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99201
Quick jump to procedure code: Printer Friendly Version
99203

CPT® 99202: OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; STRAIGHTFORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PHYSICIANS, OTHER QUALIFIED HEALTH CARE PROFESSIONALS, OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE OF LOW TO MODERATE SEVERITY. TYPICALLY, 20 MINUTES ARE SPENT FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY.

Short Description: Office/outpatient visit new

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$ 75.60
$ 50.88


*Based on National 2013 Medicare Part B submitted claims.

2016 OPPS Status Indicator: B

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
4.0% 729.5    Pain in limb M79.609   Pain in unspecified limb
3.7% 702.0    Actinic keratosis L57.0   Actinic keratosis
3.5% 238.2    Neoplasm of uncertain behavior of skin D48.5   Neoplasm of uncertain behavior of skin
2.3% 702.19    Other seborrheic keratosis L82.1   Other seborrheic keratosis
1.9% 110.1    Dermatophytosis of nail B35.1   Tinea unguium
1.8% 692.9    Contact dermatitis and other eczema, unspecified cause L25.9   Unspecified contact dermatitis, unspecified cause
1.5% 702.11    Inflamed seborrheic keratosis L82.0   Inflamed seborrheic keratosis
1.3% 173.3    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
1.3% 380.4    Impacted cerumen H61.23   Impacted cerumen, bilateral
1.0% 703.0    Ingrowing nail L60.0   Ingrowing nail

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

99202 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 99202

CCI and MUE Edits*         Hide this section.

