CodeMap® Report 54163

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Commonly Associated Diagnosis Codes

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54163 not found in an Local Coverage Determination (LCD) for your contractor.
54163 not found in an Local Coverage Article (LCA) for your contractor.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report

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CCI Edits where 54163 appears in Column 1:

Column 2-Denied Codes (1) Effective Modifier
Accepted (2)

0213T NJX PARAVERT W/US CER/THOR
07/01/2010 XXXX

0216T NJX PARAVERT W/US LUMB/SAC
07/01/2010 XXXX

0596T TEMP FML IU VLV-PMP 1ST INSJ
01/01/2021 XXXX

0597T TEMP FML IU VALVE-PMP RPLCMT
01/01/2021 XXXX

0708T ID CA IMMNTX PREP & 1ST NJX
01/01/2022 XXXX

0709T ID CA IMMNTX EACH ADDL NJX
01/01/2022 XXXX

12001 RPR S/N/AX/GEN/TRNK 2.5CM/<
10/01/2012 XXXX

12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM
10/01/2012 XXXX

12004 RPR S/N/AX/GEN/TRK7.6-12.5CM
10/01/2012 XXXX

12005 RPR S/N/A/GEN/TRK12.6-20.0CM
10/01/2012 XXXX

12006 RPR S/N/A/GEN/TRK20.1-30.0CM
10/01/2012 XXXX

12007 RPR S/N/AX/GEN/TRNK >30.0 CM
10/01/2012 XXXX

12011 RPR F/E/E/N/L/M 2.5 CM/<
10/01/2012 XXXX

12013 RPR F/E/E/N/L/M 2.6-5.0 CM
10/01/2012 XXXX

12014 RPR F/E/E/N/L/M 5.1-7.5 CM
10/01/2012 XXXX

12015 RPR F/E/E/N/L/M 7.6-12.5 CM
10/01/2012 XXXX

12016 RPR FE/E/EN/L/M 12.6-20.0 CM
10/01/2012 XXXX

12017 RPR FE/E/EN/L/M 20.1-30.0 CM
10/01/2012 XXXX

12018 RPR F/E/E/N/L/M >30.0 CM
10/01/2012 XXXX

12020 TX SUPFC WND DEHSN SMPL CLSR
10/01/2012 XXXX

12021 TX SUPFC WND DEHSN W/PACKING
10/01/2012 XXXX

12031 INTMD RPR S/A/T/EXT 2.5 CM/<
10/01/2012 XXXX

12032 INTMD RPR S/A/T/EXT 2.6-7.5
10/01/2012 XXXX

12034 INTMD RPR S/TR/EXT 7.6-12.5
10/01/2012 XXXX

12035 INTMD RPR S/A/T/EXT 12.6-20
10/01/2012 XXXX

12036 INTMD RPR S/A/T/EXT 20.1-30
10/01/2012 XXXX

12037 INTMD RPR S/TR/EXT >30.0 CM
10/01/2012 XXXX

12041 INTMD RPR N-HF/GENIT 2.5CM/<
10/01/2012 XXXX

12042 INTMD RPR N-HF/GENIT2.6-7.5
10/01/2012 XXXX

12044 INTMD RPR N-HF/GENIT7.6-12.5
10/01/2012 XXXX

12045 INTMD RPR N-HF/GENIT12.6-20
10/01/2012 XXXX

12046 INTMD RPR N-HF/GENIT20.1-30
10/01/2012 XXXX

12047 INTMD RPR N-HF/GENIT >30.0CM
10/01/2012 XXXX

12051 INTMD RPR FACE/MM 2.5 CM/<
10/01/2012 XXXX

12052 INTMD RPR FACE/MM 2.6-5.0 CM
10/01/2012 XXXX

12053 INTMD RPR FACE/MM 5.1-7.5 CM
10/01/2012 XXXX

12054 INTMD RPR FACE/MM 7.6-12.5CM
10/01/2012 XXXX

12055 INTMD RPR FACE/MM 12.6-20 CM
10/01/2012 XXXX

12056 INTMD RPR FACE/MM 20.1-30.0
10/01/2012 XXXX

12057 INTMD RPR FACE/MM >30.0 CM
10/01/2012 XXXX

13100 CMPLX RPR TRUNK 1.1-2.5 CM
10/01/2012 XXXX

13101 CMPLX RPR TRUNK 2.6-7.5 CM
10/01/2012 XXXX

13102 CMPLX RPR TRUNK ADDL 5CM/<
10/01/2012 XXXX

13120 CMPLX RPR S/A/L 1.1-2.5 CM
10/01/2012 XXXX

13121 CMPLX RPR S/A/L 2.6-7.5 CM
10/01/2012 XXXX

13122 CMPLX RPR S/A/L ADDL 5 CM/>
10/01/2012 XXXX

13131 CMPLX RPR F/C/C/M/N/AX/G/H/F
10/01/2012 XXXX

13132 CMPLX RPR F/C/C/M/N/AX/G/H/F
10/01/2012 XXXX

13133 CMPLX RPR F/C/C/M/N/AX/G/H/F
10/01/2012 XXXX

13151 CMPLX RPR E/N/E/L 1.1-2.5 CM
10/01/2012 XXXX

