joint lining
|
$XXX.XX
|
A2
|
Y
|
| 28072 |
Removal of foot joint lining
|
$XXX.XX
|
A2
|
Y
|
| 28080 |
Removal of foot lesion
|
$XXX.XX
|
A2
|
Y
|
| 28086 |
Excise foot tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 28088 |
Excise foot tendon sheath
|
$XXX.XX
|
A2
|
Y
|
| 28090 |
Removal of foot lesion
|
$XXX.XX
|
A2
|
Y
|
| 28092 |
Removal of toe lesions
|
$XXX.XX
|
A2
|
Y
|
| 28100 |
Removal of ankle/heel lesion
|
$XXX.XX
|
A2
|
Y
|
| 28102 |
Remove/graft foot lesion
|
$XXX.XX
|
J8
|
Y
|
| 28103 |
Remove/graft foot lesion
|
$XXX.XX
|
J8
|
Y
|
| 28104 |
Removal of foot lesion
|
$XXX.XX
|
A2
|
Y
|
| 28106 |
Remove/graft foot lesion
|
$XXX.XX
|
J8
|
Y
|
| 28107 |
Remove/graft foot lesion
|
$XXX.XX
|
G2
|
Y
|
| 28108 |
Removal of toe lesions
|
$XXX.XX
|
A2
|
Y
|
| 28110 |
Part removal of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28111 |
Part removal of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28112 |
Part removal of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28113 |
Part removal of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28114 |
Removal of metatarsal heads
|
$XXX.XX
|
A2
|
Y
|
| 28116 |
Revision of foot
|
$XXX.XX
|
A2
|
Y
|
| 28118 |
Removal of heel bone
|
$XXX.XX
|
A2
|
Y
|
| 28119 |
Removal of heel spur
|
$XXX.XX
|
A2
|
Y
|
| 28120 |
Part removal of ankle/heel
|
$XXX.XX
|
A2
|
Y
|
| 28122 |
Partial removal of foot bone
|
$XXX.XX
|
A2
|
Y
|
| 28124 |
Partial removal of toe
|
$XXX.XX
|
P3
|
Y
|
| 28126 |
Partial removal of toe
|
$XXX.XX
|
A2
|
Y
|
| 28130 |
Removal of ankle bone
|
$XXX.XX
|
J8
|
Y
|
| 28140 |
Removal of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28150 |
Removal of toe
|
$XXX.XX
|
A2
|
Y
|
| 28153 |
Partial removal of toe
|
$XXX.XX
|
A2
|
Y
|
| 28160 |
Partial removal of toe
|
$XXX.XX
|
A2
|
Y
|
| 28171 |
Resect tarsal tumor
|
$XXX.XX
|
A2
|
Y
|
| 28173 |
Resect metatarsal tumor
|
$XXX.XX
|
A2
|
Y
|
| 28175 |
Resect phalanx of toe tumor
|
$XXX.XX
|
A2
|
Y
|
| 28190 |
Removal of foot foreign body
|
$XXX.XX
|
P3
|
Y
|
| 28192 |
Removal of foot foreign body
|
$XXX.XX
|
A2
|
Y
|
| 28193 |
Removal of foot foreign body
|
$XXX.XX
|
A2
|
Y
|
| 28200 |
Repair of foot tendon
|
$XXX.XX
|
A2
|
Y
|
| 28202 |
Repair/graft of foot tendon
|
$XXX.XX
|
J8
|
Y
|
| 28208 |
Repair of foot tendon
|
$XXX.XX
|
A2
|
Y
|
| 28210 |
Repair/graft of foot tendon
|
$XXX.XX
|
J8
|
Y
|
| 28220 |
Release of foot tendon
|
$XXX.XX
|
P3
|
Y
|
| 28222 |
Release of foot tendons
|
$XXX.XX
|
A2
|
Y
|
| 28225 |
Release of foot tendon
|
$XXX.XX
|
A2
|
Y
|
| 28226 |
Release of foot tendons
|
$XXX.XX
|
A2
|
Y
|
| 28230 |
Incision of foot tendon(s)
|
$XXX.XX
|
P3
|
Y
|
| 28232 |
Incision of toe tendon
|
$XXX.XX
|
P3
|
Y
|
| 28234 |
Incision of foot tendon
|
$XXX.XX
|
A2
|
Y
|
| 28238 |
Revision of foot tendon
|
$XXX.XX
|
A2
|
Y
|
| 28240 |
Release of big toe
|
$XXX.XX
|
A2
|
Y
|
| 28250 |
Revision of foot fascia
|
$XXX.XX
|
A2
|
Y
|
| 28260 |
Release of midfoot joint
|
$XXX.XX
|
A2
|
Y
|
| 28261 |
Revision of foot tendon
|
$XXX.XX
|
A2
|
Y
|
| 28262 |
Revision of foot and ankle
|
$XXX.XX
|
J8
|
Y
|
| 28264 |
Release of midfoot joint
|
$XXX.XX
|
A2
|
Y
|
| 28270 |
Release of foot contracture
|
$XXX.XX
|
A2
|
Y
|
| 28272 |
Release of toe joint each
|
$XXX.XX
|
P3
|
Y
|
| 28280 |
Fusion of toes
|
$XXX.XX
|
A2
|
Y
|
| 28285 |
Repair of hammertoe
|
$XXX.XX
|
A2
|
Y
|
| 28286 |
Repair of hammertoe
|
$XXX.XX
|
A2
|
Y
|
| 28288 |
Partial removal of foot bone
|
$XXX.XX
|
A2
|
Y
|
| 28289 |
Corrj halux rigdus w/o implt
|
$XXX.XX
|
A2
|
Y
|
| 28291 |
Corrj halux rigdus w/implt
|
$XXX.XX
|
J8
|
Y
|
| 28292 |
Cor hlx vlgs rsc prx phlx bs
|
$XXX.XX
|
A2
|
Y
|
| 28295 |
Cor hlx vlgs prx mtar osteot
|
$XXX.XX
|
G2
|
Y
|
| 28296 |
Cor hlx vlgs dstl mtar osteo
|
$XXX.XX
|
A2
|
Y
|
| 28297 |
Cor hlx vlgs jt arthrd
|
$XXX.XX
|
J8
|
Y
|
| 28298 |
Cor hlx vlgs prx phlx osteot
|
$XXX.XX
|
J8
|
Y
|
| 28299 |
Cor hlx vlgs double osteot
|
$XXX.XX
|
J8
|
Y
|
| 28300 |
Incision of heel bone
|
$XXX.XX
|
J8
|
Y
|
| 28302 |
Incision of ankle bone
|
$XXX.XX
|
J8
|
Y
|
| 28304 |
Incision of midfoot bones
|
$XXX.XX
|
A2
|
Y
|
| 28305 |
Incise/graft midfoot bones
|
$XXX.XX
|
J8
|
Y
|
| 28306 |
Incision of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28307 |
Incision of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28308 |
Incision of metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28309 |
Incision of metatarsals
|
$XXX.XX
|
A2
|
Y
|
| 28310 |
Revision of big toe
|
$XXX.XX
|
A2
|
Y
|
| 28312 |
Revision of toe
|
$XXX.XX
|
A2
|
Y
|
| 28313 |
Repair deformity of toe
|
$XXX.XX
|
A2
|
Y
|
| 28315 |
Removal of sesamoid bone
|
$XXX.XX
|
A2
|
Y
|
| 28320 |
Repair of foot bones
|
$XXX.XX
|
J8
|
Y
|
| 28322 |
Repair of metatarsals
|
$XXX.XX
|
J8
|
Y
|
| 28340 |
Resect enlarged toe tissue
|
$XXX.XX
|
A2
|
Y
|
| 28341 |
Resect enlarged toe
|
$XXX.XX
|
A2
|
Y
|
| 28344 |
Repair extra toe(s)
|
$XXX.XX
|
A2
|
Y
|
| 28345 |
Repair webbed toe(s)
|
$XXX.XX
|
A2
|
Y
|
| 28360 |
Reconstruct cleft foot
|
$XXX.XX
|
J8
|
Y
|
| 28400 |
Cltx calcaneal fx w/o mnpj
|
$XXX.XX
|
A2
|
Y
|
| 28405 |
Cltx calcaneal fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 28406 |
Prq skel fix clcnl fx w/mnpj
|
$XXX.XX
|
G2
|
Y
|
| 28415 |
Optx calcaneal fracture
|
$XXX.XX
|
J8
|
Y
|
| 28420 |
Optx calcaneal fx w/bone grf
|
$XXX.XX
|
J8
|
Y
|
| 28430 |
Cltx talus fracture w/o mnpj
|
$XXX.XX
|
P2
|
Y
|
| 28435 |
Cltx talus fracture w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 28436 |
Prq skel fix talus fx w/mnpj
|
$XXX.XX
|
J8
|
Y
|
| 28445 |
Optx talus fracture
|
$XXX.XX
|
J8
|
Y
|
| 28446 |
Opn osteochondrl agrft talus
|
$XXX.XX
|
J8
|
Y
|
| 28450 |
Tx tarsal b1 fx w/o mnpj ea
|
$XXX.XX
|
P2
|
Y
|
| 28455 |
Tx tarsal b1 fx w/mnpj each
|
$XXX.XX
|
P3
|
Y
|
| 28456 |
Prq skel fix tarsl fx w/mnpj
|
$XXX.XX
|
J8
|
Y
|
| 28465 |
Optx tarsal bone fx each
|
$XXX.XX
|
J8
|
Y
|
| 28470 |
Cltx metatarsal fx wo mnp ea
|
$XXX.XX
|
P2
|
Y
|
| 28475 |
Cltx metatarsal fx w/mnpj ea
|
$XXX.XX
|
P2
|
Y
|
| 28476 |
Prq skel fix metar fx w/mnpj
|
$XXX.XX
|
A2
|
Y
|
| 28485 |
Optx metatarsal fx each
|
$XXX.XX
|
J8
|
Y
|
| 28490 |
Treat big toe fracture
|
$XXX.XX
|
P3
|
Y
|
| 28495 |
Treat big toe fracture
|
$XXX.XX
|
P3
|
Y
|
| 28496 |
Treat big toe fracture
|
$XXX.XX
|
A2
|
Y
|
| 28505 |
Treat big toe fracture
|
$XXX.XX
|
A2
|
Y
|
| 28510 |
Treatment of toe fracture
|
$XXX.XX
|
P3
|
Y
|
| 28515 |
Treatment of toe fracture
|
$XXX.XX
|
P3
|
Y
|
| 28525 |
Treat toe fracture
|
$XXX.XX
|
A2
|
Y
|
| 28530 |
Treat sesamoid bone fracture
|
$XXX.XX
|
P3
|
Y
|
| 28531 |
Treat sesamoid bone fracture
|
$XXX.XX
|
J8
|
Y
|
| 28540 |
Treat foot dislocation
|
$XXX.XX
|
P3
|
Y
|
| 28545 |
Treat foot dislocation
|
$XXX.XX
|
G2
|
Y
|
| 28546 |
Treat foot dislocation
|
$XXX.XX
|
J8
|
Y
|
| 28555 |
Repair foot dislocation
|
$XXX.XX
|
J8
|
Y
|
| 28570 |
Treat foot dislocation
|
$XXX.XX
|
P2
|
Y
|
| 28575 |
Treat foot dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28576 |
Treat foot dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28585 |
Repair foot dislocation
|
$XXX.XX
|
J8
|
Y
|
| 28600 |
Treat foot dislocation
|
$XXX.XX
|
P3
|
Y
|
| 28605 |
Treat foot dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28606 |
Treat foot dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28615 |
Repair foot dislocation
|
$XXX.XX
|
J8
|
Y
|
| 28630 |
Treat toe dislocation
|
$XXX.XX
|
P3
|
Y
|
| 28635 |
Treat toe dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28636 |
Treat toe dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28645 |
Repair toe dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28660 |
Treat toe dislocation
|
$XXX.XX
|
P3
|
Y
|
| 28665 |
Treat toe dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28666 |
Treat toe dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28675 |
Repair of toe dislocation
|
$XXX.XX
|
A2
|
Y
|
| 28705 |
Arthrodesis pantalar
|
$XXX.XX
|
J8
|
Y
|
| 28715 |
Arthrodesis triple
|
$XXX.XX
|
J8
|
Y
|
| 28725 |
Arthrodesis subtalar
|
$XXX.XX
|
J8
|
Y
|
| 28730 |
Fusion of foot bones
|
$XXX.XX
|
J8
|
Y
|
| 28735 |
Fusion of foot bones
|
$XXX.XX
|
J8
|
Y
|
| 28737 |
Revision of foot bones
|
$XXX.XX
|
J8
|
Y
|
| 28740 |
Fusion of foot bones
|
$XXX.XX
|
J8
|
Y
|
| 28750 |
Fusion of big toe joint
|
$XXX.XX
|
J8
|
Y
|
| 28755 |
Fusion of big toe joint
|
$XXX.XX
|
A2
|
Y
|
| 28760 |
Fusion of big toe joint
|
$XXX.XX
|
J8
|
Y
|
| 28800 |
Amputation of midfoot
|
$XXX.XX
|
G2
|
Y
|
| 28805 |
Amputation thru metatarsal
|
$XXX.XX
|
G2
|
Y
|
| 28810 |
Amputation toe & metatarsal
|
$XXX.XX
|
A2
|
Y
|
| 28820 |
Amputation of toe
|
$XXX.XX
|
A2
|
Y
|
| 28825 |
Partial amputation of toe
|
$XXX.XX
|
A2
|
Y
|
| 28890 |
Hi enrgy eswt plantar fascia
|
$XXX.XX
|
P3
|
Y
|
| 29000 |
Appl halo type body cast
|
$XXX.XX
|
G2
|
Y
|
| 29010 |
Appl risser jacket body only
|
$XXX.XX
|
P2
|
Y
|
| 29015 |
Appl rissr jacket bdy w/head
|
$XXX.XX
|
P2
|
Y
|
| 29035 |
Appl body cast sho to hips
|
$XXX.XX
|
P2
|
Y
|
| 29040 |
Appl bdy cst sho to hip head
|
$XXX.XX
|
G2
|
Y
|
| 29044 |
Appl bdy cst sho to hip 1thi
|
$XXX.XX
|
P2
|
Y
|
| 29046 |
Appl bdy cst sho to hip b th
|
$XXX.XX
|
G2
|
Y
|
| 29049 |
Appl cast figure-of-eight
|
$XXX.XX
|
P3
|
Y
|
| 29055 |
Appl cast shoulder spica
|
$XXX.XX
|
P2
|
Y
|
| 29058 |
Appl cast plaster velpeau
|
$XXX.XX
|
P3
|
Y
|
| 29065 |
Appl cst sho to hand lng arm
|
$XXX.XX
|
P3
|
Y
|
| 29075 |
Appl cst elbw fngr short arm
|
$XXX.XX
|
P3
|
Y
|
| 29085 |
Appl cast hand&lwr forearm
|
$XXX.XX
|
P3
|
Y
|
| 29086 |
Application cast finger
|
$XXX.XX
|
P3
|
Y
|
| 29105 |
Application long arm splint
|
$XXX.XX
|
P3
|
Y
|
| 29125 |
Appl short arm splint static
|
$XXX.XX
|
N1
|
N
|
| 29126 |
Appl short arm splint dyn
|
$XXX.XX
|
N1
|
N
|
| 29130 |
Appl finger splint static
|
$XXX.XX
|
N1
|
N
|
| 29131 |
Appl finger splint dynamic
|
$XXX.XX
|
N1
|
N
|
| 29200 |
Strapping thorax
|
$XXX.XX
|
P3
|
Y
|
| 29240 |
Strapping of shoulder
|
$XXX.XX
|
N1
|
N
|
| 29260 |
Strapping of elbow or wrist
|
$XXX.XX
|
N1
|
N
|
| 29280 |
Strapping of hand or finger
|
$XXX.XX
|
N1
|
N
|
| 29305 |
Appl hip spica cast 1 leg
|
$XXX.XX
|
P2
|
Y
|
| 29325 |
Appl hip spica cast1&1/2
|
$XXX.XX
|
P2
|
Y
|
| 29345 |
Application of long leg cast
|
$XXX.XX
|
P3
|
Y
|
| 29355 |
Appl long leg cast walker
|
$XXX.XX
|
P3
|
Y
|
| 29358 |
Appl long leg cast brace
|
$XXX.XX
|
P3
|
Y
|
| 29365 |
Appl cylinder cast
|
$XXX.XX
|
P3
|
Y
|
| 29405 |
Appl short leg cast
|
$XXX.XX
|
P3
|
Y
|
| 29425 |
Appl short leg cast walking
|
$XXX.XX
|
P3
|
Y
|
| 29435 |
Appl patllr tdn bearing cast
|
$XXX.XX
|
P3
|
Y
|
| 29440 |
Adding walker to prev cast
|
$XXX.XX
|
P3
|
Y
|
| 29445 |
Appl rigid tot cntc leg cast
|
$XXX.XX
|
P3
|
Y
|
| 29450 |
Application clubfoot cast
|
$XXX.XX
|
P3
|
Y
|
| 29505 |
Application long leg splint
|
$XXX.XX
|
P3
|
Y
|
| 29515 |
Application short leg splint
|
$XXX.XX
|
P3
|
Y
|
| 29520 |
Strapping of hip
|
$XXX.XX
|
N1
|
N
|
| 29530 |
Strapping of knee
|
$XXX.XX
|
N1
|
N
|
| 29540 |
Strapping ankle &/foot
|
$XXX.XX
|
P3
|
Y
|
| 29550 |
Strapping of toes
|
$XXX.XX
|
N1
|
N
|
| 29580 |
Strapping unna boot
|
$XXX.XX
|
P3
|
Y
|
| 29581 |
Appl multlayer cmprn sys leg
|
$XXX.XX
|
P3
|
Y
|
| 29584 |
Appl mltlay cmprn sys up arm
|
$XXX.XX
|
P3
|
Y
|
| 29700 |
Rmvl/bivlv gauntlet boot/cst
|
$XXX.XX
|
P3
|
Y
|
| 29705 |
Rmvl/bivlv full arm/leg cast
|
$XXX.XX
|
P3
|
Y
|
| 29710 |
Rmvl/bivlv sho/hip spica
|
$XXX.XX
|
P3
|
Y
|
| 29720 |
Repair spica body cst/jacket
|
$XXX.XX
|
P3
|
Y
|
| 29730 |
Windowing of cast
|
$XXX.XX
|
P3
|
Y
|
| 29740 |
Wedging of cast
|
$XXX.XX
|
P3
|
Y
|
| 29750 |
Wedging of clubfoot cast
|
$XXX.XX
|
P3
|
Y
|
| 29800 |
Jaw arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29804 |
Jaw arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29805 |
Sho arthrs dx +- synovial bx
|
$XXX.XX
|
A2
|
Y
|
| 29806 |
Sho arthrs srg capsulorraphy
|
$XXX.XX
|
A2
|
Y
|
| 29807 |
Sho arthrs srg rpr slap les
|
$XXX.XX
|
A2
|
Y
|
| 29819 |
Sho arthrs srg rmvl loose/fb
|
$XXX.XX
|
A2
|
Y
|
| 29820 |
Sho arthrs srg prtl synvct
|
$XXX.XX
|
A2
|
Y
|
| 29821 |
Sho arthrs srg compl synvct
|
$XXX.XX
|
A2
|
Y
|
| 29822 |
Sho arthrs srg lmtd dbrdmt
|
$XXX.XX
|
A2
|
Y
|
| 29823 |
Sho arthrs srg xtnsv dbrdmt
|
$XXX.XX
|
A2
|
Y
|
| 29824 |
Sho arthrs srg dstl claviclc
|
$XXX.XX
|
A2
|
Y
|
| 29825 |
Sho arthrs srg lss&rescj ads
|
$XXX.XX
|
A2
|
Y
|
| 29826 |
Sho arthrs srg decompression
|
$XXX.XX
|
N1
|
N
|
| 29827 |
Sho arthrs srg rt8tr cuf rpr
|
$XXX.XX
|
A2
|
Y
|
| 29828 |
Sho arthrs srg bicp tenodsis
|
$XXX.XX
|
G2
|
Y
|
| 29830 |
Elbow arthroscopy
|
$XXX.XX
|
A2
|
Y
|
| 29834 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29835 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29836 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29837 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29838 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29840 |
Wrist arthroscopy
|
$XXX.XX
|
A2
|
Y
|
| 29843 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29844 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29845 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29846 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29847 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29848 |
Wrist endoscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29850 |
Knee arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29851 |
Knee arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29855 |
Tibial arthroscopy/surgery
|
$XXX.XX
|
J8
|
Y
|
| 29856 |
Tibial arthroscopy/surgery
|
$XXX.XX
|
J8
|
Y
|
| 29860 |
Hip arthroscopy dx
|
$XXX.XX
|
A2
|
Y
|
| 29861 |
Hip arthro w/fb removal
|
$XXX.XX
|
A2
|
Y
|
| 29862 |
Hip arthr0 w/debridement
|
$XXX.XX
|
A2
|
Y
|
| 29863 |
Hip arthr0 w/synovectomy
|
$XXX.XX
|
A2
|
Y
|
| 29866 |
Autgrft implnt knee w/scope
|
$XXX.XX
|
G2
|
Y
|
| 29867 |
Allgrft implnt knee w/scope
|
$XXX.XX
|
J8
|
Y
|
| 29868 |
Meniscal trnspl knee w/scpe
|
$XXX.XX
|
G2
|
Y
|
| 29870 |
Arthrs knee dx w/wo syn bx
|
$XXX.XX
|
A2
|
Y
|
| 29871 |
Arthrs knee surg for infctj
|
$XXX.XX
|
A2
|
Y
|
| 29873 |
Arthrs knee surg w/lat rls
|
$XXX.XX
|
A2
|
Y
|
| 29874 |
Arthrs knee surg rmv loos/fb
|
$XXX.XX
|
A2
|
Y
|
| 29875 |
Arthrs knee surg synvct lmtd
|
$XXX.XX
|
A2
|
Y
|
| 29876 |
Arthrs knee surg synvct maj
|
$XXX.XX
|
A2
|
Y
|
| 29877 |
Arthrs knee surg dbrdmt/shvg
|
$XXX.XX
|
A2
|
Y
|
| 29879 |
Arthrs kne srg abrasj arthrp
|
$XXX.XX
|
A2
|
Y
|
| 29880 |
Arthrs kne srg mnisectmy m&l
|
$XXX.XX
|
A2
|
Y
|
| 29881 |
Arthrs kne srg mnisectmy m/l
|
$XXX.XX
|
A2
|
Y
|
| 29882 |
Arthrs kne srg mnisc rpr m/l
|
$XXX.XX
|
A2
|
Y
|
| 29883 |
Arthrs kne srg mnisc rpr m&l
|
$XXX.XX
|
A2
|
Y
|
| 29884 |
Arthrs knee surg lysis ads
|
$XXX.XX
|
A2
|
Y
|
| 29885 |
Arthrs kne srg drlg ost diss
|
$XXX.XX
|
J8
|
Y
|
| 29886 |
Arthrs knee surg drlg od les
|
$XXX.XX
|
A2
|
Y
|
| 29887 |
Arthrs knee srg drlg od fixj
|
$XXX.XX
|
J8
|
Y
|
| 29888 |
Arthrs aid acl rpr/agmntj
|
$XXX.XX
|
J8
|
Y
|
| 29889 |
Arthrs aid pcl rpr/agmntj
|
$XXX.XX
|
J8
|
Y
|
| 29891 |
Arthr ank ostchn df tal&/tib
|
$XXX.XX
|
A2
|
Y
|
| 29892 |
Arthrs aid rpr od les/tib fx
|
$XXX.XX
|
A2
|
Y
|
| 29893 |
Endoscopic plantr fasciotomy
|
$XXX.XX
|
A2
|
Y
|
| 29894 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29895 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29897 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29898 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
A2
|
Y
|
| 29899 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J8
|
Y
|
| 29900 |
Mcp joint arthroscopy dx
|
$XXX.XX
|
A2
|
Y
|
| 29901 |
Mcp joint arthroscopy surg
|
$XXX.XX
|
A2
|
Y
|
| 29902 |
Mcp joint arthroscopy surg
|
$XXX.XX
|
A2
|
Y
|
| 29904 |
Subtalar arthro w/fb rmvl
|
$XXX.XX
|
G2
|
Y
|
| 29905 |
Subtalar arthro w/exc
|
$XXX.XX
|
G2
|
Y
|
| 29906 |
Subtalar arthro w/deb
|
$XXX.XX
|
G2
|
Y
|
| 29907 |
Subtalar arthro w/fusion
|
$XXX.XX
|
J8
|
Y
|
| 29914 |
Hip arthro w/femoroplasty
|
$XXX.XX
|
G2
|
Y
|
| 29915 |
Hip arthro acetabuloplasty
|
$XXX.XX
|
G2
|
Y
|
| 29916 |
Hip arthro w/labral repair
|
$XXX.XX
|
G2
|
Y
|
| 30000 |
Drainage of nose lesion
|
$XXX.XX
|
P2
|
Y
|
| 30020 |
Drainage of nose lesion
|
$XXX.XX
|
P3
|
Y
|
| 30100 |
Intranasal biopsy
|
$XXX.XX
|
P3
|
Y
|
| 30110 |
Removal of nose polyp(s)
|
$XXX.XX
|
P3
|
Y
|
| 30115 |
Removal of nose polyp(s)
|
$XXX.XX
|
A2
|
Y
|
| 30117 |
Removal of intranasal lesion
|
$XXX.XX
|
A2
|
Y
|
| 30118 |
Removal of intranasal lesion
|
$XXX.XX
|
A2
|
Y
|
| 30120 |
Revision of nose
|
$XXX.XX
|
A2
|
Y
|
| 30124 |
Removal of nose lesion
|
$XXX.XX
|
R2
|
Y
|
| 30125 |
Removal of nose lesion
|
$XXX.XX
|
A2
|
Y
|
| 30130 |
Excise inferior turbinate
|
$XXX.XX
|
A2
|
Y
|
| 30140 |
Resect inferior turbinate
|
$XXX.XX
|
A2
|
Y
|
| 30150 |
Rhinectomy partial
|
$XXX.XX
|
A2
|
Y
|
| 30160 |
Rhinectomy total
|
$XXX.XX
|
A2
|
Y
|
| 30200 |
Injection treatment of nose
|
$XXX.XX
|
P3
|
Y
|
| 30210 |
Nasal sinus therapy
|
$XXX.XX
|
P3
|
Y
|
| 30220 |
Insert nasal septal button
|
$XXX.XX
|
A2
|
Y
|
| 30300 |
Remove nasal foreign body
|
$XXX.XX
|
N1
|
N
|
| 30310 |
Remove nasal foreign body
|
$XXX.XX
|
A2
|
Y
|
| 30320 |
Remove nasal foreign body
|
$XXX.XX
|
A2
|
Y
|
| 30400 |
Reconstruction of nose
|
$XXX.XX
|
A2
|
Y
|
| 30410 |
Reconstruction of nose
|
$XXX.XX
|
A2
|
Y
|
| 30420 |
Reconstruction of nose
|
$XXX.XX
|
A2
|
Y
|
| 30430 |
Revision of nose
|
$XXX.XX
|
A2
|
Y
|
| 30435 |
Revision of nose
|
$XXX.XX
|
A2
|
Y
|
| 30450 |
Revision of nose
|
$XXX.XX
|
A2
|
Y
|
| 30460 |
Revision of nose
|
$XXX.XX
|
A2
|
Y
|
| 30462 |
Revision of nose
|
$XXX.XX
|
A2
|
Y
|
| 30465 |
Repair nasal stenosis
|
$XXX.XX
|
A2
|
Y
|
| 30468 |
Rpr nsl vlv collapse w/implt
|
$XXX.XX
|
J8
|
Y
|
| 30469 |
Rpr nsl vlv collapse w/rmdlg
|
$XXX.XX
|
J8
|
Y
|
| 30520 |
Repair of nasal septum
|
$XXX.XX
|
A2
|
Y
|
| 30540 |
Rpr choanal atresia ntranasl
|
$XXX.XX
|
A2
|
Y
|
| 30545 |
Rpr choanal atresia trsnpltn
|
$XXX.XX
|
A2
|
Y
|
| 30560 |
Lysis intranasal synechia
|
$XXX.XX
|
A2
|
Y
|
| 30580 |
Repair upper jaw fistula
|
$XXX.XX
|
A2
|
Y
|
| 30600 |
Repair mouth/nose fistula
|
$XXX.XX
|
A2
|
Y
|
| 30620 |
Intranasal reconstruction
|
$XXX.XX
|
A2
|
Y
|
| 30630 |
Repair nasal septum defect
|
$XXX.XX
|
A2
|
Y
|
| 30801 |
Ablate inf turbinate superf
|
$XXX.XX
|
A2
|
Y
|
| 30802 |
Ablate inf turbinate submuc
|
$XXX.XX
|
A2
|
Y
|
| 30901 |
Control of nosebleed
|
$XXX.XX
|
N1
|
N
|
| 30903 |
Control of nosebleed
|
$XXX.XX
|
A2
|
Y
|
| 30905 |
Control of nosebleed
|
$XXX.XX
|
A2
|
Y
|
| 30906 |
Repeat control of nosebleed
|
$XXX.XX
|
A2
|
Y
|
| 30915 |
Ligation nasal sinus artery
|
$XXX.XX
|
A2
|
Y
|
| 30920 |
Ligation upper jaw artery
|
$XXX.XX
|
A2
|
Y
|
| 30930 |
Ther fx nasal inf turbinate
|
$XXX.XX
|
A2
|
Y
|
| 31000 |
Irrigation maxillary sinus
|
$XXX.XX
|
P2
|
Y
|
| 31002 |
Irrigation sphenoid sinus
|
$XXX.XX
|
R2
|
Y
|
| 31020 |
Exploration maxillary sinus
|
$XXX.XX
|
A2
|
Y
|
| 31030 |
Exploration maxillary sinus
|
$XXX.XX
|
A2
|
Y
|
| 31032 |
Explore sinus remove polyps
|
$XXX.XX
|
A2
|
Y
|
| 31040 |
Exploration behind upper jaw
|
$XXX.XX
|
R2
|
Y
|
| 31050 |
Exploration sphenoid sinus
|
$XXX.XX
|
A2
|
Y
|
| 31051 |
Sphenoid sinus surgery
|
$XXX.XX
|
A2
|
Y
|
| 31070 |
Exploration of frontal sinus
|
$XXX.XX
|
A2
|
Y
|
| 31075 |
Exploration of frontal sinus
|
$XXX.XX
|
A2
|
Y
|
| 31080 |
Removal of frontal sinus
|
$XXX.XX
|
A2
|
Y
|
| 31081 |
Removal of frontal sinus
|
$XXX.XX
|
A2
|
Y
|
| 31084 |
Removal of frontal sinus
|
$XXX.XX
|
J8
|
Y
|
| 31085 |
Removal of frontal sinus
|
$XXX.XX
|
J8
|
Y
|
| 31086 |
Removal of frontal sinus
|
$XXX.XX
|
A2
|
Y
|
| 31087 |
Removal of frontal sinus
|
$XXX.XX
|
J8
|
Y
|
| 31090 |
Exploration of sinuses
|
$XXX.XX
|
A2
|
Y
|
| 31200 |
Removal of ethmoid sinus
|
$XXX.XX
|
A2
|
Y
|
| 31201 |
Removal of ethmoid sinus
|
$XXX.XX
|
A2
|
Y
|
| 31205 |
Removal of ethmoid sinus
|
$XXX.XX
|
A2
|
Y
|
| 31231 |
Nasal endoscopy dx
|
$XXX.XX
|
P2
|
Y
|
| 31233 |
Nsl/sins ndsc dx max sinusc
|
$XXX.XX
|
A2
|
Y
|
| 31235 |
Nsl/sins ndsc dx sphn sinusc
|
$XXX.XX
|
A2
|
Y
|
| 31237 |
Nsl/sins ndsc surg bx polypc
|
$XXX.XX
|
A2
|
Y
|
| 31238 |
Nsl/sins ndsc srg nsl hemrrg
|
$XXX.XX
|
A2
|
Y
|
| 31239 |
Nsl/sinus endoscopy surg dcr
|
$XXX.XX
|
A2
|
Y
|
| 31240 |
Nsl/sns ndsc cnch bull rescj
|
$XXX.XX
|
A2
|
Y
|
| 31241 |
Nsl/sns ndsc lig sphnptn art
|
$XXX.XX
|
G2
|
Y
|
| 31242 |
Nsl/sinus ndsc rf abltj pnn
|
$XXX.XX
|
J8
|
Y
|
| 31243 |
Nsl/sinus ndsc cryoabltj pnn
|
$XXX.XX
|
J8
|
Y
|
| 31253 |
Nsl/sins ndsc total
|
$XXX.XX
|
G2
|
Y
|
| 31254 |
Nsl/sins ndsc w/prtl ethmdct
|
$XXX.XX
|
A2
|
Y
|
| 31255 |
Nsl/sins ndsc w/tot ethmdct
|
$XXX.XX
|
A2
|
Y
|
| 31256 |
Exploration maxillary sinus
|
$XXX.XX
|
A2
|
Y
|
| 31257 |
Nsl/sins ndsc tot w/sphendt
|
$XXX.XX
|
G2
|
Y
|
| 31259 |
Nsl/sins ndsc sphn tiss rmvl
|