CCI Edits for 99202
Denied Codes (1)
Effective
Modifier
Accepted (2)
00100 Anesth salivary gland
01/01/1996 No
00102 Anesth repair of cleft lip
01/01/1996 No
00103 Anesth blepharoplasty
01/01/1996 No
00104 Anesth electroshock
01/01/1996 No
00120 Anesth ear surgery
01/01/1996 No
00124 Anesth ear exam
01/01/1996 No
00126 Anesth tympanotomy
01/01/1996 No
00140 Anesth procedures on eye
01/01/1996 No
00142 Anesth lens surgery
01/01/1996 No
00144 Anesth corneal transplant
01/01/1996 No
00145 Anesth vitreoretinal surg
01/01/1996 No
00147 Anesth iridectomy
01/01/1996 No
00148 Anesth eye exam
01/01/1996 No
00160 Anesth nose/sinus surgery
01/01/1996 No
00162 Anesth nose/sinus surgery
01/01/1996 No
00164 Anesth biopsy of nose
01/01/1996 No
00170 Anesth procedure on mouth
01/01/1996 No
00172 Anesth cleft palate repair
01/01/1996 No
00174 Anesth pharyngeal surgery
01/01/1996 No
00176 Anesth pharyngeal surgery
01/01/1996 No
00190 Anesth face/skull bone surg
01/01/1996 No
00192 Anesth facial bone surgery
01/01/1996 No
00210 Anesth cranial surg nos
01/01/1996 No
00211 Anesth cran surg hemotoma
01/01/2009 No
00212 Anesth skull drainage
01/01/1996 No
00214 Anesth skull drainage
01/01/1996 No
00215 Anesth skull repair/fract
01/01/1996 No
00216 Anesth head vessel surgery
01/01/1996 No
00218 Anesth special head surgery
01/01/1996 No
00220 Anesth intrcrn nerve
01/01/1996 No
00222 Anesth head nerve surgery
01/01/1996 No
00300 Anesth head/neck/ptrunk
01/01/1996 No
00320 Anesth neck organ 1yr/>
01/01/1996 No
00322 Anesth biopsy of thyroid
01/01/1996 No
00326 Anesth larynx/trach < 1 yr
01/01/2003 No
00350 Anesth neck vessel surgery
01/01/1996 No
00352 Anesth neck vessel surgery
01/01/1996 No
00400 Anesth skin ext/per/atrunk
01/01/1996 No
00402 Anesth surgery of breast
01/01/1996 No
00404 Anesth surgery of breast
01/01/1996 No
00406 Anesth surgery of breast
01/01/1996 No
00410 Anesth correct heart rhythm
01/01/1996 No
00450 Anesth surgery of shoulder
01/01/1996 No
00454 Anesth collar bone biopsy
01/01/1996 No
00470 Anesth removal of rib
01/01/1996 No
00472 Anesth chest wall repair
01/01/1996 No
00474 Anesth surgery of rib
01/01/1996 No
00500 Anesth esophageal surgery
01/01/1996 No
00520 Anesth chest procedure
01/01/1996 No
00522 Anesth chest lining biopsy
01/01/1996 No
00524 Anesth chest drainage
01/01/1996 No
00528 Anes mediascpy & dx thorscpy
01/01/1996 No
00529 Anes medscpy&thorscpy 1 lung
01/01/2004 No
00530 Anesth pacemaker insertion
01/01/1996 No
00532 Anesth vascular access
01/01/1996 No
00534 Anesth cardioverter/defib
01/01/1996 No
00537 Anesth cardiac electrophys
10/01/2001 No
00539 Anesth trach-bronch reconst
01/01/2003 No
00540 Anesth chest surgery
01/01/1996 No
00541 Anesth one lung ventilation
01/01/2003 No
00542 Anesthesia removal pleura
01/01/1996 No
00546 Anesth lung chest wall surg
01/01/1996 No
00548 Anesth trachea bronchi surg
01/01/1996 No
00550 Anesth sternal debridement
10/01/2001 No
00560 Anesth heart surg w/o pump
01/01/1996 No
00561 Anesth heart surg <1 yr
01/01/2005 No
00562 Anesth hrt surg w/pmp age 1+
01/01/1996 No
00563 Anesth heart surg w/arrest
10/01/2001 No
00566 Anesth cabg w/o pump
10/01/2001 No
00567 Anesth cabg w/pump
01/01/2009 No
00580 Anesth heart/lung transplnt
01/01/1996 No
00600 Anesth spine cord surgery
01/01/1996 No
00604 Anesth sitting procedure
01/01/1996 No
00620 Anesth spine cord surgery
01/01/1996 No
00625 Anes spine tranthor w/o vent
01/01/2007 No
00626 Anes spine transthor w/vent
01/01/2007 No
00630 Anesth spine cord surgery
01/01/1996 No
00632 Anesth removal of nerves
01/01/1996 No
00635 Anesth lumbar puncture
10/01/2001 No
00640 Anesth spine manipulation
01/01/2003 No
00670 Anesth spine cord surgery
01/01/1996 No
00700 Anesth abdominal wall surg
01/01/1996 No
00702 Anesth for liver biopsy
01/01/1996 No
00730 Anesth abdominal wall surg
01/01/1996 No
00740 Anesth upper gi visualize
01/01/1996 No
00750 Anesth repair of hernia
01/01/1996 No
00752 Anesth repair of hernia
01/01/1996 No
00754 Anesth repair of hernia
01/01/1996 No
00756 Anesth repair of hernia
01/01/1996 No
00770 Anesth blood vessel repair
01/01/1996 No
00790 Anesth surg upper abdomen
01/01/1996 No
00792 Anesth hemorr/excise liver
01/01/1996 No
00794 Anesth pancreas removal
01/01/1996 No
00796 Anesth for liver transplant
01/01/1996 No
00797 Anesth surgery for obesity
01/01/2002 No
00800 Anesth abdominal wall surg
01/01/1996 No
00802 Anesth fat layer removal
01/01/1996 No
00810 Anesth low intestine scope
01/01/1996 No
00820 Anesth abdominal wall surg
01/01/1996 No
00830 Anesth repair of hernia
01/01/1996 No
00832 Anesth repair of hernia
01/01/1996 No
00834 Anesth hernia repair < 1 yr
01/01/2003 No
00836 Anesth hernia repair preemie
01/01/2003 No
00840 Anesth surg lower abdomen
01/01/1996 No
00842 Anesth amniocentesis
01/01/1996 No
00844 Anesth pelvis surgery
01/01/1996 No
00846 Anesth hysterectomy
01/01/1996 No
00848 Anesth pelvic organ surg
01/01/1996 No
00851 Anesth tubal ligation
01/01/2002 No
00860 Anesth surgery of abdomen
01/01/1996 No
00862 Anesth kidney/ureter surg
01/01/1996 No
00864 Anesth removal of bladder
01/01/1996 No
00865 Anesth removal of prostate
04/01/1998 No
00866 Anesth removal of adrenal
01/01/1996 No
00868 Anesth kidney transplant
01/01/1996 No
00870 Anesth bladder stone surg
01/01/1996 No
00872 Anesth kidney stone destruct
01/01/1996 No
00873 Anesth kidney stone destruct
01/01/1996 No
