| Procedure |
Short Descriptor |
Unadjusted 2020 OPPS Fee Schedule |
Status Indicator |
APC |
| 0058T |
Cryopreservation ovary tiss
|
$XXX.XX
|
Q1
|
5672
|
| 0071T |
Us leiomyomata ablate <200
|
$XXX.XX
|
J1
|
5414
|
| 0072T |
Us leiomyomata ablate >200
|
$XXX.XX
|
J1
|
5414
|
| 0100T |
Prosth retina receive&gen
|
$XXX.XX
|
T
|
1908
|
| 0101T |
Extracorp shockwv tx hi enrg
|
$XXX.XX
|
J1
|
5113
|
| 0102T |
Extracorp shockwv tx anesth
|
$XXX.XX
|
J1
|
5113
|
| 0106T |
Touch quant sensory test
|
$XXX.XX
|
Q1
|
5732
|
| 0107T |
Vibrate quant sensory test
|
$XXX.XX
|
Q1
|
5732
|
| 0108T |
Cool quant sensory test
|
$XXX.XX
|
Q1
|
5733
|
| 0109T |
Heat quant sensory test
|
$XXX.XX
|
Q1
|
5732
|
| 0110T |
Nos quant sensory test
|
$XXX.XX
|
Q1
|
5734
|
| 0126T |
Chd risk imt study
|
$XXX.XX
|
Q1
|
5731
|
| 0184T |
Exc rectal tumor endoscopic
|
$XXX.XX
|
J1
|
5331
|
| 0191T |
Insert ant segment drain int
|
$XXX.XX
|
J1
|
5492
|
| 0198T |
Ocular blood flow measure
|
$XXX.XX
|
Q1
|
5734
|
| 0200T |
Perq sacral augmt unilat inj
|
$XXX.XX
|
J1
|
5114
|
| 0201T |
Perq sacral augmt bilat inj
|
$XXX.XX
|
J1
|
5114
|
| 0207T |
Clear eyelid gland w/heat
|
$XXX.XX
|
Q1
|
5733
|
| 0208T |
Audiometry air only
|
$XXX.XX
|
Q1
|
5732
|
| 0209T |
Audiometry air & bone
|
$XXX.XX
|
Q1
|
5732
|
| 0210T |
Speech audiometry threshold
|
$XXX.XX
|
Q1
|
5732
|
| 0211T |
Speech audiom thresh & recog
|
$XXX.XX
|
Q1
|
5732
|
| 0212T |
Compre audiometry evaluation
|
$XXX.XX
|
Q1
|
5721
|
| 0213T |
Njx paravert w/us cer/thor
|
$XXX.XX
|
T
|
5443
|
| 0216T |
Njx paravert w/us lumb/sac
|
$XXX.XX
|
T
|
5443
|
| 0221T |
Plmt post facet implt lumb
|
$XXX.XX
|
J1
|
5114
|
| 0228T |
Njx tfrml eprl w/us cer/thor
|
$XXX.XX
|
T
|
5443
|
| 0230T |
Njx tfrml eprl w/us lumb/sac
|
$XXX.XX
|
T
|
5443
|
| 0232T |
Njx platelet plasma
|
$XXX.XX
|
Q1
|
5735
|
| 0234T |
Trluml perip athrc renal art
|
$XXX.XX
|
J1
|
5193
|
| 0236T |
Trluml perip athrc abd aorta
|
$XXX.XX
|
J1
|
5193
|
| 0237T |
Trluml perip athrc brchiocph
|
$XXX.XX
|
J1
|
5193
|
| 0238T |
Trluml perip athrc iliac art
|
$XXX.XX
|
J1
|
5194
|
| 0253T |
Insert aqueous drain device
|
$XXX.XX
|
J1
|
5492
|
| 0263T |
Im b1 mrw cel ther cmpl
|
$XXX.XX
|
S
|
5243
|
| 0264T |
Im b1 mrw cel ther xcl hrvst
|
$XXX.XX
|
S
|
5243
|
| 0265T |
Im b1 mrw cel ther hrvst onl
|
$XXX.XX
|
S
|
5243
|
| 0266T |
Implt/rpl crtd sns dev total
|
$XXX.XX
|
J1
|
5464
|
| 0267T |
Implt/rpl crtd sns dev lead
|
$XXX.XX
|
J1
|
5461
|
| 0268T |
Implt/rpl crtd sns dev gen
|
$XXX.XX
|
J1
|
5464
|
| 0269T |
Rev/remvl crtd sns dev total
|
$XXX.XX
|
Q2
|
5432
|
| 0270T |
Rev/remvl crtd sns dev lead
|
$XXX.XX
|
J1
|
5461
|
| 0271T |
Rev/remvl crtd sns dev gen
|
$XXX.XX
|
J1
|
5461
|
| 0272T |
Interrogate crtd sns dev
|
$XXX.XX
|
S
|
5721
|
| 0273T |
Interrogate crtd sns w/pgrmg
|
$XXX.XX
|
S
|
5721
|
| 0274T |
Perq lamot/lam crv/thrc
|
$XXX.XX
|
J1
|
5114
|
| 0275T |
Perq lamot/lam lumbar
|
$XXX.XX
|
J1
|
5114
|
| 0278T |
Tempr
|
$XXX.XX
|
Q1
|
5721
|
| 0296T |
Ext ecg recording
|
$XXX.XX
|
Q1
|
5733
|
| 0297T |
Ext ecg scan w/report
|
$XXX.XX
|
Q1
|
5734
|
| 0308T |
Insj ocular telescope prosth
|
$XXX.XX
|
J1
|
5495
|
| 0312T |
Laps impltj nstim vagus
|
$XXX.XX
|
J1
|
5464
|
| 0313T |
Laps rmvl nstim array vagus
|
$XXX.XX
|
J1
|
5461
|
| 0314T |
Laps rmvl vgl arry&pls gen
|
$XXX.XX
|
J1
|
5461
|
| 0315T |
Rmvl vagus nerve pls gen
|
$XXX.XX
|
J1
|
5461
|
| 0316T |
Replc vagus nerve pls gen
|
$XXX.XX
|
J1
|
5464
|
| 0317T |
Elec alys vagus nrv pls gen
|
$XXX.XX
|
Q1
|
5741
|
| 0330T |
Tear film img uni/bi w/i&r
|
$XXX.XX
|
Q1
|
5732
|
| 0331T |
Heart symp image plnr
|
$XXX.XX
|
S
|
5593
|
| 0332T |
Heart symp image plnr spect
|
$XXX.XX
|
S
|
5593
|
| 0335T |
Insj sinus tarsi implant
|
$XXX.XX
|
J1
|
5114
|
| 0338T |
Trnscth renal symp denrv unl
|
$XXX.XX
|
J1
|
5192
|
| 0339T |
Trnscth renal symp denrv bil
|
$XXX.XX
|
J1
|
5192
|
| 0342T |
Thxp apheresis w/hdl delip
|
$XXX.XX
|
S
|
5243
|
| 0347T |
Ins bone device for rsa
|
$XXX.XX
|
Q1
|
5733
|
| 0348T |
Rsa spine exam
|
$XXX.XX
|
Q1
|
5522
|
| 0349T |
Rsa upper extr exam
|
$XXX.XX
|
Q1
|
5522
|
| 0350T |
Rsa lower extr exam
|
$XXX.XX
|
Q1
|
5521
|
| 0355T |
Gi tract capsule endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 0356T |
Insrt drug device for iop
|
$XXX.XX
|
Q1
|
5692
|
| 0358T |
Bia whole body
|
$XXX.XX
|
Q1
|
5731
|
| 0362T |
Bhv id suprt assmt ea 15 min
|
$XXX.XX
|
Q3
|
5821
|
| 0373T |
Adapt bhv tx ea 15 min
|
$XXX.XX
|
Q3
|
5821
|
| 0379T |
Vis field assmnt tech suppt
|
$XXX.XX
|
Q1
|
5732
|
| 0394T |
Hdr elctrnc skn surf brchytx
|
$XXX.XX
|
S
|
5622
|
| 0395T |
Hdr elctr ntrst/ntrcv brchtx
|
$XXX.XX
|
S
|
5624
|
| 0398T |
Mrgfus strtctc les abltj
|
$XXX.XX
|
S
|
1575
|
| 0402T |
Colgn cross-link crn med sep
|
$XXX.XX
|
J1
|
5503
|
| 0404T |
Trnscrv uterin fibroid abltj
|
$XXX.XX
|
J1
|
5416
|
| 0408T |
Insj/rplc cardiac modulj sys
|
$XXX.XX
|
J1
|
5231
|
| 0409T |
Insj/rplc car modulj pls gn
|
$XXX.XX
|
J1
|
5231
|
| 0410T |
Insj/rplc car modulj atr elt
|
$XXX.XX
|
J1
|
5222
|
| 0411T |
Insj/rplc car modulj vnt elt
|
$XXX.XX
|
J1
|
5222
|
| 0412T |
Rmvl cardiac modulj pls gen
|
$XXX.XX
|
Q2
|
5221
|
| 0413T |
Rmvl car modulj tranvns elt
|
$XXX.XX
|
Q2
|
5221
|
| 0414T |
Rmvl & rpl car modulj pls gn
|
$XXX.XX
|
J1
|
5231
|
| 0415T |
Repos car modulj tranvns elt
|
$XXX.XX
|
T
|
5181
|
| 0416T |
Reloc skin pocket pls gen
|
$XXX.XX
|
T
|
5054
|
| 0417T |
Prgrmg eval cardiac modulj
|
$XXX.XX
|
Q1
|
5741
|
| 0418T |
Interro eval cardiac modulj
|
$XXX.XX
|
Q1
|
5741
|
| 0419T |
Dstrj neurofibroma xtnsv
|
$XXX.XX
|
T
|
5053
|
| 0420T |
Dstrj neurofibroma xtnsv
|
$XXX.XX
|
T
|
5053
|
| 0421T |
Waterjet prostate abltj cmpl
|
$XXX.XX
|
J1
|
5376
|
| 0422T |
Tactile breast img uni/bi
|
$XXX.XX
|
Q1
|
5521
|
| 0424T |
Insj/rplc nstim apnea compl
|
$XXX.XX
|
J1
|
5464
|
| 0425T |
Insj/rplc nstim apnea sen ld
|
$XXX.XX
|
J1
|
5462
|
| 0426T |
Insj/rplc nstim apnea stm ld
|
$XXX.XX
|
J1
|
5463
|
| 0427T |
Insj/rplc nstim apnea pls gn
|
$XXX.XX
|
J1
|
5464
|
| 0428T |
Rmvl nstim apnea pls gen
|
$XXX.XX
|
J1
|
5461
|
| 0429T |
Rmvl nstim apnea sen ld
|
$XXX.XX
|
J1
|
5461
|
| 0430T |
Rmvl nstim apnea stimj ld
|
$XXX.XX
|
J1
|
5461
|
| 0431T |
Rmvl/rplc nstim apnea pls gn
|
$XXX.XX
|
J1
|
5464
|
| 0432T |
Repos nstim apnea stimj ld
|
$XXX.XX
|
J1
|
5461
|
| 0433T |
Repos nstim apnea sensing ld
|
$XXX.XX
|
J1
|
5461
|
| 0434T |
Interro eval npgs apnea
|
$XXX.XX
|
S
|
5742
|
| 0435T |
Prgrmg eval npgs apnea 1 ses
|
$XXX.XX
|
S
|
5742
|
| 0436T |
Prgrmg eval npgs apnea study
|
$XXX.XX
|
S
|
5724
|
| 0440T |
Abltj perc uxtr/perph nrv
|
$XXX.XX
|
J1
|
5431
|
| 0441T |
Abltj perc lxtr/perph nrv
|
$XXX.XX
|
J1
|
5431
|
| 0442T |
Abltj perc plex/trncl nrv
|
$XXX.XX
|
J1
|
5432
|
| 0446T |
Insj impltbl glucose sensor
|
$XXX.XX
|
T
|
5053
|
| 0447T |
Rmvl impltbl glucose sensor
|
$XXX.XX
|
Q2
|
5051
|
| 0448T |
Remvl insj impltbl gluc sens
|
$XXX.XX
|
T
|
5053
|
| 0449T |
Insj aqueous drain dev 1st
|
$XXX.XX
|
J1
|
5492
|
| 0453T |
Insj/rplcmt mech-elec ntrfce
|
$XXX.XX
|
J1
|
5222
|
| 0454T |
Insj/rplcmt subq electrode
|
$XXX.XX
|
J1
|
5222
|
| 0457T |
Remvl mech-elec skin ntrfce
|
$XXX.XX
|
Q2
|
5221
|
| 0458T |
Remvl subq electrode
|
$XXX.XX
|
Q2
|
5221
|
| 0460T |
Repos aortic ventr dev eltrd
|
$XXX.XX
|
T
|
5221
|
| 0462T |
Prgrmg eval aortic ventr sys
|
$XXX.XX
|
S
|
5743
|
| 0463T |
Interrog aortic ventr sys
|
$XXX.XX
|
S
|
5743
|
| 0464T |
Visual ep test for glaucoma
|
$XXX.XX
|
S
|
5721
|
| 0465T |
Supchrdl njx rx w/o supply
|
$XXX.XX
|
T
|
5694
|
| 0467T |
Revj/rplmnt ch respir eltrd
|
$XXX.XX
|
J1
|
5461
|
| 0468T |
Rmvl ch wal respir eltrd/ra
|
$XXX.XX
|
J1
|
5461
|
| 0472T |
Prgrmg io rta eltrd ra
|
$XXX.XX
|
Q1
|
5743
|
| 0473T |
Reprgrmg io rta eltrd ra
|
$XXX.XX
|
Q1
|
5742
|
| 0476T |
Rec ftl car sgl elec tr data
|
$XXX.XX
|
Q1
|
5734
|
| 0477T |
Rec ftl car sgl xrtj alys
|
$XXX.XX
|
Q1
|
5734
|
| 0479T |
Fxjl abl lsr 1st 100 sq cm
|
$XXX.XX
|
T
|
5052
|
| 0481T |
Njx autol wbc concentrate
|
$XXX.XX
|
Q1
|
5735
|
| 0485T |
Oct mid ear i&r unilateral
|
$XXX.XX
|
Q1
|
5732
|
| 0486T |
Oct mid ear i&r bilateral
|
$XXX.XX
|
Q1
|
5732
|
| 0487T |
Trvg biomchn mapg w/reprt
|
$XXX.XX
|
Q1
|
5734
|
| 0491T |
Abl lsr opn wnd 1st 20 sqcm
|
$XXX.XX
|
T
|
5052
|
| 0497T |
Xtrnl pt act ecg in-off conn
|
$XXX.XX
|
Q1
|
5741
|
| 0499T |
Cysto f/urtl strix/stenosis
|
$XXX.XX
|
J1
|
5374
|
| 0503T |
Cor ffr alys gnrj ffr mdl
|
$XXX.XX
|
S
|
1511
|
| 0505T |
Ev fempop artl revsc
|
$XXX.XX
|
J1
|
5193
|
| 0506T |
Mac pgmt opt dns meas hfp
|
$XXX.XX
|
Q1
|
5733
|
| 0507T |
Near ifr 2img mibmn glnd i&r
|
$XXX.XX
|
Q1
|
5733
|
| 0508T |
Pls echo us b1 dns meas tib
|
$XXX.XX
|
S
|
5522
|
| 0509T |
Pattern erg w/i&r
|
$XXX.XX
|
S
|
5721
|
| 0510T |
Rmvl sinus tarsi implant
|
$XXX.XX
|
Q2
|
5113
|
| 0511T |
Rmvl&rinsj sinus tarsi implt
|
$XXX.XX
|
J1
|
5114
|
| 0512T |
Esw integ wnd hlg 1st wnd
|
$XXX.XX
|
S
|
5052
|
| 0515T |
Insj wcs lv compl sys
|
$XXX.XX
|
J1
|
5231
|
| 0516T |
Insj wcs lv eltrd only
|
$XXX.XX
|
J1
|
5222
|
| 0517T |
Insj wcs lv pg compnt
|
$XXX.XX
|
J1
|
5222
|
| 0518T |
Rmvl pg compnt wcs
|
$XXX.XX
|
T
|
5221
|
| 0519T |
Rmvl & rplcmt pg compnt wcs
|
$XXX.XX
|
T
|
5221
|
| 0520T |
Rmvl&rplcmt pg wcs new eltrd
|
$XXX.XX
|
J1
|
5231
|
| 0521T |
Interrog dev eval wcs ip
|
$XXX.XX
|
Q1
|
5731
|
| 0522T |
Prgrmg dev eval wcs ip
|
$XXX.XX
|
Q1
|
5741
|
| 0524T |
Ev cath dir chem abltj w/img
|
$XXX.XX
|
T
|
5183
|
| 0525T |
Insj/rplcmt compl iims
|
$XXX.XX
|
J1
|
5223
|
| 0526T |
Insj/rplcmt iims eltrd only
|
$XXX.XX
|
J1
|
5222
|
| 0527T |
Insj/rplcmt iims implt mntr
|
$XXX.XX
|
J1
|
5222
|
| 0528T |
Prgrmg dev eval iims ip
|
$XXX.XX
|
Q1
|
5741
|
| 0529T |
Interrog dev eval iims ip
|
$XXX.XX
|
Q1
|
5741
|
| 0530T |
Removal complete iims
|
$XXX.XX
|
Q2
|
5221
|
| 0531T |
Removal iims electrode only
|
$XXX.XX
|
Q2
|
5221
|
| 0532T |
Removal iims implt mntr only
|
$XXX.XX
|
Q2
|
5221
|
| 0534T |
Cont rec mvmt do setup&train
|
$XXX.XX
|
Q1
|
5741
|
| 0535T |
Cont rec mvmt do reprt cnfig
|
$XXX.XX
|
Q1
|
5741
|
| 0540T |
Car-t cll admn autologous
|
$XXX.XX
|
S
|
5694
|
| 0541T |
Myocardial imaging mcg
|
$XXX.XX
|
S
|
5723
|
| 0548T |
Tprnl balo cntnc dev bi
|
$XXX.XX
|
J1
|
5376
|
| 0549T |
Tprnl balo cntnc dev uni
|
$XXX.XX
|
J1
|
5375
|
| 0550T |
Tprnl balo cntnc dev rmvl ea
|
$XXX.XX
|
J1
|
5374
|
| 0551T |
Tprnl balo cntnc dev adjmt
|
$XXX.XX
|
T
|
5371
|
| 0555T |
B1 str&fx rsk transmis data
|
$XXX.XX
|
S
|
5731
|
| 0556T |
B1 str & fx rsk assessment
|
$XXX.XX
|
S
|
5523
|
| 0558T |
Ct scan f/biomchn ct alys
|
$XXX.XX
|
S
|
5521
|
| 0559T |
Antmc mdl 3d print 1st cmpnt
|
$XXX.XX
|
Q1
|
5733
|
| 0561T |
Antmc guide 3d print 1st gd
|
$XXX.XX
|
Q1
|
5733
|
| 0563T |
Evac meibomian glnd heat bi
|
$XXX.XX
|
Q1
|
5733
|
| 0564T |
Onc chemo rx cytotox csc 14
|
$XXX.XX
|
Q1
|
5671
|
| 0565T |
Autol cell implt adps hrvg
|
$XXX.XX
|
Q1
|
5733
|
| 0566T |
Autol cell implt adps njx
|
$XXX.XX
|
T
|
5441
|
| 0571T |
Insj/rplcmt icds ss eltrd
|
$XXX.XX
|
J1
|
5232
|
| 0572T |
Insertion ss dfb electrode
|
$XXX.XX
|
J1
|
5222
|
| 0573T |
Removal ss dfb electrode
|
$XXX.XX
|
Q2
|
5221
|
| 0574T |
Repos prev ss impl dfb eltrd
|
$XXX.XX
|
Q2
|
5221
|
| 0575T |
Prgrmg dev eval icds ss ip
|
$XXX.XX
|
Q1
|
5741
|
| 0576T |
Interrog dev eval icds ss ip
|
$XXX.XX
|
Q1
|
5741
|
| 0577T |
Ephys eval icds ss
|
$XXX.XX
|
J1
|
5211
|
| 0579T |
Rem interrog dev icds tech
|
$XXX.XX
|
Q1
|
5741
|
| 0580T |
Rmvl ss impl dfb pg only
|
$XXX.XX
|
Q2
|
5221
|
| 0587T |
Perq impltj/rplcmt isdns ptn
|
$XXX.XX
|
T
|
5442
|
| 0588T |
Revision/removal isdns ptn
|
$XXX.XX
|
T
|
5441
|
| 0589T |
Elec alys smpl prgrmg iins
|
$XXX.XX
|
S
|
5742
|
| 0590T |
Elec alys cplx prgrmg iins
|
$XXX.XX
|
S
|
5742
|
| 0594T |
Osteot hum xtrnl lngth dev
|
$XXX.XX
|
J1
|
5114
|
| 0596T |
Temp fml iu vlv-pmp 1st insj
|
$XXX.XX
|
T
|
5372
|
| 0597T |
Temp fml iu valve-pmp rplcmt
|
$XXX.XX
|
T
|
5372
|
| 0598T |
Ncntc r-t fluor wnd img 1st
|
$XXX.XX
|
T
|
5722
|
| 0600T |
Ire abltj 1+tum organ perq
|
$XXX.XX
|
J1
|
5361
|
| 0601T |
Ire abltj 1+tumors open
|
$XXX.XX
|
J1
|
5361
|
| 0604T |
Rem oct rta dev setup&educaj
|
$XXX.XX
|
V
|
5012
|
| 0605T |
Rem oct rta techl sprt min 8
|
$XXX.XX
|
Q1
|
5741
|
| 0607T |
Rem mntr pulm flu mntr setup
|
$XXX.XX
|
V
|
5012
|
| 0608T |
Rem mntr pulm flu mntr alys
|
$XXX.XX
|
S
|
5741
|
| 0614T |
Rmvl&rplcmt ss impl dfb pg
|
$XXX.XX
|
J1
|
5231
|
| 0615T |
Eye mvmt alys w/o calbrj i&r
|
$XXX.XX
|
Q1
|
5734
|
| 0616T |
Insertion of iris prosthesis
|
$XXX.XX
|
J1
|
5491
|
| 0617T |
Insj iris prosth w/rmvl&insj
|
$XXX.XX
|
J1
|
5492
|
| 0618T |
Insj iris prosth sec io lens
|
$XXX.XX
|
J1
|
5492
|
| 0619T |
Cysto w/prst8 commissurotomy
|
$XXX.XX
|
J1
|
5375
|
| 10005 |
Fna bx w/us gdn 1st les
|
$XXX.XX
|
T
|
5071
|
| 10007 |
Fna bx w/fluor gdn 1st les
|
$XXX.XX
|
T
|
5071
|
| 10009 |
Fna bx w/ct gdn 1st les
|
$XXX.XX
|
T
|
5071
|
| 10011 |
Fna bx w/mr gdn 1st les
|
$XXX.XX
|
T
|
5071
|
| 10021 |
Fna bx w/o img gdn 1st les
|
$XXX.XX
|
T
|
5052
|
| 10030 |
Guide cathet fluid drainage
|
$XXX.XX
|
T
|
5071
|
| 10035 |
Perq dev soft tiss 1st imag
|
$XXX.XX
|
T
|
5071
|
| 10040 |
Acne surgery
|
$XXX.XX
|
Q1
|
5051
|
| 10060 |
Drainage of skin abscess
|
$XXX.XX
|
T
|
5051
|
| 10061 |
Drainage of skin abscess
|
$XXX.XX
|
T
|
5052
|
| 10080 |
Drainage of pilonidal cyst
|
$XXX.XX
|
T
|
5071
|
| 10081 |
Drainage of pilonidal cyst
|
$XXX.XX
|
T
|
5071
|
| 10120 |
Remove foreign body
|
$XXX.XX
|
T
|
5052
|
| 10121 |
Remove foreign body
|
$XXX.XX
|
J1
|
5072
|
| 10140 |
Drainage of hematoma/fluid
|
$XXX.XX
|
J1
|
5072
|
| 10160 |
Puncture drainage of lesion
|
$XXX.XX
|
T
|
5052
|
| 10180 |
Complex drainage wound
|
$XXX.XX
|
J1
|
5073
|
| 11000 |
Debride infected skin
|
$XXX.XX
|
T
|
5053
|
| 11010 |
Debride skin at fx site
|
$XXX.XX
|
T
|
5071
|
| 11011 |
Debride skin musc at fx site
|
$XXX.XX
|
T
|
5071
|
| 11012 |
Deb skin bone at fx site
|
$XXX.XX
|
J1
|
5073
|
| 11042 |
Deb subq tissue 20 sq cm/<
|
$XXX.XX
|
T
|
5052
|
| 11043 |
Deb musc/fascia 20 sq cm/<
|
$XXX.XX
|
T
|
5053
|
| 11044 |
Deb bone 20 sq cm/<
|
$XXX.XX
|
J1
|
5072
|
| 11055 |
Trim skin lesion
|
$XXX.XX
|
Q1
|
5051
|
| 11056 |
Trim skin lesions 2 to 4
|
$XXX.XX
|
Q1
|
5051
|
| 11057 |
Trim skin lesions over 4
|
$XXX.XX
|
T
|
5051
|
| 11102 |
Tangntl bx skin single les
|
$XXX.XX
|
T
|
5051
|
| 11104 |
Punch bx skin single lesion
|
$XXX.XX
|
T
|
5051
|
| 11106 |
Incal bx skn single les
|
$XXX.XX
|
T
|
5052
|
| 11200 |
Removal of skin tags
|
$XXX.XX
|
Q1
|
5051
|
|
| 11300 |
Shave skin lesion 0.5 cm/<
|
$XXX.XX
|
Q1
|
5051
|
| 11301 |
Shave skin lesion 0.6-1.0 cm
|
$XXX.XX
|
Q1
|
5051
|
| 11302 |
Shave skin lesion 1.1-2.0 cm
|
$XXX.XX
|
Q1
|
5051
|
| 11303 |
Shave skin lesion >2.0 cm
|
$XXX.XX
|
Q1
|
5052
|
| 11305 |
Shave skin lesion 0.5 cm/<
|
$XXX.XX
|
Q1
|
5051
|
| 11306 |
Shave skin lesion 0.6-1.0 cm
|
$XXX.XX
|
Q1
|
5051
|
| 11307 |
Shave skin lesion 1.1-2.0 cm
|
$XXX.XX
|
T
|
5051
|
| 11308 |
Shave skin lesion >2.0 cm
|
$XXX.XX
|
Q1
|
5052
|
| 11310 |
Shave skin lesion 0.5 cm/<
|
$XXX.XX
|
T
|
5051
|
| 11311 |
Shave skin lesion 0.6-1.0 cm
|
$XXX.XX
|
T
|
5051
|
| 11312 |
Shave skin lesion 1.1-2.0 cm
|
$XXX.XX
|
T
|
5052
|
| 11313 |
Shave skin lesion >2.0 cm
|
$XXX.XX
|
T
|
5052
|
| 11400 |
Exc tr-ext b9+marg 0.5 cm<
|
$XXX.XX
|
T
|
5071
|
| 11401 |
Exc tr-ext b9+marg 0.6-1 cm
|
$XXX.XX
|
T
|
5052
|
| 11402 |
Exc tr-ext b9+marg 1.1-2 cm
|
$XXX.XX
|
T
|
5071
|
| 11403 |
Exc tr-ext b9+marg 2.1-3cm
|
$XXX.XX
|
T
|
5071
|
| 11404 |
Exc tr-ext b9+marg 3.1-4 cm
|
$XXX.XX
|
J1
|
5072
|
| 11406 |
Exc tr-ext b9+marg >4.0 cm
|
$XXX.XX
|
J1
|
5072
|
| 11420 |
Exc h-f-nk-sp b9+marg 0.5/<
|
$XXX.XX
|
J1
|
5072
|
| 11421 |
Exc h-f-nk-sp b9+marg 0.6-1
|
$XXX.XX
|
T
|
5071
|
| 11422 |
Exc h-f-nk-sp b9+marg 1.1-2
|
$XXX.XX
|
J1
|
5072
|
| 11423 |
Exc h-f-nk-sp b9+marg 2.1-3
|
$XXX.XX
|
J1
|
5072
|
| 11424 |
Exc h-f-nk-sp b9+marg 3.1-4
|
$XXX.XX
|
J1
|
5072
|
| 11426 |
Exc h-f-nk-sp b9+marg >4 cm
|
$XXX.XX
|
J1
|
5073
|
| 11440 |
Exc face-mm b9+marg 0.5 cm/<
|
$XXX.XX
|
T
|
5071
|
| 11441 |
Exc face-mm b9+marg 0.6-1 cm
|
$XXX.XX
|
T
|
5071
|
| 11442 |
Exc face-mm b9+marg 1.1-2 cm
|
$XXX.XX
|
T
|
5071
|
| 11443 |
Exc face-mm b9+marg 2.1-3 cm
|
$XXX.XX
|
J1
|
5072
|
| 11444 |
Exc face-mm b9+marg 3.1-4 cm
|
$XXX.XX
|
J1
|
5072
|
| 11446 |
Exc face-mm b9+marg >4 cm
|
$XXX.XX
|
J1
|
5073
|
| 11450 |
Removal sweat gland lesion
|
$XXX.XX
|
J1
|
5073
|
| 11451 |
Removal sweat gland lesion
|
$XXX.XX
|
J1
|
5073
|
| 11462 |
Removal sweat gland lesion
|
$XXX.XX
|
J1
|
5073
|
| 11463 |
Removal sweat gland lesion
|
$XXX.XX
|
J1
|
5073
|
| 11470 |
Removal sweat gland lesion
|
$XXX.XX
|
J1
|
5073
|
| 11471 |
Removal sweat gland lesion
|
$XXX.XX
|
J1
|
5073
|
| 11600 |
Exc tr-ext mal+marg 0.5 cm/<
|
$XXX.XX
|
T
|
5071
|
| 11601 |
Exc tr-ext mal+marg 0.6-1 cm
|
$XXX.XX
|
T
|
5071
|
| 11602 |
Exc tr-ext mal+marg 1.1-2 cm
|
$XXX.XX
|
T
|
5052
|
| 11603 |
Exc tr-ext mal+marg 2.1-3 cm
|
$XXX.XX
|
T
|
5071
|
| 11604 |
Exc tr-ext mal+marg 3.1-4 cm
|
$XXX.XX
|
T
|
5071
|
| 11606 |
Exc tr-ext mal+marg >4 cm
|
$XXX.XX
|
J1
|
5072
|
| 11620 |
Exc h-f-nk-sp mal+marg 0.5/<
|
$XXX.XX
|
J1
|
5072
|
| 11621 |
Exc s/n/h/f/g mal+mrg 0.6-1
|
$XXX.XX
|
T
|
5071
|
| 11622 |
Exc s/n/h/f/g mal+mrg 1.1-2
|
$XXX.XX
|
T
|
5071
|
| 11623 |
Exc s/n/h/f/g mal+mrg 2.1-3
|
$XXX.XX
|
J1
|
5072
|
| 11624 |
Exc s/n/h/f/g mal+mrg 3.1-4
|
$XXX.XX
|
J1
|
5072
|
| 11626 |
Exc s/n/h/f/g mal+mrg >4 cm
|
$XXX.XX
|
J1
|
5073
|
| 11640 |
Exc f/e/e/n/l mal+mrg 0.5cm<
|
$XXX.XX
|
T
|
5071
|
| 11641 |
Exc f/e/e/n/l mal+mrg 0.6-1
|
$XXX.XX
|
T
|
5071
|
| 11642 |
Exc f/e/e/n/l mal+mrg 1.1-2
|
$XXX.XX
|
T
|
5071
|
| 11643 |
Exc f/e/e/n/l mal+mrg 2.1-3
|
$XXX.XX
|
J1
|
5072
|
| 11644 |
Exc f/e/e/n/l mal+mrg 3.1-4
|
$XXX.XX
|
J1
|
5072
|
| 11646 |
Exc f/e/e/n/l mal+mrg >4 cm
|
$XXX.XX
|
J1
|
5073
|
| 11719 |
Trim nail(s) any number
|
$XXX.XX
|
Q1
|
5733
|
| 11720 |
Debride nail 1-5
|
$XXX.XX
|
Q1
|
5733
|
| 11721 |
Debride nail 6 or more
|
$XXX.XX
|
Q1
|
5733
|
| 11730 |
Removal of nail plate
|
$XXX.XX
|
Q1
|
5051
|
| 11740 |
Drain blood from under nail
|
$XXX.XX
|
Q1
|
5734
|
| 11750 |
Removal of nail bed
|
$XXX.XX
|
T
|
5052
|
| 11755 |
Biopsy nail unit
|
$XXX.XX
|
T
|
5071
|
| 11760 |
Repair of nail bed
|
$XXX.XX
|
T
|
5053
|
| 11762 |
Reconstruction of nail bed
|
$XXX.XX
|
T
|
5054
|
| 11765 |
Excision of nail fold toe
|
$XXX.XX
|
Q1
|
5052
|
| 11770 |
Remove pilonidal cyst simple
|
$XXX.XX
|
J1
|
5073
|
| 11771 |
Remove pilonidal cyst exten
|
$XXX.XX
|
J1
|
5073
|
| 11772 |
Remove pilonidal cyst compl
|
$XXX.XX
|
J1
|
5073
|
| 11900 |
Inject skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 11901 |
Inject skin lesions >7
|
$XXX.XX
|
Q1
|
5051
|
| 11920 |
Correct skin color 6.0 cm/<
|
$XXX.XX
|
T
|
5053
|
| 11921 |
Correct skn color 6.1-20.0cm
|
$XXX.XX
|
T
|
5053
|
| 11950 |
Tx contour defects 1 cc/<
|
$XXX.XX
|
T
|
5051
|
| 11951 |
Tx contour defects 1.1-5.0cc
|
$XXX.XX
|
T
|
5053
|
| 11952 |
Tx contour defects 5.1-10cc
|
$XXX.XX
|
T
|
5053
|
| 11954 |
Tx contour defects >10.0 cc
|
$XXX.XX
|
T
|
5052
|
| 11960 |
Insert tissue expander(s)
|
$XXX.XX
|
T
|
5055
|
| 11970 |
Replace tissue expander
|
$XXX.XX
|
J1
|
5114
|
| 11971 |
Remove tissue expander(s)
|
$XXX.XX
|
Q2
|
5073
|
| 11976 |
Remove contraceptive capsule
|
$XXX.XX
|
Q2
|
5071
|
| 11980 |
Implant hormone pellet(s)
|
$XXX.XX
|
Q1
|
5735
|
| 11981 |
Insert drug implant device
|
$XXX.XX
|
Q1
|
5734
|
| 11982 |
Remove drug implant device
|
$XXX.XX
|
Q1
|
5735
|
| 11983 |
Remove/insert drug implant
|
$XXX.XX
|
Q1
|
5735
|
| 12001 |
Rpr s/n/ax/gen/trnk 2.5cm/<
|
$XXX.XX
|
Q1
|
5051
|
| 12002 |
Rpr s/n/ax/gen/trnk2.6-7.5cm
|
$XXX.XX
|
Q1
|
5051
|
| 12004 |
Rpr s/n/ax/gen/trk7.6-12.5cm
|
$XXX.XX
|
Q1
|
5051
|
| 12005 |
Rpr s/n/a/gen/trk12.6-20.0cm
|
$XXX.XX
|
Q1
|
5052
|
| 12006 |
Rpr s/n/a/gen/trk20.1-30.0cm
|
$XXX.XX
|
Q2
|
5052
|
| 12007 |
Rpr s/n/ax/gen/trnk >30.0 cm
|
$XXX.XX
|
T
|
5051
|
| 12011 |
Rpr f/e/e/n/l/m 2.5 cm/<
|
$XXX.XX
|
Q1
|
5051
|
| 12013 |
Rpr f/e/e/n/l/m 2.6-5.0 cm
|
$XXX.XX
|
Q1
|
5051
|
| 12014 |
Rpr f/e/e/n/l/m 5.1-7.5 cm
|
$XXX.XX
|
Q1
|
5051
|
| 12015 |
Rpr f/e/e/n/l/m 7.6-12.5 cm
|
$XXX.XX
|
Q1
|
5051
|
| 12016 |
Rpr fe/e/en/l/m 12.6-20.0 cm
|
$XXX.XX
|
Q1
|
5052
|
| 12017 |
Rpr fe/e/en/l/m 20.1-30.0 cm
|
$XXX.XX
|
Q1
|
5052
|
| 12018 |
Rpr f/e/e/n/l/m >30.0 cm
|
$XXX.XX
|
Q1
|
5051
|
| 12020 |
Closure of split wound
|
$XXX.XX
|
T
|
5053
|
| 12021 |
Closure of split wound
|
$XXX.XX
|
T
|
5052
|
| 12031 |
Intmd rpr s/a/t/ext 2.5 cm/<
|
$XXX.XX
|
T
|
5052
|
| 12032 |
Intmd rpr s/a/t/ext 2.6-7.5
|
$XXX.XX
|
T
|
5052
|
| 12034 |
Intmd rpr s/tr/ext 7.6-12.5
|
$XXX.XX
|
T
|
5052
|
| 12035 |
Intmd rpr s/a/t/ext 12.6-20
|
$XXX.XX
|
T
|
5052
|
| 12036 |
Intmd rpr s/a/t/ext 20.1-30
|
$XXX.XX
|
T
|
5053
|
| 12037 |
Intmd rpr s/tr/ext >30.0 cm
|
$XXX.XX
|
T
|
5054
|
| 12041 |
Intmd rpr n-hf/genit 2.5cm/<
|
$XXX.XX
|
Q2
|
5052
|
| 12042 |
Intmd rpr n-hf/genit2.6-7.5
|
$XXX.XX
|
T
|
5052
|
| 12044 |
Intmd rpr n-hf/genit7.6-12.5
|
$XXX.XX
|
T
|
5053
|
| 12045 |
Intmd rpr n-hf/genit12.6-20
|
$XXX.XX
|
T
|
5053
|
| 12046 |
Intmd rpr n-hf/genit20.1-30
|
$XXX.XX
|
T
|
5052
|
| 12047 |
Intmd rpr n-hf/genit >30.0cm
|
$XXX.XX
|
T
|
5054
|
| 12051 |
Intmd rpr face/mm 2.5 cm/<
|
$XXX.XX
|
T
|
5052
|
| 12052 |
Intmd rpr face/mm 2.6-5.0 cm
|
$XXX.XX
|
T
|
5052
|
| 12053 |
Intmd rpr face/mm 5.1-7.5 cm
|
$XXX.XX
|
T
|
5052
|
| 12054 |
Intmd rpr face/mm 7.6-12.5cm
|
$XXX.XX
|
Q2
|
5052
|
| 12055 |
Intmd rpr face/mm 12.6-20 cm
|
$XXX.XX
|
T
|
5052
|
| 12056 |
Intmd rpr face/mm 20.1-30.0
|
$XXX.XX
|
Q2
|
5052
|
| 12057 |
Intmd rpr face/mm >30.0 cm
|
$XXX.XX
|
T
|
5052
|
| 13100 |
Cmplx rpr trunk 1.1-2.5 cm
|
$XXX.XX
|
T
|
5053
|
| 13101 |
Cmplx rpr trunk 2.6-7.5 cm
|
$XXX.XX
|
T
|
5053
|
| 13120 |
Cmplx rpr s/a/l 1.1-2.5 cm
|
$XXX.XX
|
T
|
5053
|
| 13121 |
Cmplx rpr s/a/l 2.6-7.5 cm
|
$XXX.XX
|
T
|
5053
|
| 13131 |
Cmplx rpr f/c/c/m/n/ax/g/h/f
|
$XXX.XX
|
T
|
5052
|
| 13132 |
Cmplx rpr f/c/c/m/n/ax/g/h/f
|
$XXX.XX
|
T
|
5053
|
| 13151 |
Cmplx rpr e/n/e/l 1.1-2.5 cm
|
$XXX.XX
|
T
|
5053
|
| 13152 |
Cmplx rpr e/n/e/l 2.6-7.5 cm
|
$XXX.XX
|
T
|
5053
|
| 13160 |
Late closure of wound
|
$XXX.XX
|
T
|
5054
|
| 14000 |
Tis trnfr trunk 10 sq cm/<
|
$XXX.XX
|
T
|
5054
|
| 14001 |
Tis trnfr trunk 10.1-30sqcm
|
$XXX.XX
|
T
|
5054
|
| 14020 |
Tis trnfr s/a/l 10 sq cm/<
|
$XXX.XX
|
T
|
5054
|
| 14021 |
Tis trnfr s/a/l 10.1-30 sqcm
|
$XXX.XX
|
T
|
5054
|
| 14040 |
Tis trnfr f/c/c/m/n/a/g/h/f
|
$XXX.XX
|
T
|
5054
|
| 14041 |
Tis trnfr f/c/c/m/n/a/g/h/f
|
$XXX.XX
|
T
|
5054
|
| 14060 |
Tis trnfr e/n/e/l 10 sq cm/<
|
$XXX.XX
|
T
|
5054
|
| 14061 |
Tis trnfr e/n/e/l10.1-30sqcm
|
$XXX.XX
|
T
|
5054
|
| 14301 |
Tis trnfr any 30.1-60 sq cm
|
$XXX.XX
|
T
|
5055
|
| 14350 |
Filleted finger/toe flap
|
$XXX.XX
|
T
|
5054
|
| 15002 |
Wound prep trk/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15004 |
Wound prep f/n/hf/g
|
$XXX.XX
|
T
|
5053
|
| 15040 |
Harvest cultured skin graft
|
$XXX.XX
|
T
|
5054
|
| 15050 |
Skin pinch graft
|
$XXX.XX
|
T
|
5053
|
| 15100 |
Skin splt grft trnk/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15110 |
Epidrm autogrft trnk/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15115 |
Epidrm a-grft face/nck/hf/g
|
$XXX.XX
|
T
|
5054
|
| 15120 |
Skn splt a-grft fac/nck/hf/g
|
$XXX.XX
|
T
|
5055
|
| 15130 |
Derm autograft trnk/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15135 |
Derm autograft face/nck/hf/g
|
$XXX.XX
|
T
|
5055
|
| 15150 |
Cult skin grft t/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15155 |
Cult skin graft f/n/hf/g
|
$XXX.XX
|
T
|
5055
|
| 15200 |
Skin full graft trunk
|
$XXX.XX
|
T
|
5054
|
| 15220 |
Skin full graft sclp/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15240 |
Skin full grft face/genit/hf
|
$XXX.XX
|
T
|
5054
|
| 15260 |
Skin full graft een & lips
|
$XXX.XX
|
T
|
5054
|
| 15271 |
Skin sub graft trnk/arm/leg
|
$XXX.XX
|
T
|
5054
|
| 15273 |
Skin sub grft t/arm/lg child
|
$XXX.XX
|
T
|
5055
|
| 15275 |
Skin sub graft face/nk/hf/g
|
$XXX.XX
|
T
|
5054
|
| 15277 |
Skn sub grft f/n/hf/g child
|
$XXX.XX
|
T
|
5054
|
| 15570 |
Skin pedicle flap trunk
|
$XXX.XX
|
T
|
5054
|
| 15572 |
Skin pedicle flap arms/legs
|
$XXX.XX
|
T
|
5055
|
| 15574 |
Pedcle fh/ch/ch/m/n/ax/g/h/f
|
$XXX.XX
|
T
|
5054
|
| 15576 |
Pedicle e/n/e/l/ntroral
|
$XXX.XX
|
T
|
5054
|
| 15600 |
Delay flap trunk
|
$XXX.XX
|
T
|
5055
|
| 15610 |
Delay flap arms/legs
|
$XXX.XX
|
T
|
5054
|
| 15620 |
Delay flap f/c/c/n/ax/g/h/f
|
$XXX.XX
|
T
|
5054
|
| 15630 |
Delay flap eye/nos/ear/lip
|
$XXX.XX
|
T
|
5054
|
| 15650 |
Transfer skin pedicle flap
|
$XXX.XX
|
T
|
5054
|
| 15730 |
Mdfc flap w/prsrv vasc pedcl
|
$XXX.XX
|
T
|
5055
|
| 15731 |
Forehead flap w/vasc pedicle
|
$XXX.XX
|
T
|
5055
|
| 15733 |
Musc myoq/fscq flp h&n pedcl
|
$XXX.XX
|
T
|
5055
|
| 15734 |
Muscle-skin graft trunk
|
$XXX.XX
|
T
|
5055
|
| 15736 |
Muscle-skin graft arm
|
$XXX.XX
|
T
|
5054
|
| 15738 |
Muscle-skin graft leg
|
$XXX.XX
|
T
|
5055
|
| 15740 |
Island pedicle flap graft
|
$XXX.XX
|
T
|
5054
|
| 15750 |
Neurovascular pedicle flap
|
$XXX.XX
|
T
|
5055
|
| 15760 |
Composite skin graft
|
$XXX.XX
|
T
|
5054
|
| 15769 |
Grfg autol soft tiss dir exc
|
$XXX.XX
|
T
|
5055
|
| 15770 |
Derma-fat-fascia graft
|
$XXX.XX
|
T
|
5055
|
| 15771 |
Grfg autol fat lipo 50 cc/<
|
$XXX.XX
|
T
|
5055
|
| 15773 |
Grfg autol fat lipo 25 cc/<
|
$XXX.XX
|
T
|
5054
|
| 15775 |
Hair trnspl 1-15 punch grfts
|
$XXX.XX
|
T
|
5052
|
| 15776 |
Hair trnspl >15 punch grafts
|
$XXX.XX
|
T
|
5052
|
| 15780 |
Dermabrasion total face
|
$XXX.XX
|
J1
|
5073
|
| 15781 |
Dermabrasion segmental face
|
$XXX.XX
|
T
|
5071
|
| 15782 |
Dermabrasion other than face
|
$XXX.XX
|
J1
|
5073
|
| 15783 |
Dermabrasion suprfl any site
|
$XXX.XX
|
T
|
5052
|
| 15786 |
Abrasion lesion single
|
$XXX.XX
|
Q1
|
5051
|
| 15788 |
Chemical peel face epiderm
|
$XXX.XX
|
Q1
|
5051
|
| 15789 |
Chemical peel face dermal
|
$XXX.XX
|
T
|
5053
|
| 15792 |
Chemical peel nonfacial
|
$XXX.XX
|
Q1
|
5052
|
| 15793 |
Chemical peel nonfacial
|
$XXX.XX
|
Q1
|
5052
|
| 15819 |
Plastic surgery neck
|
$XXX.XX
|
T
|
5054
|
| 15820 |
Revision of lower eyelid
|
$XXX.XX
|
T
|
5054
|
| 15821 |
Revision of lower eyelid
|
$XXX.XX
|
T
|
5054
|
| 15822 |
Revision of upper eyelid
|
$XXX.XX
|
T
|
5054
|
| 15823 |
Revision of upper eyelid
|
$XXX.XX
|
T
|
5054
|
| 15824 |
Removal of forehead wrinkles
|
$XXX.XX
|
T
|
5054
|
| 15825 |
Removal of neck wrinkles
|
$XXX.XX
|
T
|
5055
|
| 15826 |
Removal of brow wrinkles
|
$XXX.XX
|
T
|
5055
|
| 15828 |
Removal of face wrinkles
|
$XXX.XX
|
T
|
5055
|
| 15829 |
Removal of skin wrinkles
|
$XXX.XX
|
T
|
5055
|
| 15830 |
Exc skin abd
|
$XXX.XX
|
J1
|
5092
|
| 15832 |
Excise excessive skin thigh
|
$XXX.XX
|
J1
|
5073
|
| 15833 |
Excise excessive skin leg
|
$XXX.XX
|
J1
|
5073
|
| 15834 |
Excise excessive skin hip
|
$XXX.XX
|
J1
|
5073
|
| 15835 |
Excise excessive skin buttck
|
$XXX.XX
|
J1
|
5073
|
| 15836 |
Excise excessive skin arm
|
$XXX.XX
|
J1
|
5073
|
| 15837 |
Excise excess skin arm/hand
|
$XXX.XX
|
J1
|
5073
|
| 15838 |
Excise excess skin fat pad
|
$XXX.XX
|
J1
|
5073
|
| 15839 |
Excise excess skin & tissue
|
$XXX.XX
|
J1
|
5073
|
| 15840 |
Nerve palsy fascial graft
|
$XXX.XX
|
T
|
5055
|
| 15841 |
Nerve palsy muscle graft
|
$XXX.XX
|
T
|
5055
|
| 15842 |
Nerve palsy microsurg graft
|
$XXX.XX
|
T
|
5054
|
| 15845 |
Skin and muscle repair face
|
$XXX.XX
|
T
|
5055
|
| 15850 |
Remove sutures same surgeon
|
$XXX.XX
|
T
|
5053
|
| 15851 |
Remove sutures diff surgeon
|
$XXX.XX
|
T
|
5054
|
| 15852 |
Dressing change not for burn
|
$XXX.XX
|
Q1
|
5053
|
| 15860 |
Test for blood flow in graft
|
$XXX.XX
|
Q1
|
5735
|
| 15876 |
Suction lipectomy head&neck
|
$XXX.XX
|
T
|
5055
|
| 15877 |
Suction lipectomy trunk
|
$XXX.XX
|
T
|
5055
|
| 15878 |
Suction lipectomy upr extrem
|
$XXX.XX
|
T
|
5054
|
| 15879 |
Suction lipectomy lwr extrem
|
$XXX.XX
|
T
|
5055
|
| 15920 |
Removal of tail bone ulcer
|
$XXX.XX
|
J1
|
5073
|
| 15922 |
Removal of tail bone ulcer
|
$XXX.XX
|
T
|
5055
|
| 15931 |
Remove sacrum pressure sore
|
$XXX.XX
|
J1
|
5073
|
| 15933 |
Remove sacrum pressure sore
|
$XXX.XX
|
J1
|
5073
|
| 15934 |
Remove sacrum pressure sore
|
$XXX.XX
|
T
|
5055
|
| 15935 |
Remove sacrum pressure sore
|
$XXX.XX
|
T
|
5055
|
| 15936 |
Remove sacrum pressure sore
|
$XXX.XX
|
T
|
5054
|
| 15937 |
Remove sacrum pressure sore
|
$XXX.XX
|
T
|
5054
|
| 15940 |
Remove hip pressure sore
|
$XXX.XX
|
J1
|
5073
|
| 15941 |
Remove hip pressure sore
|
$XXX.XX
|
J1
|
5073
|
| 15944 |
Remove hip pressure sore
|
$XXX.XX
|
T
|
5055
|
| 15945 |
Remove hip pressure sore
|
$XXX.XX
|
T
|
5054
|
| 15946 |
Remove hip pressure sore
|
$XXX.XX
|
T
|
5054
|
| 15950 |
Remove thigh pressure sore
|
$XXX.XX
|
J1
|
5072
|
| 15951 |
Remove thigh pressure sore
|
$XXX.XX
|
J1
|
5073
|
| 15952 |
Remove thigh pressure sore
|
$XXX.XX
|
T
|
5054
|
| 15953 |
Remove thigh pressure sore
|
$XXX.XX
|
T
|
5055
|
| 15956 |
Remove thigh pressure sore
|
$XXX.XX
|
T
|
5054
|
| 15958 |
Remove thigh pressure sore
|
$XXX.XX
|
T
|
5055
|
| 15999 |
Removal of pressure sore
|
$XXX.XX
|
T
|
5071
|
| 16000 |
Initial treatment of burn(s)
|
$XXX.XX
|
Q1
|
5051
|
| 16020 |
Dress/debrid p-thick burn s
|
$XXX.XX
|
Q1
|
5051
|
| 16025 |
Dress/debrid p-thick burn m
|
$XXX.XX
|
T
|
5051
|
| 16030 |
Dress/debrid p-thick burn l
|
$XXX.XX
|
T
|
5052
|
| 16035 |
Incision of burn scab initi
|
$XXX.XX
|
T
|
5052
|
| 17000 |
Destruct premalg lesion
|
$XXX.XX
|
Q1
|
5051
|
| 17004 |
Destroy premal lesions 15/>
|
$XXX.XX
|
T
|
5052
|
| 17106 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17107 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5053
|
| 17108 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5054
|
| 17110 |
Destruct b9 lesion 1-14
|
$XXX.XX
|
Q1
|
5051
|
| 17111 |
Destruct lesion 15 or more
|
$XXX.XX
|
Q1
|
5051
|
| 17250 |
Chem caut of granltj tissue
|
$XXX.XX
|
Q1
|
5051
|
| 17260 |
Destruction of skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 17261 |
Destruction of skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 17262 |
Destruction of skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 17263 |
Destruction of skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 17264 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17266 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17270 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5051
|
| 17271 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5051
|
| 17272 |
Destruction of skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 17273 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17274 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17276 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17280 |
Destruction of skin lesions
|
$XXX.XX
|
Q1
|
5051
|
| 17281 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17282 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17283 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5052
|
| 17284 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5053
|
| 17286 |
Destruction of skin lesions
|
$XXX.XX
|
T
|
5053
|
| 17311 |
Mohs 1 stage h/n/hf/g
|
$XXX.XX
|
T
|
5053
|
| 17313 |
Mohs 1 stage t/a/l
|
$XXX.XX
|
T
|
5053
|
| 17340 |
Cryotherapy of skin
|
$XXX.XX
|
Q1
|
5732
|
| 17360 |
Skin peel therapy
|
$XXX.XX
|
Q1
|
5051
|
| 17380 |
Hair removal by electrolysis
|
$XXX.XX
|
T
|
5053
|
| 17999 |
Skin tissue procedure
|
$XXX.XX
|
Q1
|
5051
|
| 19000 |
Drainage of breast lesion
|
$XXX.XX
|
T
|
5071
|
| 19020 |
Incision of breast lesion
|
$XXX.XX
|
J1
|
5072
|
| 19081 |
Bx breast 1st lesion strtctc
|
$XXX.XX
|
J1
|
5072
|
| 19083 |
Bx breast 1st lesion us imag
|
$XXX.XX
|
J1
|
5072
|
| 19085 |
Bx breast 1st lesion mr imag
|
$XXX.XX
|
J1
|
5072
|
| 19100 |
Bx breast percut w/o image
|
$XXX.XX
|
J1
|
5072
|
| 19101 |
Biopsy of breast open
|
$XXX.XX
|
J1
|
5091
|
| 19105 |
Cryosurg ablate fa each
|
$XXX.XX
|
J1
|
5091
|
| 19110 |
Nipple exploration
|
$XXX.XX
|
J1
|
5091
|
| 19112 |
Excise breast duct fistula
|
$XXX.XX
|
J1
|
5091
|
| 19120 |
Removal of breast lesion
|
$XXX.XX
|
J1
|
5091
|
| 19125 |
Excision breast lesion
|
$XXX.XX
|
J1
|
5091
|
| 19281 |
Perq device breast 1st imag
|
$XXX.XX
|
Q1
|
5071
|
| 19283 |
Perq dev breast 1st strtctc
|
$XXX.XX
|
Q1
|
5071
|
| 19285 |
Perq dev breast 1st us imag
|
$XXX.XX
|
Q1
|
5071
|
| 19287 |
Perq dev breast 1st mr guide
|
$XXX.XX
|
Q1
|
5071
|
| 19296 |
Place po breast cath for rad
|
$XXX.XX
|
J1
|
5093
|
| 19298 |
Place breast rad tube/caths
|
$XXX.XX
|
J1
|
5092
|
| 19300 |
Removal of breast tissue
|
$XXX.XX
|
J1
|
5091
|
| 19301 |
Partial mastectomy
|
$XXX.XX
|
J1
|
5091
|
| 19302 |
P-mastectomy w/ln removal
|
$XXX.XX
|
J1
|
5092
|
| 19303 |
Mast simple complete
|
$XXX.XX
|
J1
|
5092
|
| 19307 |
Mast mod rad
|
$XXX.XX
|
J1
|
5092
|
| 19316 |
Suspension of breast
|
$XXX.XX
|
J1
|
5092
|
| 19318 |
Reduction of large breast
|
$XXX.XX
|
J1
|
5092
|
| 19324 |
Enlarge breast
|
$XXX.XX
|
J1
|
5093
|
| 19325 |
Enlarge breast with implant
|
$XXX.XX
|
J1
|
5093
|
| 19328 |
Removal of breast implant
|
$XXX.XX
|
Q2
|
5091
|
| 19330 |
Removal of implant material
|
$XXX.XX
|
Q2
|
5091
|
| 19340 |
Immediate breast prosthesis
|
$XXX.XX
|
J1
|
5092
|
| 19342 |
Delayed breast prosthesis
|
$XXX.XX
|
J1
|
5093
|
| 19350 |
Breast reconstruction
|
$XXX.XX
|
J1
|
5091
|
| 19355 |
Correct inverted nipple(s)
|
$XXX.XX
|
J1
|
5091
|
| 19357 |
Breast reconstruction
|
$XXX.XX
|
J1
|
5094
|
| 19366 |
Breast reconstruction
|
$XXX.XX
|
J1
|
5092
|
| 19370 |
Surgery of breast capsule
|
$XXX.XX
|
J1
|
5091
|
| 19371 |
Removal of breast capsule
|
$XXX.XX
|
J1
|
5091
|
| 19380 |
Revise breast reconstruction
|
$XXX.XX
|
J1
|
5092
|
| 19396 |
Design custom breast implant
|
$XXX.XX
|
J1
|
5091
|
| 19499 |
Breast surgery procedure
|
$XXX.XX
|
J1
|
5091
|
| 20100 |
Explore wound neck
|
$XXX.XX
|
T
|
5162
|
| 20101 |
Explore wound chest
|
$XXX.XX
|
T
|
5054
|
| 20102 |
Explore wound abdomen
|
$XXX.XX
|
T
|
5054
|
| 20103 |
Explore wound extremity
|
$XXX.XX
|
T
|
5071
|
| 20150 |
Excise epiphyseal bar
|
$XXX.XX
|
J1
|
5113
|
| 20200 |
Muscle biopsy
|
$XXX.XX
|
J1
|
5072
|
| 20205 |
Deep muscle biopsy
|
$XXX.XX
|
J1
|
5073
|
| 20206 |
Needle biopsy muscle
|
$XXX.XX
|
J1
|
5072
|
| 20220 |
Bone biopsy trocar/needle
|
$XXX.XX
|
J1
|
5072
|
| 20225 |
Bone biopsy trocar/needle
|
$XXX.XX
|
J1
|
5072
|
| 20240 |
Bone biopsy open superficial
|
$XXX.XX
|
J1
|
5073
|
| 20245 |
Bone biopsy open deep
|
$XXX.XX
|
J1
|
5073
|
| 20250 |
Open bone biopsy
|
$XXX.XX
|
J1
|
5113
|
| 20251 |
Open bone biopsy
|
$XXX.XX
|
J1
|
5114
|
| 20500 |
Injection of sinus tract
|
$XXX.XX
|
J1
|
5163
|
| 20520 |
Removal of foreign body
|
$XXX.XX
|
J1
|
5072
|
| 20525 |
Removal of foreign body
|
$XXX.XX
|
J1
|
5073
|
| 20526 |
Ther injection carp tunnel
|
$XXX.XX
|
T
|
5441
|
| 20527 |
Inj dupuytren cord w/enzyme
|
$XXX.XX
|
T
|
5441
|
| 20550 |
Inj tendon sheath/ligament
|
$XXX.XX
|
T
|
5441
|
| 20551 |
Inj tendon origin/insertion
|
$XXX.XX
|
T
|
5441
|
| 20552 |
Inj trigger point 1/2 muscl
|
$XXX.XX
|
T
|
5441
|
| 20553 |
Inject trigger points 3/>
|
$XXX.XX
|
T
|
5441
|
| 20555 |
Place ndl musc/tis for rt
|
$XXX.XX
|
J1
|
5113
|
| 20560 |
Ndl insj w/o njx 1 or 2 musc
|
$XXX.XX
|
S
|
5731
|
| 20561 |
Ndl insj w/o njx 3+ musc
|
$XXX.XX
|
S
|
5731
|
| 20600 |
Drain/inj joint/bursa w/o us
|
$XXX.XX
|
T
|
5441
|
| 20604 |
Drain/inj joint/bursa w/us
|
$XXX.XX
|
T
|
5441
|
| 20605 |
Drain/inj joint/bursa w/o us
|
$XXX.XX
|
T
|
5441
|
| 20606 |
Drain/inj joint/bursa w/us
|
$XXX.XX
|
T
|
5442
|
| 20610 |
Drain/inj joint/bursa w/o us
|
$XXX.XX
|
T
|
5441
|
| 20611 |
Drain/inj joint/bursa w/us
|
$XXX.XX
|
T
|
5441
|
| 20612 |
Aspirate/inj ganglion cyst
|
$XXX.XX
|
T
|
5441
|
| 20615 |
Treatment of bone cyst
|
$XXX.XX
|
T
|
5071
|
| 20650 |
Insert and remove bone pin
|
$XXX.XX
|
J1
|
5113
|
| 20660 |
Apply rem fixation device
|
$XXX.XX
|
Q2
|
5112
|
| 20662 |
Application of pelvis brace
|
$XXX.XX
|
J1
|
5112
|
| 20663 |
Application of thigh brace
|
$XXX.XX
|
J1
|
5113
|
| 20665 |
Removal of fixation device
|
$XXX.XX
|
Q1
|
5735
|
| 20670 |
Removal of support implant
|
$XXX.XX
|
Q2
|
5072
|
| 20680 |
Removal of support implant
|
$XXX.XX
|
Q2
|
5073
|
| 20690 |
Apply bone fixation device
|
$XXX.XX
|
J1
|
5114
|
| 20692 |
Apply bone fixation device
|
$XXX.XX
|
J1
|
5115
|
| 20693 |
Adjust bone fixation device
|
$XXX.XX
|
J1
|
5114
|
| 20694 |
Remove bone fixation device
|
$XXX.XX
|
Q2
|
5112
|
| 20696 |
Comp multiplane ext fixation
|
$XXX.XX
|
J1
|
5116
|
| 20697 |
Comp ext fixate strut change
|
$XXX.XX
|
J1
|
5112
|
| 20822 |
Replantation digit complete
|
$XXX.XX
|
J1
|
5112
|
| 20900 |
Removal of bone for graft
|
$XXX.XX
|
J1
|
5114
|
| 20902 |
Removal of bone for graft
|
$XXX.XX
|
J1
|
5114
|
| 20910 |
Remove cartilage for graft
|
$XXX.XX
|
T
|
5053
|
| 20912 |
Remove cartilage for graft
|
$XXX.XX
|
T
|
5055
|
| 20920 |
Removal of fascia for graft
|
$XXX.XX
|
T
|
5054
|
| 20922 |
Removal of fascia for graft
|
$XXX.XX
|
T
|
5054
|
| 20924 |
Removal of tendon for graft
|
$XXX.XX
|
J1
|
5114
|
| 20950 |
Fluid pressure muscle
|
$XXX.XX
|
T
|
5071
|
| 20972 |
Bone/skin graft metatarsal
|
$XXX.XX
|
J1
|
5114
|
| 20973 |
Bone/skin graft great toe
|
$XXX.XX
|
J1
|
5114
|
| 20979 |
Us bone stimulation
|
$XXX.XX
|
Q1
|
5731
|
| 20982 |
Ablate bone tumor(s) perq
|
$XXX.XX
|
J1
|
5114
|
| 20983 |
Ablate bone tumor(s) perq
|
$XXX.XX
|
J1
|
5114
|
| 20999 |
Musculoskeletal surgery
|
$XXX.XX
|
T
|
5111
|
| 21010 |
Incision of jaw joint
|
$XXX.XX
|
J1
|
5164
|
| 21011 |
Exc face les sc <2 cm
|
$XXX.XX
|
J1
|
5072
|
| 21012 |
Exc face les sbq 2 cm/>
|
$XXX.XX
|
J1
|
5072
|
| 21013 |
Exc face tum deep < 2 cm
|
$XXX.XX
|
J1
|
5072
|
| 21014 |
Exc face tum deep 2 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 21015 |
Resect face/scalp tum < 2 cm
|
$XXX.XX
|
J1
|
5073
|
| 21016 |
Resect face/scalp tum 2 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 21025 |
Excision of bone lower jaw
|
$XXX.XX
|
J1
|
5165
|
| 21026 |
Excision of facial bone(s)
|
$XXX.XX
|
J1
|
5165
|
| 21029 |
Contour of face bone lesion
|
$XXX.XX
|
J1
|
5164
|
| 21030 |
Excise max/zygoma b9 tumor
|
$XXX.XX
|
J1
|
5165
|
| 21031 |
Remove exostosis mandible
|
$XXX.XX
|
J1
|
5164
|
| 21032 |
Remove exostosis maxilla
|
$XXX.XX
|
J1
|
5164
|
| 21034 |
Excise max/zygoma mal tumor
|
$XXX.XX
|
J1
|
5165
|
| 21040 |
Excise mandible lesion
|
$XXX.XX
|
J1
|
5164
|
| 21044 |
Removal of jaw bone lesion
|
$XXX.XX
|
J1
|
5165
|
| 21046 |
Remove mandible cyst complex
|
$XXX.XX
|
J1
|
5165
|
| 21047 |
Excise lwr jaw cyst w/repair
|
$XXX.XX
|
J1
|
5165
|
| 21048 |
Remove maxilla cyst complex
|
$XXX.XX
|
J1
|
5165
|
| 21049 |
Excis uppr jaw cyst w/repair
|
$XXX.XX
|
J1
|
5165
|
| 21050 |
Removal of jaw joint
|
$XXX.XX
|
J1
|
5165
|
| 21060 |
Remove jaw joint cartilage
|
$XXX.XX
|
J1
|
5165
|
| 21070 |
Remove coronoid process
|
$XXX.XX
|
J1
|
5165
|
| 21073 |
Mnpj of tmj w/anesth
|
$XXX.XX
|
J1
|
5163
|
| 21076 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5163
|
| 21077 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5165
|
| 21079 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21080 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21081 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5165
|
| 21082 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21083 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21084 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21085 |
Prepare face/oral prosthesis
|
$XXX.XX
|
T
|
5161
|
| 21086 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21087 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5165
|
| 21088 |
Prepare face/oral prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 21089 |
Prepare face/oral prosthesis
|
$XXX.XX
|
T
|
5161
|
| 21100 |
Maxillofacial fixation
|
$XXX.XX
|
J1
|
5165
|
| 21110 |
Interdental fixation
|
$XXX.XX
|
Q2
|
5163
|
| 21120 |
Reconstruction of chin
|
$XXX.XX
|
J1
|
5165
|
| 21121 |
Reconstruction of chin
|
$XXX.XX
|
J1
|
5164
|
| 21122 |
Reconstruction of chin
|
$XXX.XX
|
J1
|
5165
|
| 21123 |
Reconstruction of chin
|
$XXX.XX
|
J1
|
5164
|
| 21125 |
Augmentation lower jaw bone
|
$XXX.XX
|
J1
|
5165
|
| 21127 |
Augmentation lower jaw bone
|
$XXX.XX
|
J1
|
5165
|
| 21137 |
Reduction of forehead
|
$XXX.XX
|
J1
|
5164
|
| 21138 |
Reduction of forehead
|
$XXX.XX
|
J1
|
5165
|
| 21139 |
Reduction of forehead
|
$XXX.XX
|
J1
|
5165
|
| 21150 |
Lefort ii anterior intrusion
|
$XXX.XX
|
J1
|
5165
|
| 21172 |
Reconstruct orbit/forehead
|
$XXX.XX
|
J1
|
5165
|
| 21175 |
Reconstruct orbit/forehead
|
$XXX.XX
|
J1
|
5165
|
| 21181 |
Contour cranial bone lesion
|
$XXX.XX
|
J1
|
5165
|
| 21193 |
Reconst lwr jaw w/o graft
|
$XXX.XX
|
J1
|
5165
|
| 21195 |
Reconst lwr jaw w/o fixation
|
$XXX.XX
|
J1
|
5165
|
| 21198 |
Reconstr lwr jaw segment
|
$XXX.XX
|
J1
|
5165
|
| 21199 |
Reconstr lwr jaw w/advance
|
$XXX.XX
|
J1
|
5165
|
| 21206 |
Reconstruct upper jaw bone
|
$XXX.XX
|
J1
|
5165
|
| 21208 |
Augmentation of facial bones
|
$XXX.XX
|
J1
|
5165
|
| 21209 |
Reduction of facial bones
|
$XXX.XX
|
J1
|
5165
|
| 21210 |
Face bone graft
|
$XXX.XX
|
J1
|
5165
|
| 21215 |
Lower jaw bone graft
|
$XXX.XX
|
J1
|
5165
|
| 21230 |
Rib cartilage graft
|
$XXX.XX
|
J1
|
5165
|
| 21235 |
Ear cartilage graft
|
$XXX.XX
|
J1
|
5165
|
| 21240 |
Reconstruction of jaw joint
|
$XXX.XX
|
J1
|
5165
|
| 21242 |
Reconstruction of jaw joint
|
$XXX.XX
|
J1
|
5165
|
| 21243 |
Reconstruction of jaw joint
|
$XXX.XX
|
J1
|
5116
|
| 21244 |
Reconstruction of lower jaw
|
$XXX.XX
|
J1
|
5165
|
| 21245 |
Reconstruction of jaw
|
$XXX.XX
|
J1
|
5165
|
| 21246 |
Reconstruction of jaw
|
$XXX.XX
|
J1
|
5165
|
| 21248 |
Reconstruction of jaw
|
$XXX.XX
|
J1
|
5165
|
| 21249 |
Reconstruction of jaw
|
$XXX.XX
|
J1
|
5165
|
| 21256 |
Reconstruction of orbit
|
$XXX.XX
|
J1
|
5165
|
| 21260 |
Revise eye sockets
|
$XXX.XX
|
J1
|
5165
|
| 21261 |
Revise eye sockets
|
$XXX.XX
|
J1
|
5165
|
| 21263 |
Revise eye sockets
|
$XXX.XX
|
J1
|
5165
|
| 21267 |
Revise eye sockets
|
$XXX.XX
|
J1
|
5165
|
| 21270 |
Augmentation cheek bone
|
$XXX.XX
|
J1
|
5165
|
| 21275 |
Revision orbitofacial bones
|
$XXX.XX
|
J1
|
5165
|
| 21280 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5164
|
| 21282 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5164
|
| 21295 |
Revision of jaw muscle/bone
|
$XXX.XX
|
J1
|
5163
|
| 21296 |
Revision of jaw muscle/bone
|
$XXX.XX
|
J1
|
5164
|
| 21299 |
Cranio/maxillofacial surgery
|
$XXX.XX
|
T
|
5161
|
| 21310 |
Closed tx nose fx w/o manj
|
$XXX.XX
|
T
|
5111
|
| 21315 |
Closed tx nose fx w/o stablj
|
$XXX.XX
|
J1
|
5163
|
| 21320 |
Closed tx nose fx w/ stablj
|
$XXX.XX
|
J1
|
5164
|
| 21325 |
Open tx nose fx uncomplicatd
|
$XXX.XX
|
J1
|
5164
|
| 21330 |
Open tx nose fx w/skele fixj
|
$XXX.XX
|
J1
|
5165
|
| 21335 |
Open tx nose & septal fx
|
$XXX.XX
|
J1
|
5164
|
| 21336 |
Open tx septal fx w/wo stabj
|
$XXX.XX
|
J1
|
5113
|
| 21337 |
Closed tx septal&nose fx
|
$XXX.XX
|
J1
|
5164
|
| 21338 |
Open nasoethmoid fx w/o fixj
|
$XXX.XX
|
J1
|
5165
|
| 21339 |
Open nasoethmoid fx w/ fixj
|
$XXX.XX
|
J1
|
5165
|
| 21340 |
Perq tx nasoethmoid fx
|
$XXX.XX
|
J1
|
5164
|
| 21345 |
Closed tx nose/jaw fx
|
$XXX.XX
|
J1
|
5163
|
| 21346 |
Opn tx nasomax fx w/fixj
|
$XXX.XX
|
J1
|
5165
|
| 21355 |
Perq tx malar fracture
|
$XXX.XX
|
J1
|
5164
|
| 21356 |
Opn tx dprsd zygomatic arch
|
$XXX.XX
|
J1
|
5165
|
| 21360 |
Opn tx dprsd malar fracture
|
$XXX.XX
|
J1
|
5165
|
| 21365 |
Opn tx complx malar fx
|
$XXX.XX
|
J1
|
5165
|
| 21385 |
Opn tx orbit fx transantral
|
$XXX.XX
|
J1
|
5165
|
| 21386 |
Opn tx orbit fx periorbital
|
$XXX.XX
|
J1
|
5165
|
| 21387 |
Opn tx orbit fx combined
|
$XXX.XX
|
J1
|
5165
|
| 21390 |
Opn tx orbit periorbtl implt
|
$XXX.XX
|
J1
|
5165
|
| 21395 |
Opn tx orbit periorbt w/grft
|
$XXX.XX
|
J1
|
5165
|
| 21400 |
Closed tx orbit w/o manipulj
|
$XXX.XX
|
T
|
5162
|
| 21401 |
Closed tx orbit w/manipulj
|
$XXX.XX
|
J1
|
5163
|
| 21406 |
Opn tx orbit fx w/o implant
|
$XXX.XX
|
J1
|
5165
|
| 21407 |
Opn tx orbit fx w/implant
|
$XXX.XX
|
J1
|
5165
|
| 21408 |
Opn tx orbit fx w/bone grft
|
$XXX.XX
|
J1
|
5165
|
| 21421 |
Treat mouth roof fracture
|
$XXX.XX
|
J1
|
5164
|
| 21440 |
Treat dental ridge fracture
|
$XXX.XX
|
J1
|
5164
|
| 21445 |
Treat dental ridge fracture
|
$XXX.XX
|
J1
|
5165
|
| 21450 |
Treat lower jaw fracture
|
$XXX.XX
|
T
|
5162
|
| 21451 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5163
|
| 21452 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21453 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21454 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21461 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21462 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21465 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21470 |
Treat lower jaw fracture
|
$XXX.XX
|
J1
|
5165
|
| 21480 |
Reset dislocated jaw
|
$XXX.XX
|
T
|
5111
|
| 21485 |
Reset dislocated jaw
|
$XXX.XX
|
J1
|
5163
|
| 21490 |
Repair dislocated jaw
|
$XXX.XX
|
J1
|
5164
|
| 21497 |
Interdental wiring
|
$XXX.XX
|
J1
|
5163
|
| 21499 |
Head surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 21501 |
Drain neck/chest lesion
|
$XXX.XX
|
J1
|
5073
|
| 21502 |
Drain chest lesion
|
$XXX.XX
|
J1
|
5113
|
| 21550 |
Biopsy of neck/chest
|
$XXX.XX
|
J1
|
5072
|
| 21552 |
Exc neck les sc 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 21554 |
Exc neck tum deep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 21555 |
Exc neck les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 21556 |
Exc neck tum deep < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 21557 |
Resect neck thorax tumor<5cm
|
$XXX.XX
|
J1
|
5073
|
| 21558 |
Resect neck tumor 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 21600 |
Partial removal of rib
|
$XXX.XX
|
J1
|
5114
|
| 21601 |
Exc chest wall tumor w/ribs
|
$XXX.XX
|
J1
|
5073
|
| 21610 |
Partial removal of rib
|
$XXX.XX
|
J1
|
5113
|
| 21685 |
Hyoid myotomy & suspension
|
$XXX.XX
|
J1
|
5165
|
| 21700 |
Revision of neck muscle
|
$XXX.XX
|
J1
|
5114
|
| 21720 |
Revision of neck muscle
|
$XXX.XX
|
J1
|
5113
|
| 21725 |
Revision of neck muscle
|
$XXX.XX
|
T
|
5071
|
| 21742 |
Repair stern/nuss w/o scope