$XXX.XX
|
G2
|
Y
|
| 31267 |
Endoscopy maxillary sinus
|
$XXX.XX
|
A2
|
Y
|
| 31276 |
Nsl/sins ndsc frnt tiss rmvl
|
$XXX.XX
|
A2
|
Y
|
| 31287 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
A2
|
Y
|
| 31288 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
A2
|
Y
|
| 31292 |
Nsl/sins ndsc med/inf dcmprn
|
$XXX.XX
|
G2
|
Y
|
| 31293 |
Nsl/sins ndsc med&inf dcmprn
|
$XXX.XX
|
G2
|
Y
|
| 31294 |
Nsl/sins ndsc surg on dcmprn
|
$XXX.XX
|
G2
|
Y
|
| 31295 |
Nsl/sins ndsc surg max sins
|
$XXX.XX
|
J8
|
Y
|
| 31296 |
Nsl/sins ndsc surg frnt sins
|
$XXX.XX
|
P3
|
Y
|
| 31297 |
Nsl/sins ndsc surg sphn sins
|
$XXX.XX
|
J8
|
Y
|
| 31298 |
Nsl/sins ndsc surg frnt&sphn
|
$XXX.XX
|
P2
|
Y
|
| 31300 |
Removal of larynx lesion
|
$XXX.XX
|
A2
|
Y
|
| 31400 |
Revision of larynx
|
$XXX.XX
|
A2
|
Y
|
| 31420 |
Epiglottidectomy
|
$XXX.XX
|
A2
|
Y
|
| 31500 |
Insert emergency airway
|
$XXX.XX
|
G2
|
Y
|
| 31502 |
Change of windpipe airway
|
$XXX.XX
|
G2
|
Y
|
| 31505 |
Diagnostic laryngoscopy
|
$XXX.XX
|
P3
|
Y
|
| 31510 |
Laryngoscopy with biopsy
|
$XXX.XX
|
A2
|
Y
|
| 31511 |
Remove foreign body larynx
|
$XXX.XX
|
A2
|
Y
|
| 31512 |
Removal of larynx lesion
|
$XXX.XX
|
A2
|
Y
|
| 31513 |
Injection into vocal cord
|
$XXX.XX
|
A2
|
Y
|
| 31515 |
Laryngoscopy for aspiration
|
$XXX.XX
|
A2
|
Y
|
| 31520 |
Dx laryngoscopy newborn
|
$XXX.XX
|
G2
|
Y
|
| 31525 |
Dx laryngoscopy excl nb
|
$XXX.XX
|
A2
|
Y
|
| 31526 |
Dx laryngoscopy w/oper scope
|
$XXX.XX
|
A2
|
Y
|
| 31527 |
Laryngoscopy for treatment
|
$XXX.XX
|
A2
|
Y
|
| 31528 |
Laryngoscopy and dilation
|
$XXX.XX
|
A2
|
Y
|
| 31529 |
Laryngoscopy and dilation
|
$XXX.XX
|
A2
|
Y
|
| 31530 |
Laryngoscopy w/fb removal
|
$XXX.XX
|
A2
|
Y
|
| 31531 |
Laryngoscopy w/fb & op scope
|
$XXX.XX
|
A2
|
Y
|
| 31535 |
Laryngoscopy w/biopsy
|
$XXX.XX
|
A2
|
Y
|
| 31536 |
Laryngoscopy w/bx & op scope
|
$XXX.XX
|
A2
|
Y
|
| 31540 |
Laryngoscopy w/exc of tumor
|
$XXX.XX
|
A2
|
Y
|
| 31541 |
Larynscop w/tumr exc + scope
|
$XXX.XX
|
A2
|
Y
|
| 31545 |
Remove vc lesion w/scope
|
$XXX.XX
|
A2
|
Y
|
| 31546 |
Remove vc lesion scope/graft
|
$XXX.XX
|
A2
|
Y
|
| 31551 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
G2
|
Y
|
| 31552 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
G2
|
Y
|
| 31553 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
G2
|
Y
|
| 31554 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
G2
|
Y
|
| 31560 |
Laryngoscop w/arytenoidectom
|
$XXX.XX
|
A2
|
Y
|
| 31561 |
Larynscop remve cart + scop
|
$XXX.XX
|
A2
|
Y
|
| 31570 |
Laryngoscope w/vc inj
|
$XXX.XX
|
A2
|
Y
|
| 31571 |
Laryngoscop w/vc inj + scope
|
$XXX.XX
|
A2
|
Y
|
| 31572 |
Largsc w/laser dstrj les
|
$XXX.XX
|
G2
|
Y
|
| 31573 |
Largsc w/ther injection
|
$XXX.XX
|
P3
|
Y
|
| 31574 |
Largsc w/njx augmentation
|
$XXX.XX
|
P3
|
Y
|
| 31575 |
Diagnostic laryngoscopy
|
$XXX.XX
|
P3
|
Y
|
| 31576 |
Laryngoscopy with biopsy
|
$XXX.XX
|
A2
|
Y
|
| 31577 |
Largsc w/rmvl foreign bdy(s)
|
$XXX.XX
|
A2
|
Y
|
| 31578 |
Largsc w/removal lesion
|
$XXX.XX
|
A2
|
Y
|
| 31579 |
Laryngoscopy telescopic
|
$XXX.XX
|
P3
|
Y
|
| 31580 |
Laryngoplasty laryngeal web
|
$XXX.XX
|
A2
|
Y
|
| 31584 |
Laryngoplasty fx rdctj fixj
|
$XXX.XX
|
G2
|
Y
|
| 31587 |
Laryngoplasty cricoid split
|
$XXX.XX
|
G2
|
Y
|
| 31590 |
Reinnervate larynx
|
$XXX.XX
|
A2
|
Y
|
| 31591 |
Laryngoplasty medialization
|
$XXX.XX
|
G2
|
Y
|
| 31592 |
Cricotracheal resection
|
$XXX.XX
|
G2
|
Y
|
| 31600 |
Planned tracheostomy
|
$XXX.XX
|
G2
|
Y
|
| 31601 |
Planned tracheostomy<2 yrs
|
$XXX.XX
|
G2
|
Y
|
| 31603 |
Emer tracheostomy ttrach
|
$XXX.XX
|
A2
|
Y
|
| 31605 |
Emer tracheostomy cthyr mem
|
$XXX.XX
|
G2
|
Y
|
| 31610 |
Tracheostomy fenest skin flp
|
$XXX.XX
|
G2
|
Y
|
| 31611 |
Constj trachesophgl fstl
|
$XXX.XX
|
A2
|
Y
|
| 31612 |
Perq trchl pnxr ttrach aspir
|
$XXX.XX
|
A2
|
Y
|
| 31613 |
Tracheostoma revj simple
|
$XXX.XX
|
A2
|
Y
|
| 31614 |
Tracheostoma revj complex
|
$XXX.XX
|
A2
|
Y
|
| 31615 |
Trcheobrnchsc est trachs inc
|
$XXX.XX
|
A2
|
Y
|
| 31622 |
Dx bronchoscope/wash
|
$XXX.XX
|
A2
|
Y
|
| 31623 |
Dx bronchoscope/brush
|
$XXX.XX
|
A2
|
Y
|
| 31624 |
Dx bronchoscope/lavage
|
$XXX.XX
|
A2
|
Y
|
| 31625 |
Bronchoscopy w/biopsy(s)
|
$XXX.XX
|
A2
|
Y
|
| 31626 |
Bronchoscopy w/markers
|
$XXX.XX
|
G2
|
Y
|
| 31627 |
Navigational bronchoscopy
|
$XXX.XX
|
N1
|
N
|
| 31628 |
Bronchoscopy/lung bx each
|
$XXX.XX
|
A2
|
Y
|
| 31629 |
Bronchoscopy/needle bx each
|
$XXX.XX
|
A2
|
Y
|
| 31630 |
Bronchoscopy dilate/fx repr
|
$XXX.XX
|
A2
|
Y
|
| 31631 |
Bronchoscopy dilate w/stent
|
$XXX.XX
|
A2
|
Y
|
| 31632 |
Bronchoscopy/lung bx addl
|
$XXX.XX
|
N1
|
N
|
| 31633 |
Bronchoscopy/needle bx addl
|
$XXX.XX
|
N1
|
N
|
| 31634 |
Bronch w/balloon occlusion
|
$XXX.XX
|
G2
|
Y
|
| 31635 |
Bronchoscopy w/fb removal
|
$XXX.XX
|
A2
|
Y
|
| 31636 |
Bronchoscopy bronch stents
|
$XXX.XX
|
J8
|
Y
|
| 31637 |
Bronchoscopy stent add-on
|
$XXX.XX
|
N1
|
N
|
| 31638 |
Bronchoscopy revise stent
|
$XXX.XX
|
A2
|
Y
|
| 31640 |
Bronchoscopy w/tumor excise
|
$XXX.XX
|
A2
|
Y
|
| 31641 |
Bronchoscopy treat blockage
|
$XXX.XX
|
A2
|
Y
|
| 31643 |
Diag bronchoscope/catheter
|
$XXX.XX
|
A2
|
Y
|
| 31645 |
Brnchsc w/ther aspir 1st
|
$XXX.XX
|
A2
|
Y
|
| 31646 |
Brnchsc w/ther aspir sbsq
|
$XXX.XX
|
A2
|
Y
|
| 31647 |
Bronchial valve init insert
|
$XXX.XX
|
J8
|
Y
|
| 31648 |
Bronchial valve remov init
|
$XXX.XX
|
G2
|
Y
|
| 31649 |
Bronchial valve remov addl
|
$XXX.XX
|
G2
|
N
|
| 31651 |
Bronchial valve addl insert
|
$XXX.XX
|
N1
|
N
|
| 31652 |
Bronch ebus samplng 1/2 node
|
$XXX.XX
|
G2
|
Y
|
| 31653 |
Bronch ebus samplng 3/> node
|
$XXX.XX
|
G2
|
Y
|
| 31654 |
Bronch ebus ivntj perph les
|
$XXX.XX
|
N1
|
N
|
| 31660 |
Bronch thermoplsty 1 lobe
|
$XXX.XX
|
J8
|
Y
|
| 31661 |
Bronch thermoplsty 2/> lobes
|
$XXX.XX
|
J8
|
Y
|
| 31717 |
Bronchial brush biopsy
|
$XXX.XX
|
A2
|
Y
|
| 31720 |
Clearance of airways
|
$XXX.XX
|
N1
|
N
|
| 31730 |
Intro windpipe wire/tube
|
$XXX.XX
|
A2
|
Y
|
| 31750 |
Tracheoplasty cervical
|
$XXX.XX
|
A2
|
Y
|
| 31755 |
Trachplsty trchphryngl fstlj
|
$XXX.XX
|
A2
|
Y
|
| 31785 |
Remove windpipe lesion
|
$XXX.XX
|
G2
|
Y
|
| 31820 |
Closure of windpipe lesion
|
$XXX.XX
|
A2
|
Y
|
| 31825 |
Repair of windpipe defect
|
$XXX.XX
|
A2
|
Y
|
| 31830 |
Revise windpipe scar
|
$XXX.XX
|
A2
|
Y
|
| 32400 |
Needle biopsy chest lining
|
$XXX.XX
|
A2
|
Y
|
| 32408 |
Core ndl bx lng/med perq
|
$XXX.XX
|
G2
|
Y
|
| 32550 |
Insert pleural cath
|
$XXX.XX
|
J8
|
Y
|
| 32551 |
Insertion of chest tube
|
$XXX.XX
|
G2
|
Y
|
| 32552 |
Remove lung catheter
|
$XXX.XX
|
G2
|
N
|
| 32553 |
Ins mark thor for rt perq
|
$XXX.XX
|
G2
|
N
|
| 32554 |
Aspirate pleura w/o imaging
|
$XXX.XX
|
G2
|
Y
|
| 32555 |
Aspirate pleura w/ imaging
|
$XXX.XX
|
G2
|
Y
|
| 32556 |
Insert cath pleura w/o image
|
$XXX.XX
|
G2
|
Y
|
| 32557 |
Insert cath pleura w/ image
|
$XXX.XX
|
G2
|
Y
|
| 32560 |
Treat pleurodesis w/agent
|
$XXX.XX
|
G2
|
Y
|
| 32561 |
Lyse chest fibrin init day
|
$XXX.XX
|
G2
|
Y
|
| 32562 |
Lyse chest fibrin subq day
|
$XXX.XX
|
G2
|
Y
|
| 32601 |
Thoracoscopy diagnostic
|
$XXX.XX
|
G2
|
Y
|
| 32604 |
Thoracoscopy wbx sac
|
$XXX.XX
|
G2
|
Y
|
| 32606 |
Thoracoscopy w/bx med space
|
$XXX.XX
|
G2
|
Y
|
| 32607 |
Thoracoscopy w/bx infiltrate
|
$XXX.XX
|
G2
|
Y
|
| 32608 |
Thoracoscopy w/bx nodule
|
$XXX.XX
|
G2
|
Y
|
| 32609 |
Thoracoscopy w/bx pleura
|
$XXX.XX
|
G2
|
Y
|
| 32960 |
Therapeutic pneumothorax
|
$XXX.XX
|
G2
|
Y
|
| 32994 |
Ablate pulm tumor perq crybl
|
$XXX.XX
|
J8
|
Y
|
| 32998 |
Ablate pulm tumor perq rf
|
$XXX.XX
|
G2
|
Y
|
| 33016 |
Pericardiocentesis w/imaging
|
$XXX.XX
|
G2
|
Y
|
| 33206 |
Insert heart pm atrial
|
$XXX.XX
|
J8
|
Y
|
| 33207 |
Insert heart pm ventricular
|
$XXX.XX
|
J8
|
Y
|
| 33208 |
Insrt heart pm atrial & vent
|
$XXX.XX
|
J8
|
Y
|
| 33210 |
Insert electrd/pm cath sngl
|
$XXX.XX
|
G2
|
Y
|
| 33211 |
Insert card electrodes dual
|
$XXX.XX
|
J8
|
Y
|
| 33212 |
Insert pulse gen sngl lead
|
$XXX.XX
|
J8
|
Y
|
| 33213 |
Insert pulse gen dual leads
|
$XXX.XX
|
J8
|
Y
|
| 33214 |
Upgrade of pacemaker system
|
$XXX.XX
|
J8
|
Y
|
| 33215 |
Reposition pacing-defib lead
|
$XXX.XX
|
G2
|
Y
|
| 33216 |
Insert 1 electrode pm-defib
|
$XXX.XX
|
J8
|
Y
|
| 33217 |
Insert 2 electrode pm-defib
|
$XXX.XX
|
J8
|
Y
|
| 33218 |
Repair lead pace-defib one
|
$XXX.XX
|
G2
|
Y
|
| 33220 |
Repair lead pace-defib dual
|
$XXX.XX
|
J8
|
Y
|
| 33221 |
Insert pulse gen mult leads
|
$XXX.XX
|
J8
|
Y
|
| 33222 |
Relocation pocket pacemaker
|
$XXX.XX
|
A2
|
Y
|
| 33223 |
Relocate pocket for defib
|
$XXX.XX
|
A2
|
Y
|
| 33224 |
Insert pacing lead & connect
|
$XXX.XX
|
J8
|
Y
|
| 33225 |
L ventric pacing lead add-on
|
$XXX.XX
|
N1
|
N
|
| 33226 |
Reposition l ventric lead
|
$XXX.XX
|
J8
|
Y
|
| 33227 |
Remove&replace pm gen singl
|
$XXX.XX
|
J8
|
Y
|
| 33228 |
Remv&replc pm gen dual lead
|
$XXX.XX
|
J8
|
Y
|
| 33229 |
Remv&replc pm gen mult leads
|
$XXX.XX
|
J8
|
Y
|
| 33230 |
Insrt pulse gen w/dual leads
|
$XXX.XX
|
J8
|
Y
|
| 33231 |
Insrt pulse gen w/mult leads
|
$XXX.XX
|
J8
|
Y
|
| 33233 |
Removal of pm generator
|
$XXX.XX
|
G2
|
N
|
| 33234 |
Removal of pacemaker system
|
$XXX.XX
|
G2
|
N
|
| 33235 |
Removal pacemaker electrode
|
$XXX.XX
|
G2
|
N
|
| 33240 |
Insrt pulse gen w/singl lead
|
$XXX.XX
|
J8
|
Y
|
| 33241 |
Remove pulse generator
|
$XXX.XX
|
G2
|
N
|
| 33244 |
Remove elctrd transvenously
|
$XXX.XX
|
G2
|
N
|
| 33249 |
Insj/rplcmt defib w/lead(s)
|
$XXX.XX
|
J8
|
Y
|
| 33262 |
Rmvl& replc pulse gen 1 lead
|
$XXX.XX
|
J8
|
Y
|
| 33263 |
Rmvl & rplcmt dfb gen 2 lead
|
$XXX.XX
|
J8
|
Y
|
| 33264 |
Rmvl & rplcmt dfb gen mlt ld
|
$XXX.XX
|
J8
|
Y
|
| 33270 |
Ins/rep subq defibrillator
|
$XXX.XX
|
J8
|
Y
|
| 33271 |
Insj subq impltbl dfb elctrd
|
$XXX.XX
|
J8
|
Y
|
| 33272 |
Rmvl of subq defibrillator
|
$XXX.XX
|
G2
|
N
|
| 33273 |
Repos prev impltbl subq dfb
|
$XXX.XX
|
G2
|
Y
|
| 33274 |
Tcat insj/rpl perm ldls pm
|
$XXX.XX
|
J8
|
Y
|
| 33275 |
Tcat rmvl perm ldls pm w/img
|
$XXX.XX
|
J8
|
Y
|
| 33276 |
Insj phrnc nrv stim sys
|
$XXX.XX
|
J8
|
N
|
| 33277 |
Insj phrnc nrv stim transvns
|
$XXX.XX
|
N1
|
N
|
| 33278 |
Rmvl phrnc nrv stim sys
|
$XXX.XX
|
G2
|
Y
|
| 33279 |
Rmvl phrnc nrv stim transvns
|
$XXX.XX
|
J8
|
Y
|
| 33280 |
Rmvl phrnc nrv stim pg only
|
$XXX.XX
|
G2
|
Y
|
| 33281 |
Reposg phrnc nrv stim trnsvn
|
$XXX.XX
|
G2
|
Y
|
| 33285 |
Insj subq car rhythm mntr
|
$XXX.XX
|
J8
|
Y
|
| 33286 |
Rmvl subq car rhythm mntr
|
$XXX.XX
|
G2
|
N
|
| 33287 |
Rmv&rplcmt phrnc nrv stim pg
|
$XXX.XX
|
J8
|
Y
|
| 33288 |
Rmv&rplcmt phrnc nrv stim ld
|
$XXX.XX
|
J8
|
Y
|
| 33289 |
Tcat impl wrls p-art prs snr
|
$XXX.XX
|
J8
|
Y
|
| 33419 |
Repair tcat mitral valve
|
$XXX.XX
|
N1
|
N
|
| 33508 |
Endoscopic vein harvest
|
$XXX.XX
|
N1
|
N
|
| 33866 |
Aortic hemiarch graft
|
$XXX.XX
|
N1
|
N
|
| 33900 |
Perq p-art revsc 1 nm nt uni
|
$XXX.XX
|
J8
|
Y
|
| 33901 |
Perq p-art revsc 1 nm nt bi
|
$XXX.XX
|
G2
|
Y
|
| 33902 |
Perq p-art revsc 1 abnor uni
|
$XXX.XX
|
J8
|
Y
|
| 33903 |
Perq p-art revsc 1 abnor bi
|
$XXX.XX
|
J8
|
Y
|
| 34101 |
Removal of artery clot
|
$XXX.XX
|
G2
|
Y
|
| 34111 |
Removal of arm artery clot
|
$XXX.XX
|
G2
|
Y
|
| 34201 |
Removal of artery clot
|
$XXX.XX
|
J8
|
Y
|
| 34203 |
Removal of leg artery clot
|
$XXX.XX
|
J8
|
Y
|
| 34421 |
Removal of vein clot
|
$XXX.XX
|
J8
|
Y
|
| 34471 |
Removal of vein clot
|
$XXX.XX
|
G2
|
Y
|
| 34490 |
Removal of vein clot
|
$XXX.XX
|
G2
|
Y
|
| 34501 |
Repair valve femoral vein
|
$XXX.XX
|
G2
|
Y
|
| 34510 |
Transposition of vein valve
|
$XXX.XX
|
G2
|
Y
|
| 34520 |
Cross-over vein graft
|
$XXX.XX
|
G2
|
Y
|
| 34530 |
Leg vein fusion
|
$XXX.XX
|
G2
|
Y
|
| 34713 |
Perq access & clsr fem art
|
$XXX.XX
|
N1
|
N
|
| 34714 |
Opn fem art expos cndt crtj
|
$XXX.XX
|
N1
|
N
|
| 34715 |
Opn ax/subcla art expos
|
$XXX.XX
|
N1
|
N
|
| 34716 |
Opn ax/subcla art expos cndt
|
$XXX.XX
|
N1
|
N
|
| 35011 |
Repair defect of artery
|
$XXX.XX
|
G2
|
Y
|
| 35045 |
Repair defect of arm artery
|
$XXX.XX
|
G2
|
Y
|
| 35180 |
Rpr cgen av fistula head&nck
|
$XXX.XX
|
G2
|
Y
|
| 35184 |
Rpr cgen av fistula xtr
|
$XXX.XX
|
G2
|
Y
|
| 35188 |
Rpr acq av fistula head&neck
|
$XXX.XX
|
A2
|
Y
|
| 35190 |
Repair acq av fistula xtr
|
$XXX.XX
|
G2
|
Y
|
| 35201 |
Repair blood vessel dir neck
|
$XXX.XX
|
G2
|
Y
|
| 35206 |
Repair blood vessel dir uxtr
|
$XXX.XX
|
G2
|
Y
|
| 35207 |
Rpr bld vsl dir hand finger
|
$XXX.XX
|
A2
|
Y
|
| 35226 |
Repair blood vessel dir lxtr
|
$XXX.XX
|
G2
|
Y
|
| 35231 |
Repair blvsl vn grf neck
|
$XXX.XX
|
G2
|
Y
|
| 35236 |
Repair blvsl vn grf uxtr
|
$XXX.XX
|
G2
|
Y
|
| 35256 |
Repair blvsl vn grf lxtr
|
$XXX.XX
|
G2
|
Y
|
| 35261 |
Rpr blvsl grf oth/thn vn nck
|
$XXX.XX
|
G2
|
Y
|
| 35266 |
Rpr blvsl grf oth/th vn uxtr
|
$XXX.XX
|
G2
|
Y
|
| 35286 |
Rpr blvsl grf oth/th vn lxtr
|
$XXX.XX
|
G2
|
Y
|
| 35321 |
Rechanneling of artery
|
$XXX.XX
|
G2
|
Y
|
| 35372 |
Rechanneling of artery
|
$XXX.XX
|
J8
|
Y
|
| 35572 |
Harvest femoropopliteal vein
|
$XXX.XX
|
N1
|
N
|
| 35800 |
Explore neck vessels
|
$XXX.XX
|
G2
|
Y
|
| 35860 |
Explore limb vessels
|
$XXX.XX
|
G2
|
Y
|
| 35875 |
Removal of clot in graft
|
$XXX.XX
|
A2
|
Y
|
| 35876 |
Removal of clot in graft
|
$XXX.XX
|
A2
|
Y
|
| 35879 |
Revise graft w/vein
|
$XXX.XX
|
G2
|
Y
|
| 35881 |
Revise graft w/vein
|
$XXX.XX
|
J8
|
Y
|
| 35883 |
Revj fem anast nonautog grf
|
$XXX.XX
|
G2
|
Y
|
| 35884 |
Revj fem anast autog vn grf
|
$XXX.XX
|
G2
|
Y
|
| 35903 |
Excision graft extremity
|
$XXX.XX
|
G2
|
Y
|
| 36000 |
Place needle in vein
|
$XXX.XX
|
N1
|
N
|
| 36002 |
Pseudoaneurysm injection trt
|
$XXX.XX
|
G2
|
Y
|
| 36005 |
Injection ext venography
|
$XXX.XX
|
N1
|
N
|
| 36010 |
Place catheter in vein
|
$XXX.XX
|
N1
|
N
|
| 36011 |
Place catheter in vein
|
$XXX.XX
|
N1
|
N
|
| 36012 |
Place catheter in vein
|
$XXX.XX
|
N1
|
N
|
| 36013 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36014 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36015 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36100 |
Establish access to artery
|
$XXX.XX
|
N1
|
N
|
| 36140 |
Intro ndl icath upr/lxtr art
|
$XXX.XX
|
N1
|
N
|
| 36160 |
Establish access to aorta
|
$XXX.XX
|
N1
|
N
|
| 36200 |
Place catheter in aorta
|
$XXX.XX
|
N1
|
N
|
| 36215 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36216 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36217 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36218 |
Place catheter in artery
|
$XXX.XX
|
N1
|
N
|
| 36221 |
Place cath thoracic aorta
|
$XXX.XX
|
N1
|
N
|
| 36222 |
Place cath carotid/inom art
|
$XXX.XX
|
N1
|
N
|
| 36223 |
Place cath carotid/inom art
|
$XXX.XX
|
N1
|
N
|
| 36224 |
Place cath carotd art
|
$XXX.XX
|
N1
|
N
|
| 36225 |
Place cath subclavian art
|
$XXX.XX
|
N1
|
N
|
| 36226 |
Place cath vertebral art
|
$XXX.XX
|
N1
|
N
|
| 36227 |
Place cath xtrnl carotid
|
$XXX.XX
|
N1
|
N
|
| 36228 |
Place cath intracranial art
|
$XXX.XX
|
N1
|
N
|
| 36245 |
Ins cath abd/l-ext art 1st
|
$XXX.XX
|
N1
|
N
|
| 36246 |
Ins cath abd/l-ext art 2nd
|
$XXX.XX
|
N1
|
N
|
| 36247 |
Ins cath abd/l-ext art 3rd
|
$XXX.XX
|
N1
|
N
|
| 36248 |
Ins cath abd/l-ext art addl
|
$XXX.XX
|
N1
|
N
|
| 36251 |
Ins cath ren art 1st unilat
|
$XXX.XX
|
N1
|
N
|
| 36252 |
Ins cath ren art 1st bilat
|
$XXX.XX
|
N1
|
N
|
| 36253 |
Ins cath ren art 2nd+ unilat
|
$XXX.XX
|
N1
|
N
|
| 36254 |
Ins cath ren art 2nd+ bilat
|
$XXX.XX
|
N1
|
N
|
| 36260 |
Insertion of infusion pump
|
$XXX.XX
|
J8
|
Y
|
| 36261 |
Revision of infusion pump
|
$XXX.XX
|
J8
|
Y
|
| 36262 |
Removal of infusion pump
|
$XXX.XX
|
G2
|
N
|
| 36400 |
Vnpnxr<3yrs phy/qhp fem/jug
|
$XXX.XX
|
N1
|
N
|
| 36405 |
Vnpnxr<3yrs phy/qhp scalp vn
|
$XXX.XX
|
N1
|
N
|
| 36406 |
Vnpnxr<3yrs phy/qhp other vn
|
$XXX.XX
|
N1
|
N
|
| 36410 |
Vnpnxr 3yr/> phy/qhp dx/ther
|
$XXX.XX
|
N1
|
N
|
| 36416 |
Collj capillary blood spec
|
$XXX.XX
|
N1
|
N
|
| 36420 |
Venipuncture cutdown < 1 yr
|
$XXX.XX
|
N1
|
N
|
| 36425 |
Venipuncture cutdown 1 yr/>
|
$XXX.XX
|
N1
|
N
|
| 36430 |
Transfusion bld/bld compnt
|
$XXX.XX
|
P3
|
N
|
| 36440 |
Bld push tfuj 2 yr/<
|
$XXX.XX
|
R2
|
N
|
| 36450 |
Bld exchange truj newborn
|
$XXX.XX
|
R2
|
N
|
| 36455 |
Bld exchange truj oth thn nb
|
$XXX.XX
|
G2
|
N
|
| 36460 |
Intrauterine transfusion ftl
|
$XXX.XX
|
G2
|
N
|
| 36465 |
Njx noncmpnd sclrsnt 1 vein
|
$XXX.XX
|
P2
|
Y
|
| 36466 |
Njx noncmpnd sclrsnt mlt vn
|
$XXX.XX
|
P2
|
Y
|
| 36468 |
Njx sclrsnt spider veins
|
$XXX.XX
|
N1
|
N
|
| 36470 |
Njx sclrsnt 1 incmptnt vein
|
$XXX.XX
|
P3
|
Y
|
| 36471 |
Njx sclrsnt mlt incmptnt vn
|
$XXX.XX
|
P3
|
Y
|
| 36473 |
Endovenous mchnchem 1st vein
|
$XXX.XX
|
P3
|
Y
|
| 36474 |
Endovenous mchnchem add-on
|
$XXX.XX
|
N1
|
N
|
| 36475 |
Endovenous rf 1st vein
|
$XXX.XX
|
A2
|
Y
|
| 36476 |
Endovenous rf vein add-on
|
$XXX.XX
|
N1
|
N
|
| 36478 |
Endovenous laser 1st vein
|
$XXX.XX
|
A2
|
Y
|
| 36479 |
Endovenous laser vein addon
|
$XXX.XX
|
N1
|
N
|
| 36481 |
Insertion of catheter vein
|
$XXX.XX
|
N1
|
N
|
| 36482 |
Endoven ther chem adhes 1st
|
$XXX.XX
|
P3
|
Y
|
| 36483 |
Endoven ther chem adhes sbsq
|
$XXX.XX
|
N1
|
N
|
| 36500 |
Insertion of catheter vein
|
$XXX.XX
|
N1
|
N
|
| 36510 |
Insertion of catheter vein
|
$XXX.XX
|
N1
|
N
|
| 36511 |
Apheresis wbc
|
$XXX.XX
|
G2
|
N
|
| 36512 |
Apheresis rbc
|
$XXX.XX
|
G2
|
N
|
| 36513 |
Apheresis platelets
|
$XXX.XX
|
R2
|
N
|
| 36514 |
Apheresis plasma
|
$XXX.XX
|
G2
|
N
|
| 36516 |
Apheresis immunoads slctv
|
$XXX.XX
|
P3
|
N
|
| 36522 |
Photopheresis
|
$XXX.XX
|
G2
|
N
|
| 36555 |
Insert non-tunnel cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36556 |
Insert non-tunnel cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36557 |
Insert tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36558 |
Insert tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36560 |
Insert tunneled cv cath
|
$XXX.XX
|
G2
|
Y
|
| 36561 |
Insert tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36563 |
Insert tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36565 |
Insert tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36566 |
Insert tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36568 |
Insj picc <5 yr w/o imaging
|
$XXX.XX
|
A2
|
Y
|
| 36569 |
Insj picc 5 yr+ w/o imaging
|
$XXX.XX
|
A2
|
Y
|
| 36570 |
Insert picvad cath
|
$XXX.XX
|
A2
|
Y
|
| 36571 |
Insert picvad cath
|
$XXX.XX
|
A2
|
Y
|
| 36572 |
Insj picc rs&i <5 yr
|
$XXX.XX
|
G2
|
Y
|
| 36573 |
Insj picc rs&i 5 yr+
|
$XXX.XX
|
G2
|
Y
|
| 36575 |
Repair tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36576 |
Repair tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36578 |
Replace tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36580 |
Replace cvad cath
|
$XXX.XX
|
A2
|
Y
|
| 36581 |
Replace tunneled cv cath
|
$XXX.XX
|
J8
|
Y
|
| 36582 |
Replace tunneled cv cath
|
$XXX.XX
|
A2
|
Y
|
| 36583 |
Replace tunneled cv cath
|
$XXX.XX
|
J8
|
Y
|
| 36584 |
Compl rplcmt picc rs&i
|
$XXX.XX
|
A2
|
Y
|
| 36585 |
Replace picvad cath
|
$XXX.XX
|
A2
|
Y
|
| 36589 |
Removal tunneled cv cath
|
$XXX.XX
|
A2
|
N
|
| 36590 |
Removal tunneled cv cath
|
$XXX.XX
|
A2
|
N
|
| 36591 |
Draw blood off venous device
|
$XXX.XX
|
N1
|
N
|
| 36592 |
Collect blood from picc
|
$XXX.XX
|
N1
|
N
|
| 36593 |
Declot vascular device
|
$XXX.XX
|
P3
|
Y
|
| 36595 |
Mech remov tunneled cv cath
|
$XXX.XX
|
P3
|
Y
|
| 36596 |
Mech remov tunneled cv cath
|
$XXX.XX
|
G2
|
Y
|
| 36597 |
Reposition venous catheter
|
$XXX.XX
|
G2
|
Y
|
| 36598 |
Inj w/fluor eval cv device
|
$XXX.XX
|
P3
|
Y
|
| 36600 |
Withdrawal of arterial blood
|
$XXX.XX
|
N1
|
N
|
| 36620 |
Insertion catheter artery
|
$XXX.XX
|
N1
|
N
|
| 36625 |
Insertion catheter artery
|
$XXX.XX
|
N1
|
N
|
| 36640 |
Insertion catheter artery
|
$XXX.XX
|
J8
|
Y
|
| 36680 |
Insert needle bone cavity
|
$XXX.XX
|
N1
|
N
|
| 36800 |
Insertion of cannula
|
$XXX.XX
|
G2
|
Y
|
| 36810 |
Insertion of cannula
|
$XXX.XX
|
J8
|
Y
|
| 36815 |
Insertion of cannula
|
$XXX.XX
|
A2
|
Y
|
| 36818 |
Av fuse uppr arm cephalic
|
$XXX.XX
|
A2
|
Y
|
| 36819 |
Av fuse uppr arm basilic
|
$XXX.XX
|
A2
|
Y
|
| 36820 |
Av fusion/forearm vein
|
$XXX.XX
|
A2
|
Y
|
| 36821 |
Av fusion direct any site
|
$XXX.XX
|
A2
|
Y
|
| 36825 |
Artery-vein autograft
|
$XXX.XX
|
A2
|
Y
|
| 36830 |
Artery-vein nonautograft
|
$XXX.XX
|
A2
|
Y
|
| 36831 |
Open thrombect av fistula
|
$XXX.XX
|
A2
|
Y
|
| 36832 |
Av fistula revision open
|
$XXX.XX
|
A2
|
Y
|
| 36833 |
Av fistula revision
|
$XXX.XX
|
A2
|
Y
|
| 36835 |
Insertion thomas shunt
|
$XXX.XX
|
J8
|
Y
|
| 36836 |
Prq av fstl crtj uxtr 1 acs
|
$XXX.XX
|
J8
|
Y
|
| 36837 |
Prq av fstl crt uxtr sep acs
|
$XXX.XX
|
J8
|
Y
|
| 36838 |
Dist revas ligation hemo
|
$XXX.XX
|
G2
|
Y
|
| 36860 |
External cannula declotting
|
$XXX.XX
|
A2
|
Y
|
| 36861 |
Cannula declotting
|
$XXX.XX
|
A2
|
Y
|
| 36901 |
Intro cath dialysis circuit
|
$XXX.XX
|
P3
|
Y
|
| 36902 |
Intro cath dialysis circuit