00880 Anesth abdomen vessel surg
01/01/1996 No
00882 Anesth major vein ligation
01/01/1996 No
00902 Anesth anorectal surgery
01/01/1996 No
00904 Anesth perineal surgery
01/01/1996 No
00906 Anesth removal of vulva
01/01/1996 No
00908 Anesth removal of prostate
01/01/1996 No
00910 Anesth bladder surgery
01/01/1996 No
00912 Anesth bladder tumor surg
01/01/1996 No
00914 Anesth removal of prostate
01/01/1996 No
00916 Anesth bleeding control
01/01/1996 No
00918 Anesth stone removal
01/01/1996 No
00920 Anesth genitalia surgery
01/01/1996 No
00921 Anesth vasectomy
01/01/2003 No
00922 Anesth sperm duct surgery
01/01/1996 No
00924 Anesth testis exploration
01/01/1996 No
00926 Anesth removal of testis
01/01/1996 No
00928 Anesth removal of testis
01/01/1996 No
00930 Anesth testis suspension
01/01/1996 No
00932 Anesth amputation of penis
01/01/1996 No
00934 Anesth penis nodes removal
01/01/1996 No
00936 Anesth penis nodes removal
01/01/1996 No
00938 Anesth insert penis device
01/01/1996 No
00940 Anesth vaginal procedures
01/01/1996 No
00942 Anesth surg on vag/urethral
01/01/1996 No
00944 Anesth vaginal hysterectomy
01/01/1996 No
00948 Anesth repair of cervix
01/01/1996 No
00950 Anesth vaginal endoscopy
01/01/1996 No
00952 Anesth hysteroscope/graph
01/01/1996 No
01112 Anesth bone aspirate/bx
10/01/2001 No
01120 Anesth pelvis surgery
01/01/1996 No
01130 Anesth body cast procedure
01/01/1996 No
01140 Anesth amputation at pelvis
01/01/1996 No
01150 Anesth pelvic tumor surgery
01/01/1996 No
01160 Anesth pelvis procedure
01/01/1996 No
01170 Anesth pelvis surgery
01/01/1996 No
01173 Anesth fx repair pelvis
01/01/2004 No
01180 Anesth pelvis nerve removal
01/01/1996 No
01190 Anesth pelvis nerve removal
01/01/1996 No
01200 Anesth hip joint procedure
01/01/1996 No
01202 Anesth arthroscopy of hip
01/01/1996 No
01210 Anesth hip joint surgery
01/01/1996 No
01212 Anesth hip disarticulation
01/01/1996 No
01214 Anesth hip arthroplasty
01/01/1996 No
01215 Anesth revise hip repair
10/01/2001 No
01220 Anesth procedure on femur
01/01/1996 No
01230 Anesth surgery of femur
01/01/1996 No
01232 Anesth amputation of femur
01/01/1996 No
01234 Anesth radical femur surg
01/01/1996 No
01250 Anesth upper leg surgery
01/01/1996 No
01260 Anesth upper leg veins surg
01/01/1996 No
01270 Anesth thigh arteries surg
01/01/1996 No
01272 Anesth femoral artery surg
01/01/1996 No
01274 Anesth femoral embolectomy
01/01/1996 No
01320 Anesth knee area surgery
01/01/1996 No
01340 Anesth knee area procedure
01/01/1996 No
01360 Anesth knee area surgery
01/01/1996 No
01380 Anesth knee joint procedure
01/01/1996 No
01382 Anesth dx knee arthroscopy
01/01/1996 No
01390 Anesth knee area procedure
01/01/1996 No
01392 Anesth knee area surgery
01/01/1996 No
01400 Anesth knee joint surgery
01/01/1996 No
01402 Anesth knee arthroplasty
01/01/1996 No
01404 Anesth amputation at knee
01/01/1996 No
01420 Anesth knee joint casting
01/01/1996 No
01430 Anesth knee veins surgery
01/01/1996 No
01432 Anesth knee vessel surg
01/01/1996 No
01440 Anesth knee arteries surg
01/01/1996 No
01442 Anesth knee artery surg
01/01/1996 No
01444 Anesth knee artery repair
01/01/1996 No
01462 Anesth lower leg procedure
01/01/1996 No
01464 Anesth ankle/ft arthroscopy
01/01/1996 No
01470 Anesth lower leg surgery
01/01/1996 No
01472 Anesth achilles tendon surg
01/01/1996 No
01474 Anesth lower leg surgery
01/01/1996 No
01480 Anesth lower leg bone surg
01/01/1996 No
01482 Anesth radical leg surgery
01/01/1996 No
01484 Anesth lower leg revision
01/01/1996 No
01486 Anesth ankle replacement
01/01/1996 No
01490 Anesth lower leg casting
01/01/1996 No
01500 Anesth leg arteries surg
01/01/1996 No
01502 Anesth lwr leg embolectomy
01/01/1996 No
01520 Anesth lower leg vein surg
01/01/1996 No
01522 Anesth lower leg vein surg
01/01/1996 No
01610 Anesth surgery of shoulder
01/01/1996 No
01620 Anesth shoulder procedure
01/01/1996 No
01622 Anes dx shoulder arthroscopy
01/01/1996 No
01630 Anesth surgery of shoulder
01/01/1996 No
01634 Anesth shoulder joint amput
01/01/1996 No
01636 Anesth forequarter amput
01/01/1996 No
01638 Anesth shoulder replacement
01/01/1996 No
01650 Anesth shoulder artery surg
01/01/1996 No
01652 Anesth shoulder vessel surg
01/01/1996 No
01654 Anesth shoulder vessel surg
01/01/1996 No
01656 Anesth arm-leg vessel surg
01/01/1996 No
01670 Anesth shoulder vein surg
01/01/1996 No
01680 Anesth shoulder casting
01/01/1996 No
01682 Anesth airplane cast
01/01/1996 No
01710 Anesth elbow area surgery
01/01/1996 No
01712 Anesth uppr arm tendon surg
01/01/1996 No
01714 Anesth uppr arm tendon surg
01/01/1996 No
01716 Anesth biceps tendon repair
01/01/1996 No
01730 Anesth uppr arm procedure
01/01/1996 No
01732 Anesth dx elbow arthroscopy
01/01/1996 No
01740 Anesth upper arm surgery
01/01/1996 No
01742 Anesth humerus surgery
01/01/1996 No
01744 Anesth humerus repair
01/01/1996 No
01756 Anesth radical humerus surg
01/01/1996 No
01758 Anesth humeral lesion surg
01/01/1996 No
01760 Anesth elbow replacement
01/01/1996 No
01770 Anesth uppr arm artery surg
01/01/1996 No
01772 Anesth uppr arm embolectomy
01/01/1996 No
01780 Anesth upper arm vein surg
01/01/1996 No
01782 Anesth uppr arm vein repair
01/01/1996 No
01810 Anesth lower arm surgery
01/01/1996 No
01820 Anesth lower arm procedure
01/01/1996 No
01829 Anesth dx wrist arthroscopy
01/01/2003 No
01830 Anesth lower arm surgery
01/01/1996 No
01832 Anesth wrist replacement