|
$XXX.XX
|
J1
|
5113
|
| 21743 |
Repair sternum/nuss w/scope
|
$XXX.XX
|
J1
|
5113
|
| 21811 |
Optx of rib fx w/fixj scope
|
$XXX.XX
|
J1
|
5114
|
| 21812 |
Treatment of rib fracture
|
$XXX.XX
|
J1
|
5114
|
| 21813 |
Treatment of rib fracture
|
$XXX.XX
|
J1
|
5112
|
| 21820 |
Treat sternum fracture
|
$XXX.XX
|
T
|
5111
|
| 21899 |
Neck/chest surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 21920 |
Biopsy soft tissue of back
|
$XXX.XX
|
J1
|
5072
|
| 21925 |
Biopsy soft tissue of back
|
$XXX.XX
|
J1
|
5072
|
| 21930 |
Exc back les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 21931 |
Exc back les sc 3 cm/>
|
$XXX.XX
|
J1
|
5072
|
| 21932 |
Exc back tum deep < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 21933 |
Exc back tum deep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 21935 |
Resect back tum < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 21936 |
Resect back tum 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 22100 |
Remove part of neck vertebra
|
$XXX.XX
|
J1
|
5114
|
| 22101 |
Remove part thorax vertebra
|
$XXX.XX
|
J1
|
5114
|
| 22102 |
Remove part lumbar vertebra
|
$XXX.XX
|
J1
|
5114
|
| 22310 |
Closed tx vert fx w/o manj
|
$XXX.XX
|
T
|
5111
|
| 22315 |
Closed tx vert fx w/manj
|
$XXX.XX
|
J1
|
5113
|
| 22505 |
Manipulation of spine
|
$XXX.XX
|
J1
|
5112
|
| 22510 |
Perq cervicothoracic inject
|
$XXX.XX
|
J1
|
5113
|
| 22511 |
Perq lumbosacral injection
|
$XXX.XX
|
J1
|
5113
|
| 22513 |
Perq vertebral augmentation
|
$XXX.XX
|
J1
|
5114
|
| 22514 |
Perq vertebral augmentation
|
$XXX.XX
|
J1
|
5114
|
| 22551 |
Neck spine fuse&remov bel c2
|
$XXX.XX
|
J1
|
5115
|
| 22554 |
Neck spine fusion
|
$XXX.XX
|
J1
|
5115
|
| 22612 |
Lumbar spine fusion
|
$XXX.XX
|
J1
|
5115
|
| 22633 |
Lumbar spine fusion combined
|
$XXX.XX
|
J1
|
5115
|
| 22856 |
Cerv artific diskectomy
|
$XXX.XX
|
J1
|
5116
|
| 22867 |
Insj stablj dev w/dcmprn
|
$XXX.XX
|
J1
|
5116
|
| 22869 |
Insj stablj dev w/o dcmprn
|
$XXX.XX
|
J1
|
5115
|
| 22899 |
Spine surgery procedure
|
$XXX.XX
|
T
|
5111
|
| 22900 |
Exc abdl tum deep < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 22901 |
Exc abdl tum deep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 22902 |
Exc abd les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 22903 |
Exc abd les sc 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 22904 |
Radical resect abd tumor<5cm
|
$XXX.XX
|
J1
|
5073
|
| 22905 |
Rad resect abd tumor 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 22999 |
Abdomen surgery procedure
|
$XXX.XX
|
T
|
5111
|
| 23000 |
Removal of calcium deposits
|
$XXX.XX
|
J1
|
5073
|
| 23020 |
Release shoulder joint
|
$XXX.XX
|
J1
|
5113
|
| 23030 |
Drain shoulder lesion
|
$XXX.XX
|
J1
|
5073
|
| 23031 |
Drain shoulder bursa
|
$XXX.XX
|
J1
|
5073
|
| 23035 |
Drain shoulder bone lesion
|
$XXX.XX
|
J1
|
5112
|
| 23040 |
Exploratory shoulder surgery
|
$XXX.XX
|
J1
|
5113
|
| 23044 |
Exploratory shoulder surgery
|
$XXX.XX
|
J1
|
5113
|
| 23065 |
Biopsy shoulder tissues
|
$XXX.XX
|
J1
|
5072
|
| 23066 |
Biopsy shoulder tissues
|
$XXX.XX
|
J1
|
5073
|
| 23071 |
Exc shoulder les sc 3 cm/>
|
$XXX.XX
|
J1
|
5072
|
| 23073 |
Exc shoulder tum deep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 23075 |
Exc shoulder les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 23076 |
Exc shoulder tum deep < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 23077 |
Resect shoulder tumor < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 23078 |
Resect shoulder tumor 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 23100 |
Biopsy of shoulder joint
|
$XXX.XX
|
J1
|
5113
|
| 23101 |
Shoulder joint surgery
|
$XXX.XX
|
J1
|
5113
|
| 23105 |
Remove shoulder joint lining
|
$XXX.XX
|
J1
|
5114
|
| 23106 |
Incision of collarbone joint
|
$XXX.XX
|
J1
|
5113
|
| 23107 |
Explore treat shoulder joint
|
$XXX.XX
|
J1
|
5114
|
| 23120 |
Partial removal collar bone
|
$XXX.XX
|
J1
|
5113
|
| 23125 |
Removal of collar bone
|
$XXX.XX
|
J1
|
5113
|
| 23130 |
Remove shoulder bone part
|
$XXX.XX
|
J1
|
5113
|
| 23140 |
Removal of bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 23145 |
Removal of bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 23146 |
Removal of bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 23150 |
Removal of humerus lesion
|
$XXX.XX
|
J1
|
5113
|
| 23155 |
Removal of humerus lesion
|
$XXX.XX
|
J1
|
5114
|
| 23156 |
Removal of humerus lesion
|
$XXX.XX
|
J1
|
5114
|
| 23170 |
Remove collar bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 23172 |
Remove shoulder blade lesion
|
$XXX.XX
|
J1
|
5113
|
| 23174 |
Remove humerus lesion
|
$XXX.XX
|
J1
|
5114
|
| 23180 |
Remove collar bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 23182 |
Remove shoulder blade lesion
|
$XXX.XX
|
J1
|
5114
|
| 23184 |
Remove humerus lesion
|
$XXX.XX
|
J1
|
5114
|
| 23190 |
Partial removal of scapula
|
$XXX.XX
|
J1
|
5113
|
| 23195 |
Removal of head of humerus
|
$XXX.XX
|
J1
|
5114
|
| 23330 |
Remove shoulder foreign body
|
$XXX.XX
|
T
|
5071
|
| 23333 |
Remove shoulder fb deep
|
$XXX.XX
|
J1
|
5073
|
| 23334 |
Shoulder prosthesis removal
|
$XXX.XX
|
J1
|
5073
|
| 23395 |
Muscle transfer shoulder/arm
|
$XXX.XX
|
J1
|
5114
|
| 23397 |
Muscle transfers
|
$XXX.XX
|
J1
|
5114
|
| 23400 |
Fixation of shoulder blade
|
$XXX.XX
|
J1
|
5114
|
| 23405 |
Incision of tendon & muscle
|
$XXX.XX
|
J1
|
5114
|
| 23406 |
Incise tendon(s) & muscle(s)
|
$XXX.XX
|
J1
|
5114
|
| 23410 |
Repair rotator cuff acute
|
$XXX.XX
|
J1
|
5114
|
| 23412 |
Repair rotator cuff chronic
|
$XXX.XX
|
J1
|
5114
|
| 23415 |
Release of shoulder ligament
|
$XXX.XX
|
J1
|
5114
|
| 23420 |
Repair of shoulder
|
$XXX.XX
|
J1
|
5114
|
| 23430 |
Repair biceps tendon
|
$XXX.XX
|
J1
|
5114
|
| 23440 |
Remove/transplant tendon
|
$XXX.XX
|
J1
|
5114
|
| 23450 |
Repair shoulder capsule
|
$XXX.XX
|
J1
|
5114
|
| 23455 |
Repair shoulder capsule
|
$XXX.XX
|
J1
|
5114
|
| 23460 |
Repair shoulder capsule
|
$XXX.XX
|
J1
|
5114
|
| 23462 |
Repair shoulder capsule
|
$XXX.XX
|
J1
|
5114
|
| 23465 |
Repair shoulder capsule
|
$XXX.XX
|
J1
|
5114
|
| 23466 |
Repair shoulder capsule
|
$XXX.XX
|
J1
|
5114
|
| 23470 |
Reconstruct shoulder joint
|
$XXX.XX
|
J1
|
5115
|
| 23473 |
Revis reconst shoulder joint
|
$XXX.XX
|
J1
|
5115
|
| 23480 |
Revision of collar bone
|
$XXX.XX
|
J1
|
5114
|
| 23485 |
Revision of collar bone
|
$XXX.XX
|
J1
|
5115
|
| 23490 |
Reinforce clavicle
|
$XXX.XX
|
J1
|
5114
|
| 23491 |
Reinforce shoulder bones
|
$XXX.XX
|
J1
|
5115
|
| 23500 |
Treat clavicle fracture
|
$XXX.XX
|
T
|
5111
|
| 23505 |
Treat clavicle fracture
|
$XXX.XX
|
J1
|
5112
|
| 23515 |
Treat clavicle fracture
|
$XXX.XX
|
J1
|
5114
|
| 23520 |
Treat clavicle dislocation
|
$XXX.XX
|
J1
|
5112
|
| 23525 |
Treat clavicle dislocation
|
$XXX.XX
|
T
|
5111
|
| 23530 |
Treat clavicle dislocation
|
$XXX.XX
|
J1
|
5114
|
| 23532 |
Treat clavicle dislocation
|
$XXX.XX
|
J1
|
5114
|
| 23540 |
Treat clavicle dislocation
|
$XXX.XX
|
T
|
5111
|
| 23545 |
Treat clavicle dislocation
|
$XXX.XX
|
T
|
5111
|
| 23550 |
Treat clavicle dislocation
|
$XXX.XX
|
J1
|
5114
|
| 23552 |
Treat clavicle dislocation
|
$XXX.XX
|
J1
|
5114
|
| 23570 |
Treat shoulder blade fx
|
$XXX.XX
|
T
|
5111
|
| 23575 |
Treat shoulder blade fx
|
$XXX.XX
|
J1
|
5112
|
| 23585 |
Treat scapula fracture
|
$XXX.XX
|
J1
|
5114
|
| 23600 |
Treat humerus fracture
|
$XXX.XX
|
T
|
5111
|
| 23605 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 23615 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5115
|
| 23616 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5116
|
| 23620 |
Treat humerus fracture
|
$XXX.XX
|
T
|
5111
|
| 23625 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 23630 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5114
|
| 23650 |
Treat shoulder dislocation
|
$XXX.XX
|
T
|
5111
|
| 23655 |
Treat shoulder dislocation
|
$XXX.XX
|
J1
|
5112
|
| 23660 |
Treat shoulder dislocation
|
$XXX.XX
|
J1
|
5114
|
| 23665 |
Treat dislocation/fracture
|
$XXX.XX
|
J1
|
5112
|
| 23670 |
Treat dislocation/fracture
|
$XXX.XX
|
J1
|
5114
|
| 23675 |
Treat dislocation/fracture
|
$XXX.XX
|
J1
|
5112
|
| 23680 |
Treat dislocation/fracture
|
$XXX.XX
|
J1
|
5115
|
| 23700 |
Fixation of shoulder
|
$XXX.XX
|
J1
|
5112
|
| 23800 |
Fusion of shoulder joint
|
$XXX.XX
|
J1
|
5114
|
| 23802 |
Fusion of shoulder joint
|
$XXX.XX
|
J1
|
5115
|
| 23921 |
Amputation follow-up surgery
|
$XXX.XX
|
T
|
5054
|
| 23929 |
Shoulder surgery procedure
|
$XXX.XX
|
T
|
5111
|
| 23930 |
Drainage of arm lesion
|
$XXX.XX
|
J1
|
5073
|
| 23931 |
Drainage of arm bursa
|
$XXX.XX
|
J1
|
5072
|
| 23935 |
Drain arm/elbow bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 24000 |
Exploratory elbow surgery
|
$XXX.XX
|
J1
|
5113
|
| 24006 |
Release elbow joint
|
$XXX.XX
|
J1
|
5113
|
| 24065 |
Biopsy arm/elbow soft tissue
|
$XXX.XX
|
J1
|
5072
|
| 24066 |
Biopsy arm/elbow soft tissue
|
$XXX.XX
|
J1
|
5073
|
| 24071 |
Exc arm/elbow les sc 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 24073 |
Ex arm/elbow tum deep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 24075 |
Exc arm/elbow les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 24076 |
Ex arm/elbow tum deep < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 24077 |
Resect arm/elbow tum < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 24079 |
Resect arm/elbow tum 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 24100 |
Biopsy elbow joint lining
|
$XXX.XX
|
J1
|
5113
|
| 24101 |
Explore/treat elbow joint
|
$XXX.XX
|
J1
|
5113
|
| 24102 |
Remove elbow joint lining
|
$XXX.XX
|
J1
|
5113
|
| 24105 |
Removal of elbow bursa
|
$XXX.XX
|
J1
|
5113
|
| 24110 |
Remove humerus lesion
|
$XXX.XX
|
J1
|
5113
|
| 24115 |
Remove/graft bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 24116 |
Remove/graft bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 24120 |
Remove elbow lesion
|
$XXX.XX
|
J1
|
5113
|
| 24125 |
Remove/graft bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 24126 |
Remove/graft bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 24130 |
Removal of head of radius
|
$XXX.XX
|
J1
|
5113
|
| 24134 |
Removal of arm bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 24136 |
Remove radius bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 24138 |
Remove elbow bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 24140 |
Partial removal of arm bone
|
$XXX.XX
|
J1
|
5113
|
| 24145 |
Partial removal of radius
|
$XXX.XX
|
J1
|
5114
|
| 24147 |
Partial removal of elbow
|
$XXX.XX
|
J1
|
5113
|
| 24149 |
Radical resection of elbow
|
$XXX.XX
|
J1
|
5114
|
| 24150 |
Resect distal humerus tumor
|
$XXX.XX
|
J1
|
5114
|
| 24152 |
Resect radius tumor
|
$XXX.XX
|
J1
|
5114
|
| 24155 |
Removal of elbow joint
|
$XXX.XX
|
J1
|
5113
|
| 24160 |
Remove elbow joint implant
|
$XXX.XX
|
Q2
|
5113
|
| 24164 |
Remove radius head implant
|
$XXX.XX
|
Q2
|
5113
|
| 24200 |
Removal of arm foreign body
|
$XXX.XX
|
J1
|
5072
|
| 24201 |
Removal of arm foreign body
|
$XXX.XX
|
J1
|
5073
|
| 24300 |
Manipulate elbow w/anesth
|
$XXX.XX
|
J1
|
5112
|
| 24301 |
Muscle/tendon transfer
|
$XXX.XX
|
J1
|
5114
|
| 24305 |
Arm tendon lengthening
|
$XXX.XX
|
J1
|
5113
|
| 24310 |
Revision of arm tendon
|
$XXX.XX
|
J1
|
5113
|
| 24320 |
Repair of arm tendon
|
$XXX.XX
|
J1
|
5114
|
| 24330 |
Revision of arm muscles
|
$XXX.XX
|
J1
|
5114
|
| 24331 |
Revision of arm muscles
|
$XXX.XX
|
J1
|
5114
|
| 24332 |
Tenolysis triceps
|
$XXX.XX
|
J1
|
5113
|
| 24340 |
Repair of biceps tendon
|
$XXX.XX
|
J1
|
5114
|
| 24341 |
Repair arm tendon/muscle
|
$XXX.XX
|
J1
|
5114
|
| 24342 |
Repair of ruptured tendon
|
$XXX.XX
|
J1
|
5114
|
| 24343 |
Repr elbow lat ligmnt w/tiss
|
$XXX.XX
|
J1
|
5113
|
| 24344 |
Reconstruct elbow lat ligmnt
|
$XXX.XX
|
J1
|
5114
|
| 24345 |
Repr elbw med ligmnt w/tissu
|
$XXX.XX
|
J1
|
5114
|
| 24346 |
Reconstruct elbow med ligmnt
|
$XXX.XX
|
J1
|
5115
|
| 24357 |
Repair elbow perc
|
$XXX.XX
|
J1
|
5113
|
| 24358 |
Repair elbow w/deb open
|
$XXX.XX
|
J1
|
5113
|
| 24359 |
Repair elbow deb/attch open
|
$XXX.XX
|
J1
|
5113
|
| 24360 |
Reconstruct elbow joint
|
$XXX.XX
|
J1
|
5114
|
| 24361 |
Reconstruct elbow joint
|
$XXX.XX
|
J1
|
5116
|
| 24362 |
Reconstruct elbow joint
|
$XXX.XX
|
J1
|
5115
|
| 24363 |
Replace elbow joint
|
$XXX.XX
|
J1
|
5116
|
| 24365 |
Reconstruct head of radius
|
$XXX.XX
|
J1
|
5115
|
| 24366 |
Reconstruct head of radius
|
$XXX.XX
|
J1
|
5115
|
| 24370 |
Revise reconst elbow joint
|
$XXX.XX
|
J1
|
5115
|
| 24371 |
Revise reconst elbow joint
|
$XXX.XX
|
J1
|
5116
|
| 24400 |
Revision of humerus
|
$XXX.XX
|
J1
|
5114
|
| 24410 |
Revision of humerus
|
$XXX.XX
|
J1
|
5115
|
| 24420 |
Revision of humerus
|
$XXX.XX
|
J1
|
5114
|
| 24430 |
Repair of humerus
|
$XXX.XX
|
J1
|
5115
|
| 24435 |
Repair humerus with graft
|
$XXX.XX
|
J1
|
5115
|
| 24470 |
Revision of elbow joint
|
$XXX.XX
|
J1
|
5113
|
| 24495 |
Decompression of forearm
|
$XXX.XX
|
J1
|
5114
|
| 24498 |
Reinforce humerus
|
$XXX.XX
|
J1
|
5115
|
| 24500 |
Treat humerus fracture
|
$XXX.XX
|
T
|
5111
|
| 24505 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 24515 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5115
|
| 24516 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5115
|
| 24530 |
Treat humerus fracture
|
$XXX.XX
|
T
|
5111
|
| 24535 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 24538 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5114
|
| 24545 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5115
|
| 24546 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5116
|
| 24560 |
Treat humerus fracture
|
$XXX.XX
|
T
|
5111
|
| 24565 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 24566 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 24575 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5115
|
| 24576 |
Treat humerus fracture
|
$XXX.XX
|
T
|
5111
|
| 24577 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5112
|
| 24579 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5115
|
| 24582 |
Treat humerus fracture
|
$XXX.XX
|
J1
|
5114
|
| 24586 |
Treat elbow fracture
|
$XXX.XX
|
J1
|
5115
|
| 24587 |
Treat elbow fracture
|
$XXX.XX
|
J1
|
5115
|
| 24600 |
Treat elbow dislocation
|
$XXX.XX
|
T
|
5111
|
| 24605 |
Treat elbow dislocation
|
$XXX.XX
|
J1
|
5112
|
| 24615 |
Treat elbow dislocation
|
$XXX.XX
|
J1
|
5114
|
| 24620 |
Treat elbow fracture
|
$XXX.XX
|
J1
|
5112
|
| 24635 |
Treat elbow fracture
|
$XXX.XX
|
J1
|
5114
|
| 24640 |
Treat elbow dislocation
|
$XXX.XX
|
T
|
5111
|
| 24650 |
Treat radius fracture
|
$XXX.XX
|
T
|
5111
|
| 24655 |
Treat radius fracture
|
$XXX.XX
|
J1
|
5112
|
| 24665 |
Treat radius fracture
|
$XXX.XX
|
J1
|
5114
|
| 24666 |
Treat radius fracture
|
$XXX.XX
|
J1
|
5115
|
| 24670 |
Treat ulnar fracture
|
$XXX.XX
|
T
|
5111
|
| 24675 |
Treat ulnar fracture
|
$XXX.XX
|
J1
|
5112
|
| 24685 |
Treat ulnar fracture
|
$XXX.XX
|
J1
|
5114
|
| 24800 |
Fusion of elbow joint
|
$XXX.XX
|
J1
|
5114
|
| 24802 |
Fusion/graft of elbow joint
|
$XXX.XX
|
J1
|
5115
|
| 24925 |
Amputation follow-up surgery
|
$XXX.XX
|
J1
|
5113
|
| 24935 |
Revision of amputation
|
$XXX.XX
|
J1
|
5114
|
| 24999 |
Upper arm/elbow surgery
|
$XXX.XX
|
T
|
5111
|
| 25000 |
Incision of tendon sheath
|
$XXX.XX
|
J1
|
5112
|
| 25001 |
Incise flexor carpi radialis
|
$XXX.XX
|
J1
|
5113
|
| 25020 |
Decompress forearm 1 space
|
$XXX.XX
|
J1
|
5112
|
| 25023 |
Decompress forearm 1 space
|
$XXX.XX
|
J1
|
5113
|
| 25024 |
Decompress forearm 2 spaces
|
$XXX.XX
|
J1
|
5113
|
| 25025 |
Decompress forearm 2 spaces
|
$XXX.XX
|
J1
|
5112
|
| 25028 |
Drainage of forearm lesion
|
$XXX.XX
|
J1
|
5113
|
| 25031 |
Drainage of forearm bursa
|
$XXX.XX
|
J1
|
5112
|
| 25035 |
Treat forearm bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 25040 |
Explore/treat wrist joint
|
$XXX.XX
|
J1
|
5113
|
| 25065 |
Biopsy forearm soft tissues
|
$XXX.XX
|
J1
|
5072
|
| 25066 |
Biopsy forearm soft tissues
|
$XXX.XX
|
J1
|
5073
|
| 25071 |
Exc forearm les sc 3 cm/>
|
$XXX.XX
|
J1
|
5072
|
| 25073 |
Exc forearm tum deep 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 25075 |
Exc forearm les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 25076 |
Exc forearm tum deep < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 25077 |
Resect forearm/wrist tum<3cm
|
$XXX.XX
|
J1
|
5073
|
| 25078 |
Resect forarm/wrist tum 3cm>
|
$XXX.XX
|
J1
|
5073
|
| 25085 |
Incision of wrist capsule
|
$XXX.XX
|
J1
|
5113
|
| 25100 |
Biopsy of wrist joint
|
$XXX.XX
|
J1
|
5113
|
| 25101 |
Explore/treat wrist joint
|
$XXX.XX
|
J1
|
5113
|
| 25105 |
Remove wrist joint lining
|
$XXX.XX
|
J1
|
5113
|
| 25107 |
Remove wrist joint cartilage
|
$XXX.XX
|
J1
|
5113
|
| 25109 |
Excise tendon forearm/wrist
|
$XXX.XX
|
J1
|
5113
|
| 25110 |
Remove wrist tendon lesion
|
$XXX.XX
|
J1
|
5112
|
| 25111 |
Remove wrist tendon lesion
|
$XXX.XX
|
J1
|
5112
|
| 25112 |
Reremove wrist tendon lesion
|
$XXX.XX
|
J1
|
5112
|
| 25115 |
Remove wrist/forearm lesion
|
$XXX.XX
|
J1
|
5112
|
| 25116 |
Remove wrist/forearm lesion
|
$XXX.XX
|
J1
|
5113
|
| 25118 |
Excise wrist tendon sheath
|
$XXX.XX
|
J1
|
5112
|
| 25119 |
Partial removal of ulna
|
$XXX.XX
|
J1
|
5113
|
| 25120 |
Removal of forearm lesion
|
$XXX.XX
|
J1
|
5113
|
| 25125 |
Remove/graft forearm lesion
|
$XXX.XX
|
J1
|
5112
|
| 25126 |
Remove/graft forearm lesion
|
$XXX.XX
|
J1
|
5113
|
| 25130 |
Removal of wrist lesion
|
$XXX.XX
|
J1
|
5113
|
| 25135 |
Remove & graft wrist lesion
|
$XXX.XX
|
J1
|
5114
|
| 25136 |
Remove & graft wrist lesion
|
$XXX.XX
|
J1
|
5114
|
| 25145 |
Remove forearm bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 25150 |
Partial removal of ulna
|
$XXX.XX
|
J1
|
5113
|
| 25151 |
Partial removal of radius
|
$XXX.XX
|
J1
|
5113
|
| 25170 |
Resect radius/ulnar tumor
|
$XXX.XX
|
J1
|
5114
|
| 25210 |
Removal of wrist bone
|
$XXX.XX
|
J1
|
5113
|
| 25215 |
Removal of wrist bones
|
$XXX.XX
|
J1
|
5113
|
| 25230 |
Partial removal of radius
|
$XXX.XX
|
J1
|
5113
|
| 25240 |
Partial removal of ulna
|
$XXX.XX
|
J1
|
5113
|
| 25248 |
Remove forearm foreign body
|
$XXX.XX
|
J1
|
5112
|
| 25250 |
Removal of wrist prosthesis
|
$XXX.XX
|
Q2
|
5112
|
| 25251 |
Removal of wrist prosthesis
|
$XXX.XX
|
Q2
|
5113
|
| 25259 |
Manipulate wrist w/anesthes
|
$XXX.XX
|
J1
|
5112
|
| 25260 |
Repair forearm tendon/muscle
|
$XXX.XX
|
J1
|
5113
|
| 25263 |
Repair forearm tendon/muscle
|
$XXX.XX
|
J1
|
5114
|
| 25265 |
Repair forearm tendon/muscle
|
$XXX.XX
|
J1
|
5113
|
| 25270 |
Repair forearm tendon/muscle
|
$XXX.XX
|
J1
|
5113
|
| 25272 |
Repair forearm tendon/muscle
|
$XXX.XX
|
J1
|
5113
|
| 25274 |
Repair forearm tendon/muscle
|
$XXX.XX
|
J1
|
5113
|
| 25275 |
Repair forearm tendon sheath
|
$XXX.XX
|
J1
|
5113
|
| 25280 |
Revise wrist/forearm tendon
|
$XXX.XX
|
J1
|
5113
|
| 25290 |
Incise wrist/forearm tendon
|
$XXX.XX
|
J1
|
5113
|
| 25295 |
Release wrist/forearm tendon
|
$XXX.XX
|
J1
|
5113
|
| 25300 |
Fusion of tendons at wrist
|
$XXX.XX
|
J1
|
5113
|
| 25301 |
Fusion of tendons at wrist
|
$XXX.XX
|
J1
|
5113
|
| 25310 |
Transplant forearm tendon
|
$XXX.XX
|
J1
|
5113
|
| 25312 |
Transplant forearm tendon
|
$XXX.XX
|
J1
|
5113
|
| 25315 |
Revise palsy hand tendon(s)
|
$XXX.XX
|
J1
|
5114
|
| 25316 |
Revise palsy hand tendon(s)
|
$XXX.XX
|
J1
|
5114
|
| 25320 |
Repair/revise wrist joint
|
$XXX.XX
|
J1
|
5114
|
| 25332 |
Revise wrist joint
|
$XXX.XX
|
J1
|
5113
|
| 25335 |
Realignment of hand
|
$XXX.XX
|
J1
|
5113
|
| 25337 |
Reconstruct ulna/radioulnar
|
$XXX.XX
|
J1
|
5114
|
| 25350 |
Revision of radius
|
$XXX.XX
|
J1
|
5114
|
| 25355 |
Revision of radius
|
$XXX.XX
|
J1
|
5113
|
| 25360 |
Revision of ulna
|
$XXX.XX
|
J1
|
5114
|
| 25365 |
Revise radius & ulna
|
$XXX.XX
|
J1
|
5115
|
| 25370 |
Revise radius or ulna
|
$XXX.XX
|
J1
|
5113
|
| 25375 |
Revise radius & ulna
|
$XXX.XX
|
J1
|
5113
|
| 25390 |
Shorten radius or ulna
|
$XXX.XX
|
J1
|
5114
|
| 25391 |
Lengthen radius or ulna
|
$XXX.XX
|
J1
|
5115
|
| 25392 |
Shorten radius & ulna
|
$XXX.XX
|
J1
|
5114
|
| 25393 |
Lengthen radius & ulna
|
$XXX.XX
|
J1
|
5114
|
| 25394 |
Repair carpal bone shorten
|
$XXX.XX
|
J1
|
5113
|
| 25400 |
Repair radius or ulna
|
$XXX.XX
|
J1
|
5114
|
| 25405 |
Repair/graft radius or ulna
|
$XXX.XX
|
J1
|
5114
|
| 25415 |
Repair radius & ulna
|
$XXX.XX
|
J1
|
5114
|
| 25420 |
Repair/graft radius & ulna
|
$XXX.XX
|
J1
|
5114
|
| 25425 |
Repair/graft radius or ulna
|
$XXX.XX
|
J1
|
5114
|
| 25426 |
Repair/graft radius & ulna
|
$XXX.XX
|
J1
|
5113
|
| 25430 |
Vasc graft into carpal bone
|
$XXX.XX
|
J1
|
5113
|
| 25431 |
Repair nonunion carpal bone
|
$XXX.XX
|
J1
|
5114
|
| 25440 |
Repair/graft wrist bone
|
$XXX.XX
|
J1
|
5114
|
| 25441 |
Reconstruct wrist joint
|
$XXX.XX
|
J1
|
5115
|
| 25442 |
Reconstruct wrist joint
|
$XXX.XX
|
J1
|
5116
|
| 25443 |
Reconstruct wrist joint
|
$XXX.XX
|
J1
|
5114
|
| 25444 |
Reconstruct wrist joint
|
$XXX.XX
|
J1
|
5115
|
| 25445 |
Reconstruct wrist joint
|
$XXX.XX
|
J1
|
5114
|
| 25446 |
Wrist replacement
|
$XXX.XX
|
J1
|
5116
|
| 25447 |
Repair wrist joints
|
$XXX.XX
|
J1
|
5113
|
| 25449 |
Remove wrist joint implant
|
$XXX.XX
|
J1
|
5114
|
| 25450 |
Revision of wrist joint
|
$XXX.XX
|
J1
|
5113
|
| 25455 |
Revision of wrist joint
|
$XXX.XX
|
J1
|
5113
|
| 25490 |
Reinforce radius
|
$XXX.XX
|
J1
|
5114
|
| 25491 |
Reinforce ulna
|
$XXX.XX
|
J1
|
5115
|
| 25492 |
Reinforce radius and ulna
|
$XXX.XX
|
J1
|
5113
|
| 25500 |
Treat fracture of radius
|
$XXX.XX
|
T
|
5111
|
| 25505 |
Treat fracture of radius
|
$XXX.XX
|
J1
|
5112
|
| 25515 |
Treat fracture of radius
|
$XXX.XX
|
J1
|
5114
|
| 25520 |
Treat fracture of radius
|
$XXX.XX
|
J1
|
5112
|
| 25525 |
Treat fracture of radius
|
$XXX.XX
|
J1
|
5114
|
| 25526 |
Treat fracture of radius
|
$XXX.XX
|
J1
|
5114
|
| 25530 |
Treat fracture of ulna
|
$XXX.XX
|
T
|
5111
|
| 25535 |
Treat fracture of ulna
|
$XXX.XX
|
T
|
5111
|
| 25545 |
Treat fracture of ulna
|
$XXX.XX
|
J1
|
5114
|
| 25560 |
Treat fracture radius & ulna
|
$XXX.XX
|
T
|
5111
|
| 25565 |
Treat fracture radius & ulna
|
$XXX.XX
|
J1
|
5112
|
| 25574 |
Treat fracture radius & ulna
|
$XXX.XX
|
J1
|
5114
|
| 25575 |
Treat fracture radius/ulna
|
$XXX.XX
|
J1
|
5114
|
| 25600 |
Treat fracture radius/ulna
|
$XXX.XX
|
T
|
5111
|
| 25605 |
Treat fracture radius/ulna
|
$XXX.XX
|
J1
|
5112
|
| 25606 |
Treat fx distal radial
|
$XXX.XX
|
J1
|
5113
|
| 25607 |
Treat fx rad extra-articul
|
$XXX.XX
|
J1
|
5114
|
| 25608 |
Treat fx rad intra-articul
|
$XXX.XX
|
J1
|
5114
|
| 25609 |
Treat fx radial 3+ frag
|
$XXX.XX
|
J1
|
5114
|
| 25622 |
Treat wrist bone fracture
|
$XXX.XX
|
T
|
5111
|
| 25624 |
Treat wrist bone fracture
|
$XXX.XX
|
J1
|
5112
|
| 25628 |
Treat wrist bone fracture
|
$XXX.XX
|
J1
|
5114
|
| 25630 |
Treat wrist bone fracture
|
$XXX.XX
|
T
|
5111
|
| 25635 |
Treat wrist bone fracture
|
$XXX.XX
|
J1
|
5112
|
| 25645 |
Treat wrist bone fracture
|
$XXX.XX
|
J1
|
5113
|
| 25650 |
Treat wrist bone fracture
|
$XXX.XX
|
T
|
5111
|
| 25651 |
Pin ulnar styloid fracture
|
$XXX.XX
|
J1
|
5113
|
| 25652 |
Treat fracture ulnar styloid
|
$XXX.XX
|
J1
|
5114
|
| 25660 |
Treat wrist dislocation
|
$XXX.XX
|
T
|
5111
|
| 25670 |
Treat wrist dislocation
|
$XXX.XX
|
J1
|
5114
|
| 25671 |
Pin radioulnar dislocation
|
$XXX.XX
|
J1
|
5113
|
| 25675 |
Treat wrist dislocation
|
$XXX.XX
|
T
|
5111
|
| 25676 |
Treat wrist dislocation
|
$XXX.XX
|
J1
|
5114
|
| 25680 |
Treat wrist fracture
|
$XXX.XX
|
T
|
5111
|
| 25685 |
Treat wrist fracture
|
$XXX.XX
|
J1
|
5114
|
| 25690 |
Treat wrist dislocation
|
$XXX.XX
|
J1
|
5112
|
| 25695 |
Treat wrist dislocation
|
$XXX.XX
|
J1
|
5114
|
| 25800 |
Fusion of wrist joint
|
$XXX.XX
|
J1
|
5114
|
| 25805 |
Fusion/graft of wrist joint
|
$XXX.XX
|
J1
|
5114
|
| 25810 |
Fusion/graft of wrist joint
|
$XXX.XX
|
J1
|
5115
|
| 25820 |
Fusion of hand bones
|
$XXX.XX
|
J1
|
5114
|
| 25825 |
Fuse hand bones with graft
|
$XXX.XX
|
J1
|
5114
|
| 25830 |
Fusion radioulnar jnt/ulna
|
$XXX.XX
|
J1
|
5114
|
| 25907 |
Amputation follow-up surgery
|
$XXX.XX
|
J1
|
5113
|
| 25909 |
Amputation follow-up surgery
|
$XXX.XX
|
J1
|
5114
|
| 25922 |
Amputate hand at wrist
|
$XXX.XX
|
J1
|
5112
|
| 25929 |
Amputation follow-up surgery
|
$XXX.XX
|
T
|
5054
|
| 25931 |
Amputation follow-up surgery
|
$XXX.XX
|
J1
|
5113
|
| 25999 |
Forearm or wrist surgery
|
$XXX.XX
|
T
|
5111
|
| 26010 |
Drainage of finger abscess
|
$XXX.XX
|
T
|
5051
|
| 26011 |
Drainage of finger abscess
|
$XXX.XX
|
J1
|
5072
|
| 26020 |
Drain hand tendon sheath
|
$XXX.XX
|
J1
|
5113
|
| 26025 |
Drainage of palm bursa
|
$XXX.XX
|
J1
|
5113
|
| 26030 |
Drainage of palm bursas
|
$XXX.XX
|
J1
|
5113
|
| 26034 |
Treat hand bone lesion
|
$XXX.XX
|
J1
|
5112
|
| 26035 |
Decompress fingers/hand
|
$XXX.XX
|
J1
|
5113
|
| 26037 |
Decompress fingers/hand
|
$XXX.XX
|
J1
|
5113
|
| 26040 |
Release palm contracture
|
$XXX.XX
|
J1
|
5112
|
| 26045 |
Release palm contracture
|
$XXX.XX
|
J1
|
5113
|
| 26055 |
Incise finger tendon sheath
|
$XXX.XX
|
J1
|
5112
|
| 26060 |
Incision of finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26070 |
Explore/treat hand joint
|
$XXX.XX
|
J1
|
5112
|
| 26075 |
Explore/treat finger joint
|
$XXX.XX
|
J1
|
5113
|
| 26080 |
Explore/treat finger joint
|
$XXX.XX
|
J1
|
5112
|
| 26100 |
Biopsy hand joint lining
|
$XXX.XX
|
J1
|
5113
|
| 26105 |
Biopsy finger joint lining
|
$XXX.XX
|
J1
|
5113
|
| 26110 |
Biopsy finger joint lining
|
$XXX.XX
|
J1
|
5112
|
| 26111 |
Exc hand les sc 1.5 cm/>
|
$XXX.XX
|
J1
|
5072
|
| 26113 |
Exc hand tum deep 1.5 cm/>
|
$XXX.XX
|
J1
|
5072
|
| 26115 |
Exc hand les sc < 1.5 cm
|
$XXX.XX
|
J1
|
5072
|
| 26116 |
Exc hand tum deep < 1.5 cm
|
$XXX.XX
|
J1
|
5072
|
| 26117 |
Rad resect hand tumor < 3 cm
|
$XXX.XX
|
J1
|
5073
|
| 26118 |
Rad resect hand tumor 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 26121 |
Release palm contracture
|
$XXX.XX
|
J1
|
5113
|
| 26123 |
Release palm contracture
|
$XXX.XX
|
J1
|
5113
|
| 26130 |
Remove wrist joint lining
|
$XXX.XX
|
J1
|
5113
|
| 26135 |
Revise finger joint each
|
$XXX.XX
|
J1
|
5113
|
| 26140 |
Revise finger joint each
|
$XXX.XX
|
J1
|
5112
|
| 26145 |
Tendon excision palm/finger
|
$XXX.XX
|
J1
|
5112
|
| 26160 |
Remove tendon sheath lesion
|
$XXX.XX
|
J1
|
5112
|
| 26170 |
Removal of palm tendon each
|
$XXX.XX
|
J1
|
5112
|
| 26180 |
Removal of finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26185 |
Remove finger bone
|
$XXX.XX
|
J1
|
5112
|
| 26200 |
Remove hand bone lesion
|
$XXX.XX
|
J1
|
5112
|
| 26205 |
Remove/graft bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 26210 |
Removal of finger lesion
|
$XXX.XX
|
J1
|
5112
|
| 26215 |
Remove/graft finger lesion
|
$XXX.XX
|
J1
|
5113
|
| 26230 |
Partial removal of hand bone
|
$XXX.XX
|
J1
|
5113
|
| 26235 |
Partial removal finger bone
|
$XXX.XX
|
J1
|
5112
|
| 26236 |
Partial removal finger bone
|
$XXX.XX
|
J1
|
5112
|
| 26250 |
Extensive hand surgery
|
$XXX.XX
|
J1
|
5113
|
| 26260 |
Resect prox finger tumor
|
$XXX.XX
|
J1
|
5113
|
| 26262 |
Resect distal finger tumor
|
$XXX.XX
|
J1
|
5112
|
| 26320 |
Removal of implant from hand
|
$XXX.XX
|
Q2
|
5072
|
| 26340 |
Manipulate finger w/anesth
|
$XXX.XX
|
J1
|
5112
|
| 26341 |
Manipulat palm cord post inj
|
$XXX.XX
|
T
|
5111
|
| 26350 |
Repair finger/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26352 |
Repair/graft hand tendon
|
$XXX.XX
|
J1
|
5114
|
| 26356 |
Repair finger/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26357 |
Repair finger/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26358 |
Repair/graft hand tendon
|
$XXX.XX
|
J1
|
5114
|
| 26370 |
Repair finger/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26372 |
Repair/graft hand tendon
|
$XXX.XX
|
J1
|
5114
|
| 26373 |
Repair finger/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26390 |
Revise hand/finger tendon
|
$XXX.XX
|
J1
|
5114
|
| 26392 |
Repair/graft hand tendon
|
$XXX.XX
|
J1
|
5114
|
| 26410 |
Repair hand tendon
|
$XXX.XX
|
J1
|
5112
|
| 26412 |
Repair/graft hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26415 |
Excision hand/finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26416 |
Graft hand or finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26418 |
Repair finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26420 |
Repair/graft finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26426 |
Repair finger/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26428 |
Repair/graft finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26432 |
Repair finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26433 |
Repair finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26434 |
Repair/graft finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26437 |
Realignment of tendons
|
$XXX.XX
|
J1
|
5113
|
| 26440 |
Release palm/finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26442 |
Release palm & finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26445 |
Release hand/finger tendon
|
$XXX.XX
|
J1
|
5113
|
| 26449 |
Release forearm/hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26450 |
Incision of palm tendon
|
$XXX.XX
|
J1
|
5113
|
| 26455 |
Incision of finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26460 |
Incise hand/finger tendon
|
$XXX.XX
|
J1
|
5112
|
| 26471 |
Fusion of finger tendons
|
$XXX.XX
|
J1
|
5113
|
| 26474 |
Fusion of finger tendons
|
$XXX.XX
|
J1
|
5112
|
| 26476 |
Tendon lengthening
|
$XXX.XX
|
J1
|
5113
|
| 26477 |
Tendon shortening
|
$XXX.XX
|
J1
|
5113
|
| 26478 |
Lengthening of hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26479 |
Shortening of hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26480 |
Transplant hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26483 |
Transplant/graft hand tendon
|
$XXX.XX
|
J1
|
5113
|
| 26485 |
Transplant palm tendon
|
$XXX.XX
|
J1
|
5113
|
| 26489 |
Transplant/graft palm tendon
|
$XXX.XX
|
J1
|
5113
|
| 26490 |
Revise thumb tendon
|
$XXX.XX
|
J1
|
5113
|
| 26492 |
Tendon transfer with graft
|
$XXX.XX
|
J1
|
5113
|
| 26494 |
Hand tendon/muscle transfer
|
$XXX.XX
|
J1
|
5113
|
| 26496 |
Revise thumb tendon
|
$XXX.XX
|
J1
|
5113
|
| 26497 |
Finger tendon transfer
|
$XXX.XX
|
J1
|
5113
|
| 26498 |
Finger tendon transfer
|
$XXX.XX
|
J1
|
5113
|
| 26499 |
Revision of finger
|
$XXX.XX
|
J1
|
5113
|
| 26500 |
Hand tendon reconstruction
|
$XXX.XX
|
J1
|
5114
|
| 26502 |
Hand tendon reconstruction
|
$XXX.XX
|
J1
|
5113
|
| 26508 |
Release thumb contracture
|
$XXX.XX
|
J1
|
5113
|
| 26510 |
Thumb tendon transfer
|
$XXX.XX
|
J1
|
5113
|
| 26516 |
Fusion of knuckle joint
|
$XXX.XX
|
J1
|
5113
|
| 26517 |
Fusion of knuckle joints
|
$XXX.XX
|
J1
|
5113
|
| 26518 |
Fusion of knuckle joints
|
$XXX.XX
|
J1
|
5114
|
| 26520 |
Release knuckle contracture
|
$XXX.XX
|
J1
|
5113
|
| 26525 |
Release finger contracture
|
$XXX.XX
|
J1
|
5112
|
| 26530 |
Revise knuckle joint
|
$XXX.XX
|
J1
|
5114
|
| 26531 |
Revise knuckle with implant
|
$XXX.XX
|
J1
|
5114
|
| 26535 |
Revise finger joint
|
$XXX.XX
|
J1
|
5113
|
| 26536 |
Revise/implant finger joint
|
$XXX.XX
|
J1
|
5114
|
| 26540 |
Repair hand joint
|
$XXX.XX
|
J1
|
5113
|
| 26541 |
Repair hand joint with graft
|
$XXX.XX
|
J1
|
5113
|
| 26542 |
Repair hand joint with graft
|
$XXX.XX
|
J1
|
5113
|
| 26545 |
Reconstruct finger joint
|
$XXX.XX
|
J1
|
5113
|
| 26546 |
Repair nonunion hand
|
$XXX.XX
|
J1
|
5114
|
| 26548 |
Reconstruct finger joint
|
$XXX.XX
|
J1
|
5113
|
| 26550 |
Construct thumb replacement
|
$XXX.XX
|
J1
|
5113
|
| 26555 |
Positional change of finger
|
$XXX.XX
|
J1
|
5114
|
| 26560 |
Repair of web finger
|
$XXX.XX
|
J1
|
5112
|
| 26561 |
Repair of web finger
|
$XXX.XX
|
J1
|
5113
|
| 26562 |
Repair of web finger
|
$XXX.XX
|
J1
|
5113
|
| 26565 |
Correct metacarpal flaw
|
$XXX.XX
|
J1
|
5113
|
| 26567 |
Correct finger deformity
|
$XXX.XX
|
J1
|
5113
|
| 26568 |
Lengthen metacarpal/finger
|
$XXX.XX
|
J1
|
5114
|
| 26580 |
Repair hand deformity
|
$XXX.XX
|
J1
|
5113
|
| 26587 |
Reconstruct extra finger
|
$XXX.XX
|
J1
|
5113
|
| 26590 |
Repair finger deformity
|
$XXX.XX
|
J1
|
5112
|
| 26591 |
Repair muscles of hand
|
$XXX.XX
|
J1
|
5113
|
| 26593 |
Release muscles of hand
|
$XXX.XX
|
J1
|
5113
|
| 26596 |
Excision constricting tissue
|
$XXX.XX
|
J1
|
5113
|
| 26600 |
Treat metacarpal fracture
|
$XXX.XX
|
T
|
5111
|
| 26605 |
Treat metacarpal fracture
|
$XXX.XX
|
T
|
5111
|
| 26607 |
Treat metacarpal fracture
|
$XXX.XX
|
J1
|
5113
|
| 26608 |
Treat metacarpal fracture
|
$XXX.XX
|
J1
|
5113
|
| 26615 |
Treat metacarpal fracture
|
$XXX.XX
|
J1
|
5113
|
| 26641 |
Treat thumb dislocation
|
$XXX.XX
|
T
|
5111
|
| 26645 |
Treat thumb fracture
|
$XXX.XX
|
J1
|
5112
|
| 26650 |
Treat thumb fracture
|
$XXX.XX
|
J1
|
5113
|
| 26665 |
Treat thumb fracture
|
$XXX.XX
|
J1
|
5113
|
| 26670 |
Treat hand dislocation
|
$XXX.XX
|
T
|
5111
|
| 26675 |
Treat hand dislocation
|
$XXX.XX
|
J1
|
5112
|
| 26676 |
Pin hand dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26685 |
Treat hand dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26686 |
Treat hand dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26700 |
Treat knuckle dislocation
|
$XXX.XX
|
T
|
5111
|
| 26705 |
Treat knuckle dislocation
|
$XXX.XX
|
J1
|
5112
|
| 26706 |
Pin knuckle dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26715 |
Treat knuckle dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26720 |
Treat finger fracture each
|
$XXX.XX
|
T
|
5111
|
| 26725 |
Treat finger fracture each
|
$XXX.XX
|
T
|
5111
|
| 26727 |
Treat finger fracture each
|
$XXX.XX
|
J1
|
5113
|
| 26735 |
Treat finger fracture each
|
$XXX.XX
|
J1
|
5113
|
| 26740 |
Treat finger fracture each
|
$XXX.XX
|
T
|
5111
|
| 26742 |
Treat finger fracture each
|
$XXX.XX
|
J1
|
5112
|
| 26746 |
Treat finger fracture each
|
$XXX.XX
|
J1
|
5113
|
| 26750 |
Treat finger fracture each
|
$XXX.XX
|
T
|
5111
|
| 26755 |
Treat finger fracture each
|
$XXX.XX
|
T
|
5111
|
| 26756 |
Pin finger fracture each
|
$XXX.XX
|
J1
|
5113
|
| 26765 |
Treat finger fracture each
|
$XXX.XX
|
J1
|
5113
|
| 26770 |
Treat finger dislocation
|
$XXX.XX
|
T
|
5111
|
| 26775 |
Treat finger dislocation
|
$XXX.XX
|
T
|
5102
|
| 26776 |
Pin finger dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26785 |
Treat finger dislocation
|
$XXX.XX
|
J1
|
5113
|
| 26820 |
Thumb fusion with graft
|
$XXX.XX
|
J1
|
5114
|
| 26841 |
Fusion of thumb
|
$XXX.XX
|
J1
|
5114
|
| 26842 |
Thumb fusion with graft
|
$XXX.XX
|
J1
|
5114
|
| 26843 |
Fusion of hand joint
|
$XXX.XX
|
J1
|
5114
|
| 26844 |
Fusion/graft of hand joint
|
$XXX.XX
|
J1
|
5114
|
| 26850 |
Fusion of knuckle
|
$XXX.XX
|
J1
|
5114
|
| 26852 |
Fusion of knuckle with graft
|
$XXX.XX
|
J1
|
5114
|
| 26860 |
Fusion of finger joint
|
$XXX.XX
|
J1
|
5113
|
| 26862 |
Fusion/graft of finger joint
|
$XXX.XX
|
J1
|
5113
|
| 26910 |
Amputate metacarpal bone
|
$XXX.XX
|
J1
|
5113
|
| 26951 |
Amputation of finger/thumb
|
$XXX.XX
|
J1
|
5113
|
| 26952 |
Amputation of finger/thumb
|
$XXX.XX
|
J1
|
5113
|
| 26989 |
Hand/finger surgery
|
$XXX.XX
|
T
|
5111
|
| 26990 |
Drainage of pelvis lesion
|
$XXX.XX
|
J1
|
5113
|
| 26991 |
Drainage of pelvis bursa
|
$XXX.XX
|
J1
|
5112
|
| 27000 |
Incision of hip tendon
|
$XXX.XX
|
J1
|
5112
|
| 27001 |
Incision of hip tendon
|
$XXX.XX
|
J1
|
5113
|
| 27003 |
Incision of hip tendon
|
$XXX.XX
|
J1
|
5114
|
| 27006 |
Incision of hip tendons
|
$XXX.XX
|
J1
|
5113
|
| 27027 |
Buttock fasciotomy
|
$XXX.XX
|
J1
|
5114
|
| 27033 |
Exploration of hip joint
|
$XXX.XX
|
J1
|
5114
|
| 27035 |
Denervation of hip joint
|
$XXX.XX
|
J1
|
5113
|
| 27040 |
Biopsy of soft tissues
|
$XXX.XX
|
J1
|
5072
|
| 27041 |
Biopsy of soft tissues
|
$XXX.XX
|
J1
|
5072
|
| 27043 |
Exc hip pelvis les sc 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27045 |
Exc hip/pelv tum deep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27047 |
Exc hip/pelvis les sc < 3 cm
|
$XXX.XX
|
J1
|
5073
|
| 27048 |
Exc hip/pelv tum deep < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 27049 |
Resect hip/pelv tum < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 27050 |
Biopsy of sacroiliac joint
|
$XXX.XX
|
J1
|
5112
|
| 27052 |
Biopsy of hip joint
|
$XXX.XX
|
J1
|
5112
|
| 27057 |
Buttock fasciotomy w/dbrdmt
|
$XXX.XX
|
J1
|
5112
|
| 27059 |
Resect hip/pelv tum 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27060 |
Removal of ischial bursa
|
$XXX.XX
|
J1
|
5114
|
| 27062 |
Remove femur lesion/bursa
|
$XXX.XX
|
J1
|
5113
|
| 27065 |
Remove hip bone les super
|
$XXX.XX
|
J1
|
5114
|
| 27066 |
Remove hip bone les deep
|
$XXX.XX
|
J1
|
5113
|
| 27067 |
Remove/graft hip bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 27080 |
Removal of tail bone
|
$XXX.XX
|
J1
|
5113
|
| 27086 |
Remove hip foreign body
|
$XXX.XX
|
J1
|
5073
|
| 27087 |
Remove hip foreign body
|
$XXX.XX
|
J1
|
5113
|
| 27097 |
Revision of hip tendon
|
$XXX.XX
|
J1
|
5113
|
| 27098 |
Transfer tendon to pelvis
|
$XXX.XX
|
J1
|
5113
|
| 27100 |
Transfer of abdominal muscle
|
$XXX.XX
|
J1
|
5114
|
| 27105 |
Transfer of spinal muscle
|
$XXX.XX
|
J1
|
5113
|
| 27110 |
Transfer of iliopsoas muscle
|
$XXX.XX
|
J1
|
5114
|
| 27111 |
Transfer of iliopsoas muscle
|
$XXX.XX
|
J1
|
5113
|
| 27130 |
Total hip arthroplasty
|
$XXX.XX
|
J1
|
5115
|
| 27179 |
Revise head/neck of femur
|
$XXX.XX
|
J1
|
5114
|
| 27197 |
Clsd tx pelvic ring fx
|
$XXX.XX
|
T
|
5111
|
| 27198 |
Clsd tx pelvic ring fx
|
$XXX.XX
|
T
|
5111
|
| 27200 |
Treat tail bone fracture
|
$XXX.XX
|
T
|
5111
|
| 27202 |
Treat tail bone fracture
|
$XXX.XX
|
J1
|
5113
|
| 27220 |
Treat hip socket fracture
|
$XXX.XX
|
T
|
5111
|
| 27230 |
Treat thigh fracture
|
$XXX.XX
|
T
|
5111
|
| 27235 |
Treat thigh fracture
|
$XXX.XX
|
J1
|
5114
|
| 27238 |
Treat thigh fracture
|
$XXX.XX
|
J1
|
5112
|
| 27246 |
Treat thigh fracture
|
$XXX.XX
|
T
|
5111
|
| 27250 |
Treat hip dislocation
|
$XXX.XX
|
T
|
5111
|
| 27252 |
Treat hip dislocation
|
$XXX.XX
|
J1
|
5112
|
| 27256 |
Treat hip dislocation
|
$XXX.XX
|
T
|
5111
|
| 27257 |
Treat hip dislocation
|
$XXX.XX
|
J1
|
5112
|
| 27265 |
Treat hip dislocation
|
$XXX.XX
|
T
|
5111
|
| 27266 |
Treat hip dislocation
|
$XXX.XX
|
J1
|
5112
|
| 27267 |
Cltx thigh fx
|
$XXX.XX
|
J1
|
5113
|
| 27275 |
Manipulation of hip joint
|
$XXX.XX
|
J1
|
5112
|
| 27279 |
Arthrodesis sacroiliac joint
|
$XXX.XX
|
J1
|
5116
|
| 27299 |
Pelvis/hip joint surgery
|
$XXX.XX
|
T
|
5111
|
| 27301 |
Drain thigh/knee lesion
|
$XXX.XX
|
J1
|
5073
|
| 27305 |
Incise thigh tendon & fascia
|
$XXX.XX
|
J1
|
5113
|
| 27306 |
Incision of thigh tendon
|
$XXX.XX
|
J1
|
5113
|
| 27307 |
Incision of thigh tendons
|
$XXX.XX
|
J1
|
5113
|
| 27310 |
Exploration of knee joint
|
$XXX.XX
|
J1
|
5113
|
| 27323 |
Biopsy thigh soft tissues
|
$XXX.XX
|
J1
|
5072
|
| 27324 |
Biopsy thigh soft tissues
|
$XXX.XX
|
J1
|
5073
|
| 27325 |
Neurectomy hamstring
|
$XXX.XX
|
J1
|
5431
|
| 27326 |
Neurectomy popliteal
|
$XXX.XX
|
J1
|
5431
|
| 27327 |
Exc thigh/knee les sc < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 27328 |
Exc thigh/knee tum deep <5cm
|
$XXX.XX
|
J1
|
5073
|
| 27329 |
Resect thigh/knee tum < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 27330 |
Biopsy knee joint lining
|
$XXX.XX
|
J1
|
5113
|
| 27331 |
Explore/treat knee joint
|
$XXX.XX
|
J1
|
5113
|
| 27332 |
Removal of knee cartilage
|
$XXX.XX
|
J1
|
5113
|
| 27333 |
Removal of knee cartilage
|
$XXX.XX
|
J1
|
5113
|
| 27334 |
Remove knee joint lining
|
$XXX.XX
|
J1
|
5113
|
| 27335 |
Remove knee joint lining
|
$XXX.XX
|
J1
|
5114
|
| 27337 |
Exc thigh/knee les sc 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27339 |
Exc thigh/knee tum dep 5cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27340 |
Removal of kneecap bursa
|
$XXX.XX
|
J1
|
5113
|
| 27345 |
Removal of knee cyst
|
$XXX.XX
|
J1
|
5113
|
| 27347 |
Remove knee cyst
|
$XXX.XX
|
J1
|
5113
|
| 27350 |
Removal of kneecap
|
$XXX.XX
|
J1
|
5114
|
| 27355 |
Remove femur lesion
|
$XXX.XX
|
J1
|
5113
|
| 27356 |
Remove femur lesion/graft
|
$XXX.XX
|
J1
|
5115
|
| 27357 |
Remove femur lesion/graft
|
$XXX.XX
|
J1
|
5114
|
| 27360 |
Partial removal leg bone(s)
|
$XXX.XX
|
J1
|
5113
|
| 27364 |
Resect thigh/knee tum 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27372 |
Removal of foreign body
|
$XXX.XX
|
J1
|
5073
|
| 27380 |
Repair of kneecap tendon
|
$XXX.XX
|
J1
|
5114
|
| 27381 |
Repair/graft kneecap tendon
|
$XXX.XX
|
J1
|
5114
|
| 27385 |
Repair of thigh muscle
|
$XXX.XX
|
J1
|
5114
|
| 27386 |
Repair/graft of thigh muscle
|
$XXX.XX
|
J1
|
5114
|
| 27390 |
Incision of thigh tendon
|
$XXX.XX
|
J1
|
5113
|
| 27391 |
Incision of thigh tendons
|
$XXX.XX
|
J1
|
5113
|
| 27392 |
Incision of thigh tendons
|
$XXX.XX
|
J1
|
5113
|
| 27393 |
Lengthening of thigh tendon
|
$XXX.XX
|
J1
|
5114
|
| 27394 |
Lengthening of thigh tendons
|
$XXX.XX
|
J1
|
5114
|
| 27395 |
Lengthening of thigh tendons
|
$XXX.XX
|
J1
|
5113
|
| 27396 |
Transplant of thigh tendon
|
$XXX.XX
|
J1
|
5114
|
| 27397 |
Transplants of thigh tendons
|
$XXX.XX
|
J1
|
5114
|
| 27400 |
Revise thigh muscles/tendons
|
$XXX.XX
|
J1
|
5114
|
| 27403 |
Repair of knee cartilage
|
$XXX.XX
|
J1
|
5114
|
| 27405 |
Repair of knee ligament
|
$XXX.XX
|
J1
|
5114
|
| 27407 |
Repair of knee ligament
|
$XXX.XX
|
J1
|
5114
|
| 27409 |
Repair of knee ligaments
|
$XXX.XX
|
J1
|
5114
|
| 27412 |
Autochondrocyte implant knee
|
$XXX.XX
|
J1
|
5114
|
| 27415 |
Osteochondral knee allograft
|
$XXX.XX
|
J1
|
5115
|
| 27416 |
Osteochondral knee autograft
|
$XXX.XX
|
J1
|
5114
|
| 27418 |
Repair degenerated kneecap
|
$XXX.XX
|
J1
|
5114
|
| 27420 |
Revision of unstable kneecap
|
$XXX.XX
|
J1
|
5114
|
| 27422 |
Revision of unstable kneecap
|
$XXX.XX
|
J1
|
5114
|
| 27424 |
Revision/removal of kneecap
|
$XXX.XX
|
J1
|
5114
|
| 27425 |
Lat retinacular release open
|
$XXX.XX
|
J1
|
5113
|
| 27427 |
Reconstruction knee
|
$XXX.XX
|
J1
|
5114
|
| 27428 |
Reconstruction knee
|
$XXX.XX
|
J1
|
5115
|
| 27429 |
Reconstruction knee
|
$XXX.XX
|
J1
|
5115
|
| 27430 |
Revision of thigh muscles
|
$XXX.XX
|
J1
|
5114
|
| 27435 |
Incision of knee joint
|
$XXX.XX
|
J1
|
5113
|
| 27437 |
Revise kneecap
|
$XXX.XX
|
J1
|
5114
|
| 27438 |
Revise kneecap with implant
|
$XXX.XX
|
J1
|
5115
|
| 27440 |
Revision of knee joint
|
$XXX.XX
|
J1
|
5115
|
| 27441 |
Revision of knee joint
|
$XXX.XX
|
J1
|
5115
|
| 27442 |
Revision of knee joint
|
$XXX.XX
|
J1
|
5115
|
| 27443 |
Revision of knee joint
|
$XXX.XX
|
J1
|
5115
|
| 27446 |
Revision of knee joint
|
$XXX.XX
|
J1
|
5115
|
| 27447 |
Total knee arthroplasty
|
$XXX.XX
|
J1
|
5115
|
| 27475 |
Surgery to stop leg growth
|
$XXX.XX
|
J1
|
5114
|
| 27477 |
Surgery to stop leg growth
|
$XXX.XX
|
J1
|
5114
|
| 27479 |
Surgery to stop leg growth
|
$XXX.XX
|
J1
|
5114
|
| 27485 |
Surgery to stop leg growth
|
$XXX.XX
|
J1
|
5114
|
| 27496 |
Decompression of thigh/knee
|
$XXX.XX
|
J1
|
5113
|
| 27497 |
Decompression of thigh/knee
|
$XXX.XX
|
J1
|
5113
|
| 27498 |
Decompression of thigh/knee
|
$XXX.XX
|
J1
|
5112
|
| 27499 |
Decompression of thigh/knee
|
$XXX.XX
|
J1
|
5114
|
| 27500 |
Treatment of thigh fracture
|
$XXX.XX
|
T
|
5111
|
| 27501 |
Treatment of thigh fracture
|
$XXX.XX
|
T
|
5111
|
| 27502 |
Treatment of thigh fracture
|
$XXX.XX
|
J1
|
5112
|
| 27503 |
Treatment of thigh fracture
|
$XXX.XX
|
J1
|
5112
|
| 27508 |
Treatment of thigh fracture
|
$XXX.XX
|
T
|
5111
|
| 27509 |
Treatment of thigh fracture
|
$XXX.XX
|
J1
|
5114
|
| 27510 |
Treatment of thigh fracture
|
$XXX.XX
|
J1
|
5112
|
| 27516 |
Treat thigh fx growth plate
|
$XXX.XX
|
T
|
5111
|
| 27517 |
Treat thigh fx growth plate
|
$XXX.XX
|
J1
|
5112
|
| 27520 |
Treat kneecap fracture
|
$XXX.XX
|
T
|
5111
|
| 27524 |
Treat kneecap fracture
|
$XXX.XX
|
J1
|
5114
|
| 27530 |
Treat knee fracture
|
$XXX.XX
|
T
|
5111
|
| 27532 |
Treat knee fracture
|
$XXX.XX
|
J1
|
5113
|
| 27538 |
Treat knee fracture(s)
|
$XXX.XX
|
T
|
5111
|
| 27550 |
Treat knee dislocation
|
$XXX.XX
|
T
|
5111
|
| 27552 |
Treat knee dislocation
|
$XXX.XX
|
J1
|
5112
|
| 27560 |
Treat kneecap dislocation
|
$XXX.XX
|
T
|
5111
|
| 27562 |
Treat kneecap dislocation
|
$XXX.XX
|
T
|
5111
|
| 27566 |
Treat kneecap dislocation
|
$XXX.XX
|
J1
|
5114
|
| 27570 |
Fixation of knee joint
|
$XXX.XX
|
J1
|
5112
|
| 27594 |
Amputation follow-up surgery
|
$XXX.XX
|
J1
|
5113
|
| 27599 |
Leg surgery procedure
|
$XXX.XX
|
T
|
5111
|
| 27600 |
Decompression of lower leg
|
$XXX.XX
|
J1
|
5113
|
| 27601 |
Decompression of lower leg
|
$XXX.XX
|
J1
|
5113
|
| 27602 |
Decompression of lower leg
|
$XXX.XX
|
J1
|
5113
|
| 27603 |
Drain lower leg lesion
|
$XXX.XX
|
J1
|
5073
|
| 27604 |
Drain lower leg bursa
|
$XXX.XX
|
J1
|
5113
|
| 27605 |
Incision of achilles tendon
|
$XXX.XX
|
J1
|
5112
|
| 27606 |
Incision of achilles tendon
|
$XXX.XX
|
J1
|
5113
|
| 27607 |
Treat lower leg bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 27610 |
Explore/treat ankle joint
|
$XXX.XX
|
J1
|
5113
|
| 27612 |
Exploration of ankle joint
|
$XXX.XX
|
J1
|
5113
|
| 27613 |
Biopsy lower leg soft tissue
|
$XXX.XX
|
J1
|
5072
|
| 27614 |
Biopsy lower leg soft tissue
|
$XXX.XX
|
J1
|
5073
|
| 27615 |
Resect leg/ankle tum < 5 cm
|
$XXX.XX
|
J1
|
5073
|
| 27616 |
Resect leg/ankle tum 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27618 |
Exc leg/ankle tum < 3 cm
|
$XXX.XX
|
J1
|
5072
|
| 27619 |
Exc leg/ankle tum deep <5 cm
|
$XXX.XX
|
J1
|
5073
|
| 27620 |
Explore/treat ankle joint
|
$XXX.XX
|
J1
|
5113
|
| 27625 |
Remove ankle joint lining
|
$XXX.XX
|
J1
|
5113
|
| 27626 |
Remove ankle joint lining
|
$XXX.XX
|
J1
|
5113
|
| 27630 |
Removal of tendon lesion
|
$XXX.XX
|
J1
|
5113
|
| 27632 |
Exc leg/ankle les sc 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27634 |
Exc leg/ankle tum dep 5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 27635 |
Remove lower leg bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 27637 |
Remove/graft leg bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 27638 |
Remove/graft leg bone lesion
|
$XXX.XX
|
J1
|
5114
|
| 27640 |
Partial removal of tibia
|
$XXX.XX
|
J1
|
5113
|
| 27641 |
Partial removal of fibula
|
$XXX.XX
|
J1
|
5113
|
| 27647 |
Resect talus/calcaneus tum
|
$XXX.XX
|
J1
|
5113
|
| 27650 |
Repair achilles tendon
|
$XXX.XX
|
J1
|
5114
|
| 27652 |
Repair/graft achilles tendon
|
$XXX.XX
|
J1
|
5114
|
| 27654 |
Repair of achilles tendon