|
$XXX.XX
|
G2
|
Y
|
| 36903 |
Intro cath dialysis circuit
|
$XXX.XX
|
J8
|
Y
|
| 36904 |
Thrmbc/nfs dialysis circuit
|
$XXX.XX
|
J8
|
Y
|
| 36905 |
Thrmbc/nfs dialysis circuit
|
$XXX.XX
|
J8
|
Y
|
| 36906 |
Thrmbc/nfs dialysis circuit
|
$XXX.XX
|
J8
|
Y
|
| 36907 |
Balo angiop ctr dialysis seg
|
$XXX.XX
|
N1
|
N
|
| 36908 |
Stent plmt ctr dialysis seg
|
$XXX.XX
|
N1
|
N
|
| 36909 |
Dialysis circuit embolj
|
$XXX.XX
|
N1
|
N
|
| 37182 |
Insert hepatic shunt (tips)
|
$XXX.XX
|
J8
|
Y
|
| 37183 |
Revision tips
|
$XXX.XX
|
J8
|
Y
|
| 37184 |
Prim art m-thrmbc 1st vsl
|
$XXX.XX
|
J8
|
Y
|
| 37185 |
Prim art m-thrmbc sbsq vsl
|
$XXX.XX
|
N1
|
N
|
| 37186 |
Sec art thrombectomy add-on
|
$XXX.XX
|
N1
|
N
|
| 37187 |
Venous mech thrombectomy
|
$XXX.XX
|
J8
|
Y
|
| 37188 |
Ven mechnl thrmbc repeat tx
|
$XXX.XX
|
J8
|
Y
|
| 37191 |
Ins endovas vena cava filtr
|
$XXX.XX
|
J8
|
Y
|
| 37192 |
Redo endovas vena cava filtr
|
$XXX.XX
|
J8
|
Y
|
| 37193 |
Rem endovas vena cava filter
|
$XXX.XX
|
G2
|
Y
|
| 37195 |
Thrombolytic therapy stroke
|
$XXX.XX
|
G2
|
Y
|
| 37197 |
Remove intrvas foreign body
|
$XXX.XX
|
G2
|
Y
|
| 37200 |
Transcatheter biopsy
|
$XXX.XX
|
G2
|
Y
|
| 37211 |
Thrombolytic art therapy
|
$XXX.XX
|
J8
|
Y
|
| 37212 |
Thrombolytic venous therapy
|
$XXX.XX
|
J8
|
Y
|
| 37213 |
Thromblytic art/ven therapy
|
$XXX.XX
|
G2
|
Y
|
| 37214 |
Cessj therapy cath removal
|
$XXX.XX
|
G2
|
Y
|
| 37220 |
Iliac revasc
|
$XXX.XX
|
D5
|
N
|
| 37221 |
Iliac revasc w/stent
|
$XXX.XX
|
D5
|
N
|
| 37222 |
Iliac revasc add-on
|
$XXX.XX
|
D5
|
N
|
| 37223 |
Iliac revasc w/stent add-on
|
$XXX.XX
|
D5
|
N
|
| 37224 |
Fem/popl revas w/tla
|
$XXX.XX
|
D5
|
N
|
| 37225 |
Fem/popl revas w/ather
|
$XXX.XX
|
D5
|
N
|
| 37226 |
Fem/popl revasc w/stent
|
$XXX.XX
|
D5
|
N
|
| 37227 |
Fem/popl revasc stnt & ather
|
$XXX.XX
|
D5
|
N
|
| 37228 |
Tib/per revasc w/tla
|
$XXX.XX
|
D5
|
N
|
| 37229 |
Tib/per revasc w/ather
|
$XXX.XX
|
D5
|
N
|
| 37230 |
Tib/per revasc w/stent
|
$XXX.XX
|
D5
|
N
|
| 37231 |
Tib/per revasc stent & ather
|
$XXX.XX
|
D5
|
N
|
| 37232 |
Tib/per revasc add-on
|
$XXX.XX
|
D5
|
N
|
| 37233 |
Tibper revasc w/ather add-on
|
$XXX.XX
|
D5
|
N
|
| 37234 |
Revsc opn/prq tib/pero stent
|
$XXX.XX
|
D5
|
N
|
| 37235 |
Tib/per revasc stnt & ather
|
$XXX.XX
|
D5
|
N
|
| 37236 |
Open/perq place stent 1st
|
$XXX.XX
|
J8
|
Y
|
| 37237 |
Open/perq place stent ea add
|
$XXX.XX
|
N1
|
N
|
| 37238 |
Open/perq place stent same
|
$XXX.XX
|
J8
|
Y
|
| 37239 |
Open/perq place stent ea add
|
$XXX.XX
|
N1
|
N
|
| 37241 |
Vasc embolize/occlude venous
|
$XXX.XX
|
J8
|
Y
|
| 37242 |
Vasc embolize/occlude artery
|
$XXX.XX
|
J8
|
Y
|
| 37243 |
Vasc embolize/occlude organ
|
$XXX.XX
|
G2
|
Y
|
| 37244 |
Vasc embolize/occlude bleed
|
$XXX.XX
|
J8
|
Y
|
| 37246 |
Trluml balo angiop 1st art
|
$XXX.XX
|
J8
|
Y
|
| 37247 |
Trluml balo angiop addl art
|
$XXX.XX
|
N1
|
N
|
| 37248 |
Trluml balo angiop 1st vein
|
$XXX.XX
|
J8
|
Y
|
| 37249 |
Trluml balo angiop addl vein
|
$XXX.XX
|
N1
|
N
|
| 37252 |
Intrvasc us noncoronary 1st
|
$XXX.XX
|
N1
|
N
|
| 37253 |
Intrvasc us noncoronary addl
|
$XXX.XX
|
N1
|
N
|
| 37254 |
Revsc evasc ivt angio sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37255 |
Revsc evasc ivt angio sf ea
|
$XXX.XX
|
N1
|
N
|
| 37256 |
Revsc evasc ivt angio cplx 1
|
$XXX.XX
|
J8
|
Y
|
| 37257 |
Revsc evsc ivt angio cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37258 |
Revsc evasc ivt stent sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37259 |
Revsc evasc ivt stent sf ea
|
$XXX.XX
|
N1
|
N
|
| 37260 |
Revsc evasc ivt st cplx 1st
|
$XXX.XX
|
J8
|
Y
|
| 37261 |
Revsc evasc ivt st cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37262 |
Iv lithotrp ivt w/in sm art
|
$XXX.XX
|
N1
|
N
|
| 37263 |
Revsc evasc fpvt angio sf 1
|
$XXX.XX
|
J8
|
Y
|
| 37264 |
Revsc evasc fpvt angio sf ea
|
$XXX.XX
|
N1
|
N
|
| 37265 |
Revsc evsc fpvt angio cplx 1
|
$XXX.XX
|
J8
|
Y
|
| 37266 |
Rvsc evsc fpvt angio cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37267 |
Revsc evsc fpvt stent sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37268 |
Revsc evasc fpvt stent sf ea
|
$XXX.XX
|
N1
|
N
|
| 37269 |
Revsc evasc fpvt st cplx 1st
|
$XXX.XX
|
J8
|
Y
|
| 37270 |
Revsc evasc fpvt st cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37271 |
Revsc evsc fpvt athrc sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37272 |
Revsc evsc fpvt athrc sf ea
|
$XXX.XX
|
N1
|
N
|
| 37273 |
Revsc evsc fpvt athrc cplx 1
|
$XXX.XX
|
J8
|
Y
|
| 37274 |
Rvsc evsc fpvt athrc cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37275 |
Rvsc evsc fpvt st athrc sf 1
|
$XXX.XX
|
J8
|
Y
|
| 37276 |
Rvsc evsc fpvt st athr sf ea
|
$XXX.XX
|
N1
|
N
|
| 37277 |
Rvsc evsc fpvt st athr cpx 1
|
$XXX.XX
|
J8
|
Y
|
| 37278 |
Rvsc evsc fpvt st ath cpx ea
|
$XXX.XX
|
N1
|
N
|
| 37279 |
Iv lithotrp fpvt w/in sm art
|
$XXX.XX
|
N1
|
N
|
| 37280 |
Revsc evsc tpvt angio sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37281 |
Revsc evsc tpvt angio sf ea
|
$XXX.XX
|
N1
|
N
|
| 37282 |
Rvsc evsc tpvt angio cplx 1
|
$XXX.XX
|
J8
|
Y
|
| 37283 |
Rvsc evsc tpvt angio cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37284 |
Revsc evasc tpvt st sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37285 |
Revsc evasc tpvt st sf ea
|
$XXX.XX
|
N1
|
N
|
| 37286 |
Revsc evasc tpvt st cplx 1st
|
$XXX.XX
|
J8
|
Y
|
| 37287 |
Revsc evasc tpvt st cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37288 |
Revsc evsc tpvt athrc sf 1st
|
$XXX.XX
|
J8
|
Y
|
| 37289 |
Revsc evsc tpvt athrc sf ea
|
$XXX.XX
|
N1
|
N
|
| 37290 |
Revsc evsc tpvt athrc cplx 1
|
$XXX.XX
|
J8
|
Y
|
| 37291 |
Revsc evsc tpvt athr cplx ea
|
$XXX.XX
|
N1
|
N
|
| 37292 |
Rvsc evsc tpvt st athrc sf 1
|
$XXX.XX
|
J8
|
Y
|
| 37293 |
Rvsc evsc tpvt st athr sf ea
|
$XXX.XX
|
N1
|
N
|
| 37294 |
Rvsc evsc tpvt st athr cpx 1
|
$XXX.XX
|
J8
|
Y
|
| 37295 |
Rvsc evsc tpvt st ath cpx ea
|
$XXX.XX
|
N1
|
N
|
| 37296 |
Revsc evasc imvt angio sf 1
|
$XXX.XX
|
J8
|
Y
|
| 37297 |
Revsc evasc imvt angio sf ea
|
$XXX.XX
|
N1
|
N
|
| 37298 |
Revsc evsc imvt angio cplx 1
|
$XXX.XX
|
J8
|
Y
|
| 37299 |
Revsc evsc imvt angio cpx ea
|
$XXX.XX
|
N1
|
N
|
| 37500 |
Endoscopy ligate perf veins
|
$XXX.XX
|
D5
|
N
|
| 37565 |
Ligation int jugular vein
|
$XXX.XX
|
G2
|
Y
|
| 37600 |
Ligation xtrnl carotid art
|
$XXX.XX
|
G2
|
Y
|
| 37605 |
Ligation int/com carotid art
|
$XXX.XX
|
G2
|
Y
|
| 37606 |
Lig int/com carotid art occl
|
$XXX.XX
|
G2
|
Y
|
| 37607 |
Lig/banding angioacs av fstl
|
$XXX.XX
|
A2
|
Y
|
| 37609 |
Ligation/bx temporal artery
|
$XXX.XX
|
A2
|
Y
|
| 37615 |
Ligation major artery neck
|
$XXX.XX
|
G2
|
Y
|
| 37617 |
Ligation major artery abd
|
$XXX.XX
|
G2
|
Y
|
| 37619 |
Ligation of inf vena cava
|
$XXX.XX
|
G2
|
Y
|
| 37650 |
Ligation of femoral vein
|
$XXX.XX
|
A2
|
Y
|
| 37700 |
Ligation&div long saph vein
|
$XXX.XX
|
A2
|
Y
|
| 37718 |
Lig div&strpg short saph vn
|
$XXX.XX
|
A2
|
Y
|
| 37722 |
Lig div&strpg long saph vein
|
$XXX.XX
|
A2
|
Y
|
| 37735 |
Lig&div&compl strpg saph vn
|
$XXX.XX
|
A2
|
Y
|
| 37760 |
Lig prfratr vn radical 1 leg
|
$XXX.XX
|
A2
|
Y
|
| 37761 |
Ligate leg veins open
|
$XXX.XX
|
R2
|
Y
|
| 37765 |
Stab phleb veins xtr 10-20
|
$XXX.XX
|
P3
|
Y
|
| 37766 |
Phleb veins - extrem 20+
|
$XXX.XX
|
P3
|
Y
|
| 37780 |
Revision of leg vein
|
$XXX.XX
|
A2
|
Y
|
| 37785 |
Ligate/divide/excise vein
|
$XXX.XX
|
A2
|
Y
|
| 37790 |
Penile venous occlusion
|
$XXX.XX
|
A2
|
Y
|
| 38120 |
Laparoscopy splenectomy
|
$XXX.XX
|
G2
|
Y
|
| 38200 |
Injection for spleen x-ray
|
$XXX.XX
|
N1
|
N
|
| 38204 |
Bl donor search management
|
$XXX.XX
|
N1
|
N
|
| 38206 |
Harvest auto stem cells
|
$XXX.XX
|
G2
|
N
|
| 38207 |
Cryopreserve stem cells
|
$XXX.XX
|
G2
|
N
|
| 38208 |
Thaw preserved stem cells
|
$XXX.XX
|
G2
|
N
|
| 38209 |
Wash harvest stem cells
|
$XXX.XX
|
G2
|
N
|
| 38210 |
T-cell depletion of harvest
|
$XXX.XX
|
G2
|
N
|
| 38211 |
Tumor cell deplete of harvst
|
$XXX.XX
|
G2
|
N
|
| 38212 |
Rbc depletion of harvest
|
$XXX.XX
|
G2
|
N
|
| 38213 |
Platelet deplete of harvest
|
$XXX.XX
|
G2
|
N
|
| 38214 |
Volume deplete of harvest
|
$XXX.XX
|
G2
|
N
|
| 38215 |
Harvest stem cell concentrte
|
$XXX.XX
|
G2
|
N
|
| 38220 |
Dx bone marrow aspirations
|
$XXX.XX
|
P3
|
Y
|
| 38221 |
Dx bone marrow biopsies
|
$XXX.XX
|
P3
|
Y
|
| 38222 |
Dx bone marrow bx & aspir
|
$XXX.XX
|
G2
|
Y
|
| 38230 |
Bone marrow harvest allogen
|
$XXX.XX
|
G2
|
N
|
| 38232 |
Bone marrow harvest autolog
|
$XXX.XX
|
R2
|
N
|
| 38240 |
Transplt allo hct/donor
|
$XXX.XX
|
G2
|
Y
|
| 38241 |
Transplt autol hct/donor
|
$XXX.XX
|
G2
|
N
|
| 38242 |
Transplt allo lymphocytes
|
$XXX.XX
|
R2
|
N
|
| 38243 |
Transplj hematopoietic boost
|
$XXX.XX
|
R2
|
N
|
| 38300 |
Drainage lymph node lesion
|
$XXX.XX
|
A2
|
Y
|
| 38305 |
Drainage lymph node lesion
|
$XXX.XX
|
A2
|
Y
|
| 38308 |
Incision of lymph channels
|
$XXX.XX
|
A2
|
Y
|
| 38500 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38505 |
Needle biopsy lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38510 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38520 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38525 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38530 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38531 |
Open bx/exc inguinofem nodes
|
$XXX.XX
|
G2
|
Y
|
| 38542 |
Explore deep node(s) neck
|
$XXX.XX
|
A2
|
Y
|
| 38550 |
Removal neck/armpit lesion
|
$XXX.XX
|
A2
|
Y
|
| 38555 |
Removal neck/armpit lesion
|
$XXX.XX
|
A2
|
Y
|
| 38562 |
Removal pelvic lymph nodes
|
$XXX.XX
|
G2
|
Y
|
| 38570 |
Laparoscopy lymph node biop
|
$XXX.XX
|
A2
|
Y
|
| 38571 |
Laparoscopy lymphadenectomy
|
$XXX.XX
|
A2
|
Y
|
| 38572 |
Laparoscopy lymphadenectomy
|
$XXX.XX
|
A2
|
Y
|
| 38573 |
Laps pelvic lymphadec
|
$XXX.XX
|
G2
|
Y
|
| 38700 |
Removal of lymph nodes neck
|
$XXX.XX
|
G2
|
Y
|
| 38720 |
Removal of lymph nodes neck
|
$XXX.XX
|
G2
|
Y
|
| 38740 |
Remove armpit lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38745 |
Remove armpit lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38760 |
Remove groin lymph nodes
|
$XXX.XX
|
A2
|
Y
|
| 38790 |
Inject for lymphatic x-ray
|
$XXX.XX
|
N1
|
N
|
| 38792 |
Ra tracer id of sentinl node
|
$XXX.XX
|
N1
|
N
|
| 38794 |
Access thoracic lymph duct
|
$XXX.XX
|
N1
|
N
|
| 38900 |
Io map of sent lymph node
|
$XXX.XX
|
N1
|
N
|
| 39401 |
Mediastinoscpy w/medstnl bx
|
$XXX.XX
|
G2
|
Y
|
| 39402 |
Mediastinoscpy w/lmph nod bx
|
$XXX.XX
|
G2
|
Y
|
| 40490 |
Biopsy of lip
|
$XXX.XX
|
P3
|
Y
|
| 40500 |
Partial excision of lip
|
$XXX.XX
|
A2
|
Y
|
| 40510 |
Partial excision of lip
|
$XXX.XX
|
A2
|
Y
|
| 40520 |
Partial excision of lip
|
$XXX.XX
|
A2
|
Y
|
| 40525 |
Reconstruct lip with flap
|
$XXX.XX
|
A2
|
Y
|
| 40527 |
Reconstruct lip with flap
|
$XXX.XX
|
A2
|
Y
|
| 40530 |
Partial removal of lip
|
$XXX.XX
|
A2
|
Y
|
| 40650 |
Rpr lip fth vermilion only
|
$XXX.XX
|
A2
|
Y
|
| 40652 |
Rpr lip fth
|
$XXX.XX
|
A2
|
Y
|
|
| 40654 |
Rpr lip fth>1half ver ht/cpx
|
$XXX.XX
|
A2
|
Y
|
| 40700 |
Repair cleft lip/nasal
|
$XXX.XX
|
A2
|
Y
|
| 40701 |
Repair cleft lip/nasal
|
$XXX.XX
|
A2
|
Y
|
| 40702 |
Repair cleft lip/nasal
|
$XXX.XX
|
R2
|
Y
|
| 40720 |
Repair cleft lip/nasal
|
$XXX.XX
|
A2
|
Y
|
| 40761 |
Repair cleft lip/nasal
|
$XXX.XX
|
A2
|
Y
|
| 40800 |
Drainage of mouth lesion
|
$XXX.XX
|
P3
|
Y
|
| 40801 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 40804 |
Removal foreign body mouth
|
$XXX.XX
|
N1
|
N
|
| 40805 |
Removal foreign body mouth
|
$XXX.XX
|
P3
|
Y
|
| 40806 |
Incision of lip fold
|
$XXX.XX
|
P3
|
Y
|
| 40808 |
Biopsy of mouth lesion
|
$XXX.XX
|
P3
|
Y
|
| 40810 |
Excision of mouth lesion
|
$XXX.XX
|
P3
|
Y
|
| 40812 |
Excise/repair mouth lesion
|
$XXX.XX
|
P3
|
Y
|
| 40814 |
Excise/repair mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 40816 |
Excision of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 40818 |
Excise oral mucosa for graft
|
$XXX.XX
|
A2
|
Y
|
| 40819 |
Excise lip or cheek fold
|
$XXX.XX
|
A2
|
Y
|
| 40820 |
Treatment of mouth lesion
|
$XXX.XX
|
P3
|
Y
|
| 40830 |
Repair mouth laceration
|
$XXX.XX
|
P2
|
Y
|
| 40831 |
Repair mouth laceration
|
$XXX.XX
|
A2
|
Y
|
| 40840 |
Reconstruction of mouth
|
$XXX.XX
|
A2
|
Y
|
| 40842 |
Reconstruction of mouth
|
$XXX.XX
|
A2
|
Y
|
| 40843 |
Reconstruction of mouth
|
$XXX.XX
|
A2
|
Y
|
| 40844 |
Reconstruction of mouth
|
$XXX.XX
|
A2
|
Y
|
| 40845 |
Reconstruction of mouth
|
$XXX.XX
|
A2
|
Y
|
| 41000 |
Drainage of mouth lesion
|
$XXX.XX
|
P3
|
Y
|
| 41005 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41006 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41007 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41008 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41009 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41010 |
Incision of tongue fold
|
$XXX.XX
|
A2
|
Y
|
| 41015 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41016 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41017 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41018 |
Drainage of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41019 |
Place needles h&n for rt
|
$XXX.XX
|
G2
|
Y
|
| 41100 |
Biopsy of tongue
|
$XXX.XX
|
P3
|
Y
|
| 41105 |
Biopsy of tongue
|
$XXX.XX
|
P3
|
Y
|
| 41108 |
Biopsy of floor of mouth
|
$XXX.XX
|
P3
|
Y
|
| 41110 |
Excision of tongue lesion
|
$XXX.XX
|
P3
|
Y
|
| 41112 |
Excision of tongue lesion
|
$XXX.XX
|
A2
|
Y
|
| 41113 |
Excision of tongue lesion
|
$XXX.XX
|
A2
|
Y
|
| 41114 |
Excision of tongue lesion
|
$XXX.XX
|
A2
|
Y
|
| 41115 |
Excision of tongue fold
|
$XXX.XX
|
P3
|
Y
|
| 41116 |
Excision of mouth lesion
|
$XXX.XX
|
A2
|
Y
|
| 41120 |
Partial removal of tongue
|
$XXX.XX
|
A2
|
Y
|
| 41250 |
Repair tongue laceration
|
$XXX.XX
|
N1
|
N
|
| 41251 |
Repair tongue laceration
|
$XXX.XX
|
A2
|
Y
|
| 41252 |
Repair tongue laceration
|
$XXX.XX
|
A2
|
Y
|
| 41510 |
Tongue to lip surgery
|
$XXX.XX
|
A2
|
Y
|
| 41512 |
Tongue suspension
|
$XXX.XX
|
J8
|
Y
|
| 41520 |
Reconstruction tongue fold
|
$XXX.XX
|
A2
|
Y
|
| 41530 |
Tongue base vol reduction
|
$XXX.XX
|
P3
|
Y
|
| 41800 |
Drainage of gum lesion
|
$XXX.XX
|
N1
|
N
|
| 41805 |
Removal foreign body gum
|
$XXX.XX
|
P3
|
Y
|
| 41806 |
Removal foreign body jawbone
|
$XXX.XX
|
P3
|
Y
|
| 41820 |
Excision gum each quadrant
|
$XXX.XX
|
R2
|
Y
|
| 41821 |
Excision of gum flap
|
$XXX.XX
|
G2
|
Y
|
| 41822 |
Excision of gum lesion
|
$XXX.XX
|
P3
|
Y
|
| 41823 |
Excision of gum lesion
|
$XXX.XX
|
P3
|
Y
|
| 41825 |
Excision of gum lesion
|
$XXX.XX
|
P3
|
Y
|
| 41826 |
Excision of gum lesion
|
$XXX.XX
|
P3
|
Y
|
| 41827 |
Excision of gum lesion
|
$XXX.XX
|
A2
|
Y
|
| 41828 |
Excision of gum lesion
|
$XXX.XX
|
P3
|
Y
|
| 41830 |
Removal of gum tissue
|
$XXX.XX
|
P3
|
Y
|
| 41850 |
Treatment of gum lesion
|
$XXX.XX
|
R2
|
Y
|
| 41870 |
Periodontal mucosal grafting
|
$XXX.XX
|
G2
|
Y
|
| 41872 |
Gingivoplasty each quadrant
|
$XXX.XX
|
P3
|
Y
|
| 41874 |
Alveoloplasty each quadrant
|
$XXX.XX
|
P3
|
Y
|
| 42000 |
Drainage mouth roof lesion
|
$XXX.XX
|
A2
|
Y
|
| 42100 |
Biopsy roof of mouth
|
$XXX.XX
|
P3
|
Y
|
| 42104 |
Excision lesion mouth roof
|
$XXX.XX
|
P3
|
Y
|
| 42106 |
Excision lesion mouth roof
|
$XXX.XX
|
P3
|
Y
|
| 42107 |
Excision lesion mouth roof
|
$XXX.XX
|
A2
|
Y
|
| 42120 |
Remove palate/lesion
|
$XXX.XX
|
A2
|
Y
|
| 42140 |
Excision of uvula
|
$XXX.XX
|
A2
|
Y
|
| 42145 |
Repair palate pharynx/uvula
|
$XXX.XX
|
A2
|
Y
|
| 42160 |
Treatment mouth roof lesion
|
$XXX.XX
|
P3
|
Y
|
| 42180 |
Repair lac palate<2 cm
|
$XXX.XX
|
A2
|
Y
|
| 42182 |
Repair palate
|
$XXX.XX
|
A2
|
Y
|
| 42200 |
Reconstruct cleft palate
|
$XXX.XX
|
A2
|
Y
|
| 42205 |
Reconstruct cleft palate
|
$XXX.XX
|
A2
|
Y
|
| 42210 |
Reconstruct cleft palate
|
$XXX.XX
|
A2
|
Y
|
| 42215 |
Reconstruct cleft palate
|
$XXX.XX
|
A2
|
Y
|
| 42220 |
Reconstruct cleft palate
|
$XXX.XX
|
A2
|
Y
|
| 42225 |
Reconstruct cleft palate
|
$XXX.XX
|
G2
|
Y
|
| 42226 |
Lengthening of palate
|
$XXX.XX
|
A2
|
Y
|
| 42227 |
Lengthening of palate
|
$XXX.XX
|
G2
|
Y
|
| 42235 |
Repair palate
|
$XXX.XX
|
A2
|
Y
|
| 42260 |
Repair nose to lip fistula
|
$XXX.XX
|
A2
|
Y
|
| 42280 |
Preparation palate mold
|
$XXX.XX
|
P3
|
Y
|
| 42281 |
Insertion palate prosthesis
|
$XXX.XX
|
G2
|
Y
|
| 42300 |
Drainage of salivary gland
|
$XXX.XX
|
A2
|
Y
|
| 42305 |
Drainage of salivary gland
|
$XXX.XX
|
A2
|
Y
|
| 42310 |
Drainage of salivary gland
|
$XXX.XX
|
A2
|
Y
|
| 42320 |
Drainage of salivary gland
|
$XXX.XX
|
A2
|
Y
|
| 42330 |
Removal of salivary stone
|
$XXX.XX
|
P3
|
Y
|
| 42335 |
Removal of salivary stone
|
$XXX.XX
|
P3
|
Y
|
| 42340 |
Removal of salivary stone
|
$XXX.XX
|
A2
|
Y
|
| 42400 |
Biopsy of salivary gland
|
$XXX.XX
|
P3
|
Y
|
| 42405 |
Biopsy of salivary gland
|
$XXX.XX
|
A2
|
Y
|
| 42408 |
Excision of salivary cyst
|
$XXX.XX
|
A2
|
Y
|
| 42409 |
Drainage of salivary cyst
|
$XXX.XX
|
A2
|
Y
|
| 42410 |
Excise parotid gland/lesion
|
$XXX.XX
|
A2
|
Y
|
| 42415 |
Excise parotid gland/lesion
|
$XXX.XX
|
A2
|
Y
|
| 42420 |
Excise parotid gland/lesion
|
$XXX.XX
|
A2
|
Y
|
| 42425 |
Excise parotid gland/lesion
|
$XXX.XX
|
A2
|
Y
|
| 42440 |
Excise submaxillary gland
|
$XXX.XX
|
A2
|
Y
|
| 42450 |
Excise sublingual gland
|
$XXX.XX
|
A2
|
Y
|
| 42500 |
Repair salivary duct
|
$XXX.XX
|
A2
|
Y
|
| 42505 |
Repair salivary duct
|
$XXX.XX
|
A2
|
Y
|
| 42507 |
Parotid duct diversion
|
$XXX.XX
|
A2
|
Y
|
| 42509 |
Parotid duct diversion
|
$XXX.XX
|
A2
|
Y
|
| 42510 |
Parotid duct diversion
|
$XXX.XX
|
A2
|
Y
|
| 42550 |
Injection for salivary x-ray
|
$XXX.XX
|
N1
|
N
|
| 42600 |
Closure of salivary fistula
|
$XXX.XX
|
A2
|
Y
|
| 42650 |
Dilation of salivary duct
|
$XXX.XX
|
P3
|
Y
|
| 42660 |
Dilation of salivary duct
|
$XXX.XX
|
P3
|
Y
|
| 42665 |
Ligation of salivary duct
|
$XXX.XX
|
A2
|
Y
|
| 42700 |
I&d abscess peritonsillar
|
$XXX.XX
|
A2
|
Y
|
| 42720 |
I&d absc phrngl ntraorl appr
|
$XXX.XX
|
A2
|
Y
|
| 42725 |
I&d absc phrngl xtrnl appr
|
$XXX.XX
|
A2
|
Y
|
| 42800 |
Biopsy of throat
|
$XXX.XX
|
P3
|
Y
|
| 42804 |
Biopsy of upper nose/throat
|
$XXX.XX
|
A2
|
Y
|
| 42806 |
Biopsy of upper nose/throat
|
$XXX.XX
|
A2
|
Y
|
| 42808 |
Excise pharynx lesion
|
$XXX.XX
|
A2
|
Y
|
| 42809 |
Remove pharynx foreign body
|
$XXX.XX
|
N1
|
N
|
| 42810 |
Excision of neck cyst
|
$XXX.XX
|
A2
|
Y
|
| 42815 |
Excision of neck cyst
|
$XXX.XX
|
A2
|
Y
|
| 42820 |
Remove tonsils and adenoids
|
$XXX.XX
|
A2
|
Y
|
| 42821 |
Remove tonsils and adenoids
|
$XXX.XX
|
A2
|
Y
|
| 42825 |
Removal of tonsils
|
$XXX.XX
|
A2
|
Y
|
| 42826 |
Removal of tonsils
|
$XXX.XX
|
A2
|
Y
|
| 42830 |
Removal of adenoids
|
$XXX.XX
|
A2
|
Y
|
| 42831 |
Removal of adenoids
|
$XXX.XX
|
A2
|
Y
|
| 42835 |
Removal of adenoids
|
$XXX.XX
|
A2
|
Y
|
| 42836 |
Removal of adenoids
|
$XXX.XX
|
A2
|
Y
|
| 42842 |
Extensive surgery of throat
|
$XXX.XX
|
G2
|
Y
|
| 42844 |
Extensive surgery of throat
|
$XXX.XX
|
G2
|
Y
|
| 42860 |
Excision of tonsil tags
|
$XXX.XX
|
A2
|
Y
|
| 42870 |
Excision of lingual tonsil
|
$XXX.XX
|
A2
|
Y
|
| 42890 |
Limited pharyngectomy
|
$XXX.XX
|
A2
|
Y
|
| 42892 |
Revision of pharyngeal walls
|
$XXX.XX
|
A2
|
Y
|
| 42900 |
Repair throat wound
|
$XXX.XX
|
J8
|
Y
|
| 42950 |
Reconstruction of throat
|
$XXX.XX
|
A2
|
Y
|
| 42955 |
Surgical opening of throat
|
$XXX.XX
|
A2
|
Y
|
| 42960 |
Control throat bleeding
|
$XXX.XX
|
A2
|
Y
|
| 42962 |
Control throat bleeding
|
$XXX.XX
|
A2
|
Y
|
| 42970 |
Control nose/throat bleeding
|
$XXX.XX
|
R2
|
Y
|
| 42972 |
Control nose/throat bleeding
|
$XXX.XX
|
A2
|
Y
|
| 42975 |
Dise eval slp do brth flx dx
|
$XXX.XX
|
R2
|
Y
|
| 43020 |
Incision of esophagus
|
$XXX.XX
|
G2
|
Y
|
| 43030 |
Cricopharyngeal myotomy
|
$XXX.XX
|
G2
|
Y
|
| 43130 |
Removal of esophagus pouch
|
$XXX.XX
|
G2
|
Y
|
| 43180 |
Esophagoscopy rigid trnso
|
$XXX.XX
|
G2
|
Y
|
| 43191 |
Esophagoscopy rigid trnso dx
|
$XXX.XX
|
G2
|
Y
|
| 43192 |
Esophagoscp rig trnso inject
|
$XXX.XX
|
G2
|
Y
|
| 43193 |
Esophagoscp rig trnso biopsy
|
$XXX.XX
|
G2
|
Y
|
| 43194 |
Esophagoscp rig trnso rem fb
|
$XXX.XX
|
G2
|
Y
|
| 43195 |
Esophagoscopy rigid balloon
|
$XXX.XX
|
G2
|
Y
|
| 43196 |
Esophagoscp guide wire dilat
|
$XXX.XX
|
G2
|
Y
|
| 43197 |
Esophagoscopy flex dx brush
|
$XXX.XX
|
P3
|
Y
|
| 43198 |
Esophagosc flex trnsn biopsy
|
$XXX.XX
|
P3
|
Y
|
| 43200 |
Esophagoscopy flexible brush
|
$XXX.XX
|
A2
|
Y
|
| 43201 |
Esoph scope w/submucous inj
|
$XXX.XX
|
A2
|
Y
|
| 43202 |
Esophagoscopy flex biopsy
|
$XXX.XX
|
A2
|
Y
|
| 43204 |
Esoph scope w/sclerosis inj
|
$XXX.XX
|
A2
|
Y
|
| 43205 |
Esophagus endoscopy/ligation
|
$XXX.XX
|
A2
|
Y
|
| 43206 |
Esoph optical endomicroscopy
|
$XXX.XX
|
G2
|
Y
|
| 43210 |
Egd esophagogastrc fndoplsty
|
$XXX.XX
|
J8
|
Y
|
| 43211 |
Esophagoscop mucosal resect
|
$XXX.XX
|
G2
|
Y
|
| 43212 |
Esophagoscop stent placement
|
$XXX.XX
|