01/01/1996 No
01840 Anesth lwr arm artery surg
01/01/1996 No
01842 Anesth lwr arm embolectomy
01/01/1996 No
01844 Anesth vascular shunt surg
01/01/1996 No
01850 Anesth lower arm vein surg
01/01/1996 No
01852 Anesth lwr arm vein repair
01/01/1996 No
01860 Anesth lower arm casting
01/01/1996 No
01916 Anesth dx arteriography
01/01/2002 No
01920 Anesth catheterize heart
07/01/2009 No
01922 Anesth cat or mri scan
07/01/2009 No
01924 Anes ther interven rad artrl
01/01/2002 No
01925 Anes ther interven rad card
01/01/2002 No
01926 Anes tx interv rad hrt/cran
01/01/2002 No
01930 Anes ther interven rad vein
01/01/2002 No
01931 Anes ther interven rad tips
01/01/2002 No
01932 Anes tx interv rad th vein
01/01/2002 No
01933 Anes tx interv rad cran vein
01/01/2002 No
01935 Anesth perc img dx sp proc
01/01/2008 No
01936 Anesth perc img tx sp proc
01/01/2008 No
01951 Anesth burn less 4 percent
10/01/2001 No
01952 Anesth burn 4-9 percent
10/01/2001 No
01958 Anesth antepartum manipul
01/01/2004 No
01960 Anesth vaginal delivery
01/01/2002 No
01961 Anesth cs delivery
01/01/2002 No
01962 Anesth emer hysterectomy
01/01/2002 No
01963 Anesth cs hysterectomy
01/01/2002 No
01965 Anesth inc/missed ab proc
01/01/2006 No
01966 Anesth induced ab procedure
01/01/2006 No
01967 Anesth/analg vag delivery
01/01/2002 No
01968 Anes/analg cs deliver add-on
01/01/2002 No
01969 Anesth/analg cs hyst add-on
01/01/2002 No
01990 Support for organ donor
07/01/2009 No
01991 Anesth nerve block/inj
01/01/2003 No
01992 Anesth n block/inj prone
01/01/2003 No
0394T Hdr elctrnc skn surf brchytx
01/01/2016 Yes
0395T Hdr elctr ntrst/ntrcv brchtx
01/01/2016 Yes
36511 Apheresis wbc
01/01/2003 Yes
36512 Apheresis rbc
01/01/2003 Yes
36513 Apheresis platelets
01/01/2003 Yes
36514 Apheresis plasma
01/01/2003 Yes
36515 Apheresis adsorp/reinfuse
01/01/2003 Yes
36516 Apheresis selective
01/01/2003 Yes
37211 Thrombolytic art therapy
01/01/2013 Yes
37212 Thrombolytic venous therapy
01/01/2013 Yes
37213 Thromblytic art/ven therapy
01/01/2013 Yes
37214 Cessj therapy cath removal
01/01/2013 Yes
38206 Harvest auto stem cells
01/01/2003 Yes
59400 Obstetrical care
01/01/2011 Yes
59410 Obstetrical care
01/01/2011 Yes
59425 Antepartum care only
01/01/2011 Yes
59426 Antepartum care only
01/01/2011 Yes
59430 Care after delivery
07/01/2012 Yes
59510 Cesarean delivery
01/01/2011 Yes
59515 Cesarean delivery
01/01/2011 Yes
59610 Vbac delivery
01/01/2011 Yes
59614 Vbac care after delivery
01/01/2011 Yes
59618 Attempted vbac delivery
01/01/2011 Yes
59622 Attempted vbac after care
01/01/2011 Yes
61645 Perq art m-thrombect &/nfs
01/01/2016 Yes
77261 Radiation therapy planning
01/01/1996 Yes
77262 Radiation therapy planning
01/01/1996 Yes
77263 Radiation therapy planning
01/01/1996 Yes
77280 Set radiation therapy field
01/01/2002 Yes
77285 Set radiation therapy field
01/01/2002 Yes
77290 Set radiation therapy field
01/01/2002 Yes
77293 Respirator motion mgmt simul
01/01/2014 Yes
77295 3-d radiotherapy plan
01/01/2002 Yes
77300 Radiation therapy dose plan
01/01/2006 Yes
77301 Radiotherapy dose plan imrt
01/01/2002 Yes
77306 Telethx isodose plan simple
01/01/2015 Yes
77307 Telethx isodose plan cplx
01/01/2015 Yes
77316 Brachytx isodose plan simple
01/01/2015 Yes
77317 Brachytx isodose intermed
01/01/2015 Yes
77318 Brachytx isodose complex
01/01/2015 Yes
77321 Special teletx port plan
01/01/2006 Yes
77331 Special radiation dosimetry
01/01/2006 Yes
77332 Radiation treatment aid(s)
01/01/2006 Yes
77333 Radiation treatment aid(s)
01/01/2006 Yes
77334 Radiation treatment aid(s)
01/01/2006 Yes
77336 Radiation physics consult
01/01/2006 Yes
77338 Design mlc device for imrt
01/01/2010 Yes
77370 Radiation physics consult
01/01/2006 Yes
77371 Srs multisource
01/01/2007 Yes
77372 Srs linear based
01/01/2007 Yes
77373 Sbrt delivery
01/01/2007 Yes
77401 Radiation treatment delivery
01/01/1996 Yes
77402 Radiation treatment delivery
01/01/1996 Yes
77407 Radiation treatment delivery
01/01/1996 Yes
77412 Radiation treatment delivery
01/01/1996 Yes
77417 Radiology port images(s)
01/01/1996 Yes
77422 Neutron beam tx simple
01/01/2006 Yes
77423 Neutron beam tx complex
01/01/2006 Yes
77424 Io rad tx delivery by x-ray
01/01/2012 Yes
77425 Io rad tx deliver by elctrns
01/01/2012 Yes
77427 Radiation tx management x5
06/05/2000 Yes
77431 Radiation therapy management
01/01/1996 Yes
77432 Stereotactic radiation trmt
01/01/1996 Yes
77435 Sbrt management
01/01/2007 Yes
77469 Io radiation tx management
01/01/2016 Yes
77470 Special radiation treatment
01/01/1996 Yes
77520 Proton trmt simple w/o comp
01/01/2006 Yes
77522 Proton trmt simple w/comp
01/01/2006 Yes
77523 Proton trmt intermediate
01/01/2006 Yes
77525 Proton treatment complex
01/01/2006 Yes
77600 Hyperthermia treatment
07/01/1999 Yes
77605 Hyperthermia treatment
07/01/1999 Yes
77610 Hyperthermia treatment
07/01/1999 Yes
77615 Hyperthermia treatment
07/01/1999 Yes
77620 Hyperthermia treatment
07/01/1999 Yes
77750 Infuse radioactive materials
01/01/1996 Yes
77761 Apply intrcav radiat simple
01/01/1996 Yes
77762 Apply intrcav radiat interm
01/01/1996 Yes
77763 Apply intrcav radiat compl
01/01/1996 Yes
77767 Hdr rdncl skn surf brachytx
01/01/2016 Yes
77768 Hdr rdncl skn surf brachytx
01/01/2016 Yes
77778 Apply interstit radiat compl
01/01/1996 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
77789 Apply surf ldr radionuclide
01/01/1996 Yes
77790 Radiation handling