|
$XXX.XX
|
J1
|
5114
|
| 27656 |
Repair leg fascia defect
|
$XXX.XX
|
J1
|
5113
|
| 27658 |
Repair of leg tendon each
|
$XXX.XX
|
J1
|
5113
|
| 27659 |
Repair of leg tendon each
|
$XXX.XX
|
J1
|
5114
|
| 27664 |
Repair of leg tendon each
|
$XXX.XX
|
J1
|
5114
|
| 27665 |
Repair of leg tendon each
|
$XXX.XX
|
J1
|
5114
|
| 27675 |
Repair lower leg tendons
|
$XXX.XX
|
J1
|
5113
|
| 27676 |
Repair lower leg tendons
|
$XXX.XX
|
J1
|
5114
|
| 27680 |
Release of lower leg tendon
|
$XXX.XX
|
J1
|
5113
|
| 27681 |
Release of lower leg tendons
|
$XXX.XX
|
J1
|
5113
|
| 27685 |
Revision of lower leg tendon
|
$XXX.XX
|
J1
|
5113
|
| 27686 |
Revise lower leg tendons
|
$XXX.XX
|
J1
|
5113
|
| 27687 |
Revision of calf tendon
|
$XXX.XX
|
J1
|
5113
|
| 27690 |
Revise lower leg tendon
|
$XXX.XX
|
J1
|
5114
|
| 27691 |
Revise lower leg tendon
|
$XXX.XX
|
J1
|
5114
|
| 27695 |
Repair of ankle ligament
|
$XXX.XX
|
J1
|
5114
|
| 27696 |
Repair of ankle ligaments
|
$XXX.XX
|
J1
|
5114
|
| 27698 |
Repair of ankle ligament
|
$XXX.XX
|
J1
|
5114
|
| 27700 |
Revision of ankle joint
|
$XXX.XX
|
J1
|
5114
|
| 27704 |
Removal of ankle implant
|
$XXX.XX
|
Q2
|
5113
|
| 27705 |
Incision of tibia
|
$XXX.XX
|
J1
|
5114
|
| 27707 |
Incision of fibula
|
$XXX.XX
|
J1
|
5113
|
| 27709 |
Incision of tibia & fibula
|
$XXX.XX
|
J1
|
5115
|
| 27720 |
Repair of tibia
|
$XXX.XX
|
J1
|
5114
|
| 27722 |
Repair/graft of tibia
|
$XXX.XX
|
J1
|
5114
|
| 27726 |
Repair fibula nonunion
|
$XXX.XX
|
J1
|
5114
|
| 27730 |
Repair of tibia epiphysis
|
$XXX.XX
|
J1
|
5113
|
| 27732 |
Repair of fibula epiphysis
|
$XXX.XX
|
J1
|
5113
|
| 27734 |
Repair lower leg epiphyses
|
$XXX.XX
|
J1
|
5113
|
| 27740 |
Repair of leg epiphyses
|
$XXX.XX
|
J1
|
5113
|
| 27742 |
Repair of leg epiphyses
|
$XXX.XX
|
J1
|
5113
|
| 27745 |
Reinforce tibia
|
$XXX.XX
|
J1
|
5114
|
| 27750 |
Treatment of tibia fracture
|
$XXX.XX
|
T
|
5111
|
| 27752 |
Treatment of tibia fracture
|
$XXX.XX
|
J1
|
5112
|
| 27756 |
Treatment of tibia fracture
|
$XXX.XX
|
J1
|
5114
|
| 27758 |
Treatment of tibia fracture
|
$XXX.XX
|
J1
|
5115
|
| 27759 |
Treatment of tibia fracture
|
$XXX.XX
|
J1
|
5115
|
| 27760 |
Cltx medial ankle fx
|
$XXX.XX
|
T
|
5111
|
| 27762 |
Cltx med ankle fx w/mnpj
|
$XXX.XX
|
J1
|
5112
|
| 27766 |
Optx medial ankle fx
|
$XXX.XX
|
J1
|
5114
|
| 27767 |
Cltx post ankle fx
|
$XXX.XX
|
T
|
5111
|
| 27768 |
Cltx post ankle fx w/mnpj
|
$XXX.XX
|
J1
|
5112
|
| 27769 |
Optx post ankle fx
|
$XXX.XX
|
J1
|
5114
|
| 27780 |
Treatment of fibula fracture
|
$XXX.XX
|
T
|
5111
|
| 27781 |
Treatment of fibula fracture
|
$XXX.XX
|
J1
|
5112
|
| 27784 |
Treatment of fibula fracture
|
$XXX.XX
|
J1
|
5114
|
| 27786 |
Treatment of ankle fracture
|
$XXX.XX
|
T
|
5111
|
| 27788 |
Treatment of ankle fracture
|
$XXX.XX
|
T
|
5111
|
| 27792 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5114
|
| 27808 |
Treatment of ankle fracture
|
$XXX.XX
|
T
|
5111
|
| 27810 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5112
|
| 27814 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5114
|
| 27816 |
Treatment of ankle fracture
|
$XXX.XX
|
T
|
5111
|
| 27818 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5112
|
| 27822 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5114
|
| 27823 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5114
|
| 27824 |
Treat lower leg fracture
|
$XXX.XX
|
T
|
5111
|
| 27825 |
Treat lower leg fracture
|
$XXX.XX
|
J1
|
5112
|
| 27826 |
Treat lower leg fracture
|
$XXX.XX
|
J1
|
5114
|
| 27827 |
Treat lower leg fracture
|
$XXX.XX
|
J1
|
5115
|
| 27828 |
Treat lower leg fracture
|
$XXX.XX
|
J1
|
5115
|
| 27829 |
Treat lower leg joint
|
$XXX.XX
|
J1
|
5114
|
| 27830 |
Treat lower leg dislocation
|
$XXX.XX
|
T
|
5111
|
| 27831 |
Treat lower leg dislocation
|
$XXX.XX
|
J1
|
5113
|
| 27832 |
Treat lower leg dislocation
|
$XXX.XX
|
J1
|
5114
|
| 27840 |
Treat ankle dislocation
|
$XXX.XX
|
T
|
5111
|
| 27842 |
Treat ankle dislocation
|
$XXX.XX
|
J1
|
5112
|
| 27846 |
Treat ankle dislocation
|
$XXX.XX
|
J1
|
5114
|
| 27848 |
Treat ankle dislocation
|
$XXX.XX
|
J1
|
5114
|
| 27860 |
Fixation of ankle joint
|
$XXX.XX
|
J1
|
5113
|
| 27870 |
Fusion of ankle joint open
|
$XXX.XX
|
J1
|
5115
|
| 27871 |
Fusion of tibiofibular joint
|
$XXX.XX
|
J1
|
5115
|
| 27884 |
Amputation follow-up surgery
|
$XXX.XX
|
J1
|
5113
|
| 27889 |
Amputation of foot at ankle
|
$XXX.XX
|
J1
|
5114
|
| 27892 |
Decompression of leg
|
$XXX.XX
|
J1
|
5113
|
| 27893 |
Decompression of leg
|
$XXX.XX
|
J1
|
5114
|
| 27894 |
Decompression of leg
|
$XXX.XX
|
J1
|
5113
|
| 27899 |
Leg/ankle surgery procedure
|
$XXX.XX
|
T
|
5111
|
| 28001 |
Drainage of bursa of foot
|
$XXX.XX
|
J1
|
5072
|
| 28002 |
Treatment of foot infection
|
$XXX.XX
|
J1
|
5112
|
| 28003 |
Treatment of foot infection
|
$XXX.XX
|
J1
|
5113
|
| 28005 |
Treat foot bone lesion
|
$XXX.XX
|
J1
|
5113
|
| 28008 |
Incision of foot fascia
|
$XXX.XX
|
J1
|
5113
|
| 28010 |
Incision of toe tendon
|
$XXX.XX
|
J1
|
5112
|
| 28011 |
Incision of toe tendons
|
$XXX.XX
|
J1
|
5112
|
| 28020 |
Exploration of foot joint
|
$XXX.XX
|
J1
|
5113
|
| 28022 |
Exploration of foot joint
|
$XXX.XX
|
J1
|
5113
|
| 28024 |
Exploration of toe joint
|
$XXX.XX
|
J1
|
5112
|
| 28035 |
Decompression of tibia nerve
|
$XXX.XX
|
J1
|
5431
|
| 28039 |
Exc foot/toe tum sc 1.5 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 28041 |
Exc foot/toe tum dep 1.5cm/>
|
$XXX.XX
|
J1
|
5073
|
| 28043 |
Exc foot/toe tum sc < 1.5 cm
|
$XXX.XX
|
J1
|
5072
|
| 28045 |
Exc foot/toe tum deep <1.5cm
|
$XXX.XX
|
J1
|
5073
|
| 28046 |
Resect foot/toe tumor < 3 cm
|
$XXX.XX
|
J1
|
5073
|
| 28047 |
Resect foot/toe tumor 3 cm/>
|
$XXX.XX
|
J1
|
5073
|
| 28050 |
Biopsy of foot joint lining
|
$XXX.XX
|
J1
|
5113
|
| 28052 |
Biopsy of foot joint lining
|
$XXX.XX
|
J1
|
5113
|
| 28054 |
Biopsy of toe joint lining
|
$XXX.XX
|
J1
|
5113
|
| 28055 |
Neurectomy foot
|
$XXX.XX
|
J1
|
5431
|
| 28060 |
Partial removal foot fascia
|
$XXX.XX
|
J1
|
5113
|
| 28062 |
Removal of foot fascia
|
$XXX.XX
|
J1
|
5113
|
| 28070 |
Removal of foot joint lining
|
$XXX.XX
|
J1
|
5114
|
| 28072 |
Removal of foot joint lining
|
$XXX.XX
|
J1
|
5113
|
| 28080 |
Removal of foot lesion
|
$XXX.XX
|
J1
|
5112
|
| 28086 |
Excise foot tendon sheath
|
$XXX.XX
|
J1
|
5113
|
| 28088 |
Excise foot tendon sheath
|
$XXX.XX
|
J1
|
5113
|
| 28090 |
Removal of foot lesion
|
$XXX.XX
|
J1
|
5112
|
| 28092 |
Removal of toe lesions
|
$XXX.XX
|
J1
|
5112
|
| 28100 |
Removal of ankle/heel lesion
|
$XXX.XX
|
J1
|
5113
|
| 28102 |
Remove/graft foot lesion
|
$XXX.XX
|
J1
|
5114
|
| 28103 |
Remove/graft foot lesion
|
$XXX.XX
|
J1
|
5114
|
| 28104 |
Removal of foot lesion
|
$XXX.XX
|
J1
|
5113
|
| 28106 |
Remove/graft foot lesion
|
$XXX.XX
|
J1
|
5114
|
| 28107 |
Remove/graft foot lesion
|
$XXX.XX
|
J1
|
5114
|
| 28108 |
Removal of toe lesions
|
$XXX.XX
|
J1
|
5112
|
| 28110 |
Part removal of metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28111 |
Part removal of metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28112 |
Part removal of metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28113 |
Part removal of metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28114 |
Removal of metatarsal heads
|
$XXX.XX
|
J1
|
5113
|
| 28116 |
Revision of foot
|
$XXX.XX
|
J1
|
5113
|
| 28118 |
Removal of heel bone
|
$XXX.XX
|
J1
|
5113
|
| 28119 |
Removal of heel spur
|
$XXX.XX
|
J1
|
5113
|
| 28120 |
Part removal of ankle/heel
|
$XXX.XX
|
J1
|
5113
|
| 28122 |
Partial removal of foot bone
|
$XXX.XX
|
J1
|
5113
|
| 28124 |
Partial removal of toe
|
$XXX.XX
|
J1
|
5113
|
| 28126 |
Partial removal of toe
|
$XXX.XX
|
J1
|
5113
|
| 28130 |
Removal of ankle bone
|
$XXX.XX
|
J1
|
5114
|
| 28140 |
Removal of metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28150 |
Removal of toe
|
$XXX.XX
|
J1
|
5113
|
| 28153 |
Partial removal of toe
|
$XXX.XX
|
J1
|
5113
|
| 28160 |
Partial removal of toe
|
$XXX.XX
|
J1
|
5113
|
| 28171 |
Resect tarsal tumor
|
$XXX.XX
|
J1
|
5113
|
| 28173 |
Resect metatarsal tumor
|
$XXX.XX
|
J1
|
5113
|
| 28175 |
Resect phalanx of toe tumor
|
$XXX.XX
|
J1
|
5112
|
| 28190 |
Removal of foot foreign body
|
$XXX.XX
|
T
|
5071
|
| 28192 |
Removal of foot foreign body
|
$XXX.XX
|
J1
|
5072
|
| 28193 |
Removal of foot foreign body
|
$XXX.XX
|
J1
|
5072
|
| 28200 |
Repair of foot tendon
|
$XXX.XX
|
J1
|
5113
|
| 28202 |
Repair/graft of foot tendon
|
$XXX.XX
|
J1
|
5114
|
| 28208 |
Repair of foot tendon
|
$XXX.XX
|
J1
|
5113
|
| 28210 |
Repair/graft of foot tendon
|
$XXX.XX
|
J1
|
5114
|
| 28220 |
Release of foot tendon
|
$XXX.XX
|
J1
|
5112
|
| 28222 |
Release of foot tendons
|
$XXX.XX
|
J1
|
5113
|
| 28225 |
Release of foot tendon
|
$XXX.XX
|
J1
|
5113
|
| 28226 |
Release of foot tendons
|
$XXX.XX
|
J1
|
5113
|
| 28230 |
Incision of foot tendon(s)
|
$XXX.XX
|
J1
|
5112
|
| 28232 |
Incision of toe tendon
|
$XXX.XX
|
J1
|
5112
|
| 28234 |
Incision of foot tendon
|
$XXX.XX
|
J1
|
5112
|
| 28238 |
Revision of foot tendon
|
$XXX.XX
|
J1
|
5114
|
| 28240 |
Release of big toe
|
$XXX.XX
|
J1
|
5113
|
| 28250 |
Revision of foot fascia
|
$XXX.XX
|
J1
|
5113
|
| 28260 |
Release of midfoot joint
|
$XXX.XX
|
J1
|
5113
|
| 28261 |
Revision of foot tendon
|
$XXX.XX
|
J1
|
5112
|
| 28262 |
Revision of foot and ankle
|
$XXX.XX
|
J1
|
5114
|
| 28264 |
Release of midfoot joint
|
$XXX.XX
|
J1
|
5112
|
| 28270 |
Release of foot contracture
|
$XXX.XX
|
J1
|
5113
|
| 28272 |
Release of toe joint each
|
$XXX.XX
|
J1
|
5112
|
| 28280 |
Fusion of toes
|
$XXX.XX
|
J1
|
5113
|
| 28285 |
Repair of hammertoe
|
$XXX.XX
|
J1
|
5113
|
| 28286 |
Repair of hammertoe
|
$XXX.XX
|
J1
|
5113
|
| 28288 |
Partial removal of foot bone
|
$XXX.XX
|
J1
|
5113
|
| 28289 |
Corrj halux rigdus w/o implt
|
$XXX.XX
|
J1
|
5113
|
| 28291 |
Corrj halux rigdus w/implt
|
$XXX.XX
|
J1
|
5114
|
| 28292 |
Correction hallux valgus
|
$XXX.XX
|
J1
|
5113
|
| 28295 |
Correction hallux valgus
|
$XXX.XX
|
J1
|
5113
|
| 28296 |
Correction hallux valgus
|
$XXX.XX
|
J1
|
5113
|
| 28297 |
Correction hallux valgus
|
$XXX.XX
|
J1
|
5114
|
| 28298 |
Correction hallux valgus
|
$XXX.XX
|
J1
|
5114
|
| 28299 |
Correction hallux valgus
|
$XXX.XX
|
J1
|
5114
|
| 28300 |
Incision of heel bone
|
$XXX.XX
|
J1
|
5114
|
| 28302 |
Incision of ankle bone
|
$XXX.XX
|
J1
|
5114
|
| 28304 |
Incision of midfoot bones
|
$XXX.XX
|
J1
|
5114
|
| 28305 |
Incise/graft midfoot bones
|
$XXX.XX
|
J1
|
5114
|
| 28306 |
Incision of metatarsal
|
$XXX.XX
|
J1
|
5114
|
| 28307 |
Incision of metatarsal
|
$XXX.XX
|
J1
|
5114
|
| 28308 |
Incision of metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28309 |
Incision of metatarsals
|
$XXX.XX
|
J1
|
5114
|
| 28310 |
Revision of big toe
|
$XXX.XX
|
J1
|
5114
|
| 28312 |
Revision of toe
|
$XXX.XX
|
J1
|
5113
|
| 28313 |
Repair deformity of toe
|
$XXX.XX
|
J1
|
5113
|
| 28315 |
Removal of sesamoid bone
|
$XXX.XX
|
J1
|
5113
|
| 28320 |
Repair of foot bones
|
$XXX.XX
|
J1
|
5115
|
| 28322 |
Repair of metatarsals
|
$XXX.XX
|
J1
|
5114
|
| 28340 |
Resect enlarged toe tissue
|
$XXX.XX
|
J1
|
5113
|
| 28341 |
Resect enlarged toe
|
$XXX.XX
|
J1
|
5113
|
| 28344 |
Repair extra toe(s)
|
$XXX.XX
|
J1
|
5113
|
| 28345 |
Repair webbed toe(s)
|
$XXX.XX
|
J1
|
5112
|
| 28360 |
Reconstruct cleft foot
|
$XXX.XX
|
J1
|
5114
|
| 28400 |
Treatment of heel fracture
|
$XXX.XX
|
T
|
5111
|
| 28405 |
Treatment of heel fracture
|
$XXX.XX
|
T
|
5111
|
| 28406 |
Treatment of heel fracture
|
$XXX.XX
|
J1
|
5114
|
| 28415 |
Treat heel fracture
|
$XXX.XX
|
J1
|
5114
|
| 28420 |
Treat/graft heel fracture
|
$XXX.XX
|
J1
|
5115
|
| 28430 |
Treatment of ankle fracture
|
$XXX.XX
|
T
|
5111
|
| 28435 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5112
|
| 28436 |
Treatment of ankle fracture
|
$XXX.XX
|
J1
|
5114
|
| 28445 |
Treat ankle fracture
|
$XXX.XX
|
J1
|
5114
|
| 28446 |
Osteochondral talus autogrft
|
$XXX.XX
|
J1
|
5114
|
| 28450 |
Treat midfoot fracture each
|
$XXX.XX
|
T
|
5111
|
| 28455 |
Treat midfoot fracture each
|
$XXX.XX
|
J1
|
5112
|
| 28456 |
Treat midfoot fracture
|
$XXX.XX
|
J1
|
5114
|
| 28465 |
Treat midfoot fracture each
|
$XXX.XX
|
J1
|
5114
|
| 28470 |
Treat metatarsal fracture
|
$XXX.XX
|
T
|
5111
|
| 28475 |
Treat metatarsal fracture
|
$XXX.XX
|
T
|
5111
|
| 28476 |
Treat metatarsal fracture
|
$XXX.XX
|
J1
|
5113
|
| 28485 |
Treat metatarsal fracture
|
$XXX.XX
|
J1
|
5114
|
| 28490 |
Treat big toe fracture
|
$XXX.XX
|
T
|
5111
|
| 28495 |
Treat big toe fracture
|
$XXX.XX
|
T
|
5111
|
| 28496 |
Treat big toe fracture
|
$XXX.XX
|
J1
|
5113
|
| 28505 |
Treat big toe fracture
|
$XXX.XX
|
J1
|
5113
|
| 28510 |
Treatment of toe fracture
|
$XXX.XX
|
T
|
5111
|
| 28515 |
Treatment of toe fracture
|
$XXX.XX
|
T
|
5111
|
| 28525 |
Treat toe fracture
|
$XXX.XX
|
J1
|
5113
|
| 28530 |
Treat sesamoid bone fracture
|
$XXX.XX
|
T
|
5111
|
| 28531 |
Treat sesamoid bone fracture
|
$XXX.XX
|
J1
|
5114
|
| 28540 |
Treat foot dislocation
|
$XXX.XX
|
T
|
5111
|
| 28545 |
Treat foot dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28546 |
Treat foot dislocation
|
$XXX.XX
|
J1
|
5112
|
| 28555 |
Repair foot dislocation
|
$XXX.XX
|
J1
|
5114
|
| 28570 |
Treat foot dislocation
|
$XXX.XX
|
T
|
5111
|
| 28575 |
Treat foot dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28576 |
Treat foot dislocation
|
$XXX.XX
|
J1
|
5114
|
| 28585 |
Repair foot dislocation
|
$XXX.XX
|
J1
|
5114
|
| 28600 |
Treat foot dislocation
|
$XXX.XX
|
T
|
5111
|
| 28605 |
Treat foot dislocation
|
$XXX.XX
|
T
|
5111
|
| 28606 |
Treat foot dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28615 |
Repair foot dislocation
|
$XXX.XX
|
J1
|
5114
|
| 28630 |
Treat toe dislocation
|
$XXX.XX
|
T
|
5111
|
| 28635 |
Treat toe dislocation
|
$XXX.XX
|
J1
|
5112
|
| 28636 |
Treat toe dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28645 |
Repair toe dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28660 |
Treat toe dislocation
|
$XXX.XX
|
T
|
5111
|
| 28665 |
Treat toe dislocation
|
$XXX.XX
|
T
|
5102
|
| 28666 |
Treat toe dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28675 |
Repair of toe dislocation
|
$XXX.XX
|
J1
|
5113
|
| 28705 |
Fusion of foot bones
|
$XXX.XX
|
J1
|
5116
|
| 28715 |
Fusion of foot bones
|
$XXX.XX
|
J1
|
5115
|
| 28725 |
Fusion of foot bones
|
$XXX.XX
|
J1
|
5115
|
| 28730 |
Fusion of foot bones
|
$XXX.XX
|
J1
|
5115
|
| 28735 |
Fusion of foot bones
|
$XXX.XX
|
J1
|
5115
|
| 28737 |
Revision of foot bones
|
$XXX.XX
|
J1
|
5115
|
| 28740 |
Fusion of foot bones
|
$XXX.XX
|
J1
|
5114
|
| 28750 |
Fusion of big toe joint
|
$XXX.XX
|
J1
|
5114
|
| 28755 |
Fusion of big toe joint
|
$XXX.XX
|
J1
|
5114
|
| 28760 |
Fusion of big toe joint
|
$XXX.XX
|
J1
|
5114
|
| 28805 |
Amputation thru metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28810 |
Amputation toe & metatarsal
|
$XXX.XX
|
J1
|
5113
|
| 28820 |
Amputation of toe
|
$XXX.XX
|
J1
|
5113
|
| 28825 |
Partial amputation of toe
|
$XXX.XX
|
J1
|
5113
|
| 28890 |
Hi enrgy eswt plantar fascia
|
$XXX.XX
|
J1
|
5112
|
| 28899 |
Foot/toes surgery procedure
|
$XXX.XX
|
T
|
5111
|
| 29000 |
Application of body cast
|
$XXX.XX
|
T
|
5102
|
| 29010 |
Application of body cast
|
$XXX.XX
|
T
|
5102
|
| 29015 |
Application of body cast
|
$XXX.XX
|
T
|
5102
|
| 29035 |
Application of body cast
|
$XXX.XX
|
T
|
5102
|
| 29040 |
Application of body cast
|
$XXX.XX
|
T
|
5102
|
| 29044 |
Application of body cast
|
$XXX.XX
|
T
|
5101
|
| 29046 |
Application of body cast
|
$XXX.XX
|
T
|
5102
|
| 29049 |
Application of figure eight
|
$XXX.XX
|
T
|
5102
|
| 29055 |
Application of shoulder cast
|
$XXX.XX
|
T
|
5102
|
| 29058 |
Application of shoulder cast
|
$XXX.XX
|
T
|
5102
|
| 29065 |
Application of long arm cast
|
$XXX.XX
|
T
|
5102
|
| 29075 |
Application of forearm cast
|
$XXX.XX
|
T
|
5102
|
| 29085 |
Apply hand/wrist cast
|
$XXX.XX
|
T
|
5101
|
| 29086 |
Apply finger cast
|
$XXX.XX
|
T
|
5101
|
| 29105 |
Apply long arm splint
|
$XXX.XX
|
T
|
5101
|
| 29125 |
Apply forearm splint
|
$XXX.XX
|
Q1
|
5734
|
| 29126 |
Apply forearm splint
|
$XXX.XX
|
Q1
|
5734
|
| 29130 |
Application of finger splint
|
$XXX.XX
|
Q1
|
5733
|
| 29131 |
Application of finger splint
|
$XXX.XX
|
Q1
|
5733
|
| 29200 |
Strapping of chest
|
$XXX.XX
|
T
|
5101
|
| 29240 |
Strapping of shoulder
|
$XXX.XX
|
Q1
|
5734
|
| 29260 |
Strapping of elbow or wrist
|
$XXX.XX
|
Q1
|
5732
|
| 29280 |
Strapping of hand or finger
|
$XXX.XX
|
Q1
|
5732
|
| 29305 |
Application of hip cast
|
$XXX.XX
|
T
|
5102
|
| 29325 |
Application of hip casts
|
$XXX.XX
|
T
|
5102
|
| 29345 |
Application of long leg cast
|
$XXX.XX
|
T
|
5102
|
| 29355 |
Application of long leg cast
|
$XXX.XX
|
T
|
5102
|
| 29358 |
Apply long leg cast brace
|
$XXX.XX
|
T
|
5102
|
| 29365 |
Application of long leg cast
|
$XXX.XX
|
T
|
5102
|
| 29405 |
Apply short leg cast
|
$XXX.XX
|
T
|
5102
|
| 29425 |
Apply short leg cast
|
$XXX.XX
|
T
|
5102
|
| 29435 |
Apply short leg cast
|
$XXX.XX
|
T
|
5102
|
| 29440 |
Addition of walker to cast
|
$XXX.XX
|
T
|
5101
|
| 29445 |
Apply rigid leg cast
|
$XXX.XX
|
T
|
5102
|
| 29450 |
Application of leg cast
|
$XXX.XX
|
T
|
5101
|
| 29505 |
Application long leg splint
|
$XXX.XX
|
T
|
5101
|
| 29515 |
Application lower leg splint
|
$XXX.XX
|
T
|
5101
|
| 29520 |
Strapping of hip
|
$XXX.XX
|
Q1
|
5733
|
| 29530 |
Strapping of knee
|
$XXX.XX
|
Q1
|
5734
|
| 29540 |
Strapping of ankle and/or ft
|
$XXX.XX
|
T
|
5101
|
| 29550 |
Strapping of toes
|
$XXX.XX
|
Q1
|
5733
|
| 29580 |
Application of paste boot
|
$XXX.XX
|
T
|
5101
|
| 29581 |
Apply multlay comprs lwr leg
|
$XXX.XX
|
T
|
5101
|
| 29584 |
Appl multlay comprs arm/hand
|
$XXX.XX
|
T
|
5101
|
| 29700 |
Removal/revision of cast
|
$XXX.XX
|
T
|
5102
|
| 29705 |
Removal/revision of cast
|
$XXX.XX
|
T
|
5102
|
| 29710 |
Removal/revision of cast
|
$XXX.XX
|
T
|
5102
|
| 29720 |
Repair of body cast
|
$XXX.XX
|
T
|
5101
|
| 29730 |
Windowing of cast
|
$XXX.XX
|
T
|
5101
|
| 29740 |
Wedging of cast
|
$XXX.XX
|
T
|
5102
|
| 29750 |
Wedging of clubfoot cast
|
$XXX.XX
|
T
|
5102
|
| 29799 |
Casting/strapping procedure
|
$XXX.XX
|
T
|
5101
|
| 29800 |
Jaw arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29804 |
Jaw arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29805 |
Shoulder arthroscopy dx
|
$XXX.XX
|
J1
|
5113
|
| 29806 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29807 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29819 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29820 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29821 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29822 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29823 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29824 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29825 |
Shoulder arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29827 |
Arthroscop rotator cuff repr
|
$XXX.XX
|
J1
|
5114
|
| 29828 |
Arthroscopy biceps tenodesis
|
$XXX.XX
|
J1
|
5114
|
| 29830 |
Elbow arthroscopy
|
$XXX.XX
|
J1
|
5113
|
| 29834 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29835 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29836 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29837 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29838 |
Elbow arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29840 |
Wrist arthroscopy
|
$XXX.XX
|
J1
|
5113
|
| 29843 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29844 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29845 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29846 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29847 |
Wrist arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29848 |
Wrist endoscopy/surgery
|
$XXX.XX
|
J1
|
5112
|
| 29850 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5112
|
| 29851 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5112
|
| 29855 |
Tibial arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29856 |
Tibial arthroscopy/surgery
|
$XXX.XX
|
J1
|
5115
|
| 29860 |
Hip arthroscopy dx
|
$XXX.XX
|
J1
|
5114
|
| 29861 |
Hip arthro w/fb removal
|
$XXX.XX
|
J1
|
5114
|
| 29862 |
Hip arthr0 w/debridement
|
$XXX.XX
|
J1
|
5114
|
| 29863 |
Hip arthr0 w/synovectomy
|
$XXX.XX
|
J1
|
5113
|
| 29866 |
Autgrft implnt knee w/scope
|
$XXX.XX
|
J1
|
5114
|
| 29867 |
Allgrft implnt knee w/scope
|
$XXX.XX
|
J1
|
5115
|
| 29868 |
Meniscal trnspl knee w/scpe
|
$XXX.XX
|
J1
|
5114
|
| 29870 |
Knee arthroscopy dx
|
$XXX.XX
|
J1
|
5113
|
| 29871 |
Knee arthroscopy/drainage
|
$XXX.XX
|
J1
|
5113
|
| 29873 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29874 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29875 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29876 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29877 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29879 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29880 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29881 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29882 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29883 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29884 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29885 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29886 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29887 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29888 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29889 |
Knee arthroscopy/surgery
|
$XXX.XX
|
J1
|
5115
|
| 29891 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29892 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29893 |
Scope plantar fasciotomy
|
$XXX.XX
|
J1
|
5113
|
| 29894 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29895 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29897 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29898 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5113
|
| 29899 |
Ankle arthroscopy/surgery
|
$XXX.XX
|
J1
|
5114
|
| 29900 |
Mcp joint arthroscopy dx
|
$XXX.XX
|
J1
|
5113
|
| 29901 |
Mcp joint arthroscopy surg
|
$XXX.XX
|
J1
|
5113
|
| 29902 |
Mcp joint arthroscopy surg
|
$XXX.XX
|
J1
|
5112
|
| 29904 |
Subtalar arthro w/fb rmvl
|
$XXX.XX
|
J1
|
5113
|
| 29905 |
Subtalar arthro w/exc
|
$XXX.XX
|
J1
|
5114
|
| 29906 |
Subtalar arthro w/deb
|
$XXX.XX
|
J1
|
5113
|
| 29907 |
Subtalar arthro w/fusion
|
$XXX.XX
|
J1
|
5115
|
| 29914 |
Hip arthro w/femoroplasty
|
$XXX.XX
|
J1
|
5114
|
| 29915 |
Hip arthro acetabuloplasty
|
$XXX.XX
|
J1
|
5114
|
| 29916 |
Hip arthro w/labral repair
|
$XXX.XX
|
J1
|
5114
|
| 29999 |
Arthroscopy of joint
|
$XXX.XX
|
T
|
5111
|
| 30000 |
Drainage of nose lesion
|
$XXX.XX
|
T
|
5161
|
| 30020 |
Drainage of nose lesion
|
$XXX.XX
|
T
|
5162
|
| 30100 |
Intranasal biopsy
|
$XXX.XX
|
J1
|
5163
|
| 30110 |
Removal of nose polyp(s)
|
$XXX.XX
|
J1
|
5163
|
| 30115 |
Removal of nose polyp(s)
|
$XXX.XX
|
J1
|
5164
|
| 30117 |
Removal of intranasal lesion
|
$XXX.XX
|
J1
|
5164
|
| 30118 |
Removal of intranasal lesion
|
$XXX.XX
|
J1
|
5164
|
| 30120 |
Revision of nose
|
$XXX.XX
|
J1
|
5164
|
| 30124 |
Removal of nose lesion
|
$XXX.XX
|
J1
|
5163
|
| 30125 |
Removal of nose lesion
|
$XXX.XX
|
J1
|
5165
|
| 30130 |
Excise inferior turbinate
|
$XXX.XX
|
J1
|
5164
|
| 30140 |
Resect inferior turbinate
|
$XXX.XX
|
J1
|
5164
|
| 30150 |
Partial removal of nose
|
$XXX.XX
|
J1
|
5165
|
| 30160 |
Removal of nose
|
$XXX.XX
|
J1
|
5165
|
| 30200 |
Injection treatment of nose
|
$XXX.XX
|
T
|
5162
|
| 30210 |
Nasal sinus therapy
|
$XXX.XX
|
J1
|
5163
|
| 30220 |
Insert nasal septal button
|
$XXX.XX
|
J1
|
5163
|
| 30300 |
Remove nasal foreign body
|
$XXX.XX
|
Q1
|
5734
|
| 30310 |
Remove nasal foreign body
|
$XXX.XX
|
J1
|
5164
|
| 30320 |
Remove nasal foreign body
|
$XXX.XX
|
J1
|
5163
|
| 30400 |
Reconstruction of nose
|
$XXX.XX
|
J1
|
5165
|
| 30410 |
Reconstruction of nose
|
$XXX.XX
|
J1
|
5165
|
| 30420 |
Reconstruction of nose
|
$XXX.XX
|
J1
|
5165
|
| 30430 |
Revision of nose
|
$XXX.XX
|
J1
|
5165
|
| 30435 |
Revision of nose
|
$XXX.XX
|
J1
|
5165
|
| 30450 |
Revision of nose
|
$XXX.XX
|
J1
|
5165
|
| 30460 |
Revision of nose
|
$XXX.XX
|
J1
|
5165
|
| 30462 |
Revision of nose
|
$XXX.XX
|
J1
|
5165
|
| 30465 |
Repair nasal stenosis
|
$XXX.XX
|
J1
|
5165
|
| 30520 |
Repair of nasal septum
|
$XXX.XX
|
J1
|
5164
|
| 30540 |
Repair nasal defect
|
$XXX.XX
|
J1
|
5165
|
| 30545 |
Repair nasal defect
|
$XXX.XX
|
J1
|
5165
|
| 30560 |
Release of nasal adhesions
|
$XXX.XX
|
T
|
5162
|
| 30580 |
Repair upper jaw fistula
|
$XXX.XX
|
J1
|
5165
|
| 30600 |
Repair mouth/nose fistula
|
$XXX.XX
|
J1
|
5165
|
| 30620 |
Intranasal reconstruction
|
$XXX.XX
|
J1
|
5165
|
| 30630 |
Repair nasal septum defect
|
$XXX.XX
|
J1
|
5164
|
| 30801 |
Ablate inf turbinate superf
|
$XXX.XX
|
J1
|
5163
|
| 30802 |
Ablate inf turbinate submuc
|
$XXX.XX
|
J1
|
5163
|
| 30901 |
Control of nosebleed
|
$XXX.XX
|
Q1
|
5734
|
| 30903 |
Control of nosebleed
|
$XXX.XX
|
T
|
5734
|
| 30905 |
Control of nosebleed
|
$XXX.XX
|
T
|
5734
|
| 30906 |
Repeat control of nosebleed
|
$XXX.XX
|
T
|
5161
|
| 30915 |
Ligation nasal sinus artery
|
$XXX.XX
|
J1
|
5183
|
| 30920 |
Ligation upper jaw artery
|
$XXX.XX
|
J1
|
5183
|
| 30930 |
Ther fx nasal inf turbinate
|
$XXX.XX
|
J1
|
5164
|
| 30999 |
Nasal surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 31000 |
Irrigation maxillary sinus
|
$XXX.XX
|
T
|
5161
|
| 31002 |
Irrigation sphenoid sinus
|
$XXX.XX
|
J1
|
5163
|
| 31020 |
Exploration maxillary sinus
|
$XXX.XX
|
J1
|
5164
|
| 31030 |
Exploration maxillary sinus
|
$XXX.XX
|
J1
|
5165
|
| 31032 |
Explore sinus remove polyps
|
$XXX.XX
|
J1
|
5165
|
| 31040 |
Exploration behind upper jaw
|
$XXX.XX
|
J1
|
5165
|
| 31050 |
Exploration sphenoid sinus
|
$XXX.XX
|
J1
|
5165
|
| 31051 |
Sphenoid sinus surgery
|
$XXX.XX
|
J1
|
5165
|
| 31070 |
Exploration of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31075 |
Exploration of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31080 |
Removal of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31081 |
Removal of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31084 |
Removal of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31085 |
Removal of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31086 |
Removal of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31087 |
Removal of frontal sinus
|
$XXX.XX
|
J1
|
5165
|
| 31090 |
Exploration of sinuses
|
$XXX.XX
|
J1
|
5165
|
| 31200 |
Removal of ethmoid sinus
|
$XXX.XX
|
J1
|
5165
|
| 31201 |
Removal of ethmoid sinus
|
$XXX.XX
|
J1
|
5163
|
| 31205 |
Removal of ethmoid sinus
|
$XXX.XX
|
J1
|
5164
|
| 31231 |
Nasal endoscopy dx
|
$XXX.XX
|
T
|
5151
|
| 31233 |
Nsl/sins ndsc dx max sinusc
|
$XXX.XX
|
T
|
5152
|
| 31235 |
Nsl/sins ndsc dx sphn sinusc
|
$XXX.XX
|
J1
|
5153
|
| 31237 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
J1
|
5153
|
| 31238 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
J1
|
5153
|
| 31239 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
J1
|
5154
|
| 31240 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
J1
|
5153
|
| 31241 |
Nsl/sins ndsc w/artery lig
|
$XXX.XX
|
J1
|
5153
|
| 31253 |
Nsl/sins ndsc total
|
$XXX.XX
|
J1
|
5155
|
| 31254 |
Nsl/sins ndsc w/prtl ethmdct
|
$XXX.XX
|
J1
|
5155
|
| 31255 |
Nsl/sins ndsc w/tot ethmdct
|
$XXX.XX
|
J1
|
5155
|
| 31256 |
Exploration maxillary sinus
|
$XXX.XX
|
J1
|
5154
|
| 31257 |
Nsl/sins ndsc tot w/sphendt
|
$XXX.XX
|
J1
|
5155
|
| 31259 |
Nsl/sins ndsc sphn tiss rmvl
|
$XXX.XX
|
J1
|
5155
|
| 31267 |
Endoscopy maxillary sinus
|
$XXX.XX
|
J1
|
5155
|
| 31276 |
Nsl/sins ndsc frnt tiss rmvl
|
$XXX.XX
|
J1
|
5155
|
| 31287 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
J1
|
5155
|
| 31288 |
Nasal/sinus endoscopy surg
|
$XXX.XX
|
J1
|
5155
|
| 31292 |
Nsl/sins ndsc med/inf dcmprn
|
$XXX.XX
|
J1
|
5155
|
| 31293 |
Nsl/sins ndsc med&inf dcmprn
|
$XXX.XX
|
J1
|
5155
|
| 31294 |
Nsl/sins ndsc surg on dcmprn
|
$XXX.XX
|
J1
|
5155
|
| 31295 |
Nsl/sins ndsc surg max sins
|
$XXX.XX
|
J1
|
5155
|
| 31296 |
Nsl/sins ndsc surg frnt sins
|
$XXX.XX
|
J1
|
5155
|
| 31297 |
Nsl/sins ndsc surg sphn sins
|
$XXX.XX
|
J1
|
5155
|
| 31298 |
Nsl/sins ndsc surg frnt&sphn
|
$XXX.XX
|
J1
|
5155
|
| 31299 |
Sinus surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 31300 |
Removal of larynx lesion
|
$XXX.XX
|
J1
|
5164
|
| 31400 |
Revision of larynx
|
$XXX.XX
|
J1
|
5165
|
| 31420 |
Removal of epiglottis
|
$XXX.XX
|
J1
|
5165
|
| 31500 |
Insert emergency airway
|
$XXX.XX
|
T
|
5161
|
| 31502 |
Change of windpipe airway
|
$XXX.XX
|
T
|
5161
|
| 31505 |
Diagnostic laryngoscopy
|
$XXX.XX
|
T
|
5151
|
| 31510 |
Laryngoscopy with biopsy
|
$XXX.XX
|
J1
|
5154
|
| 31511 |
Remove foreign body larynx
|
$XXX.XX
|
T
|
5151
|
| 31512 |
Removal of larynx lesion
|
$XXX.XX
|
J1
|
5154
|
| 31513 |
Injection into vocal cord
|
$XXX.XX
|
T
|
5152
|
| 31515 |
Laryngoscopy for aspiration
|
$XXX.XX
|
T
|
5152
|
| 31520 |
Dx laryngoscopy newborn
|
$XXX.XX
|
T
|
5152
|
| 31525 |
Dx laryngoscopy excl nb
|
$XXX.XX
|
J1
|
5153
|
| 31526 |
Dx laryngoscopy w/oper scope
|
$XXX.XX
|
J1
|
5153
|
| 31527 |
Laryngoscopy for treatment
|
$XXX.XX
|
J1
|
5154
|
| 31528 |
Laryngoscopy and dilation
|
$XXX.XX
|
J1
|
5154
|
| 31529 |
Laryngoscopy and dilation
|
$XXX.XX
|
J1
|
5154
|
| 31530 |
Laryngoscopy w/fb removal
|
$XXX.XX
|
J1
|
5153
|
| 31531 |
Laryngoscopy w/fb & op scope
|
$XXX.XX
|
J1
|
5154
|
| 31535 |
Laryngoscopy w/biopsy
|
$XXX.XX
|
J1
|
5154
|
| 31536 |
Laryngoscopy w/bx & op scope
|
$XXX.XX
|
J1
|
5154
|
| 31540 |
Laryngoscopy w/exc of tumor
|
$XXX.XX
|
J1
|
5154
|
| 31541 |
Larynscop w/tumr exc + scope
|
$XXX.XX
|
J1
|
5154
|
| 31545 |
Remove vc lesion w/scope
|
$XXX.XX
|
J1
|
5154
|
| 31546 |
Remove vc lesion scope/graft
|
$XXX.XX
|
J1
|
5155
|
| 31551 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
J1
|
5165
|
| 31552 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
J1
|
5165
|
| 31553 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
J1
|
5165
|
| 31554 |
Laryngoplasty laryngeal sten
|
$XXX.XX
|
J1
|
5165
|
| 31560 |
Laryngoscop w/arytenoidectom
|
$XXX.XX
|
J1
|
5155
|
| 31561 |
Larynscop remve cart + scop
|
$XXX.XX
|
J1
|
5155
|
| 31570 |
Laryngoscope w/vc inj
|
$XXX.XX
|
J1
|
5154
|
| 31571 |
Laryngoscop w/vc inj + scope
|
$XXX.XX
|
J1
|
5154
|
| 31572 |
Largsc w/laser dstrj les
|
$XXX.XX
|
J1
|
5154
|
| 31573 |
Largsc w/ther injection
|
$XXX.XX
|
J1
|
5153
|
| 31574 |
Largsc w/njx augmentation
|
$XXX.XX
|
J1
|
5153
|
| 31575 |
Diagnostic laryngoscopy
|
$XXX.XX
|
T
|
5151
|
| 31576 |
Laryngoscopy with biopsy
|
$XXX.XX
|
J1
|
5153
|
| 31577 |
Largsc w/rmvl foreign bdy(s)
|
$XXX.XX
|
T
|
5152
|
| 31578 |
Largsc w/removal lesion
|
$XXX.XX
|
J1
|
5154
|
| 31579 |
Laryngoscopy telescopic
|
$XXX.XX
|
T
|
5152
|
| 31580 |
Laryngoplasty laryngeal web
|
$XXX.XX
|
J1
|
5165
|
| 31584 |
Laryngoplasty fx rdctj fixj
|
$XXX.XX
|
J1
|
5165
|
| 31587 |
Laryngoplasty cricoid split
|
$XXX.XX
|
J1
|
5165
|
| 31590 |
Reinnervate larynx
|
$XXX.XX
|
J1
|
5165
|
| 31591 |
Laryngoplasty medialization
|
$XXX.XX
|
J1
|
5165
|
| 31592 |
Cricotracheal resection
|
$XXX.XX
|
J1
|
5165
|
| 31599 |
Larynx surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 31600 |
Incision of windpipe
|
$XXX.XX
|
J1
|
5164
|
| 31601 |
Incision of windpipe
|
$XXX.XX
|
J1
|
5165
|
| 31603 |
Incision of windpipe
|
$XXX.XX
|
J1
|
5163
|
| 31605 |
Incision of windpipe
|
$XXX.XX
|
T
|
5161
|
| 31610 |
Incision of windpipe
|
$XXX.XX
|
J1
|
5165
|
| 31611 |
Surgery/speech prosthesis
|
$XXX.XX
|
J1
|
5164
|
| 31612 |
Puncture/clear windpipe
|
$XXX.XX
|
J1
|
5164
|
| 31613 |
Repair windpipe opening
|
$XXX.XX
|
J1
|
5164
|
| 31614 |
Repair windpipe opening
|
$XXX.XX
|
J1
|
5165
|
| 31615 |
Visualization of windpipe
|
$XXX.XX
|
T
|
5162
|
| 31622 |
Dx bronchoscope/wash
|
$XXX.XX
|
J1
|
5153
|
| 31623 |
Dx bronchoscope/brush
|
$XXX.XX
|
J1
|
5153
|
| 31624 |
Dx bronchoscope/lavage
|
$XXX.XX
|
J1
|
5153
|
| 31625 |
Bronchoscopy w/biopsy(s)
|
$XXX.XX
|
J1
|
5153
|
| 31626 |
Bronchoscopy w/markers
|
$XXX.XX
|
J1
|
5155
|
| 31628 |
Bronchoscopy/lung bx each
|
$XXX.XX
|
J1
|
5154
|
| 31629 |
Bronchoscopy/needle bx each
|
$XXX.XX
|
J1
|
5154
|
| 31630 |
Bronchoscopy dilate/fx repr
|
$XXX.XX
|
J1
|
5154
|
| 31631 |
Bronchoscopy dilate w/stent
|
$XXX.XX
|
J1
|
5155
|
| 31634 |
Bronch w/balloon occlusion
|
$XXX.XX
|
J1
|
5155
|
| 31635 |
Bronchoscopy w/fb removal
|
$XXX.XX
|
J1
|
5153
|
| 31636 |
Bronchoscopy bronch stents
|
$XXX.XX
|
J1
|
5155
|
| 31638 |
Bronchoscopy revise stent
|
$XXX.XX
|
J1
|
5155
|
| 31640 |
Bronchoscopy w/tumor excise
|
$XXX.XX
|
J1
|
5154
|
| 31641 |
Bronchoscopy treat blockage
|
$XXX.XX
|
J1
|
5154
|
| 31643 |
Diag bronchoscope/catheter
|
$XXX.XX
|
J1
|
5153
|
| 31645 |
Brnchsc w/ther aspir 1st
|
$XXX.XX
|
J1
|
5153
|
| 31646 |
Brnchsc w/ther aspir sbsq
|
$XXX.XX
|
T
|
5152
|
| 31647 |
Bronchial valve init insert
|
$XXX.XX
|
J1
|
5155
|
| 31648 |
Bronchial valve remov init
|
$XXX.XX
|
J1
|
5154
|
| 31649 |
Bronchial valve remov addl
|
$XXX.XX
|
Q2
|
5153
|
| 31652 |
Bronch ebus samplng 1/2 node
|
$XXX.XX
|
J1
|
5154
|
| 31653 |
Bronch ebus samplng 3/> node
|
$XXX.XX
|
J1
|
5154
|
| 31660 |
Bronch thermoplsty 1 lobe
|
$XXX.XX
|
J1
|
5155
|
| 31661 |
Bronch thermoplsty 2/> lobes
|
$XXX.XX
|
J1
|
5155
|
| 31717 |
Bronchial brush biopsy
|
$XXX.XX
|
T
|
5152
|
| 31720 |
Clearance of airways
|
$XXX.XX
|
Q1
|
5791
|
| 31730 |
Intro windpipe wire/tube
|
$XXX.XX
|
J1
|
5153
|
| 31750 |
Repair of windpipe
|
$XXX.XX
|
J1
|
5165
|
| 31755 |
Repair of windpipe
|
$XXX.XX
|
J1
|
5165
|
| 31785 |
Remove windpipe lesion
|
$XXX.XX
|
J1
|
5165
|
| 31820 |
Closure of windpipe lesion
|
$XXX.XX
|
J1
|
5164
|
| 31825 |
Repair of windpipe defect
|
$XXX.XX
|
J1
|
5164
|
| 31830 |
Revise windpipe scar
|
$XXX.XX
|
J1
|
5164
|
| 31899 |
Airways surgical procedure
|
$XXX.XX
|
T
|
5151
|
| 32400 |
Needle biopsy chest lining
|
$XXX.XX
|
J1
|
5072
|
| 32405 |
Percut bx lung/mediastinum
|
$XXX.XX
|
J1
|
5072
|
| 32550 |
Insert pleural cath
|
$XXX.XX
|
J1
|
5341
|
| 32551 |
Insertion of chest tube
|
$XXX.XX
|
J1
|
5182
|
| 32552 |
Remove lung catheter
|
$XXX.XX
|
Q2
|
5181
|
| 32553 |
Ins mark thor for rt perq
|
$XXX.XX
|
S
|
5613
|
| 32554 |
Aspirate pleura w/o imaging
|
$XXX.XX
|
T
|
5181
|
| 32555 |
Aspirate pleura w/ imaging
|
$XXX.XX
|
T
|
5181
|
| 32556 |
Insert cath pleura w/o image
|
$XXX.XX
|
J1
|
5302
|
| 32557 |
Insert cath pleura w/ image
|
$XXX.XX
|
J1
|
5182
|
| 32560 |
Treat pleurodesis w/agent
|
$XXX.XX
|
T
|
5181
|
| 32561 |
Lyse chest fibrin init day
|
$XXX.XX
|
T
|
5181
|
| 32562 |
Lyse chest fibrin subq day
|
$XXX.XX
|
T
|
5181
|
| 32601 |
Thoracoscopy diagnostic
|
$XXX.XX
|
J1
|
5361
|
| 32604 |
Thoracoscopy wbx sac
|
$XXX.XX
|
J1
|
5361
|
| 32606 |
Thoracoscopy w/bx med space
|
$XXX.XX
|
J1
|
5361
|
| 32607 |
Thoracoscopy w/bx infiltrate
|
$XXX.XX
|
J1
|
5361
|
| 32608 |
Thoracoscopy w/bx nodule
|
$XXX.XX
|
J1
|
5361
|
| 32609 |
Thoracoscopy w/bx pleura
|
$XXX.XX
|
J1
|
5361
|
| 32960 |
Therapeutic pneumothorax
|
$XXX.XX
|
T
|
5181
|
| 32994 |
Ablate pulm tumor perq crybl
|
$XXX.XX
|
J1
|
5361
|
| 32998 |
Ablate pulm tumor perq rf
|
$XXX.XX
|
J1
|
5361
|
| 32999 |
Chest surgery procedure
|
$XXX.XX
|
T
|
5181
|
| 33016 |
Pericardiocentesis w/imaging
|
$XXX.XX
|
J1
|
5182
|
| 33206 |
Insert heart pm atrial
|
$XXX.XX
|
J1
|
5223
|
| 33207 |
Insert heart pm ventricular
|
$XXX.XX
|
J1
|
5223
|
| 33208 |
Insrt heart pm atrial & vent
|
$XXX.XX
|
J1
|
5223
|
| 33210 |
Insert electrd/pm cath sngl
|
$XXX.XX
|
J1
|
5222
|
| 33211 |
Insert card electrodes dual
|
$XXX.XX
|
J1
|
5222
|
| 33212 |
Insert pulse gen sngl lead
|
$XXX.XX
|
J1
|
5222
|
| 33213 |
Insert pulse gen dual leads
|
$XXX.XX
|
J1
|
5223
|
| 33214 |
Upgrade of pacemaker system
|
$XXX.XX
|
J1
|
5223
|
| 33215 |
Reposition pacing-defib lead
|
$XXX.XX
|
J1
|
5183
|
| 33216 |
Insert 1 electrode pm-defib
|
$XXX.XX
|
J1
|
5222
|
| 33217 |
Insert 2 electrode pm-defib
|
$XXX.XX
|
J1
|
5222
|
| 33218 |
Repair lead pace-defib one
|
$XXX.XX
|
T
|
5221
|
| 33220 |
Repair lead pace-defib dual
|
$XXX.XX
|
T
|
5221
|
| 33221 |
Insert pulse gen mult leads
|
$XXX.XX
|
J1
|
5224
|
| 33222 |
Relocation pocket pacemaker
|
$XXX.XX
|
T
|
5054
|
| 33223 |
Relocate pocket for defib
|
$XXX.XX
|
T
|
5054
|
| 33224 |
Insert pacing lead & connect
|
$XXX.XX
|
J1
|
5223
|
| 33226 |
Reposition l ventric lead
|
$XXX.XX
|
J1
|
5183
|
| 33227 |
Remove&replace pm gen singl
|
$XXX.XX
|
J1
|
5222
|
| 33228 |
Remv&replc pm gen dual lead
|
$XXX.XX
|
J1
|
5223
|
| 33229 |
Remv&replc pm gen mult leads
|
$XXX.XX
|
J1
|
5224
|
| 33230 |
Insrt pulse gen w/dual leads
|
$XXX.XX
|
J1
|
5231
|
| 33231 |
Insrt pulse gen w/mult leads
|
$XXX.XX
|
J1
|
5232
|
| 33233 |
Removal of pm generator
|
$XXX.XX
|
Q2
|
5222
|
| 33234 |
Removal of pacemaker system
|
$XXX.XX
|
Q2
|
5221
|
| 33235 |
Removal pacemaker electrode
|
$XXX.XX
|
Q2
|
5221
|
| 33240 |
Insrt pulse gen w/singl lead
|
$XXX.XX
|
J1
|
5231
|
| 33241 |
Remove pulse generator
|
$XXX.XX
|
Q2
|
5221
|
| 33244 |
Remove elctrd transvenously
|
$XXX.XX
|
Q2
|
5221
|
| 33249 |
Insj/rplcmt defib w/lead(s)
|
$XXX.XX
|
J1
|
5232
|
| 33262 |
Rmvl& replc pulse gen 1 lead
|
$XXX.XX
|
J1
|
5231
|
| 33263 |
Rmvl & rplcmt dfb gen 2 lead
|
$XXX.XX
|
J1
|
5231
|
| 33264 |
Rmvl & rplcmt dfb gen mlt ld
|
$XXX.XX
|
J1
|
5232
|
| 33270 |
Ins/rep subq defibrillator
|
$XXX.XX
|
J1
|
5232
|
| 33271 |
Insj subq impltbl dfb elctrd
|
$XXX.XX
|
J1
|
5222
|
| 33272 |
Rmvl of subq defibrillator
|
$XXX.XX
|
Q2
|
5221
|
| 33273 |
Repos prev impltbl subq dfb
|
$XXX.XX
|
T
|
5221
|
| 33274 |
Tcat insj/rpl perm ldls pm
|
$XXX.XX
|
J1
|
5194
|
| 33275 |
Tcat rmvl perm ldls pm w/img
|
$XXX.XX
|
T
|
5183
|
| 33285 |
Insj subq car rhythm mntr
|
$XXX.XX
|
J1
|
5222
|
| 33286 |
Rmvl subq car rhythm mntr
|
$XXX.XX
|
Q2
|
5071
|
| 33289 |
Tcat impl wrls p-art prs snr
|
$XXX.XX
|
J1
|
5200
|
| 33999 |
Cardiac surgery procedure
|
$XXX.XX
|
T
|
5181
|
| 34101 |
Removal of artery clot
|
$XXX.XX
|
J1
|
5184
|
| 34111 |
Removal of arm artery clot
|
$XXX.XX
|
J1
|
5184
|
| 34201 |
Removal of artery clot
|
$XXX.XX
|
J1
|
5184
|
| 34203 |
Removal of leg artery clot
|
$XXX.XX
|
J1
|
5184
|
| 34421 |
Removal of vein clot
|
$XXX.XX
|
J1
|
5183
|
| 34471 |
Removal of vein clot
|
$XXX.XX
|
T
|
5181
|
| 34490 |
Removal of vein clot
|
$XXX.XX
|
J1
|
5183
|
| 34501 |
Repair valve femoral vein
|
$XXX.XX
|
J1
|
5184
|
| 34510 |
Transposition of vein valve
|
$XXX.XX
|
J1
|
5184
|
| 34520 |
Cross-over vein graft
|
$XXX.XX
|
J1
|
5184
|
| 34530 |
Leg vein fusion
|
$XXX.XX
|
J1
|
5183
|
| 35011 |
Repair defect of artery
|
$XXX.XX
|
J1
|
5184
|
| 35045 |
Repair defect of arm artery
|
$XXX.XX
|
J1
|
5184
|
| 35180 |
Repair blood vessel lesion
|
$XXX.XX
|
T
|
5181
|
| 35184 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5183
|
| 35188 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35190 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35201 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35206 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5183
|
| 35207 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5183
|
| 35226 |
Repair blood vessel lesion
|
$XXX.XX
|
T
|
5071
|
| 35231 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5183
|
| 35236 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35256 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35261 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5183
|
| 35266 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35286 |
Repair blood vessel lesion
|
$XXX.XX
|
J1
|
5184
|
| 35321 |
Rechanneling of artery
|
$XXX.XX
|
J1
|
5184
|
| 35860 |
Explore limb vessels
|
$XXX.XX
|
J1
|
5183
|
| 35875 |
Removal of clot in graft
|
$XXX.XX
|
J1
|
5184
|
| 35876 |
Removal of clot in graft
|
$XXX.XX
|
J1
|
5184
|
| 35879 |
Revise graft w/vein
|
$XXX.XX
|
J1
|
5184
|
| 35881 |
Revise graft w/vein
|
$XXX.XX
|
J1
|
5184
|
| 35883 |
Revise graft w/nonauto graft
|
$XXX.XX
|
J1
|
5184
|
| 35884 |
Revise graft w/vein
|
$XXX.XX
|
J1
|
5184
|
| 35903 |
Excision graft extremity
|
$XXX.XX
|
J1
|
5183
|
| 36002 |
Pseudoaneurysm injection trt
|
$XXX.XX
|
T
|
5181
|
| 36221 |
Place cath thoracic aorta
|
$XXX.XX
|
Q2
|
5183
|
| 36222 |
Place cath carotid/inom art
|
$XXX.XX
|
Q2
|
5183
|
| 36223 |
Place cath carotid/inom art
|
$XXX.XX
|
Q2
|
5184
|
| 36224 |
Place cath carotd art
|
$XXX.XX
|
Q2
|
5184
|
| 36225 |
Place cath subclavian art
|
$XXX.XX
|
Q2
|
5183
|
| 36226 |
Place cath vertebral art
|
$XXX.XX
|
Q2
|
5184
|
| 36251 |
Ins cath ren art 1st unilat
|
$XXX.XX
|
Q2
|
5183
|
| 36252 |
Ins cath ren art 1st bilat
|
$XXX.XX
|
Q2
|
5183
|
| 36253 |
Ins cath ren art 2nd+ unilat
|
$XXX.XX
|
Q2
|
5184
|
| 36254 |
Ins cath ren art 2nd+ bilat
|
$XXX.XX
|
Q2
|
5183
|
| 36260 |
Insertion of infusion pump
|
$XXX.XX
|
J1
|
5184
|
| 36261 |
Revision of infusion pump
|
$XXX.XX
|
T
|
5221
|
| 36262 |
Removal of infusion pump
|
$XXX.XX
|
Q2
|
5221
|
| 36420 |
Vein access cutdown < 1 yr
|
$XXX.XX
|
Q1
|
5733
|
| 36425 |
Vein access cutdown > 1 yr
|
$XXX.XX
|
Q1
|
5735
|
| 36430 |
Blood transfusion service
|
$XXX.XX
|
S
|
5241
|
| 36440 |
Bl push transfuse 2 yr/<
|
$XXX.XX
|
S
|
5241
|
| 36450 |
Bl exchange/transfuse nb
|
$XXX.XX
|
S
|
5241
|
| 36455 |
Bl exchange/transfuse non-nb
|
$XXX.XX
|
S
|
5241
|
| 36456 |
Prtl exchange transfuse nb
|
$XXX.XX
|
S
|
5241
|
| 36460 |
Transfusion service fetal
|
$XXX.XX
|
S
|
5241
|
| 36465 |
Njx noncmpnd sclrsnt 1 vein
|
$XXX.XX
|
T
|
5054
|
| 36466 |
Njx noncmpnd sclrsnt mlt vn
|
$XXX.XX
|
T
|
5054
|
| 36468 |
Njx sclrsnt spider veins
|
$XXX.XX
|
Q1
|
5051
|
| 36470 |
Njx sclrsnt 1 incmptnt vein
|
$XXX.XX
|
T
|
5052
|
| 36471 |
Njx sclrsnt mlt incmptnt vn
|
$XXX.XX
|
T
|
5052
|
| 36473 |
Endovenous mchnchem 1st vein
|
$XXX.XX
|
J1
|
5183
|
| 36475 |
Endovenous rf 1st vein
|
$XXX.XX
|
J1
|
5183
|
| 36478 |
Endovenous laser 1st vein
|
$XXX.XX
|
J1
|
5183
|
| 36482 |
Endoven ther chem adhes 1st
|
$XXX.XX
|
J1
|
5184
|
| 36511 |
Apheresis wbc
|
$XXX.XX
|
S
|
5242
|
| 36512 |
Apheresis rbc
|
$XXX.XX
|
S
|
5242
|
| 36513 |
Apheresis platelets
|
$XXX.XX
|
S
|
5241
|
| 36514 |
Apheresis plasma
|
$XXX.XX
|
S
|
5242
|
| 36516 |
Apheresis immunoads slctv
|
$XXX.XX
|
S
|
5243
|
| 36522 |
Photopheresis
|
$XXX.XX
|
S
|
5243
|
| 36555 |
Insert non-tunnel cv cath
|
$XXX.XX
|
J1
|
5182
|
| 36556 |
Insert non-tunnel cv cath
|
$XXX.XX
|
J1
|
5182
|
| 36557 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5184
|
| 36558 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36560 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36561 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36563 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5184
|
| 36565 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36566 |
Insert tunneled cv cath
|
$XXX.XX
|
J1
|
5184
|
| 36568 |
Insj picc <5 yr w/o imaging
|
$XXX.XX
|
T
|
5181
|
| 36569 |
Insj picc 5 yr+ w/o imaging
|
$XXX.XX
|
J1
|
5182
|
| 36570 |
Insert picvad cath
|
$XXX.XX
|
J1
|
5183
|
| 36571 |
Insert picvad cath
|
$XXX.XX
|
J1
|
5183
|
| 36572 |
Insj picc rs&i <5 yr
|
$XXX.XX
|
T
|
5181
|
| 36573 |
Insj picc rs&i 5 yr+
|
$XXX.XX
|
J1
|
5182
|
| 36575 |
Repair tunneled cv cath
|
$XXX.XX
|
T
|
5181
|
| 36576 |
Repair tunneled cv cath
|
$XXX.XX
|
J1
|
5182
|
| 36578 |
Replace tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36580 |
Replace cvad cath
|
$XXX.XX
|
J1
|
5182
|
| 36581 |
Replace tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36582 |
Replace tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36583 |
Replace tunneled cv cath
|
$XXX.XX
|
J1
|
5184
|
| 36584 |
Compl rplcmt picc rs&i
|
$XXX.XX
|
J1
|
5182
|
| 36585 |
Replace picvad cath
|
$XXX.XX
|
J1
|
5183
|
| 36589 |
Removal tunneled cv cath
|
$XXX.XX
|
Q2
|
5181
|
| 36590 |
Removal tunneled cv cath
|
$XXX.XX
|
Q2
|
5181
|
| 36591 |
Draw blood off venous device
|
$XXX.XX
|
Q1
|
5734
|
| 36592 |
Collect blood from picc
|
$XXX.XX
|
Q1
|
5734
|
| 36593 |
Declot vascular device
|
$XXX.XX
|
T
|
5694
|
| 36595 |
Mech remov tunneled cv cath
|
$XXX.XX
|
J1
|
5183
|
| 36596 |
Mech remov tunneled cv cath
|
$XXX.XX
|
J1
|
5182
|
| 36597 |
Reposition venous catheter
|
$XXX.XX
|
J1
|
5182
|
| 36598 |
Inj w/fluor eval cv device
|
$XXX.XX
|
T
|
5693
|
| 36600 |
Withdrawal of arterial blood
|
$XXX.XX
|
Q1
|
5734
|
| 36640 |
Insertion catheter artery
|
$XXX.XX
|
J1
|
5183
|
| 36680 |
Insert needle bone cavity
|
$XXX.XX
|
Q1
|
5735
|
| 36800 |
Insertion of cannula
|
$XXX.XX
|
J1
|
5184
|
| 36810 |
Insertion of cannula
|
$XXX.XX
|
J1
|
5183
|
| 36815 |
Insertion of cannula
|
$XXX.XX
|
J1
|
5184
|
| 36818 |
Av fuse uppr arm cephalic
|
$XXX.XX
|
J1
|
5184
|
| 36819 |
Av fuse uppr arm basilic
|
$XXX.XX
|
J1
|
5184
|
| 36820 |
Av fusion/forearm vein
|
$XXX.XX
|
J1
|
5184
|
| 36821 |
Av fusion direct any site
|
$XXX.XX
|
J1
|
5183
|
| 36825 |
Artery-vein autograft
|
$XXX.XX
|
J1
|
5184
|
| 36830 |
Artery-vein nonautograft
|
$XXX.XX
|
J1
|
5184
|
| 36831 |
Open thrombect av fistula
|
$XXX.XX
|
J1
|
5184
|
| 36832 |
Av fistula revision open
|
$XXX.XX
|
J1
|
5184
|
| 36833 |
Av fistula revision
|
$XXX.XX
|
J1
|
5184
|
| 36835 |
Artery to vein shunt
|
$XXX.XX
|
J1
|
5183
|
| 36838 |
Dist revas ligation hemo
|
$XXX.XX
|
J1
|
5184
|
| 36860 |
External cannula declotting
|
$XXX.XX
|
T
|
5181
|
| 36861 |
Cannula declotting
|
$XXX.XX
|
J1
|
5184
|
| 36901 |
Intro cath dialysis circuit
|
$XXX.XX
|
J1
|
5182
|
| 36902 |
Intro cath dialysis circuit
|
$XXX.XX
|
J1
|
5192
|
| 36903 |
Intro cath dialysis circuit
|
$XXX.XX
|
J1
|
5193
|
| 36904 |
Thrmbc/nfs dialysis circuit
|
$XXX.XX
|
J1
|
5192
|
| 36905 |
Thrmbc/nfs dialysis circuit
|
$XXX.XX
|
J1
|
5193
|
| 36906 |
Thrmbc/nfs dialysis circuit
|
$XXX.XX
|
J1
|
5194
|
| 37183 |
Remove hepatic shunt (tips)
|
$XXX.XX
|
J1
|
5192
|
| 37184 |
Prim art m-thrmbc 1st vsl
|
$XXX.XX
|
J1
|
5193
|
| 37187 |
Venous mech thrombectomy
|
$XXX.XX
|
J1
|
5192
|
| 37188 |
Ven mechnl thrmbc repeat tx
|
$XXX.XX
|
J1
|
5183
|
| 37191 |
Ins endovas vena cava filtr
|
$XXX.XX
|
J1
|
5184
|
| 37192 |
Redo endovas vena cava filtr
|
$XXX.XX
|
J1
|
5183
|
| 37193 |
Rem endovas vena cava filter
|
$XXX.XX
|
J1
|
5183
|
| 37195 |
Thrombolytic therapy stroke
|
$XXX.XX
|
T
|
5694
|
| 37197 |
Remove intrvas foreign body
|
$XXX.XX
|
J1
|
5183
|
| 37200 |
Transcatheter biopsy