J8
|
Y
|
| 43213 |
Esophagoscopy retro balloon
|
$XXX.XX
|
G2
|
Y
|
| 43214 |
Esophagosc dilate balloon 30
|
$XXX.XX
|
G2
|
Y
|
| 43215 |
Esophagoscopy flex remove fb
|
$XXX.XX
|
A2
|
Y
|
| 43216 |
Esophagoscopy lesion removal
|
$XXX.XX
|
A2
|
Y
|
| 43217 |
Esophagoscopy snare les remv
|
$XXX.XX
|
A2
|
Y
|
| 43220 |
Esophagoscopy balloon <30mm
|
$XXX.XX
|
A2
|
Y
|
| 43226 |
Esoph endoscopy dilation
|
$XXX.XX
|
A2
|
Y
|
| 43227 |
Esophagoscopy control bleed
|
$XXX.XX
|
A2
|
Y
|
| 43229 |
Esophagoscopy lesion ablate
|
$XXX.XX
|
J8
|
Y
|
| 43231 |
Esophagoscop ultrasound exam
|
$XXX.XX
|
A2
|
Y
|
| 43232 |
Esophagoscopy w/us needle bx
|
$XXX.XX
|
A2
|
Y
|
| 43233 |
Egd balloon dil esoph30 mm/>
|
$XXX.XX
|
G2
|
Y
|
| 43235 |
Egd diagnostic brush wash
|
$XXX.XX
|
A2
|
Y
|
| 43236 |
Uppr gi scope w/submuc inj
|
$XXX.XX
|
A2
|
Y
|
| 43237 |
Endoscopic us exam esoph
|
$XXX.XX
|
A2
|
Y
|
| 43238 |
Egd us fine needle bx/aspir
|
$XXX.XX
|
A2
|
Y
|
| 43239 |
Egd biopsy single/multiple
|
$XXX.XX
|
A2
|
Y
|
| 43240 |
Egd w/transmural drain cyst
|
$XXX.XX
|
J8
|
Y
|
| 43241 |
Egd tube/cath insertion
|
$XXX.XX
|
A2
|
Y
|
| 43242 |
Egd us fine needle bx/aspir
|
$XXX.XX
|
A2
|
Y
|
| 43243 |
Egd injection varices
|
$XXX.XX
|
A2
|
Y
|
| 43244 |
Egd varices ligation
|
$XXX.XX
|
A2
|
Y
|
| 43245 |
Egd dilate stricture
|
$XXX.XX
|
A2
|
Y
|
| 43246 |
Egd place gastrostomy tube
|
$XXX.XX
|
A2
|
Y
|
| 43247 |
Egd remove foreign body
|
$XXX.XX
|
A2
|
Y
|
| 43248 |
Egd guide wire insertion
|
$XXX.XX
|
A2
|
Y
|
| 43249 |
Esoph egd dilation <30 mm
|
$XXX.XX
|
A2
|
Y
|
| 43250 |
Egd cautery tumor polyp
|
$XXX.XX
|
A2
|
Y
|
| 43251 |
Egd remove lesion snare
|
$XXX.XX
|
A2
|
Y
|
| 43252 |
Egd optical endomicroscopy
|
$XXX.XX
|
G2
|
Y
|
| 43253 |
Egd us transmural injxn/mark
|
$XXX.XX
|
G2
|
Y
|
| 43254 |
Egd endo mucosal resection
|
$XXX.XX
|
G2
|
Y
|
| 43255 |
Egd control bleeding any
|
$XXX.XX
|
A2
|
Y
|
| 43257 |
Egd w/thrml txmnt gerd
|
$XXX.XX
|
J8
|
Y
|
| 43259 |
Egd us exam duodenum/jejunum
|
$XXX.XX
|
A2
|
Y
|
| 43260 |
Ercp w/specimen collection
|
$XXX.XX
|
A2
|
Y
|
| 43261 |
Endo cholangiopancreatograph
|
$XXX.XX
|
A2
|
Y
|
| 43262 |
Endo cholangiopancreatograph
|
$XXX.XX
|
A2
|
Y
|
| 43263 |
Ercp sphincter pressure meas
|
$XXX.XX
|
A2
|
Y
|
| 43264 |
Ercp remove duct calculi
|
$XXX.XX
|
A2
|
Y
|
| 43265 |
Ercp lithotripsy calculi
|
$XXX.XX
|
A2
|
Y
|
| 43266 |
Egd endoscopic stent place
|
$XXX.XX
|
J8
|
Y
|
| 43270 |
Egd lesion ablation
|
$XXX.XX
|
J8
|
Y
|
| 43273 |
Endoscopic pancreatoscopy
|
$XXX.XX
|
N1
|
N
|
| 43274 |
Ercp duct stent placement
|
$XXX.XX
|
J8
|
Y
|
| 43275 |
Ercp remove forgn body duct
|
$XXX.XX
|
G2
|
Y
|
| 43276 |
Ercp stent exchange w/dilate
|
$XXX.XX
|
J8
|
Y
|
| 43277 |
Ercp ea duct/ampulla dilate
|
$XXX.XX
|
G2
|
Y
|
| 43278 |
Ercp lesion ablate w/dilate
|
$XXX.XX
|
G2
|
Y
|
| 43280 |
Laparoscopy fundoplasty
|
$XXX.XX
|
G2
|
Y
|
| 43281 |
Lap paraesophag hern repair
|
$XXX.XX
|
G2
|
Y
|
| 43282 |
Lap paraesoph her rpr w/mesh
|
$XXX.XX
|
G2
|
Y
|
| 43284 |
Laps esophgl sphnctr agmntj
|
$XXX.XX
|
J8
|
Y
|
| 43285 |
Rmvl esophgl sphnctr dev
|
$XXX.XX
|
G2
|
N
|
| 43290 |
Egd flx trnsorl dplmnt balo
|
$XXX.XX
|
J8
|
Y
|
| 43291 |
Egd flx trnsorl rmvl balo
|
$XXX.XX
|
G2
|
Y
|
| 43420 |
Repair esophagus opening
|
$XXX.XX
|
G2
|
Y
|
| 43450 |
Dilate esophagus 1/mult pass
|
$XXX.XX
|
A2
|
Y
|
| 43453 |
Dilate esophagus
|
$XXX.XX
|
A2
|
Y
|
| 43497 |
Transorl lwr esophgl myotomy
|
$XXX.XX
|
G2
|
Y
|
| 43510 |
Surgical opening of stomach
|
$XXX.XX
|
G2
|
Y
|
| 43647 |
Lap impl electrode antrum
|
$XXX.XX
|
J8
|
N
|
| 43648 |
Lap revise/remv eltrd antrum
|
$XXX.XX
|
G2
|
Y
|
| 43651 |
Laparoscopy vagus nerve
|
$XXX.XX
|
G2
|
Y
|
| 43652 |
Laparoscopy vagus nerve
|
$XXX.XX
|
G2
|
Y
|
| 43653 |
Laparoscopy gastrostomy
|
$XXX.XX
|
A2
|
Y
|
| 43752 |
Nasal/orogastric w/tube plmt
|
$XXX.XX
|
G2
|
N
|
| 43753 |
Tx gastro intub w/asp
|
$XXX.XX
|
N1
|
N
|
| 43754 |
Dx gastr intub w/asp spec
|
$XXX.XX
|
N1
|
N
|
| 43755 |
Dx gastr intub w/asp specs
|
$XXX.XX
|
G2
|
N
|
| 43756 |
Dx duod intub w/asp spec
|
$XXX.XX
|
G2
|
N
|
| 43757 |
Dx duod intub w/asp specs
|
$XXX.XX
|
G2
|
Y
|
| 43761 |
Reposition gastrostomy tube
|
$XXX.XX
|
A2
|
Y
|
| 43762 |
Rplc gtube no revj trc
|
$XXX.XX
|
G2
|
Y
|
| 43763 |
Rplc gtube revj gstrst trc
|
$XXX.XX
|
G2
|
Y
|
| 43770 |
Lap place gastr adj device
|
$XXX.XX
|
J8
|
Y
|
| 43772 |
Lap rmvl gastr adj device
|
$XXX.XX
|
G2
|
Y
|
| 43773 |
Lap replace gastr adj device
|
$XXX.XX
|
G2
|
Y
|
| 43774 |
Lap rmvl gastr adj all parts
|
$XXX.XX
|
G2
|
Y
|
| 43830 |
Gstrst open wo constj tube
|
$XXX.XX
|
G2
|
Y
|
| 43831 |
Gastrostomy open neonatal
|
$XXX.XX
|
G2
|
Y
|
| 43840 |
Gstrrphy sutr duol/gstr ulcr
|
$XXX.XX
|
G2
|
Y
|
| 43870 |
Closure gastrostomy surgical
|
$XXX.XX
|
A2
|
Y
|
| 43886 |
Gstr rstcv px opn revj port
|
$XXX.XX
|
G2
|
Y
|
| 43887 |
Gstr rstcv px opn rmvl port
|
$XXX.XX
|
G2
|
N
|
| 43888 |
Gstr rstcv px opn rmvl&rplc
|
$XXX.XX
|
G2
|
Y
|
| 43889 |
Gstr rstcv px trnsorl esg
|
$XXX.XX
|
G2
|
Y
|
| 44100 |
Biopsy of bowel
|
$XXX.XX
|
A2
|
Y
|
| 44180 |
Lap enterolysis
|
$XXX.XX
|
G2
|
Y
|
| 44186 |
Lap jejunostomy
|
$XXX.XX
|
G2
|
Y
|
| 44300 |
Open bowel to skin
|
$XXX.XX
|
G2
|
Y
|
| 44312 |
Revision of ileostomy
|
$XXX.XX
|
A2
|
Y
|
| 44314 |
Revision of ileostomy
|
$XXX.XX
|
G2
|
Y
|
| 44340 |
Revision of colostomy
|
$XXX.XX
|
A2
|
Y
|
| 44345 |
Revision of colostomy
|
$XXX.XX
|
G2
|
Y
|
| 44346 |
Revision of colostomy
|
$XXX.XX
|
G2
|
Y
|
| 44360 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44361 |
Small bowel endoscopy/biopsy
|
$XXX.XX
|
A2
|
Y
|
| 44363 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44364 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44365 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44366 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44369 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44370 |
Small bowel endoscopy/stent
|
$XXX.XX
|
J8
|
Y
|
| 44372 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44373 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44376 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44377 |
Small bowel endoscopy/biopsy
|
$XXX.XX
|
A2
|
Y
|
| 44378 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44379 |
S bowel endoscope w/stent
|
$XXX.XX
|
J8
|
Y
|
| 44380 |
Small bowel endoscopy br/wa
|
$XXX.XX
|
A2
|
Y
|
| 44381 |
Small bowel endoscopy br/wa
|
$XXX.XX
|
G2
|
Y
|
| 44382 |
Small bowel endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 44384 |
Small bowel endoscopy
|
$XXX.XX
|
G2
|
Y
|
| 44385 |
Endoscopy of bowel pouch
|
$XXX.XX
|
A2
|
Y
|
| 44386 |
Endoscopy bowel pouch/biop
|
$XXX.XX
|
A2
|
Y
|
| 44388 |
Colonoscopy thru stoma spx
|
$XXX.XX
|
A2
|
Y
|
| 44389 |
Colonoscopy with biopsy
|
$XXX.XX
|
A2
|
Y
|
| 44390 |
Colonoscopy for foreign body
|
$XXX.XX
|
A2
|
Y
|
| 44391 |
Colonoscopy for bleeding
|
$XXX.XX
|
A2
|
Y
|
| 44392 |
Colonoscopy & polypectomy
|
$XXX.XX
|
A2
|
Y
|
| 44394 |
Colonoscopy w/snare
|
$XXX.XX
|
A2
|
Y
|
| 44401 |
Colonoscopy with ablation
|
$XXX.XX
|
G2
|
Y
|
| 44402 |
Colonoscopy w/stent plcmt
|
$XXX.XX
|
J8
|
Y
|
| 44403 |
Colonoscopy w/resection
|
$XXX.XX
|
G2
|
Y
|
| 44404 |
Colonoscopy w/injection
|
$XXX.XX
|
G2
|
Y
|
| 44405 |
Colonoscopy w/dilation
|
$XXX.XX
|
G2
|
Y
|
| 44406 |
Colonoscopy w/ultrasound
|
$XXX.XX
|
G2
|
Y
|
| 44407 |
Colonoscopy w/ndl aspir/bx
|
$XXX.XX
|
G2
|
Y
|
| 44408 |
Colonoscopy w/decompression
|
$XXX.XX
|
R2
|
Y
|
| 44500 |
Intro gastrointestinal tube
|
$XXX.XX
|
G2
|
Y
|
| 44602 |
Suture small intestine
|
$XXX.XX
|
G2
|
Y
|
| 44701 |
Intraop colon lavage add-on
|
$XXX.XX
|
N1
|
N
|
| 44950 |
Appendectomy
|
$XXX.XX
|
G2
|
Y
|
| 44955 |
Appendectomy add-on
|
$XXX.XX
|
N1
|
N
|
| 44970 |
Laparoscopy appendectomy
|
$XXX.XX
|
G2
|
Y
|
| 45000 |
Drainage of pelvic abscess
|
$XXX.XX
|
A2
|
Y
|
| 45005 |
Drainage of rectal abscess
|
$XXX.XX
|
A2
|
Y
|
| 45020 |
Drainage of rectal abscess
|
$XXX.XX
|
A2
|
Y
|
| 45100 |
Biopsy of rectum
|
$XXX.XX
|
A2
|
Y
|
| 45108 |
Anorectal myomectomy
|
$XXX.XX
|
A2
|
Y
|
| 45150 |
Excision of rectal stricture
|
$XXX.XX
|
A2
|
Y
|
| 45160 |
Excision of rectal lesion
|
$XXX.XX
|
A2
|
Y
|
| 45171 |
Exc rect tum transanal part
|
$XXX.XX
|
G2
|
Y
|
| 45172 |
Exc rect tum transanal full
|
$XXX.XX
|
G2
|
Y
|
| 45190 |
Destruction rectal tumor
|
$XXX.XX
|
A2
|
Y
|
| 45300 |
Proctosigmoidoscopy dx
|
$XXX.XX
|
P3
|
Y
|
| 45303 |
Proctosigmoidoscopy dilate
|
$XXX.XX
|
P2
|
Y
|
| 45305 |
Proctosigmoidoscopy w/bx
|
$XXX.XX
|
A2
|
Y
|
| 45307 |
Proctosigmoidoscopy fb
|
$XXX.XX
|
A2
|
Y
|
| 45308 |
Proctosigmoidoscopy removal
|
$XXX.XX
|
A2
|
Y
|
| 45309 |
Proctosigmoidoscopy removal
|
$XXX.XX
|
A2
|
Y
|
| 45315 |
Proctosigmoidoscopy removal
|
$XXX.XX
|
A2
|
Y
|
| 45317 |
Proctosigmoidoscopy bleed
|
$XXX.XX
|
A2
|
Y
|
| 45320 |
Proctosigmoidoscopy ablate
|
$XXX.XX
|
A2
|
Y
|
| 45321 |
Proctosigmoidoscopy volvul
|
$XXX.XX
|
A2
|
Y
|
| 45327 |
Proctosigmoidoscopy w/stent
|
$XXX.XX
|
J8
|
Y
|
| 45330 |
Diagnostic sigmoidoscopy
|
$XXX.XX
|
P3
|
Y
|
| 45331 |
Sigmoidoscopy and biopsy
|
$XXX.XX
|
A2
|
Y
|
| 45332 |
Sigmoidoscopy w/fb removal
|
$XXX.XX
|
A2
|
Y
|
| 45333 |
Sigmoidoscopy & polypectomy
|
$XXX.XX
|
A2
|
Y
|
| 45334 |
Sigmoidoscopy for bleeding
|
$XXX.XX
|
A2
|
Y
|
| 45335 |
Sigmoidoscopy w/submuc inj
|
$XXX.XX
|
A2
|
Y
|
| 45337 |
Sigmoidoscopy & decompress
|
$XXX.XX
|
A2
|
Y
|
| 45338 |
Sigmoidoscopy w/tumr remove
|
$XXX.XX
|
A2
|
Y
|
| 45340 |
Sig w/tndsc balloon dilation
|
$XXX.XX
|
A2
|
Y
|
| 45341 |
Sigmoidoscopy w/ultrasound
|
$XXX.XX
|
A2
|
Y
|
| 45342 |
Sigmoidoscopy w/us guide bx
|
$XXX.XX
|
A2
|
Y
|
| 45346 |
Sigmoidoscopy w/ablation
|
$XXX.XX
|
G2
|
Y
|
| 45347 |
Sigmoidoscopy w/plcmt stent
|
$XXX.XX
|
J8
|
Y
|
| 45349 |
Sigmoidoscopy w/resection
|
$XXX.XX
|
G2
|
Y
|
| 45350 |
Sgmdsc w/band ligation
|
$XXX.XX
|
G2
|
Y
|
| 45378 |
Diagnostic colonoscopy
|
$XXX.XX
|
A2
|
Y
|
| 45379 |
Colonoscopy w/fb removal
|
$XXX.XX
|
A2
|
Y
|
| 45380 |
Colonoscopy and biopsy
|
$XXX.XX
|
A2
|
Y
|
| 45381 |
Colonoscopy submucous njx
|
$XXX.XX
|
A2
|
Y
|
| 45382 |
Colonoscopy w/control bleed
|
$XXX.XX
|
A2
|
Y
|
| 45384 |
Colonoscopy w/lesion removal
|
$XXX.XX
|
A2
|
Y
|
| 45385 |
Colonoscopy w/lesion removal
|
$XXX.XX
|
A2
|
Y
|
| 45386 |
Colonoscopy w/balloon dilat
|
$XXX.XX
|
A2
|
Y
|
| 45388 |
Colonoscopy w/ablation
|
$XXX.XX
|
G2
|
Y
|
| 45389 |
Colonoscopy w/stent plcmt
|
$XXX.XX
|
J8
|
Y
|
| 45390 |
Colonoscopy w/resection
|
$XXX.XX
|
G2
|
Y
|
| 45391 |
Colonoscopy w/endoscope us
|
$XXX.XX
|
A2
|
Y
|
| 45392 |
Colonoscopy w/endoscopic fnb
|
$XXX.XX
|
A2
|
Y
|
| 45393 |
Colonoscopy w/decompression
|
$XXX.XX
|
G2
|
Y
|
| 45398 |
Colonoscopy w/band ligation
|
$XXX.XX
|
G2
|
Y
|
| 45500 |
Repair of rectum
|
$XXX.XX
|
A2
|
Y
|
| 45505 |
Repair of rectum
|
$XXX.XX
|
A2
|
Y
|
| 45520 |
Treatment of rectal prolapse
|
$XXX.XX
|
N1
|
N
|
| 45541 |
Correct rectal prolapse
|
$XXX.XX
|
G2
|
Y
|
| 45560 |
Repair of rectocele
|
$XXX.XX
|
A2
|
Y
|
| 45900 |
Reduction of rectal prolapse
|
$XXX.XX
|
A2
|
Y
|
| 45905 |
Dilation of anal sphincter
|
$XXX.XX
|
A2
|
Y
|
| 45910 |
Dilation of rectal narrowing
|
$XXX.XX
|
A2
|
Y
|
| 45915 |
Remove rectal obstruction
|
$XXX.XX
|
A2
|
Y
|
| 45990 |
Surg dx exam anorectal
|
$XXX.XX
|
A2
|
Y
|
| 46020 |
Placement of seton
|
$XXX.XX
|
A2
|
Y
|
| 46030 |
Removal anal seton oth mrk
|
$XXX.XX
|
A2
|
Y
|
| 46040 |
I&d ischiorct&/perirct absc
|
$XXX.XX
|
A2
|
Y
|
| 46045 |
I&d absc tranal under anes
|
$XXX.XX
|
A2
|
Y
|
| 46050 |
I&d perianal abscess supfc
|
$XXX.XX
|
A2
|
Y
|
| 46060 |
I&d ischiorectal/ntrmrl absc
|
$XXX.XX
|
A2
|
Y
|
| 46070 |
Incision anal septum infant
|
$XXX.XX
|
G2
|
Y
|
| 46080 |
Sphnctrotmy anal div sphnctr
|
$XXX.XX
|
A2
|
Y
|
| 46083 |
Inc thrombosed hroid xtrnl
|
$XXX.XX
|
P2
|
Y
|
| 46200 |
Removal of anal fissure
|
$XXX.XX
|
A2
|
Y
|
| 46220 |
Excise anal ext tag/papilla
|
$XXX.XX
|
A2
|
Y
|
| 46221 |
Ligation of hemorrhoid(s)
|
$XXX.XX
|
P3
|
Y
|
| 46230 |
Removal of anal tags
|
$XXX.XX
|
A2
|
Y
|
| 46250 |
Remove ext hem groups 2+
|
$XXX.XX
|
A2
|
Y
|
| 46255 |
Remove int/ext hem 1 group
|
$XXX.XX
|
A2
|
Y
|
| 46257 |
Remove in/ex hem grp & fiss
|
$XXX.XX
|
A2
|
Y
|
| 46258 |
Remove in/ex hem grp w/fistu
|
$XXX.XX
|
A2
|
Y
|
| 46260 |
Remove in/ex hem groups 2+
|
$XXX.XX
|
A2
|
Y
|
| 46261 |
Remove in/ex hem grps & fiss
|
$XXX.XX
|
A2
|
Y
|
| 46262 |
Remove in/ex hem grps w/fist
|
$XXX.XX
|
A2
|
Y
|
| 46270 |
Remove anal fist subq
|
$XXX.XX
|
A2
|
Y
|
| 46275 |
Remove anal fist inter
|
$XXX.XX
|
A2
|
Y
|
| 46280 |
Remove anal fist complex
|
$XXX.XX
|
A2
|
Y
|
| 46285 |
Remove anal fist 2 stage
|
$XXX.XX
|
A2
|
Y
|
| 46288 |
Repair anal fistula
|
$XXX.XX
|
A2
|
Y
|
| 46320 |
Removal of hemorrhoid clot
|
$XXX.XX
|
P3
|
Y
|
| 46500 |
Injection into hemorrhoid(s)
|
$XXX.XX
|
P3
|
Y
|
| 46505 |
Chemodenervation anal musc
|
$XXX.XX
|
G2
|
Y
|
| 46600 |
Diagnostic anoscopy spx
|
$XXX.XX
|
N1
|
N
|
| 46601 |
Diagnostic anoscopy
|
$XXX.XX
|
N1
|
N
|
| 46604 |
Anoscopy and dilation
|
$XXX.XX
|
P3
|
Y
|
| 46606 |
Anoscopy and biopsy
|
$XXX.XX
|
P3
|
Y
|
| 46607 |
Diagnostic anoscopy & biopsy
|
$XXX.XX
|
G2
|
Y
|
| 46608 |
Anoscopy remove for body
|
$XXX.XX
|
A2
|
Y
|
| 46610 |
Anoscopy remove lesion
|
$XXX.XX
|
A2
|
Y
|
| 46611 |
Anoscopy
|
$XXX.XX
|
A2
|
Y
|
| 46612 |
Anoscopy remove lesions
|
$XXX.XX
|
A2
|
Y
|
| 46614 |
Anoscopy control bleeding
|
$XXX.XX
|
P3
|
Y
|
| 46615 |
Anoscopy
|
$XXX.XX
|
A2
|
Y
|
| 46700 |
Repair of anal stricture
|
$XXX.XX
|
A2
|
Y
|
| 46706 |
Repr of anal fistula w/glue
|
$XXX.XX
|
G2
|
Y
|
| 46707 |
Repair anorectal fist w/plug
|
$XXX.XX
|
J8
|
Y
|
| 46750 |
Repair of anal sphincter
|
$XXX.XX
|
A2
|
Y
|
| 46753 |
Reconstruction of anus
|
$XXX.XX
|
A2
|
Y
|
| 46754 |
Removal of suture from anus
|
$XXX.XX
|
A2
|
Y
|
| 46760 |
Repair of anal sphincter
|
$XXX.XX
|
A2
|
Y
|
| 46761 |
Repair of anal sphincter
|
$XXX.XX
|
A2
|
Y
|
| 46900 |
Destruction anal lesion(s)
|
$XXX.XX
|
P3
|
Y
|
| 46910 |
Destruction anal lesion(s)
|
$XXX.XX
|
P3
|
Y
|
| 46916 |
Cryosurgery anal lesion(s)
|
$XXX.XX
|
P2
|
Y
|
| 46917 |
Laser surgery anal lesions
|
$XXX.XX
|
A2
|
Y
|
| 46922 |
Excision of anal lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 46924 |
Destruction anal lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 46930 |
Destroy internal hemorrhoids
|
$XXX.XX
|
P3
|
Y
|
| 46940 |
Treatment of anal fissure
|
$XXX.XX
|
P3
|
Y
|
| 46942 |
Treatment of anal fissure
|
$XXX.XX
|
P3
|
Y
|
| 46945 |
Int hrhc lig 1 hroid w/o img
|
$XXX.XX
|
R2
|
Y
|
| 46946 |
Int hrhc lig 2+hroid w/o img
|
$XXX.XX
|
A2
|
Y
|
| 46947 |
Hemorrhoidopexy by stapling
|
$XXX.XX
|
A2
|
Y
|
| 46948 |
Int hrhc tranal dartlzj 2+
|
$XXX.XX
|
G2
|
Y
|
| 47000 |
Needle biopsy of liver perq
|
$XXX.XX
|
A2
|
Y
|
| 47001 |
Ndl biopsy lvr tm oth maj px
|
$XXX.XX
|
N1
|
N
|
| 47370 |
Laparo ablate liver tumor rf
|
$XXX.XX
|
G2
|
Y
|
| 47371 |
Laparo ablate liver cryosurg
|
$XXX.XX
|
G2
|
Y
|
| 47382 |
Percut ablate liver rf
|
$XXX.XX
|
G2
|
Y
|
| 47383 |
Perq abltj lvr cryoablation
|
$XXX.XX
|
J8
|
Y
|
| 47384 |
Abltj ire liver 1+ tum perq
|
$XXX.XX
|
J8
|
Y
|
| 47490 |
Incision of gallbladder
|
$XXX.XX
|
G2
|
Y
|
| 47531 |
Injection for cholangiogram
|
$XXX.XX
|
N1
|
N
|
| 47532 |
Injection for cholangiogram
|
$XXX.XX
|
N1
|
N
|
| 47533 |
Plmt biliary drainage cath
|
$XXX.XX
|
G2
|
Y
|
| 47534 |
Plmt biliary drainage cath
|
$XXX.XX
|
G2
|
Y
|
| 47535 |
Conversion ext bil drg cath
|
$XXX.XX
|
G2
|
Y
|
| 47536 |
Exchange biliary drg cath
|
$XXX.XX
|
G2
|
Y
|
| 47537 |
Removal biliary drg cath
|
$XXX.XX
|
G2
|
N
|
| 47538 |
Perq plmt bile duct stent
|
$XXX.XX
|
J8
|
Y
|
| 47539 |
Perq plmt bile duct stent
|
$XXX.XX
|
J8
|
Y
|
| 47540 |
Perq plmt bile duct stent
|
$XXX.XX
|
J8
|
Y
|
| 47541 |
Plmt access bil tree sm bwl
|
$XXX.XX
|
G2
|
Y
|
| 47542 |
Dilate biliary duct/ampulla
|
$XXX.XX
|
N1
|
N
|
| 47543 |
Endoluminal bx biliary tree
|
$XXX.XX
|
N1
|
N
|
| 47544 |
Removal duct glbldr calculi
|
$XXX.XX
|
N1
|
N
|
| 47550 |
Bile duct endoscopy add-on
|
$XXX.XX
|
N1
|
N
|
| 47552 |
Biliary endo perq dx w/speci
|
$XXX.XX
|
A2
|
Y
|
| 47553 |
Biliary endoscopy thru skin
|
$XXX.XX
|
G2
|
Y
|
| 47554 |
Biliary endoscopy thru skin
|
$XXX.XX
|
G2
|
Y
|
| 47555 |
Biliary endoscopy thru skin
|
$XXX.XX
|
J8
|
Y
|
| 47556 |
Biliary endoscopy thru skin
|
$XXX.XX
|
J8
|
Y
|
| 47562 |
Laparoscopic cholecystectomy
|
$XXX.XX
|
G2
|
Y
|
| 47563 |
Laparo cholecystectomy/graph
|
$XXX.XX
|
G2
|
Y
|
| 47564 |
Laparo cholecystectomy/explr
|
$XXX.XX
|
G2
|
Y
|
| 48102 |
Needle biopsy pancreas
|
$XXX.XX
|
A2
|
Y
|
| 49010 |
Exploration behind abdomen
|
$XXX.XX
|
G2
|
Y
|
| 49082 |
Abd paracentesis
|
$XXX.XX
|
G2
|
Y
|
| 49083 |
Abd paracentesis w/imaging
|
$XXX.XX
|
G2
|
Y
|
| 49084 |
Peritoneal lavage
|
$XXX.XX
|
G2
|
Y
|
| 49180 |
Biopsy abdominal mass
|
$XXX.XX
|
A2
|
Y
|
| 49185 |
Sclerotx fluid collection
|
$XXX.XX
|
G2
|
Y
|
| 49250 |
Excision of umbilicus
|
$XXX.XX
|
A2
|
Y
|
| 49255 |
Removal of omentum
|
$XXX.XX
|
G2
|
Y
|
| 49320 |
Diag laparo separate proc
|
$XXX.XX
|
A2
|
Y
|
| 49321 |
Laparoscopy biopsy
|
$XXX.XX
|
A2
|
Y
|
| 49322 |
Laparoscopy aspiration
|
$XXX.XX
|
A2
|
Y
|
| 49323 |
Laparo drain lymphocele
|
$XXX.XX
|
G2
|
Y
|
| 49324 |
Lap insert tunnel ip cath
|
$XXX.XX
|
G2
|
Y
|
| 49325 |
Lap revision perm ip cath
|
$XXX.XX
|
G2
|
Y
|
| 49326 |
Lap w/omentopexy add-on
|
$XXX.XX
|
N1
|
N
|
| 49327 |
Lap ins device for rt
|
$XXX.XX
|
N1
|
N
|
| 49400 |
Air injection into abdomen
|
$XXX.XX
|
N1
|
N
|
| 49402 |
Remove foreign body adbomen
|
$XXX.XX
|
A2
|
Y
|
| 49405 |
Image cath fluid colxn visc
|
$XXX.XX
|
G2
|
Y
|
| 49406 |
Image cath fluid peri/retro
|
$XXX.XX
|
G2
|
Y
|
| 49407 |
Image cath fluid trns/vgnl
|
$XXX.XX
|
G2
|
Y
|
| 49411 |
Ins mark abd/pel for rt perq
|
$XXX.XX
|
P3
|
N
|
| 49418 |
Insert tun ip cath perc
|
$XXX.XX
|
G2
|
Y
|
| 49419 |
Insert tun ip cath w/port
|
$XXX.XX
|
G2
|
Y
|
| 49421 |
Ins tun ip cath for dial opn
|
$XXX.XX
|
G2
|
Y
|
| 49422 |
Remove tunneled ip cath
|
$XXX.XX
|
A2
|
N
|
| 49423 |
Exchange drainage catheter
|
$XXX.XX
|
G2
|
Y
|
| 49424 |
Assess cyst contrast inject
|
$XXX.XX
|
N1
|
N
|
| 49426 |
Revise abdomen-venous shunt
|
$XXX.XX
|
A2
|
Y
|
| 49427 |
Injection abdominal shunt
|
$XXX.XX
|
N1
|
N
|
| 49429 |
Removal of shunt
|
$XXX.XX
|
G2
|
N
|
| 49435 |
Insert subq exten to ip cath
|
$XXX.XX
|
N1
|
N
|
| 49436 |
Embedded ip cath exit-site
|
$XXX.XX
|
G2
|
Y
|
| 49440 |
Place gastrostomy tube perc
|
$XXX.XX
|
G2
|
Y
|
| 49441 |
Place duod/jej tube perc
|
$XXX.XX
|
G2
|
Y
|
| 49442 |
Place cecostomy tube perc
|
$XXX.XX
|
G2
|
Y
|
| 49446 |
Change g-tube to g-j perc
|
$XXX.XX
|
G2
|
Y
|
| 49450 |
Replace g/c tube perc
|
$XXX.XX
|
G2
|
Y
|
| 49451 |
Replace duod/jej tube perc
|
$XXX.XX
|
G2
|
Y
|
| 49452 |
Replace g-j tube perc
|
$XXX.XX
|
G2
|
Y
|
| 49460 |
Fix g/colon tube w/device
|
$XXX.XX
|
G2
|
Y
|
| 49465 |
Fluoro exam of g/colon tube
|
$XXX.XX
|
G2
|
N
|
| 49491 |
Rpr hern preemie reduc
|
$XXX.XX
|
G2
|
Y
|
| 49492 |
Rpr ing hern premie blocked
|
$XXX.XX
|
G2
|
Y
|
| 49495 |
Rpr ing hernia baby reduc
|
$XXX.XX
|
A2
|
Y
|
| 49496 |
Rpr ing hernia baby blocked
|
$XXX.XX
|
A2
|
Y
|
| 49500 |
Rpr ing hernia init reduce
|
$XXX.XX
|
A2
|
Y
|
| 49501 |
Rpr ing hernia init blocked
|
$XXX.XX
|
A2
|
Y
|
| 49505 |
Prp i/hern init reduc >5 yr
|
$XXX.XX
|
A2
|
Y
|
| 49507 |
Prp i/hern init block >5 yr
|
$XXX.XX
|
A2
|
Y
|
| 49520 |
Rerepair ing hernia reduce
|
$XXX.XX
|
A2
|
Y
|
| 49521 |
Rerepair ing hernia blocked
|
$XXX.XX
|
A2
|
Y
|
| 49525 |
Repair ing hernia sliding
|
$XXX.XX
|
A2
|
Y
|
| 49540 |
Repair lumbar hernia
|
$XXX.XX
|
A2
|
Y
|
| 49550 |
Rpr rem hernia init reduce
|
$XXX.XX
|
A2
|
Y
|
| 49553 |
Rpr fem hernia init blocked
|
$XXX.XX
|
A2
|
Y
|
| 49555 |
Rerepair fem hernia reduce
|
$XXX.XX
|
A2
|
Y
|
| 49557 |
Rerepair fem hernia blocked
|
$XXX.XX
|
A2
|
Y
|
| 49591 |
Rpr aa hrn 1st < 3 cm rdc
|
$XXX.XX
|
G2
|
Y
|
| 49592 |
Rpr aa hrn 1st < 3 ncr/strn
|
$XXX.XX
|
G2
|
Y
|
| 49593 |
Rpr aa hrn 1st 3-10 rdc
|
$XXX.XX
|
G2
|
Y
|
| 49594 |
Rpr aa hrn 1st 3-10 ncr/strn
|
$XXX.XX
|
G2
|
Y
|
| 49595 |
Rpr aa hrn 1st > 10 rdc
|
$XXX.XX
|
G2
|
Y
|
| 49600 |
Repair umbilical lesion
|
$XXX.XX
|
A2
|
Y
|
| 49613 |
Rpr aa hrn rcr < 3 rdc
|
$XXX.XX
|
G2
|
Y
|
| 49614 |
Rpr aa hrn rcr < 3 ncr/strn
|
$XXX.XX
|
G2
|
Y
|
| 49615 |
Rpr aa hrn rcr 3-10 rdc
|
$XXX.XX
|
G2
|
Y
|
| 49650 |
Lap ing hernia repair init
|
$XXX.XX
|
A2
|
Y
|
| 49651 |
Lap ing hernia repair recur
|
$XXX.XX
|
A2
|
Y
|
| 50020 |
Drg perirnl/renal absc open
|
$XXX.XX
|
G2
|
Y
|
| 50080 |
Perq nl/pl lithotrp smpl<2cm
|
$XXX.XX
|
G2
|
Y
|
| 50081 |
Perq nl/pl lithotrp cplx>2cm
|
$XXX.XX
|
G2
|
Y
|
| 50200 |
Renal biopsy perq
|
$XXX.XX
|
A2
|
Y
|
| 50382 |
Change ureter stent percut
|
$XXX.XX
|
G2
|
Y
|
| 50384 |