01/01/1996 Yes
90460 Im admin 1st/only component
01/01/2013 Yes
90461 Im admin each addl component
01/01/2013 Yes
90471 Immunization admin
01/01/2013 Yes
90472 Immunization admin each add
01/01/2013 Yes
90473 Immune admin oral/nasal
01/01/2013 Yes
90474 Immune admin oral/nasal addl
01/01/2013 Yes
90791 Psych diagnostic evaluation
01/01/2013 No
90792 Psych diag eval w/med srvcs
01/01/2013 No
90832 Psytx pt&/family 30 minutes
01/01/2014 No
90834 Psytx pt&/family 45 minutes
01/01/2013 No
90837 Psytx pt&/family 60 minutes
01/01/2013 No
90845 Psychoanalysis
01/01/1996 No
90846 Family psytx w/o patient
01/01/2002 Yes
90847 Family psytx w/patient
01/01/2002 Yes
90849 Multiple family group psytx
01/01/2002 Yes
90853 Group psychotherapy
01/01/2002 Yes
90865 Narcosynthesis
01/01/2002 No
90867 Tcranial magn stim tx plan
01/01/2012 Yes
90868 Tcranial magn stim tx deli
01/01/2012 Yes
90869 Tcran magn stim redetemine
01/01/2012 Yes
90880 Hypnotherapy
01/01/2002 No
90935 Hemodialysis one evaluation
01/01/2007 Yes
90937 Hemodialysis repeated eval
01/01/2007 Yes
90945 Dialysis one evaluation
01/01/2007 Yes
90947 Dialysis repeated eval
01/01/2007 Yes
90951 Esrd serv 4 visits p mo <2yr
01/01/2013 Yes
90952 Esrd serv 2-3 vsts p mo <2yr
01/01/2013 Yes
90953 Esrd serv 1 visit p mo <2yrs
01/01/2013 Yes
90954 Esrd serv 4 vsts p mo 2-11
01/01/2013 Yes
90955 Esrd srv 2-3 vsts p mo 2-11
01/01/2013 Yes
90956 Esrd srv 1 visit p mo 2-11
01/01/2013 Yes
90957 Esrd srv 4 vsts p mo 12-19
01/01/2013 Yes
90958 Esrd srv 2-3 vsts p mo 12-19
01/01/2013 Yes
90959 Esrd serv 1 vst p mo 12-19
01/01/2013 Yes
90960 Esrd srv 4 visits p mo 20+
01/01/2013 Yes
90961 Esrd srv 2-3 vsts p mo 20+
01/01/2013 Yes
90962 Esrd serv 1 visit p mo 20+
01/01/2013 Yes
90963 Esrd home pt serv p mo <2yrs
01/01/2013 Yes
90964 Esrd home pt serv p mo 2-11
01/01/2013 Yes
90965 Esrd home pt serv p mo 12-19
01/01/2013 Yes
90966 Esrd home pt serv p mo 20+
01/01/2013 Yes
90967 Esrd home pt serv p day <2
01/01/2013 Yes
90968 Esrd home pt srv p day 2-11
01/01/2013 Yes
90969 Esrd home pt srv p day 12-19
01/01/2013 Yes
90970 Esrd home pt serv p day 20+
01/01/2013 Yes
93015 Cardiovascular stress test
01/01/2011 Yes
93016 Cardiovascular stress test
01/01/2011 Yes
93017 Cardiovascular stress test
01/01/2011 Yes
93018 Cardiovascular stress test
01/01/2011 Yes
94010 Breathing capacity test
01/01/2014 Yes
94011 Spirometry up to 2 yrs old
01/01/2014 Yes
94012 Spirmtry w/brnchdil inf-2 yr
01/01/2014 Yes
94013 Meas lung vol thru 2 yrs
01/01/2014 Yes
94014 Patient recorded spirometry
01/01/2014 Yes
94015 Patient recorded spirometry
01/01/2014 Yes
94016 Review patient spirometry
01/01/2014 Yes
94060 Evaluation of wheezing
01/01/2014 Yes
94070 Evaluation of wheezing
01/01/2014 Yes
94150 Vital capacity test
01/01/2014 Yes
94200 Lung function test (mbc/mvv)
01/01/2014 Yes
94250 Expired gas collection
01/01/2014 Yes
94375 Respiratory flow volume loop
01/01/2014 Yes
94400 Co2 breathing response curve
01/01/2014 Yes
94450 Hypoxia response curve
01/01/2014 Yes
94452 Hast w/report
01/01/2014 Yes
94453 Hast w/oxygen titrate
01/01/2014 Yes
94610 Surfactant admin thru tube
01/01/2014 Yes
94620 Pulmonary stress test/simple
01/01/2014 Yes
94621 Pulm stress test/complex
01/01/2014 Yes
94640 Airway inhalation treatment
01/01/2014 Yes
94642 Aerosol inhalation treatment
01/01/2014 Yes
94644 Cbt 1st hour
01/01/2014 Yes
94645 Cbt each addl hour
01/01/2014 Yes
94664 Evaluate pt use of inhaler
01/01/2014 Yes
94667 Chest wall manipulation
01/01/2014 Yes
94668 Chest wall manipulation
01/01/2014 Yes
94669 Mechanical chest wall oscill
01/01/2014 Yes
94680 Exhaled air analysis o2
01/01/2014 Yes
94681 Exhaled air analysis o2/co2
01/01/2014 Yes
94690 Exhaled air analysis
01/01/2014 Yes
94726 Pulm funct tst plethysmograp
01/01/2014 Yes
94727 Pulm function test by gas
01/01/2014 Yes
94728 Pulm funct test oscillometry
01/01/2014 Yes
94729 Co/membane diffuse capacity
01/01/2014 Yes
94750 Pulmonary compliance study
01/01/2014 Yes
94760 Measure blood oxygen level
01/01/2014 Yes
94761 Measure blood oxygen level
01/01/2014 Yes
94762 Measure blood oxygen level
01/01/2014 Yes
94770 Exhaled carbon dioxide test
01/01/2014 Yes
94772 Breath recording infant
01/01/2014 Yes
94774 Ped home apnea rec compl
01/01/2014 Yes
94775 Ped home apnea rec hk-up
01/01/2014 Yes
94776 Ped home apnea rec downld
01/01/2014 Yes
94777 Ped home apnea rec report
01/01/2014 Yes
94780 Car seat/bed test 60 min
01/01/2014 Yes
94781 Car seat/bed test + 30 min
01/01/2014 Yes
95004 Percut allergy skin tests
01/01/2008 Yes
95012 Exhaled nitric oxide meas
01/01/2008 Yes
95017 Perq & icut allg test venoms
01/01/2013 Yes
95018 Perq&ic allg test drugs/biol
01/01/2013 Yes
95024 Icut allergy test drug/bug
01/01/2008 Yes
95027 Icut allergy titrate-airborn
01/01/2008 Yes
95028 Icut allergy test-delayed
01/01/2008 Yes
95044 Allergy patch tests
01/01/2008 Yes
95052 Photo patch test
01/01/2008 Yes
95056 Photosensitivity tests
01/01/2008 Yes
95060 Eye allergy tests
01/01/2008 Yes
95065 Nose allergy test
01/01/2008 Yes
95070 Bronchial allergy tests
01/01/2008 Yes
95071 Bronchial allergy tests
01/01/2008 Yes
95076 Ingest challenge ini 120 min
01/01/2013 Yes
95079 Ingest challenge addl 60 min
01/01/2013 Yes
95115 Immunotherapy one injection
04/01/2014 Yes
95117 Immunotherapy injections
04/01/2014 Yes
95120 Immunotherapy one injection
04/01/2014 Yes
95125 Immunotherapy 2/> injections