|
$XXX.XX
|
J1
|
5184
|
| 37211 |
Thrombolytic art therapy
|
$XXX.XX
|
J1
|
5184
|
| 37212 |
Thrombolytic venous therapy
|
$XXX.XX
|
J1
|
5183
|
| 37213 |
Thromblytic art/ven therapy
|
$XXX.XX
|
J1
|
5182
|
| 37214 |
Cessj therapy cath removal
|
$XXX.XX
|
J1
|
5182
|
| 37220 |
Iliac revasc
|
$XXX.XX
|
J1
|
5192
|
| 37221 |
Iliac revasc w/stent
|
$XXX.XX
|
J1
|
5193
|
| 37224 |
Fem/popl revas w/tla
|
$XXX.XX
|
J1
|
5192
|
| 37225 |
Fem/popl revas w/ather
|
$XXX.XX
|
J1
|
5193
|
| 37226 |
Fem/popl revasc w/stent
|
$XXX.XX
|
J1
|
5193
|
| 37227 |
Fem/popl revasc stnt & ather
|
$XXX.XX
|
J1
|
5194
|
| 37228 |
Tib/per revasc w/tla
|
$XXX.XX
|
J1
|
5193
|
| 37229 |
Tib/per revasc w/ather
|
$XXX.XX
|
J1
|
5194
|
| 37230 |
Tib/per revasc w/stent
|
$XXX.XX
|
J1
|
5194
|
| 37231 |
Tib/per revasc stent & ather
|
$XXX.XX
|
J1
|
5194
|
| 37236 |
Open/perq place stent 1st
|
$XXX.XX
|
J1
|
5193
|
| 37238 |
Open/perq place stent same
|
$XXX.XX
|
J1
|
5193
|
| 37241 |
Vasc embolize/occlude venous
|
$XXX.XX
|
J1
|
5193
|
| 37242 |
Vasc embolize/occlude artery
|
$XXX.XX
|
J1
|
5193
|
| 37243 |
Vasc embolize/occlude organ
|
$XXX.XX
|
J1
|
5193
|
| 37244 |
Vasc embolize/occlude bleed
|
$XXX.XX
|
J1
|
5193
|
| 37246 |
Trluml balo angiop 1st art
|
$XXX.XX
|
J1
|
5192
|
| 37248 |
Trluml balo angiop 1st vein
|
$XXX.XX
|
J1
|
5192
|
| 37500 |
Endoscopy ligate perf veins
|
$XXX.XX
|
J1
|
5184
|
| 37501 |
Vascular endoscopy procedure
|
$XXX.XX
|
T
|
5181
|
| 37565 |
Ligation of neck vein
|
$XXX.XX
|
J1
|
5182
|
| 37600 |
Ligation of neck artery
|
$XXX.XX
|
J1
|
5183
|
| 37605 |
Ligation of neck artery
|
$XXX.XX
|
J1
|
5183
|
| 37606 |
Ligation of neck artery
|
$XXX.XX
|
J1
|
5183
|
| 37607 |
Ligation of a-v fistula
|
$XXX.XX
|
J1
|
5183
|
| 37609 |
Temporal artery procedure
|
$XXX.XX
|
J1
|
5072
|
| 37615 |
Ligation of neck artery
|
$XXX.XX
|
J1
|
5182
|
| 37619 |
Ligation of inf vena cava
|
$XXX.XX
|
J1
|
5184
|
| 37650 |
Revision of major vein
|
$XXX.XX
|
J1
|
5183
|
| 37700 |
Revise leg vein
|
$XXX.XX
|
J1
|
5183
|
| 37718 |
Ligate/strip short leg vein
|
$XXX.XX
|
J1
|
5183
|
| 37722 |
Ligate/strip long leg vein
|
$XXX.XX
|
J1
|
5183
|
| 37735 |
Removal of leg veins/lesion
|
$XXX.XX
|
J1
|
5183
|
| 37760 |
Ligate leg veins radical
|
$XXX.XX
|
J1
|
5183
|
| 37761 |
Ligate leg veins open
|
$XXX.XX
|
J1
|
5182
|
| 37765 |
Stab phleb veins xtr 10-20
|
$XXX.XX
|
J1
|
5183
|
| 37766 |
Phleb veins - extrem 20+
|
$XXX.XX
|
J1
|
5183
|
| 37780 |
Revision of leg vein
|
$XXX.XX
|
J1
|
5182
|
| 37785 |
Ligate/divide/excise vein
|
$XXX.XX
|
J1
|
5183
|
| 37790 |
Penile venous occlusion
|
$XXX.XX
|
J1
|
5374
|
| 37799 |
Vascular surgery procedure
|
$XXX.XX
|
T
|
5181
|
| 38120 |
Laparoscopy splenectomy
|
$XXX.XX
|
J1
|
5362
|
| 38129 |
Laparoscope proc spleen
|
$XXX.XX
|
J1
|
5361
|
| 38206 |
Harvest auto stem cells
|
$XXX.XX
|
S
|
5242
|
| 38207 |
Cryopreserve stem cells
|
$XXX.XX
|
S
|
5241
|
| 38208 |
Thaw preserved stem cells
|
$XXX.XX
|
S
|
5241
|
| 38209 |
Wash harvest stem cells
|
$XXX.XX
|
S
|
5241
|
| 38210 |
T-cell depletion of harvest
|
$XXX.XX
|
S
|
5241
|
| 38211 |
Tumor cell deplete of harvst
|
$XXX.XX
|
S
|
5241
|
| 38212 |
Rbc depletion of harvest
|
$XXX.XX
|
S
|
5241
|
| 38213 |
Platelet deplete of harvest
|
$XXX.XX
|
S
|
5241
|
| 38214 |
Volume deplete of harvest
|
$XXX.XX
|
S
|
5241
|
| 38215 |
Harvest stem cell concentrte
|
$XXX.XX
|
S
|
5241
|
| 38220 |
Dx bone marrow aspirations
|
$XXX.XX
|
J1
|
5072
|
| 38221 |
Dx bone marrow biopsies
|
$XXX.XX
|
J1
|
5072
|
| 38222 |
Dx bone marrow bx & aspir
|
$XXX.XX
|
J1
|
5073
|
| 38230 |
Bone marrow harvest allogen
|
$XXX.XX
|
S
|
5242
|
| 38232 |
Bone marrow harvest autolog
|
$XXX.XX
|
S
|
5243
|
| 38240 |
Transplt allo hct/donor
|
$XXX.XX
|
J1
|
5244
|
| 38241 |
Transplt autol hct/donor
|
$XXX.XX
|
S
|
5242
|
| 38242 |
Transplt allo lymphocytes
|
$XXX.XX
|
S
|
5242
|
| 38243 |
Transplj hematopoietic boost
|
$XXX.XX
|
S
|
5242
|
| 38300 |
Drainage lymph node lesion
|
$XXX.XX
|
J1
|
5073
|
| 38305 |
Drainage lymph node lesion
|
$XXX.XX
|
J1
|
5073
|
| 38308 |
Incision of lymph channels
|
$XXX.XX
|
J1
|
5091
|
| 38500 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
J1
|
5091
|
| 38505 |
Needle biopsy lymph nodes
|
$XXX.XX
|
J1
|
5072
|
| 38510 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
J1
|
5091
|
| 38520 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
J1
|
5091
|
| 38525 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
J1
|
5091
|
| 38530 |
Biopsy/removal lymph nodes
|
$XXX.XX
|
J1
|
5091
|
| 38531 |
Open bx/exc inguinofem nodes
|
$XXX.XX
|
J1
|
5091
|
| 38542 |
Explore deep node(s) neck
|
$XXX.XX
|
J1
|
5361
|
| 38550 |
Removal neck/armpit lesion
|
$XXX.XX
|
J1
|
5091
|
| 38555 |
Removal neck/armpit lesion
|
$XXX.XX
|
J1
|
5092
|
| 38570 |
Laparoscopy lymph node biop
|
$XXX.XX
|
J1
|
5361
|
| 38571 |
Laparoscopy lymphadenectomy
|
$XXX.XX
|
J1
|
5362
|
| 38572 |
Laparoscopy lymphadenectomy
|
$XXX.XX
|
J1
|
5362
|
| 38573 |
Laps pelvic lymphadec
|
$XXX.XX
|
J1
|
5362
|
| 38589 |
Laparoscope proc lymphatic
|
$XXX.XX
|
J1
|
5361
|
| 38700 |
Removal of lymph nodes neck
|
$XXX.XX
|
J1
|
5092
|
| 38720 |
Removal of lymph nodes neck
|
$XXX.XX
|
J1
|
5093
|
| 38740 |
Remove armpit lymph nodes
|
$XXX.XX
|
J1
|
5361
|
| 38745 |
Remove armpit lymph nodes
|
$XXX.XX
|
J1
|
5361
|
| 38760 |
Remove groin lymph nodes
|
$XXX.XX
|
J1
|
5092
|
| 38792 |
Ra tracer id of sentinl node
|
$XXX.XX
|
Q1
|
5591
|
| 38999 |
Blood/lymph system procedure
|
$XXX.XX
|
S
|
5241
|
| 39401 |
Mediastinoscpy w/medstnl bx
|
$XXX.XX
|
J1
|
5361
|
| 39402 |
Mediastinoscpy w/lmph nod bx
|
$XXX.XX
|
J1
|
5361
|
| 40490 |
Biopsy of lip
|
$XXX.XX
|
T
|
5161
|
| 40500 |
Partial excision of lip
|
$XXX.XX
|
J1
|
5164
|
| 40510 |
Partial excision of lip
|
$XXX.XX
|
J1
|
5164
|
| 40520 |
Partial excision of lip
|
$XXX.XX
|
J1
|
5164
|
| 40525 |
Reconstruct lip with flap
|
$XXX.XX
|
J1
|
5164
|
| 40527 |
Reconstruct lip with flap
|
$XXX.XX
|
J1
|
5165
|
| 40530 |
Partial removal of lip
|
$XXX.XX
|
J1
|
5164
|
| 40650 |
Repair lip
|
$XXX.XX
|
T
|
5162
|
| 40652 |
Repair lip
|
$XXX.XX
|
T
|
5162
|
| 40654 |
Repair lip
|
$XXX.XX
|
J1
|
5163
|
| 40700 |
Repair cleft lip/nasal
|
$XXX.XX
|
J1
|
5165
|
| 40701 |
Repair cleft lip/nasal
|
$XXX.XX
|
J1
|
5165
|
| 40702 |
Repair cleft lip/nasal
|
$XXX.XX
|
J1
|
5165
|
| 40720 |
Repair cleft lip/nasal
|
$XXX.XX
|
J1
|
5164
|
| 40761 |
Repair cleft lip/nasal
|
$XXX.XX
|
J1
|
5165
|
| 40799 |
Lip surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 40800 |
Drainage of mouth lesion
|
$XXX.XX
|
T
|
5071
|
| 40801 |
Drainage of mouth lesion
|
$XXX.XX
|
T
|
5162
|
| 40804 |
Removal foreign body mouth
|
$XXX.XX
|
Q1
|
5301
|
| 40805 |
Removal foreign body mouth
|
$XXX.XX
|
T
|
5162
|
| 40806 |
Incision of lip fold
|
$XXX.XX
|
T
|
5162
|
| 40808 |
Biopsy of mouth lesion
|
$XXX.XX
|
T
|
5162
|
| 40810 |
Excision of mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 40812 |
Excise/repair mouth lesion
|
$XXX.XX
|
J1
|
5163
|
| 40814 |
Excise/repair mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 40816 |
Excision of mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 40818 |
Excise oral mucosa for graft
|
$XXX.XX
|
T
|
5162
|
| 40819 |
Excise lip or cheek fold
|
$XXX.XX
|
J1
|
5163
|
| 40820 |
Treatment of mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 40830 |
Repair mouth laceration
|
$XXX.XX
|
T
|
5161
|
| 40831 |
Repair mouth laceration
|
$XXX.XX
|
T
|
5162
|
| 40840 |
Reconstruction of mouth
|
$XXX.XX
|
J1
|
5165
|
| 40842 |
Reconstruction of mouth
|
$XXX.XX
|
J1
|
5165
|
| 40843 |
Reconstruction of mouth
|
$XXX.XX
|
J1
|
5165
|
| 40844 |
Reconstruction of mouth
|
$XXX.XX
|
J1
|
5165
|
| 40845 |
Reconstruction of mouth
|
$XXX.XX
|
J1
|
5165
|
| 40899 |
Mouth surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 41000 |
Drainage of mouth lesion
|
$XXX.XX
|
T
|
5162
|
| 41005 |
Drainage of mouth lesion
|
$XXX.XX
|
T
|
5161
|
| 41006 |
Drainage of mouth lesion
|
$XXX.XX
|
J1
|
5163
|
| 41007 |
Drainage of mouth lesion
|
$XXX.XX
|
J1
|
5163
|
| 41008 |
Drainage of mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 41009 |
Drainage of mouth lesion
|
$XXX.XX
|
T
|
5162
|
| 41010 |
Incision of tongue fold
|
$XXX.XX
|
J1
|
5163
|
| 41015 |
Drainage of mouth lesion
|
$XXX.XX
|
T
|
5162
|
| 41016 |
Drainage of mouth lesion
|
$XXX.XX
|
J1
|
5165
|
| 41017 |
Drainage of mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 41018 |
Drainage of mouth lesion
|
$XXX.XX
|
J1
|
5163
|
| 41019 |
Place needles h&n for rt
|
$XXX.XX
|
J1
|
5165
|
| 41100 |
Biopsy of tongue
|
$XXX.XX
|
T
|
5162
|
| 41105 |
Biopsy of tongue
|
$XXX.XX
|
J1
|
5164
|
| 41108 |
Biopsy of floor of mouth
|
$XXX.XX
|
J1
|
5072
|
| 41110 |
Excision of tongue lesion
|
$XXX.XX
|
J1
|
5164
|
| 41112 |
Excision of tongue lesion
|
$XXX.XX
|
J1
|
5164
|
| 41113 |
Excision of tongue lesion
|
$XXX.XX
|
J1
|
5164
|
| 41114 |
Excision of tongue lesion
|
$XXX.XX
|
J1
|
5164
|
| 41115 |
Excision of tongue fold
|
$XXX.XX
|
J1
|
5163
|
| 41116 |
Excision of mouth lesion
|
$XXX.XX
|
J1
|
5164
|
| 41120 |
Partial removal of tongue
|
$XXX.XX
|
J1
|
5165
|
| 41250 |
Repair tongue laceration
|
$XXX.XX
|
Q1
|
5734
|
| 41251 |
Repair tongue laceration
|
$XXX.XX
|
T
|
5161
|
| 41252 |
Repair tongue laceration
|
$XXX.XX
|
T
|
5161
|
| 41510 |
Tongue to lip surgery
|
$XXX.XX
|
J1
|
5164
|
| 41512 |
Tongue suspension
|
$XXX.XX
|
J1
|
5165
|
| 41520 |
Reconstruction tongue fold
|
$XXX.XX
|
J1
|
5164
|
| 41530 |
Tongue base vol reduction
|
$XXX.XX
|
J1
|
5164
|
| 41599 |
Tongue and mouth surgery
|
$XXX.XX
|
T
|
5161
|
| 41800 |
Drainage of gum lesion
|
$XXX.XX
|
Q1
|
5734
|
| 41805 |
Removal foreign body gum
|
$XXX.XX
|
J1
|
5163
|
| 41806 |
Removal foreign body jawbone
|
$XXX.XX
|
J1
|
5163
|
| 41820 |
Excision gum each quadrant
|
$XXX.XX
|
J1
|
5164
|
| 41821 |
Excision of gum flap
|
$XXX.XX
|
J1
|
5163
|
| 41822 |
Excision of gum lesion
|
$XXX.XX
|
J1
|
5163
|
| 41823 |
Excision of gum lesion
|
$XXX.XX
|
J1
|
5165
|
| 41825 |
Excision of gum lesion
|
$XXX.XX
|
J1
|
5164
|
| 41826 |
Excision of gum lesion
|
$XXX.XX
|
J1
|
5164
|
| 41827 |
Excision of gum lesion
|
$XXX.XX
|
J1
|
5165
|
| 41828 |
Excision of gum lesion
|
$XXX.XX
|
J1
|
5163
|
| 41830 |
Removal of gum tissue
|
$XXX.XX
|
J1
|
5164
|
| 41850 |
Treatment of gum lesion
|
$XXX.XX
|
J1
|
5163
|
| 41870 |
Gum graft
|
$XXX.XX
|
J1
|
5163
|
| 41872 |
Repair gum
|
$XXX.XX
|
J1
|
5164
|
| 41874 |
Repair tooth socket
|
$XXX.XX
|
J1
|
5164
|
| 41899 |
Dental surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 42000 |
Drainage mouth roof lesion
|
$XXX.XX
|
T
|
5161
|
| 42100 |
Biopsy roof of mouth
|
$XXX.XX
|
J1
|
5163
|
| 42104 |
Excision lesion mouth roof
|
$XXX.XX
|
J1
|
5164
|
| 42106 |
Excision lesion mouth roof
|
$XXX.XX
|
J1
|
5164
|
| 42107 |
Excision lesion mouth roof
|
$XXX.XX
|
J1
|
5165
|
| 42120 |
Remove palate/lesion
|
$XXX.XX
|
J1
|
5165
|
| 42140 |
Excision of uvula
|
$XXX.XX
|
J1
|
5164
|
| 42145 |
Repair palate pharynx/uvula
|
$XXX.XX
|
J1
|
5165
|
| 42160 |
Treatment mouth roof lesion
|
$XXX.XX
|
J1
|
5164
|
| 42180 |
Repair palate
|
$XXX.XX
|
T
|
5162
|
| 42182 |
Repair palate
|
$XXX.XX
|
J1
|
5165
|
| 42200 |
Reconstruct cleft palate
|
$XXX.XX
|
J1
|
5165
|
| 42205 |
Reconstruct cleft palate
|
$XXX.XX
|
J1
|
5164
|
| 42210 |
Reconstruct cleft palate
|
$XXX.XX
|
J1
|
5165
|
| 42215 |
Reconstruct cleft palate
|
$XXX.XX
|
J1
|
5165
|
| 42220 |
Reconstruct cleft palate
|
$XXX.XX
|
J1
|
5165
|
| 42225 |
Reconstruct cleft palate
|
$XXX.XX
|
J1
|
5165
|
| 42226 |
Lengthening of palate
|
$XXX.XX
|
J1
|
5165
|
| 42227 |
Lengthening of palate
|
$XXX.XX
|
J1
|
5165
|
| 42235 |
Repair palate
|
$XXX.XX
|
J1
|
5165
|
| 42260 |
Repair nose to lip fistula
|
$XXX.XX
|
J1
|
5165
|
| 42280 |
Preparation palate mold
|
$XXX.XX
|
T
|
5162
|
| 42281 |
Insertion palate prosthesis
|
$XXX.XX
|
J1
|
5165
|
| 42299 |
Palate/uvula surgery
|
$XXX.XX
|
T
|
5161
|
| 42300 |
Drainage of salivary gland
|
$XXX.XX
|
J1
|
5163
|
| 42305 |
Drainage of salivary gland
|
$XXX.XX
|
J1
|
5164
|
| 42310 |
Drainage of salivary gland
|
$XXX.XX
|
T
|
5162
|
| 42320 |
Drainage of salivary gland
|
$XXX.XX
|
T
|
5162
|
| 42330 |
Removal of salivary stone
|
$XXX.XX
|
J1
|
5164
|
| 42335 |
Removal of salivary stone
|
$XXX.XX
|
J1
|
5164
|
| 42340 |
Removal of salivary stone
|
$XXX.XX
|
J1
|
5164
|
| 42400 |
Biopsy of salivary gland
|
$XXX.XX
|
T
|
5071
|
| 42405 |
Biopsy of salivary gland
|
$XXX.XX
|
J1
|
5163
|
| 42408 |
Excision of salivary cyst
|
$XXX.XX
|
J1
|
5164
|
| 42409 |
Drainage of salivary cyst
|
$XXX.XX
|
J1
|
5164
|
| 42410 |
Excise parotid gland/lesion
|
$XXX.XX
|
J1
|
5165
|
| 42415 |
Excise parotid gland/lesion
|
$XXX.XX
|
J1
|
5165
|
| 42420 |
Excise parotid gland/lesion
|
$XXX.XX
|
J1
|
5165
|
| 42425 |
Excise parotid gland/lesion
|
$XXX.XX
|
J1
|
5165
|
| 42440 |
Excise submaxillary gland
|
$XXX.XX
|
J1
|
5165
|
| 42450 |
Excise sublingual gland
|
$XXX.XX
|
J1
|
5165
|
| 42500 |
Repair salivary duct
|
$XXX.XX
|
J1
|
5165
|
| 42505 |
Repair salivary duct
|
$XXX.XX
|
J1
|
5165
|
| 42507 |
Parotid duct diversion
|
$XXX.XX
|
J1
|
5165
|
| 42509 |
Parotid duct diversion
|
$XXX.XX
|
J1
|
5165
|
| 42510 |
Parotid duct diversion
|
$XXX.XX
|
J1
|
5164
|
| 42600 |
Closure of salivary fistula
|
$XXX.XX
|
J1
|
5164
|
| 42650 |
Dilation of salivary duct
|
$XXX.XX
|
J1
|
5163
|
| 42660 |
Dilation of salivary duct
|
$XXX.XX
|
T
|
5162
|
| 42665 |
Ligation of salivary duct
|
$XXX.XX
|
J1
|
5164
|
| 42699 |
Salivary surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 42700 |
Drainage of tonsil abscess
|
$XXX.XX
|
T
|
5161
|
| 42720 |
Drainage of throat abscess
|
$XXX.XX
|
J1
|
5164
|
| 42725 |
Drainage of throat abscess
|
$XXX.XX
|
J1
|
5165
|
| 42800 |
Biopsy of throat
|
$XXX.XX
|
J1
|
5163
|
| 42804 |
Biopsy of upper nose/throat
|
$XXX.XX
|
J1
|
5164
|
| 42806 |
Biopsy of upper nose/throat
|
$XXX.XX
|
J1
|
5164
|
| 42808 |
Excise pharynx lesion
|
$XXX.XX
|
J1
|
5164
|
| 42809 |
Remove pharynx foreign body
|
$XXX.XX
|
Q1
|
5735
|
| 42810 |
Excision of neck cyst
|
$XXX.XX
|
J1
|
5164
|
| 42815 |
Excision of neck cyst
|
$XXX.XX
|
J1
|
5165
|
| 42820 |
Remove tonsils and adenoids
|
$XXX.XX
|
J1
|
5165
|
| 42821 |
Remove tonsils and adenoids
|
$XXX.XX
|
J1
|
5164
|
| 42825 |
Removal of tonsils
|
$XXX.XX
|
J1
|
5165
|
| 42826 |
Removal of tonsils
|
$XXX.XX
|
J1
|
5164
|
| 42830 |
Removal of adenoids
|
$XXX.XX
|
J1
|
5164
|
| 42831 |
Removal of adenoids
|
$XXX.XX
|
J1
|
5164
|
| 42835 |
Removal of adenoids
|
$XXX.XX
|
J1
|
5164
|
| 42836 |
Removal of adenoids
|
$XXX.XX
|
J1
|
5164
|
| 42842 |
Extensive surgery of throat
|
$XXX.XX
|
J1
|
5165
|
| 42844 |
Extensive surgery of throat
|
$XXX.XX
|
J1
|
5165
|
| 42860 |
Excision of tonsil tags
|
$XXX.XX
|
J1
|
5164
|
| 42870 |
Excision of lingual tonsil
|
$XXX.XX
|
J1
|
5165
|
| 42890 |
Partial removal of pharynx
|
$XXX.XX
|
J1
|
5165
|
| 42892 |
Revision of pharyngeal walls
|
$XXX.XX
|
J1
|
5165
|
| 42900 |
Repair throat wound
|
$XXX.XX
|
J1
|
5163
|
| 42950 |
Reconstruction of throat
|
$XXX.XX
|
J1
|
5165
|
| 42955 |
Surgical opening of throat
|
$XXX.XX
|
J1
|
5163
|
| 42960 |
Control throat bleeding
|
$XXX.XX
|
T
|
5162
|
| 42962 |
Control throat bleeding
|
$XXX.XX
|
J1
|
5164
|
| 42970 |
Control nose/throat bleeding
|
$XXX.XX
|
T
|
5161
|
| 42972 |
Control nose/throat bleeding
|
$XXX.XX
|
J1
|
5164
|
| 42999 |
Throat surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 43020 |
Incision of esophagus
|
$XXX.XX
|
J1
|
5163
|
| 43030 |
Throat muscle surgery
|
$XXX.XX
|
J1
|
5165
|
| 43130 |
Removal of esophagus pouch
|
$XXX.XX
|
J1
|
5165
|
| 43180 |
Esophagoscopy rigid trnso
|
$XXX.XX
|
J1
|
5165
|
| 43191 |
Esophagoscopy rigid trnso dx
|
$XXX.XX
|
J1
|
5302
|
| 43192 |
Esophagoscp rig trnso inject
|
$XXX.XX
|
J1
|
5302
|
| 43193 |
Esophagoscp rig trnso biopsy
|
$XXX.XX
|
J1
|
5302
|
| 43194 |
Esophagoscp rig trnso rem fb
|
$XXX.XX
|
J1
|
5302
|
| 43195 |
Esophagoscopy rigid balloon
|
$XXX.XX
|
J1
|
5303
|
| 43196 |
Esophagoscp guide wire dilat
|
$XXX.XX
|
J1
|
5303
|
| 43197 |
Esophagoscopy flex dx brush
|
$XXX.XX
|
T
|
5301
|
| 43198 |
Esophagosc flex trnsn biopsy
|
$XXX.XX
|
T
|
5301
|
| 43200 |
Esophagoscopy flexible brush
|
$XXX.XX
|
T
|
5301
|
| 43201 |
Esoph scope w/submucous inj
|
$XXX.XX
|
J1
|
5302
|
| 43202 |
Esophagoscopy flex biopsy
|
$XXX.XX
|
J1
|
5302
|
| 43204 |
Esoph scope w/sclerosis inj
|
$XXX.XX
|
J1
|
5302
|
| 43205 |
Esophagus endoscopy/ligation
|
$XXX.XX
|
J1
|
5302
|
| 43206 |
Esoph optical endomicroscopy
|
$XXX.XX
|
J1
|
5302
|
| 43210 |
Egd esophagogastrc fndoplsty
|
$XXX.XX
|
J1
|
5362
|
| 43211 |
Esophagoscop mucosal resect
|
$XXX.XX
|
J1
|
5302
|
| 43212 |
Esophagoscop stent placement
|
$XXX.XX
|
J1
|
5331
|
| 43213 |
Esophagoscopy retro balloon
|
$XXX.XX
|
J1
|
5302
|
| 43214 |
Esophagosc dilate balloon 30
|
$XXX.XX
|
J1
|
5302
|
| 43215 |
Esophagoscopy flex remove fb
|
$XXX.XX
|
J1
|
5302
|
| 43216 |
Esophagoscopy lesion removal
|
$XXX.XX
|
J1
|
5302
|
| 43217 |
Esophagoscopy snare les remv
|
$XXX.XX
|
J1
|
5302
|
| 43220 |
Esophagoscopy balloon <30mm
|
$XXX.XX
|
J1
|
5302
|
| 43226 |
Esoph endoscopy dilation
|
$XXX.XX
|
J1
|
5302
|
| 43227 |
Esophagoscopy control bleed
|
$XXX.XX
|
J1
|
5302
|
| 43229 |
Esophagoscopy lesion ablate
|
$XXX.XX
|
J1
|
5303
|
| 43231 |
Esophagoscop ultrasound exam
|
$XXX.XX
|
J1
|
5302
|
| 43232 |
Esophagoscopy w/us needle bx
|
$XXX.XX
|
J1
|
5302
|
| 43233 |
Egd balloon dil esoph30 mm/>
|
$XXX.XX
|
J1
|
5302
|
| 43235 |
Egd diagnostic brush wash
|
$XXX.XX
|
T
|
5301
|
| 43236 |
Uppr gi scope w/submuc inj
|
$XXX.XX
|
T
|
5301
|
| 43237 |
Endoscopic us exam esoph
|
$XXX.XX
|
J1
|
5302
|
| 43238 |
Egd us fine needle bx/aspir
|
$XXX.XX
|
J1
|
5302
|
| 43239 |
Egd biopsy single/multiple
|
$XXX.XX
|
T
|
5301
|
| 43240 |
Egd w/transmural drain cyst
|
$XXX.XX
|
J1
|
5303
|
| 43241 |
Egd tube/cath insertion
|
$XXX.XX
|
J1
|
5302
|
| 43242 |
Egd us fine needle bx/aspir
|
$XXX.XX
|
J1
|
5302
|
| 43243 |
Egd injection varices
|
$XXX.XX
|
J1
|
5302
|
| 43244 |
Egd varices ligation
|
$XXX.XX
|
J1
|
5302
|
| 43245 |
Egd dilate stricture
|
$XXX.XX
|
J1
|
5302
|
| 43246 |
Egd place gastrostomy tube
|
$XXX.XX
|
J1
|
5302
|
| 43247 |
Egd remove foreign body
|
$XXX.XX
|
T
|
5301
|
| 43248 |
Egd guide wire insertion
|
$XXX.XX
|
T
|
5301
|
| 43249 |
Esoph egd dilation <30 mm
|
$XXX.XX
|
J1
|
5302
|
| 43250 |
Egd cautery tumor polyp
|
$XXX.XX
|
J1
|
5302
|
| 43251 |
Egd remove lesion snare
|
$XXX.XX
|
J1
|
5302
|
| 43252 |
Egd optical endomicroscopy
|
$XXX.XX
|
J1
|
5303
|
| 43253 |
Egd us transmural injxn/mark
|
$XXX.XX
|
J1
|
5302
|
| 43254 |
Egd endo mucosal resection
|
$XXX.XX
|
J1
|
5302
|
| 43255 |
Egd control bleeding any
|
$XXX.XX
|
J1
|
5302
|
| 43257 |
Egd w/thrml txmnt gerd
|
$XXX.XX
|
J1
|
5303
|
| 43259 |
Egd us exam duodenum/jejunum
|
$XXX.XX
|
J1
|
5302
|
| 43260 |
Ercp w/specimen collection
|
$XXX.XX
|
J1
|
5303
|
| 43261 |
Endo cholangiopancreatograph
|
$XXX.XX
|
J1
|
5303
|
| 43262 |
Endo cholangiopancreatograph
|
$XXX.XX
|
J1
|
5303
|
| 43263 |
Ercp sphincter pressure meas
|
$XXX.XX
|
J1
|
5303
|
| 43264 |
Ercp remove duct calculi
|
$XXX.XX
|
J1
|
5303
|
| 43265 |
Ercp lithotripsy calculi
|
$XXX.XX
|
J1
|
5331
|
| 43266 |
Egd endoscopic stent place
|
$XXX.XX
|
J1
|
5331
|
| 43270 |
Egd lesion ablation
|
$XXX.XX
|
J1
|
5302
|
| 43274 |
Ercp duct stent placement
|
$XXX.XX
|
J1
|
5331
|
| 43275 |
Ercp remove forgn body duct
|
$XXX.XX
|
J1
|
5303
|
| 43276 |
Ercp stent exchange w/dilate
|
$XXX.XX
|
J1
|
5331
|
| 43277 |
Ercp ea duct/ampulla dilate
|
$XXX.XX
|
J1
|
5303
|
| 43278 |
Ercp lesion ablate w/dilate
|
$XXX.XX
|
J1
|
5303
|
| 43280 |
Laparoscopy fundoplasty
|
$XXX.XX
|
J1
|
5362
|
| 43281 |
Lap paraesophag hern repair
|
$XXX.XX
|
J1
|
5362
|
| 43282 |
Lap paraesoph her rpr w/mesh
|
$XXX.XX
|
J1
|
5362
|
| 43284 |
Laps esophgl sphnctr agmntj
|
$XXX.XX
|
J1
|
5362
|
| 43285 |
Rmvl esophgl sphnctr dev
|
$XXX.XX
|
Q2
|
5361
|
| 43289 |
Laparoscope proc esoph
|
$XXX.XX
|
J1
|
5361
|
| 43420 |
Repair esophagus opening
|
$XXX.XX
|
J1
|
5164
|
| 43450 |
Dilate esophagus 1/mult pass
|
$XXX.XX
|
T
|
5301
|
| 43453 |
Dilate esophagus
|
$XXX.XX
|
J1
|
5302
|
| 43499 |
Esophagus surgery procedure
|
$XXX.XX
|
T
|
5301
|
| 43510 |
Surgical opening of stomach
|
$XXX.XX
|
T
|
5301
|
| 43647 |
Lap impl electrode antrum
|
$XXX.XX
|
J1
|
5462
|
| 43648 |
Lap revise/remv eltrd antrum
|
$XXX.XX
|
J1
|
5361
|
| 43651 |
Laparoscopy vagus nerve
|
$XXX.XX
|
J1
|
5361
|
| 43652 |
Laparoscopy vagus nerve
|
$XXX.XX
|
J1
|
5361
|
| 43653 |
Laparoscopy gastrostomy
|
$XXX.XX
|
J1
|
5361
|
| 43659 |
Laparoscope proc stom
|
$XXX.XX
|
J1
|
5361
|
| 43752 |
Nasal/orogastric w/tube plmt
|
$XXX.XX
|
Q1
|
5735
|
| 43753 |
Tx gastro intub w/asp
|
$XXX.XX
|
Q1
|
5722
|
| 43754 |
Dx gastr intub w/asp spec
|
$XXX.XX
|
Q1
|
5722
|
| 43755 |
Dx gastr intub w/asp specs
|
$XXX.XX
|
S
|
5721
|
| 43756 |
Dx duod intub w/asp spec
|
$XXX.XX
|
Q1
|
5301
|
| 43757 |
Dx duod intub w/asp specs
|
$XXX.XX
|
T
|
5301
|
| 43761 |
Reposition gastrostomy tube
|
$XXX.XX
|
T
|
5371
|
| 43762 |
Rplc gtube no revj trc
|
$XXX.XX
|
T
|
5371
|
| 43763 |
Rplc gtube revj gstrst trc
|
$XXX.XX
|
T
|
5371
|
| 43770 |
Lap place gastr adj device
|
$XXX.XX
|
J1
|
5362
|
| 43772 |
Lap rmvl gastr adj device
|
$XXX.XX
|
J1
|
5303
|
| 43773 |
Lap replace gastr adj device
|
$XXX.XX
|
J1
|
5361
|
| 43774 |
Lap rmvl gastr adj all parts
|
$XXX.XX
|
J1
|
5303
|
| 43830 |
Place gastrostomy tube
|
$XXX.XX
|
J1
|
5302
|
| 43831 |
Place gastrostomy tube
|
$XXX.XX
|
T
|
5301
|
| 43870 |
Repair stomach opening
|
$XXX.XX
|
J1
|
5303
|
| 43886 |
Revise gastric port open
|
$XXX.XX
|
T
|
5055
|
| 43887 |
Remove gastric port open
|
$XXX.XX
|
Q2
|
5054
|
| 43888 |
Change gastric port open
|
$XXX.XX
|
T
|
5055
|
| 43999 |
Stomach surgery procedure
|
$XXX.XX
|
T
|
5301
|
| 44100 |
Biopsy of bowel
|
$XXX.XX
|
T
|
5301
|
| 44180 |
Lap enterolysis
|
$XXX.XX
|
J1
|
5361
|
| 44186 |
Lap jejunostomy
|
$XXX.XX
|
J1
|
5361
|
| 44238 |
Laparoscope proc intestine
|
$XXX.XX
|
J1
|
5361
|
| 44312 |
Revision of ileostomy
|
$XXX.XX
|
T
|
5055
|
| 44340 |
Revision of colostomy
|
$XXX.XX
|
T
|
5055
|
| 44360 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44361 |
Small bowel endoscopy/biopsy
|
$XXX.XX
|
J1
|
5302
|
| 44363 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44364 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44365 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44366 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44369 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44370 |
Small bowel endoscopy/stent
|
$XXX.XX
|
J1
|
5331
|
| 44372 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44373 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44376 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44377 |
Small bowel endoscopy/biopsy
|
$XXX.XX
|
J1
|
5302
|
| 44378 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5302
|
| 44379 |
S bowel endoscope w/stent
|
$XXX.XX
|
J1
|
5331
|
| 44380 |
Small bowel endoscopy br/wa
|
$XXX.XX
|
T
|
5301
|
| 44381 |
Small bowel endoscopy br/wa
|
$XXX.XX
|
J1
|
5302
|
| 44382 |
Small bowel endoscopy
|
$XXX.XX
|
T
|
5301
|
| 44384 |
Small bowel endoscopy
|
$XXX.XX
|
J1
|
5303
|
| 44385 |
Endoscopy of bowel pouch
|
$XXX.XX
|
T
|
5311
|
| 44386 |
Endoscopy bowel pouch/biop
|
$XXX.XX
|
T
|
5311
|
| 44388 |
Colonoscopy thru stoma spx
|
$XXX.XX
|
T
|
5311
|
| 44389 |
Colonoscopy with biopsy
|
$XXX.XX
|
T
|
5312
|
| 44390 |
Colonoscopy for foreign body
|
$XXX.XX
|
T
|
5311
|
| 44391 |
Colonoscopy for bleeding
|
$XXX.XX
|
T
|
5312
|
| 44392 |
Colonoscopy & polypectomy
|
$XXX.XX
|
T
|
5312
|
| 44394 |
Colonoscopy w/snare
|
$XXX.XX
|
T
|
5312
|
| 44401 |
Colonoscopy with ablation
|
$XXX.XX
|
T
|
5312
|
| 44402 |
Colonoscopy w/stent plcmt
|
$XXX.XX
|
J1
|
5331
|
| 44403 |
Colonoscopy w/resection
|
$XXX.XX
|
T
|
5312
|
| 44404 |
Colonoscopy w/injection
|
$XXX.XX
|
T
|
5312
|
| 44405 |
Colonoscopy w/dilation
|
$XXX.XX
|
T
|
5312
|
| 44406 |
Colonoscopy w/ultrasound
|
$XXX.XX
|
T
|
5312
|
| 44407 |
Colonoscopy w/ndl aspir/bx
|
$XXX.XX
|
T
|
5312
|
| 44408 |
Colonoscopy w/decompression
|
$XXX.XX
|
T
|
5311
|
| 44500 |
Intro gastrointestinal tube
|
$XXX.XX
|
T
|
5301
|
| 44799 |
Unlisted px small intestine
|
$XXX.XX
|
T
|
5301
|
| 44950 |
Appendectomy
|
$XXX.XX
|
J1
|
5341
|
| 44970 |
Laparoscopy appendectomy
|
$XXX.XX
|
J1
|
5361
|
| 44979 |
Laparoscope proc app
|
$XXX.XX
|
J1
|
5361
|
| 45000 |
Drainage of pelvic abscess
|
$XXX.XX
|
T
|
5312
|
| 45005 |
Drainage of rectal abscess
|
$XXX.XX
|
T
|
5312
|
| 45020 |
Drainage of rectal abscess
|
$XXX.XX
|
J1
|
5313
|
| 45100 |
Biopsy of rectum
|
$XXX.XX
|
J1
|
5313
|
| 45108 |
Removal of anorectal lesion
|
$XXX.XX
|
J1
|
5313
|
| 45150 |
Excision of rectal stricture
|
$XXX.XX
|
T
|
5312
|
| 45160 |
Excision of rectal lesion
|
$XXX.XX
|
J1
|
5313
|
| 45171 |
Exc rect tum transanal part
|
$XXX.XX
|
J1
|
5313
|
| 45172 |
Exc rect tum transanal full
|
$XXX.XX
|
J1
|
5313
|
| 45190 |
Destruction rectal tumor
|
$XXX.XX
|
J1
|
5313
|
| 45300 |
Proctosigmoidoscopy dx
|
$XXX.XX
|
T
|
5311
|
| 45303 |
Proctosigmoidoscopy dilate
|
$XXX.XX
|
T
|
5312
|
| 45305 |
Proctosigmoidoscopy w/bx
|
$XXX.XX
|
T
|
5312
|
| 45307 |
Proctosigmoidoscopy fb
|
$XXX.XX
|
J1
|
5313
|
| 45308 |
Proctosigmoidoscopy removal
|
$XXX.XX
|
J1
|
5313
|
| 45309 |
Proctosigmoidoscopy removal
|
$XXX.XX
|
T
|
5312
|
| 45315 |
Proctosigmoidoscopy removal
|
$XXX.XX
|
T
|
5312
|
| 45317 |
Proctosigmoidoscopy bleed
|
$XXX.XX
|
T
|
5312
|
| 45320 |
Proctosigmoidoscopy ablate
|
$XXX.XX
|
J1
|
5313
|
| 45321 |
Proctosigmoidoscopy volvul
|
$XXX.XX
|
J1
|
5313
|
| 45327 |
Proctosigmoidoscopy w/stent
|
$XXX.XX
|
J1
|
5331
|
| 45330 |
Diagnostic sigmoidoscopy
|
$XXX.XX
|
T
|
5311
|
| 45331 |
Sigmoidoscopy and biopsy
|
$XXX.XX
|
T
|
5311
|
| 45332 |
Sigmoidoscopy w/fb removal
|
$XXX.XX
|
T
|
5312
|
| 45333 |
Sigmoidoscopy & polypectomy
|
$XXX.XX
|
T
|
5311
|
| 45334 |
Sigmoidoscopy for bleeding
|
$XXX.XX
|
T
|
5312
|
| 45335 |
Sigmoidoscopy w/submuc inj
|
$XXX.XX
|
T
|
5311
|
| 45337 |
Sigmoidoscopy & decompress
|
$XXX.XX
|
T
|
5311
|
| 45338 |
Sigmoidoscopy w/tumr remove
|
$XXX.XX
|
T
|
5312
|
| 45340 |
Sig w/tndsc balloon dilation
|
$XXX.XX
|
T
|
5312
|
| 45341 |
Sigmoidoscopy w/ultrasound
|
$XXX.XX
|
T
|
5311
|
| 45342 |
Sigmoidoscopy w/us guide bx
|
$XXX.XX
|
T
|
5312
|
| 45346 |
Sigmoidoscopy w/ablation
|
$XXX.XX
|
T
|
5312
|
| 45347 |
Sigmoidoscopy w/plcmt stent
|
$XXX.XX
|
J1
|
5331
|
| 45349 |
Sigmoidoscopy w/resection
|
$XXX.XX
|
J1
|
5313
|
| 45350 |
Sgmdsc w/band ligation
|
$XXX.XX
|
T
|
5312
|
| 45378 |
Diagnostic colonoscopy
|
$XXX.XX
|
T
|
5311
|
| 45379 |
Colonoscopy w/fb removal
|
$XXX.XX
|
T
|
5312
|
| 45380 |
Colonoscopy and biopsy
|
$XXX.XX
|
T
|
5312
|
| 45381 |
Colonoscopy submucous njx
|
$XXX.XX
|
T
|
5312
|
| 45382 |
Colonoscopy w/control bleed
|
$XXX.XX
|
T
|
5312
|
| 45384 |
Colonoscopy w/lesion removal
|
$XXX.XX
|
T
|
5312
|
| 45385 |
Colonoscopy w/lesion removal
|
$XXX.XX
|
T
|
5312
|
| 45386 |
Colonoscopy w/balloon dilat
|
$XXX.XX
|
T
|
5312
|
| 45388 |
Colonoscopy w/ablation
|
$XXX.XX
|
T
|
5312
|
| 45389 |
Colonoscopy w/stent plcmt
|
$XXX.XX
|
J1
|
5331
|
| 45390 |
Colonoscopy w/resection
|
$XXX.XX
|
J1
|
5313
|
| 45391 |
Colonoscopy w/endoscope us
|
$XXX.XX
|
T
|
5312
|
| 45392 |
Colonoscopy w/endoscopic fnb
|
$XXX.XX
|
T
|
5312
|
| 45393 |
Colonoscopy w/decompression
|
$XXX.XX
|
T
|
5312
|
| 45398 |
Colonoscopy w/band ligation
|
$XXX.XX
|
T
|
5312
|
| 45399 |
Unlisted procedure colon
|
$XXX.XX
|
T
|
5311
|
| 45499 |
Laparoscope proc rectum
|
$XXX.XX
|
J1
|
5361
|
| 45500 |
Repair of rectum
|
$XXX.XX
|
J1
|
5313
|
| 45505 |
Repair of rectum
|
$XXX.XX
|
J1
|
5313
|
| 45520 |
Treatment of rectal prolapse
|
$XXX.XX
|
Q1
|
5311
|
| 45541 |
Correct rectal prolapse
|
$XXX.XX
|
J1
|
5313
|
| 45560 |
Repair of rectocele
|
$XXX.XX
|
J1
|
5313
|
| 45900 |
Reduction of rectal prolapse
|
$XXX.XX
|
T
|
5311
|
| 45905 |
Dilation of anal sphincter
|
$XXX.XX
|
T
|
5312
|
| 45910 |
Dilation of rectal narrowing
|
$XXX.XX
|
T
|
5312
|
| 45915 |
Remove rectal obstruction
|
$XXX.XX
|
T
|
5312
|
| 45990 |
Surg dx exam anorectal
|
$XXX.XX
|
J1
|
5313
|
| 45999 |
Rectum surgery procedure
|
$XXX.XX
|
T
|
5311
|
| 46020 |
Placement of seton
|
$XXX.XX
|
J1
|
5313
|
| 46030 |
Removal of rectal marker
|
$XXX.XX
|
T
|
5312
|
| 46040 |
Incision of rectal abscess
|
$XXX.XX
|
T
|
5312
|
| 46045 |
Incision of rectal abscess
|
$XXX.XX
|
J1
|
5313
|
| 46050 |
Incision of anal abscess
|
$XXX.XX
|
T
|
5311
|
| 46060 |
Incision of rectal abscess
|
$XXX.XX
|
J1
|
5313
|
| 46070 |
Incision of anal septum
|
$XXX.XX
|
J1
|
5313
|
| 46080 |
Incision of anal sphincter
|
$XXX.XX
|
J1
|
5313
|
| 46083 |
Incise external hemorrhoid
|
$XXX.XX
|
T
|
5371
|
| 46200 |
Removal of anal fissure
|
$XXX.XX
|
J1
|
5313
|
| 46220 |
Excise anal ext tag/papilla
|
$XXX.XX
|
T
|
5312
|
| 46221 |
Ligation of hemorrhoid(s)
|
$XXX.XX
|
T
|
5311
|
| 46230 |
Removal of anal tags
|
$XXX.XX
|
J1
|
5313
|
| 46250 |
Remove ext hem groups 2+
|
$XXX.XX
|
J1
|
5313
|
| 46255 |
Remove int/ext hem 1 group
|
$XXX.XX
|
J1
|
5313
|
| 46257 |
Remove in/ex hem grp & fiss
|
$XXX.XX
|
J1
|
5313
|
| 46258 |
Remove in/ex hem grp w/fistu
|
$XXX.XX
|
J1
|
5313
|
| 46260 |
Remove in/ex hem groups 2+
|
$XXX.XX
|
J1
|
5313
|
| 46261 |
Remove in/ex hem grps & fiss
|
$XXX.XX
|
J1
|
5313
|
| 46262 |
Remove in/ex hem grps w/fist
|
$XXX.XX
|
J1
|
5313
|
| 46270 |
Remove anal fist subq
|
$XXX.XX
|
J1
|
5313
|
| 46275 |
Remove anal fist inter
|
$XXX.XX
|
J1
|
5313
|
| 46280 |
Remove anal fist complex
|
$XXX.XX
|
J1
|
5313
|
| 46285 |
Remove anal fist 2 stage
|
$XXX.XX
|
J1
|
5313
|
| 46288 |
Repair anal fistula
|
$XXX.XX
|
J1
|
5313
|
| 46320 |
Removal of hemorrhoid clot
|
$XXX.XX
|
T
|
5312
|
| 46500 |
Injection into hemorrhoid(s)
|
$XXX.XX
|
T
|
5311
|
| 46505 |
Chemodenervation anal musc
|
$XXX.XX
|
T
|
5312
|
| 46600 |
Diagnostic anoscopy spx
|
$XXX.XX
|
Q1
|
5734
|
| 46601 |
Diagnostic anoscopy
|
$XXX.XX
|
Q1
|
5734
|
| 46604 |
Anoscopy and dilation
|
$XXX.XX
|
T
|
5312
|
| 46606 |
Anoscopy and biopsy
|
$XXX.XX
|
T
|
5312
|
| 46607 |
Diagnostic anoscopy & biopsy
|
$XXX.XX
|
T
|
5312
|
| 46608 |
Anoscopy remove for body
|
$XXX.XX
|
T
|
5311
|
| 46610 |
Anoscopy remove lesion
|
$XXX.XX
|
J1
|
5313
|
| 46611 |
Anoscopy
|
$XXX.XX
|
T
|
5311
|
| 46612 |
Anoscopy remove lesions
|
$XXX.XX
|
J1
|
5313
|
| 46614 |
Anoscopy control bleeding
|
$XXX.XX
|
T
|
5312
|
| 46615 |
Anoscopy
|
$XXX.XX
|
J1
|
5313
|
| 46700 |
Repair of anal stricture
|
$XXX.XX
|
J1
|
5313
|
| 46706 |
Repr of anal fistula w/glue
|
$XXX.XX
|
J1
|
5313
|
| 46707 |
Repair anorectal fist w/plug
|
$XXX.XX
|
J1
|
5313
|
| 46750 |
Repair of anal sphincter
|
$XXX.XX
|
J1
|
5313
|
| 46753 |
Reconstruction of anus
|
$XXX.XX
|
J1
|
5313
|
| 46754 |
Removal of suture from anus
|
$XXX.XX
|
J1
|
5313
|
| 46760 |
Repair of anal sphincter
|
$XXX.XX
|
J1
|
5313
|
| 46761 |
Repair of anal sphincter
|
$XXX.XX
|
J1
|
5313
|
| 46900 |
Destruction anal lesion(s)
|
$XXX.XX
|
T
|
5052
|
| 46910 |
Destruction anal lesion(s)
|
$XXX.XX
|
T
|
5054
|
| 46916 |
Cryosurgery anal lesion(s)
|
$XXX.XX
|
T
|
5051
|
| 46917 |
Laser surgery anal lesions
|
$XXX.XX
|
J1
|
5313
|
| 46922 |
Excision of anal lesion(s)
|
$XXX.XX
|
J1
|
5313
|
| 46924 |
Destruction anal lesion(s)
|
$XXX.XX
|
J1
|
5313
|
| 46930 |
Destroy internal hemorrhoids
|
$XXX.XX
|
T
|
5312
|
| 46940 |
Treatment of anal fissure
|
$XXX.XX
|
J1
|
5313
|
| 46942 |
Treatment of anal fissure
|
$XXX.XX
|
T
|
5311
|
| 46945 |
Int hrhc lig 1 hroid w/o img
|
$XXX.XX
|
J1
|
5313
|
| 46946 |
Int hrhc lig 2+hroid w/o img
|
$XXX.XX
|
J1
|
5313
|
| 46947 |
Hemorrhoidopexy by stapling
|
$XXX.XX
|
J1
|
5313
|
| 46948 |
Int hrhc tranal dartlzj 2+
|
$XXX.XX
|
J1
|
5313
|
| 46999 |
Anus surgery procedure
|
$XXX.XX
|
T
|
5311
|
| 47000 |
Needle biopsy of liver
|
$XXX.XX
|
J1
|
5072
|
| 47370 |
Laparo ablate liver tumor rf
|
$XXX.XX
|
J1
|
5362
|
| 47371 |
Laparo ablate liver cryosurg
|
$XXX.XX
|
J1
|
5362
|
| 47379 |
Laparoscope procedure liver
|
$XXX.XX
|
J1
|
5361
|
| 47382 |
Percut ablate liver rf
|
$XXX.XX
|
J1
|
5361
|
| 47383 |
Perq abltj lvr cryoablation
|
$XXX.XX
|
J1
|
5361
|
| 47399 |
Liver surgery procedure
|
$XXX.XX
|
T
|
5071
|
| 47490 |
Incision of gallbladder
|
$XXX.XX
|
J1
|
5341
|
| 47531 |
Injection for cholangiogram
|
$XXX.XX
|
Q2
|
5341
|
| 47532 |
Injection for cholangiogram
|
$XXX.XX
|
Q2
|
5341
|
| 47533 |
Plmt biliary drainage cath
|
$XXX.XX
|
J1
|
5341
|
| 47534 |
Plmt biliary drainage cath
|
$XXX.XX
|
J1
|
5341
|
| 47535 |
Conversion ext bil drg cath
|
$XXX.XX
|
J1
|
5341
|
| 47536 |
Exchange biliary drg cath
|
$XXX.XX
|
J1
|
5341
|
| 47537 |
Removal biliary drg cath
|
$XXX.XX
|
Q2
|
5301
|
| 47538 |
Perq plmt bile duct stent
|
$XXX.XX
|
J1
|
5361
|
| 47539 |
Perq plmt bile duct stent
|
$XXX.XX
|
J1
|
5361
|
| 47540 |
Perq plmt bile duct stent
|
$XXX.XX
|
J1
|
5361
|
| 47541 |
Plmt access bil tree sm bwl
|
$XXX.XX
|
J1
|
5341
|
| 47552 |
Biliary endo perq dx w/speci
|
$XXX.XX
|
J1
|
5341
|
| 47553 |
Biliary endoscopy thru skin
|
$XXX.XX
|
J1
|
5341
|
| 47554 |
Biliary endoscopy thru skin
|
$XXX.XX
|
J1
|
5361
|
| 47555 |
Biliary endoscopy thru skin
|
$XXX.XX
|
J1
|
5341
|
| 47556 |
Biliary endoscopy thru skin
|
$XXX.XX
|
J1
|
5361
|
| 47562 |
Laparoscopic cholecystectomy
|
$XXX.XX
|
J1
|
5361
|
| 47563 |
Laparo cholecystectomy/graph
|
$XXX.XX
|
J1
|
5361
|
| 47564 |
Laparo cholecystectomy/explr
|
$XXX.XX
|
J1
|
5361
|
| 47579 |
Laparoscope proc biliary
|
$XXX.XX
|
J1
|
5361
|
| 47999 |
Bile tract surgery procedure
|
$XXX.XX
|
T
|
5301
|
| 48102 |
Needle biopsy pancreas
|
$XXX.XX
|
J1
|
5072
|
| 48999 |
Pancreas surgery procedure
|
$XXX.XX
|
T
|
5071
|
| 49082 |
Abd paracentesis
|
$XXX.XX
|
T
|
5301
|
| 49083 |
Abd paracentesis w/imaging
|
$XXX.XX
|
T
|
5301
|
| 49084 |
Peritoneal lavage
|
$XXX.XX
|
T
|
5301
|
| 49180 |
Biopsy abdominal mass
|
$XXX.XX
|
J1
|
5072
|
| 49185 |
Sclerotx fluid collection
|
$XXX.XX
|
T
|
5071
|
| 49250 |
Excision of umbilicus
|
$XXX.XX
|
J1
|
5341
|
| 49320 |
Diag laparo separate proc
|
$XXX.XX
|
J1
|
5361
|
| 49321 |
Laparoscopy biopsy
|
$XXX.XX
|
J1
|
5361
|
| 49322 |
Laparoscopy aspiration
|
$XXX.XX
|
J1
|
5361
|
| 49323 |
Laparo drain lymphocele
|
$XXX.XX
|
J1
|
5361
|
| 49324 |
Lap insert tunnel ip cath
|
$XXX.XX
|
J1
|
5361
|
| 49325 |
Lap revision perm ip cath
|
$XXX.XX
|
J1
|
5361
|
| 49329 |
Laparo proc abdm/per/oment
|
$XXX.XX
|
J1
|
5361
|
| 49402 |
Remove foreign body adbomen
|
$XXX.XX
|
J1
|
5341
|
| 49405 |
Image cath fluid colxn visc
|
$XXX.XX
|
J1
|
5072
|
| 49406 |
Image cath fluid peri/retro
|
$XXX.XX
|
J1
|
5072
|
| 49407 |
Image cath fluid trns/vgnl
|
$XXX.XX
|
J1
|
5072
|
| 49411 |
Ins mark abd/pel for rt perq
|
$XXX.XX
|
S
|
5613
|
| 49418 |
Insert tun ip cath perc
|
$XXX.XX
|
J1
|
5341
|
| 49419 |
Insert tun ip cath w/port
|
$XXX.XX
|
J1
|
5184
|
| 49421 |
Ins tun ip cath for dial opn
|
$XXX.XX
|
J1
|
5341
|
| 49422 |
Remove tunneled ip cath
|
$XXX.XX
|
Q2
|
5183
|
| 49423 |
Exchange drainage catheter
|
$XXX.XX
|
J1
|
5302
|
| 49426 |
Revise abdomen-venous shunt
|
$XXX.XX
|
J1
|
5341
|
| 49429 |
Removal of shunt
|
$XXX.XX
|
Q2
|
5183
|
| 49436 |
Embedded ip cath exit-site
|
$XXX.XX
|
J1
|
5302
|
| 49440 |
Place gastrostomy tube perc
|
$XXX.XX
|
J1
|
5302
|
| 49441 |
Place duod/jej tube perc
|
$XXX.XX
|
J1
|
5302
|
| 49442 |
Place cecostomy tube perc
|
$XXX.XX
|
T
|
5312
|
| 49446 |
Change g-tube to g-j perc
|
$XXX.XX
|
J1
|
5302
|
| 49450 |
Replace g/c tube perc
|
$XXX.XX
|
T
|
5301
|
| 49451 |
Replace duod/jej tube perc
|
$XXX.XX
|
T
|
5301
|
| 49452 |
Replace g-j tube perc
|
$XXX.XX
|
T
|
5301
|
| 49460 |
Fix g/colon tube w/device
|
$XXX.XX
|
T
|
5301
|
| 49465 |
Fluoro exam of g/colon tube
|
$XXX.XX
|
Q1
|
5523
|
| 49491 |
Rpr hern preemie reduc
|
$XXX.XX
|
J1
|
5361
|
| 49492 |
Rpr ing hern premie blocked
|
$XXX.XX
|
J1
|
5341
|
| 49495 |
Rpr ing hernia baby reduc
|
$XXX.XX
|
J1
|
5341
|
| 49496 |
Rpr ing hernia baby blocked
|
$XXX.XX
|
J1
|
5341
|
| 49500 |
Rpr ing hernia init reduce
|
$XXX.XX
|
J1
|
5341
|
| 49501 |
Rpr ing hernia init blocked
|
$XXX.XX
|
J1
|
5341
|
| 49505 |
Prp i/hern init reduc >5 yr
|
$XXX.XX
|
J1
|
5341
|
| 49507 |
Prp i/hern init block >5 yr
|
$XXX.XX
|
J1
|
5341
|
| 49520 |
Rerepair ing hernia reduce
|
$XXX.XX
|
J1
|
5341
|
| 49521 |
Rerepair ing hernia blocked
|
$XXX.XX
|
J1
|
5341
|
| 49525 |
Repair ing hernia sliding
|
$XXX.XX
|
J1
|
5341
|
| 49540 |
Repair lumbar hernia
|
$XXX.XX
|
J1
|
5361
|
| 49550 |
Rpr rem hernia init reduce
|
$XXX.XX
|
J1
|
5341
|
| 49553 |
Rpr fem hernia init blocked
|
$XXX.XX
|
J1
|
5341
|
| 49555 |
Rerepair fem hernia reduce
|
$XXX.XX
|
J1
|
5341
|
| 49557 |
Rerepair fem hernia blocked
|
$XXX.XX
|
J1
|
5341
|
| 49560 |
Rpr ventral hern init reduc
|
$XXX.XX
|
J1
|
5341
|
| 49561 |
Rpr ventral hern init block
|
$XXX.XX
|
J1
|
5341
|
| 49565 |
Rerepair ventrl hern reduce
|
$XXX.XX
|
J1
|
5361
|
| 49566 |
Rerepair ventrl hern block
|
$XXX.XX
|
J1
|
5361
|
| 49570 |
Rpr epigastric hern reduce
|
$XXX.XX
|
J1
|
5341
|
| 49572 |
Rpr epigastric hern blocked
|
$XXX.XX
|
J1
|
5341
|
| 49580 |
Rpr umbil hern reduc < 5 yr
|
$XXX.XX
|
J1
|
5341
|
| 49582 |
Rpr umbil hern block < 5 yr
|
$XXX.XX
|
J1
|
5341
|
| 49585 |
Rpr umbil hern reduc > 5 yr
|
$XXX.XX
|
J1
|
5341
|
| 49587 |
Rpr umbil hern block > 5 yr
|
$XXX.XX
|
J1
|
5341
|
| 49590 |
Repair spigelian hernia
|
$XXX.XX
|
J1
|
5341
|
| 49600 |
Repair umbilical lesion
|
$XXX.XX
|
J1
|
5341
|
| 49650 |
Lap ing hernia repair init
|
$XXX.XX
|
J1
|
5361
|
| 49651 |
Lap ing hernia repair recur
|
$XXX.XX
|
J1
|
5361
|
| 49652 |
Lap vent/abd hernia repair
|
$XXX.XX
|
J1
|
5361
|
| 49653 |
Lap vent/abd hern proc comp
|
$XXX.XX
|
J1
|
5361
|
| 49654 |
Lap inc hernia repair
|
$XXX.XX
|
J1
|
5362
|
| 49655 |
Lap inc hern repair comp
|
$XXX.XX
|
J1
|
5362
|
| 49656 |
Lap inc hernia repair recur
|
$XXX.XX
|
J1
|
5362
|
| 49657 |
Lap inc hern recur comp
|
$XXX.XX
|
J1
|
5362
|
| 49659 |
Laparo proc hernia repair
|
$XXX.XX
|
J1
|
5361
|
| 49999 |
Abdomen surgery procedure
|
$XXX.XX
|
T
|
5301
|
| 50020 |
Renal abscess open drain
|
$XXX.XX
|
J1
|
5373
|
| 50080 |
Removal of kidney stone
|
$XXX.XX
|
J1
|
5376
|
| 50081 |
Removal of kidney stone
|
$XXX.XX
|
J1
|
5376
|
| 50200 |
Renal biopsy perq
|
$XXX.XX
|
J1
|
5072
|
| 50382 |
Change ureter stent percut
|
$XXX.XX
|
J1
|
5373
|
| 50384 |
Remove ureter stent percut
|
$XXX.XX
|
Q2
|
5373
|
| 50385 |
Change stent via transureth
|
$XXX.XX
|
J1
|
5373
|
| 50386 |
Remove stent via transureth
|
$XXX.XX
|
Q2
|
5373
|
| 50387 |
Change nephroureteral cath
|
$XXX.XX
|
J1
|
5373
|
| 50389 |
Remove renal tube w/fluoro
|
$XXX.XX
|
Q2
|
5372
|
| 50390 |
Drainage of kidney lesion
|
$XXX.XX
|
T
|
5071
|
| 50391 |
Instll rx agnt into rnal tub
|
$XXX.XX
|
T
|
5371
|
| 50396 |
Measure kidney pressure
|
$XXX.XX
|
T
|
5372
|
| 50430 |
Njx px nfrosgrm &/urtrgrm
|
$XXX.XX
|
Q2
|
5372
|
| 50431 |
Njx px nfrosgrm &/urtrgrm
|
$XXX.XX
|
Q2
|
5372
|
| 50432 |
Plmt nephrostomy catheter
|
$XXX.XX
|
J1
|
5373
|
| 50433 |
Plmt nephroureteral catheter
|
$XXX.XX
|
J1
|
5374
|
| 50434 |
Convert nephrostomy catheter
|
$XXX.XX
|
J1
|
5373
|
| 50435 |
Exchange nephrostomy cath
|
$XXX.XX
|
J1
|
5373
|
| 50436 |
Dilat xst trc ndurlgc px
|
$XXX.XX
|
J1
|
5373
|
| 50437 |
Dilat xst trc new access rcs
|
$XXX.XX
|
J1
|
5374
|
| 50541 |
Laparo ablate renal cyst
|
$XXX.XX
|
J1
|
5361
|
| 50542 |
Laparo ablate renal mass
|
$XXX.XX
|
J1
|
5362
|
| 50543 |
Laparo partial nephrectomy
|
$XXX.XX
|
J1
|
5362
|
| 50544 |
Laparoscopy pyeloplasty
|
$XXX.XX
|
J1
|
5362
|
| 50549 |
Laparoscope proc renal
|
$XXX.XX
|
J1
|
5361
|
| 50551 |
Kidney endoscopy
|
$XXX.XX
|
J1
|
5375
|
| 50553 |
Kidney endoscopy
|
$XXX.XX
|
J1
|
5375
|
| 50555 |
Kidney endoscopy & biopsy
|
$XXX.XX
|
J1
|
5376
|
| 50557 |
Kidney endoscopy & treatment
|
$XXX.XX
|
J1
|
5376
|
| 50561 |
Kidney endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 50562 |
Renal scope w/tumor resect
|
$XXX.XX
|
J1
|
5376
|
| 50570 |
Kidney endoscopy
|
$XXX.XX
|
J1
|
5374
|
| 50572 |
Kidney endoscopy
|
$XXX.XX
|
T
|
5372
|
| 50574 |
Kidney endoscopy & biopsy
|
$XXX.XX
|
J1
|
5373
|
| 50575 |
Kidney endoscopy
|
$XXX.XX
|
J1
|
5375
|
| 50576 |
Kidney endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 50580 |
Kidney endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 50590 |
Fragmenting of kidney stone
|
$XXX.XX
|
J1
|
5374
|
| 50592 |
Perc rf ablate renal tumor
|
$XXX.XX
|
J1
|
5361
|
| 50593 |
Perc cryo ablate renal tum
|
$XXX.XX
|
J1
|
5362
|
| 50686 |
Measure ureter pressure
|
$XXX.XX
|
S
|
5721
|
| 50688 |
Change of ureter tube/stent
|
$XXX.XX
|
J1
|
5373
|
| 50693 |
Plmt ureteral stent prq
|
$XXX.XX
|
J1
|
5374
|
| 50694 |
Plmt ureteral stent prq
|
$XXX.XX
|
J1
|
5374
|
| 50695 |
Plmt ureteral stent prq
|
$XXX.XX
|
J1
|
5374
|
| 50727 |
Revise ureter
|
$XXX.XX
|
J1
|
5374
|
| 50945 |
Laparoscopy ureterolithotomy
|
$XXX.XX
|
J1
|
5361
|
| 50947 |
Laparo new ureter/bladder
|
$XXX.XX
|
J1
|
5361
|
| 50948 |
Laparo new ureter/bladder
|
$XXX.XX
|
J1
|
5362
|
| 50949 |
Laparoscope proc ureter
|
$XXX.XX
|
J1
|
5361
|
| 50951 |
Endoscopy of ureter
|
$XXX.XX
|
J1
|
5374
|
| 50953 |
Endoscopy of ureter
|
$XXX.XX
|
J1
|
5374
|
| 50955 |
Ureter endoscopy & biopsy
|
$XXX.XX
|
J1
|
5375
|
| 50957 |
Ureter endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 50961 |
Ureter endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 50970 |
Ureter endoscopy
|
$XXX.XX
|
J1
|
5374
|
| 50972 |
Ureter endoscopy & catheter
|
$XXX.XX
|
J1
|
5374
|
| 50974 |
Ureter endoscopy & biopsy
|
$XXX.XX
|
J1
|
5375
|
| 50976 |
Ureter endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 50980 |
Ureter endoscopy & treatment
|
$XXX.XX
|
J1
|
5375
|
| 51020 |
Incise & treat bladder
|
$XXX.XX
|
J1
|
5374
|
| 51030 |
Incise & treat bladder
|
$XXX.XX
|
J1
|
5374
|
| 51040 |
Incise & drain bladder
|
$XXX.XX
|
J1
|
5373
|
| 51045 |
Incise bladder/drain ureter
|
$XXX.XX
|
J1
|
5373
|
| 51050 |
Removal of bladder stone
|
$XXX.XX
|
J1
|
5375
|
| 51060 |
Removal of ureter stone
|
$XXX.XX
|
J1
|
5373
|
| 51065 |
Remove ureter calculus
|
$XXX.XX
|
J1
|
5374
|
| 51080 |
Drainage of bladder abscess
|
$XXX.XX
|
J1
|
5073
|
| 51100 |
Drain bladder by needle
|
$XXX.XX
|
T
|
5371
|
| 51101 |
Drain bladder by trocar/cath
|
$XXX.XX
|
S
|
5724
|
| 51102 |
Drain bl w/cath insertion
|
$XXX.XX
|
J1
|
5373
|
| 51500 |
Removal of bladder cyst
|
$XXX.XX
|
J1
|
5361
|
| 51520 |
Removal of bladder lesion
|
$XXX.XX
|
J1
|
5374
|
| 51535 |
Repair of ureter lesion
|
$XXX.XX
|
J1
|
5374
|
| 51700 |
Irrigation of bladder
|
$XXX.XX
|
T
|
5371
|
| 51701 |
Insert bladder catheter
|
$XXX.XX
|
Q1
|
5734
|
| 51702 |
Insert temp bladder cath
|
$XXX.XX
|
Q1
|
5734
|
| 51703 |
Insert bladder cath complex
|
$XXX.XX
|
S
|
5721
|
| 51705 |
Change of bladder tube
|
$XXX.XX
|
T
|
5371
|
| 51710 |
Change of bladder tube
|
$XXX.XX
|
T
|
5372
|
| 51715 |
Endoscopic injection/implant
|
$XXX.XX
|
J1
|
5374
|
| 51720 |
Treatment of bladder lesion
|
$XXX.XX
|
T
|
5371
|
| 51725 |
Simple cystometrogram
|
$XXX.XX
|
T
|
5371
|
| 51726 |
Complex cystometrogram
|
$XXX.XX
|
T
|
5371
|
| 51727 |
Cystometrogram w/up
|
$XXX.XX
|
T
|
5372
|
| 51728 |
Cystometrogram w/vp
|
$XXX.XX
|
T
|
5372
|
| 51729 |
Cystometrogram w/vp&up
|
$XXX.XX
|
T
|
5372
|
| 51736 |
Urine flow measurement
|
$XXX.XX
|
Q1
|
5734
|
| 51741 |
Electro-uroflowmetry first
|
$XXX.XX
|
Q1
|
5721
|
| 51784 |
Anal/urinary muscle study
|
$XXX.XX
|
S
|
5721
|
| 51785 |
Anal/urinary muscle study
|
$XXX.XX
|
T
|
5371
|
| 51792 |
Urinary reflex study
|
$XXX.XX
|
Q1
|
5733
|
| 51798 |
Us urine capacity measure
|
$XXX.XX
|
Q1
|
5733
|
| 51845 |
Repair bladder neck
|
$XXX.XX
|
J1
|
5415
|
| 51860 |
Repair of bladder wound
|
$XXX.XX
|
J1
|
5375
|
| 51880 |
Repair of bladder opening
|
$XXX.XX
|
J1
|
5374
|
| 51990 |
Laparo urethral suspension
|
$XXX.XX
|
J1
|
5361
|
| 51992 |
Laparo sling operation
|
$XXX.XX
|
J1
|
5361
|
| 51999 |
Laparoscope proc bla
|
$XXX.XX
|
J1
|
5361
|
| 52000 |
Cystoscopy
|
$XXX.XX
|
T
|
5372
|
| 52001 |
Cystoscopy removal of clots
|
$XXX.XX
|
J1
|
5374
|
| 52005 |
Cystoscopy & ureter catheter
|
$XXX.XX
|
J1
|
5373
|
| 52007 |
Cystoscopy and biopsy
|
$XXX.XX
|
J1
|
5374
|
| 52010 |
Cystoscopy & duct catheter
|
$XXX.XX
|
T
|
5372
|
| 52204 |
Cystoscopy w/biopsy(s)
|
$XXX.XX
|
J1
|
5373
|
| 52214 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52224 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52234 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52235 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52240 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5375
|
| 52250 |
Cystoscopy and radiotracer
|
$XXX.XX
|
J1
|
5374
|
| 52260 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52265 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52270 |
Cystoscopy & revise urethra
|
$XXX.XX
|
J1
|
5373
|
| 52275 |
Cystoscopy & revise urethra
|
$XXX.XX
|
J1
|
5373
|
| 52276 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52277 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52281 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52282 |
Cystoscopy implant stent
|
$XXX.XX
|
J1
|
5374
|
| 52283 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52285 |
Cystoscopy and treatment
|
$XXX.XX
|
T
|
5372
|
| 52287 |
Cystoscopy chemodenervation
|
$XXX.XX
|
J1
|
5373
|
| 52290 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52300 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52301 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52305 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5375
|
| 52310 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52315 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5373
|
| 52317 |
Remove bladder stone
|
$XXX.XX
|
J1
|
5374
|
| 52318 |
Remove bladder stone
|
$XXX.XX
|
J1
|
5374
|
| 52320 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52325 |
Cystoscopy stone removal
|
$XXX.XX
|
J1
|
5375
|
| 52327 |
Cystoscopy inject material
|
$XXX.XX
|
J1
|
5375
|
| 52330 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52332 |
Cystoscopy and treatment
|
$XXX.XX
|
J1
|
5374
|
| 52334 |