13152 CMPLX RPR E/N/E/L 2.6-7.5 CM
10/01/2012 XXXX

13153 CMPLX RPR E/N/E/L ADDL 5CM/<
10/01/2012 XXXX

36000 PLACE NEEDLE IN VEIN
10/01/2002 XXXX

36400 VNPNXR<3YRS PHY/QHP FEM/JUG
04/01/2009 XXXX

36405 VNPNXR<3YRS PHY/QHP SCALP VN
04/01/2009 XXXX

36406 VNPNXR<3YRS PHY/QHP OTHER VN
04/01/2009 XXXX

36410 VNPNXR 3YR/> PHY/QHP DX/THER
10/01/2002 XXXX

36420 VENIPUNCTURE CUTDOWN < 1 YR
04/01/2009 XXXX

36425 VENIPUNCTURE CUTDOWN 1 YR/>
04/01/2009 XXXX

36430 TRANSFUSION BLD/BLD COMPNT
04/01/2009 XXXX

36440 BLD PUSH TFUJ 2 YR/<
04/01/2009 XXXX

36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 XXXX

36592 COLLECT BLOOD FROM PICC
10/01/2015 XXXX

36600 WITHDRAWAL OF ARTERIAL BLOOD
04/01/2009 XXXX

36640 INSERTION CATHETER ARTERY
04/01/2009 XXXX

43752 NASAL/OROGASTRIC W/TUBE PLMT
04/01/2009 XXXX

51701 INSERT BLADDER CATHETER
01/01/2003 XXXX

51702 INSERT TEMP BLADDER CATH
01/01/2003 XXXX

51703 INSERT BLADDER CATH COMPLEX
10/01/2007 XXXX

54000 SLITTING OF PREPUCE
01/01/2003 XXXX

54001 SLITTING OF PREPUCE
01/01/2003 XXXX

54100 BIOPSY OF PENIS
01/01/2003 XXXX

54162 LYSIS PENIL CIRCUMIC LESION
01/01/2003 XXXX

54164 FRENULOTOMY OF PENIS
01/01/2002 XXXX

62320 NJX INTERLAMINAR CRV/THRC
01/01/2017 XXXX

62321 NJX INTERLAMINAR CRV/THRC
01/01/2017 XXXX

62322 NJX INTERLAMINAR LMBR/SAC
01/01/2017 XXXX

62323 NJX INTERLAMINAR LMBR/SAC
01/01/2017 XXXX

62324 NJX INTERLAMINAR CRV/THRC
01/01/2017 XXXX

62325 NJX INTERLAMINAR CRV/THRC
01/01/2017 XXXX

62326 NJX INTERLAMINAR LMBR/SAC
01/01/2017 XXXX

62327 NJX INTERLAMINAR LMBR/SAC
01/01/2017 XXXX

64400 NJX AA&/STRD TRIGEMINAL NRV
04/01/2009 XXXX

64405 NJX AA&/STRD GR OCPL NRV
04/01/2009 XXXX

64408 NJX AA&/STRD VAGUS NRV
04/01/2009 XXXX

64415 NJX AA&/STRD BRCH PLXS IMG
10/01/2002 XXXX

64416 NJX AA&/STRD BRCH PL NFS IMG
01/01/2003 XXXX

64417 NJX AA&/STRD AX NERVE IMG
10/01/2002 XXXX

64418 NJX AA&/STRD SPRSCAP NRV
04/01/2009 XXXX

64420 NJX AA&/STRD NTRCOST NRV 1
04/01/2009 XXXX

64421 NJX AA&/STRD NTRCOST NRV EA
04/01/2009 XXXX

64425 NJX AA&/STRD II IH NERVES
04/01/2009 XXXX

64430 NJX AA&/STRD PUDENDAL NERVE
04/01/2009 XXXX

64435 NJX AA&/STRD PARACRV NRV
04/01/2009 XXXX

64445 NJX AA&/STRD SCIATIC NRV IMG
04/01/2009 XXXX

64446 NJX AA&/STRD SC NRV NFS IMG
04/01/2009 XXXX

64447 NJX AA&/STRD FEMORAL NRV IMG
04/01/2009 XXXX

64448 NJX AA&/STRD FEM NRV NFS IMG
04/01/2009 XXXX

64449 NJX AA&/STRD LMBR PLEX NFS
04/01/2009 XXXX

64450 NJX AA&/STRD OTHER PN/BRANCH
10/01/2002 XXXX

64451 NJX AA&/STRD NRV NRVTG SI JT
01/01/2020 XXXX

64454 NJX AA&/STRD GNCLR NRV BRNCH
01/01/2020 XXXX

64461 PVB THORACIC SINGLE INJ SITE
01/01/2016 XXXX

64462 PVB THORACIC 2ND+ INJ SITE
04/01/2017 XXXX

64463 PVB THORACIC CONT INFUSION
01/01/2016 XXXX

64466 THRC FASCIAL PLN BLK UNI NJX
04/01/2025 XXXX

64467 THRC FASCIAL PLN BLK UNI NFS
04/01/2025 XXXX

64468 THRC FASCIAL PLN BLK BI NJX
04/01/2025 XXXX

64469 THRC FASCIAL PLN BLK BI NFS
04/01/2025 XXXX

64473 LWR XTR FSCL PLN BLK UNI NJX
04/01/2025 XXXX

64474 LWR XTR FSCL PLN BLK UNI NFS
04/01/2025 XXXX

Column 2-Denied Codes (1) Effective Modifier
Accepted (2)