Remove ureter stent percut
|
$XXX.XX
|
G2
|
N
|
| 50385 |
Change stent via transureth
|
$XXX.XX
|
G2
|
Y
|
| 50386 |
Remove stent via transureth
|
$XXX.XX
|
P3
|
N
|
| 50387 |
Change nephroureteral cath
|
$XXX.XX
|
G2
|
Y
|
| 50389 |
Remove renal tube w/fluoro
|
$XXX.XX
|
G2
|
N
|
| 50390 |
Drainage of kidney lesion
|
$XXX.XX
|
A2
|
Y
|
| 50391 |
Instll rx agnt into rnal tub
|
$XXX.XX
|
P3
|
Y
|
| 50396 |
Measure kidney pressure
|
$XXX.XX
|
A2
|
Y
|
| 50430 |
Njx px nfrosgrm &/urtrgrm
|
$XXX.XX
|
N1
|
N
|
| 50431 |
Njx px nfrosgrm &/urtrgrm
|
$XXX.XX
|
N1
|
N
|
| 50432 |
Plmt nephrostomy catheter
|
$XXX.XX
|
G2
|
Y
|
| 50433 |
Plmt nephroureteral catheter
|
$XXX.XX
|
G2
|
Y
|
| 50434 |
Convert nephrostomy catheter
|
$XXX.XX
|
G2
|
Y
|
| 50435 |
Exchange nephrostomy cath
|
$XXX.XX
|
G2
|
Y
|
| 50436 |
Dilat xst trc ndurlgc px
|
$XXX.XX
|
G2
|
Y
|
| 50437 |
Dilat xst trc new access rcs
|
$XXX.XX
|
G2
|
Y
|
| 50541 |
Laparo ablate renal cyst
|
$XXX.XX
|
G2
|
Y
|
| 50542 |
Laparo ablate renal mass
|
$XXX.XX
|
G2
|
Y
|
| 50543 |
Laparo partial nephrectomy
|
$XXX.XX
|
G2
|
Y
|
| 50544 |
Laparoscopy pyeloplasty
|
$XXX.XX
|
G2
|
Y
|
| 50551 |
Kidney endoscopy
|
$XXX.XX
|
A2
|
Y
|
| 50553 |
Kidney endoscopy
|
$XXX.XX
|
G2
|
Y
|
| 50555 |
Kidney endoscopy & biopsy
|
$XXX.XX
|
A2
|
Y
|
| 50557 |
Kidney endoscopy & treatment
|
$XXX.XX
|
A2
|
Y
|
| 50561 |
Kidney endoscopy & treatment
|
$XXX.XX
|
J8
|
Y
|
| 50562 |
Renal scope w/tumor resect
|
$XXX.XX
|
G2
|
Y
|
| 50570 |
Kidney endoscopy
|
$XXX.XX
|
G2
|
Y
|
| 50572 |
Kidney endoscopy
|
$XXX.XX
|
G2
|
Y
|
| 50574 |
Kidney endoscopy & biopsy
|
$XXX.XX
|
G2
|
Y
|
| 50575 |
Kidney endoscopy
|
$XXX.XX
|
G2
|
Y
|
| 50576 |
Kidney endoscopy & treatment
|
$XXX.XX
|
G2
|
Y
|
| 50580 |
Kidney endoscopy & treatment
|
$XXX.XX
|
G2
|
Y
|
| 50590 |
Fragmenting of kidney stone
|
$XXX.XX
|
G2
|
Y
|
| 50592 |
Perc rf ablate renal tumor
|
$XXX.XX
|
G2
|
Y
|
| 50593 |
Perc cryo ablate renal tum
|
$XXX.XX
|
J8
|
Y
|
| 50606 |
Endoluminal bx urtr rnl plvs
|
$XXX.XX
|
N1
|
N
|
| 50684 |
Injection for ureter x-ray
|
$XXX.XX
|
N1
|
N
|
| 50686 |
Measure ureter pressure
|
$XXX.XX
|
P2
|
N
|
| 50688 |
Change of ureter tube/stent
|
$XXX.XX
|
A2
|
Y
|
| 50690 |
Injection for ureter x-ray
|
$XXX.XX
|
N1
|
N
|
| 50693 |
Plmt ureteral stent prq
|
$XXX.XX
|
G2
|
Y
|
| 50694 |
Plmt ureteral stent prq
|
$XXX.XX
|
G2
|
Y
|
| 50695 |
Plmt ureteral stent prq
|
$XXX.XX
|
G2
|
Y
|
| 50705 |
Ureteral embolization/occl
|
$XXX.XX
|
N1
|
N
|
| 50706 |
Balloon dilate urtrl strix
|
$XXX.XX
|
N1
|
N
|
| 50727 |
Revise ureter
|
$XXX.XX
|
G2
|
Y
|
| 50945 |
Laparoscopy ureterolithotomy
|
$XXX.XX
|
G2
|
Y
|
| 50947 |
Laparo new ureter/bladder
|
$XXX.XX
|
A2
|
Y
|
| 50948 |
Laparo new ureter/bladder
|
$XXX.XX
|
A2
|
Y
|
| 50951 |
Endoscopy of ureter
|
$XXX.XX
|
A2
|
Y
|
| 50953 |
Endoscopy of ureter
|
$XXX.XX
|
A2
|
Y
|
| 50955 |
Ureter endoscopy & biopsy
|
$XXX.XX
|
A2
|
Y
|
| 50957 |
Ureter endoscopy & treatment
|
$XXX.XX
|
A2
|
Y
|
| 50961 |
Ureter endoscopy & treatment
|
$XXX.XX
|
A2
|
Y
|
| 50970 |
Ureter endoscopy
|
$XXX.XX
|
J8
|
Y
|
| 50972 |
Ureter endoscopy & catheter
|
$XXX.XX
|
A2
|
Y
|
| 50974 |
Ureter endoscopy & biopsy
|
$XXX.XX
|
A2
|
Y
|
| 50976 |
Ureter endoscopy & treatment
|
$XXX.XX
|
A2
|
Y
|
| 50980 |
Ureter endoscopy & treatment
|
$XXX.XX
|
A2
|
Y
|
| 51020 |
Cystotomy/cystostomy w/fulg
|
$XXX.XX
|
A2
|
Y
|
| 51040 |
Incise & drain bladder
|
$XXX.XX
|
A2
|
Y
|
| 51045 |
Incise bladder/drain ureter
|
$XXX.XX
|
A2
|
Y
|
| 51050 |
Removal of bladder stone
|
$XXX.XX
|
A2
|
Y
|
| 51060 |
Removal of ureter stone
|
$XXX.XX
|
G2
|
Y
|
| 51065 |
Remove ureter calculus
|
$XXX.XX
|
A2
|
Y
|
| 51080 |
Drainage of bladder abscess
|
$XXX.XX
|
A2
|
Y
|
| 51100 |
Drain bladder by needle
|
$XXX.XX
|
P3
|
Y
|
| 51101 |
Drain bladder by trocar/cath
|
$XXX.XX
|
P3
|
N
|
| 51102 |
Drain bl w/cath insertion
|
$XXX.XX
|
A2
|
Y
|
| 51500 |
Removal of bladder cyst
|
$XXX.XX
|
A2
|
Y
|
| 51520 |
Removal of bladder lesion
|
$XXX.XX
|
A2
|
Y
|
| 51535 |
Repair of ureter lesion
|
$XXX.XX
|
G2
|
Y
|
| 51600 |
Injection for bladder x-ray
|
$XXX.XX
|
N1
|
N
|
| 51605 |
Preparation for bladder xray
|
$XXX.XX
|
N1
|
N
|
| 51610 |
Injection for bladder x-ray
|
$XXX.XX
|
N1
|
N
|
| 51700 |
Irrigation of bladder
|
$XXX.XX
|
P3
|
Y
|
| 51701 |
Insert bladder catheter
|
$XXX.XX
|
N1
|
N
|
| 51702 |
Insert temp bladder cath
|
$XXX.XX
|
N1
|
N
|
| 51703 |
Insert bladder cath complex
|
$XXX.XX
|
P2
|
N
|
| 51705 |
Change of bladder tube
|
$XXX.XX
|
P3
|
Y
|
| 51710 |
Change of bladder tube
|
$XXX.XX
|
A2
|
Y
|
| 51715 |
Endoscopic injection/implant
|
$XXX.XX
|
J8
|
Y
|
| 51720 |
Treatment of bladder lesion
|
$XXX.XX
|
P3
|
Y
|
| 51725 |
Simple cystometrogram
|
$XXX.XX
|
P3
|
Y
|
| 51726 |
Complex cystometrogram
|
$XXX.XX
|
A2
|
Y
|
| 51727 |
Cystometrogram w/up
|
$XXX.XX
|
P3
|
Y
|
| 51728 |
Cystometrogram w/vp
|
$XXX.XX
|
P3
|
Y
|
| 51729 |
Cystometrogram w/vp&up
|
$XXX.XX
|
P3
|
Y
|
| 51736 |
Urine flow measurement
|
$XXX.XX
|
N1
|
N
|
| 51741 |
Electro-uroflowmetry first
|
$XXX.XX
|
N1
|
N
|
| 51784 |
Anal/urinary muscle study
|
$XXX.XX
|
P3
|
N
|
| 51785 |
Anal/urinary muscle study
|
$XXX.XX
|
A2
|
Y
|
| 51792 |
Urinary reflex study
|
$XXX.XX
|
N1
|
N
|
| 51797 |
Intraabdominal pressure test
|
$XXX.XX
|
N1
|
N
|
| 51798 |
Us urine capacity measure
|
$XXX.XX
|
N1
|
N
|
| 51840 |
Attach bladder/urethra
|
$XXX.XX
|
G2
|
Y
|
| 51845 |
Repair bladder neck
|
$XXX.XX
|
G2
|
Y
|
| 51860 |
Repair of bladder wound
|
$XXX.XX
|
G2
|
Y
|
| 51880 |
Repair of bladder opening
|
$XXX.XX
|
A2
|
Y
|
| 51990 |
Laparo urethral suspension
|
$XXX.XX
|
G2
|
Y
|
| 51992 |
Laparo sling operation
|
$XXX.XX
|
J8
|
Y
|
| 52000 |
Cystourethroscopy
|
$XXX.XX
|
A2
|
Y
|
| 52001 |
Cysto w/irrg&evac mlt clots
|
$XXX.XX
|
A2
|
Y
|
| 52005 |
Cysto w/urtrl cathj
|
$XXX.XX
|
A2
|
Y
|
| 52007 |
Cysto urtrl cathj brush bx
|
$XXX.XX
|
A2
|
Y
|
| 52010 |
Cystoscopy & duct catheter
|
$XXX.XX
|
A2
|
Y
|
| 52204 |
Cystoscopy w/biopsy(s)
|
$XXX.XX
|
A2
|
Y
|
| 52214 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52224 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52234 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52235 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52240 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52250 |
Cystoscopy and radiotracer
|
$XXX.XX
|
A2
|
Y
|
| 52260 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52265 |
Cystoscopy and treatment
|
$XXX.XX
|
P3
|
Y
|
| 52270 |
Cystoscopy & revise urethra
|
$XXX.XX
|
A2
|
Y
|
| 52275 |
Cystoscopy & revise urethra
|
$XXX.XX
|
A2
|
Y
|
| 52276 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52277 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52281 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52282 |
Cystoscopy implant stent
|
$XXX.XX
|
A2
|
Y
|
| 52283 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52284 |
Cysto rx balo cath urtl strx
|
$XXX.XX
|
J8
|
Y
|
| 52285 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52287 |
Cystoscopy chemodenervation
|
$XXX.XX
|
G2
|
Y
|
| 52290 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52300 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52301 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52305 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52310 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52315 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52317 |
Remove bladder stone
|
$XXX.XX
|
A2
|
Y
|
| 52318 |
Remove bladder stone
|
$XXX.XX
|
A2
|
Y
|
| 52320 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52325 |
Cystoscopy stone removal
|
$XXX.XX
|
A2
|
Y
|
| 52327 |
Cystoscopy inject material
|
$XXX.XX
|
J8
|
Y
|
| 52330 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52332 |
Cystoscopy and treatment
|
$XXX.XX
|
A2
|
Y
|
| 52334 |
Create passage to kidney
|
$XXX.XX
|
A2
|
Y
|
| 52341 |
Cysto w/ureter stricture tx
|
$XXX.XX
|
A2
|
Y
|
| 52342 |
Cysto w/up stricture tx
|
$XXX.XX
|
A2
|
Y
|
| 52343 |
Cysto w/renal stricture tx
|
$XXX.XX
|
A2
|
Y
|
| 52344 |
Cysto/uretero stricture tx
|
$XXX.XX
|
A2
|
Y
|
| 52345 |
Cysto/uretero w/up stricture
|
$XXX.XX
|
A2
|
Y
|
| 52346 |
Cystouretero w/renal strict
|
$XXX.XX
|
A2
|
Y
|
| 52351 |
Cystouretero & or pyeloscope
|
$XXX.XX
|
A2
|
Y
|
| 52352 |
Cystouretero w/stone remove
|
$XXX.XX
|
A2
|
Y
|
| 52353 |
Cystouretero w/lithotripsy
|
$XXX.XX
|
A2
|
Y
|
| 52354 |
Cystouretero w/biopsy
|
$XXX.XX
|
A2
|
Y
|
| 52355 |
Cystouretero w/excise tumor
|
$XXX.XX
|
A2
|
Y
|
| 52356 |
Cysto/uretero w/lithotripsy
|
$XXX.XX
|
G2
|
Y
|
| 52400 |
Cysto cgen post urtl valves
|
$XXX.XX
|
A2
|
Y
|
| 52402 |
Cysto trurl rescj ejacul dux
|
$XXX.XX
|
A2
|
Y
|
| 52443 |
Cysto 1st trurl prst8 comis
|
$XXX.XX
|
J8
|
Y
|
| 52450 |
Transurethral inc prostate
|
$XXX.XX
|
A2
|
Y
|
| 52500 |
Trurl resection bladder neck
|
$XXX.XX
|
A2
|
Y
|
| 52597 |
Trurl rbtc wtrjt rescj prst8
|
$XXX.XX
|
J8
|
Y
|
| 52601 |
Prostatectomy (turp)
|
$XXX.XX
|
A2
|
Y
|
| 52630 |
Remove prostate regrowth
|
$XXX.XX
|
A2
|
Y
|
| 52640 |
Relieve bladder contracture
|
$XXX.XX
|
A2
|
Y
|
| 52647 |
Laser surgery of prostate
|
$XXX.XX
|
D5
|
N
|
| 52648 |
Laser surgery of prostate
|
$XXX.XX
|
A2
|
Y
|
| 52649 |
Prostate laser enucleation
|
$XXX.XX
|
G2
|
Y
|
| 52700 |
Drainage of prostate abscess
|
$XXX.XX
|
A2
|
Y
|
| 53000 |
Incision of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53010 |
Incision of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53020 |
Incision of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53025 |
Incision of urethra
|
$XXX.XX
|
R2
|
Y
|
| 53040 |
Drainage of urethra abscess
|
$XXX.XX
|
A2
|
Y
|
| 53060 |
Drainage of urethra abscess
|
$XXX.XX
|
P3
|
Y
|
| 53080 |
Drainage of urinary leakage
|
$XXX.XX
|
A2
|
Y
|
| 53085 |
Drainage of urinary leakage
|
$XXX.XX
|
G2
|
Y
|
| 53200 |
Biopsy of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53210 |
Removal of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53215 |
Removal of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53220 |
Treatment of urethra lesion
|
$XXX.XX
|
A2
|
Y
|
| 53230 |
Removal of urethra lesion
|
$XXX.XX
|
A2
|
Y
|
| 53235 |
Removal of urethra lesion
|
$XXX.XX
|
A2
|
Y
|
| 53240 |
Surgery for urethra pouch
|
$XXX.XX
|
A2
|
Y
|
| 53250 |
Removal of urethra gland
|
$XXX.XX
|
A2
|
Y
|
| 53260 |
Treatment of urethra lesion
|
$XXX.XX
|
A2
|
Y
|
| 53265 |
Treatment of urethra lesion
|
$XXX.XX
|
A2
|
Y
|
| 53270 |
Removal of urethra gland
|
$XXX.XX
|
A2
|
Y
|
| 53275 |
Repair of urethra defect
|
$XXX.XX
|
A2
|
Y
|
| 53400 |
Revise urethra stage 1
|
$XXX.XX
|
A2
|
Y
|
| 53405 |
Revise urethra stage 2
|
$XXX.XX
|
A2
|
Y
|
| 53410 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53420 |
Reconstruct urethra stage 1
|
$XXX.XX
|
A2
|
Y
|
| 53425 |
Reconstruct urethra stage 2
|
$XXX.XX
|
A2
|
Y
|
| 53430 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53431 |
Reconstruct urethra/bladder
|
$XXX.XX
|
A2
|
Y
|
| 53440 |
Male sling procedure
|
$XXX.XX
|
J8
|
Y
|
| 53442 |
Remove/revise male sling
|
$XXX.XX
|
A2
|
Y
|
| 53444 |
Insert tandem cuff
|
$XXX.XX
|
J8
|
Y
|
| 53445 |
Insert uro/ves nck sphincter
|
$XXX.XX
|
J8
|
Y
|
| 53446 |
Remove uro sphincter
|
$XXX.XX
|
A2
|
N
|
| 53447 |
Remove/replace ur sphincter
|
$XXX.XX
|
J8
|
Y
|
| 53449 |
Repair uro sphincter
|
$XXX.XX
|
A2
|
Y
|
| 53450 |
Revision of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53451 |
Tprnl balo cntnc dev bi
|
$XXX.XX
|
J8
|
Y
|
| 53452 |
Tprnl balo cntnc dev uni
|
$XXX.XX
|
J8
|
Y
|
| 53453 |
Tprnl balo cntnc dev rmvl ea
|
$XXX.XX
|
G2
|
Y
|
| 53454 |
Tprnl balo cntnc dev adjmt
|
$XXX.XX
|
R2
|
Y
|
| 53460 |
Revision of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53500 |
Urethrlys transvag w/ scope
|
$XXX.XX
|
G2
|
Y
|
| 53502 |
Repair of urethra injury
|
$XXX.XX
|
A2
|
Y
|
| 53505 |
Repair of urethra injury
|
$XXX.XX
|
A2
|
Y
|
| 53510 |
Repair of urethra injury
|
$XXX.XX
|
A2
|
Y
|
| 53515 |
Repair of urethra injury
|
$XXX.XX
|
A2
|
Y
|
| 53520 |
Repair of urethra defect
|
$XXX.XX
|
A2
|
Y
|
| 53600 |
Dilate urethra stricture
|
$XXX.XX
|
P3
|
Y
|
| 53601 |
Dilate urethra stricture
|
$XXX.XX
|
N1
|
N
|
| 53605 |
Dilate urethra stricture
|
$XXX.XX
|
A2
|
Y
|
| 53620 |
Dilate urethra stricture
|
$XXX.XX
|
P3
|
Y
|
| 53621 |
Dilate urethra stricture
|
$XXX.XX
|
P3
|
Y
|
| 53660 |
Dilation of urethra
|
$XXX.XX
|
P3
|
N
|
| 53661 |
Dilation of urethra
|
$XXX.XX
|
N1
|
N
|
| 53665 |
Dilation of urethra
|
$XXX.XX
|
A2
|
Y
|
| 53850 |
Prostatic microwave thermotx
|
$XXX.XX
|
P3
|
Y
|
| 53852 |
Prostatic rf thermotx
|
$XXX.XX
|
P3
|
Y
|
| 53854 |
Trurl dstrj prst8 tiss rf wv
|
$XXX.XX
|
P2
|
Y
|
| 53855 |
Insert prost urethral stent
|
$XXX.XX
|
J8
|
Y
|
| 53860 |
Transurethral rf treatment
|
$XXX.XX
|
P2
|
Y
|
| 53865 |
Cysto insj dev ischmc rmdlg
|
$XXX.XX
|
J8
|
Y
|
| 53866 |
Cathj rmvl dev ischmc rmdlg
|
$XXX.XX
|
P3
|
Y
|
| 54000 |
Slitting of prepuce
|
$XXX.XX
|
A2
|
Y
|
| 54001 |
Slitting of prepuce
|
$XXX.XX
|
A2
|
Y
|
| 54015 |
I&d penis deep
|
$XXX.XX
|
A2
|
Y
|
| 54050 |
Destruction penis lesion(s)
|
$XXX.XX
|
N1
|
N
|
| 54055 |
Destruction penis lesion(s)
|
$XXX.XX
|
P3
|
Y
|
| 54056 |
Cryosurgery penis lesion(s)
|
$XXX.XX
|
N1
|
N
|
| 54057 |
Laser surg penis lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 54060 |
Excision of penis lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 54065 |
Destruction penis lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 54100 |
Biopsy of penis
|
$XXX.XX
|
A2
|
Y
|
| 54105 |
Biopsy of penis
|
$XXX.XX
|
A2
|
Y
|
| 54110 |
Treatment of penis lesion
|
$XXX.XX
|
A2
|
Y
|
| 54111 |
Treat penis lesion graft
|
$XXX.XX
|
A2
|
Y
|
| 54112 |
Treat penis lesion graft
|
$XXX.XX
|
A2
|
Y
|
| 54115 |
Treatment of penis lesion
|
$XXX.XX
|
A2
|
Y
|
| 54120 |
Partial removal of penis
|
$XXX.XX
|
A2
|
Y
|
| 54150 |
Circumcision w/regionl block
|
$XXX.XX
|
A2
|
Y
|
| 54160 |
Circumcision neonate
|
$XXX.XX
|
A2
|
Y
|
| 54161 |
Circum 28 days or older
|
$XXX.XX
|
A2
|
Y
|
| 54162 |
Lysis penil circumic lesion
|
$XXX.XX
|
A2
|
Y
|
| 54163 |
Repair of circumcision
|
$XXX.XX
|
A2
|
Y
|
| 54164 |
Frenulotomy of penis
|
$XXX.XX
|
A2
|
Y
|
| 54200 |
Injection px peyronie ds
|
$XXX.XX
|
P3
|
Y
|
| 54205 |
Njx px peyronie ds exps plaq
|
$XXX.XX
|
A2
|
Y
|
| 54220 |
Irrg crpra cavrnosa priapism
|
$XXX.XX
|
A2
|
Y
|
| 54230 |
Njx corpora cavernosograpy
|
$XXX.XX
|
N1
|
N
|
| 54231 |
Dynamic cavernosometry
|
$XXX.XX
|
P3
|
Y
|
| 54235 |
Njx corpora cavernosa rx agt
|
$XXX.XX
|
P3
|
Y
|
| 54240 |
Penile plethysmography
|
$XXX.XX
|
P3
|
N
|
| 54250 |
Nctrnl pen tmscn&/rgdity tst
|
$XXX.XX
|
P3
|
Y
|
| 54300 |
Revision of penis
|
$XXX.XX
|
A2
|
Y
|
| 54304 |
Revision of penis
|
$XXX.XX
|
A2
|
Y
|
| 54308 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54312 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54316 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54318 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54322 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54324 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54326 |
Reconstruction of urethra
|
$XXX.XX
|
A2
|
Y
|
| 54328 |
Revise penis/urethra
|
$XXX.XX
|
A2
|
Y
|
| 54332 |
Revise penis/urethra
|
$XXX.XX
|
G2
|
Y
|
| 54336 |
Revise penis/urethra
|
$XXX.XX
|
G2
|
Y
|
| 54340 |
Rpr hypspad comp simple
|
$XXX.XX
|
A2
|
Y
|
| 54344 |
Rrp hypspad comp moblj&urtp
|
$XXX.XX
|
A2
|
Y
|
| 54348 |
Rpr hypspad comp dsj & urtp
|
$XXX.XX
|
A2
|
Y
|
| 54352 |
Revj prior hypspad repair
|
$XXX.XX
|
A2
|
Y
|
| 54360 |
Penis plastic surgery
|
$XXX.XX
|
A2
|
Y
|
| 54380 |
Repair penis
|
$XXX.XX
|
A2
|
Y
|
| 54385 |
Repair penis
|
$XXX.XX
|
A2
|
Y
|
| 54400 |
Insert semi-rigid prosthesis
|
$XXX.XX
|
J8
|
N
|
| 54401 |
Insert self-contd prosthesis
|
$XXX.XX
|
J8
|
N
|
| 54405 |
Insert multi-comp penis pros
|
$XXX.XX
|
J8
|
N
|
| 54406 |
Remove muti-comp penis pros
|
$XXX.XX
|
A2
|
N
|
| 54408 |
Repair multi-comp penis pros
|
$XXX.XX
|
A2
|
Y
|
| 54410 |
Remove/replace penis prosth
|
$XXX.XX
|
J8
|
N
|
| 54411 |
Remov/replc penis pros comp
|
$XXX.XX
|
J8
|
Y
|
| 54415 |
Remove self-contd penis pros
|
$XXX.XX
|
A2
|
N
|
| 54416 |
Remv/repl penis contain pros
|
$XXX.XX
|
J8
|
N
|
| 54417 |
Remv/replc penis pros compl
|
$XXX.XX
|
J8
|
Y
|
| 54420 |
Revision of penis
|
$XXX.XX
|
A2
|
Y
|
| 54435 |
Revision of penis
|
$XXX.XX
|
A2
|
Y
|
| 54437 |
Repair corporeal tear
|
$XXX.XX
|
G2
|
Y
|
| 54440 |
Repair of penis
|
$XXX.XX
|
A2
|
Y
|
| 54450 |
Preputial stretching
|
$XXX.XX
|
A2
|
Y
|
| 54500 |
Biopsy of testis
|
$XXX.XX
|
A2
|
Y
|
| 54505 |
Biopsy of testis
|
$XXX.XX
|
A2
|
Y
|
| 54512 |
Excise lesion testis
|
$XXX.XX
|
A2
|
Y
|
| 54520 |
Removal of testis
|
$XXX.XX
|
A2
|
Y
|
| 54522 |
Orchiectomy partial
|
$XXX.XX
|
A2
|
Y
|
| 54530 |
Removal of testis
|
$XXX.XX
|
A2
|
Y
|
| 54535 |
Extensive testis surgery
|
$XXX.XX
|
G2
|
Y
|
| 54550 |
Exploration for testis
|
$XXX.XX
|
A2
|
Y
|
| 54560 |
Exploration for testis
|
$XXX.XX
|
G2
|
Y
|
| 54600 |
Reduce testis torsion
|
$XXX.XX
|
A2
|
Y
|
| 54620 |
Suspension of testis
|
$XXX.XX
|
A2
|
Y
|
| 54640 |
Orchiopexy ingun/scrot appr
|
$XXX.XX
|
A2
|
Y
|
| 54650 |
Orchiopexy (fowler-stephens)
|
$XXX.XX
|
G2
|
Y
|
| 54660 |
Revision of testis
|
$XXX.XX
|
J8
|
Y
|
| 54670 |
Repair testis injury
|
$XXX.XX
|
A2
|
Y
|
| 54680 |
Relocation of testis(es)
|
$XXX.XX
|
A2
|
Y
|
| 54690 |
Laparoscopy orchiectomy
|
$XXX.XX
|
A2
|
Y
|
| 54692 |
Laparoscopy orchiopexy
|
$XXX.XX
|
G2
|
Y
|
| 54700 |
I&d epdidyms tstis&/scrot sp
|
$XXX.XX
|
A2
|
Y
|
| 54800 |
Biopsy of epididymis
|
$XXX.XX
|
A2
|
Y
|
| 54830 |
Remove epididymis lesion
|
$XXX.XX
|
A2
|
Y
|
| 54840 |
Remove epididymis lesion
|
$XXX.XX
|
A2
|
Y
|
| 54860 |
Removal of epididymis
|
$XXX.XX
|
A2
|
Y
|
| 54861 |
Removal of epididymis
|
$XXX.XX
|
A2
|
Y
|
| 54865 |
Explore epididymis
|
$XXX.XX
|
A2
|
Y
|
| 54900 |
Fusion of spermatic ducts
|
$XXX.XX
|
A2
|
Y
|
| 54901 |
Fusion of spermatic ducts
|
$XXX.XX
|
A2
|
Y
|
| 55000 |
Drainage of hydrocele
|
$XXX.XX
|
P3
|
Y
|
| 55040 |
Removal of hydrocele
|
$XXX.XX
|
A2
|
Y
|
| 55041 |
Removal of hydroceles
|
$XXX.XX
|
A2
|
Y
|
| 55060 |
Repair of hydrocele
|
$XXX.XX
|
A2
|
Y
|
| 55100 |
Drainage of scrotum abscess
|
$XXX.XX
|
A2
|
Y
|
| 55110 |
Explore scrotum
|
$XXX.XX
|
A2
|
Y
|
| 55120 |
Removal of scrotum lesion
|
$XXX.XX
|
A2
|
Y
|
| 55150 |
Removal of scrotum
|
$XXX.XX
|
A2
|
Y
|
| 55175 |
Revision of scrotum
|
$XXX.XX
|
A2
|
Y
|
| 55180 |
Revision of scrotum
|
$XXX.XX
|
A2
|
Y
|
| 55200 |
Incision of sperm duct
|
$XXX.XX
|
A2
|
Y
|
| 55250 |
Removal of sperm duct(s)
|
$XXX.XX
|
A2
|
Y
|
| 55300 |
Prepare sperm duct x-ray
|
$XXX.XX
|
N1
|
N
|
| 55400 |
Repair of sperm duct
|
$XXX.XX
|
A2
|
Y
|
| 55500 |
Removal of hydrocele
|
$XXX.XX
|
A2
|
Y
|
| 55520 |
Removal of sperm cord lesion
|
$XXX.XX
|
A2
|
Y
|
| 55530 |
Revise spermatic cord veins
|
$XXX.XX
|
A2
|
Y
|
| 55535 |
Revise spermatic cord veins
|
$XXX.XX
|
A2
|
Y
|
| 55540 |
Revise hernia & sperm veins
|
$XXX.XX
|
A2
|
Y
|
| 55550 |
Laparo ligate spermatic vein
|
$XXX.XX
|
A2
|
Y
|
| 55600 |
Vesiculotomy
|
$XXX.XX
|
R2
|
Y
|
| 55680 |
Remove sperm pouch lesion
|
$XXX.XX
|
A2
|
Y
|
| 55700 |
Biopsy of prostate
|
$XXX.XX
|
D5
|
N
|
| 55705 |
Bx prst8 any approach nonimg
|
$XXX.XX
|
A2
|
Y
|
| 55706 |
Bx prst8 ndl sat sampling
|
$XXX.XX
|
G2
|
Y
|
| 55707 |
Bx prst8 trct us guided
|
$XXX.XX
|
G2
|
Y
|
| 55708 |
Bx prst8 trct us w/mri fus 1
|
$XXX.XX
|
G2
|
Y
|
| 55709 |
Bx prst8 tprnl us guided
|
$XXX.XX
|
G2
|
Y
|
| 55710 |
Bx prst8 tprn us w/mri fus 1
|
$XXX.XX
|
G2
|
Y
|
| 55711 |
Bx prst8 trct mri-us 1st
|
$XXX.XX
|
G2
|
Y
|
| 55712 |
Bx prst8 tprnl mri-us 1st
|
$XXX.XX
|
G2
|
Y
|
| 55713 |
Bx prst8 in-bore ct/mri bx 1
|
$XXX.XX
|
G2
|
Y
|
| 55714 |
Bx prst8 in-bore ct/mri 1
|
$XXX.XX
|
G2
|
Y
|
| 55715 |
Bx prst8 ea add mri-us/ct/mr
|
$XXX.XX
|
N1
|
N
|
| 55720 |
Drainage of prostate abscess
|
$XXX.XX
|
A2
|
Y
|
| 55725 |
Drainage of prostate abscess
|
$XXX.XX
|
A2
|
Y
|
| 55860 |
Surgical exposure prostate
|
$XXX.XX
|
G2
|
Y
|
| 55866 |
Laps surg prst8ect rpbic rad
|
$XXX.XX
|
G2
|
Y
|
| 55867 |
Laps surg prst8ect smpl stot
|
$XXX.XX
|
G2
|
Y
|
| 55868 |
Lap srg prst8ct lymph nod bx
|
$XXX.XX
|
G2
|
Y
|
| 55869 |
Lap srg prst8ct bi pl lmphad
|
$XXX.XX
|
G2
|
Y
|
| 55870 |
Electroejaculation
|
$XXX.XX
|
P3
|
Y
|
| 55873 |
Cryoablate prostate
|
$XXX.XX
|
J8
|
Y
|
| 55874 |
Tprnl plmt biodegrdabl matrl
|
$XXX.XX
|
J8
|
Y
|
| 55875 |
Transperi needle place pros
|
$XXX.XX
|
A2
|
Y
|
| 55876 |
Place rt device/marker pros
|
$XXX.XX
|
J8
|
N
|
| 55877 |
Abltj ire prst8 1+ tum perq
|
$XXX.XX
|
J8
|
Y
|
| 55880 |
Abltj mal prst8 tiss hifu
|
$XXX.XX
|
G2
|
Y
|
| 55882 |
Ablt trurl prst8 tis trnsdcr
|
$XXX.XX
|
J8
|
Y
|
| 55920 |
Place needles pelvic for rt
|
$XXX.XX
|
G2