Create passage to kidney
|
$XXX.XX
|
J1
|
5374
|
| 52341 |
Cysto w/ureter stricture tx
|
$XXX.XX
|
J1
|
5374
|
| 52342 |
Cysto w/up stricture tx
|
$XXX.XX
|
J1
|
5374
|
| 52343 |
Cysto w/renal stricture tx
|
$XXX.XX
|
J1
|
5373
|
| 52344 |
Cysto/uretero stricture tx
|
$XXX.XX
|
J1
|
5374
|
| 52345 |
Cysto/uretero w/up stricture
|
$XXX.XX
|
J1
|
5374
|
| 52346 |
Cystouretero w/renal strict
|
$XXX.XX
|
J1
|
5375
|
| 52351 |
Cystouretero & or pyeloscope
|
$XXX.XX
|
J1
|
5374
|
| 52352 |
Cystouretero w/stone remove
|
$XXX.XX
|
J1
|
5374
|
| 52353 |
Cystouretero w/lithotripsy
|
$XXX.XX
|
J1
|
5375
|
| 52354 |
Cystouretero w/biopsy
|
$XXX.XX
|
J1
|
5375
|
| 52355 |
Cystouretero w/excise tumor
|
$XXX.XX
|
J1
|
5375
|
| 52356 |
Cysto/uretero w/lithotripsy
|
$XXX.XX
|
J1
|
5375
|
| 52400 |
Cystouretero w/congen repr
|
$XXX.XX
|
J1
|
5374
|
| 52402 |
Cystourethro cut ejacul duct
|
$XXX.XX
|
J1
|
5374
|
| 52450 |
Incision of prostate
|
$XXX.XX
|
J1
|
5374
|
| 52500 |
Revision of bladder neck
|
$XXX.XX
|
J1
|
5374
|
| 52601 |
Prostatectomy (turp)
|
$XXX.XX
|
J1
|
5375
|
| 52630 |
Remove prostate regrowth
|
$XXX.XX
|
J1
|
5375
|
| 52640 |
Relieve bladder contracture
|
$XXX.XX
|
J1
|
5374
|
| 52647 |
Laser surgery of prostate
|
$XXX.XX
|
J1
|
5375
|
| 52648 |
Laser surgery of prostate
|
$XXX.XX
|
J1
|
5375
|
| 52649 |
Prostate laser enucleation
|
$XXX.XX
|
J1
|
5375
|
| 52700 |
Drainage of prostate abscess
|
$XXX.XX
|
J1
|
5374
|
| 53000 |
Incision of urethra
|
$XXX.XX
|
J1
|
5373
|
| 53010 |
Incision of urethra
|
$XXX.XX
|
J1
|
5375
|
| 53020 |
Incision of urethra
|
$XXX.XX
|
J1
|
5373
|
| 53025 |
Incision of urethra
|
$XXX.XX
|
J1
|
5373
|
| 53040 |
Drainage of urethra abscess
|
$XXX.XX
|
J1
|
5373
|
| 53060 |
Drainage of urethra abscess
|
$XXX.XX
|
J1
|
5373
|
| 53080 |
Drainage of urinary leakage
|
$XXX.XX
|
T
|
5372
|
| 53085 |
Drainage of urinary leakage
|
$XXX.XX
|
J1
|
5373
|
| 53200 |
Biopsy of urethra
|
$XXX.XX
|
J1
|
5373
|
| 53210 |
Removal of urethra
|
$XXX.XX
|
J1
|
5374
|
| 53215 |
Removal of urethra
|
$XXX.XX
|
J1
|
5375
|
| 53220 |
Treatment of urethra lesion
|
$XXX.XX
|
J1
|
5374
|
| 53230 |
Removal of urethra lesion
|
$XXX.XX
|
J1
|
5375
|
| 53235 |
Removal of urethra lesion
|
$XXX.XX
|
J1
|
5375
|
| 53240 |
Surgery for urethra pouch
|
$XXX.XX
|
J1
|
5374
|
| 53250 |
Removal of urethra gland
|
$XXX.XX
|
J1
|
5374
|
| 53260 |
Treatment of urethra lesion
|
$XXX.XX
|
J1
|
5373
|
| 53265 |
Treatment of urethra lesion
|
$XXX.XX
|
J1
|
5373
|
| 53270 |
Removal of urethra gland
|
$XXX.XX
|
J1
|
5373
|
| 53275 |
Repair of urethra defect
|
$XXX.XX
|
J1
|
5373
|
| 53400 |
Revise urethra stage 1
|
$XXX.XX
|
J1
|
5375
|
| 53405 |
Revise urethra stage 2
|
$XXX.XX
|
J1
|
5375
|
| 53410 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5375
|
| 53420 |
Reconstruct urethra stage 1
|
$XXX.XX
|
J1
|
5375
|
| 53425 |
Reconstruct urethra stage 2
|
$XXX.XX
|
J1
|
5375
|
| 53430 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5375
|
| 53431 |
Reconstruct urethra/bladder
|
$XXX.XX
|
J1
|
5375
|
| 53440 |
Male sling procedure
|
$XXX.XX
|
J1
|
5376
|
| 53442 |
Remove/revise male sling
|
$XXX.XX
|
J1
|
5375
|
| 53444 |
Insert tandem cuff
|
$XXX.XX
|
J1
|
5377
|
| 53445 |
Insert uro/ves nck sphincter
|
$XXX.XX
|
J1
|
5377
|
| 53446 |
Remove uro sphincter
|
$XXX.XX
|
Q2
|
5375
|
| 53447 |
Remove/replace ur sphincter
|
$XXX.XX
|
J1
|
5377
|
| 53449 |
Repair uro sphincter
|
$XXX.XX
|
J1
|
5375
|
| 53450 |
Revision of urethra
|
$XXX.XX
|
J1
|
5374
|
| 53460 |
Revision of urethra
|
$XXX.XX
|
J1
|
5374
|
| 53500 |
Urethrlys transvag w/ scope
|
$XXX.XX
|
J1
|
5374
|
| 53502 |
Repair of urethra injury
|
$XXX.XX
|
J1
|
5374
|
| 53505 |
Repair of urethra injury
|
$XXX.XX
|
J1
|
5375
|
| 53510 |
Repair of urethra injury
|
$XXX.XX
|
J1
|
5375
|
| 53515 |
Repair of urethra injury
|
$XXX.XX
|
J1
|
5375
|
| 53520 |
Repair of urethra defect
|
$XXX.XX
|
J1
|
5375
|
| 53600 |
Dilate urethra stricture
|
$XXX.XX
|
T
|
5371
|
| 53601 |
Dilate urethra stricture
|
$XXX.XX
|
Q1
|
5734
|
| 53605 |
Dilate urethra stricture
|
$XXX.XX
|
J1
|
5373
|
| 53620 |
Dilate urethra stricture
|
$XXX.XX
|
T
|
5372
|
| 53621 |
Dilate urethra stricture
|
$XXX.XX
|
T
|
5371
|
| 53660 |
Dilation of urethra
|
$XXX.XX
|
S
|
5721
|
| 53661 |
Dilation of urethra
|
$XXX.XX
|
Q1
|
5734
|
| 53665 |
Dilation of urethra
|
$XXX.XX
|
J1
|
5373
|
| 53850 |
Prostatic microwave thermotx
|
$XXX.XX
|
J1
|
5374
|
| 53852 |
Prostatic rf thermotx
|
$XXX.XX
|
J1
|
5374
|
| 53854 |
Trurl dstrj prst8 tiss rf wv
|
$XXX.XX
|
J1
|
5373
|
| 53855 |
Insert prost urethral stent
|
$XXX.XX
|
J1
|
5373
|
| 53860 |
Transurethral rf treatment
|
$XXX.XX
|
J1
|
5373
|
| 53899 |
Urology surgery procedure
|
$XXX.XX
|
T
|
5371
|
| 54000 |
Slitting of prepuce
|
$XXX.XX
|
J1
|
5374
|
| 54001 |
Slitting of prepuce
|
$XXX.XX
|
J1
|
5373
|
| 54015 |
Drain penis lesion
|
$XXX.XX
|
J1
|
5072
|
| 54050 |
Destruction penis lesion(s)
|
$XXX.XX
|
Q1
|
5052
|
| 54055 |
Destruction penis lesion(s)
|
$XXX.XX
|
T
|
5054
|
| 54056 |
Cryosurgery penis lesion(s)
|
$XXX.XX
|
Q1
|
5051
|
| 54057 |
Laser surg penis lesion(s)
|
$XXX.XX
|
T
|
5054
|
| 54060 |
Excision of penis lesion(s)
|
$XXX.XX
|
T
|
5054
|
| 54065 |
Destruction penis lesion(s)
|
$XXX.XX
|
T
|
5054
|
| 54100 |
Biopsy of penis
|
$XXX.XX
|
J1
|
5072
|
| 54105 |
Biopsy of penis
|
$XXX.XX
|
J1
|
5073
|
| 54110 |
Treatment of penis lesion
|
$XXX.XX
|
J1
|
5374
|
| 54111 |
Treat penis lesion graft
|
$XXX.XX
|
J1
|
5375
|
| 54112 |
Treat penis lesion graft
|
$XXX.XX
|
J1
|
5376
|
| 54115 |
Treatment of penis lesion
|
$XXX.XX
|
J1
|
5073
|
| 54120 |
Partial removal of penis
|
$XXX.XX
|
J1
|
5374
|
| 54150 |
Circumcision w/regionl block
|
$XXX.XX
|
J1
|
5373
|
| 54160 |
Circumcision neonate
|
$XXX.XX
|
T
|
5372
|
| 54161 |
Circum 28 days or older
|
$XXX.XX
|
J1
|
5373
|
| 54162 |
Lysis penil circumic lesion
|
$XXX.XX
|
J1
|
5373
|
| 54163 |
Repair of circumcision
|
$XXX.XX
|
J1
|
5373
|
| 54164 |
Frenulotomy of penis
|
$XXX.XX
|
J1
|
5373
|
| 54200 |
Treatment of penis lesion
|
$XXX.XX
|
T
|
5371
|
| 54205 |
Treatment of penis lesion
|
$XXX.XX
|
J1
|
5375
|
| 54220 |
Treatment of penis lesion
|
$XXX.XX
|
T
|
5371
|
| 54231 |
Dynamic cavernosometry
|
$XXX.XX
|
T
|
5371
|
| 54235 |
Penile injection
|
$XXX.XX
|
T
|
5371
|
| 54240 |
Penis study
|
$XXX.XX
|
S
|
5721
|
| 54250 |
Penis study
|
$XXX.XX
|
T
|
5371
|
| 54300 |
Revision of penis
|
$XXX.XX
|
J1
|
5374
|
| 54304 |
Revision of penis
|
$XXX.XX
|
J1
|
5374
|
| 54308 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5375
|
| 54312 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5374
|
| 54316 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5375
|
| 54318 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5374
|
| 54322 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5374
|
| 54324 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5374
|
| 54326 |
Reconstruction of urethra
|
$XXX.XX
|
J1
|
5373
|
| 54328 |
Revise penis/urethra
|
$XXX.XX
|
J1
|
5374
|
| 54332 |
Revise penis/urethra
|
$XXX.XX
|
J1
|
5374
|
| 54336 |
Revise penis/urethra
|
$XXX.XX
|
J1
|
5374
|
| 54340 |
Secondary urethral surgery
|
$XXX.XX
|
J1
|
5374
|
| 54344 |
Secondary urethral surgery
|
$XXX.XX
|
J1
|
5375
|
| 54348 |
Secondary urethral surgery
|
$XXX.XX
|
J1
|
5375
|
| 54352 |
Reconstruct urethra/penis
|
$XXX.XX
|
J1
|
5375
|
| 54360 |
Penis plastic surgery
|
$XXX.XX
|
J1
|
5374
|
| 54380 |
Repair penis
|
$XXX.XX
|
J1
|
5373
|
| 54385 |
Repair penis
|
$XXX.XX
|
J1
|
5373
|
| 54400 |
Insert semi-rigid prosthesis
|
$XXX.XX
|
J1
|
5377
|
| 54401 |
Insert self-contd prosthesis
|
$XXX.XX
|
J1
|
5377
|
| 54405 |
Insert multi-comp penis pros
|
$XXX.XX
|
J1
|
5377
|
| 54406 |
Remove muti-comp penis pros
|
$XXX.XX
|
Q2
|
5374
|
| 54408 |
Repair multi-comp penis pros
|
$XXX.XX
|
J1
|
5375
|
| 54410 |
Remove/replace penis prosth
|
$XXX.XX
|
J1
|
5377
|
| 54411 |
Remov/replc penis pros comp
|
$XXX.XX
|
J1
|
5377
|
| 54415 |
Remove self-contd penis pros
|
$XXX.XX
|
Q2
|
5374
|
| 54416 |
Remv/repl penis contain pros
|
$XXX.XX
|
J1
|
5377
|
| 54417 |
Remv/replc penis pros compl
|
$XXX.XX
|
J1
|
5377
|
| 54420 |
Revision of penis
|
$XXX.XX
|
J1
|
5373
|
| 54435 |
Revision of penis
|
$XXX.XX
|
J1
|
5374
|
| 54437 |
Repair corporeal tear
|
$XXX.XX
|
J1
|
5374
|
| 54440 |
Repair of penis
|
$XXX.XX
|
J1
|
5374
|
| 54450 |
Preputial stretching
|
$XXX.XX
|
T
|
5371
|
| 54500 |
Biopsy of testis
|
$XXX.XX
|
J1
|
5073
|
| 54505 |
Biopsy of testis
|
$XXX.XX
|
J1
|
5374
|
| 54512 |
Excise lesion testis
|
$XXX.XX
|
J1
|
5374
|
| 54520 |
Removal of testis
|
$XXX.XX
|
J1
|
5374
|
| 54522 |
Orchiectomy partial
|
$XXX.XX
|
J1
|
5374
|
| 54530 |
Removal of testis
|
$XXX.XX
|
J1
|
5341
|
| 54535 |
Extensive testis surgery
|
$XXX.XX
|
J1
|
5374
|
| 54550 |
Exploration for testis
|
$XXX.XX
|
J1
|
5341
|
| 54560 |
Exploration for testis
|
$XXX.XX
|
J1
|
5373
|
| 54600 |
Reduce testis torsion
|
$XXX.XX
|
J1
|
5374
|
| 54620 |
Suspension of testis
|
$XXX.XX
|
J1
|
5374
|
| 54640 |
Orchiopexy ingun/scrot appr
|
$XXX.XX
|
J1
|
5341
|
| 54650 |
Orchiopexy (fowler-stephens)
|
$XXX.XX
|
J1
|
5341
|
| 54660 |
Revision of testis
|
$XXX.XX
|
J1
|
5375
|
| 54670 |
Repair testis injury
|
$XXX.XX
|
J1
|
5373
|
| 54680 |
Relocation of testis(es)
|
$XXX.XX
|
J1
|
5374
|
| 54690 |
Laparoscopy orchiectomy
|
$XXX.XX
|
J1
|
5361
|
| 54692 |
Laparoscopy orchiopexy
|
$XXX.XX
|
J1
|
5361
|
| 54699 |
Laparoscope proc testis
|
$XXX.XX
|
J1
|
5361
|
| 54700 |
Drainage of scrotum
|
$XXX.XX
|
J1
|
5373
|
| 54800 |
Biopsy of epididymis
|
$XXX.XX
|
J1
|
5072
|
| 54830 |
Remove epididymis lesion
|
$XXX.XX
|
J1
|
5373
|
| 54840 |
Remove epididymis lesion
|
$XXX.XX
|
J1
|
5373
|
| 54860 |
Removal of epididymis
|
$XXX.XX
|
J1
|
5373
|
| 54861 |
Removal of epididymis
|
$XXX.XX
|
J1
|
5374
|
| 54865 |
Explore epididymis
|
$XXX.XX
|
J1
|
5374
|
| 54900 |
Fusion of spermatic ducts
|
$XXX.XX
|
J1
|
5373
|
| 54901 |
Fusion of spermatic ducts
|
$XXX.XX
|
J1
|
5374
|
| 55000 |
Drainage of hydrocele
|
$XXX.XX
|
T
|
5071
|
| 55040 |
Removal of hydrocele
|
$XXX.XX
|
J1
|
5341
|
| 55041 |
Removal of hydroceles
|
$XXX.XX
|
J1
|
5341
|
| 55060 |
Repair of hydrocele
|
$XXX.XX
|
J1
|
5374
|
| 55100 |
Drainage of scrotum abscess
|
$XXX.XX
|
J1
|
5072
|
| 55110 |
Explore scrotum
|
$XXX.XX
|
J1
|
5374
|
| 55120 |
Removal of scrotum lesion
|
$XXX.XX
|
J1
|
5373
|
| 55150 |
Removal of scrotum
|
$XXX.XX
|
J1
|
5374
|
| 55175 |
Revision of scrotum
|
$XXX.XX
|
J1
|
5374
|
| 55180 |
Revision of scrotum
|
$XXX.XX
|
J1
|
5375
|
| 55200 |
Incision of sperm duct
|
$XXX.XX
|
J1
|
5374
|
| 55250 |
Removal of sperm duct(s)
|
$XXX.XX
|
J1
|
5373
|
| 55400 |
Repair of sperm duct
|
$XXX.XX
|
J1
|
5374
|
| 55500 |
Removal of hydrocele
|
$XXX.XX
|
J1
|
5374
|
| 55520 |
Removal of sperm cord lesion
|
$XXX.XX
|
J1
|
5374
|
| 55530 |
Revise spermatic cord veins
|
$XXX.XX
|
J1
|
5374
|
| 55535 |
Revise spermatic cord veins
|
$XXX.XX
|
J1
|
5341
|
| 55540 |
Revise hernia & sperm veins
|
$XXX.XX
|
J1
|
5341
|
| 55550 |
Laparo ligate spermatic vein
|
$XXX.XX
|
J1
|
5361
|
| 55559 |
Laparo proc spermatic cord
|
$XXX.XX
|
J1
|
5361
|
| 55600 |
Incise sperm duct pouch
|
$XXX.XX
|
J1
|
5373
|
| 55680 |
Remove sperm pouch lesion
|
$XXX.XX
|
J1
|
5374
|
| 55700 |
Biopsy of prostate
|
$XXX.XX
|
J1
|
5373
|
| 55705 |
Biopsy of prostate
|
$XXX.XX
|
J1
|
5373
|
| 55706 |
Prostate saturation sampling
|
$XXX.XX
|
J1
|
5374
|
| 55720 |
Drainage of prostate abscess
|
$XXX.XX
|
J1
|
5373
|
| 55725 |
Drainage of prostate abscess
|
$XXX.XX
|
J1
|
5374
|
| 55860 |
Surgical exposure prostate
|
$XXX.XX
|
J1
|
5375
|
| 55866 |
Laparo radical prostatectomy
|
$XXX.XX
|
J1
|
5362
|
| 55870 |
Electroejaculation
|
$XXX.XX
|
T
|
5413
|
| 55873 |
Cryoablate prostate
|
$XXX.XX
|
J1
|
5376
|
| 55874 |
Tprnl plmt biodegrdabl matrl
|
$XXX.XX
|
T
|
5375
|
| 55875 |
Transperi needle place pros
|
$XXX.XX
|
J1
|
5375
|
| 55876 |
Place rt device/marker pros
|
$XXX.XX
|
S
|
5613
|
| 55899 |
Genital surgery procedure
|
$XXX.XX
|
T
|
5371
|
| 55920 |
Place needles pelvic for rt
|
$XXX.XX
|
J1
|
5415
|
| 55970 |
Sex transformation m to f
|
$XXX.XX
|
J1
|
5415
|
| 55980 |
Sex transformation f to m
|
$XXX.XX
|
J1
|
5374
|
| 56405 |
I & d of vulva/perineum
|
$XXX.XX
|
T
|
5412
|
| 56420 |
Drainage of gland abscess
|
$XXX.XX
|
T
|
5411
|
| 56440 |
Surgery for vulva lesion
|
$XXX.XX
|
J1
|
5414
|
| 56441 |
Lysis of labial lesion(s)
|
$XXX.XX
|
J1
|
5414
|
| 56442 |
Hymenotomy
|
$XXX.XX
|
J1
|
5414
|
| 56501 |
Destroy vulva lesions sim
|
$XXX.XX
|
T
|
5054
|
| 56515 |
Destroy vulva lesion/s compl
|
$XXX.XX
|
T
|
5054
|
| 56605 |
Biopsy of vulva/perineum
|
$XXX.XX
|
T
|
5413
|
| 56620 |
Partial removal of vulva
|
$XXX.XX
|
J1
|
5414
|
| 56625 |
Complete removal of vulva
|
$XXX.XX
|
J1
|
5414
|
| 56700 |
Partial removal of hymen
|
$XXX.XX
|
J1
|
5414
|
| 56740 |
Remove vagina gland lesion
|
$XXX.XX
|
J1
|
5414
|
| 56800 |
Repair of vagina
|
$XXX.XX
|
J1
|
5414
|
| 56805 |
Repair clitoris
|
$XXX.XX
|
J1
|
5414
|
| 56810 |
Repair of perineum
|
$XXX.XX
|
J1
|
5414
|
| 56820 |
Exam of vulva w/scope
|
$XXX.XX
|
T
|
5411
|
| 56821 |
Exam/biopsy of vulva w/scope
|
$XXX.XX
|
T
|
5412
|
| 57000 |
Exploration of vagina
|
$XXX.XX
|
J1
|
5414
|
| 57010 |
Drainage of pelvic abscess
|
$XXX.XX
|
J1
|
5414
|
| 57020 |
Drainage of pelvic fluid
|
$XXX.XX
|
J1
|
5415
|
| 57022 |
I & d vaginal hematoma pp
|
$XXX.XX
|
J1
|
5073
|
| 57023 |
I & d vag hematoma non-ob
|
$XXX.XX
|
J1
|
5073
|
| 57061 |
Destroy vag lesions simple
|
$XXX.XX
|
J1
|
5414
|
| 57065 |
Destroy vag lesions complex
|
$XXX.XX
|
J1
|
5414
|
| 57100 |
Biopsy of vagina
|
$XXX.XX
|
T
|
5413
|
| 57105 |
Biopsy of vagina
|
$XXX.XX
|
J1
|
5414
|
| 57106 |
Remove vagina wall partial
|
$XXX.XX
|
J1
|
5414
|
| 57107 |
Remove vagina tissue part
|
$XXX.XX
|
J1
|
5414
|
| 57109 |
Vaginectomy partial w/nodes
|
$XXX.XX
|
J1
|
5414
|
| 57120 |
Closure of vagina
|
$XXX.XX
|
J1
|
5415
|
| 57130 |
Remove vagina lesion
|
$XXX.XX
|
J1
|
5414
|
| 57135 |
Remove vagina lesion
|
$XXX.XX
|
J1
|
5414
|
| 57150 |
Treat vagina infection
|
$XXX.XX
|
Q1
|
5733
|
| 57155 |
Insert uteri tandem/ovoids
|
$XXX.XX
|
J1
|
5415
|
| 57156 |
Ins vag brachytx device
|
$XXX.XX
|
T
|
5412
|
| 57160 |
Insert pessary/other device
|
$XXX.XX
|
T
|
5411
|
| 57170 |
Fitting of diaphragm/cap
|
$XXX.XX
|
T
|
5411
|
| 57180 |
Treat vaginal bleeding
|
$XXX.XX
|
T
|
5411
|
| 57200 |
Repair of vagina
|
$XXX.XX
|
J1
|
5414
|
| 57210 |
Repair vagina/perineum
|
$XXX.XX
|
J1
|
5414
|
| 57220 |
Revision of urethra
|
$XXX.XX
|
J1
|
5415
|
| 57230 |
Repair of urethral lesion
|
$XXX.XX
|
J1
|
5414
|
| 57240 |
Anterior colporrhaphy
|
$XXX.XX
|
J1
|
5415
|
| 57250 |
Repair rectum & vagina
|
$XXX.XX
|
J1
|
5415
|
| 57260 |
Cmbn ant pst colprhy
|
$XXX.XX
|
J1
|
5415
|
| 57265 |
Cmbn ap colprhy w/ntrcl rpr
|
$XXX.XX
|
J1
|
5415
|
| 57268 |
Repair of bowel bulge
|
$XXX.XX
|
J1
|
5415
|
| 57282 |
Colpopexy extraperitoneal
|
$XXX.XX
|
J1
|
5416
|
| 57283 |
Colpopexy intraperitoneal
|
$XXX.XX
|
J1
|
5416
|
| 57284 |
Repair paravag defect open
|
$XXX.XX
|
J1
|
5415
|
| 57285 |
Repair paravag defect vag
|
$XXX.XX
|
J1
|
5416
|
| 57287 |
Revise/remove sling repair
|
$XXX.XX
|
Q2
|
5414
|
| 57288 |
Repair bladder defect
|
$XXX.XX
|
J1
|
5415
|
| 57289 |
Repair bladder & vagina
|
$XXX.XX
|
J1
|
5416
|
| 57291 |
Construction of vagina
|
$XXX.XX
|
J1
|
5415
|
| 57292 |
Construct vagina with graft
|
$XXX.XX
|
J1
|
5415
|
| 57295 |
Revise vag graft via vagina
|
$XXX.XX
|
J1
|
5414
|
| 57300 |
Repair rectum-vagina fistula
|
$XXX.XX
|
J1
|
5414
|
| 57310 |
Repair urethrovaginal lesion
|
$XXX.XX
|
J1
|
5416
|
| 57320 |
Repair bladder-vagina lesion
|
$XXX.XX
|
J1
|
5415
|
| 57330 |
Repair bladder-vagina lesion
|
$XXX.XX
|
J1
|
5416
|
| 57335 |
Repair vagina
|
$XXX.XX
|
J1
|
5415
|
| 57400 |
Dilation of vagina
|
$XXX.XX
|
J1
|
5414
|
| 57410 |
Pelvic examination
|
$XXX.XX
|
J1
|
5414
|
| 57415 |
Remove vaginal foreign body
|
$XXX.XX
|
J1
|
5414
|
| 57420 |
Exam of vagina w/scope
|
$XXX.XX
|
T
|
5412
|
| 57421 |
Exam/biopsy of vag w/scope
|
$XXX.XX
|
T
|
5413
|
| 57423 |
Repair paravag defect lap
|
$XXX.XX
|
J1
|
5362
|
| 57425 |
Laparoscopy surg colpopexy
|
$XXX.XX
|
J1
|
5362
|
| 57426 |
Revise prosth vag graft lap
|
$XXX.XX
|
J1
|
5416
|
| 57452 |
Exam of cervix w/scope
|
$XXX.XX
|
T
|
5411
|
| 57454 |
Bx/curett of cervix w/scope
|
$XXX.XX
|
T
|
5412
|
| 57455 |
Biopsy of cervix w/scope
|
$XXX.XX
|
T
|
5412
|
| 57456 |
Endocerv curettage w/scope
|
$XXX.XX
|
T
|
5412
|
| 57460 |
Bx of cervix w/scope leep
|
$XXX.XX
|
J1
|
5414
|
| 57461 |
Conz of cervix w/scope leep
|
$XXX.XX
|
J1
|
5414
|
| 57500 |
Biopsy of cervix
|
$XXX.XX
|
T
|
5413
|
| 57505 |
Endocervical curettage
|
$XXX.XX
|
T
|
5413
|
| 57510 |
Cauterization of cervix
|
$XXX.XX
|
J1
|
5414
|
| 57511 |
Cryocautery of cervix
|
$XXX.XX
|
T
|
5412
|
| 57513 |
Laser surgery of cervix
|
$XXX.XX
|
J1
|
5414
|
| 57520 |
Conization of cervix
|
$XXX.XX
|
J1
|
5414
|
| 57522 |
Conization of cervix
|
$XXX.XX
|
J1
|
5414
|
| 57530 |
Removal of cervix
|
$XXX.XX
|
J1
|
5415
|
| 57550 |
Removal of residual cervix
|
$XXX.XX
|
J1
|
5415
|
| 57555 |
Remove cervix/repair vagina
|
$XXX.XX
|
J1
|
5415
|
| 57556 |
Remove cervix repair bowel
|
$XXX.XX
|
J1
|
5415
|
| 57558 |
D&c of cervical stump
|
$XXX.XX
|
J1
|
5414
|
| 57700 |
Revision of cervix
|
$XXX.XX
|
J1
|
5414
|
| 57720 |
Revision of cervix
|
$XXX.XX
|
J1
|
5414
|
| 57800 |
Dilation of cervical canal
|
$XXX.XX
|
J1
|
5414
|
| 58100 |
Biopsy of uterus lining
|
$XXX.XX
|
T
|
5411
|
| 58120 |
Dilation and curettage
|
$XXX.XX
|
J1
|
5414
|
| 58145 |
Myomectomy vag method
|
$XXX.XX
|
J1
|
5414
|
| 58260 |
Vaginal hysterectomy
|
$XXX.XX
|
J1
|
5415
|
| 58262 |
Vag hyst including t/o
|
$XXX.XX
|
J1
|
5415
|
| 58263 |
Vag hyst w/t/o & vag repair
|
$XXX.XX
|
J1
|
5415
|
| 58270 |
Vag hyst w/enterocele repair
|
$XXX.XX
|
J1
|
5415
|
| 58290 |
Vag hyst complex
|
$XXX.XX
|
J1
|
5416
|
| 58291 |
Vag hyst incl t/o complex
|
$XXX.XX
|
J1
|
5415
|
| 58292 |
Vag hyst t/o & repair compl
|
$XXX.XX
|
J1
|
5416
|
| 58294 |
Vag hyst w/enterocele compl
|
$XXX.XX
|
J1
|
5415
|
| 58301 |
Remove intrauterine device
|
$XXX.XX
|
Q2
|
5412
|
| 58321 |
Artificial insemination
|
$XXX.XX
|
T
|
5412
|
| 58322 |
Artificial insemination
|
$XXX.XX
|
T
|
5411
|
| 58323 |
Sperm washing
|
$XXX.XX
|
T
|
5411
|
| 58345 |
Reopen fallopian tube
|
$XXX.XX
|
J1
|
5414
|
| 58346 |
Insert heyman uteri capsule
|
$XXX.XX
|
J1
|
5415
|
| 58350 |
Reopen fallopian tube
|
$XXX.XX
|
J1
|
5415
|
| 58353 |
Endometr ablate thermal
|
$XXX.XX
|
J1
|
5415
|
| 58356 |
Endometrial cryoablation
|
$XXX.XX
|
J1
|
5415
|
| 58541 |
Lsh uterus 250 g or less
|
$XXX.XX
|
J1
|
5361
|
| 58542 |
Lsh w/t/o ut 250 g or less
|
$XXX.XX
|
J1
|
5362
|
| 58543 |
Lsh uterus above 250 g
|
$XXX.XX
|
J1
|
5362
|
| 58544 |
Lsh w/t/o uterus above 250 g
|
$XXX.XX
|
J1
|
5362
|
| 58545 |
Laparoscopic myomectomy
|
$XXX.XX
|
J1
|
5361
|
| 58546 |
Laparo-myomectomy complex
|
$XXX.XX
|
J1
|
5362
|
| 58550 |
Laparo-asst vag hysterectomy
|
$XXX.XX
|
J1
|
5361
|
| 58552 |
Laparo-vag hyst incl t/o
|
$XXX.XX
|
J1
|
5362
|
| 58553 |
Laparo-vag hyst complex
|
$XXX.XX
|
J1
|
5362
|
| 58554 |
Laparo-vag hyst w/t/o compl
|
$XXX.XX
|
J1
|
5362
|
| 58555 |
Hysteroscopy dx sep proc
|
$XXX.XX
|
J1
|
5414
|
| 58558 |
Hysteroscopy biopsy
|
$XXX.XX
|
J1
|
5414
|
| 58559 |
Hysteroscopy lysis
|
$XXX.XX
|
J1
|
5415
|
| 58560 |
Hysteroscopy resect septum
|
$XXX.XX
|
J1
|
5415
|
| 58561 |
Hysteroscopy remove myoma
|
$XXX.XX
|
J1
|
5415
|
| 58562 |
Hysteroscopy remove fb
|
$XXX.XX
|
J1
|
5414
|
| 58563 |
Hysteroscopy ablation
|
$XXX.XX
|
J1
|
5415
|
| 58565 |
Hysteroscopy sterilization
|
$XXX.XX
|
J1
|
5415
|
| 58570 |
Tlh uterus 250 g or less
|
$XXX.XX
|
J1
|
5362
|
| 58571 |
Tlh w/t/o 250 g or less
|
$XXX.XX
|
J1
|
5362
|
| 58572 |
Tlh uterus over 250 g
|
$XXX.XX
|
J1
|
5362
|
| 58573 |
Tlh w/t/o uterus over 250 g
|
$XXX.XX
|
J1
|
5362
|
| 58578 |
Laparo proc uterus
|
$XXX.XX
|
J1
|
5361
|
| 58579 |
Hysteroscope procedure
|
$XXX.XX
|
T
|
5411
|
| 58600 |
Division of fallopian tube
|
$XXX.XX
|
J1
|
5414
|
| 58615 |
Occlude fallopian tube(s)
|
$XXX.XX
|
J1
|
5414
|
| 58660 |
Laparoscopy lysis
|
$XXX.XX
|
J1
|
5361
|
| 58661 |
Laparoscopy remove adnexa
|
$XXX.XX
|
J1
|
5361
|
| 58662 |
Laparoscopy excise lesions
|
$XXX.XX
|
J1
|
5361
|
| 58670 |
Laparoscopy tubal cautery
|
$XXX.XX
|
J1
|
5361
|
| 58671 |
Laparoscopy tubal block
|
$XXX.XX
|
J1
|
5361
|
| 58672 |
Laparoscopy fimbrioplasty
|
$XXX.XX
|
J1
|
5361
|
| 58673 |
Laparoscopy salpingostomy
|
$XXX.XX
|
J1
|
5361
|
| 58674 |
Laps abltj uterine fibroids
|
$XXX.XX
|
J1
|
5362
|
| 58679 |
Laparo proc oviduct-ovary
|
$XXX.XX
|
J1
|
5361
|
| 58770 |
Create new tubal opening
|
$XXX.XX
|
J1
|
5414
|
| 58800 |
Drainage of ovarian cyst(s)
|
$XXX.XX
|
J1
|
5414
|
| 58805 |
Drainage of ovarian cyst(s)
|
$XXX.XX
|
J1
|
5414
|
| 58820 |
Drain ovary abscess open
|
$XXX.XX
|
J1
|
5414
|
| 58900 |
Biopsy of ovary(s)
|
$XXX.XX
|
J1
|
5414
|
| 58920 |
Partial removal of ovary(s)
|
$XXX.XX
|
J1
|
5416
|
| 58925 |
Removal of ovarian cyst(s)
|
$XXX.XX
|
J1
|
5415
|
| 58970 |
Retrieval of oocyte
|
$XXX.XX
|
T
|
5413
|
| 58974 |
Transfer of embryo
|
$XXX.XX
|
T
|
5413
|
| 58976 |
Transfer of embryo
|
$XXX.XX
|
T
|
5412
|
| 58999 |
Genital surgery procedure
|
$XXX.XX
|
T
|
5411
|
| 59000 |
Amniocentesis diagnostic
|
$XXX.XX
|
T
|
5413
|
| 59001 |
Amniocentesis therapeutic
|
$XXX.XX
|
T
|
5412
|
| 59012 |
Fetal cord puncture prenatal
|
$XXX.XX
|
T
|
5412
|
| 59015 |
Chorion biopsy
|
$XXX.XX
|
T
|
5413
|
| 59020 |
Fetal contract stress test
|
$XXX.XX
|
T
|
5411
|
| 59025 |
Fetal non-stress test
|
$XXX.XX
|
T
|
5411
|
| 59030 |
Fetal scalp blood sample
|
$XXX.XX
|
T
|
5412
|
| 59070 |
Transabdom amnioinfus w/us
|
$XXX.XX
|
T
|
5412
|
| 59072 |
Umbilical cord occlud w/us
|
$XXX.XX
|
T
|
5412
|
| 59074 |
Fetal fluid drainage w/us
|
$XXX.XX
|
T
|
5412
|
| 59076 |
Fetal shunt placement w/us
|
$XXX.XX
|
T
|
5412
|
| 59100 |
Remove uterus lesion
|
$XXX.XX
|
J1
|
5415
|
| 59150 |
Treat ectopic pregnancy
|
$XXX.XX
|
J1
|
5361
|
| 59151 |
Treat ectopic pregnancy
|
$XXX.XX
|
J1
|
5361
|
| 59160 |
D & c after delivery
|
$XXX.XX
|
J1
|
5414
|
| 59200 |
Insert cervical dilator
|
$XXX.XX
|
T
|
5412
|
| 59300 |
Episiotomy or vaginal repair
|
$XXX.XX
|
J1
|
5414
|
| 59320 |
Revision of cervix
|
$XXX.XX
|
J1
|
5414
|
| 59409 |
Obstetrical care
|
$XXX.XX
|
J1
|
5414
|
| 59412 |
Antepartum manipulation
|
$XXX.XX
|
J1
|
5414
|
| 59414 |
Deliver placenta
|
$XXX.XX
|
J1
|
5414
|
| 59612 |
Vbac delivery only
|
$XXX.XX
|
J1
|
5414
|
| 59812 |
Treatment of miscarriage
|
$XXX.XX
|
J1
|
5414
|
| 59820 |
Care of miscarriage
|
$XXX.XX
|
J1
|
5414
|
| 59821 |
Treatment of miscarriage
|
$XXX.XX
|
J1
|
5414
|
| 59840 |
Abortion
|
$XXX.XX
|
J1
|
5414
|
| 59841 |
Abortion
|
$XXX.XX
|
J1
|
5414
|
| 59866 |
Abortion (mpr)
|
$XXX.XX
|
T
|
5412
|
| 59870 |
Evacuate mole of uterus
|
$XXX.XX
|
J1
|
5414
|
| 59871 |
Remove cerclage suture
|
$XXX.XX
|
Q2
|
5414
|
| 59897 |
Fetal invas px w/us
|
$XXX.XX
|
T
|
5411
|
| 59898 |
Laparo proc ob care/deliver
|
$XXX.XX
|
J1
|
5361
|
| 59899 |
Maternity care procedure
|
$XXX.XX
|
T
|
5411
|
| 60000 |
Drain thyroid/tongue cyst
|
$XXX.XX
|
J1
|
5163
|
| 60100 |
Biopsy of thyroid
|
$XXX.XX
|
T
|
5071
|
| 60200 |
Remove thyroid lesion
|
$XXX.XX
|
J1
|
5361
|
| 60210 |
Partial thyroid excision
|
$XXX.XX
|
J1
|
5361
|
| 60212 |
Partial thyroid excision
|
$XXX.XX
|
J1
|
5361
|
| 60220 |
Partial removal of thyroid
|
$XXX.XX
|
J1
|
5361
|
| 60225 |
Partial removal of thyroid
|
$XXX.XX
|
J1
|
5361
|
| 60240 |
Removal of thyroid
|
$XXX.XX
|
J1
|
5361
|
| 60252 |
Removal of thyroid
|
$XXX.XX
|
J1
|
5165
|
| 60260 |
Repeat thyroid surgery
|
$XXX.XX
|
J1
|
5165
|
| 60271 |
Removal of thyroid
|
$XXX.XX
|
J1
|
5165
|
| 60280 |
Remove thyroid duct lesion
|
$XXX.XX
|
J1
|
5361
|
| 60281 |
Remove thyroid duct lesion
|
$XXX.XX
|
J1
|
5361
|
| 60300 |
Aspir/inj thyroid cyst
|
$XXX.XX
|
T
|
5071
|
| 60500 |
Explore parathyroid glands
|
$XXX.XX
|
J1
|
5165
|
| 60502 |
Re-explore parathyroids
|
$XXX.XX
|
J1
|
5165
|
| 60520 |
Removal of thymus gland
|
$XXX.XX
|
J1
|
5165
|
| 60659 |
Laparo proc endocrine
|
$XXX.XX
|
J1
|
5361
|
| 60699 |
Endocrine surgery procedure
|
$XXX.XX
|
J1
|
5361
|
| 61000 |
Remove cranial cavity fluid
|
$XXX.XX
|
T
|
5442
|
| 61001 |
Remove cranial cavity fluid
|
$XXX.XX
|
T
|
5442
|
| 61020 |
Remove brain cavity fluid
|
$XXX.XX
|
T
|
5443
|
| 61026 |
Injection into brain canal
|
$XXX.XX
|
T
|
5442
|
| 61050 |
Remove brain canal fluid
|
$XXX.XX
|
T
|
5441
|
| 61055 |
Injection into brain canal
|
$XXX.XX
|
T
|
5441
|
| 61070 |
Brain canal shunt procedure
|
$XXX.XX
|
T
|
5442
|
| 61215 |
Insert brain-fluid device
|
$XXX.XX
|
J1
|
5432
|
| 61330 |
Decompress eye socket
|
$XXX.XX
|
J1
|
5164
|
| 61623 |
Endovasc tempory vessel occl
|
$XXX.XX
|
J1
|
5193
|
| 61626 |
Transcath occlusion non-cns
|
$XXX.XX
|
J1
|
5193
|
| 61720 |
Incise skull/brain surgery
|
$XXX.XX
|
J1
|
5432
|
| 61770 |
Incise skull for treatment
|
$XXX.XX
|
J1
|
5432
|
| 61790 |
Treat trigeminal nerve
|
$XXX.XX
|
J1
|
5431
|
| 61791 |
Treat trigeminal tract
|
$XXX.XX
|
J1
|
5431
|
| 61880 |
Revise/remove neuroelectrode
|
$XXX.XX
|
J1
|
5461
|
| 61885 |
Insrt/redo neurostim 1 array
|
$XXX.XX
|
J1
|
5463
|
| 61886 |
Implant neurostim arrays
|
$XXX.XX
|
J1
|
5464
|
| 61888 |
Revise/remove neuroreceiver
|
$XXX.XX
|
J1
|
5462
|
| 62000 |
Treat skull fracture
|
$XXX.XX
|
J1
|
5164
|
| 62194 |
Replace/irrigate catheter
|
$XXX.XX
|
J1
|
5431
|
| 62225 |
Replace/irrigate catheter
|
$XXX.XX
|
J1
|
5432
|
| 62230 |
Replace/revise brain shunt
|
$XXX.XX
|
J1
|
5432
|
| 62252 |
Csf shunt reprogram
|
$XXX.XX
|
S
|
5743
|
| 62263 |
Epidural lysis mult sessions
|
$XXX.XX
|
T
|
5443
|
| 62264 |
Epidural lysis on single day
|
$XXX.XX
|
T
|
5443
|
| 62267 |
Interdiscal perq aspir dx
|
$XXX.XX
|
T
|
5071
|
| 62268 |
Drain spinal cord cyst
|
$XXX.XX
|
T
|
5443
|
| 62269 |
Needle biopsy spinal cord
|
$XXX.XX
|
J1
|
5072
|
| 62270 |
Dx lmbr spi pnxr
|
$XXX.XX
|
T
|
5442
|
| 62272 |
Ther spi pnxr drg csf
|
$XXX.XX
|
T
|
5442
|
| 62273 |
Inject epidural patch
|
$XXX.XX
|
T
|
5442
|
| 62280 |
Treat spinal cord lesion
|
$XXX.XX
|
T
|
5443
|
| 62281 |
Treat spinal cord lesion
|
$XXX.XX
|
T
|
5443
|
| 62282 |
Treat spinal canal lesion
|
$XXX.XX
|
T
|
5443
|
| 62287 |
Percutaneous diskectomy
|
$XXX.XX
|
J1
|
5431
|
| 62292 |
Njx chemonucleolysis lmbr
|
$XXX.XX
|
J1
|
5431
|
| 62294 |
Injection into spinal artery
|
$XXX.XX
|
T
|
5443
|
| 62302 |
Myelography lumbar injection
|
$XXX.XX
|
Q2
|
5573
|
| 62303 |
Myelography lumbar injection
|
$XXX.XX
|
Q2
|
5573
|
| 62304 |
Myelography lumbar injection
|
$XXX.XX
|
Q2
|
5573
|
| 62305 |
Myelography lumbar injection
|
$XXX.XX
|
Q2
|
5573
|
| 62320 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
T
|
5442
|
| 62321 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
T
|
5442
|
| 62322 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
T
|
5442
|
| 62323 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
T
|
5442
|
| 62324 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
T
|
5443
|
| 62325 |
Njx interlaminar crv/thrc
|
$XXX.XX
|
T
|
5443
|
| 62326 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
T
|
5443
|
| 62327 |
Njx interlaminar lmbr/sac
|
$XXX.XX
|
T
|
5443
|
| 62328 |
Dx lmbr spi pnxr w/fluor/ct
|
$XXX.XX
|
T
|
5442
|
| 62329 |
Ther spi pnxr csf fluor/ct
|
$XXX.XX
|
T
|
5442
|
| 62350 |
Implant spinal canal cath
|
$XXX.XX
|
J1
|
5432
|
| 62351 |
Implant spinal canal cath
|
$XXX.XX
|
J1
|
5114
|
| 62355 |
Remove spinal canal catheter
|
$XXX.XX
|
Q2
|
5431
|
| 62360 |
Insert spine infusion device
|
$XXX.XX
|
J1
|
5471
|
| 62361 |
Implant spine infusion pump
|
$XXX.XX
|
J1
|
5471
|
| 62362 |
Implant spine infusion pump
|
$XXX.XX
|
J1
|
5471
|
| 62365 |
Remove spine infusion device
|
$XXX.XX
|
Q2
|
5432
|
| 62367 |
Analyze spine infus pump
|
$XXX.XX
|
S
|
5743
|
| 62368 |
Analyze sp inf pump w/reprog
|
$XXX.XX
|
S
|
5743
|
| 62369 |
Anal sp inf pmp w/reprg&fill
|
$XXX.XX
|
S
|
5743
|
| 62370 |
Anl sp inf pmp w/mdreprg&fil
|
$XXX.XX
|
S
|
5743
|
| 62380 |
Ndsc dcmprn 1 ntrspc lumbar
|
$XXX.XX
|
J1
|
5114
|
| 63001 |
Remove spine lamina 1/2 crvl
|
$XXX.XX
|
J1
|
5114
|
| 63003 |
Remove spine lamina 1/2 thrc
|
$XXX.XX
|
J1
|
5114
|
| 63005 |
Remove spine lamina 1/2 lmbr
|
$XXX.XX
|
J1
|
5114
|
| 63011 |
Remove spine lamina 1/2 scrl
|
$XXX.XX
|
J1
|
5114
|
| 63012 |
Remove lamina/facets lumbar
|
$XXX.XX
|
J1
|
5114
|
| 63015 |
Remove spine lamina >2 crvcl
|
$XXX.XX
|
J1
|
5114
|
| 63016 |
Remove spine lamina >2 thrc
|
$XXX.XX
|
J1
|
5114
|
| 63017 |
Remove spine lamina >2 lmbr
|
$XXX.XX
|
J1
|
5114
|
| 63020 |
Neck spine disk surgery
|
$XXX.XX
|
J1
|
5114
|
| 63030 |
Low back disk surgery
|
$XXX.XX
|
J1
|
5114
|
| 63040 |
Laminotomy single cervical
|
$XXX.XX
|
J1
|
5114
|
| 63042 |
Laminotomy single lumbar
|
$XXX.XX
|
J1
|
5114
|
| 63045 |
Remove spine lamina 1 crvl
|
$XXX.XX
|
J1
|
5114
|
| 63046 |
Remove spine lamina 1 thrc
|
$XXX.XX
|
J1
|
5114
|
| 63047 |
Remove spine lamina 1 lmbr
|
$XXX.XX
|
J1
|
5114
|
| 63055 |
Decompress spinal cord thrc
|
$XXX.XX
|
J1
|
5114
|
| 63056 |
Decompress spinal cord lmbr
|
$XXX.XX
|
J1
|
5114
|
| 63064 |
Decompress spinal cord thrc
|
$XXX.XX
|
J1
|
5114
|
| 63075 |
Neck spine disk surgery
|
$XXX.XX
|
J1
|
5114
|
| 63265 |
Excise intraspinl lesion crv
|
$XXX.XX
|
J1
|
5114
|
| 63266 |
Excise intrspinl lesion thrc
|
$XXX.XX
|
J1
|
5114
|
| 63267 |
Excise intrspinl lesion lmbr
|
$XXX.XX
|
J1
|
5114
|
| 63268 |
Excise intrspinl lesion scrl
|
$XXX.XX
|
J1
|
5114
|
| 63600 |
Remove spinal cord lesion
|
$XXX.XX
|
J1
|
5431
|
| 63610 |
Stimulation of spinal cord
|
$XXX.XX
|
J1
|
5431
|
| 63650 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5462
|
| 63655 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5463
|
| 63661 |
Remove spine eltrd perq aray
|
$XXX.XX
|
Q2
|
5431
|
| 63662 |
Remove spine eltrd plate
|
$XXX.XX
|
J1
|
5461
|
| 63663 |
Revise spine eltrd perq aray
|
$XXX.XX
|
J1
|
5462
|
| 63664 |
Revise spine eltrd plate
|
$XXX.XX
|
J1
|
5463
|
| 63685 |
Insrt/redo spine n generator
|
$XXX.XX
|
J1
|
5464
|
| 63688 |
Revise/remove neuroreceiver
|
$XXX.XX
|
J1
|
5461
|
| 63741 |
Install spinal shunt
|
$XXX.XX
|
J1
|
5432
|
| 63744 |
Revision of spinal shunt
|
$XXX.XX
|
J1
|
5432
|
| 63746 |
Removal of spinal shunt
|
$XXX.XX
|
Q2
|
5431
|
| 64400 |
Njx aa&/strd trigeminal nrv
|
$XXX.XX
|
T
|
5441
|
| 64405 |
Njx aa&/strd gr ocpl nrv
|
$XXX.XX
|
T
|
5441
|
| 64408 |
Njx aa&/strd vagus nrv
|
$XXX.XX
|
T
|
5441
|
| 64415 |
Njx aa&/strd brach plexus
|
$XXX.XX
|
T
|
5443
|
| 64416 |
Njx aa&/strd brach plex nfs
|
$XXX.XX
|
T
|
5443
|
| 64417 |
Njx aa&/strd axillary nrv
|
$XXX.XX
|
T
|
5443
|
| 64418 |
Njx aa&/strd sprscap nrv
|
$XXX.XX
|
T
|
5442
|
| 64420 |
Njx aa&/strd ntrcost nrv 1
|
$XXX.XX
|
T
|
5442
|
| 64421 |
Njx aa&/strd ntrcost nrv ea
|
$XXX.XX
|
T
|
5443
|
| 64425 |
Njx aa&/strd ii ih nerves
|
$XXX.XX
|
T
|
5442
|
| 64430 |
Njx aa&/strd pudendal nerve
|
$XXX.XX
|
T
|
5443
|
| 64435 |
Njx aa&/strd paracrv nrv
|
$XXX.XX
|
T
|
5442
|
| 64445 |
Njx aa&/strd sciatic nerve
|
$XXX.XX
|
T
|
5442
|
| 64446 |
Njx aa&/strd sciatic nrv nfs
|
$XXX.XX
|
T
|
5443
|
| 64447 |
Njx aa&/strd femoral nerve
|
$XXX.XX
|
T
|
5442
|
| 64448 |
Njx aa&/strd fem nerve nfs
|
$XXX.XX
|
T
|
5443
|
| 64449 |
Njx aa&/strd lmbr plex nfs
|
$XXX.XX
|
T
|
5443
|
| 64450 |
Njx aa&/strd other pn/branch
|
$XXX.XX
|
T
|
5442
|
| 64451 |
Njx aa&/strd nrv nrvtg si jt
|
$XXX.XX
|
T
|
5442
|
| 64454 |
Njx aa&/strd gnclr nrv brnch
|
$XXX.XX
|
T
|
5442
|
| 64455 |
N block inj plantar digit
|
$XXX.XX
|
T
|
5441
|
| 64461 |
Pvb thoracic single inj site
|
$XXX.XX
|
T
|
5442
|
| 64463 |
Pvb thoracic cont infusion
|
$XXX.XX
|
T
|
5442
|
| 64479 |
Inj foramen epidural c/t
|
$XXX.XX
|
T
|
5443
|
| 64483 |
Inj foramen epidural l/s
|
$XXX.XX
|
T
|
5443
|
| 64490 |
Inj paravert f jnt c/t 1 lev
|
$XXX.XX
|
T
|
5443
|
| 64493 |
Inj paravert f jnt l/s 1 lev
|
$XXX.XX
|
T
|
5443
|
| 64505 |
N block spenopalatine gangl
|
$XXX.XX
|
T
|
5441
|
| 64510 |
N block stellate ganglion
|
$XXX.XX
|
T
|
5443
|
| 64517 |
N block inj hypogas plxs
|
$XXX.XX
|
T
|
5443
|
| 64520 |
N block lumbar/thoracic
|
$XXX.XX
|
T
|
5443
|
| 64530 |
N block inj celiac pelus
|
$XXX.XX
|
T
|
5443
|
| 64553 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5462
|
| 64555 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5462
|
| 64561 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5462
|
| 64566 |
Neuroeltrd stim post tibial
|
$XXX.XX
|
T
|
5441
|
| 64568 |
Inc for vagus n elect impl
|
$XXX.XX
|
J1
|
5464
|
| 64569 |
Revise/repl vagus n eltrd
|
$XXX.XX
|
J1
|
5462
|
| 64570 |
Remove vagus n eltrd
|
$XXX.XX
|
Q2
|
5432
|
| 64575 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5463
|
| 64580 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5463
|
| 64581 |
Implant neuroelectrodes
|
$XXX.XX
|
J1
|
5462
|
| 64585 |
Revise/remove neuroelectrode
|
$XXX.XX
|
J1
|
5461
|
| 64590 |
Insrt/redo pn/gastr stimul
|
$XXX.XX
|
J1
|
5463
|
| 64595 |
Revise/rmv pn/gastr stimul
|
$XXX.XX
|
J1
|
5461
|
| 64600 |
Injection treatment of nerve
|
$XXX.XX
|
T
|
5443
|
| 64605 |
Injection treatment of nerve
|
$XXX.XX
|
J1
|
5431
|
| 64610 |
Injection treatment of nerve
|
$XXX.XX
|
J1
|
5431
|
| 64611 |
Chemodenerv saliv glands
|
$XXX.XX
|
T
|
5441
|
| 64612 |
Destroy nerve face muscle
|
$XXX.XX
|
T
|
5441
|
| 64615 |
Chemodenerv musc migraine
|
$XXX.XX
|
T
|
5441
|
| 64616 |
Chemodenerv musc neck dyston
|
$XXX.XX
|
T
|
5441
|
| 64617 |
Chemodener muscle larynx emg
|
$XXX.XX
|
T
|
5441
|
| 64620 |
Injection treatment of nerve
|
$XXX.XX
|
T
|
5443
|
| 64624 |
Dstrj nulyt agt gnclr nrv
|
$XXX.XX
|
J1
|
5431
|
| 64625 |
Rf abltj nrv nrvtg si jt
|
$XXX.XX
|
J1
|
5431
|
| 64630 |
Injection treatment of nerve
|
$XXX.XX
|
T
|
5443
|
| 64632 |
N block inj common digit
|
$XXX.XX
|
T
|
5441
|
| 64633 |
Destroy cerv/thor facet jnt
|
$XXX.XX
|
J1
|
5431
|
| 64635 |
Destroy lumb/sac facet jnt
|
$XXX.XX
|
J1
|
5431
|
| 64640 |
Injection treatment of nerve
|
$XXX.XX
|
T
|
5443
|
| 64642 |
Chemodenerv 1 extremity 1-4
|
$XXX.XX
|
T
|
5442
|
| 64644 |
Chemodenerv 1 extrem 5/> mus
|
$XXX.XX
|
T
|
5442
|
| 64646 |
Chemodenerv trunk musc 1-5
|
$XXX.XX
|
T
|
5442
|
| 64647 |
Chemodenerv trunk musc 6/>
|
$XXX.XX
|
T
|
5442
|
| 64650 |
Chemodenerv eccrine glands
|
$XXX.XX
|
T
|
5441
|
| 64653 |
Chemodenerv eccrine glands
|
$XXX.XX
|
T
|
5441
|
| 64680 |
Injection treatment of nerve
|
$XXX.XX
|
T
|
5443
|
| 64681 |
Injection treatment of nerve
|
$XXX.XX
|
T
|
5443
|
| 64702 |
Revise finger/toe nerve
|
$XXX.XX
|
J1
|
5431
|
| 64704 |
Revise hand/foot nerve
|
$XXX.XX
|
J1
|
5431
|
| 64708 |
Revise arm/leg nerve
|
$XXX.XX
|
J1
|
5431
|
| 64712 |
Revision of sciatic nerve
|
$XXX.XX
|
J1
|
5431
|
| 64713 |
Revision of arm nerve(s)
|
$XXX.XX
|
J1
|
5431
|
| 64714 |
Revise low back nerve(s)
|
$XXX.XX
|
J1
|
5431
|
| 64716 |
Revision of cranial nerve
|
$XXX.XX
|
J1
|
5431
|
| 64718 |
Revise ulnar nerve at elbow
|
$XXX.XX
|
J1
|
5431
|
| 64719 |
Revise ulnar nerve at wrist
|
$XXX.XX
|
J1
|
5431
|
| 64721 |
Carpal tunnel surgery
|
$XXX.XX
|
J1
|
5431
|
| 64722 |
Relieve pressure on nerve(s)
|
$XXX.XX
|
J1
|
5431
|
| 64726 |
Release foot/toe nerve
|
$XXX.XX
|
J1
|
5431
|
| 64732 |
Incision of brow nerve
|
$XXX.XX
|
J1
|
5431
|
| 64734 |
Incision of cheek nerve
|
$XXX.XX
|
J1
|
5431
|
| 64736 |
Incision of chin nerve
|
$XXX.XX
|
J1
|
5431
|
| 64738 |
Incision of jaw nerve
|
$XXX.XX
|
J1
|
5431
|
| 64740 |
Incision of tongue nerve
|
$XXX.XX
|
J1
|
5431
|
| 64742 |
Incision of facial nerve
|
$XXX.XX
|
J1
|
5431
|
| 64744 |
Incise nerve back of head
|
$XXX.XX
|
J1
|
5431
|
| 64746 |
Incise diaphragm nerve
|
$XXX.XX
|
J1
|
5431
|
| 64763 |
Incise hip/thigh nerve
|
$XXX.XX
|
J1
|
5431
|
| 64766 |
Incise hip/thigh nerve
|
$XXX.XX
|
J1
|
5431
|
| 64771 |
Sever cranial nerve
|
$XXX.XX
|
J1
|
5431
|
| 64772 |
Incision of spinal nerve
|
$XXX.XX
|
J1
|
5431
|
| 64774 |
Remove skin nerve lesion
|
$XXX.XX
|
J1
|
5431
|
| 64776 |
Remove digit nerve lesion
|
$XXX.XX
|
J1
|
5431
|
| 64782 |
Remove limb nerve lesion
|
$XXX.XX
|
J1
|
5431
|
| 64784 |
Remove nerve lesion
|
$XXX.XX
|
J1
|
5431
|
| 64786 |
Remove sciatic nerve lesion
|
$XXX.XX
|
J1
|
5432
|
| 64788 |
Remove skin nerve lesion
|
$XXX.XX
|
J1
|
5431
|
| 64790 |
Removal of nerve lesion
|
$XXX.XX
|
J1
|
5431
|
| 64792 |
Removal of nerve lesion
|
$XXX.XX
|
J1
|
5432
|
| 64795 |
Biopsy of nerve
|
$XXX.XX
|
J1
|
5431
|
| 64802 |
Sympathectomy cervical
|
$XXX.XX
|
J1
|
5431
|
| 64804 |
Remove sympathetic nerves
|
$XXX.XX
|
J1
|
5431
|
| 64820 |
Sympathectomy digital artery
|
$XXX.XX
|
J1
|
5431
|
| 64821 |
Remove sympathetic nerves
|
$XXX.XX
|
J1
|
5113
|
| 64822 |
Remove sympathetic nerves
|
$XXX.XX
|
J1
|
5113
|
| 64823 |
Sympathectomy supfc palmar
|
$XXX.XX
|
J1
|
5113
|
| 64831 |
Repair of digit nerve
|
$XXX.XX
|
J1
|
5431
|
| 64834 |
Repair of hand or foot nerve
|
$XXX.XX
|
J1
|
5432
|
| 64835 |
Repair of hand or foot nerve
|
$XXX.XX
|
J1
|
5432
|
| 64836 |
Repair of hand or foot nerve
|
$XXX.XX
|
J1
|
5432
|
| 64840 |
Repair of leg nerve
|
$XXX.XX
|
J1
|
5432
|
| 64856 |
Repair/transpose nerve
|
$XXX.XX
|
J1
|
5432
|
| 64857 |
Repair arm/leg nerve
|
$XXX.XX
|
J1
|
5432
|
| 64858 |
Repair sciatic nerve
|
$XXX.XX
|
J1
|
5431
|
| 64861 |
Repair of arm nerves
|
$XXX.XX
|
J1
|
5431
|
| 64862 |
Repair of low back nerves
|
$XXX.XX
|
J1
|
5432
|
| 64864 |
Repair of facial nerve
|
$XXX.XX
|
J1
|
5432
|
| 64865 |
Repair of facial nerve
|
$XXX.XX
|
J1
|
5432
|
| 64885 |
Nerve graft head/neck 4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64886 |
Nerve graft head/neck >4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64890 |
Nerve graft hand/foot 4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64891 |
Nerve graft hand/foot >4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64892 |
Nerve graft arm/leg <4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64893 |
Nerve graft arm/leg >4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64895 |
Nerve graft hand/foot 4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64896 |
Nerve graft hand/foot >4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64897 |
Nerve graft arm/leg 4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64898 |
Nerve graft arm/leg >4 cm
|
$XXX.XX
|
J1
|
5432
|
| 64905 |
Nerve pedicle transfer
|
$XXX.XX
|
J1
|
5432
|
| 64907 |
Nerve pedicle transfer
|
$XXX.XX
|
J1
|
5432
|
| 64910 |
Nerve repair w/allograft
|
$XXX.XX
|
J1
|
5432
|
| 64911 |
Neurorraphy w/vein autograft
|
$XXX.XX
|
J1
|
5432
|
| 64912 |
Nrv rpr w/nrv algrft 1st
|
$XXX.XX
|
J1
|
5432
|
| 64999 |
Nervous system surgery
|
$XXX.XX
|
T
|
5441
|
| 65091 |
Revise eye
|
$XXX.XX
|
J1
|
5504
|
| 65093 |
Revise eye with implant
|
$XXX.XX
|
J1
|
5504
|
| 65101 |
Removal of eye
|
$XXX.XX
|
J1
|
5504
|
| 65103 |
Remove eye/insert implant
|
$XXX.XX
|
J1
|
5504
|
| 65105 |
Remove eye/attach implant
|
$XXX.XX
|
J1
|
5504
|
| 65110 |
Removal of eye
|
$XXX.XX
|
J1
|
5504
|
| 65112 |
Remove eye/revise socket
|
$XXX.XX
|
J1
|
5504
|
| 65114 |
Remove eye/revise socket
|
$XXX.XX
|
J1
|
5504
|
| 65125 |
Revise ocular implant
|
$XXX.XX
|
J1
|
5503
|
| 65130 |
Insert ocular implant
|
$XXX.XX
|
J1
|
5504
|
| 65135 |
Insert ocular implant
|
$XXX.XX
|
J1
|
5504
|
| 65140 |
Attach ocular implant
|
$XXX.XX
|
J1
|
5504
|
| 65150 |
Revise ocular implant
|
$XXX.XX
|
J1
|
5504
|
| 65155 |
Reinsert ocular implant
|
$XXX.XX
|
J1
|
5504
|
| 65175 |
Removal of ocular implant
|
$XXX.XX
|
J1
|
5504
|
| 65205 |
Remove foreign body from eye
|
$XXX.XX
|
Q1
|
5734
|
| 65210 |
Remove foreign body from eye
|
$XXX.XX
|
Q1
|
5735
|
| 65220 |
Remove foreign body from eye
|
$XXX.XX
|
Q1
|
5735
|
| 65222 |
Remove foreign body from eye
|
$XXX.XX
|
Q1
|
5734
|
| 65235 |
Remove foreign body from eye
|
$XXX.XX
|
J1
|
5491
|
| 65260 |
Remove foreign body from eye
|
$XXX.XX
|
J1
|
5491
|
| 65265 |
Remove foreign body from eye
|
$XXX.XX
|
J1
|
5491
|
| 65270 |
Repair of eye wound
|
$XXX.XX
|
J1
|
5503
|
| 65272 |
Repair of eye wound
|
$XXX.XX
|
J1
|
5503
|
| 65275 |
Repair of eye wound
|
$XXX.XX
|
J1
|
5504
|
| 65280 |
Repair of eye wound
|
$XXX.XX
|
J1
|
5492
|
| 65285 |
Repair of eye wound
|
$XXX.XX
|
J1
|
5492
|
| 65286 |
Repair of eye wound
|
$XXX.XX
|
J1
|
5491
|
| 65290 |
Repair of eye socket wound
|
$XXX.XX
|
J1
|
5504
|
| 65400 |
Removal of eye lesion
|
$XXX.XX
|
T
|
5502
|
| 65410 |
Biopsy of cornea
|
$XXX.XX
|
J1
|
5503
|
| 65420 |
Removal of eye lesion
|
$XXX.XX
|
J1
|
5503
|
| 65426 |
Removal of eye lesion
|
$XXX.XX
|
J1
|
5503
|
| 65430 |
Corneal smear
|
$XXX.XX
|
Q1
|
5735
|
| 65435 |
Curette/treat cornea
|
$XXX.XX
|
T
|
5502
|
| 65436 |
Curette/treat cornea
|
$XXX.XX
|
J1
|
5503
|
| 65450 |
Treatment of corneal lesion
|
$XXX.XX
|
T
|
5501
|
| 65600 |
Revision of cornea
|
$XXX.XX
|
J1
|
5503
|
| 65710 |
Corneal transplant
|
$XXX.XX
|
J1
|
5492
|
| 65730 |
Corneal transplant
|
$XXX.XX
|
J1
|
5492
|
| 65750 |
Corneal transplant
|
$XXX.XX
|
J1
|
5492
|
| 65755 |
Corneal transplant
|
$XXX.XX
|
J1
|
5492
|
| 65756 |
Corneal trnspl endothelial
|
$XXX.XX
|
J1
|
5492
|
| 65770 |
Revise cornea with implant
|
$XXX.XX
|
J1
|
5493
|
| 65772 |
Correction of astigmatism
|
$XXX.XX
|
T
|
5502
|
| 65775 |
Correction of astigmatism
|
$XXX.XX
|
J1
|
5503
|
| 65778 |
Cover eye w/membrane
|
$XXX.XX
|
Q2
|
5502
|
| 65779 |
Cover eye w/membrane suture
|
$XXX.XX
|
Q2
|
5504
|
| 65780 |
Ocular reconst transplant
|
$XXX.XX
|
J1
|
5504
|
| 65781 |
Ocular reconst transplant
|
$XXX.XX
|
J1
|
5492
|
| 65782 |
Ocular reconst transplant
|
$XXX.XX
|
J1
|
5504
|
| 65785 |
Impltj ntrstrml crnl rng seg
|
$XXX.XX
|
J1
|
5492
|
| 65800 |
Drainage of eye
|
$XXX.XX
|
J1
|
5491
|
| 65810 |
Drainage of eye
|
$XXX.XX
|
J1
|
5491
|
| 65815 |
Drainage of eye
|
$XXX.XX
|
J1
|
5491
|
| 65820 |
Relieve inner eye pressure
|
$XXX.XX
|
J1
|
5492
|
| 65850 |
Incision of eye
|
$XXX.XX
|
J1
|
5491
|
| 65855 |
Trabeculoplasty laser surg
|
$XXX.XX
|
T
|
5481
|
| 65860 |
Incise inner eye adhesions
|
$XXX.XX
|
T
|
5481
|
| 65865 |
Incise inner eye adhesions
|
$XXX.XX
|
J1
|
5491
|
| 65870 |
Incise inner eye adhesions
|
$XXX.XX
|
J1
|
5491
|
| 65875 |
Incise inner eye adhesions
|
$XXX.XX
|
J1
|
5491
|
| 65880 |
Incise inner eye adhesions
|
$XXX.XX
|
J1
|
5492
|
| 65900 |
Remove eye lesion
|
$XXX.XX
|
J1
|
5491
|
| 65920 |
Remove implant of eye
|
$XXX.XX
|
J1
|
5491
|
| 65930 |
Remove blood clot from eye
|
$XXX.XX
|
J1
|
5491
|
| 66020 |
Injection treatment of eye
|
$XXX.XX
|
J1
|
5491
|
| 66030 |
Injection treatment of eye
|
$XXX.XX
|
J1
|
5491
|
| 66130 |
Remove eye lesion
|
$XXX.XX
|
J1
|
5503
|
| 66150 |
Glaucoma surgery
|
$XXX.XX
|
J1
|
5492
|
| 66155 |
Glaucoma surgery
|
$XXX.XX
|
J1
|
5492
|
| 66160 |
Glaucoma surgery
|
$XXX.XX
|
J1
|
5491
|
| 66170 |
Glaucoma surgery
|
$XXX.XX
|
J1
|
5491
|
| 66172 |
Incision of eye
|
$XXX.XX
|
J1
|
5491
|
| 66174 |
Translum dil eye canal
|
$XXX.XX
|
J1
|
5492
|
| 66175 |
Trnslum dil eye canal w/stnt
|
$XXX.XX
|
J1
|
5492
|
| 66179 |
Aqueous shunt eye w/o graft
|
$XXX.XX
|
J1
|
5492
|
| 66180 |
Aqueous shunt eye w/graft
|
$XXX.XX
|
J1
|
5492
|
| 66183 |
Insert ant drainage device
|
$XXX.XX
|
J1
|
5492
|
| 66184 |
Revision of aqueous shunt
|
$XXX.XX
|
J1
|
5491
|
| 66185 |
Revise aqueous shunt eye
|
$XXX.XX
|
J1
|
5491
|
| 66225 |
Repair/graft eye lesion
|
$XXX.XX
|
J1
|
5492
|
| 66250 |
Follow-up surgery of eye
|
$XXX.XX
|
J1
|
5503
|
| 66500 |
Incision of iris
|
$XXX.XX
|
J1
|
5491
|
| 66505 |
Incision of iris
|
$XXX.XX
|
J1
|
5491
|
| 66600 |
Remove iris and lesion
|
$XXX.XX
|
J1
|
5492
|
| 66605 |
Removal of iris
|
$XXX.XX
|
J1
|
5491
|
| 66625 |
Removal of iris
|
$XXX.XX
|
J1
|
5491
|
| 66630 |
Removal of iris
|
$XXX.XX
|
J1
|
5491
|
| 66635 |
Removal of iris
|
$XXX.XX
|
J1
|
5491
|
| 66680 |
Repair iris & ciliary body
|
$XXX.XX
|
J1
|
5491
|
| 66682 |
Repair iris & ciliary body
|
$XXX.XX
|
J1
|
5491
|
| 66700 |
Destruction ciliary body
|
$XXX.XX
|
J1
|
5491
|
| 66710 |
Ciliary transsleral therapy
|
$XXX.XX
|
J1
|
5503
|
| 66711 |
Ecp ciliary body destruction
|
$XXX.XX
|
J1
|
5491
|
| 66720 |
Destruction ciliary body
|
$XXX.XX
|
J1
|
5503
|
| 66740 |
Destruction ciliary body
|
$XXX.XX
|
J1
|
5503
|
| 66761 |
Revision of iris
|
$XXX.XX
|
T
|
5481
|
| 66762 |
Revision of iris
|
$XXX.XX
|
T
|
5481
|
| 66770 |
Removal of inner eye lesion
|
$XXX.XX
|
T
|
5481
|
| 66820 |
Incision secondary cataract
|
$XXX.XX
|
J1
|
5491
|
| 66821 |
After cataract laser surgery
|
$XXX.XX
|
T
|
5481
|
| 66825 |
Reposition intraocular lens
|
$XXX.XX
|
J1
|
5491
|
| 66830 |
Removal of lens lesion
|
$XXX.XX
|
J1
|
5491
|
| 66840 |
Removal of lens material
|
$XXX.XX
|
J1
|
5491
|
| 66850 |
Removal of lens material
|
$XXX.XX
|
J1
|
5491
|
| 66852 |
Removal of lens material
|
$XXX.XX
|
J1
|
5492
|
| 66920 |
Extraction of lens
|
$XXX.XX
|
J1
|
5491
|
| 66930 |
Extraction of lens
|
$XXX.XX
|
J1
|
5492
|
| 66940 |
Extraction of lens
|
$XXX.XX
|
J1
|
5491
|
| 66982 |
Xcapsl ctrc rmvl cplx wo ecp
|
$XXX.XX
|
J1
|
5491
|
| 66983 |
Cataract surg w/iol 1 stage
|
$XXX.XX
|
J1
|
5491
|
| 66984 |
Xcapsl ctrc rmvl w/o ecp
|
$XXX.XX
|
J1
|
5491
|
| 66985 |
Insert lens prosthesis
|
$XXX.XX
|
J1
|
5491
|
| 66986 |
Exchange lens prosthesis
|
$XXX.XX
|
J1
|
5491
|
| 66987 |
Xcapsl ctrc rmvl cplx w/ecp
|
$XXX.XX
|
J1
|
5492
|
| 66988 |
Xcapsl ctrc rmvl w/ecp
|
$XXX.XX
|
J1
|
5492
|
| 66999 |
Eye surgery procedure
|
$XXX.XX
|
J1
|
5491
|
| 67005 |
Partial removal of eye fluid
|
$XXX.XX
|
J1
|
5491
|
| 67010 |
Partial removal of eye fluid
|
$XXX.XX
|
J1
|
5491
|
| 67015 |
Release of eye fluid
|
$XXX.XX
|
J1
|
5491
|
| 67025 |
Replace eye fluid
|
$XXX.XX
|
J1
|
5491
|
| 67027 |
Implant eye drug system
|
$XXX.XX
|
J1
|
5494
|
| 67028 |
Injection eye drug
|
$XXX.XX
|
S
|
5694
|
| 67030 |
Incise inner eye strands
|
$XXX.XX
|
J1
|
5491
|
| 67031 |
Laser surgery eye strands
|
$XXX.XX
|
T
|
5481
|
| 67036 |
Removal of inner eye fluid
|
$XXX.XX
|
J1
|
5492
|
| 67039 |
Laser treatment of retina
|
$XXX.XX
|
J1
|
5492
|
| 67040 |
Laser treatment of retina
|
$XXX.XX
|
J1
|
5492
|
| 67041 |
Vit for macular pucker
|
$XXX.XX
|
J1
|
5492
|
| 67042 |
Vit for macular hole
|
$XXX.XX
|
J1
|
5492
|
| 67043 |