04/01/2014 Yes
95130 Immntx 1 sting insect
04/01/2014 Yes
95131 Immntx 2 sting insects
04/01/2014 Yes
95132 Immntx 3 sting insects
04/01/2014 Yes
95133 Immntx 4 sting insects
04/01/2014 Yes
95134 Immntx 5 sting insects
04/01/2014 Yes
95144 Antigen therapy services
04/01/2014 Yes
95145 Antigen therapy services
04/01/2014 Yes
95146 Antigen therapy services
04/01/2014 Yes
95147 Antigen therapy services
04/01/2014 Yes
95148 Antigen therapy services
04/01/2014 Yes
95149 Antigen therapy services
04/01/2014 Yes
95165 Antigen therapy services
04/01/2014 Yes
95170 Antigen therapy services
04/01/2014 Yes
95180 Rapid desensitization
04/01/2014 Yes
96111 Developmental test extend
01/01/2004 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
96369 Sc ther infusion up to 1 hr
01/01/2009 Yes
96372 Ther/proph/diag inj sc/im
01/01/2009 Yes
96373 Ther/proph/diag inj ia
01/01/2009 Yes
96374 Ther/proph/diag inj iv push
01/01/2009 Yes
96401 Chemo anti-neopl sq/im
01/01/2006 Yes
96402 Chemo hormon antineopl sq/im
01/01/2006 Yes
96405 Chemo intralesional up to 7
01/01/2006 Yes
96406 Chemo intralesional over 7
01/01/2006 Yes
96409 Chemo iv push sngl drug
01/01/2006 Yes
96413 Chemo iv infusion 1 hr
01/01/2006 Yes
96416 Chemo prolong infuse w/pump
01/01/2006 Yes
96420 Chemo ia push tecnique
01/01/2004 Yes
96422 Chemo ia infusion up to 1 hr
01/01/2004 Yes
96425 Chemotherapy infusion method
01/01/2004 Yes
96440 Chemotherapy intracavitary
01/01/2006 Yes
96446 Chemotx admn prtl cavity
01/01/2011 Yes
96450 Chemotherapy into cns
01/01/2006 Yes
96521 Refill/maint portable pump
01/01/2006 Yes
96522 Refill/maint pump/resvr syst
01/01/2006 Yes
96542 Chemotherapy injection
01/01/2006 Yes
97001 Pt evaluation
04/01/1998 Yes
97002 Pt re-evaluation
04/01/1998 Yes
97003 Ot evaluation
07/01/2001 Yes
97004 Ot re-evaluation
07/01/2001 Yes
97810 Acupunct w/o stimul 15 min
01/01/2013 Yes
97811 Acupunct w/o stimul addl 15m
01/01/2013 Yes
97813 Acupunct w/stimul 15 min
01/01/2013 Yes
97814 Acupunct w/stimul addl 15m
01/01/2013 Yes
98925 Osteopath manj 1-2 regions
01/01/2005 Yes
98926 Osteopath manj 3-4 regions
01/01/2005 Yes
98927 Osteopath manj 5-6 regions
01/01/2005 Yes
98928 Osteopath manj 7-8 regions
01/01/2005 Yes
98929 Osteopath manj 9-10 regions
01/01/2005 Yes
98940 Chiropract manj 1-2 regions
01/01/2006 Yes
98941 Chiropract manj 3-4 regions
01/01/2006 Yes
98942 Chiropractic manj 5 regions
01/01/2006 Yes
98943 Chiropract manj xtrspinl 1/>
01/01/2006 Yes
99143 Mod sedat phys/qhp <5 yrs
04/01/2006 Yes
99144 Mod sedat phys/qhp 5yrs/>
04/01/2006 Yes
99148 Mod sed diff phys/qhp<5 yrs
04/01/2006 No
99149 Mod sed diff phys/qhp 5/>yrs
04/01/2006 No
99183 Hyperbaric oxygen therapy
10/01/2015 Yes
0359T Behavioral id assessment
10/01/2014 Yes
0360T Observ behav assessment
10/01/2014 Yes
0361T Observ behav assess addl
10/01/2014 Yes
0362T Expose behav assessment
10/01/2014 Yes
0363T Expose behav assess addl
10/01/2014 Yes
0364T Adaptive behavior treatment
10/01/2014 Yes
0365T Adaptive behavior tx addl
10/01/2014 Yes
0366T Group behavior treatment
10/01/2014 Yes
0367T Group behav treatment addl
10/01/2014 Yes
0368T Behavior treatment modified
10/01/2014 Yes
0369T Behav treatment modify addl
10/01/2014 Yes
0370T Fam behav treatment guidance
10/01/2014 Yes
0371T Mult fam behav treat guide
10/01/2014 Yes
0372T Social skills training group
10/01/2014 Yes
0373T Exposure behavior treatment
10/01/2014 Yes
0374T Expose behav treatment addl
10/01/2014 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
43752 Nasal/orogastric w/tube plmt
01/01/2004 Yes
80500 Lab pathology consultation
10/30/2000 No
80502 Lab pathology consultation
10/30/2000 No
90863 Pharmacologic mgmt w/psytx
01/01/2013 No
90940 Hemodialysis access study
04/01/2002 No
92002 Eye exam new patient
04/01/2003 No
92004 Eye exam new patient
04/01/2003 No
92012 Eye exam establish patient
04/01/2003 No
92014 Eye exam&tx estab pt 1/>vst
04/01/2003 No
92227 Remote dx retinal imaging
01/01/2011 Yes
92228 Remote retinal imaging mgmt
01/01/2011 Yes
92531 Spontaneous nystagmus study
01/01/2009 No
92532 Positional nystagmus test
01/01/2009 No
93561 Cardiac output measurement
04/01/2008 Yes
93562 Card output measure subsq
04/01/2008 Yes
94002 Vent mgmt inpat init day
01/01/2007 No
94003 Vent mgmt inpat subq day
01/01/2007 No
94004 Vent mgmt nf per day
01/01/2007 No
94660 Pos airway pressure cpap
01/01/2016 No
94662 Neg press ventilation cnp
01/01/2016 No
95831 Limb muscle testing manual
04/01/2001 No
95832 Hand muscle testing manual
04/01/2001 No
95833 Body muscle testing manual
04/01/2001 No
95834 Body muscle testing manual
04/01/2001 No
95851 Range of motion measurements
04/01/2001 No
95852 Range of motion measurements
04/01/2001 No
96020 Functional brain mapping
01/01/2007 Yes
96101 Psycho testing by psych/phys
10/01/2010 Yes
96102 Psycho testing by technician
10/01/2010 Yes
96103 Psycho testing admin by comp
10/01/2010 Yes
96105 Assessment of aphasia
10/01/2010 Yes
96116 Neurobehavioral status exam
01/01/2006 Yes
96118 Neuropsych tst by psych/phys
10/01/2010 Yes
96119 Neuropsych testing by tec
10/01/2010 Yes
96120 Neuropsych tst admin w/comp
10/01/2010 Yes
96125 Cognitive test by hc pro
10/01/2010 Yes
96150 Assess hlth/behave init
01/01/2002 No
96151 Assess hlth/behave subseq
01/01/2002 No
96152 Intervene hlth/behave indiv
01/01/2002 No
96153 Intervene hlth/behave group
01/01/2002 No