64479 NJX AA&/STRD TFRM EPI C/T 1
04/01/2009 XXXX

64480 NJX AA&/STRD TFRM EPI C/T EA
04/01/2017 XXXX

64483 NJX AA&/STRD TFRM EPI L/S 1
04/01/2009 XXXX

64484 NJX AA&/STRD TFRM EPI L/S EA
04/01/2017 XXXX

64486 TAP BLOCK UNIL BY INJECTION
01/01/2015 XXXX

64487 TAP BLOCK UNI BY INFUSION
01/01/2015 XXXX

64488 TAP BLOCK BI INJECTION
01/01/2015 XXXX

64489 TAP BLOCK BI BY INFUSION
01/01/2015 XXXX

64490 INJ PARAVERT F JNT C/T 1 LEV
01/01/2010 XXXX

64491 INJ PARAVERT F JNT C/T 2 LEV
04/01/2017 XXXX

64492 INJ PARAVERT F JNT C/T 3 LEV
04/01/2017 XXXX

64493 INJ PARAVERT F JNT L/S 1 LEV
01/01/2010 XXXX

64494 INJ PARAVERT F JNT L/S 2 LEV
04/01/2017 XXXX

64495 INJ PARAVERT F JNT L/S 3 LEV
04/01/2017 XXXX

64505 N BLOCK SPENOPALATINE GANGL
04/01/2009 XXXX

64510 N BLOCK STELLATE GANGLION
04/01/2009 XXXX

64517 N BLOCK INJ HYPOGAS PLXS
04/01/2009 XXXX

64520 N BLOCK LUMBAR/THORACIC
04/01/2009 XXXX

64530 N BLOCK INJ CELIAC PELUS
04/01/2009 XXXX

69990 MICROSURGERY ADD-ON
07/01/2002 XXXX

92012 INTRM OPH EXAM EST PATIENT
04/01/2014 XXXX

92014 COMPRE OPH EXAM EST PT 1/>
04/01/2014 XXXX

93000 ELECTROCARDIOGRAM COMPLETE
04/01/2009 XXXX

93005 ELECTROCARDIOGRAM TRACING
04/01/2009 XXXX

93010 ELECTROCARDIOGRAM REPORT
04/01/2009 XXXX

93040 RHYTHM ECG WITH REPORT
04/01/2009 XXXX

93041 RHYTHM ECG TRACING
04/01/2009 XXXX

93042 RHYTHM ECG REPORT
04/01/2009 XXXX

93318 ECHO TRANSESOPHAGEAL INTRAOP
04/01/2009 XXXX

93355 ECHO TRANSESOPHAGEAL (TEE)
01/01/2015 XXXX

94002 VENT MGMT INPAT INIT DAY
04/01/2009 XXXX

94200 LUNG FUNCTION TEST (MBC/MVV)
04/01/2009 XXXX

94680 EXHALED AIR ANALYSIS O2
04/01/2009 XXXX

94681 O2 UPTK EXP GAS ALYS W/CO2
04/01/2009 XXXX

94690 O2 UPTK EXP GAS ALYS REST
04/01/2009 XXXX

95812 EEG 41-60 MINUTES
04/01/2009 XXXX

95813 EEG EXTND MNTR 61-119 MIN
04/01/2009 XXXX

95816 EEG AWAKE AND DROWSY
04/01/2009 XXXX

95819 EEG AWAKE AND ASLEEP
04/01/2009 XXXX

95822 EEG COMA OR SLEEP ONLY
04/01/2009 XXXX

95829 SURGERY ELECTROCORTICOGRAM
04/01/2009 XXXX

95955 EEG DURING SURGERY
04/01/2009 XXXX

96360 HYDRATION IV INFUSION INIT
01/01/2009 XXXX

96361 HYDRATE IV INFUSION ADD-ON
04/01/2016 XXXX

96365 THER/PROPH/DIAG IV INF INIT
01/01/2009 XXXX

96366 THER/PROPH/DIAG IV INF ADDON
04/01/2016 XXXX

96367 TX/PROPH/DG ADDL SEQ IV INF