|
Y
|
| 55970 |
Sex transformation m to f
|
$XXX.XX
|
G2
|
Y
|
| 55980 |
Sex transformation f to m
|
$XXX.XX
|
G2
|
Y
|
| 56405 |
I&d vulva/perineal abscess
|
$XXX.XX
|
P3
|
Y
|
| 56420 |
I&d bartholins gland abscess
|
$XXX.XX
|
P2
|
Y
|
| 56440 |
Mrsplzatn brthlns glnd cst
|
$XXX.XX
|
A2
|
Y
|
| 56441 |
Lysis of labial adhesions
|
$XXX.XX
|
A2
|
Y
|
| 56442 |
Hymenotomy
|
$XXX.XX
|
A2
|
Y
|
| 56501 |
Destroy vulva lesions sim
|
$XXX.XX
|
P3
|
Y
|
| 56515 |
Destroy vulva lesion/s compl
|
$XXX.XX
|
A2
|
Y
|
| 56605 |
Biopsy of vulva/perineum
|
$XXX.XX
|
P3
|
Y
|
| 56606 |
Biopsy of vulva/perineum
|
$XXX.XX
|
N1
|
N
|
| 56620 |
Vulvectomy simple partial
|
$XXX.XX
|
A2
|
Y
|
| 56625 |
Vulvectomy simple complete
|
$XXX.XX
|
A2
|
Y
|
| 56630 |
Vulvectomy radical partial
|
$XXX.XX
|
G2
|
Y
|
| 56700 |
Prtl hymnctmy/revj hymnl rng
|
$XXX.XX
|
A2
|
Y
|
| 56740 |
Exc bartholins gland/cyst
|
$XXX.XX
|
A2
|
Y
|
| 56800 |
Plastic repair introitus
|
$XXX.XX
|
A2
|
Y
|
| 56805 |
Clitoroplasty intersex state
|
$XXX.XX
|
G2
|
Y
|
| 56810 |
Perineoplasty rpr per nonob
|
$XXX.XX
|
A2
|
Y
|
| 56820 |
Colposcopy vulva
|
$XXX.XX
|
P3
|
Y
|
| 56821 |
Colposcopy vulva w/biopsy
|
$XXX.XX
|
P3
|
Y
|
| 57000 |
Colpotomy w/exploration
|
$XXX.XX
|
A2
|
Y
|
| 57010 |
Colpotomy drg pel abscess
|
$XXX.XX
|
A2
|
Y
|
| 57020 |
Colpocentesis sep px
|
$XXX.XX
|
A2
|
Y
|
| 57022 |
I&d vaginal hematoma ob/pp
|
$XXX.XX
|
R2
|
Y
|
| 57023 |
I&d vaginal hematoma non-ob
|
$XXX.XX
|
A2
|
Y
|
| 57061 |
Destruction vag lesions smpl
|
$XXX.XX
|
P3
|
Y
|
| 57065 |
Destruction vag lesion xtnsv
|
$XXX.XX
|
A2
|
Y
|
| 57100 |
Biopsy vaginal mucosa simple
|
$XXX.XX
|
P3
|
Y
|
| 57105 |
Biopsy vaginal mucosa xtnsv
|
$XXX.XX
|
A2
|
Y
|
| 57106 |
Vagnc prtl rmvl vag wall
|
$XXX.XX
|
G2
|
Y
|
| 57107 |
Vagnc compl rmvl paravag tis
|
$XXX.XX
|
G2
|
Y
|
| 57109 |
Vagnc bi total pel lymphadec
|
$XXX.XX
|
G2
|
Y
|
| 57120 |
Colpocleisis le fort type
|
$XXX.XX
|
G2
|
Y
|
| 57130 |
Excision vaginal septum
|
$XXX.XX
|
A2
|
Y
|
| 57135 |
Excision vaginal cyst/tumor
|
$XXX.XX
|
A2
|
Y
|
| 57150 |
Treat vagina infection
|
$XXX.XX
|
N1
|
N
|
| 57155 |
Insert uteri tandem/ovoids
|
$XXX.XX
|
A2
|
Y
|
| 57156 |
Ins vag brachytx device
|
$XXX.XX
|
G2
|
Y
|
| 57160 |
Insert pessary/other device
|
$XXX.XX
|
P3
|
Y
|
| 57170 |
Fitting of diaphragm/cap
|
$XXX.XX
|
P3
|
Y
|
| 57180 |
Treat vaginal bleeding
|
$XXX.XX
|
A2
|
Y
|
| 57200 |
Repair of vagina
|
$XXX.XX
|
A2
|
Y
|
| 57210 |
Repair vagina/perineum
|
$XXX.XX
|
A2
|
Y
|
| 57220 |
Revision of urethra
|
$XXX.XX
|
A2
|
Y
|
| 57230 |
Repair of urethral lesion
|
$XXX.XX
|
A2
|
Y
|
| 57240 |
Anterior colporrhaphy
|
$XXX.XX
|
A2
|
Y
|
| 57250 |
Repair rectum & vagina
|
$XXX.XX
|
A2
|
Y
|
| 57260 |
Cmbn ant pst colprhy
|
$XXX.XX
|
A2
|
Y
|
| 57265 |
Cmbn ap colprhy w/ntrcl rpr
|
$XXX.XX
|
A2
|
Y
|
| 57267 |
Insert mesh/pelvic flr addon
|
$XXX.XX
|
N1
|
N
|
| 57268 |
Repair of bowel bulge
|
$XXX.XX
|
A2
|
Y
|
| 57282 |
Colpopexy extraperitoneal
|
$XXX.XX
|
G2
|
Y
|
| 57283 |
Colpopexy intraperitoneal
|
$XXX.XX
|
G2
|
Y
|
| 57284 |
Repair paravag defect open
|
$XXX.XX
|
J8
|
Y
|
| 57285 |
Repair paravag defect vag
|
$XXX.XX
|
G2
|
Y
|
| 57287 |
Revise/remove sling repair
|
$XXX.XX
|
G2
|
N
|
| 57288 |
Repair bladder defect
|
$XXX.XX
|
J8
|
Y
|
| 57289 |
Repair bladder & vagina
|
$XXX.XX
|
A2
|
Y
|
| 57291 |
Construction of vagina
|
$XXX.XX
|
A2
|
Y
|
| 57292 |
Construct vagina with graft
|
$XXX.XX
|
G2
|
Y
|
| 57295 |
Revise vag graft via vagina
|
$XXX.XX
|
G2
|
Y
|
| 57300 |
Repair rectum-vagina fistula
|
$XXX.XX
|
A2
|
Y
|
| 57310 |
Repair urethrovaginal lesion
|
$XXX.XX
|
G2
|
Y
|
| 57320 |
Repair bladder-vagina lesion
|
$XXX.XX
|
G2
|
Y
|
| 57330 |
Repair bladder-vagina lesion
|
$XXX.XX
|
G2
|
Y
|
| 57335 |
Repair vagina
|
$XXX.XX
|
G2
|
Y
|
| 57400 |
Dilation of vagina
|
$XXX.XX
|
A2
|
Y
|
| 57410 |
Pelvic examination
|
$XXX.XX
|
A2
|
Y
|
| 57415 |
Remove vaginal foreign body
|
$XXX.XX
|
A2
|
Y
|
| 57420 |
Exam of vagina w/scope
|
$XXX.XX
|
P3
|
Y
|
| 57421 |
Exam/biopsy of vag w/scope
|
$XXX.XX
|
P3
|
Y
|
| 57423 |
Repair paravag defect lap
|
$XXX.XX
|
G2
|
Y
|
| 57425 |
Laparoscopy surg colpopexy
|
$XXX.XX
|
G2
|
Y
|
| 57426 |
Revise prosth vag graft lap
|
$XXX.XX
|
G2
|
Y
|
| 57452 |
Exam of cervix w/scope
|
$XXX.XX
|
P3
|
Y
|
| 57454 |
Bx/curett of cervix w/scope
|
$XXX.XX
|
P3
|
Y
|
| 57455 |
Biopsy of cervix w/scope
|
$XXX.XX
|
P3
|
Y
|
| 57456 |
Endocerv curettage w/scope
|
$XXX.XX
|
P3
|
Y
|
| 57460 |
Bx of cervix w/scope leep
|
$XXX.XX
|
P3
|
Y
|
| 57461 |
Conz of cervix w/scope leep
|
$XXX.XX
|
P3
|
Y
|
| 57500 |
Biopsy of cervix
|
$XXX.XX
|
P3
|
Y
|
| 57505 |
Endocervical curettage
|
$XXX.XX
|
P3
|
Y
|
| 57510 |
Cauterization of cervix
|
$XXX.XX
|
P3
|
Y
|
| 57511 |
Cryocautery of cervix
|
$XXX.XX
|
P3
|
Y
|
| 57513 |
Laser surgery of cervix
|
$XXX.XX
|
A2
|
Y
|
| 57520 |
Conization of cervix
|
$XXX.XX
|
A2
|
Y
|
| 57522 |
Conization of cervix
|
$XXX.XX
|
A2
|
Y
|
| 57530 |
Removal of cervix
|
$XXX.XX
|
A2
|
Y
|
| 57550 |
Removal of residual cervix
|
$XXX.XX
|
A2
|
Y
|
| 57555 |
Remove cervix/repair vagina
|
$XXX.XX
|
G2
|
Y
|
| 57556 |
Remove cervix repair bowel
|
$XXX.XX
|
A2
|
Y
|
| 57558 |
D&c of cervical stump
|
$XXX.XX
|
A2
|
Y
|
| 57700 |
Revision of cervix
|
$XXX.XX
|
A2
|
Y
|
| 57720 |
Revision of cervix
|
$XXX.XX
|
A2
|
Y
|
| 57800 |
Dilation of cervical canal
|
$XXX.XX
|
P3
|
Y
|
| 58100 |
Biopsy of uterus lining
|
$XXX.XX
|
P3
|
Y
|
| 58110 |
Bx done w/colposcopy add-on
|
$XXX.XX
|
N1
|
N
|
| 58120 |
Dilation and curettage
|
$XXX.XX
|
A2
|
Y
|
| 58145 |
Myomectomy vag method
|
$XXX.XX
|
A2
|
Y
|
| 58260 |
Vaginal hysterectomy
|
$XXX.XX
|
G2
|
Y
|
| 58262 |
Vag hyst including t/o
|
$XXX.XX
|
G2
|
Y
|
| 58263 |
Vag hyst w/t/o & vag repair
|
$XXX.XX
|
G2
|
Y
|
| 58270 |
Vag hyst w/enterocele repair
|
$XXX.XX
|
G2
|
Y
|
| 58290 |
Vag hyst complex
|
$XXX.XX
|
G2
|
Y
|
| 58291 |
Vag hyst incl t/o complex
|
$XXX.XX
|
G2
|
Y
|
| 58292 |
Vag hyst t/o & repair compl
|
$XXX.XX
|
G2
|
Y
|
| 58294 |
Vag hyst w/enterocele compl
|
$XXX.XX
|
G2
|
Y
|
| 58301 |
Remove intrauterine device
|
$XXX.XX
|
P3
|
N
|
| 58321 |
Artificial insemination
|
$XXX.XX
|
P3
|
Y
|
| 58322 |
Artificial insemination
|
$XXX.XX
|
P3
|
Y
|
| 58323 |
Sperm washing
|
$XXX.XX
|
P3
|
Y
|
| 58340 |
Catheter for hysterography
|
$XXX.XX
|
N1
|
N
|
| 58345 |
Reopen fallopian tube
|
$XXX.XX
|
R2
|
Y
|
| 58346 |
Insert heyman uteri capsule
|
$XXX.XX
|
A2
|
Y
|
| 58350 |
Reopen fallopian tube
|
$XXX.XX
|
A2
|
Y
|
| 58353 |
Endometr ablate thermal
|
$XXX.XX
|
A2
|
Y
|
| 58356 |
Endometrial cryoablation
|
$XXX.XX
|
P3
|
Y
|
| 58541 |
Lsh uterus 250 g or less
|
$XXX.XX
|
G2
|
Y
|
| 58542 |
Lsh w/t/o ut 250 g or less
|
$XXX.XX
|
G2
|
Y
|
| 58543 |
Lsh uterus above 250 g
|
$XXX.XX
|
G2
|
Y
|
| 58544 |
Lsh w/t/o uterus above 250 g
|
$XXX.XX
|
G2
|
Y
|
| 58545 |
Laparoscopic myomectomy
|
$XXX.XX
|
A2
|
Y
|
| 58546 |
Laparo-myomectomy complex
|
$XXX.XX
|
A2
|
Y
|
| 58550 |
Laparo-asst vag hysterectomy
|
$XXX.XX
|
A2
|
Y
|
| 58552 |
Laparo-vag hyst incl t/o
|
$XXX.XX
|
G2
|
Y
|
| 58553 |
Laparo-vag hyst complex
|
$XXX.XX
|
G2
|
Y
|
| 58554 |
Laparo-vag hyst w/t/o compl
|
$XXX.XX
|
G2
|
Y
|
| 58555 |
Hysteroscopy dx sep proc
|
$XXX.XX
|
A2
|
Y
|
| 58558 |
Hysteroscopy biopsy
|
$XXX.XX
|
A2
|
Y
|
| 58559 |
Hysteroscopy lysis
|
$XXX.XX
|
A2
|
Y
|
| 58560 |
Hysteroscopy resect septum
|
$XXX.XX
|
A2
|
Y
|
| 58561 |
Hysteroscopy remove myoma
|
$XXX.XX
|
A2
|
Y
|
| 58562 |
Hysteroscopy remove fb
|
$XXX.XX
|
A2
|
Y
|
| 58563 |
Hysteroscopy ablation
|
$XXX.XX
|
A2
|
Y
|
| 58565 |
Hysteroscopy sterilization
|
$XXX.XX
|
J8
|
Y
|
| 58570 |
Tlh uterus 250 g or less
|
$XXX.XX
|
G2
|
Y
|
| 58571 |
Tlh w/t/o 250 g or less
|
$XXX.XX
|
G2
|
Y
|
| 58572 |
Tlh uterus over 250 g
|
$XXX.XX
|
G2
|
Y
|
| 58573 |
Tlh w/t/o uterus over 250 g
|
$XXX.XX
|
G2
|
Y
|
| 58580 |
Transcrv abltj utrn fibrd rf
|
$XXX.XX
|
J8
|
Y
|
| 58600 |
Division of fallopian tube
|
$XXX.XX
|
G2
|
Y
|
| 58615 |
Occlude fallopian tube(s)
|
$XXX.XX
|
G2
|
Y
|
| 58660 |
Laparoscopy lysis
|
$XXX.XX
|
A2
|
Y
|
| 58661 |
Laparoscopy remove adnexa
|
$XXX.XX
|
A2
|
Y
|
| 58662 |
Laparoscopy excise lesions
|
$XXX.XX
|
A2
|
Y
|
| 58670 |
Laparoscopy tubal cautery
|
$XXX.XX
|
A2
|
Y
|
| 58671 |
Laparoscopy tubal block
|
$XXX.XX
|
A2
|
Y
|
| 58672 |
Laparoscopy fimbrioplasty
|
$XXX.XX
|
A2
|
Y
|
| 58673 |
Laparoscopy salpingostomy
|
$XXX.XX
|
A2
|
Y
|
| 58674 |
Laps abltj uterine fibroids
|
$XXX.XX
|
G2
|
Y
|
| 58770 |
Create new tubal opening
|
$XXX.XX
|
G2
|
Y
|
| 58800 |
Drainage of ovarian cyst(s)
|
$XXX.XX
|
A2
|
Y
|
| 58805 |
Drainage of ovarian cyst(s)
|
$XXX.XX
|
G2
|
Y
|
| 58820 |
Drain ovary abscess open
|
$XXX.XX
|
A2
|
Y
|
| 58900 |
Biopsy of ovary(s)
|
$XXX.XX
|
A2
|
Y
|
| 58920 |
Partial removal of ovary(s)
|
$XXX.XX
|
G2
|
Y
|
| 58925 |
Removal of ovarian cyst(s)
|
$XXX.XX
|
G2
|
Y
|
| 58970 |
Retrieval of oocyte
|
$XXX.XX
|
A2
|
Y
|
| 58974 |
Embryo transfer intrauterine
|
$XXX.XX
|
A2
|
Y
|
| 58976 |
Transfer of embryo
|
$XXX.XX
|
A2
|
Y
|
| 59000 |
Amniocentesis diagnostic
|
$XXX.XX
|
P3
|
Y
|
| 59001 |
Amniocentesis therapeutic
|
$XXX.XX
|
R2
|
Y
|
| 59012 |
Fetal cord puncture prenatal
|
$XXX.XX
|
G2
|
Y
|
| 59015 |
Chorion biopsy
|
$XXX.XX
|
P3
|
Y
|
| 59020 |
Fetal contract stress test
|
$XXX.XX
|
P3
|
Y
|
| 59025 |
Fetal non-stress test
|
$XXX.XX
|
P3
|
Y
|
| 59030 |
Fetal scalp blood sampling
|
$XXX.XX
|
G2
|
Y
|
| 59070 |
Transabdom amnioinfus w/us
|
$XXX.XX
|
G2
|
Y
|
| 59072 |
Umbilical cord occlud w/us
|
$XXX.XX
|
J8
|
Y
|
| 59074 |
Fetal fluid drainage w/us
|
$XXX.XX
|
G2
|
Y
|
| 59076 |
Fetal shunt placement w/us
|
$XXX.XX
|
G2
|
Y
|
| 59100 |
Remove uterus lesion
|
$XXX.XX
|
R2
|
Y
|
| 59150 |
Treat ectopic pregnancy
|
$XXX.XX
|
G2
|
Y
|
| 59151 |
Treat ectopic pregnancy
|
$XXX.XX
|
G2
|
Y
|
| 59160 |
D & c after delivery
|
$XXX.XX
|
A2
|
Y
|
| 59200 |
Insert cervical dilator
|
$XXX.XX
|
P3
|
Y
|
| 59300 |
Episiotomy or vaginal repair
|
$XXX.XX
|
P3
|
Y
|
| 59320 |
Revision of cervix
|
$XXX.XX
|
A2
|
Y
|
| 59409 |
Obstetrical care
|
$XXX.XX
|
G2
|
Y
|
| 59412 |
Antepartum manipulation
|
$XXX.XX
|
G2
|
Y
|
| 59414 |
Deliver placenta
|
$XXX.XX
|
G2
|
Y
|
| 59612 |
Vbac delivery only
|
$XXX.XX
|
G2
|
Y
|
| 59812 |
Treatment of miscarriage
|
$XXX.XX
|
A2
|
Y
|
| 59820 |
Care of miscarriage
|
$XXX.XX
|
A2
|
Y
|
| 59821 |
Treatment of miscarriage
|
$XXX.XX
|
A2
|
Y
|
| 59840 |
Induced abortion d&c
|
$XXX.XX
|
A2
|
Y
|
| 59841 |
Induced abortion dilat&evac
|
$XXX.XX
|
A2
|
Y
|
| 59866 |
Abortion (mpr)
|
$XXX.XX
|
G2
|
Y
|
| 59870 |
Evacuate mole of uterus
|
$XXX.XX
|
A2
|
Y
|
| 59871 |
Remove cerclage suture
|
$XXX.XX
|
A2
|
N
|
| 60000 |
I&d thyroglssl dux cst infct
|
$XXX.XX
|
A2
|
Y
|
| 60100 |
Biopsy of thyroid
|
$XXX.XX
|
P3
|
Y
|
| 60200 |
Remove thyroid lesion
|
$XXX.XX
|
A2
|
Y
|
| 60210 |
Partial thyroid excision
|
$XXX.XX
|
G2
|
Y
|
| 60212 |
Partial thyroid excision
|
$XXX.XX
|
G2
|
Y
|
| 60220 |
Partial removal of thyroid
|
$XXX.XX
|
G2
|
Y
|
| 60225 |
Partial removal of thyroid
|
$XXX.XX
|
G2
|
Y
|
| 60240 |
Removal of thyroid
|
$XXX.XX
|
G2
|
Y
|
| 60252 |
Removal of thyroid
|
$XXX.XX
|
G2
|
Y
|
| 60260 |
Repeat thyroid surgery
|
$XXX.XX
|
G2
|
Y
|
| 60271 |
Removal of thyroid
|
$XXX.XX
|
G2
|
Y
|
| 60280 |
Remove thyroid duct lesion
|
$XXX.XX
|
A2
|
Y
|
| 60281 |
Remove thyroid duct lesion
|
$XXX.XX
|
A2
|
Y
|
| 60300 |
Aspir/inj thyroid cyst
|
$XXX.XX
|
P3
|
Y
|
| 60500 |
Explore parathyroid glands
|
$XXX.XX
|
G2
|
Y
|
| 60502 |
Re-explore parathyroids
|
$XXX.XX
|
G2
|
Y
|
| 60512 |
Autotransplant parathyroid
|
$XXX.XX
|
N1
|
N
|
| 60520 |
Removal of thymus gland
|
$XXX.XX
|
G2
|
Y
|
| 60660 |
Abltj 1/+thyr ndul 1lobe prq
|
$XXX.XX
|
G2
|
Y
|
| 60661 |
Abltj 1/+thyr ndul addl prq
|
$XXX.XX
|
N1
|
N
|
| 61000 |
Remove cranial cavity fluid
|
$XXX.XX
|
R2
|
Y
|
| 61001 |
Remove cranial cavity fluid
|
$XXX.XX
|
R2
|
Y
|
| 61020 |
Remove brain cavity fluid
|
$XXX.XX
|
A2
|
Y
|
| 61026 |
Injection into brain canal
|
$XXX.XX
|
A2
|
Y
|
| 61050 |
Remove brain canal fluid
|
$XXX.XX
|
A2
|
Y
|
| 61055 |
Injection into brain canal
|
$XXX.XX
|
A2
|
Y
|
| 61070 |
Brain canal shunt procedure
|
$XXX.XX
|
A2
|
Y
|
| 61215 |
Ins subq rsvr pmp/nfs sys
|
$XXX.XX
|
A2
|
Y
|
| 61330 |
Dcmprn orbit only transcrnl
|
$XXX.XX
|
G2
|
Y
|
| 61623 |
Evasc temp balo artl occ h/n
|
$XXX.XX
|
J8
|
Y
|
| 61624 |
Tcat perm occls/embolj cns
|
$XXX.XX
|
J8
|
Y
|
| 61626 |
Tcat perm occls/embol noncns
|
$XXX.XX
|
J8
|
Y
|
| 61720 |
Incise skull/brain surgery
|
$XXX.XX
|
G2
|
Y
|
| 61770 |
Incise skull for treatment
|
$XXX.XX
|
G2
|
Y
|
| 61781 |
Scan proc cranial intra
|
$XXX.XX
|
N1
|
N
|
| 61782 |
Scan proc cranial extra
|
$XXX.XX
|
N1
|
N
|
| 61783 |
Scan proc spinal
|
$XXX.XX
|
N1
|
N
|
| 61790 |
Treat trigeminal nerve
|
$XXX.XX
|
A2
|
Y
|
| 61791 |
Treat trigeminal tract
|
$XXX.XX
|
A2
|
Y
|
| 61880 |
Revise/remove neuroelectrode
|
$XXX.XX
|
G2
|
Y
|
| 61885 |
Insrt/redo neurostim 1 array
|
$XXX.XX
|
J8
|
N
|
| 61886 |
Implant neurostim arrays
|
$XXX.XX
|
J8
|
N
|
| 61888 |
Revise/remove neuroreceiver
|
$XXX.XX
|
J8
|
Y
|
| 61891 |
Rev/rplcmt sk-mnt crnl nstm
|
$XXX.XX
|
J8
|
Y
|
| 61892 |
Rmv sk-mnt crnl nstm pg/rcvr
|
$XXX.XX
|
G2
|
Y
|
| 62000 |
Treat skull fracture
|
$XXX.XX
|
G2
|
Y
|
| 62160 |
Neuroendoscopy add-on
|
$XXX.XX
|
N1
|
N
|
| 62194 |
Replace/irrigate catheter
|
$XXX.XX
|
A2
|
Y
|
| 62225 |
Replace/irrigate catheter
|
$XXX.XX
|
A2
|
Y
|
| 62230 |
Replace/revise brain shunt
|
$XXX.XX
|
G2
|
Y
|
| 62252 |
Csf shunt reprogram
|
$XXX.XX
|
P3
|
N
|
| 62263 |
Epidural lysis mult sessions
|
$XXX.XX
|
A2
|
Y
|
| 62264 |
Epidural lysis on single day
|
$XXX.XX
|
A2
|
Y
|
| 62267 |
Interdiscal perq aspir dx
|
$XXX.XX
|
G2
|
Y
|
| 62268 |
Drain spinal cord cyst
|
$XXX.XX
|
A2
|
Y
|
| 62269 |
Needle biopsy spinal cord
|
$XXX.XX
|
A2
|
Y
|
| 62270 |
Dx lmbr spi pnxr
|
$XXX.XX
|
A2
|
Y
|
| 62272 |
Ther spi pnxr drg csf
|
$XXX.XX
|
A2
|
Y
|
| 62273 |
Inject epidural patch
|
$XXX.XX
|
A2
|
Y
|
| 62280 |
Treat spinal cord lesion
|
$XXX.XX
|
A2
|
Y
|
| 62281 |
Treat spinal cord lesion
|
$XXX.XX
|
A2
|
Y
|
| 62282 |
Treat spinal canal lesion
|
$XXX.XX
|
A2
|
Y
|
| 62284 |
Injection for myelogram
|
$XXX.XX
|
N1
|
N
|
| 62287 |
Dcmprn pq nuc pul 1/mlt lmbr
|
$XXX.XX
|
A2
|
Y
|
| 62290 |
Njx px discography lumbar
|
$XXX.XX
|
N1
|
N
|
| 62291 |
Njx px discography crv/thrc
|
$XXX.XX
|
N1
|
N
|
| 62292 |
Njx chemonucleolysis lmbr
|
$XXX.XX
|
R2
|
Y
|
| 62294 |
Injection into spinal artery
|
$XXX.XX
|
A2
|
Y
|
| 62302 |
Myelography lumbar injection
|
$XXX.XX
|
N1
|
N
|
| 62303 |
Myelography lumbar injection
|
$XXX.XX
|
N1
|
N
|
| 62304 |
Myelography lumbar injection
|
$XXX.XX
|
N1
|
N
|
| 62305 |
Myelography lumbar injection
|
$XXX.XX
|
N1
|
N
|
| 62320 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
G2
|
Y
|
| 62321 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
G2
|
Y
|
| 62322 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
G2
|
Y
|
| 62323 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
G2
|
Y
|
| 62324 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
G2
|
Y
|
| 62325 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
G2
|
Y
|
| 62326 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
G2
|
Y
|
| 62327 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
G2
|
Y
|
| 62328 |
Dx lmbr spi pnxr w/fluor/ct
|
$XXX.XX
|
G2
|
Y
|
| 62329 |
Ther spi pnxr csf fluor/ct
|
$XXX.XX
|
G2
|
Y
|
| 62330 |
Dcmprn prq rmv lig flv 1lmbr
|
$XXX.XX
|
J8
|
Y
|
| 62331 |
Dcmprn prq rmv lig flv addl
|
$XXX.XX
|
N1
|
N
|
| 62350 |
Implant spinal canal cath
|
$XXX.XX
|
J8
|
Y
|
| 62351 |
Implant spinal canal cath
|
$XXX.XX
|
J8
|
Y
|
| 62355 |
Remove spinal canal catheter
|
$XXX.XX
|
A2
|
N
|
| 62360 |
Insert spine infusion device
|
$XXX.XX
|
J8
|
Y
|
| 62361 |
Implant spine infusion pump
|
$XXX.XX
|
J8
|
Y
|
| 62362 |
Implant spine infusion pump
|
$XXX.XX
|
J8
|
Y
|
| 62365 |
Remove spine infusion device
|
$XXX.XX
|
A2
|
N
|
| 62367 |
Analyze spine infus pump
|
$XXX.XX
|
P3
|
N
|
| 62368 |
Analyze sp inf pump w/reprog
|
$XXX.XX
|
P3
|
N
|
| 62369 |
Anal sp inf pmp w/reprg&fill
|
$XXX.XX
|
P3
|
N
|
| 62370 |
Anl sp inf pmp w/mdreprg&fil
|
$XXX.XX
|
P3
|
N
|
| 62380 |
Ndsc dcmprn 1 ntrspc lumbar
|
$XXX.XX
|
G2
|
Y
|
| 63001 |
Remove spine lamina 1/2 crvl
|
$XXX.XX
|
G2
|
Y
|
| 63003 |
Remove spine lamina 1/2 thrc
|
$XXX.XX
|
G2
|
Y
|
| 63005 |
Remove spine lamina 1/2 lmbr
|
$XXX.XX
|
G2
|
Y
|
| 63011 |
Remove spine lamina 1/2 scrl
|
$XXX.XX
|
G2
|
Y
|
| 63012 |
Remove lamina/facets lumbar
|
$XXX.XX
|
G2
|
Y
|
| 63015 |
Remove spine lamina >2 crvcl
|
$XXX.XX
|
G2
|
Y
|
| 63016 |
Remove spine lamina >2 thrc
|
$XXX.XX
|
G2
|
Y
|
| 63017 |
Remove spine lamina >2 lmbr
|
$XXX.XX
|
G2
|
Y
|
| 63020 |
Lamot dcmprn nrv rt 1 cerv
|
$XXX.XX
|
G2
|
Y
|
| 63030 |
Lamot dcmprn nrv rt 1 lmbr
|
$XXX.XX
|
G2
|
Y
|
| 63035 |
Lamot dcmprn nrv rt ea addl
|
$XXX.XX
|
N1
|
N
|
| 63040 |
Laminotomy single cervical
|
$XXX.XX
|
G2
|
Y
|
| 63042 |
Laminotomy single lumbar
|
$XXX.XX
|
G2
|
Y
|
| 63043 |
Laminotomy addl cervical
|
$XXX.XX
|
N1
|
N
|
| 63044 |
Laminotomy addl lumbar
|
$XXX.XX
|
N1
|
N
|
| 63045 |
Lam facetec & foramot crv
|
$XXX.XX
|
G2
|
Y
|
| 63046 |
Lam facetec & foramot thrc
|
$XXX.XX
|
G2
|
Y
|
| 63047 |
Lam facetec & foramot lumbar
|
$XXX.XX
|
G2
|
Y
|
| 63048 |
Lam facetec &foramot ea addl
|
$XXX.XX
|
N1
|
N
|
| 63055 |
Decompress spinal cord thrc
|
$XXX.XX
|
G2
|
Y
|
| 63056 |
Decompress spinal cord lmbr
|
$XXX.XX
|
G2
|
Y
|
| 63057 |
Decompress spine cord add-on
|
$XXX.XX
|
N1
|
N
|
| 63064 |
Decompress spinal cord thrc
|
$XXX.XX
|
G2
|
Y
|
| 63066 |
Decompress spine cord add-on
|
$XXX.XX
|
N1
|
N
|
| 63075 |
Neck spine disk surgery
|
$XXX.XX
|
G2
|
Y
|
| 63076 |
Neck spine disk surgery
|
$XXX.XX
|
N1
|
N
|
| 63265 |
Excise intraspinl lesion crv
|
$XXX.XX
|
G2
|
Y
|
| 63266 |
Excise intrspinl lesion thrc
|
$XXX.XX
|
G2
|
Y
|
| 63267 |
Excise intrspinl lesion lmbr
|
$XXX.XX
|
G2
|
Y
|
| 63268 |
Excise intrspinl lesion scrl
|
$XXX.XX
|
G2
|
Y
|
| 63600 |
Remove spinal cord lesion
|
$XXX.XX
|
A2
|
Y
|
| 63610 |
Stimulation of spinal cord
|
$XXX.XX
|
J8
|
Y
|
| 63650 |
Implant neuroelectrodes
|
$XXX.XX
|
J8
|
N
|
| 63655 |
Implant neuroelectrodes
|
$XXX.XX
|
J8
|
N
|
| 63661 |
Remove spine eltrd perq aray
|
$XXX.XX
|
G2
|
N
|
| 63662 |
Remove spine eltrd plate
|
$XXX.XX
|
G2
|
Y
|
| 63663 |
Revise spine eltrd perq aray
|
$XXX.XX
|
J8
|
N
|
| 63664 |
Revise spine eltrd plate
|
$XXX.XX
|
J8
|
N
|
| 63685 |
Ins/rplc spi npg/rcvr pocket
|
$XXX.XX
|
J8
|
N
|
| 63688 |
Rev/rmv imp sp npg/r dtch cn
|
$XXX.XX
|
A2
|
Y
|
| 63741 |
Install spinal shunt
|
$XXX.XX
|
J8
|
Y
|
| 63744 |
Revision of spinal shunt
|
$XXX.XX
|
J8
|
Y
|
| 63746 |
Removal of spinal shunt
|
$XXX.XX
|
A2
|
N
|
| 64400 |
Njx aa&/strd trigeminal nrv
|
$XXX.XX
|
P3
|
Y
|
| 64405 |
Njx aa&/strd gr ocpl nrv
|
$XXX.XX
|
P3
|
Y
|
| 64408 |
Njx aa&/strd vagus nrv
|
$XXX.XX
|
P3
|
Y
|
| 64415 |
Njx aa&/strd brch plxs img
|
$XXX.XX
|
A2
|
Y
|
| 64416 |
Njx aa&/strd brch pl nfs img
|
$XXX.XX
|
J8
|
Y
|
| 64417 |
Njx aa&/strd ax nerve img
|
$XXX.XX
|
A2
|
Y
|
| 64418 |
Njx aa&/strd sprscap nrv
|
$XXX.XX
|
P3
|
Y
|
| 64420 |
Njx aa&/strd ntrcost nrv 1
|
$XXX.XX
|
A2
|
Y
|
| 64421 |
Njx aa&/strd ntrcost nrv ea
|
$XXX.XX
|
A2
|
Y
|
| 64425 |
Njx aa&/strd ii ih nerves
|
$XXX.XX
|
P3
|
Y
|
| 64430 |
Njx aa&/strd pudendal nerve
|
$XXX.XX
|
A2
|
Y
|
| 64435 |
Njx aa&/strd paracrv nrv
|
$XXX.XX
|
P3
|
Y
|
| 64445 |
Njx aa&/strd sciatic nrv img
|
$XXX.XX
|
P3
|
Y
|
| 64446 |
Njx aa&/strd sc nrv nfs img
|
$XXX.XX
|
G2
|
Y
|
| 64447 |
Njx aa&/strd femoral nrv img
|
$XXX.XX
|
P3
|
Y
|
| 64448 |
Njx aa&/strd fem nrv nfs img
|
$XXX.XX
|
J8
|
Y
|
| 64449 |
Njx aa&/strd lmbr plex nfs
|
$XXX.XX
|
G2
|
Y
|
| 64450 |
Njx aa&/strd other pn/branch
|
$XXX.XX
|
P3
|
Y
|
| 64451 |
Njx aa&/strd nrv nrvtg si jt
|
$XXX.XX
|
G2
|
Y
|
| 64454 |
Njx aa&/strd gnclr nrv brnch
|
$XXX.XX
|
G2
|
Y
|
| 64455 |
Njx aa&/strd pltr com dg nrv
|
$XXX.XX
|
P3
|
Y
|
| 64461 |
Pvb thoracic single inj site
|
$XXX.XX
|
G2
|
Y
|
| 64462 |
Pvb thoracic 2nd+ inj site
|
$XXX.XX
|
N1
|
N
|
| 64463 |
Pvb thoracic cont infusion
|
$XXX.XX
|
G2
|
Y
|
| 64466 |
Thrc fascial pln blk uni njx
|
$XXX.XX
|
N1
|
N
|
| 64467 |
Thrc fascial pln blk uni nfs
|
$XXX.XX
|
N1
|
N
|
| 64468 |
Thrc fascial pln blk bi njx
|
$XXX.XX
|
N1
|
N
|
| 64469 |
Thrc fascial pln blk bi nfs
|
$XXX.XX
|
N1
|
N
|
| 64473 |
Lwr xtr fscl pln blk uni njx
|
$XXX.XX
|
N1
|
N
|
| 64474 |
Lwr xtr fscl pln blk uni nfs
|
$XXX.XX
|
N1
|
N
|
| 64479 |
Njx aa&/strd tfrm epi c/t 1
|
$XXX.XX
|
A2
|
Y
|
| 64480 |
Njx aa&/strd tfrm epi c/t ea
|
$XXX.XX
|
N1
|
N
|
| 64483 |
Njx aa&/strd tfrm epi l/s 1
|
$XXX.XX
|
A2
|
Y
|
| 64484 |
Njx aa&/strd tfrm epi l/s ea
|
$XXX.XX
|
N1
|
N
|
| 64486 |
Tap block unil by injection