96154 Interv hlth/behav fam w/pt
01/01/2002 No
96523 Irrig drug delivery device
01/01/2006 No
97802 Medical nutrition indiv in
01/01/2002 No
97803 Med nutrition indiv subseq
01/01/2002 No
97804 Medical nutrition group
01/01/2002 No
99172 Ocular function screen
04/01/2014 No
99173 Visual acuity screen
07/01/2016 Yes
99201 Office/outpatient visit new
04/01/2007 No
99211 Office/outpatient visit est
07/01/2014 Yes
99212 Office/outpatient visit est
07/01/2014 Yes
99213 Office/outpatient visit est
07/01/2014 Yes
99214 Office/outpatient visit est
07/01/2014 Yes
99215 Office/outpatient visit est
07/01/2014 Yes
99408 Audit/dast 15-30 min
04/01/2011 No
99409 Audit/dast over 30 min
04/01/2011 No
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99463 Same day nb discharge
01/01/2009 No
99605 Mtms by pharm np 15 min
01/01/2008 Yes
99606 Mtms by pharm est 15 min
01/01/2008 Yes
G0102 Prostate ca screening; dre
06/05/2000 No
G0117 Glaucoma scrn hgh risk direc
01/01/2002 No
G0118 Glaucoma scrn hgh risk direc
01/01/2002 No
G0245 Initial foot exam pt lops
07/01/2002 No
G0246 Followup eval of foot pt lop
07/01/2002 No
G0248 Demonstrate use home inr mon
10/01/2002 Yes
G0250 Md inr test revie inter mgmt
10/01/2002 Yes
G0270 Mnt subs tx for change dx
07/01/2003 No
G0271 Group mnt 2 or more 30 mins
07/01/2003 No
G0396 Alcohol/subs interv 15-30mn
04/01/2011 Yes
G0397 Alcohol/subs interv >30 min
04/01/2011 Yes
G0442 Annual alcohol screen 15 min
07/01/2012 Yes
G0443 Brief alcohol misuse counsel
07/01/2012 Yes
G0444 Depression screen annual
10/01/2012 Yes
G0445 High inten beh couns std 30m
07/01/2012 Yes
G0446 Intens behave ther cardio dx
07/01/2012 Yes
G0447 Behavior counsel obesity 15m
07/01/2012 Yes
G0459 Telehealth inpt pharm mgmt
10/01/2013 No
G0473 Group behave couns 2-10
07/01/2015 Yes
99203 Office/outpatient visit new
04/01/2007 No
99204 Office/outpatient visit new
04/01/2007 No
99205 Office/outpatient visit new
04/01/2007 No
99218 Initial observation care
10/01/2002 Yes
99219 Initial observation care
10/01/2002 Yes
99220 Initial observation care
10/01/2002 Yes
99221 Initial hospital care
04/01/2009 Yes
99222 Initial hospital care
04/01/2009 Yes
99223 Initial hospital care
04/01/2009 Yes
99224 Subsequent observation care
01/01/2011 Yes
99225 Subsequent observation care
01/01/2011 Yes
99226 Subsequent observation care
01/01/2011 Yes
99234 Observ/hosp same date
10/01/2002 Yes
99235 Observ/hosp same date
10/01/2002 Yes
99236 Observ/hosp same date
10/01/2002 Yes
99238 Hospital discharge day
10/01/2013 No
99239 Hospital discharge day
10/01/2013 No
99304 Nursing facility care init
07/01/2006 No
99305 Nursing facility care init
07/01/2006 No
99306 Nursing facility care init
07/01/2006 No
99455 Work related disability exam
01/01/1997 No
99456 Disability examination
01/01/1997 No
99466 Ped crit care transport
01/01/2009 No
99468 Neonate crit care initial
01/01/2009 Yes
99469 Neonate crit care subsq
01/01/2009 No
99471 Ped critical care initial
01/01/2009 Yes
99472 Ped critical care subsq
01/01/2009 No
99475 Ped crit care age 2-5 init
01/01/2009 Yes
99476 Ped crit care age 2-5 subsq
01/01/2009 No
99477 Init day hosp neonate care
01/01/2008 No
99478 Ic lbw inf < 1500 gm subsq
01/01/2009 No
99479 Ic lbw inf 1500-2500 g subsq
01/01/2009 No
99480 Ic inf pbw 2501-5000 g subsq
01/01/2009 No
99485 Suprv interfacilty transport
01/01/2013 No
99486 Suprv interfac trnsport addl
01/01/2013 No
C8957 Prolonged iv inf, req pump
01/01/2006 Yes
G0101 Ca screen;pelvic/breast exam
04/01/1998 Yes
G0104 Ca screen;flexi sigmoidscope
04/01/1998 Yes
G0105 Colorectal scrn; hi risk ind
04/01/1998 Yes
G0106 Colon ca screen;barium enema
04/01/1998 Yes
G0120 Colon ca scrn; barium enema
04/01/1998 Yes
G0121 Colon ca scrn not hi rsk ind
04/01/2002 Yes
G0302 Pre-op service lvrs complete
01/01/2005 Yes
G0303 Pre-op service lvrs 10-15dos
01/01/2005 Yes
G0304 Pre-op service lvrs 1-9 dos
01/01/2005 Yes
G0305 Post op service lvrs min 6
01/01/2005 Yes
G0337 Hospice evaluation preelecti
01/01/2005 No
G0339 Robot lin-radsurg com, first
07/01/2004 No
G0340 Robt lin-radsurg fractx 2-5
07/01/2004 No
G0402 Initial preventive exam
01/01/2010 Yes
G0410 Grp psych partial hosp 45-50
01/01/2010 Yes
G0411 Inter active grp psych parti
01/01/2010 Yes
G0438 Ppps, initial visit
07/01/2011 Yes
G0439 Ppps, subseq visit
07/01/2011 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G6002 Stereoscopic x-ray guidance
01/01/2015 Yes
G6003 Radiation treatment delivery
01/01/2015 Yes
G6004 Radiation treatment delivery
01/01/2015 Yes
G6005 Radiation treatment delivery
01/01/2015 Yes
G6006 Radiation treatment delivery
01/01/2015 Yes
G6007 Radiation treatment delivery
01/01/2015 Yes
G6008 Radiation treatment delivery
01/01/2015 Yes
G6009 Radiation treatment delivery
01/01/2015 Yes
G6010 Radiation treatment delivery
01/01/2015 Yes
G6011 Radiation treatment delivery
01/01/2015 Yes
G6012 Radiation treatment delivery
01/01/2015 Yes
G6013 Radiation treatment delivery
01/01/2015 Yes
G6014 Radiation treatment delivery
01/01/2015 Yes
G6015 Radiation tx delivery imrt
01/01/2015 Yes
G6016 Delivery comp imrt
01/01/2015 No
G6017 Intrafraction track motion
01/01/2015 Yes
P3000 Screen pap by tech w md supv
04/01/1998 Yes
P3001 Screening pap smear by phys
04/01/1999 Yes
Q0091 Obtaining screen pap smear
01/01/1998 Yes
Q2043 Sipuleucel-t auto cd54+
07/01/2011 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 99202.