Vit for membrane dissect
|
$XXX.XX
|
J1
|
5492
|
| 67101 |
Repair detached retina crtx
|
$XXX.XX
|
J1
|
5491
|
| 67105 |
Repair detached retina pc
|
$XXX.XX
|
T
|
5481
|
| 67107 |
Repair detached retina
|
$XXX.XX
|
J1
|
5492
|
| 67108 |
Repair detached retina
|
$XXX.XX
|
J1
|
5492
|
| 67110 |
Repair detached retina
|
$XXX.XX
|
J1
|
5491
|
| 67113 |
Repair retinal detach cplx
|
$XXX.XX
|
J1
|
5492
|
| 67115 |
Release encircling material
|
$XXX.XX
|
J1
|
5492
|
| 67120 |
Remove eye implant material
|
$XXX.XX
|
J1
|
5491
|
| 67121 |
Remove eye implant material
|
$XXX.XX
|
J1
|
5491
|
| 67141 |
Treatment of retina
|
$XXX.XX
|
T
|
5501
|
| 67145 |
Treatment of retina
|
$XXX.XX
|
T
|
5481
|
| 67208 |
Treatment of retinal lesion
|
$XXX.XX
|
T
|
5501
|
| 67210 |
Treatment of retinal lesion
|
$XXX.XX
|
T
|
5481
|
| 67218 |
Treatment of retinal lesion
|
$XXX.XX
|
J1
|
5504
|
| 67220 |
Treatment of choroid lesion
|
$XXX.XX
|
T
|
5481
|
| 67221 |
Ocular photodynamic ther
|
$XXX.XX
|
T
|
5481
|
| 67227 |
Dstrj extensive retinopathy
|
$XXX.XX
|
J1
|
5504
|
| 67228 |
Treatment x10sv retinopathy
|
$XXX.XX
|
T
|
5481
|
| 67229 |
Tr retinal les preterm inf
|
$XXX.XX
|
T
|
5481
|
| 67250 |
Reinforce eye wall
|
$XXX.XX
|
J1
|
5503
|
| 67255 |
Reinforce/graft eye wall
|
$XXX.XX
|
J1
|
5491
|
| 67299 |
Eye surgery procedure
|
$XXX.XX
|
J1
|
5491
|
| 67311 |
Revise eye muscle
|
$XXX.XX
|
J1
|
5503
|
| 67312 |
Revise two eye muscles
|
$XXX.XX
|
J1
|
5504
|
| 67314 |
Revise eye muscle
|
$XXX.XX
|
J1
|
5503
|
| 67316 |
Revise two eye muscles
|
$XXX.XX
|
J1
|
5503
|
| 67318 |
Revise eye muscle(s)
|
$XXX.XX
|
J1
|
5503
|
| 67343 |
Release eye tissue
|
$XXX.XX
|
J1
|
5503
|
| 67345 |
Destroy nerve of eye muscle
|
$XXX.XX
|
T
|
5501
|
| 67346 |
Biopsy eye muscle
|
$XXX.XX
|
J1
|
5504
|
| 67399 |
Unlisted px extraocular musc
|
$XXX.XX
|
T
|
5501
|
| 67400 |
Explore/biopsy eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67405 |
Explore/drain eye socket
|
$XXX.XX
|
J1
|
5503
|
| 67412 |
Explore/treat eye socket
|
$XXX.XX
|
J1
|
5503
|
| 67413 |
Explore/treat eye socket
|
$XXX.XX
|
J1
|
5503
|
| 67414 |
Explr/decompress eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67415 |
Aspiration orbital contents
|
$XXX.XX
|
J1
|
5503
|
| 67420 |
Explore/treat eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67430 |
Explore/treat eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67440 |
Explore/drain eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67445 |
Explr/decompress eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67450 |
Explore/biopsy eye socket
|
$XXX.XX
|
J1
|
5504
|
| 67500 |
Inject/treat eye socket
|
$XXX.XX
|
T
|
5501
|
| 67505 |
Inject/treat eye socket
|
$XXX.XX
|
T
|
5501
|
| 67515 |
Inject/treat eye socket
|
$XXX.XX
|
T
|
5501
|
| 67550 |
Insert eye socket implant
|
$XXX.XX
|
J1
|
5504
|
| 67560 |
Revise eye socket implant
|
$XXX.XX
|
J1
|
5504
|
| 67570 |
Decompress optic nerve
|
$XXX.XX
|
J1
|
5504
|
| 67599 |
Orbit surgery procedure
|
$XXX.XX
|
T
|
5501
|
| 67700 |
Drainage of eyelid abscess
|
$XXX.XX
|
T
|
5501
|
| 67710 |
Incision of eyelid
|
$XXX.XX
|
T
|
5502
|
| 67715 |
Incision of eyelid fold
|
$XXX.XX
|
J1
|
5503
|
| 67800 |
Remove eyelid lesion
|
$XXX.XX
|
T
|
5501
|
| 67801 |
Remove eyelid lesions
|
$XXX.XX
|
T
|
5502
|
| 67805 |
Remove eyelid lesions
|
$XXX.XX
|
T
|
5501
|
| 67808 |
Remove eyelid lesion(s)
|
$XXX.XX
|
J1
|
5503
|
| 67810 |
Biopsy eyelid & lid margin
|
$XXX.XX
|
T
|
5501
|
| 67820 |
Revise eyelashes
|
$XXX.XX
|
Q1
|
5734
|
| 67825 |
Revise eyelashes
|
$XXX.XX
|
T
|
5501
|
| 67830 |
Revise eyelashes
|
$XXX.XX
|
T
|
5502
|
| 67835 |
Revise eyelashes
|
$XXX.XX
|
J1
|
5503
|
| 67840 |
Remove eyelid lesion
|
$XXX.XX
|
T
|
5502
|
| 67850 |
Treat eyelid lesion
|
$XXX.XX
|
T
|
5502
|
| 67875 |
Closure of eyelid by suture
|
$XXX.XX
|
T
|
5502
|
| 67880 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67882 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67900 |
Repair brow defect
|
$XXX.XX
|
J1
|
5503
|
| 67901 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67902 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5504
|
| 67903 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67904 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67906 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5504
|
| 67908 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67909 |
Revise eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67911 |
Revise eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67912 |
Correction eyelid w/implant
|
$XXX.XX
|
J1
|
5503
|
| 67914 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67915 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67916 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67917 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67921 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67922 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67923 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67924 |
Repair eyelid defect
|
$XXX.XX
|
J1
|
5503
|
| 67930 |
Repair eyelid wound
|
$XXX.XX
|
J1
|
5503
|
| 67935 |
Repair eyelid wound
|
$XXX.XX
|
J1
|
5503
|
| 67938 |
Remove eyelid foreign body
|
$XXX.XX
|
T
|
5501
|
| 67950 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67961 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67966 |
Revision of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67971 |
Reconstruction of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67973 |
Reconstruction of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67974 |
Reconstruction of eyelid
|
$XXX.XX
|
J1
|
5504
|
| 67975 |
Reconstruction of eyelid
|
$XXX.XX
|
J1
|
5503
|
| 67999 |
Revision of eyelid
|
$XXX.XX
|
T
|
5501
|
| 68020 |
Incise/drain eyelid lining
|
$XXX.XX
|
T
|
5502
|
| 68040 |
Treatment of eyelid lesions
|
$XXX.XX
|
T
|
5501
|
| 68100 |
Biopsy of eyelid lining
|
$XXX.XX
|
J1
|
5503
|
| 68110 |
Remove eyelid lining lesion
|
$XXX.XX
|
J1
|
5503
|
| 68115 |
Remove eyelid lining lesion
|
$XXX.XX
|
J1
|
5503
|
| 68130 |
Remove eyelid lining lesion
|
$XXX.XX
|
J1
|
5503
|
| 68135 |
Remove eyelid lining lesion
|
$XXX.XX
|
J1
|
5503
|
| 68200 |
Treat eyelid by injection
|
$XXX.XX
|
Q1
|
5734
|
| 68320 |
Revise/graft eyelid lining
|
$XXX.XX
|
J1
|
5503
|
| 68325 |
Revise/graft eyelid lining
|
$XXX.XX
|
J1
|
5504
|
| 68326 |
Revise/graft eyelid lining
|
$XXX.XX
|
J1
|
5504
|
| 68328 |
Revise/graft eyelid lining
|
$XXX.XX
|
J1
|
5503
|
| 68330 |
Revise eyelid lining
|
$XXX.XX
|
J1
|
5491
|
| 68335 |
Revise/graft eyelid lining
|
$XXX.XX
|
J1
|
5504
|
| 68340 |
Separate eyelid adhesions
|
$XXX.XX
|
J1
|
5503
|
| 68360 |
Revise eyelid lining
|
$XXX.XX
|
J1
|
5504
|
| 68362 |
Revise eyelid lining
|
$XXX.XX
|
J1
|
5503
|
| 68371 |
Harvest eye tissue alograft
|
$XXX.XX
|
J1
|
5503
|
| 68399 |
Eyelid lining surgery
|
$XXX.XX
|
T
|
5501
|
| 68400 |
Incise/drain tear gland
|
$XXX.XX
|
T
|
5502
|
| 68420 |
Incise/drain tear sac
|
$XXX.XX
|
J1
|
5503
|
| 68440 |
Incise tear duct opening
|
$XXX.XX
|
T
|
5501
|
| 68500 |
Removal of tear gland
|
$XXX.XX
|
J1
|
5504
|
| 68505 |
Partial removal tear gland
|
$XXX.XX
|
J1
|
5504
|
| 68510 |
Biopsy of tear gland
|
$XXX.XX
|
J1
|
5503
|
| 68520 |
Removal of tear sac
|
$XXX.XX
|
J1
|
5504
|
| 68525 |
Biopsy of tear sac
|
$XXX.XX
|
J1
|
5503
|
| 68530 |
Clearance of tear duct
|
$XXX.XX
|
T
|
5501
|
| 68540 |
Remove tear gland lesion
|
$XXX.XX
|
J1
|
5503
|
| 68550 |
Remove tear gland lesion
|
$XXX.XX
|
J1
|
5504
|
| 68700 |
Repair tear ducts
|
$XXX.XX
|
J1
|
5503
|
| 68705 |
Revise tear duct opening
|
$XXX.XX
|
T
|
5501
|
| 68720 |
Create tear sac drain
|
$XXX.XX
|
J1
|
5504
|
| 68745 |
Create tear duct drain
|
$XXX.XX
|
J1
|
5504
|
| 68750 |
Create tear duct drain
|
$XXX.XX
|
J1
|
5504
|
| 68760 |
Close tear duct opening
|
$XXX.XX
|
T
|
5501
|
| 68761 |
Close tear duct opening
|
$XXX.XX
|
T
|
5501
|
| 68770 |
Close tear system fistula
|
$XXX.XX
|
J1
|
5503
|
| 68801 |
Dilate tear duct opening
|
$XXX.XX
|
Q1
|
5735
|
| 68810 |
Probe nasolacrimal duct
|
$XXX.XX
|
T
|
5501
|
| 68811 |
Probe nasolacrimal duct
|
$XXX.XX
|
J1
|
5503
|
| 68815 |
Probe nasolacrimal duct
|
$XXX.XX
|
J1
|
5503
|
| 68816 |
Probe nl duct w/balloon
|
$XXX.XX
|
J1
|
5503
|
| 68840 |
Explore/irrigate tear ducts
|
$XXX.XX
|
T
|
5501
|
| 68899 |
Tear duct system surgery
|
$XXX.XX
|
T
|
5501
|
| 69000 |
Drain external ear lesion
|
$XXX.XX
|
T
|
5071
|
| 69005 |
Drain external ear lesion
|
$XXX.XX
|
J1
|
5072
|
| 69020 |
Drain outer ear canal lesion
|
$XXX.XX
|
T
|
5071
|
| 69100 |
Biopsy of external ear
|
$XXX.XX
|
T
|
5161
|
| 69105 |
Biopsy of external ear canal
|
$XXX.XX
|
J1
|
5163
|
| 69110 |
Remove external ear partial
|
$XXX.XX
|
J1
|
5073
|
| 69120 |
Removal of external ear
|
$XXX.XX
|
J1
|
5165
|
| 69140 |
Remove ear canal lesion(s)
|
$XXX.XX
|
J1
|
5165
|
| 69145 |
Remove ear canal lesion(s)
|
$XXX.XX
|
J1
|
5073
|
| 69150 |
Extensive ear canal surgery
|
$XXX.XX
|
J1
|
5165
|
| 69200 |
Clear outer ear canal
|
$XXX.XX
|
Q1
|
5734
|
| 69205 |
Clear outer ear canal
|
$XXX.XX
|
J1
|
5072
|
| 69209 |
Remove impacted ear wax uni
|
$XXX.XX
|
Q1
|
5733
|
| 69210 |
Remove impacted ear wax uni
|
$XXX.XX
|
Q1
|
5733
|
| 69220 |
Clean out mastoid cavity
|
$XXX.XX
|
Q1
|
5051
|
| 69222 |
Clean out mastoid cavity
|
$XXX.XX
|
T
|
5162
|
| 69300 |
Revise external ear
|
$XXX.XX
|
J1
|
5164
|
| 69310 |
Rebuild outer ear canal
|
$XXX.XX
|
J1
|
5165
|
| 69320 |
Rebuild outer ear canal
|
$XXX.XX
|
J1
|
5165
|
| 69399 |
Outer ear surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 69420 |
Incision of eardrum
|
$XXX.XX
|
T
|
5161
|
| 69421 |
Incision of eardrum
|
$XXX.XX
|
J1
|
5164
|
| 69424 |
Remove ventilating tube
|
$XXX.XX
|
Q2
|
5164
|
| 69433 |
Create eardrum opening
|
$XXX.XX
|
T
|
5162
|
| 69436 |
Create eardrum opening
|
$XXX.XX
|
J1
|
5163
|
| 69440 |
Exploration of middle ear
|
$XXX.XX
|
J1
|
5164
|
| 69450 |
Eardrum revision
|
$XXX.XX
|
J1
|
5164
|
| 69501 |
Mastoidectomy
|
$XXX.XX
|
J1
|
5165
|
| 69502 |
Mastoidectomy
|
$XXX.XX
|
J1
|
5165
|
| 69505 |
Remove mastoid structures
|
$XXX.XX
|
J1
|
5165
|
| 69511 |
Extensive mastoid surgery
|
$XXX.XX
|
J1
|
5165
|
| 69530 |
Extensive mastoid surgery
|
$XXX.XX
|
J1
|
5165
|
| 69540 |
Remove ear lesion
|
$XXX.XX
|
J1
|
5163
|
| 69550 |
Remove ear lesion
|
$XXX.XX
|
J1
|
5165
|
| 69552 |
Remove ear lesion
|
$XXX.XX
|
J1
|
5165
|
| 69601 |
Mastoid surgery revision
|
$XXX.XX
|
J1
|
5165
|
| 69602 |
Mastoid surgery revision
|
$XXX.XX
|
J1
|
5165
|
| 69603 |
Mastoid surgery revision
|
$XXX.XX
|
J1
|
5165
|
| 69604 |
Mastoid surgery revision
|
$XXX.XX
|
J1
|
5165
|
| 69605 |
Mastoid surgery revision
|
$XXX.XX
|
J1
|
5165
|
| 69610 |
Repair of eardrum
|
$XXX.XX
|
J1
|
5163
|
| 69620 |
Repair of eardrum
|
$XXX.XX
|
J1
|
5164
|
| 69631 |
Repair eardrum structures
|
$XXX.XX
|
J1
|
5165
|
| 69632 |
Rebuild eardrum structures
|
$XXX.XX
|
J1
|
5165
|
| 69633 |
Rebuild eardrum structures
|
$XXX.XX
|
J1
|
5165
|
| 69635 |
Repair eardrum structures
|
$XXX.XX
|
J1
|
5165
|
| 69636 |
Rebuild eardrum structures
|
$XXX.XX
|
J1
|
5165
|
| 69637 |
Rebuild eardrum structures
|
$XXX.XX
|
J1
|
5165
|
| 69641 |
Revise middle ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69642 |
Revise middle ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69643 |
Revise middle ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69644 |
Revise middle ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69645 |
Revise middle ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69646 |
Revise middle ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69650 |
Release middle ear bone
|
$XXX.XX
|
J1
|
5164
|
| 69660 |
Revise middle ear bone
|
$XXX.XX
|
J1
|
5165
|
| 69661 |
Revise middle ear bone
|
$XXX.XX
|
J1
|
5165
|
| 69662 |
Revise middle ear bone
|
$XXX.XX
|
J1
|
5165
|
| 69666 |
Repair middle ear structures
|
$XXX.XX
|
J1
|
5164
|
| 69667 |
Repair middle ear structures
|
$XXX.XX
|
J1
|
5164
|
| 69670 |
Remove mastoid air cells
|
$XXX.XX
|
J1
|
5165
|
| 69676 |
Remove middle ear nerve
|
$XXX.XX
|
J1
|
5164
|
| 69700 |
Close mastoid fistula
|
$XXX.XX
|
J1
|
5163
|
| 69711 |
Remove/repair hearing aid
|
$XXX.XX
|
J1
|
5164
|
| 69714 |
Implant temple bone w/stimul
|
$XXX.XX
|
J1
|
5115
|
| 69715 |
Temple bne implnt w/stimulat
|
$XXX.XX
|
J1
|
5116
|
| 69717 |
Temple bone implant revision
|
$XXX.XX
|
J1
|
5114
|
| 69718 |
Revise temple bone implant
|
$XXX.XX
|
J1
|
5115
|
| 69720 |
Release facial nerve
|
$XXX.XX
|
J1
|
5165
|
| 69725 |
Release facial nerve
|
$XXX.XX
|
J1
|
5165
|
| 69740 |
Repair facial nerve
|
$XXX.XX
|
J1
|
5165
|
| 69745 |
Repair facial nerve
|
$XXX.XX
|
J1
|
5165
|
| 69799 |
Middle ear surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 69801 |
Incise inner ear
|
$XXX.XX
|
J1
|
5163
|
| 69805 |
Explore inner ear
|
$XXX.XX
|
J1
|
5165
|
| 69806 |
Explore inner ear
|
$XXX.XX
|
J1
|
5165
|
| 69905 |
Remove inner ear
|
$XXX.XX
|
J1
|
5165
|
| 69910 |
Remove inner ear & mastoid
|
$XXX.XX
|
J1
|
5165
|
| 69915 |
Incise inner ear nerve
|
$XXX.XX
|
J1
|
5164
|
| 69930 |
Implant cochlear device
|
$XXX.XX
|
J1
|
5166
|
| 69949 |
Inner ear surgery procedure
|
$XXX.XX
|
T
|
5161
|
| 69955 |
Release facial nerve
|
$XXX.XX
|
J1
|
5165
|
| 69960 |
Release inner ear canal
|
$XXX.XX
|
J1
|
5165
|
| 69970 |
Remove inner ear lesion
|
$XXX.XX
|
J1
|
5165
|
| 69979 |
Temporal bone surgery
|
$XXX.XX
|
T
|
5161
|
| 70010 |
Contrast x-ray of brain
|
$XXX.XX
|
Q2
|
5572
|
| 70015 |
Contrast x-ray of brain
|
$XXX.XX
|
Q2
|
5573
|
| 70030 |
X-ray eye for foreign body
|
$XXX.XX
|
Q1
|
5521
|
| 70100 |
X-ray exam of jaw <4views
|
$XXX.XX
|
Q1
|
5521
|
| 70110 |
X-ray exam of jaw 4/> views
|
$XXX.XX
|
Q1
|
5522
|
| 70120 |
X-ray exam of mastoids
|
$XXX.XX
|
Q1
|
5522
|
| 70130 |
X-ray exam of mastoids
|
$XXX.XX
|
Q1
|
5522
|
| 70134 |
X-ray exam of middle ear
|
$XXX.XX
|
Q1
|
5524
|
| 70140 |
X-ray exam of facial bones
|
$XXX.XX
|
Q1
|
5521
|
| 70150 |
X-ray exam of facial bones
|
$XXX.XX
|
Q1
|
5522
|
| 70160 |
X-ray exam of nasal bones
|
$XXX.XX
|
Q1
|
5521
|
| 70170 |
X-ray exam of tear duct
|
$XXX.XX
|
Q2
|
5523
|
| 70190 |
X-ray exam of eye sockets
|
$XXX.XX
|
Q1
|
5521
|
| 70200 |
X-ray exam of eye sockets
|
$XXX.XX
|
Q1
|
5522
|
| 70210 |
X-ray exam of sinuses
|
$XXX.XX
|
Q1
|
5521
|
| 70220 |
X-ray exam of sinuses
|
$XXX.XX
|
Q1
|
5521
|
| 70240 |
X-ray exam pituitary saddle
|
$XXX.XX
|
Q1
|
5521
|
| 70250 |
X-ray exam of skull
|
$XXX.XX
|
Q1
|
5522
|
| 70260 |
X-ray exam of skull
|
$XXX.XX
|
Q1
|
5522
|
| 70300 |
X-ray exam of teeth
|
$XXX.XX
|
Q1
|
5521
|
| 70310 |
X-ray exam of teeth
|
$XXX.XX
|
Q1
|
5523
|
| 70320 |
Full mouth x-ray of teeth
|
$XXX.XX
|
Q1
|
5523
|
| 70328 |
X-ray exam of jaw joint
|
$XXX.XX
|
Q1
|
5521
|
| 70330 |
X-ray exam of jaw joints
|
$XXX.XX
|
Q1
|
5521
|
| 70332 |
X-ray exam of jaw joint
|
$XXX.XX
|
Q2
|
5523
|
| 70336 |
Magnetic image jaw joint
|
$XXX.XX
|
Q3
|
5523
|
| 70350 |
X-ray head for orthodontia
|
$XXX.XX
|
Q1
|
5521
|
| 70355 |
Panoramic x-ray of jaws
|
$XXX.XX
|
Q1
|
5521
|
| 70360 |
X-ray exam of neck
|
$XXX.XX
|
Q1
|
5521
|
| 70370 |
Throat x-ray & fluoroscopy
|
$XXX.XX
|
Q1
|
5521
|
| 70371 |
Speech evaluation complex
|
$XXX.XX
|
Q1
|
5523
|
| 70380 |
X-ray exam of salivary gland
|
$XXX.XX
|
Q1
|
5521
|
| 70390 |
X-ray exam of salivary duct
|
$XXX.XX
|
Q2
|
5523
|
| 70450 |
Ct head/brain w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 70460 |
Ct head/brain w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70470 |
Ct head/brain w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70480 |
Ct orbit/ear/fossa w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 70481 |
Ct orbit/ear/fossa w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70482 |
Ct orbit/ear/fossa w/o&w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70486 |
Ct maxillofacial w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 70487 |
Ct maxillofacial w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70488 |
Ct maxillofacial w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70490 |
Ct soft tissue neck w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 70491 |
Ct soft tissue neck w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70492 |
Ct sft tsue nck w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 70496 |
Ct angiography head
|
$XXX.XX
|
Q3
|
5571
|
| 70498 |
Ct angiography neck
|
$XXX.XX
|
Q3
|
5571
|
| 70540 |
Mri orbit/face/neck w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 70542 |
Mri orbit/face/neck w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70543 |
Mri orbt/fac/nck w/o &w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70544 |
Mr angiography head w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 70545 |
Mr angiography head w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70546 |
Mr angiograph head w/o&w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70547 |
Mr angiography neck w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 70548 |
Mr angiography neck w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70549 |
Mr angiograph neck w/o&w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70551 |
Mri brain stem w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 70552 |
Mri brain stem w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70553 |
Mri brain stem w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 70554 |
Fmri brain by tech
|
$XXX.XX
|
Q3
|
5523
|
| 70555 |
Fmri brain by phys/psych
|
$XXX.XX
|
S
|
5523
|
| 70557 |
Mri brain w/o dye
|
$XXX.XX
|
S
|
5524
|
| 70558 |
Mri brain w/dye
|
$XXX.XX
|
S
|
5571
|
| 70559 |
Mri brain w/o & w/dye
|
$XXX.XX
|
S
|
5571
|
| 71045 |
X-ray exam chest 1 view
|
$XXX.XX
|
Q3
|
5521
|
| 71046 |
X-ray exam chest 2 views
|
$XXX.XX
|
Q3
|
5521
|
| 71047 |
X-ray exam chest 3 views
|
$XXX.XX
|
Q1
|
5521
|
| 71048 |
X-ray exam chest 4+ views
|
$XXX.XX
|
Q1
|
5522
|
| 71100 |
X-ray exam ribs uni 2 views
|
$XXX.XX
|
Q1
|
5521
|
| 71101 |
X-ray exam unilat ribs/chest
|
$XXX.XX
|
Q1
|
5522
|
| 71110 |
X-ray exam ribs bil 3 views
|
$XXX.XX
|
Q1
|
5522
|
| 71111 |
X-ray exam ribs/chest4/> vws
|
$XXX.XX
|
Q1
|
5522
|
| 71120 |
X-ray exam breastbone 2/>vws
|
$XXX.XX
|
Q1
|
5521
|
| 71130 |
X-ray strenoclavic jt 3/>vws
|
$XXX.XX
|
Q1
|
5521
|
| 71250 |
Ct thorax w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 71260 |
Ct thorax w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 71270 |
Ct thorax w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 71275 |
Ct angiography chest
|
$XXX.XX
|
Q3
|
5571
|
| 71550 |
Mri chest w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 71551 |
Mri chest w/dye
|
$XXX.XX
|
Q3
|
5573
|
| 71552 |
Mri chest w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72020 |
X-ray exam of spine 1 view
|
$XXX.XX
|
Q1
|
5521
|
| 72040 |
X-ray exam neck spine 2-3 vw
|
$XXX.XX
|
Q1
|
5521
|
| 72050 |
X-ray exam neck spine 4/5vws
|
$XXX.XX
|
Q1
|
5522
|
| 72052 |
X-ray exam neck spine 6/>vws
|
$XXX.XX
|
Q1
|
5522
|
| 72070 |
X-ray exam thorac spine 2vws
|
$XXX.XX
|
Q1
|
5522
|
| 72072 |
X-ray exam thorac spine 3vws
|
$XXX.XX
|
Q1
|
5522
|
| 72074 |
X-ray exam thorac spine4/>vw
|
$XXX.XX
|
Q1
|
5522
|
| 72080 |
X-ray exam thoracolmb 2/> vw
|
$XXX.XX
|
Q1
|
5521
|
| 72081 |
X-ray exam entire spi 1 vw
|
$XXX.XX
|
Q1
|
5521
|
| 72082 |
X-ray exam entire spi 2/3 vw
|
$XXX.XX
|
Q1
|
5522
|
| 72083 |
X-ray exam entire spi 4/5 vw
|
$XXX.XX
|
S
|
5522
|
| 72084 |
X-ray exam entire spi 6/> vw
|
$XXX.XX
|
S
|
5522
|
| 72100 |
X-ray exam l-s spine 2/3 vws
|
$XXX.XX
|
Q1
|
5522
|
| 72110 |
X-ray exam l-2 spine 4/>vws
|
$XXX.XX
|
Q1
|
5522
|
| 72114 |
X-ray exam l-s spine bending
|
$XXX.XX
|
Q1
|
5522
|
| 72120 |
X-ray bend only l-s spine
|
$XXX.XX
|
Q1
|
5522
|
| 72125 |
Ct neck spine w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 72126 |
Ct neck spine w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72127 |
Ct neck spine w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72128 |
Ct chest spine w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 72129 |
Ct chest spine w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72130 |
Ct chest spine w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72131 |
Ct lumbar spine w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 72132 |
Ct lumbar spine w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72133 |
Ct lumbar spine w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72141 |
Mri neck spine w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 72142 |
Mri neck spine w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72146 |
Mri chest spine w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 72147 |
Mri chest spine w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72148 |
Mri lumbar spine w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 72149 |
Mri lumbar spine w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72156 |
Mri neck spine w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72157 |
Mri chest spine w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72158 |
Mri lumbar spine w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72170 |
X-ray exam of pelvis
|
$XXX.XX
|
Q1
|
5522
|
| 72190 |
X-ray exam of pelvis
|
$XXX.XX
|
Q1
|
5522
|
| 72191 |
Ct angiograph pelv w/o&w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72192 |
Ct pelvis w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 72193 |
Ct pelvis w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72194 |
Ct pelvis w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 72195 |
Mri pelvis w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 72196 |
Mri pelvis w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72197 |
Mri pelvis w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 72200 |
X-ray exam si joints
|
$XXX.XX
|
Q1
|
5522
|
| 72202 |
X-ray exam si joints 3/> vws
|
$XXX.XX
|
Q1
|
5522
|
| 72220 |
X-ray exam sacrum tailbone
|
$XXX.XX
|
Q1
|
5521
|
| 72240 |
Myelography neck spine
|
$XXX.XX
|
Q2
|
5573
|
| 72255 |
Myelography thoracic spine
|
$XXX.XX
|
Q2
|
5573
|
| 72265 |
Myelography l-s spine
|
$XXX.XX
|
Q2
|
5573
|
| 72270 |
Myelogphy 2/> spine regions
|
$XXX.XX
|
Q2
|
5573
|
| 72285 |
Discography cerv/thor spine
|
$XXX.XX
|
Q2
|
5431
|
| 72295 |
X-ray of lower spine disk
|
$XXX.XX
|
Q2
|
5431
|
| 73000 |
X-ray exam of collar bone
|
$XXX.XX
|
Q1
|
5521
|
| 73010 |
X-ray exam of shoulder blade
|
$XXX.XX
|
Q1
|
5522
|
| 73020 |
X-ray exam of shoulder
|
$XXX.XX
|
Q1
|
5521
|
| 73030 |
X-ray exam of shoulder
|
$XXX.XX
|
Q1
|
5521
|
| 73040 |
Contrast x-ray of shoulder
|
$XXX.XX
|
Q2
|
5572
|
| 73050 |
X-ray exam of shoulders
|
$XXX.XX
|
Q1
|
5521
|
| 73060 |
X-ray exam of humerus
|
$XXX.XX
|
Q1
|
5521
|
| 73070 |
X-ray exam of elbow
|
$XXX.XX
|
Q1
|
5521
|
| 73080 |
X-ray exam of elbow
|
$XXX.XX
|
Q1
|
5521
|
| 73085 |
Contrast x-ray of elbow
|
$XXX.XX
|
Q2
|
5572
|
| 73090 |
X-ray exam of forearm
|
$XXX.XX
|
Q1
|
5521
|
| 73092 |
X-ray exam of arm infant
|
$XXX.XX
|
Q1
|
5522
|
| 73100 |
X-ray exam of wrist
|
$XXX.XX
|
Q1
|
5521
|
| 73110 |
X-ray exam of wrist
|
$XXX.XX
|
Q1
|
5521
|
| 73115 |
Contrast x-ray of wrist
|
$XXX.XX
|
Q2
|
5572
|
| 73120 |
X-ray exam of hand
|
$XXX.XX
|
Q1
|
5522
|
| 73130 |
X-ray exam of hand
|
$XXX.XX
|
Q1
|
5521
|
| 73140 |
X-ray exam of finger(s)
|
$XXX.XX
|
Q1
|
5521
|
| 73200 |
Ct upper extremity w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 73201 |
Ct upper extremity w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 73202 |
Ct uppr extremity w/o&w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 73206 |
Ct angio upr extrm w/o&w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 73218 |
Mri upper extremity w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 73219 |
Mri upper extremity w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 73220 |
Mri uppr extremity w/o&w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 73221 |
Mri joint upr extrem w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 73222 |
Mri joint upr extrem w/dye
|
$XXX.XX
|
Q3
|
5573
|
| 73223 |
Mri joint upr extr w/o&w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 73501 |
X-ray exam hip uni 1 view
|
$XXX.XX
|
Q1
|
5521
|
| 73502 |
X-ray exam hip uni 2-3 views
|
$XXX.XX
|
Q1
|
5521
|
| 73503 |
X-ray exam hip uni 4/> views
|
$XXX.XX
|
Q1
|
5522
|
| 73521 |
X-ray exam hips bi 2 views
|
$XXX.XX
|
Q1
|
5522
|
| 73522 |
X-ray exam hips bi 3-4 views
|
$XXX.XX
|
Q1
|
5522
|
| 73523 |
X-ray exam hips bi 5/> views
|
$XXX.XX
|
S
|
5522
|
| 73525 |
Contrast x-ray of hip
|
$XXX.XX
|
Q2
|
5572
|
| 73551 |
X-ray exam of femur 1
|
$XXX.XX
|
Q1
|
5521
|
| 73552 |
X-ray exam of femur 2/>
|
$XXX.XX
|
Q1
|
5521
|
| 73560 |
X-ray exam of knee 1 or 2
|
$XXX.XX
|
Q1
|
5521
|
| 73562 |
X-ray exam of knee 3
|
$XXX.XX
|
Q1
|
5521
|
| 73564 |
X-ray exam knee 4 or more
|
$XXX.XX
|
Q1
|
5522
|
| 73565 |
X-ray exam of knees
|
$XXX.XX
|
Q1
|
5521
|
| 73580 |
Contrast x-ray of knee joint
|
$XXX.XX
|
Q2
|
5572
|
| 73590 |
X-ray exam of lower leg
|
$XXX.XX
|
Q1
|
5521
|
| 73592 |
X-ray exam of leg infant
|
$XXX.XX
|
Q1
|
5521
|
| 73600 |
X-ray exam of ankle
|
$XXX.XX
|
Q1
|
5521
|
| 73610 |
X-ray exam of ankle
|
$XXX.XX
|
Q1
|
5521
|
| 73615 |
Contrast x-ray of ankle
|
$XXX.XX
|
Q2
|
5572
|
| 73620 |
X-ray exam of foot
|
$XXX.XX
|
Q1
|
5521
|
| 73630 |
X-ray exam of foot
|
$XXX.XX
|
Q1
|
5521
|
| 73650 |
X-ray exam of heel
|
$XXX.XX
|
Q1
|
5521
|
| 73660 |
X-ray exam of toe(s)
|
$XXX.XX
|
Q1
|
5521
|
| 73700 |
Ct lower extremity w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 73701 |
Ct lower extremity w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 73702 |
Ct lwr extremity w/o&w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 73706 |
Ct angio lwr extr w/o&w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 73718 |
Mri lower extremity w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 73719 |
Mri lower extremity w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 73720 |
Mri lwr extremity w/o&w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 73721 |
Mri jnt of lwr extre w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 73722 |
Mri joint of lwr extr w/dye
|
$XXX.XX
|
Q3
|
5573
|
| 73723 |
Mri joint lwr extr w/o&w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 74018 |
X-ray exam abdomen 1 view
|
$XXX.XX
|
Q1
|
5521
|
| 74019 |
X-ray exam abdomen 2 views
|
$XXX.XX
|
Q1
|
5522
|
| 74021 |
X-ray exam abdomen 3+ views
|
$XXX.XX
|
Q1
|
5522
|
| 74022 |
X-ray exam complete abdomen
|
$XXX.XX
|
Q1
|
5522
|
| 74150 |
Ct abdomen w/o dye
|
$XXX.XX
|
Q3
|
5522
|
| 74160 |
Ct abdomen w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 74170 |
Ct abdomen w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 74174 |
Ct angio abd&pelv w/o&w/dye
|
$XXX.XX
|
S
|
5572
|
| 74175 |
Ct angio abdom w/o & w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 74176 |
Ct abd & pelvis w/o contrast
|
$XXX.XX
|
Q3
|
5523
|
| 74177 |
Ct abd & pelv w/contrast
|
$XXX.XX
|
Q3
|
5572
|
| 74178 |
Ct abd & pelv 1/> regns
|
$XXX.XX
|
Q3
|
5572
|
| 74181 |
Mri abdomen w/o dye
|
$XXX.XX
|
Q3
|
5523
|
| 74182 |
Mri abdomen w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 74183 |
Mri abdomen w/o & w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 74190 |
X-ray exam of peritoneum
|
$XXX.XX
|
Q2
|
5524
|
| 74210 |
X-ray xm phrnx&/crv esoph c+
|
$XXX.XX
|
Q1
|
5571
|
| 74220 |
X-ray xm esophagus 1cntrst
|
$XXX.XX
|
Q1
|
5571
|
| 74221 |
X-ray xm esophagus 2cntrst
|
$XXX.XX
|
Q1
|
5571
|
| 74230 |
X-ray xm swlng funcj c+
|
$XXX.XX
|
Q1
|
5571
|
| 74240 |
X-ray xm upr gi trc 1cntrst
|
$XXX.XX
|
Q1
|
5571
|
| 74246 |
X-ray xm upr gi trc 2cntrst
|
$XXX.XX
|
Q1
|
5571
|
| 74250 |
X-ray xm sm int 1cntrst std
|
$XXX.XX
|
Q1
|
5571
|
| 74251 |
X-ray xm sm int 2cntrst std
|
$XXX.XX
|
Q1
|
5571
|
| 74261 |
Ct colonography dx
|
$XXX.XX
|
Q3
|
5522
|
| 74262 |
Ct colonography dx w/dye
|
$XXX.XX
|
Q3
|
5571
|
| 74270 |
X-ray xm colon 1cntrst std
|
$XXX.XX
|
Q1
|
5571
|
| 74280 |
X-ray xm colon 2cntrst std
|
$XXX.XX
|
Q1
|
5571
|
| 74283 |
Ther nma rdctj intus/obstrcj
|
$XXX.XX
|
S
|
5571
|
| 74290 |
Contrast x-ray gallbladder
|
$XXX.XX
|
Q1
|
5571
|
| 74400 |
Contrst x-ray urinary tract
|
$XXX.XX
|
S
|
5571
|
| 74410 |
Contrst x-ray urinary tract
|
$XXX.XX
|
S
|
5571
|
| 74415 |
Contrst x-ray urinary tract
|
$XXX.XX
|
S
|
5571
|
| 74420 |
Contrst x-ray urinary tract
|
$XXX.XX
|
S
|
5572
|
| 74425 |
Contrst x-ray urinary tract
|
$XXX.XX
|
Q2
|
5572
|
| 74430 |
Contrast x-ray bladder
|
$XXX.XX
|
Q2
|
5572
|
| 74440 |
X-ray male genital tract
|
$XXX.XX
|
Q2
|
5523
|
| 74445 |
X-ray exam of penis
|
$XXX.XX
|
Q2
|
5522
|
| 74450 |
X-ray urethra/bladder
|
$XXX.XX
|
Q2
|
5523
|
| 74455 |
X-ray urethra/bladder
|
$XXX.XX
|
Q2
|
5523
|
| 74470 |
X-ray exam of kidney lesion
|
$XXX.XX
|
Q2
|
5524
|
| 74485 |
Dilation urtr/urt rs&i
|
$XXX.XX
|
Q2
|
5373
|
| 74710 |
X-ray measurement of pelvis
|
$XXX.XX
|
Q1
|
5521
|
| 74712 |
Mri fetal sngl/1st gestation
|
$XXX.XX
|
S
|
5523
|
| 74740 |
X-ray female genital tract
|
$XXX.XX
|
Q2
|
5523
|
| 74775 |
X-ray exam of perineum
|
$XXX.XX
|
S
|
5523
|
| 75557 |
Cardiac mri for morph
|
$XXX.XX
|
Q3
|
5523
|
| 75559 |
Cardiac mri w/stress img
|
$XXX.XX
|
Q3
|
5524
|
| 75561 |
Cardiac mri for morph w/dye
|
$XXX.XX
|
Q3
|
5572
|
| 75563 |
Card mri w/stress img & dye
|
$XXX.XX
|
Q3
|
5573
|
| 75571 |
Ct hrt w/o dye w/ca test
|
$XXX.XX
|
Q1
|
5521
|
| 75572 |
Ct hrt w/3d image
|
$XXX.XX
|
S
|
5571
|
| 75573 |
Ct hrt w/3d image congen
|
$XXX.XX
|
S
|
5571
|
| 75574 |
Ct angio hrt w/3d image
|
$XXX.XX
|
S
|
5571
|
| 75600 |
Contrast exam thoracic aorta
|
$XXX.XX
|
Q2
|
5183
|
| 75605 |
Contrast exam thoracic aorta
|
$XXX.XX
|
Q2
|
5184
|
| 75625 |
Contrast exam abdominl aorta
|
$XXX.XX
|
Q2
|
5183
|
| 75630 |
X-ray aorta leg arteries
|
$XXX.XX
|
Q2
|
5183
|
| 75635 |
Ct angio abdominal arteries
|
$XXX.XX
|
Q2
|
5571
|
| 75705 |
Artery x-rays spine
|
$XXX.XX
|
Q2
|
5184
|
| 75710 |
Artery x-rays arm/leg
|
$XXX.XX
|
Q2
|
5183
|
| 75716 |
Artery x-rays arms/legs
|
$XXX.XX
|
Q2
|
5183
|
| 75726 |
Artery x-rays abdomen
|
$XXX.XX
|
Q2
|
5184
|
| 75731 |
Artery x-rays adrenal gland
|
$XXX.XX
|
J1
|
5182
|
| 75733 |
Artery x-rays adrenals
|
$XXX.XX
|
Q2
|
5183
|
| 75736 |
Artery x-rays pelvis
|
$XXX.XX
|
Q2
|
5184
|
| 75741 |
Artery x-rays lung
|
$XXX.XX
|
Q2
|
5183
|
| 75743 |
Artery x-rays lungs
|
$XXX.XX
|
Q2
|
5183
|
| 75746 |
Artery x-rays lung
|
$XXX.XX
|
J1
|
5182
|
| 75756 |
Artery x-rays chest
|
$XXX.XX
|
Q2
|
5183
|
| 75801 |
Lymph vessel x-ray arm/leg
|
$XXX.XX
|
Q2
|
5181
|
| 75803 |
Lymph vessel x-ray arms/legs
|
$XXX.XX
|
J1
|
5182
|
| 75805 |
Lymph vessel x-ray trunk
|
$XXX.XX
|
J1
|
5182
|
| 75807 |
Lymph vessel x-ray trunk
|
$XXX.XX
|
Q2
|
5183
|
| 75809 |
Nonvascular shunt x-ray
|
$XXX.XX
|
Q2
|
5522
|
| 75810 |
Vein x-ray spleen/liver
|
$XXX.XX
|
J1
|
5182
|
| 75820 |
Vein x-ray arm/leg
|
$XXX.XX
|
Q2
|
5181
|
| 75822 |
Vein x-ray arms/legs
|
$XXX.XX
|
J1
|
5182
|
| 75825 |
Vein x-ray trunk
|
$XXX.XX
|
Q2
|
5183
|
| 75827 |
Vein x-ray chest
|
$XXX.XX
|
Q2
|
5181
|
| 75831 |
Vein x-ray kidney
|
$XXX.XX
|
Q2
|
5183
|
| 75833 |
Vein x-ray kidneys
|
$XXX.XX
|
Q2
|
5183
|
| 75840 |
Vein x-ray adrenal gland
|
$XXX.XX
|
Q2
|
5183
|
| 75842 |
Vein x-ray adrenal glands
|
$XXX.XX
|
Q2
|
5184
|
| 75860 |
Vein x-ray neck
|
$XXX.XX
|
Q2
|
5183
|
| 75870 |
Vein x-ray skull
|
$XXX.XX
|
J1
|
5182
|
| 75872 |
Vein x-ray skull epidural
|
$XXX.XX
|
Q2
|
5181
|
| 75880 |
Vein x-ray eye socket
|
$XXX.XX
|
Q2
|
5181
|
| 75885 |
Vein x-ray liver w/hemodynam
|
$XXX.XX
|
Q2
|
5183
|
| 75887 |
Vein x-ray liver w/o hemodyn
|
$XXX.XX
|
J1
|
5182
|
| 75889 |
Vein x-ray liver w/hemodynam
|
$XXX.XX
|
Q2
|
5183
|
| 75891 |
Vein x-ray liver
|
$XXX.XX
|
Q2
|
5183
|
| 75893 |
Venous sampling by catheter
|
$XXX.XX
|
Q2
|
5184
|
| 75898 |
Follow-up angiography
|
$XXX.XX
|
J1
|
5182
|
| 76000 |
Fluoroscopy <1 hr phys/qhp
|
$XXX.XX
|
S
|
5523
|
| 76010 |
X-ray nose to rectum
|
$XXX.XX
|
Q1
|
5521
|
| 76080 |
X-ray exam of fistula
|
$XXX.XX
|
Q2
|
5524
|
| 76098 |
X-ray exam surgical specimen
|
$XXX.XX
|
Q2
|
5524
|
| 76100 |
X-ray exam of body section
|
$XXX.XX
|
Q1
|
5522
|
| 76101 |
Complex body section x-ray
|
$XXX.XX
|
Q1
|
5522
|
| 76102 |
Complex body section x-rays
|
$XXX.XX
|
S
|
5522
|
| 76120 |
Cine/video x-rays
|
$XXX.XX
|
Q1
|
5522
|
| 76380 |
Cat scan follow-up study
|
$XXX.XX
|
Q1
|
5521
|
| 76391 |
Mr elastography
|
$XXX.XX
|
Q3
|
5523
|
| 76496 |
Fluoroscopic procedure
|
$XXX.XX
|
Q1
|
5521
|
| 76497 |
Ct procedure
|
$XXX.XX
|
Q1
|
5521
|
| 76498 |
Mri procedure
|
$XXX.XX
|
S
|
5521
|
| 76499 |
Radiographic procedure
|
$XXX.XX
|
Q1
|
5521
|
| 76506 |
Echo exam of head
|
$XXX.XX
|
Q1
|
5522
|
| 76510 |
Ophth us b & quant a
|
$XXX.XX
|
Q1
|
5734
|
| 76511 |
Ophth us quant a only
|
$XXX.XX
|
Q1
|
5522
|
| 76512 |
Ophth us b w/non-quant a
|
$XXX.XX
|
Q1
|
5522
|
| 76513 |
Echo exam of eye water bath
|
$XXX.XX
|
Q1
|
5522
|
| 76514 |
Echo exam of eye thickness
|
$XXX.XX
|
Q1
|
5731
|
| 76516 |
Echo exam of eye
|
$XXX.XX
|
Q1
|
5522
|
| 76519 |
Echo exam of eye
|
$XXX.XX
|
Q1
|
5522
|
| 76529 |
Echo exam of eye
|
$XXX.XX
|
Q1
|
5521
|
| 76536 |
Us exam of head and neck
|
$XXX.XX
|
Q1
|
5522
|
| 76604 |
Us exam chest
|
$XXX.XX
|
Q1
|
5522
|
| 76641 |
Ultrasound breast complete
|
$XXX.XX
|
Q1
|
5522
|
| 76642 |
Ultrasound breast limited
|
$XXX.XX
|
Q1
|
5521
|
| 76700 |
Us exam abdom complete
|
$XXX.XX
|
Q3
|
5522
|
| 76705 |
Echo exam of abdomen
|
$XXX.XX
|
Q3
|
5522
|
| 76706 |
Us abdl aorta screen aaa
|
$XXX.XX
|
S
|
5522
|
| 76770 |
Us exam abdo back wall comp
|
$XXX.XX
|
Q3
|
5522
|
| 76775 |
Us exam abdo back wall lim
|
$XXX.XX
|
Q1
|
5522
|
| 76776 |
Us exam k transpl w/doppler
|
$XXX.XX
|
Q3
|
5522
|
| 76800 |
Us exam spinal canal
|
$XXX.XX
|
Q1
|
5522
|
| 76801 |
Ob us < 14 wks single fetus
|
$XXX.XX
|
S
|
5522
|
| 76805 |
Ob us >= 14 wks sngl fetus
|
$XXX.XX
|
S
|
5522
|
| 76811 |
Ob us detailed sngl fetus
|
$XXX.XX
|
S
|
5523
|
| 76813 |
Ob us nuchal meas 1 gest
|
$XXX.XX
|
Q1
|
5522
|
| 76815 |
Ob us limited fetus(s)
|
$XXX.XX
|
Q1
|
5522
|
| 76816 |
Ob us follow-up per fetus
|
$XXX.XX
|
Q1
|
5522
|
| 76817 |
Transvaginal us obstetric
|
$XXX.XX
|
Q1
|
5522
|
| 76818 |
Fetal biophys profile w/nst
|
$XXX.XX
|
S
|
5522
|
| 76819 |
Fetal biophys profil w/o nst
|
$XXX.XX
|
S
|
5522
|
| 76820 |
Umbilical artery echo
|
$XXX.XX
|
Q1
|
5522
|
| 76821 |
Middle cerebral artery echo
|
$XXX.XX
|
Q1
|
5522
|
| 76825 |
Echo exam of fetal heart
|
$XXX.XX
|
S
|
5524
|
| 76826 |
Echo exam of fetal heart
|
$XXX.XX
|
S
|
5523
|
| 76827 |
Echo exam of fetal heart
|
$XXX.XX
|
Q1
|
5522
|
| 76828 |
Echo exam of fetal heart
|
$XXX.XX
|
Q1
|
5522
|
| 76830 |
Transvaginal us non-ob
|
$XXX.XX
|
S
|
5522
|
| 76831 |
Echo exam uterus
|
$XXX.XX
|
Q3
|
5523
|
| 76856 |
Us exam pelvic complete
|
$XXX.XX
|
Q3
|
5522
|
| 76857 |
Us exam pelvic limited
|
$XXX.XX
|
Q3
|
5522
|
| 76870 |
Us exam scrotum
|
$XXX.XX
|
Q1
|
5522
|
| 76872 |
Us transrectal
|
$XXX.XX
|
S
|
5522
|
| 76873 |
Echograp trans r pros study
|
$XXX.XX
|
S
|
5522
|
| 76881 |
Us compl joint r-t w/img
|
$XXX.XX
|
S
|
5522
|
| 76882 |
Us lmtd jt/nonvasc xtr strux
|
$XXX.XX
|
Q1
|
5522
|
| 76885 |
Us exam infant hips dynamic
|
$XXX.XX
|
Q1
|
5521
|
| 76886 |
Us exam infant hips static
|
$XXX.XX
|
Q1
|
5521
|
| 76936 |
Echo guide for artery repair
|
$XXX.XX
|
S
|
5722
|
| 76970 |
Ultrasound exam follow-up
|
$XXX.XX
|
Q1
|
5522
|
| 76975 |
Gi endoscopic ultrasound
|
$XXX.XX
|
Q2
|
5523
|
| 76977 |
Us bone density measure
|
$XXX.XX
|
S
|
5522
|
| 76978 |
Us trgt dyn mbubb 1st les
|
$XXX.XX
|
S
|
5571
|
| 76981 |
Use parenchyma
|
$XXX.XX
|
Q3
|
5522
|
| 76982 |
Use 1st target lesion
|
$XXX.XX
|
Q3
|
5522
|
| 76999 |
Echo examination procedure
|
$XXX.XX
|
Q1
|
5521
|
| 77046 |
Mri breast c- unilateral
|
$XXX.XX
|
Q3
|
5523
|
| 77047 |
Mri breast c- bilateral
|
$XXX.XX
|
Q3
|
5523
|
| 77053 |
X-ray of mammary duct
|
$XXX.XX
|
Q2
|
5523
|
| 77054 |
X-ray of mammary ducts
|
$XXX.XX
|
Q2
|
5523
|
| 77071 |
X-ray stress view
|
$XXX.XX
|
Q1
|
5521
|
| 77072 |
X-rays for bone age
|
$XXX.XX
|
Q1
|
5522
|
| 77073 |
X-rays bone length studies
|
$XXX.XX
|
Q1
|
5522
|
| 77074 |
X-rays bone survey limited
|
$XXX.XX
|
Q1
|
5522
|
| 77075 |
X-rays bone survey complete
|
$XXX.XX
|
Q1
|
5522
|
| 77076 |
X-rays bone survey infant
|
$XXX.XX
|
Q1
|
5522
|
| 77077 |
Joint survey single view
|
$XXX.XX
|
Q1
|
5522
|
| 77078 |
Ct bone density axial
|
$XXX.XX
|
S
|
5521
|
| 77080 |
Dxa bone density axial
|
$XXX.XX
|
S
|
5522
|
| 77081 |
Dxa bone density/peripheral
|
$XXX.XX
|
S
|
5521
|
| 77084 |
Magnetic image bone marrow
|
$XXX.XX
|
S
|
5523
|
| 77085 |
Dxa bone density study
|
$XXX.XX
|
Q1
|
5522
|
| 77086 |
Fracture assessment via dxa
|
$XXX.XX
|
Q1
|
5521
|
| 77280 |
Set radiation therapy field
|
$XXX.XX
|
S
|
5611
|
| 77285 |
Set radiation therapy field
|
$XXX.XX
|
S
|
5612
|
| 77290 |
Set radiation therapy field
|
$XXX.XX
|
S
|
5612
|
| 77295 |
3-d radiotherapy plan
|
$XXX.XX
|
S
|
5613
|
| 77299 |
Radiation therapy planning
|
$XXX.XX
|
S
|
5611
|
| 77300 |
Radiation therapy dose plan
|
$XXX.XX
|
S
|
5611
|
| 77301 |
Radiotherapy dose plan imrt
|
$XXX.XX
|
S
|
5613
|
| 77306 |
Telethx isodose plan simple
|
$XXX.XX
|
S
|
5612
|
| 77307 |
Telethx isodose plan cplx
|
$XXX.XX
|
S
|
5612
|
| 77316 |
Brachytx isodose plan simple
|
$XXX.XX
|
S
|
5612
|
| 77317 |
Brachytx isodose intermed
|
$XXX.XX
|
S
|
5612
|
| 77318 |
Brachytx isodose complex
|
$XXX.XX
|
S
|
5612
|
| 77321 |
Special teletx port plan
|
$XXX.XX
|
S
|
5612
|
| 77331 |
Special radiation dosimetry
|
$XXX.XX
|
S
|
5611
|
| 77332 |
Radiation treatment aid(s)
|
$XXX.XX
|
S
|
5611
|
| 77333 |
Radiation treatment aid(s)
|
$XXX.XX
|
S
|
5611
|
| 77334 |
Radiation treatment aid(s)
|
$XXX.XX
|
S
|
5612
|
| 77336 |
Radiation physics consult
|
$XXX.XX
|
S
|
5611
|
| 77338 |
Design mlc device for imrt
|
$XXX.XX
|
S
|
5612
|
| 77370 |
Radiation physics consult
|
$XXX.XX
|
S
|
5611
|
| 77371 |
Srs multisource
|
$XXX.XX
|
J1
|
5627
|
| 77372 |
Srs linear based
|
$XXX.XX
|
J1
|
5627
|
| 77373 |
Sbrt delivery
|
$XXX.XX
|
S
|
5626
|
| 77385 |
Ntsty modul rad tx dlvr smpl
|
$XXX.XX
|
S
|
5623
|
| 77386 |
Ntsty modul rad tx dlvr cplx
|
$XXX.XX
|
S
|
5623
|
| 77399 |
External radiation dosimetry
|
$XXX.XX
|
S
|
5611
|
| 77401 |
Radiation treatment delivery
|
$XXX.XX
|
S
|
5621
|
| 77402 |
Radiation treatment delivery
|
$XXX.XX
|
S
|
5621
|
| 77407 |
Radiation treatment delivery
|
$XXX.XX
|
S
|
5622
|
| 77412 |
Radiation treatment delivery
|
$XXX.XX
|
S
|
5622
|
| 77423 |
Neutron beam tx complex
|
$XXX.XX
|
S
|
5623
|
| 77424 |
Io rad tx delivery by x-ray
|
$XXX.XX
|
J1
|
5627
|
| 77425 |
Io rad tx deliver by elctrns
|
$XXX.XX
|
J1
|
5627
|
| 77470 |
Special radiation treatment
|
$XXX.XX
|
S
|
5623
|
| 77520 |
Proton trmt simple w/o comp
|
$XXX.XX
|
S
|
5623
|
| 77522 |
Proton trmt simple w/comp
|
$XXX.XX
|
S
|
5625
|
| 77523 |
Proton trmt intermediate
|
$XXX.XX
|
S
|
5625
|
| 77525 |
Proton treatment complex
|
$XXX.XX
|
S
|
5625
|
| 77600 |
Hyperthermia treatment
|
$XXX.XX
|
S
|
5622
|
| 77605 |
Hyperthermia treatment
|
$XXX.XX
|
S
|
5624
|
| 77610 |
Hyperthermia treatment
|
$XXX.XX
|
S
|
5623
|
| 77615 |
Hyperthermia treatment
|
$XXX.XX
|
S
|
5623
|
| 77620 |
Hyperthermia treatment
|
$XXX.XX
|
S
|
5623
|
| 77750 |
Infuse radioactive materials
|
$XXX.XX
|
S
|
5622
|
| 77761 |
Apply intrcav radiat simple
|
$XXX.XX
|
S
|
5623
|
| 77762 |
Apply intrcav radiat interm
|
$XXX.XX
|
S
|
5623
|
| 77763 |
Apply intrcav radiat compl
|
$XXX.XX
|
S
|
5624
|
| 77767 |
Hdr rdncl skn surf brachytx
|
$XXX.XX
|
S
|
5622
|
| 77768 |
Hdr rdncl skn surf brachytx
|
$XXX.XX
|
S
|
5622
|
| 77770 |
Hdr rdncl ntrstl/icav brchtx
|
$XXX.XX
|
S
|
5624
|
| 77771 |
Hdr rdncl ntrstl/icav brchtx
|
$XXX.XX
|
S
|
5624
|
| 77772 |
Hdr rdncl ntrstl/icav brchtx
|
$XXX.XX
|
S
|
5624
|
| 77778 |
Apply interstit radiat compl
|
$XXX.XX
|
S
|
5624
|
| 77789 |
Apply surf ldr radionuclide
|
$XXX.XX
|
S
|
5621
|
| 77799 |
Radium/radioisotope therapy
|
$XXX.XX
|
S
|
5621
|
| 78012 |
Thyroid uptake measurement
|
$XXX.XX
|
S
|
5591
|
| 78013 |
Thyroid imaging w/blood flow
|
$XXX.XX
|
S
|
5591
|
| 78014 |
Thyroid imaging w/blood flow
|
$XXX.XX
|
S
|
5591
|
| 78015 |
Thyroid met imaging
|
$XXX.XX
|
S
|
5591
|
| 78016 |
Thyroid met imaging/studies
|
$XXX.XX
|
S
|
5591
|
| 78018 |
Thyroid met imaging body
|
$XXX.XX
|
S
|
5592
|
| 78070 |
Parathyroid planar imaging
|
$XXX.XX
|
S
|
5591
|
| 78071 |
Parathyrd planar w/wo subtrj
|
$XXX.XX
|
S
|
5591
|
| 78072 |
Parathyrd planar w/spect&ct
|
$XXX.XX
|
S
|
5592
|
| 78075 |
Adrenal cortex & medulla img
|
$XXX.XX
|
S
|
5593
|
| 78099 |
Endocrine nuclear procedure
|
$XXX.XX
|
S
|
5591
|
| 78102 |
Bone marrow imaging ltd
|
$XXX.XX
|
S
|
5591
|
| 78103 |
Bone marrow imaging mult
|
$XXX.XX
|
S
|
5591
|
| 78104 |
Bone marrow imaging body
|
$XXX.XX
|
S
|
5591
|
| 78110 |
Plasma volume single
|
$XXX.XX
|
S
|
5593
|
| 78111 |
Plasma volume multiple
|
$XXX.XX
|
S
|
5593
|
| 78120 |
Red cell mass single
|
$XXX.XX
|
S
|
5591
|
| 78121 |
Red cell mass multiple
|
$XXX.XX
|
S
|
5592
|
| 78122 |
Blood volume
|
$XXX.XX
|
S
|
5592
|
| 78130 |
Red cell survival study
|
$XXX.XX
|
S
|
5591
|
| 78135 |
Red cell survival kinetics
|
$XXX.XX
|
S
|
5591
|
| 78140 |
Red cell sequestration
|
$XXX.XX
|
S
|
5591
|
| 78185 |
Spleen imaging
|
$XXX.XX
|
S
|
5591
|
| 78191 |
Platelet survival
|
$XXX.XX
|
S
|
5591
|
| 78195 |
Lymph system imaging
|
$XXX.XX
|
S
|
5592
|
| 78199 |
Blood/lymph nuclear exam
|
$XXX.XX
|
S
|
5591
|
| 78201 |
Liver imaging
|
$XXX.XX
|
S
|
5593
|
| 78202 |
Liver imaging with flow
|
$XXX.XX
|
S
|
5593
|
| 78215 |
Liver and spleen imaging
|
$XXX.XX
|
S
|
5591
|
| 78216 |
Liver & spleen image/flow
|
$XXX.XX
|
S
|
5591
|
| 78226 |
Hepatobiliary system imaging
|
$XXX.XX
|
S
|
5591
|
| 78227 |
Hepatobil syst image w/drug
|
$XXX.XX
|
S
|
5592
|
| 78230 |
Salivary gland imaging
|
$XXX.XX
|
S
|
5591
|
| 78231 |
Serial salivary imaging
|
$XXX.XX
|
S
|
5591
|
| 78232 |
Salivary gland function exam
|
$XXX.XX
|
S
|
5591
|
| 78258 |
Esophageal motility study
|
$XXX.XX
|
S
|
5591
|
| 78261 |
Gastric mucosa imaging
|
$XXX.XX
|
S
|
5591
|
| 78262 |
Gastroesophageal reflux exam
|
$XXX.XX
|
S
|
5591
|
| 78264 |
Gastric emptying imag study
|
$XXX.XX
|
S
|
5591
|
| 78265 |
Gastric emptying imag study
|
$XXX.XX
|
S
|
5591
|
| 78266 |
Gastric emptying imag study
|
$XXX.XX
|
S
|
5592
|
| 78278 |
Acute gi blood loss imaging
|
$XXX.XX
|
S
|
5591
|
| 78282 |
Gi protein loss exam
|
$XXX.XX
|
S
|
5591
|
| 78290 |
Meckels divert exam
|
$XXX.XX
|
S
|
5591
|
| 78291 |
Leveen/shunt patency exam
|
$XXX.XX
|
S
|
5591
|
| 78299 |
Gi nuclear procedure
|
$XXX.XX
|
S
|
5591
|
| 78300 |
Bone imaging limited area
|
$XXX.XX
|
S
|
5591
|
| 78305 |
Bone imaging multiple areas
|
$XXX.XX
|
S
|
5591
|
| 78306 |
Bone imaging whole body
|
$XXX.XX
|
S
|
5591
|
| 78315 |
Bone imaging 3 phase
|
$XXX.XX
|
S
|
5591
|
| 78399 |
Musculoskeletal nuclear exam
|
$XXX.XX
|
S
|
5591
|
| 78414 |
Non-imaging heart function
|
$XXX.XX
|
S
|
5592
|
| 78428 |
Cardiac shunt imaging
|
$XXX.XX
|
S
|
5591
|
| 78429 |
Myocrd img pet 1 std w/ct
|
$XXX.XX
|
S
|
5594
|
| 78430 |
Myocrd img pet rst/strs w/ct
|
$XXX.XX
|
S
|
5594
|
| 78431 |
Myocrd img pet rst&strs ct
|
$XXX.XX
|
S
|
1522
|
| 78432 |
Myocrd img pet 2rtracer
|
$XXX.XX
|
S
|
1523
|
| 78433 |
Myocrd img pet 2rtracer ct
|
$XXX.XX
|
S
|
1523
|
| 78445 |
Vascular flow imaging
|
$XXX.XX
|
S
|
5591
|
| 78451 |
Ht muscle image spect sing
|
$XXX.XX
|
S
|
5593
|
| 78452 |
Ht muscle image spect mult
|
$XXX.XX
|
S
|
5593
|
| 78453 |
Ht muscle image planar sing
|
$XXX.XX
|
S
|
5593
|
| 78454 |
Ht musc image planar mult
|
$XXX.XX
|
S
|
5593
|
| 78456 |
Acute venous thrombus image
|
$XXX.XX
|
S
|
5593
|
| 78457 |
Venous thrombosis imaging
|
$XXX.XX
|
S
|
5593
|
| 78458 |
Ven thrombosis images bilat
|
$XXX.XX
|
S
|
5591
|
| 78459 |
Myocrd img pet single study
|
$XXX.XX
|
S
|
5593
|
| 78466 |
Heart infarct image
|
$XXX.XX
|
S
|
5591
|
| 78468 |
Heart infarct image (ef)
|
$XXX.XX
|
S
|
5592
|
| 78469 |
Heart infarct image (3d)
|
$XXX.XX
|
S
|
5593
|
| 78472 |
Gated heart planar single
|
$XXX.XX
|
S
|
5591
|
| 78473 |
Gated heart multiple
|
$XXX.XX
|
S
|
5591
|
| 78481 |
Heart first pass single
|
$XXX.XX
|
S
|
5592
|
| 78483 |
Heart first pass multiple
|
$XXX.XX
|
S
|
5592
|
| 78491 |
Myocrd img pet 1std rst/strs
|
$XXX.XX
|
S
|
5594
|
| 78492 |
Myocrd img pet mlt rst&strs
|
$XXX.XX
|
S
|
5594
|
| 78494 |
Heart image spect
|
$XXX.XX
|
S
|
5591
|
| 78499 |
Cardiovascular nuclear exam
|
$XXX.XX
|
S
|
5591
|
| 78579 |
Lung ventilation imaging
|
$XXX.XX
|
S
|
5591
|
| 78580 |
Lung perfusion imaging
|
$XXX.XX
|
S
|
5591
|
| 78582 |
Lung ventilat&perfus imaging
|
$XXX.XX
|
S
|
5592
|
| 78597 |
Lung perfusion differential
|
$XXX.XX
|
S
|
5591
|
| 78598 |
Lung perf&ventilat diferentl
|
$XXX.XX
|
S
|
5592
|
| 78599 |
Respiratory nuclear exam
|
$XXX.XX
|
S
|
5591
|
| 78600 |
Brain image < 4 views
|
$XXX.XX
|
S
|
5591
|
| 78601 |
Brain image w/flow < 4 views
|
$XXX.XX
|
S
|
5591
|
| 78605 |
Brain image 4+ views
|
$XXX.XX
|
S
|
5592
|
| 78606 |
Brain image w/flow 4 + views
|
$XXX.XX
|
S
|
5592
|
| 78608 |
Brain imaging (pet)
|
$XXX.XX
|
S
|
5594
|
| 78610 |
Brain flow imaging only
|
$XXX.XX
|
S
|
5592
|
| 78630 |
Cerebrospinal fluid scan
|
$XXX.XX
|
S
|
5592
|
| 78635 |
Csf ventriculography
|
$XXX.XX
|
S
|
5592
|
| 78645 |
Csf shunt evaluation
|
$XXX.XX
|
S
|
5592
|
| 78650 |
Csf leakage imaging
|
$XXX.XX
|
S
|
5593
|
| 78660 |
Nuclear exam of tear flow
|
$XXX.XX
|
S
|
5591
|
| 78699 |
Nervous system nuclear exam
|
$XXX.XX
|
S
|
5591
|
| 78700 |
Kidney imaging morphol
|
$XXX.XX
|
S
|
5591
|
| 78701 |
Kidney imaging with flow
|
$XXX.XX
|
S
|
5591
|
| 78707 |
K flow/funct image w/o drug
|
$XXX.XX
|
S
|
5592
|
| 78708 |
K flow/funct image w/drug
|
$XXX.XX
|
S
|
5592
|
| 78709 |
K flow/funct image multiple
|
$XXX.XX
|
S
|
5592
|
| 78725 |
Kidney function study
|
$XXX.XX
|
S
|
5591
|
| 78740 |
Ureteral reflux study
|
$XXX.XX
|
S
|
5591
|
| 78761 |
Testicular imaging w/flow
|
$XXX.XX
|
S
|
5591
|
| 78799 |
Genitourinary nuclear exam
|
$XXX.XX
|
S
|
5591
|
| 78800 |
Rp loclzj tum 1 area 1 d img
|
$XXX.XX
|
S
|
5591