|
$XXX.XX
|
N1
|
N
|
| 64487 |
Tap block uni by infusion
|
$XXX.XX
|
N1
|
N
|
| 64488 |
Tap block bi injection
|
$XXX.XX
|
N1
|
N
|
| 64489 |
Tap block bi by infusion
|
$XXX.XX
|
N1
|
N
|
| 64490 |
Inj paravert f jnt c/t 1 lev
|
$XXX.XX
|
G2
|
Y
|
| 64491 |
Inj paravert f jnt c/t 2 lev
|
$XXX.XX
|
N1
|
N
|
| 64492 |
Inj paravert f jnt c/t 3 lev
|
$XXX.XX
|
N1
|
N
|
| 64493 |
Inj paravert f jnt l/s 1 lev
|
$XXX.XX
|
G2
|
Y
|
| 64494 |
Inj paravert f jnt l/s 2 lev
|
$XXX.XX
|
N1
|
N
|
| 64495 |
Inj paravert f jnt l/s 3 lev
|
$XXX.XX
|
N1
|
N
|
| 64505 |
N block spenopalatine gangl
|
$XXX.XX
|
P3
|
Y
|
| 64510 |
N block stellate ganglion
|
$XXX.XX
|
A2
|
Y
|
| 64517 |
N block inj hypogas plxs
|
$XXX.XX
|
A2
|
Y
|
| 64520 |
N block lumbar/thoracic
|
$XXX.XX
|
A2
|
Y
|
| 64530 |
N block inj celiac pelus
|
$XXX.XX
|
A2
|
Y
|
| 64553 |
Implant neuroelectrodes
|
$XXX.XX
|
J8
|
N
|
| 64555 |
Implant neuroelectrodes
|
$XXX.XX
|
J8
|
N
|
| 64561 |
Implant neuroelectrodes
|
$XXX.XX
|
J8
|
N
|
| 64566 |
Neuroeltrd stim post tibial
|
$XXX.XX
|
P3
|
Y
|
| 64567 |
Perq elec nrv field stimj cn
|
$XXX.XX
|
G2
|
Y
|
| 64568 |
Opn impltj crnl nrv nea&pg
|
$XXX.XX
|
J8
|
N
|
| 64569 |
Revise/repl vagus n eltrd
|
$XXX.XX
|
J8
|
N
|
| 64570 |
Remove vagus n eltrd
|
$XXX.XX
|
G2
|
N
|
| 64575 |
Opn impltj nea perph nerve
|
$XXX.XX
|
J8
|
N
|
| 64580 |
Opn impltj nea neuromuscular
|
$XXX.XX
|
J8
|
N
|
| 64581 |
Opn impltj nea sacral nerve
|
$XXX.XX
|
J8
|
N
|
| 64582 |
Opn mpltj hpglsl nstm ary pg
|
$XXX.XX
|
J8
|
N
|
| 64583 |
Rev/rplct hpglsl nstm ary pg
|
$XXX.XX
|
J8
|
Y
|
| 64584 |
Rmvl hpglsl nstim ary pg
|
$XXX.XX
|
G2
|
N
|
| 64585 |
Rev/rmv perph nstim eltrd ra
|
$XXX.XX
|
A2
|
Y
|
| 64590 |
Ins/rpl prph sac/gstr npg/r
|
$XXX.XX
|
J8
|
N
|
| 64595 |
Rev/rmv prph sac/gstr npg/r
|
$XXX.XX
|
A2
|
Y
|
| 64596 |
Ins/rplcmt prq eltrd ra pn 1
|
$XXX.XX
|
J8
|
Y
|
| 64597 |
Ins/rplcm prq eltrd ra pn ea
|
$XXX.XX
|
N1
|
N
|
| 64598 |
Revj/rmvl nea pn w/int nstim
|
$XXX.XX
|
R2
|
Y
|
| 64600 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64605 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64610 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64611 |
Chemodenerv saliv glands
|
$XXX.XX
|
P3
|
Y
|
| 64612 |
Destroy nerve face muscle
|
$XXX.XX
|
P3
|
Y
|
| 64615 |
Chemodenerv musc migraine
|
$XXX.XX
|
P3
|
Y
|
| 64616 |
Chemodenerv musc neck dyston
|
$XXX.XX
|
P3
|
Y
|
| 64617 |
Chemodener muscle larynx emg
|
$XXX.XX
|
P3
|
Y
|
| 64620 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64624 |
Dstrj nulyt agt gnclr nrv
|
$XXX.XX
|
G2
|
Y
|
| 64625 |
Rf abltj nrv nrvtg si jt
|
$XXX.XX
|
G2
|
Y
|
| 64628 |
Trml dstrj ios bvn 1st 2 l/s
|
$XXX.XX
|
J8
|
Y
|
| 64630 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64632 |
N block inj common digit
|
$XXX.XX
|
P3
|
Y
|
| 64633 |
Destroy cerv/thor facet jnt
|
$XXX.XX
|
G2
|
Y
|
| 64634 |
Destroy c/th facet jnt addl
|
$XXX.XX
|
N1
|
N
|
| 64635 |
Destroy lumb/sac facet jnt
|
$XXX.XX
|
G2
|
Y
|
| 64636 |
Destroy l/s facet jnt addl
|
$XXX.XX
|
N1
|
N
|
| 64640 |
Injection treatment of nerve
|
$XXX.XX
|
P3
|
Y
|
| 64642 |
Chemodenerv 1 extremity 1-4
|
$XXX.XX
|
P3
|
Y
|
| 64643 |
Chemodenerv 1 extrem 1-4 ea
|
$XXX.XX
|
N1
|
N
|
| 64644 |
Chemodenerv 1 extrem 5/> mus
|
$XXX.XX
|
P3
|
Y
|
| 64645 |
Chemodenerv 1 extrem 5/> ea
|
$XXX.XX
|
N1
|
N
|
| 64646 |
Chemodenerv trunk musc 1-5
|
$XXX.XX
|
P3
|
Y
|
| 64647 |
Chemodenerv trunk musc 6/>
|
$XXX.XX
|
P3
|
Y
|
| 64650 |
Chemodenerv eccrine glands
|
$XXX.XX
|
P3
|
Y
|
| 64653 |
Chemodenerv eccrine glands
|
$XXX.XX
|
P3
|
Y
|
| 64654 |
1st opn implt bat modulj sys
|
$XXX.XX
|
J8
|
N
|
| 64655 |
Revj/rplcmt bat mod sys lead
|
$XXX.XX
|
J8
|
Y
|
| 64656 |
Revj/rplcmt bat mod sys pg
|
$XXX.XX
|
J8
|
Y
|
| 64657 |
Rmvl bat modulj sys tot sys
|
$XXX.XX
|
G2
|
N
|
| 64658 |
Rmvl bat modul sys lead only
|
$XXX.XX
|
G2
|
Y
|
| 64659 |
Rmvl bat modulj sys pg only
|
$XXX.XX
|
G2
|
Y
|
| 64680 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64681 |
Injection treatment of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64702 |
Revise finger/toe nerve
|
$XXX.XX
|
A2
|
Y
|
| 64704 |
Revise hand/foot nerve
|
$XXX.XX
|
A2
|
Y
|
| 64708 |
Revise arm/leg nerve
|
$XXX.XX
|
G2
|
Y
|
| 64712 |
Revision of sciatic nerve
|
$XXX.XX
|
G2
|
Y
|
| 64713 |
Revision of arm nerve(s)
|
$XXX.XX
|
G2
|
Y
|
| 64714 |
Revise low back nerve(s)
|
$XXX.XX
|
G2
|
Y
|
| 64716 |
Revision of cranial nerve
|
$XXX.XX
|
A2
|
Y
|
| 64718 |
Revise ulnar nerve at elbow
|
$XXX.XX
|
A2
|
Y
|
| 64719 |
Revise ulnar nerve at wrist
|
$XXX.XX
|
A2
|
Y
|
| 64721 |
Carpal tunnel surgery
|
$XXX.XX
|
A2
|
Y
|
| 64722 |
Decompression unspec nerve
|
$XXX.XX
|
A2
|
Y
|
| 64726 |
Dcmprn plantar digital nerve
|
$XXX.XX
|
A2
|
Y
|
| 64727 |
Internal neurolysis
|
$XXX.XX
|
N1
|
N
|
| 64728 |
Dcmprn median nrv carpl tunl
|
$XXX.XX
|
J8
|
Y
|
| 64732 |
Incision of brow nerve
|
$XXX.XX
|
A2
|
Y
|
| 64734 |
Incision of cheek nerve
|
$XXX.XX
|
A2
|
Y
|
| 64736 |
Incision of chin nerve
|
$XXX.XX
|
A2
|
Y
|
| 64738 |
Incision of jaw nerve
|
$XXX.XX
|
A2
|
Y
|
| 64740 |
Incision of tongue nerve
|
$XXX.XX
|
A2
|
Y
|
| 64742 |
Incision of facial nerve
|
$XXX.XX
|
A2
|
Y
|
| 64744 |
Incise nerve back of head
|
$XXX.XX
|
A2
|
Y
|
| 64746 |
Incise diaphragm nerve
|
$XXX.XX
|
A2
|
Y
|
| 64763 |
Incise hip/thigh nerve
|
$XXX.XX
|
G2
|
Y
|
| 64766 |
Incise hip/thigh nerve
|
$XXX.XX
|
J8
|
Y
|
| 64771 |
Sever cranial nerve
|
$XXX.XX
|
A2
|
Y
|
| 64772 |
Incision of spinal nerve
|
$XXX.XX
|
A2
|
Y
|
| 64774 |
Remove skin nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64776 |
Remove digit nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64778 |
Digit nerve surgery add-on
|
$XXX.XX
|
N1
|
N
|
| 64782 |
Remove limb nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64783 |
Limb nerve surgery add-on
|
$XXX.XX
|
N1
|
N
|
| 64784 |
Remove nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64786 |
Remove sciatic nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64787 |
Implant nerve end
|
$XXX.XX
|
N1
|
N
|
| 64788 |
Remove skin nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64790 |
Removal of nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64792 |
Removal of nerve lesion
|
$XXX.XX
|
A2
|
Y
|
| 64795 |
Biopsy of nerve
|
$XXX.XX
|
A2
|
Y
|
| 64802 |
Sympathectomy cervical
|
$XXX.XX
|
A2
|
Y
|
| 64804 |
Sympathectomy cervicothorac
|
$XXX.XX
|
G2
|
Y
|
| 64820 |
Sympathectomy digital artery
|
$XXX.XX
|
G2
|
Y
|
| 64821 |
Sympathectomy radial artery
|
$XXX.XX
|
A2
|
Y
|
| 64822 |
Sympathectomy ulnar artery
|
$XXX.XX
|
G2
|
Y
|
| 64823 |
Sympathectomy supfc palmar
|
$XXX.XX
|
G2
|
Y
|
| 64831 |
Repair of digit nerve
|
$XXX.XX
|
A2
|
Y
|
| 64832 |
Repair nerve add-on
|
$XXX.XX
|
N1
|
N
|
| 64834 |
Repair of hand or foot nerve
|
$XXX.XX
|
A2
|
Y
|
| 64835 |
Repair of hand or foot nerve
|
$XXX.XX
|
A2
|
Y
|
| 64836 |
Repair of hand or foot nerve
|
$XXX.XX
|
A2
|
Y
|
| 64837 |
Repair nerve add-on
|
$XXX.XX
|
N1
|
N
|
| 64840 |
Repair of leg nerve
|
$XXX.XX
|
A2
|
Y
|
| 64856 |
Repair/transpose nerve
|
$XXX.XX
|
A2
|
Y
|
| 64857 |
Repair arm/leg nerve
|
$XXX.XX
|
A2
|
Y
|
| 64858 |
Repair sciatic nerve
|
$XXX.XX
|
A2
|
Y
|
| 64859 |
Nerve surgery
|
$XXX.XX
|
N1
|
N
|
| 64861 |
Repair of arm nerves
|
$XXX.XX
|
A2
|
Y
|
| 64862 |
Repair of low back nerves
|
$XXX.XX
|
A2
|
Y
|
| 64864 |
Repair of facial nerve
|
$XXX.XX
|
A2
|
Y
|
| 64865 |
Repair of facial nerve
|
$XXX.XX
|
J8
|
Y
|
| 64872 |
Subsequent repair of nerve
|
$XXX.XX
|
N1
|
N
|
| 64874 |
Repair & revise nerve add-on
|
$XXX.XX
|
N1
|
N
|
| 64876 |
Repair nerve/shorten bone
|
$XXX.XX
|
N1
|
N
|
| 64885 |
Nerve graft head/neck <4 cm
|
$XXX.XX
|
A2
|
Y
|
| 64886 |
Nerve graft head/neck >4 cm
|
$XXX.XX
|
J8
|
Y
|
| 64890 |
Nrv grf 1strnd hnd/foot <4cm
|
$XXX.XX
|
J8
|
Y
|
| 64891 |
Nrv grf 1strnd hnd/foot >4cm
|
$XXX.XX
|
J8
|
Y
|
| 64892 |
Nrv grf 1strnd arm/leg <4cm
|
$XXX.XX
|
J8
|
Y
|
| 64893 |
Nrv grf 1strnd arm/leg >4 cm
|
$XXX.XX
|
G2
|
Y
|
| 64895 |
Nrv grf mltst hnd/foot <4 cm
|
$XXX.XX
|
A2
|
Y
|
| 64896 |
Nrv grf mltst hnd/foot >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 64897 |
Nrv grf mltst arm/leg <4 cm
|
$XXX.XX
|
J8
|
Y
|
| 64898 |
Nrv grf mltst arm/leg >4 cm
|
$XXX.XX
|
A2
|
Y
|
| 64901 |
Nerve graft add-on
|
$XXX.XX
|
N1
|
N
|
| 64902 |
Nerve graft add-on
|
$XXX.XX
|
N1
|
N
|
| 64905 |
Nerve pedicle transfer
|
$XXX.XX
|
A2
|
Y
|
| 64907 |
Nerve pedicle transfer
|
$XXX.XX
|
A2
|
Y
|
| 64910 |
Nerve repair w/allograft
|
$XXX.XX
|
J8
|
Y
|
| 64911 |
Neurorraphy w/vein autograft
|
$XXX.XX
|
J8
|
Y
|
| 64912 |
Nrv rpr w/nrv algrft 1st
|
$XXX.XX
|
J8
|
Y
|
| 64913 |
Nrv rpr w/nrv algrft ea addl
|
$XXX.XX
|
N1
|
N
|
| 65091 |
Revise eye
|
$XXX.XX
|
A2
|
Y
|
| 65093 |
Revise eye with implant
|
$XXX.XX
|
A2
|
Y
|
| 65101 |
Removal of eye
|
$XXX.XX
|
A2
|
Y
|
| 65103 |
Remove eye/insert implant
|
$XXX.XX
|
A2
|
Y
|
| 65105 |
Remove eye/attach implant
|
$XXX.XX
|
A2
|
Y
|
| 65110 |
Removal of eye
|
$XXX.XX
|
A2
|
Y
|
| 65112 |
Remove eye/revise socket
|
$XXX.XX
|
A2
|
Y
|
| 65114 |
Remove eye/revise socket
|
$XXX.XX
|
A2
|
Y
|
| 65125 |
Revise ocular implant
|
$XXX.XX
|
G2
|
Y
|
| 65130 |
Insert ocular implant
|
$XXX.XX
|
A2
|
Y
|
| 65135 |
Insert ocular implant
|
$XXX.XX
|
A2
|
Y
|
| 65140 |
Attach ocular implant
|
$XXX.XX
|
A2
|
Y
|
| 65150 |
Revise ocular implant
|
$XXX.XX
|
A2
|
Y
|
| 65155 |
Reinsert ocular implant
|
$XXX.XX
|
A2
|
Y
|
| 65175 |
Removal of ocular implant
|
$XXX.XX
|
A2
|
Y
|
| 65205 |
Remove foreign body from eye
|
$XXX.XX
|
N1
|
N
|
| 65210 |
Remove foreign body from eye
|
$XXX.XX
|
N1
|
N
|
| 65220 |
Remove foreign body from eye
|
$XXX.XX
|
N1
|
N
|
| 65222 |
Remove foreign body from eye
|
$XXX.XX
|
N1
|
N
|
| 65235 |
Remove foreign body from eye
|
$XXX.XX
|
A2
|
Y
|
| 65260 |
Remove foreign body from eye
|
$XXX.XX
|
A2
|
Y
|
| 65265 |
Remove foreign body from eye
|
$XXX.XX
|
A2
|
Y
|
| 65270 |
Repair of eye wound
|
$XXX.XX
|
A2
|
Y
|
| 65272 |
Repair of eye wound
|
$XXX.XX
|
A2
|
Y
|
| 65275 |
Repair of eye wound
|
$XXX.XX
|
A2
|
Y
|
| 65280 |
Repair of eye wound
|
$XXX.XX
|
A2
|
Y
|
| 65285 |
Repair of eye wound
|
$XXX.XX
|
A2
|
Y
|
| 65286 |
Repair of eye wound
|
$XXX.XX
|
P3
|
Y
|
| 65290 |
Repair of eye socket wound
|
$XXX.XX
|
A2
|
Y
|
| 65400 |
Removal of eye lesion
|
$XXX.XX
|
A2
|
Y
|
| 65410 |
Biopsy of cornea
|
$XXX.XX
|
A2
|
Y
|
| 65420 |
Removal of eye lesion
|
$XXX.XX
|
A2
|
Y
|
| 65426 |
Removal of eye lesion
|
$XXX.XX
|
A2
|
Y
|
| 65430 |
Corneal smear
|
$XXX.XX
|
N1
|
N
|
| 65435 |
Curette/treat cornea
|
$XXX.XX
|
P3
|
Y
|
| 65436 |
Curette/treat cornea
|
$XXX.XX
|
P3
|
Y
|
| 65450 |
Treatment of corneal lesion
|
$XXX.XX
|
G2
|
Y
|
| 65600 |
Revision of cornea
|
$XXX.XX
|
P3
|
Y
|
| 65710 |
Corneal transplant
|
$XXX.XX
|
A2
|
Y
|
| 65730 |
Corneal transplant
|
$XXX.XX
|
A2
|
Y
|
| 65750 |
Corneal transplant
|
$XXX.XX
|
A2
|
Y
|
| 65755 |
Corneal transplant
|
$XXX.XX
|
A2
|
Y
|
| 65756 |
Corneal trnspl endothelial
|
$XXX.XX
|
G2
|
Y
|
| 65757 |
Prep corneal endo allograft
|
$XXX.XX
|
N1
|
N
|
| 65770 |
Keratoprosthesis
|
$XXX.XX
|
J8
|
Y
|
| 65772 |
Correction of astigmatism
|
$XXX.XX
|
A2
|
Y
|
| 65775 |
Correction of astigmatism
|
$XXX.XX
|
A2
|
Y
|
| 65778 |
Cover eye w/membrane
|
$XXX.XX
|
N1
|
N
|
| 65779 |
Cover eye w/membrane suture
|
$XXX.XX
|
N1
|
N
|
| 65780 |
Ocular reconst transplant
|
$XXX.XX
|
J8
|
Y
|
| 65781 |
Ocular reconst transplant
|
$XXX.XX
|
J8
|
Y
|
| 65782 |
Ocular reconst transplant
|
$XXX.XX
|
A2
|
Y
|
| 65785 |
Impltj ntrstrml crnl rng seg
|
$XXX.XX
|
J8
|
Y
|
| 65800 |
Drainage of eye
|
$XXX.XX
|
A2
|
Y
|
| 65810 |
Drainage of eye
|
$XXX.XX
|
A2
|
Y
|
| 65815 |
Drainage of eye
|
$XXX.XX
|
A2
|
Y
|
| 65820 |
Goniotomy
|
$XXX.XX
|
A2
|
Y
|
| 65850 |
Trabeculotomy ab externo
|
$XXX.XX
|
A2
|
Y
|
| 65855 |
Trabeculoplasty laser surg
|
$XXX.XX
|
P3
|
Y
|
| 65860 |
Severing ads ant sgm laser
|
$XXX.XX
|
P3
|
Y
|
| 65865 |
Incise inner eye adhesions
|
$XXX.XX
|
A2
|
Y
|
| 65870 |
Incise inner eye adhesions
|
$XXX.XX
|
A2
|
Y
|
| 65875 |
Incise inner eye adhesions
|
$XXX.XX
|
A2
|
Y
|
| 65880 |
Incise inner eye adhesions
|
$XXX.XX
|
A2
|
Y
|
| 65900 |
Remove eye lesion
|
$XXX.XX
|
A2
|
Y
|
| 65920 |
Remove implant of eye
|
$XXX.XX
|
A2
|
Y
|
| 65930 |
Remove blood clot from eye
|
$XXX.XX
|
A2
|
Y
|
| 66020 |
Injection treatment of eye
|
$XXX.XX
|
A2
|
Y
|
| 66030 |
Injection treatment of eye
|
$XXX.XX
|
A2
|
Y
|
| 66130 |
Remove eye lesion
|
$XXX.XX
|
A2
|
Y
|
| 66150 |
Glaucoma surgery
|
$XXX.XX
|
A2
|
Y
|
| 66155 |
Glaucoma surgery
|
$XXX.XX
|
A2
|
Y
|
| 66160 |
Glaucoma surgery
|
$XXX.XX
|
A2
|
Y
|
| 66170 |
Glaucoma surgery
|
$XXX.XX
|
A2
|
Y
|
| 66172 |
Incision of eye
|
$XXX.XX
|
A2
|
Y
|
| 66174 |
Trluml dil aq o/f can w/o st
|
$XXX.XX
|
A2
|
Y
|
| 66175 |
Trluml dil aq o/f can w/st
|
$XXX.XX
|
J8
|
Y
|
| 66179 |
Aqueous shunt eye w/o graft
|
$XXX.XX
|
J8
|
Y
|
| 66180 |
Aqueous shunt eye w/graft
|
$XXX.XX
|
J8
|
Y
|
| 66183 |
Insert ant drainage device
|
$XXX.XX
|
J8
|
Y
|
| 66184 |
Revision of aqueous shunt
|
$XXX.XX
|
G2
|
Y
|
| 66185 |
Revise aqueous shunt eye
|
$XXX.XX
|
A2
|
Y
|
| 66225 |
Repair/graft eye lesion
|
$XXX.XX
|
A2
|
Y
|
| 66250 |
Follow-up surgery of eye
|
$XXX.XX
|
A2
|
Y
|
| 66500 |
Incision of iris
|
$XXX.XX
|
A2
|
Y
|
| 66505 |
Incision of iris
|
$XXX.XX
|
A2
|
Y
|
| 66600 |
Remove iris and lesion
|
$XXX.XX
|
A2
|
Y
|
| 66605 |
Removal of iris
|
$XXX.XX
|
A2
|
Y
|
| 66625 |
Removal of iris
|
$XXX.XX
|
A2
|
Y
|
| 66630 |
Removal of iris
|
$XXX.XX
|
A2
|
Y
|
| 66635 |
Removal of iris
|
$XXX.XX
|
A2
|
Y
|
| 66680 |
Repair iris & ciliary body
|
$XXX.XX
|
A2
|
Y
|
| 66682 |
Repair iris & ciliary body
|
$XXX.XX
|
A2
|
Y
|
| 66683 |
Implantation iris prosthesis
|
$XXX.XX
|
J8
|
Y
|
| 66700 |
Destruction ciliary body
|
$XXX.XX
|
A2
|
Y
|
| 66710 |
Ciliary transsleral therapy
|
$XXX.XX
|
A2
|
Y
|
| 66711 |
Ecp ciliary body destruction
|
$XXX.XX
|
A2
|
Y
|
| 66720 |
Destruction ciliary body
|
$XXX.XX
|
A2
|
Y
|
| 66740 |
Destruction ciliary body
|
$XXX.XX
|
A2
|
Y
|
| 66761 |
Revision of iris
|
$XXX.XX
|
P3
|
Y
|
| 66762 |
Revision of iris
|
$XXX.XX
|
P3
|
Y
|
| 66770 |
Removal of inner eye lesion
|
$XXX.XX
|
P2
|
Y
|
| 66820 |
Incision secondary cataract
|
$XXX.XX
|
G2
|
Y
|
| 66821 |
After cataract laser surgery
|
$XXX.XX
|
A2
|
Y
|
| 66825 |
Reposition intraocular lens
|
$XXX.XX
|
A2
|
Y
|
| 66830 |
Removal of lens lesion
|
$XXX.XX
|
A2
|
Y
|
| 66840 |
Removal of lens material
|
$XXX.XX
|
A2
|
Y
|
| 66850 |
Removal of lens material
|
$XXX.XX
|
A2
|
Y
|
| 66852 |
Removal of lens material
|
$XXX.XX
|
A2
|
Y
|
| 66920 |
Extraction of lens
|
$XXX.XX
|
A2
|
Y
|
| 66930 |
Extraction of lens
|
$XXX.XX
|
A2
|
Y
|
| 66940 |
Extraction of lens
|
$XXX.XX
|
A2
|
Y
|
| 66982 |
Xcapsl ctrc rmvl cplx wo ecp
|
$XXX.XX
|
A2
|
Y
|
| 66983 |
Cataract surg w/iol 1 stage
|
$XXX.XX
|
A2
|
Y
|
| 66984 |
Xcapsl ctrc rmvl w/o ecp
|
$XXX.XX
|
A2
|
Y
|
| 66985 |
Insert lens prosthesis
|
$XXX.XX
|
A2
|
Y
|
| 66986 |
Exchange lens prosthesis
|
$XXX.XX
|
A2
|
Y
|
| 66987 |
Xcapsl ctrc rmvl cplx w/ecp
|
$XXX.XX
|
G2
|
Y
|
| 66988 |
Xcapsl ctrc rmvl w/ecp
|
$XXX.XX
|
G2
|
Y
|
| 66989 |
Xcpsl ctrc rmvl cplx insj 1+
|
$XXX.XX
|
J8
|
Y
|
| 66990 |
Ophthalmic endoscope add-on
|
$XXX.XX
|
N1
|
N
|
| 66991 |
Xcapsl ctrc rmvl insj 1+
|
$XXX.XX
|
J8
|
Y
|
| 67005 |
Partial removal of eye fluid
|
$XXX.XX
|
A2
|
Y
|
| 67010 |
Partial removal of eye fluid
|
$XXX.XX
|
A2
|
Y
|
| 67015 |
Release of eye fluid
|
$XXX.XX
|
A2
|
Y
|
| 67025 |
Replace eye fluid
|
$XXX.XX
|
A2
|
Y
|
| 67027 |
Implant eye drug system
|
$XXX.XX
|
A2
|
Y
|
| 67028 |
Injection eye drug
|
$XXX.XX
|
P3
|
N
|
| 67030 |
Incise inner eye strands
|
$XXX.XX
|
A2
|
Y
|
| 67031 |
Laser surgery eye strands
|
$XXX.XX
|
A2
|
Y
|
| 67036 |
Removal of inner eye fluid
|
$XXX.XX
|
A2
|
Y
|
| 67039 |
Laser treatment of retina
|
$XXX.XX
|
A2
|
Y
|
| 67040 |
Laser treatment of retina
|
$XXX.XX
|
A2
|
Y
|
| 67041 |
Vit for macular pucker
|
$XXX.XX
|
G2
|
Y
|
| 67042 |
Vit for macular hole
|
$XXX.XX
|
G2
|
Y
|
| 67043 |
Vit for membrane dissect
|
$XXX.XX
|
G2
|
Y
|
| 67101 |
Repair detached retina crtx
|
$XXX.XX
|
P3
|
Y
|
| 67105 |
Repair detached retina pc
|
$XXX.XX
|
P3
|
Y
|
| 67107 |
Repair detached retina
|
$XXX.XX
|
G2
|
Y
|
| 67108 |
Repair detached retina
|
$XXX.XX
|
G2
|
Y
|
| 67110 |
Repair detached retina
|
$XXX.XX
|
P3
|
Y
|
| 67113 |
Repair retinal detach cplx
|
$XXX.XX
|
G2
|
Y
|
| 67115 |
Release encircling material
|
$XXX.XX
|
A2
|
Y
|
| 67120 |
Remove eye implant material
|
$XXX.XX
|
A2
|
Y
|
| 67121 |
Remove eye implant material
|
$XXX.XX
|
A2
|
Y
|
| 67141 |
Proph rta dtchmnt crtx dthrm
|
$XXX.XX
|
A2
|
Y
|
| 67145 |
Proph rta dtchmnt pc
|
$XXX.XX
|
P3
|
Y
|
| 67208 |
Treatment of retinal lesion
|
$XXX.XX
|
P2
|
Y
|
| 67210 |
Treatment of retinal lesion
|
$XXX.XX
|
P3
|
Y
|
| 67218 |
Treatment of retinal lesion
|
$XXX.XX
|
A2
|
Y
|
| 67220 |
Treatment of choroid lesion
|
$XXX.XX
|
P2
|
Y
|
| 67221 |
Ocular photodynamic ther
|
$XXX.XX
|
P3
|
Y
|
| 67225 |
Eye photodynamic ther add-on
|
$XXX.XX
|
N1
|
N
|
| 67227 |
Dstrj extensive retinopathy
|
$XXX.XX
|
P3
|
Y
|
| 67228 |
Treatment x10sv retinopathy
|
$XXX.XX
|
P3
|
Y
|
| 67229 |
Tr retinal les preterm inf
|
$XXX.XX
|
R2
|
Y
|
| 67250 |
Reinforce eye wall
|
$XXX.XX
|
A2
|
Y
|
| 67255 |
Reinforce/graft eye wall
|
$XXX.XX
|
A2
|
Y
|
| 67311 |
Revise eye muscle
|
$XXX.XX
|
A2
|
Y
|
| 67312 |
Revise two eye muscles
|
$XXX.XX
|
A2
|
Y
|
| 67314 |
Revise eye muscle
|
$XXX.XX
|
A2
|
Y
|
| 67316 |
Revise two eye muscles
|
$XXX.XX
|
A2
|
Y
|
| 67318 |
Revise eye muscle(s)
|
$XXX.XX
|
A2
|
Y
|
| 67320 |
Revise eye muscle(s) add-on
|
$XXX.XX
|
N1
|
N
|
| 67331 |
Eye surgery follow-up add-on
|
$XXX.XX
|
N1
|
N
|
| 67332 |
Rerevise eye muscles add-on
|
$XXX.XX
|
N1
|
N
|
| 67334 |
Revise eye muscle w/suture
|
$XXX.XX
|
N1
|
N
|
| 67335 |
Eye suture during surgery
|
$XXX.XX
|
N1
|
N
|
| 67340 |
Revise eye muscle add-on
|
$XXX.XX
|
N1
|
N
|
| 67343 |
Release eye tissue
|
$XXX.XX
|
A2
|
Y
|
| 67345 |
Destroy nerve of eye muscle
|
$XXX.XX
|
P3
|
Y
|
| 67346 |
Biopsy eye muscle
|
$XXX.XX
|
A2
|
Y
|
| 67400 |
Explore/biopsy eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67405 |
Explore/drain eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67412 |
Explore/treat eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67413 |
Explore/treat eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67414 |
Explr/decompress eye socket
|
$XXX.XX
|
G2
|
Y
|
| 67415 |
Aspiration orbital contents
|
$XXX.XX
|
A2
|
Y
|
| 67420 |
Explore/treat eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67430 |
Explore/treat eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67440 |
Explore/drain eye socket
|
$XXX.XX
|
J8
|
Y
|
| 67445 |
Explr/decompress eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67450 |
Explore/biopsy eye socket
|
$XXX.XX
|
A2
|
Y
|
| 67500 |
Inject/treat eye socket
|
$XXX.XX
|
P3
|
Y
|
| 67505 |
Inject/treat eye socket
|
$XXX.XX
|
P3
|
Y
|
| 67515 |
Inject/treat eye socket
|
$XXX.XX
|
P3
|
Y
|
| 67516 |
Sprchoroidal spc njx rx agt
|
$XXX.XX
|
P3
|
Y
|
| 67550 |
Insert eye socket implant
|
$XXX.XX
|
A2
|
Y
|
| 67560 |
Revise eye socket implant
|
$XXX.XX
|
A2
|
Y
|
| 67570 |
Decompress optic nerve
|
$XXX.XX
|
A2
|
Y
|
| 67700 |
Blepharotomy drg absc eyelid
|
$XXX.XX
|
P2
|
Y
|
| 67710 |
Severing tarsorrhaphy
|
$XXX.XX
|
P3
|
Y
|
| 67715 |
Canthotomy
|
$XXX.XX
|
A2
|
Y
|
| 67800 |
Remove eyelid lesion
|
$XXX.XX
|
P3
|
Y
|
| 67801 |
Remove eyelid lesions
|
$XXX.XX
|
P3
|
Y
|
| 67805 |
Remove eyelid lesions
|
$XXX.XX
|
P3
|
Y
|
| 67808 |
Remove eyelid lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 67810 |
Incal bx eyelid skn lid mrgn
|
$XXX.XX
|
P3
|
Y
|
| 67820 |
Revise eyelashes
|
$XXX.XX
|
N1
|
N
|
| 67825 |
Revise eyelashes
|
$XXX.XX
|
P3
|
Y
|
| 67830 |
Revise eyelashes
|
$XXX.XX
|
A2
|
Y
|
| 67835 |
Revise eyelashes
|
$XXX.XX
|
A2
|
Y
|
| 67840 |
Remove eyelid lesion
|
$XXX.XX
|
P3
|
Y
|
| 67850 |
Dstrj lesion lid margin <1cm
|
$XXX.XX
|
P3
|
Y
|
| 67875 |
Closure of eyelid by suture
|
$XXX.XX
|
G2
|
Y
|
| 67880 |
Revision of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67882 |
Revision of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67900 |
Repair brow defect
|
$XXX.XX
|
A2
|
Y
|
| 67901 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67902 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67903 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67904 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67906 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67908 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67909 |
Revise eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67911 |
Revise eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67912 |