(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.


Medically Unlikely Edits for 99202


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Clinical: Data CMS Policy Not Listed

* 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.


   99202 Top 5 Ordering Providers National*
KEITH GROSS -VICTORVILLE,CA 1,501
ANTHONY PERRI -CONROE,TX 1,171
JAMES TURNER -BARTLETT,TN 1,113
THOMAS BURKE -NEWARK,DE 904
JEFFREY MARCUS -BOCA RATON,FL 861

   99202 Top 5 Ordering Organizations National*
HEATHER A. DOWNES, M.D., P.C., L.L.C.-IL 54
DIANE M PHALEN-TX 35
RICHARD C CONNORS MD PC-CT 17

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 99202*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 3,410,748
Total Services Denied 2015: 455,241 (13.3%)
National Charges Submitted 2015: $435,189,477.00
National Charges Allowed 2015: $207,163,991.00
National Average (No Modifier) Fee Submitted 2015: $131.19
National Average (No Modifier) Fee Allowed 2015: $ 69.68
National Average (26) Fee Submitted 2015: $152.00
National Average (26) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Dermatology 753,554 22.1% $120.53 44,577 5.9%
Podiatry 421,684 12.4% $113.81 32,628 7.7%
Physician assistant
(eff 5/92)
266,647 7.8% $127.64 24,973 9.4%
Family practice 255,973 7.5% $133.63 30,827 12.0%
Nurse practitioner 239,218 7.0% $119.03 27,784 11.6%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 2,936,055 86.1% $126.39 393,989 13.4%
Outpatient hospital 331,567 9.7% $129.57 39,730 12.0%
Urgent Care Facility (eff. 1/1/03) 125,535 3.7% $149.54 16,013 12.8%
Ambulatory surgical center 4,681 0.1% $153.89 804 17.2%
Emergency room - hospital 2,425 0.1% $157.93 428 17.6%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 2,076,271 60.9% $131.19 221,504 10.7%
25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure 1,200,341 35.2% $121.90 176,401 14.7%
GY 37,224 1.1% $ 74.89 37,224 100.0%
GC 25,356 0.7% $157.57 2,720 10.7%
57 - Decision for Surgery 24,765 0.7% $136.68 2,238 9.0%

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.



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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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