04/01/2016 XXXX

96368 THER/DIAG CONCURRENT INF
04/01/2016 XXXX

96372 THER/PROPH/DIAG INJ SC/IM
01/01/2009 XXXX

96374 THER/PROPH/DIAG INJ IV PUSH
01/01/2009 XXXX

96375 TX/PRO/DX INJ NEW DRUG ADDON
01/01/2009 XXXX

96376 TX/PRO/DX INJ SAME DRUG ADON
04/01/2009 XXXX

96377 APPLICATON ON-BODY INJECTOR
01/01/2017 XXXX

96523 IRRIG DRUG DELIVERY DEVICE
04/01/2019 XXXX

99155 MOD SED OTH PHYS/QHP <5 YRS
01/01/2017 XXXX

99156 MOD SED OTH PHYS/QHP 5/>YRS
01/01/2017 XXXX

99157 MOD SED OTHER PHYS/QHP EA
01/01/2017 XXXX

99211 OFF/OP EST MAY X REQ PHY/QHP
10/01/2020 XXXX

99212 OFFICE O/P EST SF 10 MIN
10/01/2020 XXXX

99213 OFFICE O/P EST LOW 20 MIN
10/01/2020 XXXX

99214 OFFICE O/P EST MOD 30 MIN
10/01/2020 XXXX

99215 OFFICE O/P EST HI 40 MIN
10/01/2020 XXXX

99221 1ST HOSP IP/OBS SF/LOW 40
10/01/2020 XXXX

99222 1ST HOSP IP/OBS MODERATE 55
10/01/2020 XXXX

99223 1ST HOSP IP/OBS HIGH 75
10/01/2020 XXXX

99231 SBSQ HOSP IP/OBS SF/LOW 25
10/01/2020 XXXX

99232 SBSQ HOSP IP/OBS MODERATE 35
10/01/2020 XXXX

99233 SBSQ HOSP IP/OBS HIGH 50
10/01/2020 XXXX

99234 HOSP IP/OBS SM DT SF/LOW 45
10/01/2020 XXXX

99235 HOSP IP/OBS SAME DATE MOD 70
10/01/2020 XXXX

99236 HOSP IP/OBS SAME DATE HI 85
10/01/2020 XXXX

99238 HOSP IP/OBS DSCHRG MGMT 30/<
10/01/2020 XXXX

99239 HOSP IP/OBS DSCHRG MGMT >30
10/01/2020 XXXX

99242 OFF/OP CONSLTJ NEW/EST SF 20
07/01/2013 XXXX

99243 OFF/OP CNSLTJ NEW/EST LOW 30
07/01/2013 XXXX

99244 OFF/OP CNSLTJ NEW/EST MOD 40
07/01/2013 XXXX

99245 OFF/OP CONSLTJ NEW/EST HI 55
07/01/2013 XXXX

99252 IP/OBS CONSLTJ NEW/EST SF 35
07/01/2013 XXXX

99253 IP/OBS CNSLTJ NEW/EST LOW 45
07/01/2013 XXXX

99254 IP/OBS CNSLTJ NEW/EST MOD 60
07/01/2013 XXXX

99255 IP/OBS CONSLTJ NEW/EST HI 80
07/01/2013 XXXX

99291 CRITICAL CARE FIRST HOUR
10/01/2020 XXXX

99292 CRITICAL CARE ADDL 30 MIN
10/01/2020 XXXX

99304 1ST NF CARE SF/LOW MDM 25
10/01/2020 XXXX

99305 1ST NF CARE MODERATE MDM 35
10/01/2020 XXXX

99306 1ST NF CARE HIGH MDM 50
10/01/2020 XXXX

99307 SBSQ NF CARE SF MDM 10
10/01/2020 XXXX

99308 SBSQ NF CARE LOW MDM 20
10/01/2020 XXXX

99309 SBSQ NF CARE MODERATE MDM 30
10/01/2020 XXXX

99310 SBSQ NF CARE HIGH MDM 45
10/01/2020 XXXX

99315 NF DSCHRG MGMT 30 MIN/LESS
10/01/2020 XXXX

99316 NF DSCHRG MGMT 30 MIN+
10/01/2020 XXXX