Correction eyelid w/implant
|
$XXX.XX
|
A2
|
Y
|
| 67914 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67915 |
Repair eyelid defect
|
$XXX.XX
|
P3
|
Y
|
| 67916 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67917 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67921 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67922 |
Repair eyelid defect
|
$XXX.XX
|
P3
|
Y
|
| 67923 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67924 |
Repair eyelid defect
|
$XXX.XX
|
A2
|
Y
|
| 67930 |
Repair eyelid wound
|
$XXX.XX
|
P3
|
Y
|
| 67935 |
Repair eyelid wound
|
$XXX.XX
|
A2
|
Y
|
| 67938 |
Remove eyelid foreign body
|
$XXX.XX
|
P2
|
Y
|
| 67950 |
Revision of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67961 |
Revision of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67966 |
Revision of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67971 |
Reconstruction of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67973 |
Reconstruction of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67974 |
Reconstruction of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 67975 |
Reconstruction of eyelid
|
$XXX.XX
|
A2
|
Y
|
| 68020 |
Incise/drain eyelid lining
|
$XXX.XX
|
P3
|
Y
|
| 68040 |
Treatment of eyelid lesions
|
$XXX.XX
|
P3
|
Y
|
| 68100 |
Biopsy conjunctiva
|
$XXX.XX
|
P3
|
Y
|
| 68110 |
Exc les conjunctiva <1 cm
|
$XXX.XX
|
P3
|
Y
|
| 68115 |
Exc les conjunctiva >1 cm
|
$XXX.XX
|
A2
|
Y
|
| 68130 |
Exc les conjunctiva adj scl
|
$XXX.XX
|
A2
|
Y
|
| 68135 |
Destruction les conjunctiva
|
$XXX.XX
|
P3
|
Y
|
| 68200 |
Treat eyelid by injection
|
$XXX.XX
|
N1
|
N
|
| 68320 |
Revise/graft eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68325 |
Revise/graft eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68326 |
Revise/graft eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68328 |
Revise/graft eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68330 |
Revise eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68335 |
Revise/graft eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68340 |
Separate eyelid adhesions
|
$XXX.XX
|
A2
|
Y
|
| 68360 |
Revise eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68362 |
Revise eyelid lining
|
$XXX.XX
|
A2
|
Y
|
| 68371 |
Harvest eye tissue alograft
|
$XXX.XX
|
A2
|
Y
|
| 68400 |
I&d lacrimal gland
|
$XXX.XX
|
P3
|
Y
|
| 68420 |
I&d lacrimal sac
|
$XXX.XX
|
P3
|
Y
|
| 68440 |
Snip inc lacrimal punctum
|
$XXX.XX
|
P3
|
Y
|
| 68500 |
Removal of tear gland
|
$XXX.XX
|
A2
|
Y
|
| 68505 |
Partial removal tear gland
|
$XXX.XX
|
A2
|
Y
|
| 68510 |
Biopsy of tear gland
|
$XXX.XX
|
A2
|
Y
|
| 68520 |
Removal of tear sac
|
$XXX.XX
|
A2
|
Y
|
| 68525 |
Biopsy of tear sac
|
$XXX.XX
|
A2
|
Y
|
| 68530 |
Clearance of tear duct
|
$XXX.XX
|
P2
|
Y
|
| 68540 |
Remove tear gland lesion
|
$XXX.XX
|
A2
|
Y
|
| 68550 |
Remove tear gland lesion
|
$XXX.XX
|
A2
|
Y
|
| 68700 |
Repair tear ducts
|
$XXX.XX
|
A2
|
Y
|
| 68705 |
Revise tear duct opening
|
$XXX.XX
|
P2
|
Y
|
| 68720 |
Create tear sac drain
|
$XXX.XX
|
A2
|
Y
|
| 68745 |
Create tear duct drain
|
$XXX.XX
|
A2
|
Y
|
| 68750 |
Create tear duct drain
|
$XXX.XX
|
A2
|
Y
|
| 68760 |
Close tear duct opening
|
$XXX.XX
|
P3
|
Y
|
| 68761 |
Close tear duct opening
|
$XXX.XX
|
P3
|
Y
|
| 68770 |
Close tear system fistula
|
$XXX.XX
|
A2
|
Y
|
| 68801 |
Dilate tear duct opening
|
$XXX.XX
|
N1
|
N
|
| 68810 |
Probe nasolacrimal duct
|
$XXX.XX
|
A2
|
Y
|
| 68811 |
Probe nasolacrimal duct
|
$XXX.XX
|
A2
|
Y
|
| 68815 |
Probe nasolacrimal duct
|
$XXX.XX
|
A2
|
Y
|
| 68816 |
Probe nl duct w/balloon
|
$XXX.XX
|
G2
|
Y
|
| 68840 |
Explore/irrigate tear ducts
|
$XXX.XX
|
P3
|
Y
|
| 68841 |
Insj rx elut implt lac canal
|
$XXX.XX
|
N1
|
N
|
| 68850 |
Injection for tear sac x-ray
|
$XXX.XX
|
N1
|
N
|
| 69000 |
Drg xtrnl ear absc/hem smpl
|
$XXX.XX
|
P3
|
Y
|
| 69005 |
Drg xtrnl ear absc/hem comp
|
$XXX.XX
|
P3
|
Y
|
| 69020 |
Drg xtrnl aud canal abscess
|
$XXX.XX
|
P3
|
Y
|
| 69100 |
Biopsy of external ear
|
$XXX.XX
|
P3
|
Y
|
| 69105 |
Biopsy of external ear canal
|
$XXX.XX
|
P3
|
Y
|
| 69110 |
Remove external ear partial
|
$XXX.XX
|
A2
|
Y
|
| 69120 |
Removal of external ear
|
$XXX.XX
|
A2
|
Y
|
| 69140 |
Remove ear canal lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 69145 |
Remove ear canal lesion(s)
|
$XXX.XX
|
A2
|
Y
|
| 69150 |
Extensive ear canal surgery
|
$XXX.XX
|
A2
|
Y
|
| 69200 |
Clear outer ear canal
|
$XXX.XX
|
N1
|
N
|
| 69205 |
Clear outer ear canal
|
$XXX.XX
|
A2
|
Y
|
| 69209 |
Remove impacted ear wax uni
|
$XXX.XX
|
N1
|
N
|
| 69210 |
Remove impacted ear wax uni
|
$XXX.XX
|
N1
|
N
|
| 69220 |
Clean out mastoid cavity
|
$XXX.XX
|
N1
|
N
|
| 69222 |
Clean out mastoid cavity
|
$XXX.XX
|
P3
|
Y
|
| 69300 |
Revise external ear
|
$XXX.XX
|
A2
|
Y
|
| 69310 |
Rebuild outer ear canal
|
$XXX.XX
|
A2
|
Y
|
| 69320 |
Rebuild outer ear canal
|
$XXX.XX
|
A2
|
Y
|
| 69420 |
Incision of eardrum
|
$XXX.XX
|
P2
|
Y
|
| 69421 |
Incision of eardrum
|
$XXX.XX
|
A2
|
Y
|
| 69424 |
Remove ventilating tube
|
$XXX.XX
|
P3
|
N
|
| 69433 |
Create eardrum opening
|
$XXX.XX
|
P3
|
Y
|
| 69436 |
Create eardrum opening
|
$XXX.XX
|
A2
|
Y
|
| 69440 |
Exploration of middle ear
|
$XXX.XX
|
A2
|
Y
|
| 69450 |
Eardrum revision
|
$XXX.XX
|
A2
|
Y
|
| 69501 |
Mastoidectomy
|
$XXX.XX
|
A2
|
Y
|
| 69502 |
Mastoidectomy
|
$XXX.XX
|
A2
|
Y
|
| 69505 |
Remove mastoid structures
|
$XXX.XX
|
A2
|
Y
|
| 69511 |
Extensive mastoid surgery
|
$XXX.XX
|
A2
|
Y
|
| 69530 |
Extensive mastoid surgery
|
$XXX.XX
|
A2
|
Y
|
| 69540 |
Excision aural polyp
|
$XXX.XX
|
P3
|
Y
|
| 69550 |
Exc aurl glomus tum trnscanl
|
$XXX.XX
|
A2
|
Y
|
| 69552 |
Exc aurl glomus tum trnsmstd
|
$XXX.XX
|
A2
|
Y
|
| 69601 |
Revj mstdc rsltg compl mstdc
|
$XXX.XX
|
A2
|
Y
|
| 69602 |
Rev mstdc rslt mod rad mstdc
|
$XXX.XX
|
A2
|
Y
|
| 69603 |
Revj mstdc rsltg rad mstdc
|
$XXX.XX
|
A2
|
Y
|
| 69604 |
Revj mstdc rsltg tympanplsty
|
$XXX.XX
|
A2
|
Y
|
| 69610 |
Tympanic membrane repair
|
$XXX.XX
|
P3
|
Y
|
| 69620 |
Myringoplasty
|
$XXX.XX
|
A2
|
Y
|
| 69631 |
Repair eardrum structures
|
$XXX.XX
|
A2
|
Y
|
| 69632 |
Rebuild eardrum structures
|
$XXX.XX
|
A2
|
Y
|
| 69633 |
Rebuild eardrum structures
|
$XXX.XX
|
A2
|
Y
|
| 69635 |
Repair eardrum structures
|
$XXX.XX
|
A2
|
Y
|
| 69636 |
Rebuild eardrum structures
|
$XXX.XX
|
A2
|
Y
|
| 69637 |
Rebuild eardrum structures
|
$XXX.XX
|
A2
|
Y
|
| 69641 |
Revise middle ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69642 |
Revise middle ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69643 |
Revise middle ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69644 |
Revise middle ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69645 |
Revise middle ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69646 |
Revise middle ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69650 |
Stapes mobilization
|
$XXX.XX
|
A2
|
Y
|
| 69660 |
Revise middle ear bone
|
$XXX.XX
|
A2
|
Y
|
| 69661 |
Revise middle ear bone
|
$XXX.XX
|
A2
|
Y
|
| 69662 |
Revise middle ear bone
|
$XXX.XX
|
A2
|
Y
|
| 69666 |
Repair middle ear structures
|
$XXX.XX
|
A2
|
Y
|
| 69667 |
Repair middle ear structures
|
$XXX.XX
|
A2
|
Y
|
| 69670 |
Remove mastoid air cells
|
$XXX.XX
|
A2
|
Y
|
| 69676 |
Remove middle ear nerve
|
$XXX.XX
|
A2
|
Y
|
| 69700 |
Close mastoid fistula
|
$XXX.XX
|
A2
|
Y
|
| 69705 |
Nps surg dilat eust tube uni
|
$XXX.XX
|
J8
|
Y
|
| 69706 |
Nps surg dilat eust tube bi
|
$XXX.XX
|
J8
|
Y
|
| 69711 |
Remove/repair hearing aid
|
$XXX.XX
|
A2
|
Y
|
| 69714 |
Impl oi implt skull perq esp
|
$XXX.XX
|
J8
|
Y
|
| 69716 |
Impl oi implt sk tc esp<100
|
$XXX.XX
|
J8
|
Y
|
| 69717 |
Rplcmt oi implt skl prq esp
|
$XXX.XX
|
J8
|
Y
|
| 69719 |
Rplcm oi implt sk tc esp<100
|
$XXX.XX
|
J8
|
Y
|
| 69720 |
Release facial nerve
|
$XXX.XX
|
A2
|
Y
|
| 69725 |
Release facial nerve
|
$XXX.XX
|
G2
|
Y
|
| 69726 |
Rmv ntr oi implt skl prq esp
|
$XXX.XX
|
G2
|
Y
|
| 69727 |
Rmv ntr oi imp sk tc esp<100
|
$XXX.XX
|
G2
|
Y
|
| 69728 |
Rmv ntr oi imp sk tc>=100
|
$XXX.XX
|
G2
|
Y
|
| 69729 |
Impl oi implt sk tc esp>=100
|
$XXX.XX
|
J8
|
Y
|
| 69730 |
Rplc oi implt sk tc esp>=100
|
$XXX.XX
|
J8
|
Y
|
| 69740 |
Repair facial nerve
|
$XXX.XX
|
A2
|
Y
|
| 69745 |
Repair facial nerve
|
$XXX.XX
|
A2
|
Y
|
| 69801 |
Incise inner ear
|
$XXX.XX
|
P3
|
Y
|
| 69805 |
Explore inner ear
|
$XXX.XX
|
A2
|
Y
|
| 69806 |
Explore inner ear
|
$XXX.XX
|
A2
|
Y
|
| 69905 |
Remove inner ear
|
$XXX.XX
|
A2
|
Y
|
| 69910 |
Remove inner ear & mastoid
|
$XXX.XX
|
A2
|
Y
|
| 69915 |
Incise inner ear nerve
|
$XXX.XX
|
A2
|
Y
|
| 69930 |
Implant cochlear device
|
$XXX.XX
|
J8
|
Y
|
| 69955 |
Release facial nerve
|
$XXX.XX
|
G2
|
Y
|
| 69960 |
Release inner ear canal
|
$XXX.XX
|
G2
|
Y
|
| 69970 |
Remove inner ear lesion
|
$XXX.XX
|
G2
|
Y
|
| 69990 |
Microsurgery add-on
|
$XXX.XX
|
N1
|
N
|
| 92920 |
Prq trluml c angiop 1art&/br
|
$XXX.XX
|
J8
|
Y
|
| 92921 |
Prq cardiac angio addl art
|
$XXX.XX
|
D5
|
N
|
| 92924 |
Prq trluml c athrc 1 art&/br
|
$XXX.XX
|
J8
|
Y
|
| 92928 |
Prq tcat plmt ntrac st 1 les
|
$XXX.XX
|
J8
|
Y
|
| 92929 |
Prq card stent w/angio addl
|
$XXX.XX
|
D5
|
N
|
| 92930 |
Prq tcat plmt ntrac st 2+les
|
$XXX.XX
|
J8
|
Y
|
| 92933 |
Prq trlml c athrc st angiop1
|
$XXX.XX
|
J8
|
Y
|
| 92937 |
Prq trluml revsc cab grf 1
|
$XXX.XX
|
J8
|
Y
|
| 92943 |
Prq trluml revsc ch occ ant
|
$XXX.XX
|
J8
|
Y
|
| 92944 |
Prq card revasc chronic addl
|
$XXX.XX
|
D5
|
N
|
| 92945 |
Prq trl rvs ch occ ant&rtrgr
|
$XXX.XX
|
J8
|
Y
|
| 92960 |
Cardioversion electric ext
|
$XXX.XX
|
G2
|
N
|
| 92961 |
Cardioversion electric int
|
$XXX.XX
|
G2
|
N
|
| 92973 |
Prq trluml c mchn asp thrmbc
|
$XXX.XX
|
N1
|
N
|
| 92974 |
Cath place cardio brachytx
|
$XXX.XX
|
N1
|
N
|
| 92978 |
Endoluminl ivus oct c 1st
|
$XXX.XX
|
N1
|
N
|
| 93451 |
Right heart cath
|
$XXX.XX
|
G2
|
Y
|
| 93452 |
Left hrt cath w/ventrclgrphy
|
$XXX.XX
|
G2
|
Y
|
| 93453 |
R&l hrt cath w/ventriclgrphy
|
$XXX.XX
|
G2
|
Y
|
| 93454 |
Coronary artery angio s&i
|
$XXX.XX
|
G2
|
Y
|
| 93455 |
Coronary art/grft angio s&i
|
$XXX.XX
|
G2
|
Y
|
| 93456 |
R hrt coronary artery angio
|
$XXX.XX
|
G2
|
Y
|
| 93457 |
R hrt art/grft angio
|
$XXX.XX
|
G2
|
Y
|
| 93458 |
L hrt artery/ventricle angio
|
$XXX.XX
|
G2
|
Y
|
| 93459 |
L hrt art/grft angio
|
$XXX.XX
|
G2
|
Y
|
| 93460 |
R&l hrt art/ventricle angio
|
$XXX.XX
|
G2
|
Y
|
| 93461 |
R&l hrt art/ventricle angio
|
$XXX.XX
|
G2
|
Y
|
| 93462 |
L hrt cath trnsptl puncture
|
$XXX.XX
|
N1
|
N
|
| 93566 |
Njx car cth slctv rv/ra ang
|
$XXX.XX
|
N1
|
N
|
| 93567 |
Njx car cth sprvlv aortgrphy
|
$XXX.XX
|
N1
|
N
|
| 93568 |
Njx car cth nslc p-art angrp
|
$XXX.XX
|
N1
|
N
|
| 93571 |
Iv dop vel&/press c flo 1st
|
$XXX.XX
|
N1
|
N
|
| 93572 |
Iv dop vel&/press c flo ea
|
$XXX.XX
|
N1
|
N
|
| 93650 |
Icar cath abltj av node func
|
$XXX.XX
|
J8
|
Y
|
| 93653 |
Compre ep eval tx svt
|
$XXX.XX
|
J8
|
Y
|
| 93654 |
Compre ep eval tx vt
|
$XXX.XX
|
J8
|
Y
|
| 93655 |
Icar cath abltj dscrt arrhyt
|
$XXX.XX
|
N1
|
N
|
| 93656 |
Compre ep eval abltj atr fib
|
$XXX.XX
|
J8
|
Y
|
| 93657 |
Tx l/r atrial fib addl
|
$XXX.XX
|
N1
|
N
|
| 93985 |
Dup-scan hemo compl bi std
|
$XXX.XX
|
P2
|
N
|
| 93986 |
Dup-scan hemo compl uni std
|
$XXX.XX
|
P2
|
N
|
| C5271 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5272 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5273 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5274 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5275 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5276 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5277 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C5278 |
Low cost skin substitute app
|
$XXX.XX
|
D5
|
N
|
| C7502 |
Perc bx breast lesions mr
|
$XXX.XX
|
G2
|
Y
|
| C7503 |
Open exc cerv node(s) w/ id
|
$XXX.XX
|
G2
|
Y
|
| C7504 |
Perq cvt&ls inj vert bodies
|
$XXX.XX
|
G2
|
Y
|
| C7505 |
Perq ls&cvt inj vert bodies
|
$XXX.XX
|
G2
|
Y
|
| C7506 |
Fusion of finger joints
|
$XXX.XX
|
G2
|
Y
|
| C7507 |
Perq thor&lumb vert aug
|
$XXX.XX
|
G2
|
Y
|
| C7508 |
Perq lumb&thor vert aug
|
$XXX.XX
|
G2
|
Y
|
| C7509 |
Dx bronch w/ navigation
|
$XXX.XX
|
G2
|
Y
|
| C7510 |
Bronch/lavag w/ navigation
|
$XXX.XX
|
G2
|
Y
|
| C7511 |
Bronch/bpsy(s) w/ navigation
|
$XXX.XX
|
G2
|
Y
|
| C7512 |
Bronch/bpsy(s) w/ ebus
|
$XXX.XX
|
G2
|
Y
|
| C7513 |
Cath/angio dialcir w/aplasty
|
$XXX.XX
|
G2
|
Y
|
| C7514 |
Cath/angio dial cir w/stents
|
$XXX.XX
|
G2
|
Y
|
| C7515 |
Cath/angio dial cir w/embol
|
$XXX.XX
|
G2
|
Y
|
| C7516 |
Cor angio w/ ivus or oct
|
$XXX.XX
|
G2
|
Y
|
| C7517 |
Cor angio w/ilic/fem angio
|
$XXX.XX
|
G2
|
Y
|
| C7518 |
Cor/gft angio w/ ivus or oct
|
$XXX.XX
|
G2
|
Y
|
| C7519 |
Cor/gft angio w/ flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7521 |
R hrt angio w/ ivus or oct
|
$XXX.XX
|
G2
|
Y
|
| C7522 |
R hrt angio w/flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7523 |
L hrt angio w/ ivus or oct
|
$XXX.XX
|
G2
|
Y
|
| C7524 |
L hrt angio w/flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7525 |
L hrt gft ang w/ ivus or oct
|
$XXX.XX
|
G2
|
Y
|
| C7526 |
L hrt gft ang w/flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7527 |
R&l hrt angio w/ ivus or oct
|
$XXX.XX
|
G2
|
Y
|
| C7528 |
R&l hrt angio w/flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7529 |
R&l hrt gft ang w/flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7532 |
Angio w/ us non-coronary
|
$XXX.XX
|
J8
|
Y
|
| C7537 |
Insrt atril pm w/l vent lead
|
$XXX.XX
|
J8
|
Y
|
| C7538 |
Insrt vent pm w/l vent lead
|
$XXX.XX
|
J8
|
Y
|
| C7539 |
Insrt a & v pm w/l vent lead
|
$XXX.XX
|
J8
|
Y
|
| C7545 |
Exch bil cath w/ rmv calculi
|
$XXX.XX
|
G2
|
Y
|
| C7547 |
Cnvrt neph cath w/ dil stric
|
$XXX.XX
|
G2
|
Y
|
| C7550 |
Cysto w/ bx(s) w/ blue light
|
$XXX.XX
|
G2
|
Y
|
| C7551 |
Exc neuroma w/ implnt nv end
|
$XXX.XX
|
G2
|
Y
|
| C7554 |
Cystureth blu li cyst fl img
|
$XXX.XX
|
G2
|
Y
|
| C7556 |
Bronch lavage w/ebus
|
$XXX.XX
|
G2
|
Y
|
| C7562 |
R&l hrt angio w/ffr & 3d map
|
$XXX.XX
|
G2
|
Y
|
| C7565 |
Rpr aa hrn < 3 rdc w/ rmvl
|
$XXX.XX
|
G2
|
Y
|
| C7566 |
Fuse finger joints w/grafts
|
$XXX.XX
|
G2
|
Y
|
| C7567 |
Bronch/needle bx(s) w/ nav
|
$XXX.XX
|
G2
|
Y
|
| C7568 |
Cor angio w/flow resrv
|
$XXX.XX
|
G2
|
Y
|
| C7569 |
Ptca w/ ivus or oct
|
$XXX.XX
|
J8
|
Y
|
| C7570 |
Cor angio w/ffr & 3d map
|
$XXX.XX
|
G2
|
Y
|
| C7571 |
Pcta w/ cor lithotrip
|
$XXX.XX
|
J8
|
Y
|
| C8002 |
Prep skin cell susp, automtd
|
$XXX.XX
|
G2
|
N
|
| C8003 |
Imp extar knee shck absrb
|
$XXX.XX
|
J8
|
Y
|
| C8004 |
Sim ang w/prs cath rad emb
|
$XXX.XX
|
J8
|
Y
|
| C8006 |
Inst pleu-perit shnt w pump
|
$XXX.XX
|
J8
|
Y
|
| C9600 |
Perc drug-el cor stent sing
|
$XXX.XX
|
J8
|
Y
|
| C9601 |
Perc drug-el cor stent bran
|
$XXX.XX
|
N1
|
N
|
| C9602 |
Perc d-e cor stent ather s
|
$XXX.XX
|
J8
|
Y
|
| C9603 |
Perc d-e cor stent ather br
|
$XXX.XX
|
N1
|
N
|
| C9604 |
Perc d-e cor revasc t cabg s
|
$XXX.XX
|
J8
|
Y
|
| C9605 |
Perc d-e cor revasc t cabg b
|
$XXX.XX
|
N1
|
N
|
| C9607 |
Perc d-e cor revasc chro sin
|
$XXX.XX
|
J8
|
Y
|
| C9608 |
Perc d-e cor revasc chro add
|
$XXX.XX
|
N1
|
N
|
| C9725 |
Place endorectal app
|
$XXX.XX
|
G2
|
Y
|
| C9726 |
Rxt breast appl place/remov
|
$XXX.XX
|
N1
|
N
|
| C9727 |
Insert palate implants
|
$XXX.XX
|
G2
|
Y
|
| C9728 |
Place device/marker, non pro
|
$XXX.XX
|
G2
|
N
|
| C9734 |
U/s trtmt, not leiomyomata
|
$XXX.XX
|
G2
|
Y
|
| C9739 |
Cystoscopy prostatic imp 1-3
|
$XXX.XX
|
J8
|
Y
|
| C9740 |
Cysto impl 4 or more
|
$XXX.XX
|
J8
|
Y
|
| C9751 |
Microwave bronch, 3d, ebus
|
$XXX.XX
|
D5
|
N
|
| C9757 |
Spine device implant surgery
|
$XXX.XX
|
J8
|
Y
|
| C9758 |
Blind interatrial shunt ide
|
$XXX.XX
|
J8
|
Y
|
| C9759 |
Transcath intraop microinf
|
$XXX.XX
|
N1
|
N
|
| C9760 |
Non-blind interatrial shunt
|
$XXX.XX
|
G2
|
Y
|
| C9761 |
Cysto, litho, vacuum kidney
|
$XXX.XX
|
J8
|
Y
|
| C9764 |
Revasc intravasc lithotripsy
|
$XXX.XX
|
J8
|
Y
|
| C9765 |
Revasc intra lithotrip-stent
|
$XXX.XX
|
J8
|
Y
|
| C9766 |
Revasc intra lithotrip-ather
|
$XXX.XX
|
J8
|
Y
|
| C9767 |
Revasc lithotrip-stent-ather
|
$XXX.XX
|
J8
|
Y
|
| C9772 |
Revasc lithotrip tibi/perone
|
$XXX.XX
|
J8
|
Y
|
| C9773 |
Revasc lithotr-stent tib/per
|
$XXX.XX
|
J8
|
Y
|
| C9774 |
Revasc lithotr-ather tib/per
|
$XXX.XX
|
J8
|
Y
|
| C9775 |
Revasc lith-sten-ath tib/per
|
$XXX.XX
|
J8
|
Y
|
| C9777 |
Esophag muc integ w/eso egd
|
$XXX.XX
|
J8
|
Y
|
| C9778 |
Colpopexy, min/inv, ex-perit
|
$XXX.XX
|
G2
|
Y
|
| C9779 |
Esd endoscopy or colonoscopy
|
$XXX.XX
|
G2
|
Y
|
| C9780 |
Insert cv cath inf & sup app
|
$XXX.XX
|
J8
|
N
|
| C9781 |
Arthro/shoul surg; w/spacer
|
$XXX.XX
|
J8
|
Y
|
| C9782 |
Blind myocar trpl bon marrow
|
$XXX.XX
|
J8
|
Y
|
| C9783 |
Blind cor sinus reducer impl
|
$XXX.XX
|
G2
|
Y
|
| C9784 |
Endo sleeve gastro w/tube
|
$XXX.XX
|
D5
|
N
|
| C9785 |
Endo outlet restrict w/tube
|
$XXX.XX
|
G2
|
Y
|
| C9789 |
Instill pharm renal pelvis
|
$XXX.XX
|
G2
|
Y
|
| C9792 |
Blind/nonblind trans atrial
|
$XXX.XX
|
G2
|
N
|
| C9796 |
Rpr intst excl anrect fist
|
$XXX.XX
|
J8
|
Y
|
| C9797 |
Vasc emb/occ w/prs cath
|
$XXX.XX
|
J8
|
Y
|
| C9901 |
Endo defect closure gi tract
|
$XXX.XX
|
J8
|
Y
|
| D4210 |
Gingivectomy/plasty 4 or mor
|
$XXX.XX
|
D2
|
Y
|
| D4211 |
Gingivectomy/plasty 1 to 3
|
$XXX.XX
|
D2
|
Y
|
| D4212 |
Gingivectomy/plasty rest
|
$XXX.XX
|
D2
|
Y
|
| D4260 |
Osseous surgery 4 or more
|
$XXX.XX
|
D2
|
Y
|
| D4263 |
Bone replce graft first site
|
$XXX.XX
|
D2
|
Y
|
| D4270 |
Pedicle soft tissue graft pr
|
$XXX.XX
|
D2
|
Y
|
| D4273 |
Auto tissue graft 1st tooth
|
$XXX.XX
|
D2
|
Y
|
| D7111 |
Extraction coronal remnants
|
$XXX.XX
|
D2
|
Y
|
| D7140 |
Extraction erupted tooth/exr
|
$XXX.XX
|
D2
|
Y
|
| D7210 |
Rem imp tooth w mucoper flp
|
$XXX.XX
|
D2
|
Y
|
| D7220 |
Impact tooth remov soft tiss
|
$XXX.XX
|
D2
|
Y
|
| D7230 |
Impact tooth remov part bony
|
$XXX.XX
|
D2
|
Y
|
| D7240 |
Impact tooth remov comp bony
|
$XXX.XX
|
D2
|
Y
|
| D7241 |
Impact tooth rem bony w/comp
|
$XXX.XX
|
D2
|
Y
|
| D7250 |
Tooth root removal
|
$XXX.XX
|
D2
|
Y
|
| D7251 |
Coronectomy
|
$XXX.XX
|
D2
|
Y
|
| D7270 |
Tooth reimplantation
|
$XXX.XX
|
D2
|
Y
|
| D7280 |
Exposure of unerupted tooth
|
$XXX.XX
|
D2
|
Y
|
| D7310 |
Alveoplasty w/ extraction
|
$XXX.XX
|
D2
|
Y
|
| D7311 |
Alveoloplasty w/extract 1-3
|
$XXX.XX
|
D2
|
Y
|
| D7320 |
Alveoplasty w/o extraction
|
$XXX.XX
|
D2
|
Y
|
| D7321 |
Alveoloplasty not w/extracts
|
$XXX.XX
|
D2
|
Y
|
| D7410 |
Rad exc lesion up to 1.25 cm
|
$XXX.XX
|
D2
|
Y
|
| D7411 |
Excision benign lesion>1.25c
|
$XXX.XX
|
D2
|
Y
|
| D7412 |
Excision benign lesion compl
|
$XXX.XX
|
D2
|
Y
|
| D7413 |
Excision malig lesion<=1.25c
|
$XXX.XX
|
D2
|
Y
|
| D7414 |
Excision malig lesion>1.25cm
|
$XXX.XX
|
D2
|
Y
|
| D7415 |
Excision malig les complicat
|
$XXX.XX
|
D2
|
Y
|
| D7440 |
Malig tumor exc to 1.25 cm
|
$XXX.XX
|
D2
|
Y
|
| D7441 |
Malig tumor > 1.25 cm
|
$XXX.XX
|
D2
|
Y
|
| D7450 |
Rem odontogen cyst to 1.25cm
|
$XXX.XX
|
D2
|
Y
|
| D7451 |
Rem odontogen cyst > 1.25 cm
|
$XXX.XX
|
D2
|
Y
|
| D7460 |
Rem nonodonto cyst to 1.25cm
|
$XXX.XX
|
D2
|
Y
|
| D7461 |
Rem nonodonto cyst > 1.25 cm
|
$XXX.XX
|
D2
|
Y
|
| D7471 |
Rem exostosis any site
|
$XXX.XX
|
D2
|
Y
|
| D7472 |
Removal of torus palatinus
|
$XXX.XX
|
D2
|
Y
|
| D7473 |
Remove torus mandibularis
|
$XXX.XX
|
D2
|
Y
|
| D7485 |
Surg reduct osseoustuberosit
|
$XXX.XX
|
D2
|
Y
|
| D7510 |
I&d absc intraoral soft tiss
|
$XXX.XX
|
D2
|
Y
|
| D7511 |
Incision/drain abscess intra
|
$XXX.XX
|
D2
|
Y
|
| D7520 |
I&d abscess extraoral
|
$XXX.XX
|
D2
|
Y
|
| D7521 |
Incision/drain abscess extra
|
$XXX.XX
|
D2
|
Y
|
| D7530 |
Removal fb skin/areolar tiss
|
$XXX.XX
|
D2
|
Y
|
| D7540 |
Removal of fb reaction
|
$XXX.XX
|
D2
|
Y
|
| D7550 |
Removal of sloughed off bone
|
$XXX.XX
|
D2
|
Y
|
| D7950 |
Mandible graft
|
$XXX.XX
|
D2
|
Y
|
| G0104 |
Ca screen;flexi sigmoidscope
|
$XXX.XX
|
P3
|
Y
|
| G0105 |
Colorectal scrn; hi risk ind
|
$XXX.XX
|
A2
|
Y
|
| G0121 |
Colon ca scrn not hi rsk ind
|
$XXX.XX
|
A2
|
Y
|
| G0186 |
Dstry eye lesn,fdr vssl tech
|
$XXX.XX
|
R2
|
Y
|
| G0260 |
Inj for sacroiliac jt anesth
|
$XXX.XX
|
A2
|
Y
|
| G0269 |
Occlusive device in vein art
|
$XXX.XX
|
N1
|
N
|
| G0276 |
Pild/placebo control clin tr
|
$XXX.XX
|
G2
|
Y
|
| G0330 |
Facility svs dental rehab
|
$XXX.XX
|
D2
|
Y
|
| G0412 |
Open tx iliac spine uni/bil
|
$XXX.XX
|
J8
|
Y
|
| G0413 |
Pelvic ring fracture uni/bil
|
$XXX.XX
|
J8
|
Y
|
| G0414 |
Pelvic ring fx treat int fix
|
$XXX.XX
|
J8
|
Y
|
| G0415 |
Open tx post pelvic fxcture
|
$XXX.XX
|
G2
|
Y
|
| G0429 |
Dermal filler injection(s)
|
$XXX.XX
|
P3
|
Y
|
| G0516 |
Insert drug del implant, >=4
|
$XXX.XX
|
N1
|
N
|
| G0517 |
Remove drug implant
|
$XXX.XX
|
N1
|
N
|
| G0518 |
Remove w insert drug implant
|
$XXX.XX
|
N1
|
N
|