|
| 78801 |
Rp loclzj tum 2+area 1+d img
|
$XXX.XX
|
S
|
5591
|
| 78802 |
Rp loclzj tum whbdy 1 d img
|
$XXX.XX
|
S
|
5593
|
| 78803 |
Rp loclzj tum spect 1 area
|
$XXX.XX
|
S
|
5593
|
| 78804 |
Rp loclzj tum whbdy 2+d img
|
$XXX.XX
|
S
|
5593
|
| 78808 |
Iv inj ra drug dx study
|
$XXX.XX
|
Q1
|
5591
|
| 78811 |
Pet image ltd area
|
$XXX.XX
|
S
|
5593
|
| 78812 |
Pet image skull-thigh
|
$XXX.XX
|
S
|
5594
|
| 78813 |
Pet image full body
|
$XXX.XX
|
S
|
5594
|
| 78814 |
Pet image w/ct lmtd
|
$XXX.XX
|
S
|
5594
|
| 78815 |
Pet image w/ct skull-thigh
|
$XXX.XX
|
S
|
5594
|
| 78816 |
Pet image w/ct full body
|
$XXX.XX
|
S
|
5594
|
| 78830 |
Rp loclzj tum spect w/ct 1
|
$XXX.XX
|
S
|
5593
|
| 78831 |
Rp loclzj tum spect 2 areas
|
$XXX.XX
|
S
|
5593
|
| 78832 |
Rp loclzj tum spect w/ct 2
|
$XXX.XX
|
S
|
5594
|
| 78999 |
Nuclear diagnostic exam
|
$XXX.XX
|
S
|
5591
|
| 79005 |
Nuclear rx oral admin
|
$XXX.XX
|
S
|
5661
|
| 79101 |
Nuclear rx iv admin
|
$XXX.XX
|
S
|
5661
|
| 79200 |
Nuclear rx intracav admin
|
$XXX.XX
|
S
|
5661
|
| 79300 |
Nuclr rx interstit colloid
|
$XXX.XX
|
S
|
5661
|
| 79403 |
Hematopoietic nuclear tx
|
$XXX.XX
|
S
|
5661
|
| 79440 |
Nuclear rx intra-articular
|
$XXX.XX
|
S
|
5661
|
| 79445 |
Nuclear rx intra-arterial
|
$XXX.XX
|
S
|
5661
|
| 79999 |
Nuclear medicine therapy
|
$XXX.XX
|
S
|
5661
|
| 80500 |
Lab pathology consultation
|
$XXX.XX
|
Q1
|
5671
|
| 80502 |
Lab pathology consultation
|
$XXX.XX
|
Q1
|
5671
|
| 85097 |
Bone marrow interpretation
|
$XXX.XX
|
Q2
|
5674
|
| 86077 |
Phys blood bank serv xmatch
|
$XXX.XX
|
Q1
|
5731
|
| 86078 |
Phys blood bank serv reactj
|
$XXX.XX
|
Q1
|
5672
|
| 86079 |
Phys blood bank serv authrj
|
$XXX.XX
|
Q1
|
5671
|
| 86485 |
Skin test candida
|
$XXX.XX
|
Q1
|
5731
|
| 86486 |
Skin test nos antigen
|
$XXX.XX
|
Q1
|
5731
|
| 86490 |
Coccidioidomycosis skin test
|
$XXX.XX
|
Q1
|
5733
|
| 86510 |
Histoplasmosis skin test
|
$XXX.XX
|
Q1
|
5733
|
| 86580 |
Tb intradermal test
|
$XXX.XX
|
Q1
|
5731
|
| 86850 |
Rbc antibody screen
|
$XXX.XX
|
Q1
|
5671
|
| 86860 |
Rbc antibody elution
|
$XXX.XX
|
Q1
|
5672
|
| 86870 |
Rbc antibody identification
|
$XXX.XX
|
Q2
|
5673
|
| 86880 |
Coombs test direct
|
$XXX.XX
|
Q1
|
5732
|
| 86885 |
Coombs test indirect qual
|
$XXX.XX
|
Q1
|
5672
|
| 86886 |
Coombs test indirect titer
|
$XXX.XX
|
Q1
|
5672
|
| 86890 |
Autologous blood process
|
$XXX.XX
|
Q1
|
5672
|
| 86891 |
Autologous blood op salvage
|
$XXX.XX
|
Q1
|
5674
|
| 86900 |
Blood typing serologic abo
|
$XXX.XX
|
Q1
|
5734
|
| 86901 |
Blood typing serologic rh(d)
|
$XXX.XX
|
Q1
|
5732
|
| 86902 |
Blood type antigen donor ea
|
$XXX.XX
|
Q1
|
5673
|
| 86904 |
Blood typing patient serum
|
$XXX.XX
|
Q1
|
5732
|
| 86905 |
Blood typing rbc antigens
|
$XXX.XX
|
Q1
|
5673
|
| 86906 |
Bld typing serologic rh phnt
|
$XXX.XX
|
Q1
|
5732
|
| 86920 |
Compatibility test spin
|
$XXX.XX
|
Q1
|
5672
|
| 86921 |
Compatibility test incubate
|
$XXX.XX
|
Q1
|
5672
|
| 86922 |
Compatibility test antiglob
|
$XXX.XX
|
Q1
|
5672
|
| 86923 |
Compatibility test electric
|
$XXX.XX
|
Q1
|
5672
|
| 86927 |
Plasma fresh frozen
|
$XXX.XX
|
S
|
5672
|
| 86930 |
Frozen blood prep
|
$XXX.XX
|
Q1
|
5673
|
| 86931 |
Frozen blood thaw
|
$XXX.XX
|
Q1
|
5673
|
| 86932 |
Frozen blood freeze/thaw
|
$XXX.XX
|
Q1
|
5732
|
| 86945 |
Blood product/irradiation
|
$XXX.XX
|
Q1
|
5732
|
| 86950 |
Leukacyte transfusion
|
$XXX.XX
|
Q1
|
5672
|
| 86960 |
Vol reduction of blood/prod
|
$XXX.XX
|
Q1
|
5672
|
| 86965 |
Pooling blood platelets
|
$XXX.XX
|
Q1
|
5672
|
| 86970 |
Rbc pretx incubatj w/chemicl
|
$XXX.XX
|
Q1
|
5732
|
| 86971 |
Rbc pretx incubatj w/enzymes
|
$XXX.XX
|
Q1
|
5673
|
| 86972 |
Rbc pretx incubatj w/density
|
$XXX.XX
|
Q1
|
5672
|
| 86975 |
Rbc serum pretx incubj drugs
|
$XXX.XX
|
Q1
|
5734
|
| 86976 |
Rbc serum pretx id dilution
|
$XXX.XX
|
Q1
|
5731
|
| 86977 |
Rbc serum pretx incubj/inhib
|
$XXX.XX
|
Q1
|
5672
|
| 86978 |
Rbc pretreatment serum
|
$XXX.XX
|
Q1
|
5732
|
| 86985 |
Split blood or products
|
$XXX.XX
|
Q1
|
5672
|
| 86999 |
Transfusion procedure
|
$XXX.XX
|
Q1
|
5731
|
| 88104 |
Cytopath fl nongyn smears
|
$XXX.XX
|
Q1
|
5732
|
| 88106 |
Cytopath fl nongyn filter
|
$XXX.XX
|
Q1
|
5731
|
| 88108 |
Cytopath concentrate tech
|
$XXX.XX
|
Q1
|
5732
|
| 88112 |
Cytopath cell enhance tech
|
$XXX.XX
|
Q1
|
5671
|
| 88120 |
Cytp urne 3-5 probes ea spec
|
$XXX.XX
|
Q2
|
5672
|
| 88121 |
Cytp urine 3-5 probes cmptr
|
$XXX.XX
|
Q1
|
5673
|
| 88125 |
Forensic cytopathology
|
$XXX.XX
|
Q1
|
5671
|
| 88160 |
Cytopath smear other source
|
$XXX.XX
|
Q1
|
5731
|
| 88161 |
Cytopath smear other source
|
$XXX.XX
|
Q1
|
5731
|
| 88162 |
Cytopath smear other source
|
$XXX.XX
|
Q1
|
5671
|
| 88172 |
Cytp dx eval fna 1st ea site
|
$XXX.XX
|
Q1
|
5672
|
| 88173 |
Cytopath eval fna report
|
$XXX.XX
|
Q1
|
5671
|
| 88182 |
Cell marker study
|
$XXX.XX
|
Q2
|
5671
|
| 88184 |
Flowcytometry/ tc 1 marker
|
$XXX.XX
|
Q2
|
5673
|
| 88199 |
Cytopathology procedure
|
$XXX.XX
|
Q1
|
5671
|
| 88299 |
Cytogenetic study
|
$XXX.XX
|
Q1
|
5671
|
| 88300 |
Surgical path gross
|
$XXX.XX
|
Q1
|
5731
|
| 88302 |
Tissue exam by pathologist
|
$XXX.XX
|
Q1
|
5731
|
| 88304 |
Tissue exam by pathologist
|
$XXX.XX
|
Q1
|
5671
|
| 88305 |
Tissue exam by pathologist
|
$XXX.XX
|
Q1
|
5671
|
| 88307 |
Tissue exam by pathologist
|
$XXX.XX
|
Q2
|
5673
|
| 88309 |
Tissue exam by pathologist
|
$XXX.XX
|
Q2
|
5674
|
| 88312 |
Special stains group 1
|
$XXX.XX
|
Q1
|
5671
|
| 88313 |
Special stains group 2
|
$XXX.XX
|
Q1
|
5732
|
| 88319 |
Enzyme histochemistry
|
$XXX.XX
|
Q2
|
5674
|
| 88321 |
Microslide consultation
|
$XXX.XX
|
Q1
|
5732
|
| 88323 |
Microslide consultation
|
$XXX.XX
|
Q1
|
5671
|
| 88325 |
Comprehensive review of data
|
$XXX.XX
|
Q1
|
5671
|
| 88329 |
Path consult introp
|
$XXX.XX
|
Q1
|
5732
|
| 88331 |
Path consult intraop 1 bloc
|
$XXX.XX
|
Q1
|
5672
|
| 88333 |
Intraop cyto path consult 1
|
$XXX.XX
|
Q2
|
5674
|
| 88342 |
Immunohisto antb 1st stain
|
$XXX.XX
|
Q2
|
5672
|
| 88344 |
Immunohisto antibody slide
|
$XXX.XX
|
Q1
|
5673
|
| 88346 |
Immunofluor antb 1st stain
|
$XXX.XX
|
Q2
|
5673
|
| 88348 |
Electron microscopy
|
$XXX.XX
|
Q2
|
5674
|
| 88355 |
Analysis skeletal muscle
|
$XXX.XX
|
Q1
|
5672
|
| 88356 |
Analysis nerve
|
$XXX.XX
|
Q1
|
5671
|
| 88358 |
Analysis tumor
|
$XXX.XX
|
Q2
|
5672
|
| 88360 |
Tumor immunohistochem/manual
|
$XXX.XX
|
Q2
|
5672
|
| 88361 |
Tumor immunohistochem/comput
|
$XXX.XX
|
Q2
|
5673
|
| 88362 |
Nerve teasing preparations
|
$XXX.XX
|
Q2
|
5674
|
| 88363 |
Xm archive tissue molec anal
|
$XXX.XX
|
Q1
|
5731
|
| 88365 |
Insitu hybridization (fish)
|
$XXX.XX
|
Q1
|
5672
|
| 88366 |
Insitu hybridization (fish)
|
$XXX.XX
|
Q1
|
5673
|
| 88367 |
Insitu hybridization auto
|
$XXX.XX
|
Q2
|
5673
|
| 88368 |
Insitu hybridization manual
|
$XXX.XX
|
Q2
|
5673
|
| 88374 |
M/phmtrc alys ishquant/semiq
|
$XXX.XX
|
Q1
|
5672
|
| 88377 |
M/phmtrc alys ishquant/semiq
|
$XXX.XX
|
Q1
|
5672
|
| 88399 |
Surgical pathology procedure
|
$XXX.XX
|
Q1
|
5671
|
| 89049 |
Chct for mal hyperthermia
|
$XXX.XX
|
Q1
|
5672
|
| 89220 |
Sputum specimen collection
|
$XXX.XX
|
Q1
|
5672
|
| 89230 |
Collect sweat for test
|
$XXX.XX
|
Q1
|
5671
|
| 89240 |
Pathology lab procedure
|
$XXX.XX
|
Q1
|
5671
|
| 89250 |
Cultr oocyte/embryo <4 days
|
$XXX.XX
|
Q1
|
5672
|
| 89251 |
Cultr oocyte/embryo <4 days
|
$XXX.XX
|
Q2
|
5672
|
| 89253 |
Embryo hatching
|
$XXX.XX
|
Q1
|
5672
|
| 89254 |
Oocyte identification
|
$XXX.XX
|
Q1
|
5672
|
| 89255 |
Prepare embryo for transfer
|
$XXX.XX
|
Q1
|
5671
|
| 89257 |
Sperm identification
|
$XXX.XX
|
Q1
|
5671
|
| 89258 |
Cryopreservation embryo(s)
|
$XXX.XX
|
Q2
|
5674
|
| 89259 |
Cryopreservation sperm
|
$XXX.XX
|
Q1
|
5672
|
| 89260 |
Sperm isolation simple
|
$XXX.XX
|
Q1
|
5671
|
| 89261 |
Sperm isolation complex
|
$XXX.XX
|
Q1
|
5671
|
| 89264 |
Identify sperm tissue
|
$XXX.XX
|
Q1
|
5671
|
| 89268 |
Insemination of oocytes
|
$XXX.XX
|
Q1
|
5672
|
| 89272 |
Extended culture of oocytes
|
$XXX.XX
|
Q2
|
5674
|
| 89280 |
Assist oocyte fertilization
|
$XXX.XX
|
Q2
|
5674
|
| 89281 |
Assist oocyte fertilization
|
$XXX.XX
|
Q1
|
5672
|
| 89290 |
Biopsy oocyte polar body
|
$XXX.XX
|
Q1
|
5672
|
| 89291 |
Biopsy oocyte polar body
|
$XXX.XX
|
Q1
|
5672
|
| 89335 |
Cryopreserve testicular tiss
|
$XXX.XX
|
Q1
|
5671
|
| 89337 |
Cryopreservation oocyte(s)
|
$XXX.XX
|
Q1
|
5672
|
| 89342 |
Storage/year embryo(s)
|
$XXX.XX
|
Q1
|
5672
|
| 89343 |
Storage/year sperm/semen
|
$XXX.XX
|
Q1
|
5672
|
| 89344 |
Storage/year reprod tissue
|
$XXX.XX
|
Q1
|
5672
|
| 89346 |
Storage/year oocyte(s)
|
$XXX.XX
|
Q2
|
5673
|
| 89352 |
Thawing cryopresrved embryo
|
$XXX.XX
|
Q1
|
5672
|
| 89353 |
Thawing cryopresrved sperm
|
$XXX.XX
|
Q1
|
5671
|
| 89354 |
Thaw cryoprsvrd reprod tiss
|
$XXX.XX
|
Q1
|
5672
|
| 89356 |
Thawing cryopresrved oocyte
|
$XXX.XX
|
Q1
|
5672
|
| 89398 |
Unlisted reprod med lab proc
|
$XXX.XX
|
Q1
|
5671
|
| 90296 |
Diphtheria antitoxin
|
$XXX.XX
|
K
|
9315
|
| 90371 |
Hep b ig im
|
$XXX.XX
|
K
|
1630
|
| 90375 |
Rabies ig im/sc
|
$XXX.XX
|
K
|
9133
|
| 90376 |
Rabies ig heat treated
|
$XXX.XX
|
K
|
9134
|
| 90378 |
Rsv mab im 50mg
|
$XXX.XX
|
K
|
9003
|
| 90396 |
Varicella-zoster ig im
|
$XXX.XX
|
K
|
9135
|
| 90471 |
Immunization admin
|
$XXX.XX
|
Q1
|
5692
|
| 90473 |
Immune admin oral/nasal
|
$XXX.XX
|
Q1
|
5692
|
| 90675 |
Rabies vaccine im
|
$XXX.XX
|
K
|
9139
|
| 90676 |
Rabies vaccine id
|
$XXX.XX
|
K
|
9140
|
| 90791 |
Psych diagnostic evaluation
|
$XXX.XX
|
Q3
|
5823
|
| 90792 |
Psych diag eval w/med srvcs
|
$XXX.XX
|
Q3
|
5823
|
| 90832 |
Psytx w pt 30 minutes
|
$XXX.XX
|
Q3
|
5823
|
| 90834 |
Psytx w pt 45 minutes
|
$XXX.XX
|
Q3
|
5823
|
| 90837 |
Psytx w pt 60 minutes
|
$XXX.XX
|
Q3
|
5823
|
| 90839 |
Psytx crisis initial 60 min
|
$XXX.XX
|
Q3
|
5823
|
| 90845 |
Psychoanalysis
|
$XXX.XX
|
Q3
|
5823
|
| 90846 |
Family psytx w/o pt 50 min
|
$XXX.XX
|
Q3
|
5823
|
| 90847 |
Family psytx w/pt 50 min
|
$XXX.XX
|
Q3
|
5823
|
| 90849 |
Multiple family group psytx
|
$XXX.XX
|
Q3
|
5823
|
| 90853 |
Group psychotherapy
|
$XXX.XX
|
Q3
|
5822
|
| 90865 |
Narcosynthesis
|
$XXX.XX
|
Q3
|
5823
|
| 90867 |
Tcranial magn stim tx plan
|
$XXX.XX
|
S
|
5722
|
| 90868 |
Tcranial magn stim tx deli
|
$XXX.XX
|
S
|
5721
|
| 90869 |
Tcran magn stim redetemine
|
$XXX.XX
|
S
|
5721
|
| 90870 |
Electroconvulsive therapy
|
$XXX.XX
|
S
|
5723
|
| 90880 |
Hypnotherapy
|
$XXX.XX
|
Q3
|
5822
|
| 90899 |
Psychiatric service/therapy
|
$XXX.XX
|
Q3
|
5821
|
| 90935 |
Hemodialysis one evaluation
|
$XXX.XX
|
S
|
5401
|
| 90945 |
Dialysis one evaluation
|
$XXX.XX
|
V
|
5024
|
| 91010 |
Esophagus motility study
|
$XXX.XX
|
S
|
5723
|
| 91020 |
Gastric motility studies
|
$XXX.XX
|
S
|
5723
|
| 91022 |
Duodenal motility study
|
$XXX.XX
|
S
|
5723
|
| 91030 |
Acid perfusion of esophagus
|
$XXX.XX
|
S
|
5723
|
| 91034 |
Gastroesophageal reflux test
|
$XXX.XX
|
S
|
5723
|
| 91035 |
G-esoph reflx tst w/electrod
|
$XXX.XX
|
S
|
5723
|
| 91037 |
Esoph imped function test
|
$XXX.XX
|
S
|
5722
|
| 91038 |
Esoph imped funct test > 1hr
|
$XXX.XX
|
S
|
5723
|
| 91040 |
Esoph balloon distension tst
|
$XXX.XX
|
S
|
5723
|
| 91065 |
Breath hydrogen/methane test
|
$XXX.XX
|
S
|
5721
|
| 91110 |
Gi tract capsule endoscopy
|
$XXX.XX
|
T
|
5301
|
| 91111 |
Esophageal capsule endoscopy
|
$XXX.XX
|
T
|
5301
|
| 91112 |
Gi wireless capsule measure
|
$XXX.XX
|
T
|
5301
|
| 91117 |
Colon motility 6 hr study
|
$XXX.XX
|
T
|
5371
|
| 91120 |
Rectal sensation test
|
$XXX.XX
|
S
|
5721
|
| 91122 |
Anal pressure record
|
$XXX.XX
|
T
|
5371
|
| 91132 |
Electrogastrography
|
$XXX.XX
|
S
|
5721
|
| 91133 |
Electrogastrography w/test
|
$XXX.XX
|
Q1
|
5734
|
| 91200 |
Liver elastography
|
$XXX.XX
|
Q1
|
5721
|
| 91299 |
Gastroenterology procedure
|
$XXX.XX
|
S
|
5721
|
| 92002 |
Eye exam new patient
|
$XXX.XX
|
V
|
5012
|
| 92004 |
Eye exam new patient
|
$XXX.XX
|
V
|
5012
|
| 92012 |
Eye exam establish patient
|
$XXX.XX
|
V
|
5012
|
| 92014 |
Eye exam&tx estab pt 1/>vst
|
$XXX.XX
|
V
|
5012
|
| 92018 |
New eye exam & treatment
|
$XXX.XX
|
J1
|
5503
|
| 92019 |
Eye exam & treatment
|
$XXX.XX
|
J1
|
5503
|
| 92020 |
Special eye evaluation
|
$XXX.XX
|
Q1
|
5734
|
| 92025 |
Corneal topography
|
$XXX.XX
|
Q1
|
5733
|
| 92060 |
Special eye evaluation
|
$XXX.XX
|
Q1
|
5733
|
| 92065 |
Orthoptic/pleoptic training
|
$XXX.XX
|
Q1
|
5733
|
| 92081 |
Visual field examination(s)
|
$XXX.XX
|
Q1
|
5733
|
| 92082 |
Visual field examination(s)
|
$XXX.XX
|
Q1
|
5733
|
| 92083 |
Visual field examination(s)
|
$XXX.XX
|
Q1
|
5734
|
| 92132 |
Cmptr ophth dx img ant segmt
|
$XXX.XX
|
Q1
|
5733
|
| 92133 |
Cmptr ophth img optic nerve
|
$XXX.XX
|
Q1
|
5733
|
| 92134 |
Cptr ophth dx img post segmt
|
$XXX.XX
|
Q1
|
5733
|
| 92136 |
Ophthalmic biometry
|
$XXX.XX
|
Q1
|
5734
|
| 92145 |
Corneal hysteresis deter
|
$XXX.XX
|
Q1
|
5732
|
| 92201 |
Opscpy extnd rta draw uni/bi
|
$XXX.XX
|
Q1
|
5733
|
| 92202 |
Opscpy extnd on/mac draw
|
$XXX.XX
|
Q1
|
5733
|
| 92227 |
Remote dx retinal imaging
|
$XXX.XX
|
Q1
|
5732
|
| 92228 |
Remote retinal imaging mgmt
|
$XXX.XX
|
Q1
|
5732
|
| 92230 |
Eye exam with photos
|
$XXX.XX
|
Q1
|
5723
|
| 92235 |
Fluorescein angrph uni/bi
|
$XXX.XX
|
S
|
5722
|
| 92240 |
Icg angiography uni/bi
|
$XXX.XX
|
S
|
5722
|
| 92242 |
Fluorescein icg angiography
|
$XXX.XX
|
S
|
5722
|
| 92250 |
Eye exam with photos
|
$XXX.XX
|
Q1
|
5734
|
| 92260 |
Ophthalmoscopy/dynamometry
|
$XXX.XX
|
Q1
|
5732
|
| 92265 |
Eye muscle evaluation
|
$XXX.XX
|
Q1
|
5733
|
| 92270 |
Electro-oculography
|
$XXX.XX
|
Q1
|
5734
|
| 92273 |
Full field erg w/i&r
|
$XXX.XX
|
S
|
5722
|
| 92274 |
Multifocal erg w/i&r
|
$XXX.XX
|
S
|
5721
|
| 92283 |
Color vision examination
|
$XXX.XX
|
Q1
|
5733
|
| 92284 |
Dark adaptation eye exam
|
$XXX.XX
|
Q1
|
5735
|
| 92285 |
Eye photography
|
$XXX.XX
|
Q1
|
5733
|
| 92286 |
Internal eye photography
|
$XXX.XX
|
Q1
|
5734
|
| 92287 |
Internal eye photography
|
$XXX.XX
|
Q1
|
5734
|
| 92311 |
Contact lens fitting
|
$XXX.XX
|
Q1
|
5735
|
| 92312 |
Contact lens fitting
|
$XXX.XX
|
Q1
|
5734
|
| 92313 |
Contact lens fitting
|
$XXX.XX
|
Q1
|
5734
|
| 92315 |
Rx cntact lens aphakia 1 eye
|
$XXX.XX
|
Q1
|
5734
|
| 92316 |
Rx cntact lens aphakia 2 eye
|
$XXX.XX
|
Q1
|
5733
|
| 92317 |
Rx corneoscleral cntact lens
|
$XXX.XX
|
Q1
|
5732
|
| 92325 |
Modification of contact lens
|
$XXX.XX
|
Q1
|
5734
|
| 92326 |
Replacement of contact lens
|
$XXX.XX
|
Q1
|
5733
|
| 92352 |
Fit aphakia spectcl monofocl
|
$XXX.XX
|
Q1
|
5733
|
| 92353 |
Fit aphakia spectcl multifoc
|
$XXX.XX
|
Q1
|
5733
|
| 92354 |
Fit spectacles single system
|
$XXX.XX
|
Q1
|
5732
|
| 92355 |
Fit spectacles compound lens
|
$XXX.XX
|
Q1
|
5732
|
| 92358 |
Aphakia prosth service temp
|
$XXX.XX
|
Q1
|
5733
|
| 92371 |
Repair & adjust spectacles
|
$XXX.XX
|
Q1
|
5733
|
| 92499 |
Eye service or procedure
|
$XXX.XX
|
Q1
|
5731
|
| 92502 |
Ear and throat examination
|
$XXX.XX
|
T
|
5162
|
| 92511 |
Nasopharyngoscopy
|
$XXX.XX
|
T
|
5151
|
| 92512 |
Nasal function studies
|
$XXX.XX
|
S
|
5722
|
| 92516 |
Facial nerve function test
|
$XXX.XX
|
S
|
5721
|
| 92520 |
Laryngeal function studies
|
$XXX.XX
|
Q1
|
5734
|
| 92537 |
Caloric vstblr test w/rec
|
$XXX.XX
|
S
|
5721
|
| 92538 |
Caloric vstblr test w/rec
|
$XXX.XX
|
S
|
5721
|
| 92540 |
Basic vestibular evaluation
|
$XXX.XX
|
S
|
5721
|
| 92541 |
Spontaneous nystagmus test
|
$XXX.XX
|
Q1
|
5734
|
| 92542 |
Positional nystagmus test
|
$XXX.XX
|
Q1
|
5734
|
| 92544 |
Optokinetic nystagmus test
|
$XXX.XX
|
S
|
5721
|
| 92545 |
Oscillating tracking test
|
$XXX.XX
|
S
|
5721
|
| 92546 |
Sinusoidal rotational test
|
$XXX.XX
|
S
|
5721
|
| 92548 |
Cdp-sot 6 cond w/i&r
|
$XXX.XX
|
Q1
|
5734
|
| 92549 |
Cdp-sot 6 cond w/i&r mct&adt
|
$XXX.XX
|
Q1
|
5734
|
| 92550 |
Tympanometry & reflex thresh
|
$XXX.XX
|
Q1
|
5721
|
| 92552 |
Pure tone audiometry air
|
$XXX.XX
|
Q1
|
5734
|
| 92553 |
Audiometry air & bone
|
$XXX.XX
|
Q1
|
5721
|
| 92555 |
Speech threshold audiometry
|
$XXX.XX
|
Q1
|
5732
|
| 92556 |
Speech audiometry complete
|
$XXX.XX
|
Q1
|
5732
|
| 92557 |
Comprehensive hearing test
|
$XXX.XX
|
Q1
|
5721
|
| 92561 |
Bekesy audiometry diagnosis
|
$XXX.XX
|
Q1
|
5734
|
| 92562 |
Loudness balance test
|
$XXX.XX
|
Q1
|
5721
|
| 92563 |
Tone decay hearing test
|
$XXX.XX
|
Q1
|
5732
|
| 92564 |
Sisi hearing test
|
$XXX.XX
|
Q1
|
5731
|
| 92565 |
Stenger test pure tone
|
$XXX.XX
|
Q1
|
5732
|
| 92567 |
Tympanometry
|
$XXX.XX
|
Q1
|
5732
|
| 92568 |
Acoustic refl threshold tst
|
$XXX.XX
|
Q1
|
5732
|
| 92570 |
Acoustic immitance testing
|
$XXX.XX
|
Q1
|
5721
|
| 92571 |
Filtered speech hearing test
|
$XXX.XX
|
Q1
|
5732
|
| 92572 |
Staggered spondaic word test
|
$XXX.XX
|
Q1
|
5721
|
| 92575 |
Sensorineural acuity test
|
$XXX.XX
|
Q1
|
5732
|
| 92576 |
Synthetic sentence test
|
$XXX.XX
|
Q1
|
5732
|
| 92577 |
Stenger test speech
|
$XXX.XX
|
Q1
|
5723
|
| 92579 |
Visual audiometry (vra)
|
$XXX.XX
|
Q1
|
5721
|
| 92582 |
Conditioning play audiometry
|
$XXX.XX
|
Q1
|
5721
|
| 92583 |
Select picture audiometry
|
$XXX.XX
|
Q1
|
5732
|
| 92584 |
Electrocochleography
|
$XXX.XX
|
S
|
5721
|
| 92585 |
Auditor evoke potent compre
|
$XXX.XX
|
S
|
5722
|
| 92586 |
Auditor evoke potent limit
|
$XXX.XX
|
S
|
5721
|
| 92587 |
Evoked auditory test limited
|
$XXX.XX
|
S
|
5722
|
| 92588 |
Evoked auditory tst complete
|
$XXX.XX
|
S
|
5722
|
| 92596 |
Ear protector evaluation
|
$XXX.XX
|
Q1
|
5732
|
| 92601 |
Cochlear implt f/up exam <7
|
$XXX.XX
|
S
|
5721
|
| 92602 |
Reprogram cochlear implt <7
|
$XXX.XX
|
S
|
5721
|
| 92603 |
Cochlear implt f/up exam 7/>
|
$XXX.XX
|
S
|
5721
|
| 92604 |
Reprogram cochlear implt 7/>
|
$XXX.XX
|
S
|
5721
|
| 92620 |
Auditory function 60 min
|
$XXX.XX
|
Q1
|
5721
|
| 92625 |
Tinnitus assessment
|
$XXX.XX
|
Q1
|
5721
|
| 92626 |
Eval aud funcj 1st hour
|
$XXX.XX
|
Q1
|
5721
|
| 92640 |
Aud brainstem implt programg
|
$XXX.XX
|
S
|
5721
|
| 92700 |
Ent procedure/service
|
$XXX.XX
|
Q1
|
5731
|
| 92920 |
Prq cardiac angioplast 1 art
|
$XXX.XX
|
J1
|
5192
|
| 92924 |
Prq card angio/athrect 1 art
|
$XXX.XX
|
J1
|
5193
|
| 92928 |
Prq card stent w/angio 1 vsl
|
$XXX.XX
|
J1
|
5193
|
| 92933 |
Prq card stent/ath/angio
|
$XXX.XX
|
J1
|
5194
|
| 92937 |
Prq revasc byp graft 1 vsl
|
$XXX.XX
|
J1
|
5193
|
| 92943 |
Prq card revasc chronic 1vsl
|
$XXX.XX
|
J1
|
5193
|
| 92950 |
Heart/lung resuscitation cpr
|
$XXX.XX
|
S
|
5722
|
| 92953 |
Temporary external pacing
|
$XXX.XX
|
Q3
|
5781
|
| 92960 |
Cardioversion electric ext
|
$XXX.XX
|
S
|
5781
|
| 92961 |
Cardioversion electric int
|
$XXX.XX
|
S
|
5781
|
| 92977 |
Dissolve clot heart vessel
|
$XXX.XX
|
T
|
5694
|
| 92986 |
Revision of aortic valve
|
$XXX.XX
|
J1
|
5192
|
| 92987 |
Revision of mitral valve
|
$XXX.XX
|
J1
|
5193
|
| 92990 |
Revision of pulmonary valve
|
$XXX.XX
|
J1
|
5193
|
| 92997 |
Pul art balloon repr percut
|
$XXX.XX
|
J1
|
5193
|
| 93005 |
Electrocardiogram tracing
|
$XXX.XX
|
Q1
|
5733
|
| 93017 |
Cardiovascular stress test
|
$XXX.XX
|
Q1
|
5722
|
| 93024 |
Cardiac drug stress test
|
$XXX.XX
|
Q1
|
5735
|
| 93025 |
Microvolt t-wave assess
|
$XXX.XX
|
S
|
5721
|
| 93041 |
Rhythm ecg tracing
|
$XXX.XX
|
Q1
|
5733
|
| 93050 |
Art pressure waveform analys
|
$XXX.XX
|
Q1
|
5731
|
| 93225 |
Ecg monit/reprt up to 48 hrs
|
$XXX.XX
|
Q1
|
5734
|
| 93226 |
Ecg monit/reprt up to 48 hrs
|
$XXX.XX
|
Q1
|
5734
|
| 93229 |
Remote 30 day ecg tech supp
|
$XXX.XX
|
S
|
5721
|
| 93260 |
Prgrmg dev eval impltbl sys
|
$XXX.XX
|
Q1
|
5741
|
| 93261 |
Interrogate subq defib
|
$XXX.XX
|
Q1
|
5741
|
| 93270 |
Remote 30 day ecg rev/report
|
$XXX.XX
|
Q1
|
5741
|
| 93271 |
Ecg/monitoring and analysis
|
$XXX.XX
|
S
|
5742
|
| 93278 |
Ecg/signal-averaged
|
$XXX.XX
|
Q1
|
5733
|
| 93279 |
Prgrmg dev eval pm/ldls pm
|
$XXX.XX
|
Q1
|
5741
|
| 93280 |
Pm device progr eval dual
|
$XXX.XX
|
Q1
|
5741
|
| 93281 |
Pm device progr eval multi
|
$XXX.XX
|
Q1
|
5741
|
| 93282 |
Prgrmg eval implantable dfb
|
$XXX.XX
|
Q1
|
5741
|
| 93283 |
Prgrmg eval implantable dfb
|
$XXX.XX
|
Q1
|
5741
|
| 93284 |
Prgrmg eval implantable dfb
|
$XXX.XX
|
Q1
|
5741
|
| 93285 |
Prgrmg dev eval scrms ip
|
$XXX.XX
|
Q1
|
5741
|
| 93288 |
Interrog evl pm/ldls pm ip
|
$XXX.XX
|
Q1
|
5741
|
| 93289 |
Interrog device eval heart
|
$XXX.XX
|
Q1
|
5741
|
| 93290 |
Interrog dev eval icpms ip
|
$XXX.XX
|
Q1
|
5741
|
| 93291 |
Interrog dev eval scrms ip
|
$XXX.XX
|
Q1
|
5731
|
| 93292 |
Wcd device interrogate
|
$XXX.XX
|
Q1
|
5741
|
| 93293 |
Pm phone r-strip device eval
|
$XXX.XX
|
Q1
|
5741
|
| 93296 |
Rem interrog evl pm/ids
|
$XXX.XX
|
Q1
|
5741
|
| 93303 |
Echo transthoracic
|
$XXX.XX
|
S
|
5524
|
| 93304 |
Echo transthoracic
|
$XXX.XX
|
S
|
5524
|
| 93306 |
Tte w/doppler complete
|
$XXX.XX
|
S
|
5524
|
| 93307 |
Tte w/o doppler complete
|
$XXX.XX
|
S
|
5523
|
| 93308 |
Tte f-up or lmtd
|
$XXX.XX
|
S
|
5523
|
| 93312 |
Echo transesophageal
|
$XXX.XX
|
S
|
5524
|
| 93313 |
Echo transesophageal
|
$XXX.XX
|
S
|
5524
|
| 93315 |
Echo transesophageal
|
$XXX.XX
|
S
|
5524
|
| 93316 |
Echo transesophageal
|
$XXX.XX
|
S
|
5524
|
| 93318 |
Echo transesophageal intraop
|
$XXX.XX
|
S
|
5524
|
| 93350 |
Stress tte only
|
$XXX.XX
|
S
|
5524
|
| 93351 |
Stress tte complete
|
$XXX.XX
|
S
|
5524
|
| 93451 |
Right heart cath
|
$XXX.XX
|
J1
|
5191
|
| 93452 |
Left hrt cath w/ventrclgrphy
|
$XXX.XX
|
J1
|
5191
|
| 93453 |
R&l hrt cath w/ventriclgrphy
|
$XXX.XX
|
J1
|
5191
|
| 93454 |
Coronary artery angio s&i
|
$XXX.XX
|
J1
|
5191
|
| 93455 |
Coronary art/grft angio s&i
|
$XXX.XX
|
J1
|
5191
|
| 93456 |
R hrt coronary artery angio
|
$XXX.XX
|
J1
|
5191
|
| 93457 |
R hrt art/grft angio
|
$XXX.XX
|
J1
|
5191
|
| 93458 |
L hrt artery/ventricle angio
|
$XXX.XX
|
J1
|
5191
|
| 93459 |
L hrt art/grft angio
|
$XXX.XX
|
J1
|
5191
|
| 93460 |
R&l hrt art/ventricle angio
|
$XXX.XX
|
J1
|
5191
|
| 93461 |
R&l hrt art/ventricle angio
|
$XXX.XX
|
J1
|
5191
|
| 93503 |
Insert/place heart catheter
|
$XXX.XX
|
J1
|
5182
|
| 93505 |
Biopsy of heart lining
|
$XXX.XX
|
J1
|
5183
|
| 93530 |
Rt heart cath congenital
|
$XXX.XX
|
J1
|
5191
|
| 93531 |
R & l heart cath congenital
|
$XXX.XX
|
J1
|
5191
|
| 93532 |
R & l heart cath congenital
|
$XXX.XX
|
J1
|
5191
|
| 93533 |
R & l heart cath congenital
|
$XXX.XX
|
J1
|
5191
|
| 93580 |
Transcath closure of asd
|
$XXX.XX
|
J1
|
5194
|
| 93581 |
Transcath closure of vsd
|
$XXX.XX
|
J1
|
5194
|
| 93582 |
Perq transcath closure pda
|
$XXX.XX
|
J1
|
5194
|
| 93590 |
Perq transcath cls mitral
|
$XXX.XX
|
J1
|
5194
|
| 93591 |
Perq transcath cls aortic
|
$XXX.XX
|
J1
|
5194
|
| 93600 |
Bundle of his recording
|
$XXX.XX
|
J1
|
5212
|
| 93602 |
Intra-atrial recording
|
$XXX.XX
|
J1
|
5212
|
| 93603 |
Right ventricular recording
|
$XXX.XX
|
J1
|
5211
|
| 93610 |
Intra-atrial pacing
|
$XXX.XX
|
J1
|
5212
|
| 93612 |
Intraventricular pacing
|
$XXX.XX
|
J1
|
5212
|
| 93615 |
Esophageal recording
|
$XXX.XX
|
J1
|
5211
|
| 93616 |
Esophageal recording
|
$XXX.XX
|
J1
|
5211
|
| 93618 |
Heart rhythm pacing
|
$XXX.XX
|
J1
|
5211
|
| 93619 |
Electrophysiology evaluation
|
$XXX.XX
|
J1
|
5212
|
| 93620 |
Electrophysiology evaluation
|
$XXX.XX
|
J1
|
5212
|
| 93624 |
Electrophysiologic study
|
$XXX.XX
|
J1
|
5212
|
| 93642 |
Electrophysiology evaluation
|
$XXX.XX
|
J1
|
5211
|
| 93650 |
Ablate heart dysrhythm focus
|
$XXX.XX
|
J1
|
5212
|
| 93653 |
Ep & ablate supravent arrhyt
|
$XXX.XX
|
J1
|
5213
|
| 93654 |
Ep & ablate ventric tachy
|
$XXX.XX
|
J1
|
5213
|
| 93656 |
Tx atrial fib pulm vein isol
|
$XXX.XX
|
J1
|
5213
|
| 93660 |
Tilt table evaluation
|
$XXX.XX
|
S
|
5723
|
| 93668 |
Peripheral vascular rehab
|
$XXX.XX
|
S
|
5733
|
| 93701 |
Bioimpedance cv analysis
|
$XXX.XX
|
Q1
|
5734
|
| 93702 |
Bis xtracell fluid analysis
|
$XXX.XX
|
S
|
5721
|
| 93724 |
Analyze pacemaker system
|
$XXX.XX
|
S
|
5743
|
| 93740 |
Temperature gradient studies
|
$XXX.XX
|
Q1
|
5721
|
| 93745 |
Set-up cardiovert-defibrill
|
$XXX.XX
|
S
|
5743
|
| 93750 |
Interrogation vad in person
|
$XXX.XX
|
S
|
5742
|
| 93786 |
Ambl bp mntr w/sw rec only
|
$XXX.XX
|
Q1
|
5734
|
| 93788 |
Ambl bp mntr w/sw a/r
|
$XXX.XX
|
Q1
|
5734
|
| 93797 |
Cardiac rehab
|
$XXX.XX
|
S
|
5771
|
| 93798 |
Cardiac rehab/monitor
|
$XXX.XX
|
S
|
5771
|
| 93799 |
Cardiovascular procedure
|
$XXX.XX
|
S
|
5721
|
| 93880 |
Extracranial bilat study
|
$XXX.XX
|
S
|
5523
|
| 93882 |
Extracranial uni/ltd study
|
$XXX.XX
|
S
|
5522
|
| 93886 |
Intracranial complete study
|
$XXX.XX
|
S
|
5523
|
| 93888 |
Intracranial limited study
|
$XXX.XX
|
S
|
5522
|
| 93890 |
Tcd vasoreactivity study
|
$XXX.XX
|
Q1
|
5523
|
| 93892 |
Tcd emboli detect w/o inj
|
$XXX.XX
|
Q1
|
5522
|
| 93893 |
Tcd emboli detect w/inj
|
$XXX.XX
|
Q1
|
5522
|
| 93922 |
Upr/l xtremity art 2 levels
|
$XXX.XX
|
Q1
|
5734
|
| 93923 |
Upr/lxtr art stdy 3+ lvls
|
$XXX.XX
|
S
|
5721
|
| 93924 |
Lwr xtr vasc stdy bilat
|
$XXX.XX
|
S
|
5721
|
| 93925 |
Lower extremity study
|
$XXX.XX
|
S
|
5523
|
| 93926 |
Lower extremity study
|
$XXX.XX
|
S
|
5522
|
| 93930 |
Upper extremity study
|
$XXX.XX
|
S
|
5523
|
| 93931 |
Upper extremity study
|
$XXX.XX
|
S
|
5522
|
| 93970 |
Extremity study
|
$XXX.XX
|
S
|
5523
|
| 93971 |
Extremity study
|
$XXX.XX
|
S
|
5522
|
| 93975 |
Vascular study
|
$XXX.XX
|
S
|
5523
|
| 93976 |
Vascular study
|
$XXX.XX
|
S
|
5522
|
| 93978 |
Vascular study
|
$XXX.XX
|
S
|
5523
|
| 93979 |
Vascular study
|
$XXX.XX
|
Q1
|
5522
|
| 93980 |
Penile vascular study
|
$XXX.XX
|
S
|
5522
|
| 93981 |
Penile vascular study
|
$XXX.XX
|
S
|
5522
|
| 93985 |
Dup-scan hemo compl bi std
|
$XXX.XX
|
S
|
5523
|
| 93986 |
Dup-scan hemo compl uni std
|
$XXX.XX
|
S
|
5522
|
| 93990 |
Doppler flow testing
|
$XXX.XX
|
Q1
|
5522
|
| 93998 |
Noninvas vasc dx study proc
|
$XXX.XX
|
Q1
|
5731
|
| 94002 |
Vent mgmt inpat init day
|
$XXX.XX
|
Q3
|
5801
|
| 94003 |
Vent mgmt inpat subq day
|
$XXX.XX
|
Q3
|
5801
|
| 94010 |
Breathing capacity test
|
$XXX.XX
|
Q1
|
5721
|
| 94011 |
Spirometry up to 2 yrs old
|
$XXX.XX
|
Q1
|
5721
|
| 94012 |
Spirmtry w/brnchdil inf-2 yr
|
$XXX.XX
|
Q1
|
5722
|
| 94013 |
Meas lung vol thru 2 yrs
|
$XXX.XX
|
S
|
5723
|
| 94014 |
Patient recorded spirometry
|
$XXX.XX
|
Q1
|
5735
|
| 94015 |
Patient recorded spirometry
|
$XXX.XX
|
Q1
|
5722
|
| 94060 |
Evaluation of wheezing
|
$XXX.XX
|
S
|
5722
|
| 94070 |
Evaluation of wheezing
|
$XXX.XX
|
S
|
5722
|
| 94150 |
Vital capacity test
|
$XXX.XX
|
Q1
|
5721
|
| 94200 |
Lung function test (mbc/mvv)
|
$XXX.XX
|
Q1
|
5733
|
| 94250 |
Expired gas collection
|
$XXX.XX
|
Q1
|
5733
|
| 94375 |
Respiratory flow volume loop
|
$XXX.XX
|
Q1
|
5722
|
| 94400 |
Co2 breathing response curve
|
$XXX.XX
|
Q1
|
5721
|
| 94450 |
Hypoxia response curve
|
$XXX.XX
|
Q1
|
5721
|
| 94452 |
Hast w/report
|
$XXX.XX
|
Q1
|
5734
|
| 94453 |
Hast w/oxygen titrate
|
$XXX.XX
|
Q1
|
5734
|
| 94610 |
Surfactant admin thru tube
|
$XXX.XX
|
Q1
|
5791
|
| 94617 |
Exercise tst brncspsm
|
$XXX.XX
|
Q1
|
5734
|
| 94618 |
Pulmonary stress testing
|
$XXX.XX
|
Q1
|
5734
|
| 94621 |
Cardiopulm exercise testing
|
$XXX.XX
|
S
|
5722
|
| 94640 |
Airway inhalation treatment
|
$XXX.XX
|
Q1
|
5791
|
| 94642 |
Aerosol inhalation treatment
|
$XXX.XX
|
Q1
|
5791
|
| 94644 |
Cbt 1st hour
|
$XXX.XX
|
Q1
|
5734
|
| 94660 |
Pos airway pressure cpap
|
$XXX.XX
|
Q1
|
5791
|
| 94662 |
Neg press ventilation cnp
|
$XXX.XX
|
Q3
|
5801
|
| 94664 |
Evaluate pt use of inhaler
|
$XXX.XX
|
Q1
|
5791
|
| 94667 |
Chest wall manipulation
|
$XXX.XX
|
Q1
|
5734
|
| 94668 |
Chest wall manipulation
|
$XXX.XX
|
Q1
|
5734
|
| 94669 |
Mechanical chest wall oscill
|
$XXX.XX
|
Q1
|
5791
|
| 94680 |
Exhaled air analysis o2
|
$XXX.XX
|
Q1
|
5721
|
| 94681 |
Exhaled air analysis o2/co2
|
$XXX.XX
|
Q1
|
5722
|
| 94690 |
Exhaled air analysis
|
$XXX.XX
|
Q1
|
5732
|
| 94726 |
Pulm funct tst plethysmograp
|
$XXX.XX
|
Q1
|
5722
|
| 94727 |
Pulm function test by gas
|
$XXX.XX
|
Q1
|
5721
|
| 94728 |
Airwy resist by oscillometry
|
$XXX.XX
|
Q1
|
5722
|
| 94750 |
Pulmonary compliance study
|
$XXX.XX
|
Q1
|
5721
|
| 94762 |
Measure blood oxygen level
|
$XXX.XX
|
Q3
|
5721
|
| 94770 |
Exhaled carbon dioxide test
|
$XXX.XX
|
S
|
5721
|
| 94772 |
Breath recording infant
|
$XXX.XX
|
S
|
5723
|
| 94775 |
Ped home apnea rec hk-up
|
$XXX.XX
|
S
|
5721
|
| 94776 |
Ped home apnea rec downld
|
$XXX.XX
|
S
|
5721
|
| 94780 |
Cars/bd tst inft-12mo 60 min
|
$XXX.XX
|
Q1
|
5732
|
| 94799 |
Pulmonary service/procedure
|
$XXX.XX
|
Q1
|
5721
|
| 95004 |
Percut allergy skin tests
|
$XXX.XX
|
Q1
|
5724
|
| 95012 |
Exhaled nitric oxide meas
|
$XXX.XX
|
Q1
|
5732
|
| 95017 |
Perq & icut allg test venoms
|
$XXX.XX
|
Q1
|
5731
|
| 95018 |
Perq&ic allg test drugs/biol
|
$XXX.XX
|
Q1
|
5732
|
| 95024 |
Icut allergy test drug/bug
|
$XXX.XX
|
Q1
|
5733
|
| 95027 |
Icut allergy titrate-airborn
|
$XXX.XX
|
Q1
|
5731
|
| 95028 |
Icut allergy test-delayed
|
$XXX.XX
|
Q1
|
5732
|
| 95044 |
Allergy patch tests
|
$XXX.XX
|
Q1
|
5724
|
| 95052 |
Photo patch test
|
$XXX.XX
|
Q1
|
5732
|
| 95056 |
Photosensitivity tests
|
$XXX.XX
|
Q1
|
5734
|
| 95060 |
Eye allergy tests
|
$XXX.XX
|
Q1
|
5734
|
| 95065 |
Nose allergy test
|
$XXX.XX
|
Q1
|
5732
|
| 95070 |
Bronchial allergy tests
|
$XXX.XX
|
S
|
5723
|
| 95071 |
Bronchial allergy tests
|
$XXX.XX
|
Q1
|
5722
|
| 95076 |
Ingest challenge ini 120 min
|
$XXX.XX
|
S
|
5723
|
| 95115 |
Immunotherapy one injection
|
$XXX.XX
|
Q1
|
5691
|
| 95117 |
Immunotherapy injections
|
$XXX.XX
|
Q1
|
5691
|
| 95144 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5691
|
| 95145 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5691
|
| 95146 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5691
|
| 95147 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5692
|
| 95148 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5692
|
| 95149 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5692
|
| 95165 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5691
|
| 95170 |
Antigen therapy services
|
$XXX.XX
|
Q1
|
5691
|
| 95180 |
Rapid desensitization
|
$XXX.XX
|
Q1
|
5735
|
| 95199 |
Allergy immunology services
|
$XXX.XX
|
Q1
|
5731
|
| 95249 |
Cont gluc mntr pt prov eqp
|
$XXX.XX
|
S
|
5733
|
| 95250 |
Cont gluc mntr phys/qhp eqp
|
$XXX.XX
|
V
|
5012
|
| 95700 |
Eeg cont rec w/vid eeg tech
|
$XXX.XX
|
S
|
5722
|
| 95705 |
Eeg w/o vid 2-12 hr unmntr
|
$XXX.XX
|
S
|
5722
|
| 95706 |
Eeg wo vid 2-12hr intmt mntr
|
$XXX.XX
|
S
|
5722
|
| 95707 |
Eeg w/o vid 2-12hr cont mntr
|
$XXX.XX
|
S
|
5722
|
| 95708 |
Eeg wo vid ea 12-26hr unmntr
|
$XXX.XX
|
S
|
5723
|
| 95709 |
Eeg w/o vid ea 12-26hr intmt
|
$XXX.XX
|
S
|
5723
|
| 95710 |
Eeg w/o vid ea 12-26hr cont
|
$XXX.XX
|
S
|
5723
|
| 95711 |
Veeg 2-12 hr unmonitored
|
$XXX.XX
|
S
|
5722
|
| 95712 |
Veeg 2-12 hr intmt mntr
|
$XXX.XX
|
S
|
5722
|
| 95713 |
Veeg 2-12 hr cont mntr
|
$XXX.XX
|
S
|
5723
|
| 95714 |
Veeg ea 12-26 hr unmntr
|
$XXX.XX
|
S
|
5723
|
| 95715 |
Veeg ea 12-26hr intmt mntr
|
$XXX.XX
|
S
|
5723
|
| 95716 |
Veeg ea 12-26hr cont mntr
|
$XXX.XX
|
S
|
5724
|
| 95782 |
Polysom <6 yrs 4/> paramtrs
|
$XXX.XX
|
S
|
5724
|
| 95783 |
Polysom <6 yrs cpap/bilvl
|
$XXX.XX
|
S
|
5724
|
| 95800 |
Slp stdy unattended
|
$XXX.XX
|
S
|
5721
|
| 95801 |
Slp stdy unatnd w/anal
|
$XXX.XX
|
Q1
|
5734
|
| 95803 |
Actigraphy testing
|
$XXX.XX
|
Q1
|
5733
|
| 95805 |
Multiple sleep latency test
|
$XXX.XX
|
S
|
5723
|
| 95806 |
Sleep study unatt&resp efft
|
$XXX.XX
|
S
|
5721
|
| 95807 |
Sleep study attended
|
$XXX.XX
|
S
|
5723
|
| 95808 |
Polysom any age 1-3> param
|
$XXX.XX
|
S
|
5724
|
| 95810 |
Polysom 6/> yrs 4/> param
|
$XXX.XX
|
S
|
5724
|
| 95811 |
Polysom 6/>yrs cpap 4/> parm
|
$XXX.XX
|
S
|
5724
|
| 95812 |
Eeg 41-60 minutes
|
$XXX.XX
|
S
|
5722
|
| 95813 |
Eeg extnd mntr 61-119 min
|
$XXX.XX
|
S
|
5722
|
| 95816 |
Eeg awake and drowsy
|
$XXX.XX
|
S
|
5722
|
| 95819 |
Eeg awake and asleep
|
$XXX.XX
|
S
|
5722
|
| 95822 |
Eeg coma or sleep only
|
$XXX.XX
|
S
|
5722
|
| 95824 |
Eeg cerebral death only
|
$XXX.XX
|
S
|
5723
|
| 95836 |
Ecog impltd brn npgt <30 d
|
$XXX.XX
|
Q1
|
5741
|
| 95857 |
Cholinesterase challenge
|
$XXX.XX
|
S
|
5722
|
| 95860 |
Muscle test one limb
|
$XXX.XX
|
Q1
|
5734
|
| 95861 |
Muscle test 2 limbs
|
$XXX.XX
|
Q1
|
5734
|
| 95863 |
Muscle test 3 limbs
|
$XXX.XX
|
S
|
5721
|
| 95864 |
Muscle test 4 limbs
|
$XXX.XX
|
S
|
5721
|
| 95865 |
Muscle test larynx
|
$XXX.XX
|
Q1
|
5734
|
| 95866 |
Muscle test hemidiaphragm
|
$XXX.XX
|
Q1
|
5721
|
| 95867 |
Muscle test cran nerv unilat
|
$XXX.XX
|
S
|
5721
|
| 95868 |
Muscle test cran nerve bilat
|
$XXX.XX
|
S
|
5721
|
| 95869 |
Muscle test thor paraspinal
|
$XXX.XX
|
Q1
|
5721
|
| 95870 |
Muscle test nonparaspinal
|
$XXX.XX
|
Q1
|
5733
|
| 95872 |
Muscle test one fiber
|
$XXX.XX
|
S
|
5721
|
| 95875 |
Limb exercise test
|
$XXX.XX
|
S
|
5721
|
| 95905 |
Motor &/ sens nrve cndj test
|
$XXX.XX
|
Q1
|
5734
|
| 95907 |
Nvr cndj tst 1-2 studies
|
$XXX.XX
|
S
|
5721
|
| 95908 |
Nrv cndj tst 3-4 studies
|
$XXX.XX
|
S
|
5722
|
| 95909 |
Nrv cndj tst 5-6 studies
|
$XXX.XX
|
S
|
5722
|
| 95910 |
Nrv cndj test 7-8 studies
|
$XXX.XX
|
S
|
5722
|
| 95911 |
Nrv cndj test 9-10 studies
|
$XXX.XX
|
S
|
5723
|
| 95912 |
Nrv cndj test 11-12 studies
|
$XXX.XX
|
S
|
5723
|
| 95913 |
Nrv cndj test 13/> studies
|
$XXX.XX
|
S
|
5723
|
| 95921 |
Autonomic nrv parasym inervj
|
$XXX.XX
|
S
|
5721
|
| 95922 |
Autonomic nrv adrenrg inervj
|
$XXX.XX
|
Q1
|
5734
|
| 95923 |
Autonomic nrv syst funj test
|
$XXX.XX
|
Q1
|
5734
|
| 95924 |
Ans parasymp & symp w/tilt
|
$XXX.XX
|
S
|
5721
|
| 95925 |
Somatosensory testing
|
$XXX.XX
|
S
|
5722
|
| 95926 |
Somatosensory testing
|
$XXX.XX
|
S
|
5722
|
| 95927 |
Somatosensory testing
|
$XXX.XX
|
S
|
5721
|
| 95928 |
C motor evoked uppr limbs
|
$XXX.XX
|
S
|
5724
|
| 95929 |
C motor evoked lwr limbs
|
$XXX.XX
|
S
|
5723
|
| 95930 |
Visual ep test cns w/i&r
|
$XXX.XX
|
S
|
5721
|
| 95933 |
Blink reflex test
|
$XXX.XX
|
Q1
|
5733
|
| 95937 |
Neuromuscular junction test
|
$XXX.XX
|
S
|
5721
|
| 95938 |
Somatosensory testing
|
$XXX.XX
|
S
|
5723
|
| 95939 |
C motor evoked upr&lwr limbs
|
$XXX.XX
|
S
|
5724
|
| 95943 |
Parasymp&symp hrt rate test
|
$XXX.XX
|
S
|
5721
|
| 95954 |
Eeg monitoring/giving drugs
|
$XXX.XX
|
S
|
5723
|
| 95958 |
Eeg monitoring/function test
|
$XXX.XX
|
S
|
5724
|
| 95961 |
Electrode stimulation brain
|
$XXX.XX
|
S
|
5724
|
| 95965 |
Meg spontaneous
|
$XXX.XX
|
S
|
5724
|
| 95966 |
Meg evoked single
|
$XXX.XX
|
S
|
5724
|
| 95970 |
Alys npgt w/o prgrmg
|
$XXX.XX
|
Q1
|
5734
|
| 95971 |
Alys smpl sp/pn npgt w/prgrm
|
$XXX.XX
|
S
|
5742
|
| 95972 |
Alys cplx sp/pn npgt w/prgrm
|
$XXX.XX
|
S
|
5742
|
| 95976 |
Alys smpl cn npgt prgrmg
|
$XXX.XX
|
S
|
5741
|
| 95977 |
Alys cplx cn npgt prgrmg
|
$XXX.XX
|
S
|
5742
|
| 95981 |
Io anal gast n-stim subsq
|
$XXX.XX
|
Q1
|
5734
|
| 95982 |
Io ga n-stim subsq w/reprog
|
$XXX.XX
|
Q1
|
5741
|
| 95983 |
Alys brn npgt prgrmg 15 min
|
$XXX.XX
|
S
|
5742
|
| 95990 |
Spin/brain pump refil & main
|
$XXX.XX
|
S
|
5694
|
| 95991 |
Spin/brain pump refil & main
|
$XXX.XX
|
T
|
5441
|
| 95999 |
Neurological procedure
|
$XXX.XX
|
Q1
|
5721
|
| 96000 |
Motion analysis video/3d
|
$XXX.XX
|
S
|
5723
|
| 96001 |
Motion test w/ft press meas
|
$XXX.XX
|
S
|
5724
|
| 96002 |
Dynamic surface emg
|
$XXX.XX
|
S
|
5721
|
| 96003 |
Dynamic fine wire emg
|
$XXX.XX
|
Q1
|
5722
|
| 96112 |
Devel tst phys/qhp 1st hr
|
$XXX.XX
|
Q3
|
5721
|
| 96116 |
Nubhvl xm phys/qhp 1st hr
|
$XXX.XX
|
Q3
|
5722
|
| 96127 |
Brief emotional/behav assmt
|
$XXX.XX
|
Q1
|
5732
|
| 96130 |
Psycl tst eval phys/qhp 1st
|
$XXX.XX
|
Q3
|
5721
|
| 96132 |
Nrpsyc tst eval phys/qhp 1st
|
$XXX.XX
|
Q3
|
5721
|
| 96136 |
Psycl/nrpsyc tst phy/qhp 1st
|
$XXX.XX
|
Q3
|
5731
|
| 96138 |
Psycl/nrpsyc tech 1st
|
$XXX.XX
|
Q3
|
5731
|
| 96146 |
Psycl/nrpsyc tst auto result
|
$XXX.XX
|
Q3
|
5731
|
| 96156 |
Hlth bhv assmt/reassessment
|
$XXX.XX
|
Q3
|
5822
|
| 96158 |
Hlth bhv ivntj indiv 1st 30
|
$XXX.XX
|
Q3
|
5822
|
| 96160 |
Pt-focused hlth risk assmt
|
$XXX.XX
|
S
|
5821
|
| 96161 |
Caregiver health risk assmt
|
$XXX.XX
|
S
|
5821
|
| 96164 |
Hlth bhv ivntj grp 1st 30
|
$XXX.XX
|
Q3
|
5821
|
| 96167 |
Hlth bhv ivntj fam 1st 30
|
$XXX.XX
|
Q3
|
5821
|
| 96360 |
Hydration iv infusion init
|
$XXX.XX
|
S
|
5693
|
| 96361 |
Hydrate iv infusion add-on
|
$XXX.XX
|
S
|
5691
|
| 96365 |
Ther/proph/diag iv inf init
|
$XXX.XX
|
S
|
5693
|
| 96366 |
Ther/proph/diag iv inf addon
|
$XXX.XX
|
S
|
5691
|
| 96367 |
Tx/proph/dg addl seq iv inf
|
$XXX.XX
|
S
|
5692
|
| 96369 |
Sc ther infusion up to 1 hr
|
$XXX.XX
|
S
|
5693
|
| 96370 |
Sc ther infusion addl hr
|
$XXX.XX
|
S
|
5691
|
| 96371 |
Sc ther infusion reset pump
|
$XXX.XX
|
Q1
|
5692
|
| 96372 |
Ther/proph/diag inj sc/im
|
$XXX.XX
|
Q1
|
5692
|
| 96373 |
Ther/proph/diag inj ia
|
$XXX.XX
|
S
|
5693
|
| 96374 |
Ther/proph/diag inj iv push
|
$XXX.XX
|
S
|
5693
|
| 96375 |
Tx/pro/dx inj new drug addon
|
$XXX.XX
|
S
|
5691
|
| 96377 |
Applicaton on-body injector
|
$XXX.XX
|
Q1
|
5691
|
| 96379 |
Ther/prop/diag inj/inf proc
|
$XXX.XX
|
Q1
|
5691
|
| 96401 |
Chemo anti-neopl sq/im
|
$XXX.XX
|
Q1
|
5692
|
| 96402 |
Chemo hormon antineopl sq/im
|
$XXX.XX
|
Q1
|
5692
|
| 96405 |
Chemo intralesional up to 7
|
$XXX.XX
|
Q1
|
5692
|
| 96406 |
Chemo intralesional over 7
|
$XXX.XX
|
S
|
5693
|
| 96409 |
Chemo iv push sngl drug
|
$XXX.XX
|
S
|
5693
|
| 96411 |
Chemo iv push addl drug
|
$XXX.XX
|
S
|
5692
|
| 96413 |
Chemo iv infusion 1 hr
|
$XXX.XX
|
S
|
5694
|
| 96415 |
Chemo iv infusion addl hr
|
$XXX.XX
|
S
|
5692
|
| 96416 |
Chemo prolong infuse w/pump
|
$XXX.XX
|
S
|
5694
|
| 96417 |
Chemo iv infus each addl seq
|
$XXX.XX
|
S
|
5692
|
| 96420 |
Chemo ia push tecnique
|
$XXX.XX
|
S
|
5694
|
| 96422 |
Chemo ia infusion up to 1 hr
|
$XXX.XX
|
S
|
5693
|
| 96423 |
Chemo ia infuse each addl hr
|
$XXX.XX
|
S
|
5691
|
| 96425 |
Chemotherapy infusion method
|
$XXX.XX
|
S
|
5694
|
| 96440 |
Chemotherapy intracavitary
|
$XXX.XX
|
S
|
5694
|
| 96446 |
Chemotx admn prtl cavity
|
$XXX.XX
|
S
|
5694
|
| 96450 |
Chemotherapy into cns
|
$XXX.XX
|
S
|
5694
|
| 96521 |
Refill/maint portable pump
|
$XXX.XX
|
S
|
5693
|
| 96522 |
Refill/maint pump/resvr syst
|
$XXX.XX
|
S
|
5693
|
| 96523 |
Irrig drug delivery device
|
$XXX.XX
|
Q1
|
5733
|
| 96542 |
Chemotherapy injection
|
$XXX.XX
|
S
|
5693
|
| 96549 |
Chemotherapy unspecified
|
$XXX.XX
|
Q1
|
5691
|
| 96567 |
Pdt dstr prmlg les skn
|
$XXX.XX
|
Q1
|
5051
|
| 96573 |
Pdt dstr prmlg les phys/qhp
|
$XXX.XX
|
Q1
|
5051
|
| 96574 |
Dbrdmt prmlg les w/pdt
|
$XXX.XX
|
Q1
|
5051
|
| 96900 |
Ultraviolet light therapy
|
$XXX.XX
|
Q1
|
5732
|
| 96910 |
Photochemotherapy with uv-b
|
$XXX.XX
|
Q1
|
5733
|
| 96912 |
Photochemotherapy with uv-a
|
$XXX.XX
|
Q1
|
5733
|
| 96913 |
Photochemotherapy uv-a or b
|
$XXX.XX
|
T
|
5052
|
| 96920 |
Laser tx skin < 250 sq cm
|
$XXX.XX
|
Q1
|
5051
|
| 96921 |
Laser tx skin 250-500 sq cm
|
$XXX.XX
|
Q1
|
5051
|
| 96922 |
Laser tx skin >500 sq cm
|
$XXX.XX
|
Q1
|
5052
|
| 96999 |
Dermatological procedure
|
$XXX.XX
|
Q1
|
5051
|
| 97151 |
Bhv id assmt by phys/qhp
|
$XXX.XX
|
Q3
|
5821
|
| 97152 |
Bhv id suprt assmt by 1 tech
|
$XXX.XX
|
Q3
|
5821
|
| 97153 |
Adaptive behavior tx by tech
|
$XXX.XX
|
Q3
|
5821
|
| 97154 |
Grp adapt bhv tx by tech
|
$XXX.XX
|
Q3
|
5821
|
| 97155 |
Adapt behavior tx phys/qhp
|
$XXX.XX
|
Q3
|
5821
|
| 97156 |
Fam adapt bhv tx gdn phy/qhp
|
$XXX.XX
|
Q3
|
5821
|
| 97157 |
Mult fam adapt bhv tx gdn
|
$XXX.XX
|
Q3
|
5821
|
| 97158 |
Grp adapt bhv tx by phy/qhp
|
$XXX.XX
|
Q3
|
5821
|
| 97597 |
Rmvl devital tis 20 cm/<
|
$XXX.XX
|
T
|
5051
|
| 97602 |
Wound(s) care non-selective
|
$XXX.XX
|
Q1
|
5051
|
| 97605 |
Neg press wound tx <=50 cm
|
$XXX.XX
|
Q1
|
5051
|
| 97606 |
Neg press wound tx >50 cm
|
$XXX.XX
|
Q1
|
5052
|
| 97607 |
Neg press wnd tx <=50 sq cm
|
$XXX.XX
|
T
|
5052
|
| 97608 |
Neg press wound tx >50 cm
|
$XXX.XX
|
T
|
5052
|
| 97610 |
Low frequency non-thermal us
|
$XXX.XX
|
Q1
|
5051
|
| 97810 |
Acupunct w/o stimul 15 min
|
$XXX.XX
|
S
|
5731
|
| 97813 |
Acupunct w/stimul 15 min
|
$XXX.XX
|
S
|
5731
|
| 98925 |
Osteopath manj 1-2 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98926 |
Osteopath manj 3-4 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98927 |
Osteopath manj 5-6 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98928 |
Osteopath manj 7-8 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98929 |
Osteopath manj 9-10 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98940 |
Chiropract manj 1-2 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98941 |
Chiropract manj 3-4 regions
|
$XXX.XX
|
Q1
|
5811
|
| 98942 |
Chiropractic manj 5 regions
|
$XXX.XX
|
Q1
|
5811
|
| 99170 |
Anogenital exam child w imag
|
$XXX.XX
|
T
|
5411
|
| 99195 |
Phlebotomy
|
$XXX.XX
|
Q1
|
5734
|
| 99281 |
Emergency dept visit
|
$XXX.XX
|
J2
|
5021
|
| 99282 |
Emergency dept visit
|
$XXX.XX
|
J2
|
5022
|
| 99283 |
Emergency dept visit
|
$XXX.XX
|
J2
|
5023
|
| 99284 |
Emergency dept visit
|
$XXX.XX
|
J2
|
5024
|
| 99285 |
Emergency dept visit
|
$XXX.XX
|
J2
|
5025
|
| 99291 |
Critical care first hour
|
$XXX.XX
|
J2
|
5041
|
| 99406 |
Behav chng smoking 3-10 min
|
$XXX.XX
|
S
|
5821
|
| 99407 |
Behav chng smoking > 10 min
|
$XXX.XX
|
S
|
5821
|
| 99453 |
Rem mntr physiol param setup
|
$XXX.XX
|
V
|
5012
|
| 99454 |
Rem mntr physiol param dev
|
$XXX.XX
|
Q1
|
5741
|
| 99460 |
Init nb em per day hosp
|
$XXX.XX
|
V
|
5012
|
| 99463 |
Same day nb discharge
|
$XXX.XX
|
V
|
5012
|
| 99465 |
Nb resuscitation
|
$XXX.XX
|
S
|
5781
|
| 99473 |
Self-meas bp pt educaj/train
|
$XXX.XX
|
Q1
|
5731
|
| 99483 |
Assmt & care pln pt cog imp
|
$XXX.XX
|
S
|
5822
|
| 99484 |
Care mgmt svc bhvl hlth cond
|
$XXX.XX
|
S
|
5821
|
| 99487 |
Cmplx chron care w/o pt vsit
|
$XXX.XX
|
S
|
5822
|
| 99490 |
Chron care mgmt srvc 20 min
|
$XXX.XX
|
S
|
5822
|
| 99492 |
1st psyc collab care mgmt
|
$XXX.XX
|
S
|
5822
|
| 99493 |
Sbsq psyc collab care mgmt
|
$XXX.XX
|
S
|
5822
|
| 99495 |
Trans care mgmt 14 day disch
|
$XXX.XX
|
V
|
5012
|
| 99496 |
Trans care mgmt 7 day disch
|
$XXX.XX
|
V
|
5012
|
| 99497 |
Advncd care plan 30 min
|
$XXX.XX
|
Q1
|
5822
|
| A9513 |
Lutetium lu 177 dotatat ther
|
$XXX.XX
|
G
|
9067
|
| A9517 |
I131 iodide cap, rx
|
$XXX.XX
|
K
|
1064
|
| A9527 |
Iodine i-125 sodium iodide
|
$XXX.XX
|
U
|
2632
|
| A9530 |
I131 iodide sol, rx
|
$XXX.XX
|
K
|
1150
|
| A9543 |
Y90 ibritumomab, rx
|
$XXX.XX
|
K
|
1643
|
| A9563 |
P32 na phosphate
|
$XXX.XX
|
K
|
1675
|
| A9590 |
Iodine i-131 iobenguane 1mci
|
$XXX.XX
|
G
|
9339
|
| A9600 |
Sr89 strontium
|
$XXX.XX
|
K
|
0701
|
| A9604 |
Sm 153 lexidronam
|
$XXX.XX
|
K
|
1295
|
| A9606 |
Radium ra223 dichloride ther
|
$XXX.XX
|
K
|
1745
|
| C1716 |
Brachytx, non-str, gold-198
|
$XXX.XX
|
U
|
2645
|
| C1717 |
Brachytx, non-str,hdr ir-192
|
$XXX.XX
|
U
|
2646
|
| C1719 |
Brachytx, ns, non-hdrir-192
|
$XXX.XX
|
U
|
2647
|
| C2616 |
Brachytx, non-str,yttrium-90
|
$XXX.XX
|
U
|
2616
|
| C2634 |
Brachytx, non-str, ha, i-125
|
$XXX.XX
|
U
|
2634
|
| C2635 |
Brachytx, non-str, ha, p-103
|
$XXX.XX
|
U
|
2635
|
| C2636 |
Brachy linear, non-str,p-103
|
$XXX.XX
|
U
|
2636
|
| C2638 |
Brachytx, stranded, i-125
|
$XXX.XX
|
U
|
2638
|
| C2639 |
Brachytx, non-stranded,i-125
|
$XXX.XX
|
U
|
2639
|
| C2640 |
Brachytx, stranded, p-103
|
$XXX.XX
|
U
|
2640
|
| C2641 |
Brachytx, non-stranded,p-103
|
$XXX.XX
|
U
|
2641
|
| C2642 |
Brachytx, stranded, c-131
|
$XXX.XX
|
U
|
2642
|
| C2643 |
Brachytx, non-stranded,c-131
|
$XXX.XX
|
U
|
2643
|
| C2645 |
Brachytx planar, p-103
|
$XXX.XX
|
U
|
2648
|
| C2698 |
Brachytx, stranded, nos
|
$XXX.XX
|
U
|
2698
|
| C2699 |
Brachytx, non-stranded, nos
|
$XXX.XX
|
U
|
2699
|
| C5271 |
Low cost skin substitute app
|
$XXX.XX
|
T
|
5053
|
| C5273 |
Low cost skin substitute app
|
$XXX.XX
|
T
|
5054
|
| C5275 |
Low cost skin substitute app
|
$XXX.XX
|
T
|
5053
|
| C5277 |
Low cost skin substitute app
|
$XXX.XX
|
T
|
5053
|
| C8900 |
Mra w/cont, abd
|
$XXX.XX
|
Q3
|
5572
|
| C8901 |
Mra w/o cont, abd
|
$XXX.XX
|
Q3
|
5523
|
| C8902 |
Mra w/o fol w/cont, abd
|
$XXX.XX
|
Q3
|
5572
|
| C8903 |
Mri w/cont, breast, uni
|
$XXX.XX
|
Q3
|
5571
|
| C8905 |
Mri w/o fol w/cont, brst, un
|
$XXX.XX
|
Q3
|
5572
|
| C8906 |
Mri w/cont, breast, bi
|
$XXX.XX
|
Q3
|
5572
|
| C8908 |
Mri w/o fol w/cont, breast,
|
$XXX.XX
|
Q3
|
5572
|
| C8909 |
Mra w/cont, chest
|
$XXX.XX
|
Q3
|
5572
|
| C8910 |
Mra w/o cont, chest
|
$XXX.XX
|
Q3
|
5523
|
| C8911 |
Mra w/o fol w/cont, chest
|
$XXX.XX
|
Q3
|
5572
|
| C8912 |
Mra w/cont, lwr ext
|
$XXX.XX
|
Q3
|
5572
|
| C8913 |
Mra w/o cont, lwr ext
|
$XXX.XX
|
Q3
|
5523
|
| C8914 |
Mra w/o fol w/cont, lwr ext
|
$XXX.XX
|
Q3
|
5572
|
| C8918 |
Mra w/cont, pelvis
|
$XXX.XX
|
Q3
|
5572
|
| C8919 |
Mra w/o cont, pelvis
|
$XXX.XX
|
Q3
|
5523
|
| C8920 |
Mra w/o fol w/cont, pelvis
|
$XXX.XX
|
Q3
|
5572
|
| C8921 |
Tte w or w/o fol w/cont, com
|
$XXX.XX
|
S
|
5573
|
| C8922 |
Tte w or w/o fol w/cont, f/u
|
$XXX.XX
|
S
|
5573
|
| C8923 |
2d tte w or w/o fol w/con,co
|
$XXX.XX
|
S
|
5573
|
| C8924 |
2d tte w or w/o fol w/con,fu
|
$XXX.XX
|
S
|
5572
|
| C8925 |
2d tee w or w/o fol w/con,in
|
$XXX.XX
|
S
|
5573
|
| C8926 |
Tee w or w/o fol w/cont,cong
|
$XXX.XX
|
S
|
5573
|
| C8927 |
Tee w or w/o fol w/cont, mon
|
$XXX.XX
|
S
|
5573
|
| C8928 |
Tte w or w/o fol w/con,stres
|
$XXX.XX
|
S
|
5573
|
| C8929 |
Tte w or wo fol wcon,doppler
|
$XXX.XX
|
S
|
5573
|
| C8930 |
Tte w or w/o contr, cont ecg
|
$XXX.XX
|
S
|
5573
|
| C8931 |
Mra, w/dye, spinal canal
|
$XXX.XX
|
Q3
|
5572
|
| C8932 |
Mra, w/o dye, spinal canal
|
$XXX.XX
|
Q3
|
5523
|
| C8933 |
Mra, w/o&w/dye, spinal canal
|
$XXX.XX
|
Q3
|
5572
|
| C8934 |
Mra, w/dye, upper extremity
|
$XXX.XX
|
Q3
|
5572
|
| C8935 |
Mra, w/o dye, upper extr
|
$XXX.XX
|
Q3
|
5523
|
| C8936 |
Mra, w/o&w/dye, upper extr
|
$XXX.XX
|
Q3
|
5572
|
| C8957 |
Prolonged iv inf, req pump
|
$XXX.XX
|
S
|
5694
|
| C9046 |
Cocaine hcl nasal solution
|
$XXX.XX
|
G
|
9307
|
| C9047 |
Injection, caplacizumab-yhdp
|
$XXX.XX
|
G
|
9199
|
| C9060 |
Fluoroestradiol f18
|
$XXX.XX
|
G
|
9370
|
| C9062 |
Daratumumab hyaluronidase
|
$XXX.XX
|
G
|
9378
|
| C9064 |
Mitomycin pyelocalyceal inst
|
$XXX.XX
|
G
|
9374
|
| C9065 |
Romidepsin non-lyophilized
|
$XXX.XX
|
G
|
9379
|
| C9066 |
Sacituzumab govitecan-hziy
|
$XXX.XX
|
G
|
9376
|
| C9067 |
Gallium ga-68 dotatoc
|
$XXX.XX
|
G
|
9323
|
| C9122 |
Mometasone furoate (sinuva)
|
$XXX.XX
|
G
|
9346
|
| C9132 |
Kcentra, per i.u.