99347 HOME/RES VST EST SF MDM 20
10/01/2020 XXXX

99348 HOME/RES VST EST LOW MDM 30
10/01/2020 XXXX

99349 HOME/RES VST EST MOD MDM 40
10/01/2020 XXXX

99350 HOME/RES VST EST HIGH MDM 60
10/01/2020 XXXX

99374 HOME HEALTH CARE SUPERVISION
07/01/2013 XXXX

99375 HOME HEALTH CARE SUPERVISION
07/01/2013 XXXX

99377 HOSPICE CARE SUPERVISION
07/01/2013 XXXX

99378 HOSPICE CARE SUPERVISION
07/01/2013 XXXX

99446 NTRPROF PH1/NTRNET/EHR 5-10
01/01/2014 XXXX

99447 NTRPROF PH1/NTRNET/EHR 11-20
01/01/2014 XXXX

99448 NTRPROF PH1/NTRNET/EHR 21-30
01/01/2014 XXXX

99449 NTRPROF PH1/NTRNET/EHR 31/>
01/01/2014 XXXX

99451 NTRPROF PH1/NTRNET/EHR 5/>
01/01/2019 XXXX

99452 NTRPROF PH1/NTRNET/EHR RFRL
01/01/2019 XXXX

99495 TRANSJ CARE MGMT MOD F2F 14D
10/01/2020 XXXX

99496 TRANSJ CARE MGMT HIGH F2F 7D
10/01/2020 XXXX

G0463 Hxxxxxxx xxxxx xxxxxx xxxxx
07/01/2014 XXXX

G0471 Vxx xxxxx xxxx xxx/xxx
07/01/2015 XXXX

(1) These codes will be denied when submitted for payment on the same date of service as 54163.
(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.

CCI Edits where 54163 appears in Column 2 (a):

Column 1 Codes Effective Modifier
Accepted (b)

54150 CIRCUMCISION W/REGIONL BLOCK 01/01/2003 XXXX

54160 CIRCUMCISION NEONATE 01/01/2003 XXXX

54161 CIRCUM 28 DAYS OR OLDER 01/01/2003 XXXX

(a) 54163 will be denied when submitted for payment on the same date of service as the Column 1 codes listed in this table.
(b) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that 54163 will always be denied.

Medically Unlikely Edits for 54163

Practitioner Hospital Outpatient DME Supplier

Allowed Frequency per Day: XXXX XXXX XXXX

Adjudication Indicator: XXXX XXXX XXXX

Rationale: XXXX XXXX XXXX

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.

Medicare Part B Utilization Data for 54163* Hide this section.

Total National Services (all modifiers) Submitted 2023: 208
Total Services Denied 2023: 15 (7.2%)
National Charges Submitted 2023: $ 279,619.63	National Charges Allowed 2023: $ 55,182.52

Click here for more information on Custom CodeMap Medicare Utililation Reports.

*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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05/09/2025 12:46:44 18.118.122.239

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