|
$XXX.XX
|
K
|
9132
|
| C9250 |
Artiss fibrin sealant
|
$XXX.XX
|
K
|
1848
|
| C9257 |
Bevacizumab injection
|
$XXX.XX
|
K
|
1281
|
| C9460 |
Injection, cangrelor
|
$XXX.XX
|
K
|
9460
|
| C9462 |
Injection, delafloxacin
|
$XXX.XX
|
G
|
9462
|
| C9482 |
Sotalol hydrochloride iv
|
$XXX.XX
|
K
|
9482
|
| C9488 |
Conivaptan hcl
|
$XXX.XX
|
K
|
9488
|
| C9600 |
Perc drug-el cor stent sing
|
$XXX.XX
|
J1
|
5193
|
| C9602 |
Perc d-e cor stent ather s
|
$XXX.XX
|
J1
|
5194
|
| C9604 |
Perc d-e cor revasc t cabg s
|
$XXX.XX
|
J1
|
5193
|
| C9607 |
Perc d-e cor revasc chro sin
|
$XXX.XX
|
J1
|
5194
|
| C9725 |
Place endorectal app
|
$XXX.XX
|
T
|
5311
|
| C9727 |
Insert palate implants
|
$XXX.XX
|
J1
|
5163
|
| C9728 |
Place device/marker, non pro
|
$XXX.XX
|
S
|
5613
|
| C9733 |
Non-ophthalmic fva
|
$XXX.XX
|
Q2
|
5572
|
| C9734 |
U/s trtmt, not leiomyomata
|
$XXX.XX
|
J1
|
5115
|
| C9739 |
Cystoscopy prostatic imp 1-3
|
$XXX.XX
|
J1
|
5375
|
| C9740 |
Cysto impl 4 or more
|
$XXX.XX
|
J1
|
5376
|
| C9745 |
Nasal endo eustachian tube
|
$XXX.XX
|
J1
|
5165
|
| C9747 |
Ablation, hifu, prostate
|
$XXX.XX
|
J1
|
5375
|
| C9749 |
Repair nasal stenosis w/imp
|
$XXX.XX
|
J1
|
5165
|
| C9751 |
Microwave bronch, 3d, ebus
|
$XXX.XX
|
T
|
1571
|
| C9752 |
Intraosseous des lumb/sacrum
|
$XXX.XX
|
J1
|
5115
|
| C9757 |
Spine/lumbar disk surgery
|
$XXX.XX
|
J1
|
5115
|
| C9758 |
Blind interatrial shunt ide
|
$XXX.XX
|
T
|
1589
|
| C9760 |
Non-blind interatrial shunt
|
$XXX.XX
|
T
|
1589
|
| C9761 |
Cysto, litho, vacuum kidney
|
$XXX.XX
|
J1
|
5375
|
| C9762 |
Cardiac MRI seg dys strain
|
$XXX.XX
|
Q3
|
5524
|
| C9763 |
Cardiac MRI seg dys stress
|
$XXX.XX
|
Q3
|
5524
|
| C9764 |
Revasc intravasc lithotripsy
|
$XXX.XX
|
J1
|
5192
|
| C9765 |
Revasc intra lithotrip-stent
|
$XXX.XX
|
J1
|
5193
|
| C9766 |
Revasc intra lithotrip-ather
|
$XXX.XX
|
J1
|
5193
|
| C9767 |
Revasc lithotrip-stent-ather
|
$XXX.XX
|
J1
|
5194
|
| C9769 |
Cysto w/temp pros implant
|
$XXX.XX
|
J1
|
5375
|
| C9803 |
Hopd covid-19 spec collect
|
$XXX.XX
|
Q1
|
5731
|
| D0150 |
Comprehensve oral evaluation
|
$XXX.XX
|
S
|
5871
|
| D0240 |
Intraoral occlusal film
|
$XXX.XX
|
S
|
5871
|
| D0250 |
Extraoral 2d project image
|
$XXX.XX
|
S
|
5871
|
| D0251 |
Extraoral posterior image
|
$XXX.XX
|
Q1
|
5521
|
| D0270 |
Dental bitewing single image
|
$XXX.XX
|
S
|
5871
|
| D0272 |
Dental bitewings two images
|
$XXX.XX
|
S
|
5871
|
| D0274 |
Bitewings four images
|
$XXX.XX
|
S
|
5871
|
| D0277 |
Vert bitewings 7 to 8 images
|
$XXX.XX
|
S
|
5871
|
| D0460 |
Pulp vitality test
|
$XXX.XX
|
S
|
5871
|
| D0600 |
Non-ionizing diag proc
|
$XXX.XX
|
S
|
5871
|
| D1510 |
Space maintainer fxd unilat
|
$XXX.XX
|
S
|
5871
|
| D1516 |
Fixed bilat space maint, max
|
$XXX.XX
|
S
|
5871
|
| D1517 |
Fixed bilat space maint, man
|
$XXX.XX
|
S
|
5871
|
| D1520 |
Remove unilat space maintain
|
$XXX.XX
|
S
|
5871
|
| D1526 |
Remove bilat space main, max
|
$XXX.XX
|
S
|
5871
|
| D1527 |
Remove bilat space main, man
|
$XXX.XX
|
S
|
5871
|
| D1551 |
Recement space maint - max
|
$XXX.XX
|
S
|
5871
|
| D1552 |
Recement space maint - man
|
$XXX.XX
|
S
|
5871
|
| D1553 |
Recement unilat space maint
|
$XXX.XX
|
S
|
5871
|
| D1575 |
Dist space maint, fixed unil
|
$XXX.XX
|
S
|
5871
|
| D2999 |
Dental unspec restorative pr
|
$XXX.XX
|
S
|
5871
|
| D3460 |
Endodontic endosseous implan
|
$XXX.XX
|
S
|
5871
|
| D3999 |
Endodontic procedure
|
$XXX.XX
|
S
|
5871
|
| D4260 |
Osseous surgery 4 or more
|
$XXX.XX
|
S
|
5871
|
| D4263 |
Bone replce graft first site
|
$XXX.XX
|
S
|
5871
|
| D4264 |
Bone replce graft each add
|
$XXX.XX
|
S
|
5871
|
| D4268 |
Surgical revision procedure
|
$XXX.XX
|
S
|
5871
|
| D4270 |
Pedicle soft tissue graft pr
|
$XXX.XX
|
S
|
5871
|
| D4273 |
Auto tissue graft 1st tooth
|
$XXX.XX
|
S
|
5871
|
| D4355 |
Full mouth debridement
|
$XXX.XX
|
S
|
5871
|
| D4381 |
Localized delivery antimicro
|
$XXX.XX
|
S
|
5871
|
| D5911 |
Facial moulage sectional
|
$XXX.XX
|
S
|
5871
|
| D5912 |
Facial moulage complete
|
$XXX.XX
|
S
|
5871
|
| D5983 |
Radiation applicator
|
$XXX.XX
|
S
|
5871
|
| D5984 |
Radiation shield
|
$XXX.XX
|
S
|
5871
|
| D5985 |
Radiation cone locator
|
$XXX.XX
|
S
|
5871
|
| D5987 |
Commissure splint
|
$XXX.XX
|
S
|
5871
|
| D6920 |
Dental connector bar
|
$XXX.XX
|
S
|
5871
|
| D7111 |
Extraction coronal remnants
|
$XXX.XX
|
S
|
5871
|
| D7140 |
Extraction erupted tooth/exr
|
$XXX.XX
|
S
|
5871
|
| D7210 |
Rem imp tooth w mucoper flp
|
$XXX.XX
|
S
|
5871
|
| D7220 |
Impact tooth remov soft tiss
|
$XXX.XX
|
S
|
5871
|
| D7230 |
Impact tooth remov part bony
|
$XXX.XX
|
S
|
5871
|
| D7240 |
Impact tooth remov comp bony
|
$XXX.XX
|
S
|
5871
|
| D7241 |
Impact tooth rem bony w/comp
|
$XXX.XX
|
S
|
5871
|
| D7250 |
Tooth root removal
|
$XXX.XX
|
S
|
5871
|
| D7260 |
Oral antral fistula closure
|
$XXX.XX
|
S
|
5871
|
| D7261 |
Primary closure sinus perf
|
$XXX.XX
|
S
|
5871
|
| D7291 |
Transseptal fiberotomy
|
$XXX.XX
|
S
|
5871
|
| D7940 |
Reshaping bone orthognathic
|
$XXX.XX
|
S
|
5871
|
| D9930 |
Treatment of complications
|
$XXX.XX
|
S
|
5871
|
| D9944 |
Occ guard, hard, full arch
|
$XXX.XX
|
S
|
5871
|
| D9945 |
Occ guard, soft, full arch
|
$XXX.XX
|
S
|
5871
|
| D9946 |
Occ guard, hard, part arch
|
$XXX.XX
|
S
|
5871
|
| D9950 |
Occlusion analysis
|
$XXX.XX
|
S
|
5871
|
| D9951 |
Limited occlusal adjustment
|
$XXX.XX
|
S
|
5871
|
| D9952 |
Complete occlusal adjustment
|
$XXX.XX
|
S
|
5871
|
| G0008 |
Admin influenza virus vac
|
$XXX.XX
|
S
|
5691
|
| G0009 |
Admin pneumococcal vaccine
|
$XXX.XX
|
S
|
5691
|
| G0010 |
Admin hepatitis b vaccine
|
$XXX.XX
|
S
|
5691
|
| G0101 |
Ca screen;pelvic/breast exam
|
$XXX.XX
|
S
|
5822
|
| G0104 |
Ca screen;flexi sigmoidscope
|
$XXX.XX
|
T
|
5311
|
| G0105 |
Colorectal scrn; hi risk ind
|
$XXX.XX
|
T
|
5311
|
| G0106 |
Colon ca screen;barium enema
|
$XXX.XX
|
S
|
5571
|
| G0117 |
Glaucoma scrn hgh risk direc
|
$XXX.XX
|
S
|
5731
|
| G0118 |
Glaucoma scrn hgh risk direc
|
$XXX.XX
|
S
|
5732
|
| G0120 |
Colon ca scrn; barium enema
|
$XXX.XX
|
S
|
5572
|
| G0121 |
Colon ca scrn not hi rsk ind
|
$XXX.XX
|
T
|
5311
|
| G0127 |
Trim nail(s)
|
$XXX.XX
|
Q1
|
5733
|
| G0130 |
Single energy x-ray study
|
$XXX.XX
|
S
|
5522
|
| G0166 |
Extrnl counterpulse, per tx
|
$XXX.XX
|
Q1
|
5734
|
| G0175 |
Opps service,sched team conf
|
$XXX.XX
|
V
|
5024
|
| G0186 |
Dstry eye lesn,fdr vssl tech
|
$XXX.XX
|
T
|
5481
|
| G0237 |
Therapeutic procd strg endur
|
$XXX.XX
|
S
|
5731
|
| G0238 |
Oth resp proc, indiv
|
$XXX.XX
|
S
|
5731
|
| G0239 |
Oth resp proc, group
|
$XXX.XX
|
S
|
5732
|
| G0245 |
Initial foot exam pt lops
|
$XXX.XX
|
V
|
5012
|
| G0246 |
Followup eval of foot pt lop
|
$XXX.XX
|
V
|
5012
|
| G0247 |
Routine footcare pt w lops
|
$XXX.XX
|
Q1
|
5051
|
| G0248 |
Demonstrate use home inr mon
|
$XXX.XX
|
V
|
5012
|
| G0249 |
Provide inr test mater/equip
|
$XXX.XX
|
V
|
5012
|
| G0257 |
Unsched dialysis esrd pt hos
|
$XXX.XX
|
S
|
5401
|
| G0260 |
Inj for sacroiliac jt anesth
|
$XXX.XX
|
T
|
5442
|
| G0276 |
Pild/placebo control clin tr
|
$XXX.XX
|
J1
|
5114
|
| G0277 |
Hbot, full body chamber, 30m
|
$XXX.XX
|
S
|
5061
|
| G0293 |
Non-cov surg proc,clin trial
|
$XXX.XX
|
Q1
|
5732
|
| G0294 |
Non-cov proc, clinical trial
|
$XXX.XX
|
Q1
|
5732
|
| G0296 |
Visit to determ ldct elig
|
$XXX.XX
|
S
|
5822
|
| G0297 |
Ldct for lung ca screen
|
$XXX.XX
|
S
|
5521
|
| G0302 |
Pre-op service lvrs complete
|
$XXX.XX
|
S
|
5723
|
| G0303 |
Pre-op service lvrs 10-15dos
|
$XXX.XX
|
S
|
5721
|
| G0304 |
Pre-op service lvrs 1-9 dos
|
$XXX.XX
|
S
|
5723
|
| G0305 |
Post op service lvrs min 6
|
$XXX.XX
|
S
|
5723
|
| G0379 |
Direct refer hospital observ
|
$XXX.XX
|
J2
|
5025
|
| G0380 |
Lev 1 hosp type b ed visit
|
$XXX.XX
|
J2
|
5031
|
| G0381 |
Lev 2 hosp type b ed visit
|
$XXX.XX
|
J2
|
5032
|
| G0382 |
Lev 3 hosp type b ed visit
|
$XXX.XX
|
J2
|
5033
|
| G0383 |
Lev 4 hosp type b ed visit
|
$XXX.XX
|
J2
|
5034
|
| G0384 |
Lev 5 hosp type b ed visit
|
$XXX.XX
|
J2
|
5035
|
| G0390 |
Trauma respons w/hosp criti
|
$XXX.XX
|
S
|
5045
|
| G0396 |
Alcohol/subs interv 15-30mn
|
$XXX.XX
|
S
|
5821
|
| G0397 |
Alcohol/subs interv >30 min
|
$XXX.XX
|
S
|
5822
|
| G0398 |
Home sleep test/type 2 porta
|
$XXX.XX
|
S
|
5721
|
| G0399 |
Home sleep test/type 3 porta
|
$XXX.XX
|
S
|
5721
|
| G0400 |
Home sleep test/type 4 porta
|
$XXX.XX
|
S
|
5721
|
| G0402 |
Initial preventive exam
|
$XXX.XX
|
V
|
5012
|
| G0404 |
Ekg tracing for initial prev
|
$XXX.XX
|
S
|
5731
|
| G0413 |
Pelvic ring fracture uni/bil
|
$XXX.XX
|
J1
|
5114
|
| G0416 |
Prostate biopsy, any mthd
|
$XXX.XX
|
Q2
|
5673
|
| G0422 |
Intens cardiac rehab w/exerc
|
$XXX.XX
|
S
|
5771
|
| G0423 |
Intens cardiac rehab no exer
|
$XXX.XX
|
S
|
5771
|
| G0424 |
Pulmonary rehab w exer
|
$XXX.XX
|
S
|
5733
|
| G0429 |
Dermal filler injection(s)
|
$XXX.XX
|
T
|
5054
|
| G0442 |
Annual alcohol screen 15 min
|
$XXX.XX
|
S
|
5821
|
| G0443 |
Brief alcohol misuse counsel
|
$XXX.XX
|
S
|
5822
|
| G0444 |
Depression screen annual
|
$XXX.XX
|
S
|
5821
|
| G0445 |
High inten beh couns std 30m
|
$XXX.XX
|
S
|
5822
|
| G0446 |
Intens behave ther cardio dx
|
$XXX.XX
|
S
|
5821
|
| G0447 |
Behavior counsel obesity 15m
|
$XXX.XX
|
S
|
5822
|
| G0451 |
Devlopment test interpt&rep
|
$XXX.XX
|
Q3
|
5822
|
| G0455 |
Fecal microbiota prep instil
|
$XXX.XX
|
Q1
|
5301
|
| G0460 |
Autologous prp for ulcers
|
$XXX.XX
|
T
|
5054
|
| G0463 |
Hospital outpt clinic visit
|
$XXX.XX
|
J2
|
5012
|
| G0473 |
Group behave couns 2-10
|
$XXX.XX
|
S
|
5821
|
| G0498 |
Chemo extend iv infus w/pump
|
$XXX.XX
|
S
|
5694
|
| G0516 |
Insert drug del implant, >=4
|
$XXX.XX
|
Q1
|
5735
|
| G0517 |
Remove drug implant
|
$XXX.XX
|
Q1
|
5735
|
| G0518 |
Remove w insert drug implant
|
$XXX.XX
|
Q1
|
5735
|
| G2000 |
Blinded conv. tx mdd clin tr
|
$XXX.XX
|
S
|
5723
|
| G2011 |
Alcohol/sub misuse assess
|
$XXX.XX
|
S
|
5731
|
| G2065 |
Clin mang h risk dx 30
|
$XXX.XX
|
S
|
5822
|
| G2066 |
Inter devc remote 30d
|
$XXX.XX
|
Q1
|
5741
|
| G2082 |
Visit esketamine 56m or less
|
$XXX.XX
|
S
|
1508
|
| G2083 |
Visit esketamine, > 56m
|
$XXX.XX
|
S
|
1511
|
| G2086 |
Off base opioid tx 70min
|
$XXX.XX
|
S
|
5823
|
| G2087 |
Off base opioid tx, 60 m
|
$XXX.XX
|
S
|
5823
|
| G2170 |
Avf by tissue w thermal e
|
$XXX.XX
|
J1
|
5194
|
| G2171 |
Avf use magnetic/art/ven
|
$XXX.XX
|
J1
|
5194
|
| J0121 |
Inj., omadacycline, 1 mg
|
$XXX.XX
|
G
|
9311
|
| J0122 |
Inj., eravacycline, 1 mg
|
$XXX.XX
|
K
|
9325
|
| J0129 |
Abatacept injection
|
$XXX.XX
|
K
|
9230
|
| J0135 |
Adalimumab injection
|
$XXX.XX
|
K
|
1083
|
| J0178 |
Aflibercept injection
|
$XXX.XX
|
K
|
1420
|
| J0179 |
Inj, brolucizumab-dbll, 1 mg
|
$XXX.XX
|
G
|
9340
|
| J0180 |
Agalsidase beta injection
|
$XXX.XX
|
K
|
9208
|
| J0185 |
Inj., aprepitant, 1 mg
|
$XXX.XX
|
G
|
9463
|
| J0202 |
Injection, alemtuzumab
|
$XXX.XX
|
K
|
1809
|
| J0207 |
Amifostine
|
$XXX.XX
|
K
|
7000
|
| J0220 |
Alglucosidase alfa injection
|
$XXX.XX
|
K
|
9234
|
| J0221 |
Lumizyme injection
|
$XXX.XX
|
K
|
1413
|
| J0222 |
Inj., patisiran, 0.1 mg
|
$XXX.XX
|
G
|
9180
|
| J0223 |
Inj givosiran 0.5 mg
|
$XXX.XX
|
G
|
9343
|
| J0256 |
Alpha 1 proteinase inhibitor
|
$XXX.XX
|
K
|
0901
|
| J0257 |
Glassia injection
|
$XXX.XX
|
K
|
1415
|
| J0287 |
Amphotericin b lipid complex
|
$XXX.XX
|
K
|
9024
|
| J0289 |
Amphotericin b liposome inj
|
$XXX.XX
|
K
|
0736
|
| J0291 |
Inj., plazomicin, 5 mg
|
$XXX.XX
|
G
|
9183
|
| J0300 |
Amobarbital 125 mg inj
|
$XXX.XX
|
K
|
1341
|
| J0401 |
Inj aripiprazole ext rel 1mg
|
$XXX.XX
|
K
|
1468
|
| J0475 |
Baclofen 10 mg injection
|
$XXX.XX
|
K
|
9032
|
| J0480 |
Basiliximab
|
$XXX.XX
|
K
|
1683
|
| J0485 |
Belatacept injection
|
$XXX.XX
|
K
|
9286
|
| J0490 |
Belimumab injection
|
$XXX.XX
|
K
|
1353
|
| J0517 |
Inj., benralizumab, 1 mg
|
$XXX.XX
|
G
|
9466
|
| J0558 |
Peng benzathine/procaine inj
|
$XXX.XX
|
K
|
9088
|
| J0561 |
Penicillin g benzathine inj
|
$XXX.XX
|
K
|
1829
|
| J0565 |
Inj, bezlotoxumab, 10 mg
|
$XXX.XX
|
K
|
9490
|
| J0567 |
Inj., cerliponase alfa 1 mg
|
$XXX.XX
|
G
|
9014
|
| J0570 |
Buprenorphine implant 74.2mg
|
$XXX.XX
|
K
|
9058
|
| J0584 |
Injection, burosumab-twza 1m
|
$XXX.XX
|
K
|
9187
|
| J0585 |
Injection,onabotulinumtoxina
|
$XXX.XX
|
K
|
0902
|
| J0586 |
Abobotulinumtoxina
|
$XXX.XX
|
K
|
1289
|
| J0587 |
Inj, rimabotulinumtoxinb
|
$XXX.XX
|
K
|
9018
|
| J0588 |
Incobotulinumtoxin a
|
$XXX.XX
|
K
|
9278
|
| J0593 |
Inj., lanadelumab-flyo, 1 mg
|
$XXX.XX
|
K
|
9326
|
| J0594 |
Busulfan injection
|
$XXX.XX
|
K
|
1178
|
| J0596 |
Injection, ruconest
|
$XXX.XX
|
K
|
9445
|
| J0597 |
C-1 esterase, berinert
|
$XXX.XX
|
K
|
9269
|
| J0598 |
C-1 esterase, cinryze
|
$XXX.XX
|
K
|
9251
|
| J0599 |
Inj., haegarda 10 units
|
$XXX.XX
|
G
|
9015
|
| J0600 |
Edetate calcium disodium inj
|
$XXX.XX
|
K
|
1274
|
| J0606 |
Inj, etelcalcetide, 0.1 mg
|
$XXX.XX
|
K
|
9031
|
| J0630 |
Calcitonin salmon injection
|
$XXX.XX
|
K
|
1433
|
| J0638 |
Canakinumab injection
|
$XXX.XX
|
K
|
1311
|
| J0641 |
Inj levoleucovorin nos 0.5mg
|
$XXX.XX
|
K
|
1236
|
| J0642 |
Injection, khapzory, 0.5 mg
|
$XXX.XX
|
G
|
9334
|
| J0691 |
Inj lefamulin 1 mg
|
$XXX.XX
|
G
|
9332
|
| J0695 |
Inj ceftolozane tazobactam
|
$XXX.XX
|
K
|
9452
|
| J0712 |
Ceftaroline fosamil inj
|
$XXX.XX
|
K
|
1824
|
| J0714 |
Ceftazidime and avibactam
|
$XXX.XX
|
K
|
1825
|
| J0716 |
Centruroides immune f(ab)
|
$XXX.XX
|
K
|
1431
|
| J0717 |
Certolizumab pegol inj 1mg
|
$XXX.XX
|
K
|
1474
|
| J0740 |
Cidofovir injection
|
$XXX.XX
|
K
|
9033
|
| J0742 |
Inj imip 4 cilas 4 releb 2mg
|
$XXX.XX
|
G
|
9362
|
| J0775 |
Collagenase, clost hist inj
|
$XXX.XX
|
K
|
1340
|
| J0791 |
Inj crizanlizumab-tmca 5mg
|
$XXX.XX
|
G
|
9359
|
| J0795 |
Corticorelin ovine triflutal
|
$XXX.XX
|
K
|
1684
|
| J0800 |
Corticotropin injection
|
$XXX.XX
|
K
|
9316
|
| J0840 |
Crotalidae poly immune fab
|
$XXX.XX
|
K
|
9274
|
| J0841 |
Inj crotalidae im f(ab')2 eq
|
$XXX.XX
|
K
|
9188
|
| J0850 |
Cytomegalovirus imm iv /vial
|
$XXX.XX
|
K
|
0903
|
| J0875 |
Injection, dalbavancin
|
$XXX.XX
|
K
|
1823
|
| J0878 |
Daptomycin injection
|
$XXX.XX
|
K
|
9124
|
| J0881 |
Darbepoetin alfa, non-esrd
|
$XXX.XX
|
K
|
1685
|
| J0882 |
Darbepoetin alfa, esrd use
|
$XXX.XX
|
K
|
1482
|
| J0883 |
Argatroban nonesrd use 1mg
|
$XXX.XX
|
K
|
1859
|
| J0884 |
Argatroban esrd dialysis 1mg
|
$XXX.XX
|
K
|
9065
|
| J0885 |
Epoetin alfa, non-esrd
|
$XXX.XX
|
K
|
1686
|
| J0894 |
Decitabine injection
|
$XXX.XX
|
K
|
9231
|
| J0896 |
Inj luspatercept-aamt 0.25mg
|
$XXX.XX
|
G
|
9347
|
| J0897 |
Denosumab injection
|
$XXX.XX
|
K
|
9272
|
| J1095 |
Injection, dexamethasone 9%
|
$XXX.XX
|
G
|
9172
|
| J1096 |
Dexametha opth insert 0.1 mg
|
$XXX.XX
|
G
|
9308
|
| J1162 |
Digoxin immune fab (ovine)
|
$XXX.XX
|
K
|
1687
|
| J1190 |
Dexrazoxane hcl injection
|
$XXX.XX
|
K
|
0726
|
| J1201 |
Inj. cetirizine hcl 0.5mg
|
$XXX.XX
|
G
|
9361
|
| J1212 |
Dimethyl sulfoxide 50% 50 ml
|
$XXX.XX
|
K
|
1832
|
| J1267 |
Doripenem injection
|
$XXX.XX
|
K
|
9317
|
| J1290 |
Ecallantide injection
|
$XXX.XX
|
K
|
9263
|
| J1300 |
Eculizumab injection
|
$XXX.XX
|
K
|
9236
|
| J1301 |
Injection, edaravone, 1 mg
|
$XXX.XX
|
K
|
9493
|
| J1303 |
Inj., ravulizumab-cwvz 10 mg
|
$XXX.XX
|
G
|
9312
|
| J1322 |
Elosulfase alfa, injection
|
$XXX.XX
|
K
|
1480
|
| J1327 |
Eptifibatide injection
|
$XXX.XX
|
K
|
1607
|
| J1410 |
Inj estrogen conjugate 25 mg
|
$XXX.XX
|
K
|
9038
|
| J1428 |
Inj, eteplirsen, 10 mg
|
$XXX.XX
|
K
|
9484
|
| J1429 |
Inj golodirsen 10 mg
|
$XXX.XX
|
G
|
9356
|
| J1430 |
Ethanolamine oleate 100 mg
|
$XXX.XX
|
K
|
1688
|
| J1438 |
Etanercept injection
|
$XXX.XX
|
K
|
1608
|
| J1439 |
Inj ferric carboxymaltos 1mg
|
$XXX.XX
|
K
|
9441
|
| J1442 |
Inj filgrastim excl biosimil
|
$XXX.XX
|
K
|
1469
|
| J1447 |
Inj tbo filgrastim 1 microg
|
$XXX.XX
|
K
|
1748
|
| J1451 |
Fomepizole, 15 mg
|
$XXX.XX
|
K
|
1689
|
| J1453 |
Fosaprepitant injection
|
$XXX.XX
|
K
|
9242
|
| J1454 |
Inj fosnetupitant, palonoset
|
$XXX.XX
|
G
|
9099
|
| J1455 |
Foscarnet sodium injection
|
$XXX.XX
|
K
|
1849
|
| J1458 |
Galsulfase injection
|
$XXX.XX
|
K
|
9224
|
| J1459 |
Inj ivig privigen 500 mg
|
$XXX.XX
|
K
|
1214
|
| J1460 |
Gamma globulin 1 cc inj
|
$XXX.XX
|
K
|
1850
|
| J1555 |
Inj cuvitru, 100 mg
|
$XXX.XX
|
K
|
9034
|
| J1557 |
Gammaplex injection
|
$XXX.XX
|
K
|
9270
|
| J1558 |
Inj. xembify, 100 mg
|
$XXX.XX
|
K
|
9372
|
| J1559 |
Hizentra injection
|
$XXX.XX
|
K
|
1312
|
| J1560 |
Gamma globulin > 10 cc inj
|
$XXX.XX
|
K
|
1851
|
| J1561 |
Gamunex-c/gammaked
|
$XXX.XX
|
K
|
0948
|
| J1566 |
Immune globulin, powder
|
$XXX.XX
|
K
|
2731
|
| J1568 |
Octagam injection
|
$XXX.XX
|
K
|
0943
|
| J1569 |
Gammagard liquid injection
|
$XXX.XX
|
K
|
0944
|
| J1571 |
Hepagam b im injection
|
$XXX.XX
|
K
|
0946
|
| J1572 |
Flebogamma injection
|
$XXX.XX
|
K
|
0947
|
| J1573 |
Hepagam b intravenous, inj
|
$XXX.XX
|
K
|
1138
|
| J1575 |
Hyqvia 100mg immuneglobulin
|
$XXX.XX
|
K
|
1826
|
| J1595 |
Injection glatiramer acetate
|
$XXX.XX
|
K
|
1015
|
| J1602 |
Golimumab for iv use 1mg
|
$XXX.XX
|
K
|
1475
|
| J1610 |
Glucagon hydrochloride/1 mg
|
$XXX.XX
|
K
|
9042
|
| J1628 |
Inj., guselkumab, 1 mg
|
$XXX.XX
|
G
|
9029
|
| J1632 |
Inj., brexanolone, 1 mg
|
$XXX.XX
|
G
|
9333
|
| J1640 |
Hemin, 1 mg
|
$XXX.XX
|
K
|
1690
|
| J1670 |
Tetanus immune globulin inj
|
$XXX.XX
|
K
|
1670
|
| J1726 |
Makena, 10 mg
|
$XXX.XX
|
K
|
9074
|
| J1729 |
Inj hydroxyprogst capoat nos
|
$XXX.XX
|
K
|
9318
|
| J1738 |
Inj. meloxicam 1 mg
|
$XXX.XX
|
G
|
9371
|
| J1740 |
Ibandronate sodium injection
|
$XXX.XX
|
K
|
9229
|
| J1742 |
Ibutilide fumarate injection
|
$XXX.XX
|
K
|
9044
|
| J1743 |
Idursulfase injection
|
$XXX.XX
|
K
|
9232
|
| J1744 |
Icatibant injection
|
$XXX.XX
|
K
|
1443
|
| J1745 |
Infliximab not biosimil 10mg
|
$XXX.XX
|
K
|
7043
|
| J1746 |
Inj., ibalizumab-uiyk, 10 mg
|
$XXX.XX
|
K
|
9189
|
| J1750 |
Inj iron dextran
|
$XXX.XX
|
K
|
1237
|
| J1786 |
Imuglucerase injection
|
$XXX.XX
|
K
|
1327
|
| J1826 |
Interferon beta-1a inj
|
$XXX.XX
|
K
|
1852
|
| J1830 |
Interferon beta-1b / .25 mg
|
$XXX.XX
|
K
|
0910
|
| J1833 |
Injection, isavuconazonium
|
$XXX.XX
|
K
|
9456
|
| J1930 |
Lanreotide injection
|
$XXX.XX
|
K
|
9237
|
| J1931 |
Laronidase injection
|
$XXX.XX
|
K
|
9209
|
| J1943 |
Inj., aristada initio, 1 mg
|
$XXX.XX
|
G
|
9179
|
| J1944 |
Aripirazole lauroxil 1 mg
|
$XXX.XX
|
K
|
9470
|
| J1950 |
Leuprolide acetate /3.75 mg
|
$XXX.XX
|
K
|
0800
|
| J2182 |
Injection, mepolizumab, 1mg
|
$XXX.XX
|
K
|
9473
|
| J2186 |
Inj., meropenem, vaborbactam
|
$XXX.XX
|
K
|
9178
|
| J2265 |
Minocycline hydrochloride
|
$XXX.XX
|
K
|
1853
|
| J2278 |
Ziconotide injection
|
$XXX.XX
|
K
|
1694
|
| J2315 |
Naltrexone, depot form
|
$XXX.XX
|
K
|
0759
|
| J2323 |
Natalizumab injection
|
$XXX.XX
|
K
|
9126
|
| J2326 |
Inj, nusinersen, 0.1mg
|
$XXX.XX
|
K
|
9489
|
| J2350 |
Injection, ocrelizumab, 1 mg
|
$XXX.XX
|
K
|
9494
|
| J2353 |
Octreotide injection, depot
|
$XXX.XX
|
K
|
1207
|
| J2355 |
Oprelvekin injection
|
$XXX.XX
|
K
|
7011
|
| J2357 |
Omalizumab injection
|
$XXX.XX
|
K
|
9300
|
| J2407 |
Injection, oritavancin
|
$XXX.XX
|
K
|
1660
|
| J2425 |
Palifermin injection
|
$XXX.XX
|
K
|
1696
|
| J2426 |
Paliperidone palmitate inj
|
$XXX.XX
|
K
|
9255
|
| J2502 |
Inj, pasireotide long acting
|
$XXX.XX
|
K
|
9454
|
| J2504 |
Pegademase bovine, 25 iu
|
$XXX.XX
|
K
|
1739
|
| J2505 |
Injection, pegfilgrastim 6mg
|
$XXX.XX
|
K
|
9119
|
| J2507 |
Pegloticase injection
|
$XXX.XX
|
K
|
9281
|
| J2515 |
Pentobarbital sodium inj
|
$XXX.XX
|
K
|
1854
|
| J2547 |
Injection, peramivir
|
$XXX.XX
|
K
|
9451
|
| J2562 |
Plerixafor injection
|
$XXX.XX
|
K
|
9252
|
| J2597 |
Inj desmopressin acetate
|
$XXX.XX
|
K
|
1440
|
| J2724 |
Protein c concentrate
|
$XXX.XX
|
K
|
1139
|
| J2760 |
Phentolaine mesylate inj
|
$XXX.XX
|
K
|
1458
|
| J2770 |
Quinupristin/dalfopristin
|
$XXX.XX
|
K
|
2770
|
| J2778 |
Ranibizumab injection
|
$XXX.XX
|
K
|
9233
|
| J2783 |
Rasburicase
|
$XXX.XX
|
K
|
0738
|
| J2786 |
Injection, reslizumab, 1mg
|
$XXX.XX
|
K
|
9481
|
| J2792 |
Rho(d) immune globulin h, sd
|
$XXX.XX
|
K
|
1609
|
| J2794 |
Inj risperdal consta, 0.5 mg
|
$XXX.XX
|
K
|
9125
|
| J2796 |
Romiplostim injection
|
$XXX.XX
|
K
|
9245
|
| J2798 |
Inj., perseris, 0.5 mg
|
$XXX.XX
|
G
|
9181
|
| J2820 |
Sargramostim injection
|
$XXX.XX
|
K
|
0731
|
| J2840 |
Inj sebelipase alfa 1 mg
|
$XXX.XX
|
K
|
9478
|
| J2850 |
Inj secretin synthetic human
|
$XXX.XX
|
K
|
1700
|
| J2860 |
Injection, siltuximab
|
$XXX.XX
|
K
|
9455
|
| J2941 |
Somatropin injection
|
$XXX.XX
|
K
|
9319
|
| J2997 |
Alteplase recombinant
|
$XXX.XX
|
K
|
7048
|
| J3031 |
Inj., fremanezumab-vfrm 1 mg
|
$XXX.XX
|
G
|
9197
|
| J3032 |
Inj. eptinezumab-jjmr 1 mg
|
$XXX.XX
|
G
|
9357
|
| J3060 |
Inj, taliglucerase alfa 10 u
|
$XXX.XX
|
K
|
9294
|
| J3090 |
Inj tedizolid phosphate
|
$XXX.XX
|
K
|
1662
|
| J3095 |
Telavancin injection
|
$XXX.XX
|
K
|
9258
|
| J3101 |
Tenecteplase injection
|
$XXX.XX
|
K
|
9002
|
| J3111 |
Inj. romosozumab-aqqg 1 mg
|
$XXX.XX
|
G
|
9327
|
| J3145 |
Testosterone undecanoate 1mg
|
$XXX.XX
|
K
|
9078
|
| J3240 |
Thyrotropin injection
|
$XXX.XX
|
K
|
9108
|
| J3241 |
Inj. teprotumumab-trbw 10 mg
|
$XXX.XX
|
G
|
9355
|
| J3243 |
Tigecycline injection
|
$XXX.XX
|
K
|
9228
|
| J3245 |
Inj., tildrakizumab, 1 mg
|
$XXX.XX
|
G
|
9306
|
| J3246 |
Tirofiban hcl
|
$XXX.XX
|
K
|
7041
|
| J3262 |
Tocilizumab injection
|
$XXX.XX
|
K
|
9264
|
| J3285 |
Treprostinil injection
|
$XXX.XX
|
K
|
1701
|
| J3304 |
Inj triamcinolone ace xr 1mg
|
$XXX.XX
|
G
|
9469
|
| J3315 |
Triptorelin pamoate
|
$XXX.XX
|
K
|
9122
|
| J3316 |
Inj., triptorelin xr 3.75 mg
|
$XXX.XX
|
G
|
9016
|
| J3357 |
Ustekinumab sub cu inj, 1 mg
|
$XXX.XX
|
K
|
9261
|
| J3358 |
Ustekinumab, iv inject, 1 mg
|
$XXX.XX
|
K
|
9487
|
| J3380 |
Injection, vedolizumab
|
$XXX.XX
|
K
|
1489
|
| J3385 |
Velaglucerase alfa
|
$XXX.XX
|
K
|
9271
|
| J3396 |
Verteporfin injection
|
$XXX.XX
|
K
|
1203
|
| J3397 |
Inj., vestronidase alfa-vjbk
|
$XXX.XX
|
K
|
9190
|
| J3398 |
Inj luxturna 1 billion vec g
|
$XXX.XX
|
G
|
9070
|
| J3399 |
Inj onase abepar-xioi treat
|
$XXX.XX
|
K
|
9373
|
| J7169 |
Inj andexxa, 10 mg
|
$XXX.XX
|
G
|
9198
|
| J7170 |
Inj., emicizumab-kxwh 0.5 mg
|
$XXX.XX
|
G
|
9257
|
| J7175 |
Inj, factor x, (human), 1iu
|
$XXX.XX
|
K
|
1857
|
| J7177 |
Inj., fibryga, 1 mg
|
$XXX.XX
|
K
|
9191
|
| J7178 |
Inj human fibrinogen con nos
|
$XXX.XX
|
K
|
1478
|
| J7179 |
Vonvendi inj 1 iu vwf:rco
|
$XXX.XX
|
K
|
9059
|
| J7180 |
Factor xiii anti-hem factor
|
$XXX.XX
|
K
|
1416
|
| J7181 |
Factor xiii recomb a-subunit
|
$XXX.XX
|
K
|
1746
|
| J7182 |
Factor viii recomb novoeight
|
$XXX.XX
|
K
|
1856
|
| J7183 |
Wilate injection
|
$XXX.XX
|
K
|
1352
|
| J7185 |
Xyntha inj
|
$XXX.XX
|
K
|
1268
|
| J7186 |
Antihemophilic viii/vwf comp
|
$XXX.XX
|
K
|
1213
|
| J7187 |
Humate-p, inj
|
$XXX.XX
|
K
|
1704
|
| J7188 |
Factor viii recomb obizur
|
$XXX.XX
|
K
|
1827
|
| J7189 |
Factor viia
|
$XXX.XX
|
K
|
1705
|
| J7190 |
Factor viii
|
$XXX.XX
|
K
|
0925
|
| J7192 |
Factor viii recombinant nos
|
$XXX.XX
|
K
|
0927
|
| J7193 |
Factor ix non-recombinant
|
$XXX.XX
|
K
|
0931
|
| J7194 |
Factor ix complex
|
$XXX.XX
|
K
|
0928
|
| J7195 |
Factor ix recombinant nos
|
$XXX.XX
|
K
|
0932
|
| J7196 |
Antithrombin recombinant
|
$XXX.XX
|
K
|
9177
|
| J7197 |
Antithrombin iii injection
|
$XXX.XX
|
K
|
1263
|
| J7198 |
Anti-inhibitor
|
$XXX.XX
|
K
|
0929
|
| J7200 |
Factor ix recombinan rixubis
|
$XXX.XX
|
K
|
1467
|
| J7201 |
Factor ix alprolix recomb
|
$XXX.XX
|
K
|
1486
|
| J7202 |
Factor ix idelvion inj
|
$XXX.XX
|
K
|
9171
|
| J7203 |
Factor ix recomb gly rebinyn
|
$XXX.XX
|
G
|
9468
|
| J7204 |
Inj recombin esperoct per iu
|
$XXX.XX
|
G
|
9354
|
| J7205 |
Factor viii fc fusion recomb
|
$XXX.XX
|
K
|
1656
|
| J7207 |
Factor viii pegylated recomb
|
$XXX.XX
|
K
|
1844
|
| J7208 |
Inj. jivi 1 iu
|
$XXX.XX
|
G
|
9299
|
| J7209 |
Factor viii nuwiq recomb 1iu
|
$XXX.XX
|
K
|
1846
|
| J7210 |
Inj, afstyla, 1 i.u.
|
$XXX.XX
|
K
|
9043
|
| J7308 |
Aminolevulinic acid hcl top
|
$XXX.XX
|
K
|
7308
|
| J7311 |
Inj., retisert, 0.01 mg
|
$XXX.XX
|
K
|
9225
|
| J7312 |
Dexamethasone intra implant
|
$XXX.XX
|
K
|
9256
|
| J7313 |
Inj., iluvien, 0.01 mg
|
$XXX.XX
|
K
|
9450
|
| J7314 |
Inj., yutiq, 0.01 mg
|
$XXX.XX
|
K
|
9328
|
| J7316 |
Inj, ocriplasmin, 0.125 mg
|
$XXX.XX
|
K
|
9298
|
| J7318 |
Inj, durolane 1 mg
|
$XXX.XX
|
G
|
9174
|
| J7320 |
Genvisc 850, inj, 1mg
|
$XXX.XX
|
K
|
9079
|
| J7322 |
Hymovis injection 1 mg
|
$XXX.XX
|
K
|
9471
|
| J7323 |
Euflexxa inj per dose
|
$XXX.XX
|
K
|
0875
|
| J7324 |
Orthovisc inj per dose
|
$XXX.XX
|
K
|
0877
|
| J7325 |
Synvisc or synvisc-one
|
$XXX.XX
|
K
|
0874
|
| J7326 |
Gel-one
|
$XXX.XX
|
K
|
1417
|
| J7327 |
Monovisc inj per dose
|
$XXX.XX
|
K
|
1747
|
| J7328 |
Gelsyn-3 injection 0.1 mg
|
$XXX.XX
|
K
|
1862
|
| J7329 |
Inj, trivisc 1 mg
|
$XXX.XX
|
K
|
9196
|
| J7331 |
Synojoynt, inj., 1 mg
|
$XXX.XX
|
G
|
9337
|
| J7332 |
Inj., triluron, 1 mg
|
$XXX.XX
|
K
|
9338
|
| J7336 |
Capsaicin 8% patch
|
$XXX.XX
|
K
|
9071
|
| J7340 |
Carbidopa levodopa ent 100ml
|
$XXX.XX
|
K
|
9320
|
| J7342 |
Ciprofloxacin otic susp 6 mg
|
$XXX.XX
|
K
|
9479
|
| J7345 |
Aminolevulinic acid, 10% gel
|
$XXX.XX
|
G
|
9301
|
| J7351 |
Inj bimatoprost itc imp 1mcg
|
$XXX.XX
|
G
|
9351
|
| J7501 |
Azathioprine parenteral
|
$XXX.XX
|
K
|
0887
|
| J7504 |
Lymphocyte immune globulin
|
$XXX.XX
|
K
|
0890
|
| J7511 |
Antithymocyte globuln rabbit
|
$XXX.XX
|
K
|
9104
|
| J7525 |
Tacrolimus injection
|
$XXX.XX
|
K
|
9006
|
| J8510 |
Oral busulfan
|
$XXX.XX
|
K
|
9335
|
| J8560 |
Etoposide oral 50 mg
|
$XXX.XX
|
K
|
0802
|
| J8655 |
Oral netupitant, palonosetro
|
$XXX.XX
|
K
|
9448
|
| J8670 |
Rolapitant, oral, 1mg
|
$XXX.XX
|
K
|
1761
|
| J9015 |
Aldesleukin injection
|
$XXX.XX
|
K
|
0807
|
| J9017 |
Arsenic trioxide injection
|
$XXX.XX
|
K
|
9012
|
| J9019 |
Erwinaze injection
|
$XXX.XX
|
K
|
9289
|
| J9022 |
Inj, atezolizumab,10 mg
|
$XXX.XX
|
K
|
9483
|
| J9023 |
Injection, avelumab, 10 mg
|
$XXX.XX
|
K
|
9491
|
| J9025 |
Azacitidine injection
|
$XXX.XX
|
K
|
1709
|
| J9027 |
Clofarabine injection
|
$XXX.XX
|
K
|
1710
|
| J9030 |
Bcg live intravesical 1mg
|
$XXX.XX
|
K
|
9322
|
| J9032 |
Injection, belinostat, 10mg
|
$XXX.XX
|
K
|
1658
|
| J9033 |
Inj., treanda 1 mg
|
$XXX.XX
|
K
|
9243
|
| J9034 |
Inj., bendeka 1 mg
|
$XXX.XX
|
K
|
1861
|
| J9035 |
Bevacizumab injection
|
$XXX.XX
|
K
|
9214
|
| J9036 |
Inj. belrapzo/bendamustine
|
$XXX.XX
|
G
|
9313
|
| J9039 |
Injection, blinatumomab
|
$XXX.XX
|
K
|
9449
|
| J9041 |
Inj., velcade 0.1 mg
|
$XXX.XX
|
K
|
9207
|
| J9042 |
Brentuximab vedotin inj
|
$XXX.XX
|
K
|
9287
|
| J9043 |
Cabazitaxel injection
|
$XXX.XX
|
K
|
9276
|
| J9044 |
Inj, bortezomib, nos, 0.1 mg
|
$XXX.XX
|
K
|
9192
|
| J9047 |
Injection, carfilzomib, 1 mg
|
$XXX.XX
|
K
|
9295
|
| J9050 |
Carmustine injection
|
$XXX.XX
|
K
|
0812
|
| J9055 |
Cetuximab injection
|
$XXX.XX
|
K
|
9215
|
| J9057 |
Inj., copanlisib, 1 mg
|
$XXX.XX
|
G
|
9030
|
| J9065 |
Inj cladribine per 1 mg
|
$XXX.XX
|
K
|
0858
|
| J9070 |
Cyclophosphamide 100 mg inj
|
$XXX.XX
|
K
|
1408
|
| J9098 |
Cytarabine liposome inj
|
$XXX.XX
|
K
|
1166
|
| J9119 |
Inj., cemiplimab-rwlc, 1 mg
|
$XXX.XX
|
G
|
9304
|
| J9120 |
Dactinomycin injection
|
$XXX.XX
|
K
|
0752
|
| J9145 |
Injection, daratumumab 10 mg
|
$XXX.XX
|
K
|
9476
|
| J9150 |
Daunorubicin injection
|
$XXX.XX
|
K
|
0820
|
| J9153 |
Inj daunorubicin, cytarabine
|
$XXX.XX
|
G
|
9302
|
| J9155 |
Degarelix injection
|
$XXX.XX
|
K
|
1296
|
| J9171 |
Docetaxel injection
|
$XXX.XX
|
K
|
0823
|
| J9173 |
Inj., durvalumab, 10 mg
|
$XXX.XX
|
K
|
9492
|
| J9176 |
Injection, elotuzumab, 1mg
|
$XXX.XX
|
K
|
9477
|
| J9177 |
Inj enfort vedo-ejfv 0.25mg
|
$XXX.XX
|
G
|
9364
|
| J9179 |
Eribulin mesylate injection
|
$XXX.XX
|
K
|
1426
|
| J9202 |
Goserelin acetate implant
|
$XXX.XX
|
K
|
0810
|
| J9203 |
Gemtuzumab ozogamicin 0.1 mg
|
$XXX.XX
|
G
|
9495
|
| J9204 |
Inj mogamulizumab-kpkc, 1 mg
|
$XXX.XX
|
G
|
9182
|
| J9205 |
Inj irinotecan liposome 1 mg
|
$XXX.XX
|
K
|
9474
|
| J9207 |
Ixabepilone injection
|
$XXX.XX
|
K
|
9240
|
| J9210 |
Inj., emapalumab-lzsg, 1 mg
|
$XXX.XX
|
G
|
9310
|
| J9213 |
Interferon alfa-2a inj
|
$XXX.XX
|
K
|
9092
|
| J9214 |
Interferon alfa-2b inj
|
$XXX.XX
|
K
|
0836
|
| J9217 |
Leuprolide acetate suspnsion
|
$XXX.XX
|
K
|
9217
|
| J9225 |
Vantas implant
|
$XXX.XX
|
K
|
1711
|
| J9226 |
Supprelin la implant
|
$XXX.XX
|
K
|
1142
|
| J9227 |
Inj. isatuximab-irfc 10 mg
|
$XXX.XX
|
G
|
9377
|
| J9228 |
Ipilimumab injection
|
$XXX.XX
|
K
|
9284
|
| J9229 |
Inj inotuzumab ozogam 0.1 mg
|
$XXX.XX
|
G
|
9028
|
| J9230 |
Mechlorethamine hcl inj
|
$XXX.XX
|
K
|
0751
|
| J9245 |
Inj melpha hydroch nos 50 mg
|
$XXX.XX
|
K
|
0840
|
| J9246 |
Inj., evomela, 1 mg
|
$XXX.XX
|
K
|
9375
|
| J9261 |
Nelarabine injection
|
$XXX.XX
|
K
|
0825
|
| J9262 |
Inj, omacetaxine mep, 0.01mg
|
$XXX.XX
|
K
|
9297
|
| J9264 |
Paclitaxel protein bound
|
$XXX.XX
|
K
|
1712
|
| J9266 |
Pegaspargase injection
|
$XXX.XX
|
K
|
0843
|
| J9268 |
Pentostatin injection
|
$XXX.XX
|
K
|
0844
|
| J9269 |
Inj. tagraxofusp-erzs 10 mcg
|
$XXX.XX
|
G
|
9309
|
| J9271 |
Inj pembrolizumab
|
$XXX.XX
|
K
|
1490
|
| J9280 |
Mitomycin injection
|
$XXX.XX
|
K
|
1232
|
| J9285 |
Inj, olaratumab, 10 mg
|
$XXX.XX
|
K
|
9485
|
| J9293 |
Mitoxantrone hydrochl / 5 mg
|
$XXX.XX
|
K
|
0864
|
| J9295 |
Injection, necitumumab, 1 mg
|
$XXX.XX
|
K
|
9475
|
| J9299 |
Injection, nivolumab
|
$XXX.XX
|
K
|
9453
|
| J9301 |
Obinutuzumab inj
|
$XXX.XX
|
K
|
1476
|
| J9302 |
Ofatumumab injection
|
$XXX.XX
|
K
|
9260
|
| J9303 |
Panitumumab injection
|
$XXX.XX
|
K
|
9235
|
| J9305 |
Inj. pemetrexed nos 10mg
|
$XXX.XX
|
K
|
9213
|
| J9306 |
Injection, pertuzumab, 1 mg
|
$XXX.XX
|
K
|
1471
|
| J9307 |
Pralatrexate injection
|
$XXX.XX
|
K
|
9259
|
| J9308 |
Injection, ramucirumab
|
$XXX.XX
|
K
|
1488
|
| J9309 |
Inj, polatuzumab vedotin 1mg
|
$XXX.XX
|
G
|
9331
|
| J9311 |
Inj rituximab, hyaluronidase
|
$XXX.XX
|
G
|
9467
|
| J9312 |
Inj., rituximab, 10 mg
|
$XXX.XX
|
K
|
9186
|
| J9313 |
Inj., lumoxiti, 0.01 mg
|
$XXX.XX
|
G
|
9305
|
| J9315 |
Romidepsin injection
|
$XXX.XX
|
K
|
9265
|
| J9320 |
Streptozocin injection
|
$XXX.XX
|
K
|
0850
|
| J9325 |
Inj talimogene laherparepvec
|
$XXX.XX
|
K
|
9472
|
| J9328 |
Temozolomide injection
|
$XXX.XX
|
K
|
9253
|
| J9330 |
Temsirolimus injection
|
$XXX.XX
|
K
|
1168
|
| J9340 |
Thiotepa injection
|
$XXX.XX
|
K
|
0851
|
| J9352 |
Injection trabectedin 0.1mg
|
$XXX.XX
|
K
|
9480
|
| J9354 |
Inj, ado-trastuzumab emt 1mg
|
$XXX.XX
|
K
|
9131
|
| J9355 |
Inj trastuzumab excl biosimi
|
$XXX.XX
|
K
|
1613
|
| J9356 |
Inj. herceptin hylecta, 10mg
|
$XXX.XX
|
G
|
9314
|
| J9357 |
Valrubicin injection
|
$XXX.XX
|
K
|
1235
|
| J9358 |
Inj fam-trastu deru-nxki 1mg
|
$XXX.XX
|
G
|
9353
|
| J9371 |
Inj, vincristine sul lip 1mg
|
$XXX.XX
|
K
|
1466
|
| J9395 |
Injection, fulvestrant
|
$XXX.XX
|
K
|
9120
|
| J9400 |
Inj, ziv-aflibercept, 1mg
|
$XXX.XX
|
K
|
9296
|
| J9600 |
Porfimer sodium injection
|
$XXX.XX
|
K
|
0856
|
| P9010 |
Whole blood for transfusion
|
$XXX.XX
|
R
|
9510
|
| P9011 |
Blood split unit
|
$XXX.XX
|
R
|
9520
|
| P9012 |
Cryoprecipitate each unit
|
$XXX.XX
|
R
|
9511
|
| P9016 |
Rbc leukocytes reduced
|
$XXX.XX
|
R
|
9512
|
| P9017 |
Plasma 1 donor frz w/in 8 hr
|
$XXX.XX
|
R
|
9508
|
| P9019 |
Platelets, each unit
|
$XXX.XX
|
R
|
9515
|
| P9020 |
Plaelet rich plasma unit
|
$XXX.XX
|
R
|
9516
|
| P9021 |
Red blood cells unit
|
$XXX.XX
|
R
|
9517
|
| P9022 |
Washed red blood cells unit
|
$XXX.XX
|
R
|
9518
|
| P9023 |
Frozen plasma, pooled, sd
|
$XXX.XX
|
R
|
9509
|
| P9031 |
Platelets leukocytes reduced
|
$XXX.XX
|
R
|
9526
|
| P9032 |
Platelets, irradiated
|
$XXX.XX
|
R
|
9500
|
| P9033 |
Platelets leukoreduced irrad
|
$XXX.XX
|
R
|
9521
|
| P9034 |
Platelets, pheresis
|
$XXX.XX
|
R
|
9507
|
| P9035 |
Platelet pheres leukoreduced
|
$XXX.XX
|
R
|
9501
|
| P9036 |
Platelet pheresis irradiated
|
$XXX.XX
|
R
|
9502
|
| P9037 |
Plate pheres leukoredu irrad
|
$XXX.XX
|
R
|
9530
|
| P9038 |
Rbc irradiated
|
$XXX.XX
|
R
|
9505
|
| P9039 |
Rbc deglycerolized
|
$XXX.XX
|
R
|
9504
|
| P9040 |
Rbc leukoreduced irradiated
|
$XXX.XX
|
R
|
9522
|
| P9041 |
Albumin (human),5%, 50ml
|
$XXX.XX
|
K
|
0961
|
| P9043 |
Plasma protein fract,5%,50ml
|
$XXX.XX
|
R
|
9514
|
| P9044 |
Cryoprecipitatereducedplasma
|
$XXX.XX
|
R
|
9523
|
| P9045 |
Albumin (human), 5%, 250 ml
|
$XXX.XX
|
K
|
0963
|
| P9046 |
Albumin (human), 25%, 20 ml
|
$XXX.XX
|
K
|
0964
|
| P9047 |
Albumin (human), 25%, 50ml
|
$XXX.XX
|
K
|
0965
|
| P9048 |
Plasmaprotein fract,5%,250ml
|
$XXX.XX
|
R
|
9519
|
| P9051 |
Blood, l/r, cmv-neg
|
$XXX.XX
|
R
|
9524
|
| P9052 |
Platelets, hla-m, l/r, unit
|
$XXX.XX
|
R
|
9525
|
| P9053 |
Plt, pher, l/r cmv-neg, irr
|
$XXX.XX
|
R
|
9531
|
| P9054 |
Blood, l/r, froz/degly/wash
|
$XXX.XX
|
R
|
9527
|
| P9055 |
Plt, aph/pher, l/r, cmv-neg
|
$XXX.XX
|
R
|
9528
|
| P9056 |
Blood, l/r, irradiated
|
$XXX.XX
|
R
|
9529
|
| P9057 |
Rbc, frz/deg/wsh, l/r, irrad
|
$XXX.XX
|
R
|
9532
|
| P9058 |
Rbc, l/r, cmv-neg, irrad
|
$XXX.XX
|
R
|
9533
|
| P9059 |
Plasma, frz between 8-24hour
|
$XXX.XX
|
R
|
9513
|
| P9060 |
Fr frz plasma donor retested
|
$XXX.XX
|
R
|
9503
|
| P9070 |
Pathogen reduced plasma pool
|
$XXX.XX
|
R
|
9534
|
| P9071 |
Pathogen reduced plasma sing
|
$XXX.XX
|
R
|
9535
|
| P9073 |
Platelets pheresis path redu
|
$XXX.XX
|
R
|
9536
|
| P9100 |
Pathogen test for platelets
|
$XXX.XX
|
S
|
1494
|
| Q0035 |
Cardiokymography
|
$XXX.XX
|
Q1
|
5732
|
| Q0091 |
Obtaining screen pap smear
|
$XXX.XX
|
S
|
5731
|
| Q0138 |
Ferumoxytol, non-esrd
|
$XXX.XX
|
K
|
1297
|
| Q0139 |
Ferumoxytol, esrd use
|
$XXX.XX
|
K
|
1485
|
| Q2009 |
Fosphenytoin inj pe
|
$XXX.XX
|
K
|
9321
|
| Q2017 |
Teniposide, 50 mg
|
$XXX.XX
|
K
|
7035
|
| Q2026 |
Radiesse injection
|
$XXX.XX
|
K
|
9094
|
| Q2028 |
Inj, sculptra, 0.5mg
|
$XXX.XX
|
K
|
9095
|
| Q2041 |
Axicabtagene ciloleucel car+
|
$XXX.XX
|
G
|
9035
|
| Q2042 |
Tisagenlecleucel car-pos t
|
$XXX.XX
|
G
|
9194
|
| Q2043 |
Sipuleucel-t auto cd54+
|
$XXX.XX
|
K
|
9273
|
| Q2049 |
Imported lipodox inj
|
$XXX.XX
|
K
|
1421
|
| Q2050 |
Doxorubicin inj 10mg
|
$XXX.XX
|
K
|
7046
|
| Q3027 |
Inj beta interferon im 1 mcg
|
$XXX.XX
|
K
|
1472
|
| Q5101 |
Injection, zarxio
|
$XXX.XX
|
K
|
1822
|
| Q5103 |
Injection, inflectra
|
$XXX.XX
|
K
|
1847
|
| Q5104 |
Injection, renflexis
|
$XXX.XX
|
G
|
9036
|
| Q5105 |
Inj retacrit esrd on dialysi
|
$XXX.XX
|
G
|
9096
|
| Q5106 |
Inj retacrit non-esrd use
|
$XXX.XX
|
G
|
9097
|
| Q5107 |
Inj mvasi 10 mg
|
$XXX.XX
|
G
|
9329
|
| Q5108 |
Injection, fulphila
|
$XXX.XX
|
G
|
9173
|
| Q5110 |
Nivestym
|
$XXX.XX
|
G
|
9193
|
| Q5111 |
Injection, udenyca 0.5 mg
|
$XXX.XX
|
G
|
9195
|
| Q5112 |
Inj ontruzant 10 mg
|
$XXX.XX
|
G
|
9382
|
| Q5113 |
Inj herzuma 10 mg
|
$XXX.XX
|
G
|
9349
|
| Q5114 |
Inj ogivri 10 mg
|
$XXX.XX
|
G
|
9341
|
| Q5115 |
Inj truxima 10 mg
|
$XXX.XX
|
G
|
9336
|
| Q5116 |
Inj., trazimera, 10 mg
|
$XXX.XX
|
G
|
9350
|
| Q5117 |
Inj., kanjinti, 10 mg
|
$XXX.XX
|
G
|
9330
|
| Q5118 |
Inj., zirabev, 10 mg
|
$XXX.XX
|
G
|
9348
|
| Q5119 |
Inj ruxience, 10 mg
|
$XXX.XX
|
G
|
9367
|
| Q5120 |
Inj pegfilgrastim-bmez 0.5mg
|
$XXX.XX
|
G
|
9345
|
| Q5121 |
Inj. avsola, 10 mg
|
$XXX.XX
|
G
|
9381
|
| Q9968 |
Visualization adjunct
|
$XXX.XX
|
K
|
1446
|
| Q9969 |
Non-heu tc-99m add-on/dose
|
$XXX.XX
|
K
|
1442
|
| Q9991 |
Buprenorph xr 100 mg or less
|
$XXX.XX
|
G
|
9073
|
| Q9992 |
Buprenorphine xr over 100 mg
|
$XXX.XX
|
G
|
9239
|